NCLEX Content Review - Study Set 1
What is involved in the nursing care of AV access?
- No BP, IVs or venipuncture on access arm - AV fistula or Graft - assess daily - Assess bruit (audible swishing) - normal and expected finding, cap refill check - Assess thrill (palpable vibrating pulsation) - Assess distal circulation/pulse - Monitor cannulation site for bleeding or infection - No compression on access limb - Carrying objects, sleeping position
What types of palliative care is availabel to pts?
- O2 tx + no smoking - anxiety meds - steroids = ↓ inflammation - pain control - radiation tx = shrink tumor laser tx = shrink size of tumor - pleurodesis = painful, burning pleura, uncommon - hospice care - dyspnea management
How would we evaluate our nursing interventions for our psychosocial problems?
- Observe the patient's non-verbal behaviors - Ask the patient to share opinions and ideas - Observe the patient's appearance - Ask if patient's expectations are being met
What are the physiological stages of dying?
- One to three months prior to death >Begins to withdraw > Sleep increases >Appetite decreases > Difficulty in digesting food - One to two weeks prior to death > Body begins to lose the ability to maintain itself > Reduced BP > Tachycardia > Decreased urine output = oliguria > Temperature fluctuates > Perspiration increases - diaphoresis/ sheen
What are the clinical manifestations of PAD?
- PAD = oxygen problem - slow cap refill - dependent rubor - distal ulcers - weak or no pulses - cyanosis - thick toenails - no hair - paresthesia - intermittent claudication - dry, dusky, pale, mottled skin - muscle atrophy - gangrene - pain that stops at rest
What are the different pain measurement scales?
"0 to 10, 0 being no pain and 10 being the worst pain in your life" Wong - baker scale - uses faces OR Numerical pain scale which seperates the segments into Mild (1-3), Moderate (4-6), and Severe (7-10) ex: tynenol for mild pain, perquecet for moderate pain, morphine for severe pain
What are some clinical manifestations of diverticulitis?
- Pain - Distention - N/v - Chills - Fever - Increased HR - Bleeding - Increased WBC - Anemia - Leukocytosis - +stool for occult blood
What is TCDB?
"Turn Cough Deep Breathe" - open up chest cavity and expand lungs - cough to clear secretions - do it every 2 hours while pt is awake, the pt may need it every hour if they have alot of suptum - use a mask, standard precautions and if there's alot use a gown and glove - q 3 - 4 hr at night
What is important for us to know about vasodilators?
** + do not admin w/ ED meds, should lower BP + chest pain, SEs hypotension
What characteristics of pulse should the nurse take note of?
*Rate* = # of pulse beats per minute *Strength*= pulse strength or amplitude = 0/absent - 1+ diminished/barely palpable - *2+ normal* - 3+ full or strong, 4+ bounding (normally felt when a person is ex: scared or running), *Equality* *Rhythm*= pattern of pulses + intervals b/t
What are some psychosocial health concerns with the elderly?
*Therapeutic communication* - express attitudes of concern, kindness, compassion. Establish a relationship/ dvlp rapport, sitting down, eye to eye contact. Older adults accept and respect nurses who meet their expectations and communicate effectively. *Touch* - is a therapeutic tool to help comfort older adults. Conveys warmth, comfort, communicates interest. OA often deprived of touch, OA who is isolated, dependent or ill, who fears death or lacks self esteem has a > need for touch. Older men sometimes wrongly accused (dirty old man) of sexual advances when they reach out to touch others. Be aware and understand cultural variation and individual preferences. Don't use it in a condescending way (patting on head). When you reach out , many times they will reciprocate. *Reality Orientation* - helps OA awareness of person, place & time. Goal- restore sense of reality, minimize confusion. Change in environment can lead to confusion, bright lights, unfamiliar noises or surroundings and the absence of normal caregivers can also cause confusion. Nursing actions - frequent reminders, use of clocks/calendars, personal belongings, stable routine & staff. Answer ?s simply & honestly with a caring attitude. *Validation Therapy* - alternate approach for a confused elder. Accepts the description of time & place as stated by the elder. Dementia patients- may become more agitated with reality orientation if caregiver insists on the correct time or place. Goal is to recognize & address the inner need or feeling. Doesn't reinforce the misperception, reflects sensitivity to the behavior. More important to respect older adults feelings than insisting on the literal time & place.*Reminiscence* - recalling the past. Enjoy sharing. Express personal identity. Process of looking back on past events uncovers new meaning for those events. Asking about their past & listening attentively shows you have respect & concern for them. *Body image* Some changes more socially acceptable than others. Distinguished gray hair. Illness & aging threatens their self esteem. Understand the importance of presenting a socially acceptable image, even during illness. Help with grooming or hygiene. Be sensitive to odors and help control them.
How are postterm NBs managed by the nurse?
- Anticipate newborn resuscitation - check respirations, ABGs - Monitor blood glucose levels - Prevent hypothermia - Screen for polycythemia & hyperbilirubinemia (physiologic jaundice over time, ⬇ O2 > RBC production)
What are some lab assessments for CAD?
- CK-MB & Troponin = looking for cardiac isoenzymes, basically saying that when your cardiac tissue dies, the tissue cells shed and that is indicated by you troponin levels, ↑troponin = ↑ likelihood of myocardial infarction - Fasting cholesterol = fasting means NPO, the NV: <200 mg/dL >> HDL aka Healthy Cholesterol/ Good NV: 35 -70 mg/dL >> LDL aka Lethal Cholesterol NV: <160 mg/dL or <70 mg/dL w/ known CAD or diabetes - Triglycerides = fat levels in the blood NV: 100 - 200, when triglycerides are high usually LDL are high too - C-reactive protein = looks out for inflammation - Homocystine = amino acid that tells us the likelihood of a pt developing a clot
What is sweat chloride testing?
- Done if on newborn screening are thought to have CF - Screening does not diagnose it - just gives an idea (if parents known they are carrier or a sibling has it) - For older child, they'll do a chest xray, look at fat in school, PFT - If positive, needs to be repeated because other things can interfere with it
What are some diagnostic procedures we can do to test the cardiac system?
- EF via echocardiography = normal = 55 - 65% < 40% = heart failure - Transthoracic echocardiogram - noninvasive - transesophageal echo = TEE - invasive
What are some causes of hyponatremia?
- Excess body water - ❤️ failure - inadequate intake - dilutional fluid overload - hypervolemia - excessive diuresis
How is diabetes diagnosed?
- Fasting Plasma Blood Glucose (FBG) test - done as part of an annual exam - Random/ Casual Plasma Glucose test - done when pt comes in w/ s/s, >200 = positive for diabetes - OGTT = oral glucose tolerance test - the pt drinks a syrupy drink before test, >180 positive for diabetes - Islet Cell Antibodies (ICAs) - looks for beta cell damage as seen with Type 1 diabetics - Hemoglobin A1c - blood glucose over the past 200 days > glycosylated hemoglobin > glycated hemoglobin NV: 4 - 6% Diabetic Goal <7%
What do nurses assess during a neuro assessment?
- Hx: ▪ Pregnancy - infections early on? premature? intraventricular hemorrhage? difficult birth? any perinatal asphyxia? did they have to do CPR on the baby when it born? any respiratory distress? ▪ Family - genetic d/o? HAs? Seizure d/o? ▪ Dvlpmtal milestones - depends on their age - when did they sit? crawl? walk? delays? subtract the # of wks they were premature from what we expect them to be doing, were they hospitalized in NICU - PPQQRSTU of the present illness: ▪ N&V ▪ Visual disturbances ▪ Gait ▪ ALOC/ loss of consciousness - bleeding? ▪ Fever - infectious issues - were they around anyone else w/ the same s/sx ▪ Any meds admin
How do we know if someone is hemorrhaging?
- Hypotensive - Tachycardia - tachypnea - dizziness - cool clammy skin - pallor - confusion - H&H trend down - abdominal pain,distention - frank bleeding - coffee ground Messi - black tarry stools (Melena) (looks like newborn poop) - hematemesis (throwing up blood) What do you do if they are hemorrhaging? Give fluids Give blood Go back to surgery Given meds to vasoconstrict
What would a nurse find upon assesment if the newborn had an infection?
- Hypothermia, inability to regulate temp - can't mount fever response to infection - Pallor or duskiness - Hypotonia - Poor weight gain - Respiratory distress - Irritability - Hypoglycemia (late sign) - Seizures (late sign) "SHHH I P Pd Rd" More lines, more site for infection Signs of sepsis are subtle
What is cystic fibrosis?
- Most common inherited disease in children - Autosomal recessive disorder - both parents donate an allele, 25% chance in any pregnancy of child having CF - Is tested on newborn screening to identify those who are thought to have it - Deletion of chromosome 7 is responsible for gene mutation ACOG - Recommends testing women presenting for preconception or prenatal care - DNA testing done -> Ethnic-based screening -> Expanded carrier screening
What are some important notes about the liver's fx (blood coagulation + bilirubin conjugation) in NBs?
- There are 2 types of bilirubin: Unconjugated (fat soluble) + Conjugated (water soluble, ready for excretion), the fx of the liver is to breakdown the unconjugated bili so that it can be excretted in bile, urine, or stool - When RBCs hemolyze (remember neonatal RBCs only last 80 - 100 days) the broken down heme becomes bilirubin - Jaundice which is the yellow discoloration of the sclera (the whites of the eyes), skin, and mucous membranes can put NBs @ an ⬆ risk of mild to severe encephalopathy
How do newborn's regulate their body temperature? Why is it important
- They can't shiver - They rely on the nurse to maintain their environment because they can't modify their environment on their own - They have limited muscle movement - Their body goes through a chemical process of breaking down brown fat/ breaking down the glycogen stores in brown fat tp produce heat, this is called THERMOGENESIS - Brown fat is found: > around the kidneys & adrenal glands > mediastinum > scapula > axilla > nape of neck NV temp = 97.7 - 99.5 * ⬆ temp = ⬆ O2 use * ⬆ temp = ⬆ metabolic rate = ⬆ O2 demand * ⬇ temp = ⬆ glucose use, energy use - NBs are unable to balance heat loss & production - Thin skin but increased body surface area & lack fat
What is a subtotal gastrectomy? When do they do this surgery?
- This only happens when they CANT treat the ulcer medically. - They take out the stomach, decrease the size of the stomach, and reattach it. - Causes pernicious anemia, decreased intrinsic factor, due a portion of the stomach being removed *more aggressive method*
What is the fx of potassium?
- Transmission of electrical impulses in cardiac & skeletal muscles - Involved in the rate & force cardiac contractions & output
What is a spica cast?
- Used for femur fractures - Can be used for dvlpmtal hip dysplasia - Positioning issues - Use pillows - Skin breakdown due to bed rest, move them as often as possible - Double diapering
Why do we admin vitamin K to NBs?
- We gives NBs vitamin K w/in 1 hour of them being born bc they are no longer getting Vitamin K from their mother and they don't have any stored in their liver which can make them @ risk of bleeding > Concern: premies @ risk of bleeding in the brain due to superficial capillaries in head & brain + r/f intrventricular hemorrhage - Vitamin K is synthesized int he intestine by our normal flora, neonates don't have this until about 1 week of age
How would a nurse manage an SGA baby?
- Weight is generally 5 lbs, 8 oz or less > Hypothermia - fewer glucose stores to provide thermogenesis, cold stress, they have even less fat > Hypoglycemia - thin umbilical cord > less glucose from mom to fetus > Polycythemia /Hyperbilirubinemia - ⬆ blood viscosity "sludge-like" leads to poor perfusion, compensation for low O2 & perfusion, trying to make more RBCs to ⬆ O2 *lab work, very red skin, respiratory distress, more RBCs breaking down > ⬆ r/f jaundice > may need their blood diluted w/ IV fluids or partial exchange transfusion >>(hematocrit >65%, hemoglobin > 20 gm) > Provide parental education > On-going growth follow-up
How is a pt weaned off of heparin or enoxaparin (Lovenox) to warfarin (Coumadin)?
- admin warfarin + heparin OR enoxaparin concurrently for 3-5 days until INR is b/t 2.0 - 3.0 (do NOT admin heparin & enoxaparin @ the same time) - it takes 48 - 72 hrs for warfarin to affect the PT/INR - once the tx range is reached the enoxaparin OR heparin will be stopped and the warfarin will continue w/ INR monitoring
What are core measures?
- affect large pop. of pts - results are tracked over time - helps rate healthcare performance - info available to public - can compare facilities - used for pay for performance initiatives
What are the complications associated w/ neuropathy? DM
- affects peripheral nervous system - affects all extremities, *legs - usually both extremities, symmetric - s/s: paresthesia, numbess, pain, skin sensitivity > foot injuries & ulcerations
What is included in a hematologic pts ax? physical ax? dx ax?
- age - gender - liver fx - drug use - diet - iron, mineral, protein, or vit deficiencies - socioeconomic status - occupation - hobbies - family hx/genetics - inherited blood clotting dz, unusual bruising, nosebleeds e.g. hemophilia, sickle cell dz - fatigue? - endurance? - Vertigo? - Tinnitus? - tissue perfusion issues? Skin? pallor jaundice, petechiae, bruises, cyanosis, poor perfusion itches Head & Neck? pallor, ulceration, sceral jaundice Respiratory? RR+depth, DOE Cardio? weak & thready pulse, JVD, edmea, phlebitis Kidney? hematuria, proteinuria, dec EPO Muscles? sternal tenderness, swollen joints, painful joints Abd? enlarged spleen, GI ulcers CNS? vit b12 > impaired nerve fx, infection, dec cognitive fx - CBC - Coomb's test - PT, INR, aPTT, Anti Xa Assay - Peripheral Blood Smear - Iron levels > serumm ferritin - TIBC
What are some risk factors of peripheral artery dz?
- aka PAD - same risk factors as atherosclersosis = "A-O-GODSSS" + HTN + Hyperlipidemia - non- modifiable risks include: Age, Gender, Hereditary, Cultural
What is Trans- Esophageal Echocardiogram?
- aka TEE - probe is placed either in esophagus or stomach - sound waves create pics of heart - pt is positioned on left side - requires consent - needs to be NPO for at least 4 - 6 hours prior to procedure - invasive - we may use numbing spray before tube insertion - some providers may prescribe anti-anxiety meds like valium before procedure, remember to administer meds with enough time for them to have an effect before the procedure
What is angina?
- aka chest pain - ↓ blood flow > ↓ O2 > heart demands ↑ O2 > demand ↑ but O2 supply is low > manifests as pain in the anterior chest - treated with Nitro - when a pt has chest pain immediately start oxygen therapy/ "MONA" = Morphine, Oxygen, Nitro, Aspirin - Morphine for pain - Oxygen = angina is caused by oxygen starvation - Nitro = vasodilation - Aspirin = anti-platelet
What is the Somogyi Effect?
- aka rebound effect - hyperglycemia in the morning due to hypoglycemia at night - gluconeogenesis happens > overrxn > hyperglycemia TX: - BG check at 2-3am - NPH admin HS instead of dinner time, change peak time OR - HS snack OR - ↓ PM NPH to ↓ circulating insulin
What are some common causes of chest trauma?
- assaults, stabbed, shot, car accidents - most common = motor vehicle accidents - OAs = ↑ r/f death
How can a nurse make they have the right drug?
- be aware of drugs with similar names - if you don't know a drug get familiar with it - know the drugs' actions, indications, and contraindications - check the drug 3x against the MAR
What are some examples of ways to violate the Florida NPA?
- being drunk or high OTJ - stealing meds from your pt or facility - going beyond your scope of practice - lying - abusing your pt - participating in criminal behavior
What are some important nursing implications and adverse rxns of aspirin?
- bleeding - gastric ulcer - renal impairment - Salicylism Mnemonic: GR(A)BS = gastric ulcers, renal impairment (aspirin) bleeding, salicylism
What is a hemothorax?
- blood in the pleural space - caused by blunt or penetrating - pulmonary bruising/cuts - orgination can be from ❤, great vessels, or intercoastal arteries
How do you tx blood loss?
- blood products - iron supplements - EPO (procrit, epogen)
What is considered a preterm newborn?
- born before completion of 37 weeks (<38 weeks) Prematurity is the 2nd leading cause of NB death -> 2nd only to congenital defects
What are indications for surgery for IBD?
- bowel perforation - hemorrhage - cell dysplasia/cancer - failure of medical therapy - toxic megacolon
What assessment finding would make a nurse believe that a patient is overly sedated?
- bradypnea (monitor respirations and O2!!!) unlabored? - change in LOC - unable to wake the patient up - decreased o2 sat - tachycardia (can mean bleed or oversedatIon) **USE ANTAGONIST TO REVERSE EFFECTS SUCH AS NARCAN (naloxone) OR ROMAZICON (flumazenil)**
What are some complications that can arise with kawasaki dz?
- coronary aneurysm may occur as early as 7-10 days after fever onset - Peak prevalence 2-4 weeks after onset - Up to 50% have cardiac manifestations: - Myocarditis - Pericarditis - Conduction disturbances - Mitral/aortic regurgitation
What are some s/s of hyponatremia?
- crave salt - CNS changes - Seizures
How does the unit dose system work?
- drawers are filled for each client with meds for 24 hours - there's a limited amount of prn meds - the pharmacy supplies meds according to client orders
What is a patients diet in ulcer tx?
- eliminate, restrict food that cause discomfort - avoid alcohol, foods that cause irritation - no longer think that a bland diet assists with healing - caffeine scan stimulate gastric acid production, if they have problems, then restrict - milk can sometimes stimulate gastric acid production as well, if it causes problems, then restrict
How do we care for a revascularization pt post op?
- evaluate pulses - assess distal pulses - monitor post-op pain - anticoag tx - rest 18 -24 h post-op - don't bend at hip or knees, over tension on sutures - physical tx - no crossing legs or sitting for too long - no tight clothes - control blood sugar - wear shoes - monitor BP = too low, collapse or too high, leak/tear in sutures
What is the oxygen concentrator?
- for home use - takes room room air and concentrates it by removing the nitrogen out of the air - up to 5 L/min - uses electricity and requires a backup if power goes out
What are some diff types of wound dressings?
- gauze - transparent film - hydrocolloid - hydrogel - foam - composite
How can diabetic pts. minimize their sick days?
- monitor BS - meds - nutrition/electrolyte replacement - hydration - know when to seek help
What is the NAS scoring system?
- most commonly used; should be done after feedings when the infant is awake -->> The higher the score, the greater the opioid effects/withdrawal effects
What are some causes of Jaundice?
- overproduction of billirubin - ⬆ RBC hemolysis > delayed cord cutting - impairment in bile excretion > billiary obstruction > ⬇ output - not feeding well, not voiding, delayed meconium removal - liver malfx
What are some mechanical interventions for a BO?
- prepare for surgery bc they have to go in and physically remove whatever is blocking it - exploratory "map"? and remove the problem and to see what the physical problem is
What should you do during a sexual history assessment?
- provide privacy - be relaxed, give client time - eye contact - look out for nonverbal and verbal cues - reassure the client - use therapeutic techniques - exam is not part of RN role, may inspect externally
What are the nursing implications of heparin?
- pt. ed. - A(x): > vitals > allergies > PTT (60-70 secs) > aPTT (30-40 secs) > platelets (150k - 400k) > H/H = hemoglobin = 12 - 16 Women, 14 -18 Men & hematocrit - 37 -47% Women or 42 -52% Men > bleeding > precautions > antidote (protamine sulfate) > contraindications
How will we treat hypomagnesemia?
- pt. education - Mg replacement, restore Ca2+ levels - diet - cardiac monitoring
How will we treat hypermagnesemia?
- pt. education - diuretics and dialysis - diet - cardiac monitoring
What is Yan Keur suction?
- pts who can't swallow or clear throat require suctioning - the nurse should use a cup of water for testing and cleaning tubes - some pts can do it themselves - go along the gum line check the pt's respiratory status - use standard precautions
What are some examples of nursing dx addressing temperature?
- r/f imbalanced temp - hyperthermia - hypothermia - ineffective thermoregulation - r/f fluid volume deficit
What factors influence SEs of Radiation tx?
- radiation site - limited to the areas exposed to radiation - total radiation dose - duration of radiotherapy - current chemo -changes may be perm like hair loss
What is TTP?
- small blood clots form throughout the body using up a large number of platelets - thrombotic thrombocytopenic purpura
What is some patient education for dumping syndrome?
- small frequent meals - diet high in protein and fat - Diet low in carbs and roughage - avoid milk, sweets and sugars - drink one liquid before meal and one hour after - stop smoking - no alcohol/caffeine - lie flat for 30 mins after eating to help delay the emptying - antispasmodic - supplements and vitamins after procedure
What is the cause of lung cancer?
- smoking most common cause - Radon gas - pollution - environmental Primary OR Metastatic
How does PVD manifest?
- stasis dermatitis aka browning = blood pooling - ankle edema/swelling - stasis ulcers - pain that is relieved with elevation - pain that is described as heavy - cyanosis
What are the different ways to collect urine?
- sterile = use straight cath - timed = throw away the first urine and the urine is kept on ice for 24 hrs - random sample - clean catch
What are some examples of oral diabetic meds?
- sulfonylureas and biguanide
What some things that can affect fluid balance?
- surgery - 24 - 48 hrs - vomitting/diarrhea - trauma - CHF
What is the nurse looking for during an IV site Ax?
- swelling - leakage - redness - infiltration - extravasation/ tissue damage - IV sol'n & flow rate accuracy
When checking daily weights for you pts how should it be done?
- take their weight at the same, using the same equipment, in the same way every time - 1 kg gained or loss = 1 L of fluid loss/ gain - 1 kg = 2.2 lbs.
What must all be true to prove negligence?
- the nurse owed a duty to the pt - the nurse didn't carry out their duty - pt was hurt - the pt was hurt as a direct result of the nurse not carrying out their duty
What should we know about medication errors?
- they should all be reported - the pt's safety is always #1 when an error happens - the nurse is responsible for writting an incident report of an error that has occured - nurses have the responsiblilty to reconcile meds
What is the goal of treating HTN and CAD?
- to avoid organ damage > target of organ damage = heart and kidneys - OAs >60 y/o = 140/90, <60 y/o = 150/90
What are the goals of VAC therapy?
- to fill dead space - absorb drainage
Why is a patient receiving an antiplatelet med? examples?
- to inhibit platelet aggregation - clopidogrel (plavix) (helps tx PAD) - aspirin - 1st gen NSAID
Why is a patient receiving aldosterone receptor blocker potassium sparing diuretics? example?
- to ↓ BP and ↑ fluid volume excretion, conserve K+ - e.g. spironolactone (Aldactone)
What types of complications manifest that are associated w/ the teeth? DM
- tooth & gum dz - pt should brush & floss regularly & see dentist
Why is a patient receiving calcium channel blockers? examples
- treat HTN - amlodipine (Norvasc) - nifedipine (Procardia) - nicardipine (Cardene) - verapmil (Calan) - diltiazem (Cardizem) "-pine"
What is the difference between tunneling and undermining?
- tunneling is when the would forms canals or pathways undermining is when the wound forms a lip
How are cancer cells different from normal cells?
- variety of conditions alter how cells fx - aka malignant - no useful fx - ↑ malignancy = smaller + rounder - r/f metastasis bc no fibronectin so break off from main tumor - no cellular regulation - uncontrolled cellular division - abnormal chromosomal make up
What should be documented after the admin of meds to a pt?
- what meds were given - what meds were refused or held - pre and post assessments
What is pharmacokinetics?
- what the body does to a drug or how a drug moves through the body - ADME > A = absorption = point of admin to blood > D = distribution = blood to tissue > M = metabolism = liver (dz process that could affect metabolism = cirrhosis) > E = excretion = kidneys (dz process that could affect excretion = ESRD)
What is extravasation? s/sx?
- when a vesicant drug (tissue damaging drug, e.g. chemotheraphy drugs) enters the tissue s/sx: taut, blancehd, cool skin, edema, and pain - may require surgical intervention and pt may end up with damage to bone, muscle, and nerves
What is the APGAR score?
A - activity (muscle tone) P - pulse (HR) G - grimace (reflex irritability, "big cry") A - appearance (color) R - respiratory effort 0 - 2 points for each category max score = 10 usually 9 because they get marked off for their color (cyanotic appearance, hands & feet) ax NB transition to extrauterine life done @ 1 & 5 min after birth score 5 >> 10 min score minimum score is 7 4 -7 moderate difficulty 0 - 3 severe distress >> respiratory interventions
What is dialysis?
Artificial kidney Removes excess fluid & waste products Improves electrolyte balance Adjusts acid/base balance Types of Dialysis CRRT (HD cath) - temporary, catheter in chest or neck is preferred, no AV fistula or graft, ICU only, can't handle rapid fluid shifts Hemodialysis (AV site or HD cath), long term 3-4 hour treatments 3x/week Daily in AKI & fluid overload Peritoneal
What is the difference b/t the lung sounds of bronchiolitis+asthma and pneumonia?
Brochiolitis - inflammation/infection of the bronchioles. When a child has this, they wheeze Pneumonia - Crackling sound (rales) because alveoli are filled with fluid. If they cough and the sound they're making clears, the secretions are higher up in the lower trachea and its less concerning
What are some orthostatic hypotension vital signs are not indicated?
Have supine or sitting hypotension, Have acute deep vein thrombosis (DVT), Have severely altered mental status, Have possible spinal injuries, Have lower extremity or pelvic fractures, Are not mobile enough to get out of bed
What are the steps of EBP?
Inquiry, have continuous curiousity Ask a clinical question - ex: "Is it better to use the baby warmer or skin to skin contact when a baby is first born?" Collect best evidnece Integrate the evidence/ implement Evaluate the change Share the outcomes
Describe the 5th stage of CKD
Kidney has <15% function (↓ urine output likely) Metabolic wastes/fluid must be removed by Dialysis high BUN & creat Acid base imbalance Diuretic requires urine output for it to be used Keep weight gain stable High protein diet bc dialysis cause loss of protein Must be on dialysis for renal transplant Prior to dialysis being prescribed: Fluid restriction possible ↓ protein, K, Phos, Na After dialysis prescribed/initiated: Fluid restriction likely ↑ protein intake, ↓ K/Phos/Na Psychosocial support Renal Transplant option
What part of the body controls the excretion of potassium?
Kidneys
What does cognitive learning entail?
Knowledge, comprehension, recall, evaluating, reading, instructional videos, thinking, lectures
What is KNPIO in regards to med admin?
Knowledge, name of the drug, pharmacology, interactions, overdose/lethal dose
How are anti-inflammatory agents used for control & pv?
Corticosteroids -> Helps decrease inflammation which helps prevent obstruction -> Used usually twice a day, sometimes only during the season their asthma picks up, but sometimes year round -> Parents sometimes forget to give because child is doing well -> Treat reversible airflow obstruction -> To control symptoms and reduce bronchial hyperresponsiveness Inhaled -> fluticasone propionate -> budesonide - Oral thrush is side effect, when taking inhaled corticosteroids mouth needs to be rinsed after every dose
What are some therapeutic reasons for bed rest?
Definition: Mobility restriction where the pt. Is confined to their bed for Tx reasons i.e. Weakness, decreased O2 consumption, major surgery/ blood loss, to rest a body part I.e. fractures, safety reasons, reduces pain, preeclampsia
What is implementation? Give examples.
Defintion: Actually *doing* what the care plan states, it involves documentation, and continuous data collection/assessment Ambulate BID, Teach potential complications of hysterectomy, Teach client amount of protein restriciton, foods high in protein, use this acronym to remember ----> PHANS = pt. education, hourly rounds, ambulation, nutritional supplements, and support
What is the difference between dependent, independent, interdependent/collaborative nursing interventions?
Dependent = requires an order (from a physcian, NP, etc) ex: oxygen therapy, changing a dressing, IVs, administering meds | Independent = does not require an order ex: repositioning the pt, taking a pt's vital signs | Collaborative = working with other members of the healthcare team ex: physical therapy, respiratory therapy
What is acute hypertrophic pyloric stenosis?
Disease in which babies stomach is blocked or abnormally narrow Pylorus becomes hypertrophied - muscle grows to large Stenosis of the pyloric sphincter - none of the food/milk from stomach can't get to small intestine - this causes them to forcefully vomit it up (can cause dehydration) - Dehydration symptoms --->>> Sunken eyes --->>> No tears while crying --->>> Sunken soft spot --->>> Less urine (or brown/dark yellow) Leads to obstruction Will need pyloromyotomy a month or two after birth, once discovered
How does a nurse count respirations?
Each Respiration is equal to one respiratory cycle,so one inspration and one expiration. Don't let the pt know you are counting their respirations, just how many times their chest go up and then down. Breath in + breath out = 1 respiration, count it for 1 minute or 30 secs then multiply by 2.
How are newborn infections managed by the nurse?
Early recognition & tx treatment - Antibiotic tx - monitor response -> 7 - 21 days for positive cultures (blood, urine, spinal tap bc it may be meningitis) -> 72 hours until neg cultures - Supportive care: oxygen PRN, pain control - Promote hydration - po/IV fluids, inotropes - Prevention: handwashing, aseptic wound care, frequent monitoring of invasive catheter sites, identifying risk factors, family education
What's involved in the nursing care of AOM & OE?
Education for prevention OM - Feeding child upright, no propping bottle - Breastfeeding until 6 months - Immunizations - Stay away from smokers - Earplugs if they have tubes OE - No using cotton swabs, earbuds - Earplugs when swimming, especially in lake water - Drying ear canal (with hair dryer on low setting)
What are the 2 different types of appendicitis?
Non-Perforated (Uncomplicated) Appendectomy: pre-op antibiotics, fluids and electrolytes, pain meds and possible post-op antibiotics Antibiotic treatment only may be as effective as surgery Perforated (Complicated) Emergency Appendectomy - Drainage and irrigation of peritoneal cavity - IV antibiotics 7-14 days Antibiotics only - Initial antibiotic therapy with interval appendectomy up to 6 weeks later OR Antibiotic treatment only - The pain comes from the inflammation, so once it perforates the pain has often dissipated - If the appendix isn't taken out, the risk of recurrence is high
What are the risk factors of CAD?
Non-modifiable = can't be changed: - "AGE-F" - Age = vascular insufficiency - Gender = Men are @ higher risk than women - Ethnicity = AA are @ higher risk - Family Hx Modifiable = can be changed: - Diet = High salt > hypertension, high fat > hyperlipidemia, high cholesterol > plaque build up aka atherosclerosis - Diabetes = damage to blood vessels - Sedentary Lifestyle - Smoking = decreases vessel elasticity and vasoconstriction > hypertension
What is the difference between oral syringes and syringes used for injections/ parenteral admin?
Oral syringes do not have a luerlock hub and injection syringes do. Oral syringes usually have a cap, injection syringes have the luerlock that secures the needle
What are the temperature sites?
Oral, rectal, axillary, tympanic membrane
What does psychomotor learning entail?
Physical skills, e.g. knowing how to check your blood glucose levels, competency, training your brain to do a specific skill
What are some general principles when providing and /or assisting with hygiene practice?
Provide privacy, only uncover the part of the body you are working with, safety 1st, keep pt warm, allow them to do as much as they can and let them take their time, bring extra supplies but not too much bc once the supplies go into a pts room it must remain there
How does a nurse palpate for the brachial artery?
Pt arm should be in relaxed position below the heart. The brachial artery is along the groove b/t the biceps + triceps above elbow @ antecubital fossa, use same techniques that were used to measure the radial pulse
What would indicate the need for dialysis?
Pts s/s is focus not labs like GFR - Uremic symptoms w/ elevated BUN - N/V, decreased cognition, pruritus - Uremic pericarditis - Uremic encephalopathy - Fluid volume excess (not responsive to diuretics) - Persistent hyperkalemia >6.5, refractory - Uncompensated metabolic acidosis <7.2 - rug overdose or toxins
What does P.A.S.S. mean?
Pull the pin, Aim at base of fire, Squeeze handle, Sweep from side 2 side
What are the s/s of lung cancer divided by location?
Pulmonary - Chest discomfort Cough Change in endurance Hemoptysis Hoarseness SOB Sputum Production Unilateral Wheeze Friction Rub Non-pulmonary - Cyanosis + clubbing fingers (Late signs) Dysrhythmias Muffled heart sounds Late signs - Fatigue Weight loss Anorexia + dysphagia N&V
What measurements can a nurse use to assess a pt's respiratory function?
Pulse oximetry (are their O2 stats greater than 95%?) Cap refill (can tell the nurse if the pt has good peripheral perfusion) Temperature (are they the same temp on both sides of their body? Are their fingers and toes cold? If so, this can indicate poor peripheral perfusion) Lung sounds (Are they diminished? Are they clear? Does the pt have crackles or wheezing? Do they have patent airways?)
What does the acronym R.A.C.E mean?
R means rescue and remove pts from danger, A means activate alarm i.e. fire alarm, C means confine/contain - close doors, turn off oxygen + electrical equipment, E means extinguish = extinguish the fire
What are typical newborn vital signs?
RR - 30 - 60 rpm HR - 110 - 160 bpm T - 97.7 - 99.5 Count vitals for a full minute > infants are intermittent breathers BP is typically y only done when there's a clinical indication for it > in the output setting the BP is not typically taken unless they have a jaundice post discharge then there may be concern VS are taken q30mins until stable for 2hrs
What is the therapeutic index?
Ratio of a drug's toxic level to the level that provides therapeutic benefits A. small/narrow T.I. = more dangerous, riskier B. large/ wide T.I. = less dangerous, safer
What are some ways to mismanage antibiotics?
1. Viral infections being treated with antibiotics 2. Not using the appropriate strength antibiotic - too strong 3. Using the antibiotic for too much time 4. not getting a culture first (cultures help you be specific) 5. ***** Incomplete patient education, not completing the full course of antibiotics
What are some immediate interventions for newborns? (Thermoregulation)
1. dry them off 2. skin to skin with mom *** - use radiant warmer - warmed blankets Maintain Neutral Thermal Environment (NTE) > warm room temp > eliminate drafts or ceiling fans - use a cap - warm stethoscope - delay bath until stable
What are some complications of revascularization surgery?
1. graft occulsion = blockage, interrupted blood flow > severe pain, no pulse, cool to the touch = ER 2. infection > REDA/COCA > RHSP + high temp + HR = s/s of infection > ↑ WBCs > tx = antibiotics > change dressing
What is the normal range for specific gravity in a urinanalysis?
1.005 - 1.030
What is the normal range of magnesium?
1.3 - 2.1 mEq/L
What is the normal range for Blood Urea Nitrogen?
10 - 20 mg/ dL
How long can it take for a newborn to transition to extrauterine life?
12 hours
What is the normal platelet count?
150k - 400k
What are some respiratory interventions?
TCDB so they can get air all the way to their bases and move secretions. Incentive spirometer (inspiration/inhalation) = helps the pt expand their lungs, suction oropharyngeal airway prn, chest physiotherapy, hydration = breaks up the mucus
What are TORCH infections?
TORCH infections- group of infections acquired perinatally - Toxoplasmosis - infected cat feces - Other (Gonorrhea[erythromycin], Syphilis[if infected antibiotics, if tx before birth they will not likely stay there], HIV, Chlamydia) STIs via birth canal, tx mom, r/f blindness - Rubella (leads to miscarriages) - Cytomegalovirus (miscarriages, FGA, hydrocephaly stillbirth) - Herpes Simplex Virus (c-section if active, otherwise if there's no lesions > vaginal birth is ok)
What are some examples of neural tube defects?
(listed mild to severe) - Spina bifida occulta - no protrusion, there's dimpling or a patch of hair @ the site of defect, no initial tx needed or no s/s or deficits, as they get older they may have back pain, numbness & tingling or the lower limbs - Meningocele - herniated vertebral defect, protrusion of meninges, need surgx w/in 1 day or 2 of birth - Myelomeningocele - most severe - spinal cord & meninges protrude out, loss of sensation below the waist, w/in 1st days, paralyzed, permanent damage to bladder/bowels - More severe types can be seen in utero - Prenatal vitamins that include folic acid - pv neural defects - Ax for hydrocephalus bc there's sometimes lower & upper neuro defects/issues - Surgx can be done prenatally - strict criteria for eligibility
What is cardiac catherization?
* Definitive dx study for children w/ ❤ dz 3 types of CATHs can be done "DIE": - Diagnostic - Interventional (fix the defect during the procedure, embolization) - Electrophysiologic (❤ arrhythmias) - e.g. burning the nerve so that it can't fire Procedure: catheter inserted into blood vessel (Femoral vein, bc their vessels are smaller) & threaded into L/R side of ❤; can use arteries, veins, or both to access the ❤ • Sedation in children - lasts 1 - 3 hrs
How are respirations regulated chemically?
- A rise in CO2 stimulates us to breathe - with COPD pts normally have high CO2 levels because they can't get CO2 out that's why they use pursed lip breathing - COPD pts have O2 sats of 88- 92%, normal rates = <95%
Why are short-acting beta2 -agonists used for "rescue" situations?
- Action: dilate smooth muscle, decreasing spasms - albuterol -> Nebulizer or metered dose inhaler (MDI) -> Oral form not effective -> Makes child jittery and not sleep -> Can cause muscle cramps, tachycardia and rarely arrhythmias - levalbuterol -> Less cardiac side effects than albuterol -> Nebulizer and MDI available -> Can use < 2 years
What are some characteristics of postterm NBs?
- At or beyond 42 weeks - Risk factor: prior post-term infant - Placental issues occur: - Decreased oxygen and nutrient supply - Wasting of fetus due to using stored nutrients placenta starts to calcify over time
What is a hypertensive crisis?
- BP = 180/120+ - targets the heart and the kidneys
What is a colonoscopy? What is it used for?
- Get it age 50 for detection of pre cancer. (Eg. Polyps) - Helps visualize anus, rectum and colon. - Most HCP will restrict patient from having any red, orange food coloring before prep. - The descending colon has the best chance of polyps and will probably remove those polyps (patient will prob have bleeding after 1-2 times) - Most HCP will recommend 24 hours prior to procedure of clear liquids only.
Who is hemodialysis?
- Large molecules like RBCs can pass through membrane and can't be filtered out - Dialsate is warmed to 100 degrees which explain the slight increase in temp pts have after dialysis - Not every pts is a candidate for heparin Dialysate (dialyzing solution) - Balanced mix of electrolytes & water - Water moved by osmosis - Wastes moved by diffusion - K & Na move from plasma to dialysate - Bicarb & Ca move from dialysate to plasma Dialyzer (artificial kidney) - Anticoagulation (heparin) - Prevent blood clots in system
What is a trancutaneous bilirubinometer?
- Like a thermometer, but it measure bilirubin levels through the skin - Jaundice usually appears H2T & disappears in the same way Jaundice spreads from skin > forhead > sclera Blanch the skin (will blanch yellow)
How do we prevent DVTs?
- SCDs = sequential compression devices - hydration - Anticoagulation = pv an ↑ blood viscosity - Ambulation = especially soon post surgery - Leg exercises = passive and active ROM exercises, no massaging - Weight loss - STOP smoking = smoking causes vasoconstriction
What are some examples of alterations in sexual health?
- STDs - Infertility - Personal and emotional conflicts - Sexual Dysfunction
What are some problems with a subtotal gastrectomy that are different from the other surgeries?
- They can have a dietary deficiency (because b12 is made in the stomach) - They may have bile reflexes - Dumping syndrome - Hemorrhage
What are some complications of progressive muscle weakness from Duchenne Muscular Dystrophy?
- Trouble walking - Some people with muscular dystrophy eventually need to use a wheelchair, end up on full bed rest towards the end - Shortening of muscles or tendons around joints (contractures) - can further limit mobility - Curved spine (scoliosis)- Weakened muscles may be unable to hold the spine straight - Heart problems. Muscular dystrophy can reduce the efficiency of the heart muscle - Swallowing problems - the muscles involved with swallowing are affected leading to nutritional problems, aspiration pneumonia. Feeding tubes are needed towards the end - ***Breathing problems*** - Progressive weakness eventually affects respiratory muscles, requiring the use of a CPAP, ventilator, initially at night, but then 24 hours - Extremely debilitating, need full care
What are vascular access devices?
- VADs - sterile technique
What are the rounding rules for med administration?
- When measuring drops per minute or per hour for IV meds use whole numbers, round to the tenths places then to the nearest whole number - when converting pounds to kg, round the nearest tenths place - use TB syringes for doses less than 1 ml, round to the nearest hundredths (2 decimal places) - when using a 3 ml syringe round to the nearest tenths place
How should a patient uses their crutches when going up and down the stairs?
- When they are going *up* the stairs the crutches go up a step followed by the GOOD leg then their BAD leg follows. - When they are going *down* the stairs the crutches go down a step followed by their BAD leg then their GOOD leg follows.
What should we know about the venturi mask?
- accurate within 1% - used for COPD aka emphysema pts - 24 - 50% oxygen 4 - 12 L/min
What is the primary factor in the development of CAD?
- atherosclerosis
What is heparin induced thrombocytopenia (HIT)? patho? s/s? tx?
- drop in platelet post heparin tx caused by the immune system rxn - monitor platelets - can be a delayed rxn - under 150K or under 50% of baseline s/s: - VTE - PE - MI - Stroke - Skin necrosis tx: - stop heparin first - use alt anticoag tx = e.g IV angiomax - medic alert bracelet - watch for liver and renal failure heparin + lovenox
What is some non surgical management of IBD?
- drug therapy such as (corticosteroids, 5 aminosalicyclic acid drugs, immunosuppressant agents = autoimmune dz) - nutritional therapy - rest - psychosocial support
What is therapeutic range?
- drugs with narrow tx ranges have a higher risk for toxicity in pts, so we use peak and trough test - you don't want too little (no response) or too much (toxic) - wide TR = "more room to play"
What is cision gauze?
- it has petroleum/ vaseline - used for burns to prevent the gauze from sticking to the wound
What are some pre op procedures before an endoscopic procedure?
-NPO 6-8 hours -consent by HCP -sedation (to help settle them, and to numb throat) —> needs consent -IV (to give meds) -stop Blood thinners, 1 week before -colonoscopy —> needs special diet (liquid, clear, no red or orange) -Diet -Vital signs before, during and after procedure as well as pulse ox included -a week without NSAIDS/anticoagulants/aleve/Advil -bowel prep - temp is important for s/s infection
What are some post op procedures after an endoscopic procedure?
-assessments -frequent vitals -safety -diet (evaluate gag before anything esp water, because we numb throat) -education: -gag reflex takes 1-2 hours to come back, head of the bed up, make sure they dont aspirate -report: abdominal pain, fever, unresolved n/v with meds, call bell for assistance -driving usually off limits 12-24 hours after procedure
How can we categorize/ characterize pain?
1. Cutaneous - ex: paper cut aka supercial 2. Visceral - ex: menstrual camps, aka deep organ pain crushing pain like chest pain 3. Deep somatic pain - ex: arthritis aka bone pain, 4. Radiating pain - follows a nerve, travels along a body part 5. Referred pain - ex: Myocardial infarction referred to left arm/shoulder, distant area, like the jaw 6. Phantom pain - ex: amputees, 7. psychogenic | *PP, QQ, RR, S, T, U*
What are the 4 different types of congenital heart dz?
1. Disorders w/ increased pulmonary blood flow = acyanotic 2. Disorders w/ decreased pulmonary blood flow = cyanotic/blu/dusky 3. Obstructive disorders 4. Mixed defects
What are 4 ways NBs can lose heat?
1. Evaporation - liquid to vapor, insensible heat loss, when are bron we immediately dry them and remove the wet towel 2. Conduction - heat lost through touch, e.g. cold hands, cold stethoscope, cold weighing table, pv heat los we warm our hands/stethoscope 3. Convection - losing heat loss due to a fan or air conditioner 4. Radiation - when heat is loss by being near an area that has a lower temp
What are the goals of J-Co?
1. Identify patient > a. 2 identifiers, name and DOB. For meds and treatment 2. Improve Staff Communication > a. Report critical results > b. The most common cause for errors > c. Use ISBAR 3. Verbal orders > a. READ BACK 4. Use medications safely > a. Labeling > b. Anticoagulation therapy > c. Medication reconciliation 5. Use alarms safely > a. Alarm fatigue 6. Prevent infection > a. Hand hygiene > b. CAUTI > c. CLABSI - Central Line Associated Bloodstream Infection 7. Identify patient safety risks > a. Suicide > b. Home oxygen > c. Pre-procedure verification process (UNIVERSAL PROTOCOL)
What are some lab tests for anticoagulation? (4)
1. PTT - Partial Thromboplastin Time > measures pathway for clot formation NV: 60 -70 secs 2. aPTT - Activated Partial Thromboplastin Time > activators + PTT to shorten normal clotting time & provide a more narrow normal range NV: 30-40 secs 3. PT - Prothrombin TIme > mechanisms for clotting NV: 11.0 - 12.5 secs depending on the reagents 4. INR - International Normalized Ratio > pts on anticoagulant tx should have values 1.5 - 2x the control value, used with pts. on Coumadin NV: 0.8 -1.1 > HCPs can report PT w/out worrying about the reagents or methods used
What is the surgical treatment for someone with CD? Crohns
The bowel resection can help in the treatment. The diseased part of the intestine is removed and reconnected back. This is not a cure.
What is a complete blood count (CBC)?
The calculation of the cellular elements of blood = wbc + rbc + platelets
What is the chain of infection?
The chain of infection is cyclical process. First there's an Infectious Agent = fungi, protozoa, microbe, bacteria, virus then we have a Reservoir = where microbes live and multiply ex: human, wound, surface. Then comes the Portal of Exit = GI tract, sneezing, secretion, in the air/ something you breathe in, coughing then it is transmitted through a Mode of Transmission = direct contact, touch, breathed in, indirect contact. The infectious agent needs to enter into a host through a Portal of Entry = how the microbe get inside of the patient, ex: ENT, breathing it in, open wound, catheter (not using proper sterile technique). Lastly, Host = the patient, a susceptible host (age, immunocompromised, AIDS).
What are the 5 criteria for pt. goals?
1. SMART - *Specific* - include time, numbers, amounts *Measurable* - ex: pain level went down from 9 to 5 *Attainable* - it has to be reasonably within the client's reach *Relevant* - ex: if the pt has no immobility issues don't write a goal that involves mobility progress *Time Bound*- deadline, timeframe 2. Patient centered - you're treating a person not a disease
How does the Braden scale work?
The higher the number, the lower the risk for skin impairment
What are the effects of med use for older adults?
The pharmacokinetics (absorbed by gut, metabolized by the liver, excreted by the kidney) of drugs are different with OAs, they impacted moreso by drug interactions because of polypharmacy, sometimes they have poor adherence bc of prescription costs and lack of health literacy
What is up to bedside chair?
The pt goes from bed to bed side chair, always use another nurse for heavy pts.
What are the general principles of isolation?
Use standard precautions which means having good hand hygiene. Dispose of contaminated supplies/equipment/PPE, think about protecting everyone including your coworkers/UAPs/techs, and be clinically competent (5Cs).
What precautions are used for contact category of transmission?
With contact precautions you (and visitors) have to "gown and glove" or don and doff everytime you leave the room. Cluster your care and gather equipment (only what is necessary for the procedure because everything has to be disposed of if it goes in the room). The pt has their own equipment and they may have a private room or cohort.
What are some characteristics of inflammation?
With inflammation there is the formation of EXUDATES/DRAINAGE = WBCs and other cellular components, nutrients, vascular rxn. There are 4 types of exudate: Serous = clear, light pink, looks like plasma, watery, Sanguineous = bloody, Serosanguineous = light pinkish, not frank blood, Purulent = pus, WBCs, pus means there's bacteria or infection at work, BAD, can be different colors. The second part of the inflammation process is TISSUE REPAIR = tissue healing. Lastly there's GRANULATION = good sign, new vascular blood supply, healthy red tissue.
What are some examples of non-insulin injectable drugs?
amylin mimetic and incretin mimetic
What is the abg adult's fluid intake?
2300 mL
What are some clinical manifestations of hyperglycemia?
3 P's - polydipsia, polyphagia, polyuria
What is phosphorus' nv?
3.0 - 4.2 mg/dl - inverse relationship with Ca2 - important for energy + neuro fx + muscle fx - needs renal fx - PT/PTH regulate phosporus -Kidney failure causes increased phosphorus
What is the normal range for potassium?
3.5 - 5 mEq/L Most abundant intracellular cation mneumonic: "3.5. to 5 keeps my heart alive"
What is the normal range for potassium?
3.5 - 5 mEq/L *Most abundant intracellular cation* mneumonic: "3.5. to 5 keeps my heart alive"
What angel should the elbows flex while using crutches?
30 degrees
What is the minimum urine output?
30 ml/hr
How does metabolic acidosis occur in patients with kidney dz?
azotemia waste increases > bicarb production decreases and reabsorption decreases > body compensates by initiating kussmaul's respirations (deep, labored, tachypneic, almost gasping breaths) > blow off CO2 > sodium bicarb admin (IV or PO) - PO is well tolerated, IV can make the pt alkalotic from too much - sodium bicarb can also be given in earlier stages to avoid acidosis
How many cycles of NREM and REM does your body require for a "good night's sleep"?
4 to 5 cycles
What is the normal range of WBC?
5,000 - 10,000/ mm^3
How long do staples last?
7 -14 days
What is the normal glucose range?
74 - 106 mg/dL fasting and <200 mg/dL non-fasting
What is an acceptable temp range?
96.8 - 100.4 F 36 - 38 C
What is hypocalcemia?
< 9.0
What is the ejection fraction?
= EF - determined using echocardiography - noninvasive - normal EF is 55 - 65% - % of blood that leaves the heart each time is contracts, contractility of ventricles - "How well is the heart pumping?"
What is polyuria?
> 3L / 24 hrs
What are some important nursing implications and adverse rxns of factor Xa inhibitors?
> Arixtra = Subq admin > Xarelto and Pradaxa = PO admin > Pradaxa = abscence of a thrombotic event - adverse rxn = bleeding
What are some complications of OME & AOM?
AOM - Tympanosclerosis - scarring from rupture - Acute mastoiditis - Intracranial infections - Tympanic membrane perforation OME - Hearing loss - Expressive speech delay
What are the different types of permanent vascular access?
AV fistula Anastomosis of artery & vein - upperarm or forearm, vein walls thicken and allows for repeat use, may require topical anesthetic over the site before dialysis AV graft - used when the fistula doesn't work or the pt is not a canidate for the fistula, can be used w/in 1 -2 wks, sites typically used included the arm, forearm or upper thigh - Tubing connecting artery & vein - check radial pulse for hand, arm perfusion and check both arms for fistula or graft - Takes 3 -4 months to mature, while waiting an HD cath is used
What is Alkalosis?
Abnormal ⬇ in H+ ions conc due to an accumulation of excess bicarbonate and/ or loss of acid
What is ADLs?
Activities of Daily Living
What is the difference between acute and chronic?
Acute = sudden onset | Chronic = longer than 6 months, constant
What is the difference b/t acute & chronic blood loss?
Acute: Hemorrhage > trauma, surgx, GI bleed, symptomatic if loss ⬆ 500 mL Chronic: > Adults/women > compensation of the body, bone marrow rxn
What organization develops the standards of professional performance for nurses?
American Nurses Association (ANA)
What is BRP?
Bed rest with bathroom privileges, pt should use the call light
What are some examples of diseases that can affect oxygenation?
COPD - pursed lip breathing Emphysema - wheezing Asthma - narrow airways
What is a closed system?
Closed system = when tubing stays together or connected to patient
What is a calibrated dropper used for?
Eye and ear meds
What sign is usually noted during the acute phase of illness?
Fever
What are some clinical manifestations of hypoglycemia?
Hunger, irritability, restlessness, confusion, weakness, diaphoresis,
How is a 3 ml syringe calibrated?
In tenths of a ml I.e. .5, .6, .7, .8, .9, 1, 1.1
What are some enviromental hazards to healthcare workers?
Infection, needle sticks, radiation, violence, biohazards, back injury
Which one has the longer half life: Lovenox or heparin?
Lovenox
What does blood loss do to BP and pulse?
Lowers BP, Increases Pulse
What is an administration route?
Method of delivery e.g. IM, IV, p.o, p.r
What are the diet restrictions for each CKD stage?
NI stands for normal
What are three types of immunity and how are they related to neonates?
Natural - skin, mucous membrane, gastric acids, enzymes Acquired - > active - absent until you get exposed to a foreign organism > Passive - antibodies from mom
Should a nurse exchange packaged droppers b/t meds?
No, drop size varies from one dropper to another
What are normal and abnormal findings of oxygen saturation?
Normal = 95 - 100% Abnormal = hypoxemia = <90%
What are the chracterististics of an "ideal" drug?
Note that no drug is absolutely perfect/ideal *Safe*, *Effective* - does it illicit the response for which it was given, *Selective* - does it illicit ONLY the response for it was given ex: if the drug was given to shrink a tumor it should ONLY shrink the tumor or target ONLY the tumor, *Reversible* - ex: birth control ex: general anesthesia, *Predictable* - we should be able to predict how the pt will respond, but ppl are different due to physiology, pathology, and genetics, *Easy to administer* - ex: antibiotic 6x a day every 4 hrs v antibiotic 1x a day pill v injection if it's easy they are more likely to comply, *Free from drug interactions* - becomes more difficult with polypharmacy and long hospital stays, *Low Cost* - ex: epipens in the news, *Chemically Stable* - maintain medicinal effects, *Have Simple Generic Name* - easy to say
How should potassium be given PO?
On a full stomach
What is OOB Ad lib?
Out of bed at liberty, they can freely walk around, make sure catheters/foleys are empty, supportive shoes
What is the difference between partial and full thickness wounds?
PARTIAL - base is red - moist and painful - shallow FULL - subq - depth varies
What's the difference between physiologic and pathologic jaundice?
PHYSIOLOGIC -> Occurs in 60% of term & 80% preterm newborns -> Occurs 1-7 days after birth ->Caused by shortened RBC life & immature liver -> Levels usually peak at 10mg/dL then decline rapidly PATHOLOGIC 5+ mg/hr Alarming! -> Occurs in first 24 hours -> Caused by severe polycythemia, blood incompatibilities (Rh-), or systemic acidosis -> May reach toxic bilirubin level > 17mg/dL -> Kernicterus → Encephalopathy
Who can prescribe medication?
Physician, NP/ARNP, PA
What labs do you need to keep an eye on when admin Lovenox?
Platelets and H/H
What are some factors that affect the prevention, control, or transmission of infection?
Poor hand hygiene, poor sterile technique when performing invasive procedures like placing catheters, not using standard precautions.
What is epithelialization?
Process of epidermal resurfacing and appears as pink or red skin
What does the colon do?
Remove extrement and responsible for shifting of electrolytes
What does RACE and PASS mean?
Remove/ Rescue, Alarm activation, Confine, Evacuation | Pull, Aim, Squeeze, Sweep
What is the 4 point walk with crutches?
Right crutch, Left leg, Left Crutch, Right Leg, used with cerebral palsy pts
What are the "five rights" for med safety?
Right pt, right drug, right dose, right route, right time
What are the 6 rights of drug administration?
Right pt, time, drug, dose, route, and documentation
What are the 3 different types of documentation formats?
SOAP - subjective, objective, assessment, plan DAR - data, action, response PIE - problem, intervention, response
What are some common problems experienced by older adults?
SPICES
What are pain descritpors?
SQT : [mild, moderate, severe, use pain scale to assess Severity], [words like aching, crushing, burning, gnawing, stabbing, sharp, dull, and throbbing assess for Quality of the pain], [When assessing for timing ask about onset (when does the pain happen?), frequency (how often does the pain occur?), and duration (how long does the pain last?)]
What are the different pieces of equipment used in BP measurement?
Stethoscope (diaphragm), BP cuff
What is the diffference between PEG tube and GT?
The PEG is endoscopic and GT is inserted surgically
What does total volume refer to?
The full amount of the drug contained in the package I.e. the total # of tablets or fluid volume
What are some J-Co recommendations for safety?
Use 2 patient identifiers (Name and DOB), use direct messages - ISBARR or SBAR, use five rights
When do we use a health promotion nursing problem?
When the pt is ready to talk about their health behavior and you may have to apply this to an individual, family, or group.
What is urinary retention and how would it manifest in a pt?
accumulation of urine due to the inability of the bladder to empty the pt would be restless the nurse will be able to palpate the bladder and it would be distended the pt would be uncomfortable pt will report pressure residual urine can be seen using a bladder scanner PVR = post void retention, after urinating residual, bladder isn't completely emptied can be acute or chronic
What do we ask to evaluate a pt sleep?
are they able to fall asleep within 20 minutes of going to bed? did they have a dream? does quiet music help?
How to assess sleep?
ask to the pt's family/ pt - are they having any problems sleeping - what is their usual sleep pattern? - what maybe going on in their life that may be interrupting their sleep? - what illnesses may be interrupting their sleep? - what is their emotional/ mental status? - what's the bedtime routine/environment? - are they exhibiting s/sx of sleep deprivation
When should you always check MD order?
before giving meds @ the begininng of every shift against the MAR
Where should foam be used?
bony prominence
What is urinary diversion and what are the different types?
diversion of urine to external source incontinent, continent, and nephrostomy
What is nonmaleficence?
do no harm
What is beneficence?
doing good on behalf of others
What is a potential complication of treatment for dehydration?
fluid overload
What is pharmacokinetics?
how the body effects drugs, the way our liver metabolizes drugs, how we excrete drugs, the movement of drugs through the body
What are some examples of barriers to teaching and learning?
illness, anxiety, language, literacy, teacher, motiviation, priorities, timing, environment, readiness, frustration
What is phlebitis? s/sx?
inflammation of the inner layer of the vein s/sx: red, heat, swelling, pain, tenderness, red streak that runs up the arm, palpable cord - tends to happen with meds like antibiotics
What are some nursing dx for a dying pt?
knowledge deficit r/t DNRs/DNIs/ processes & expectations as death approaches pain r/t organ failure, immobility, progressive dz state
What is hypoxemia?
lack of oxygen in the blood @ cellular level
What is effleurage?
long, slow, gliding strokes of massage associated w/ reduced measured anxiety, HR, RR
What is evaporation?
losing heat through sweat, cooling the skin through sweat
What laboratory results would a nurse expect to find in a patient that has hypervolemia?
low serum sodium level
What are some examples of restraints?
mittens, wrist restraints, belts
What is convection?
moving air removes radiated heat
What are some factors that can affect fetal development?
multifactorial Fetal - •Sex (males larger) •Multiple gestations •Anomalies/chromosomal defects - intrauterine growth retardation or spontaneous abortions •Fetal infection (TORCH) Placental - impacts supply of nutrients •Calcification (aging) of the placenta, size/insufficiency, previa/abruption Maternal - •HTN, smoking, diabetes, weight gain, drug use
Where should the weight be when a client is using a walker?
on their hands
What is a pathogen?
organism that causes disease
What two glands regulate calcium?
parathyroid and thyroid glands
What are receptors?
points of control in the body, special chemicals aka places that drugs interact with to produce an effect
What is autonomy?
pts being involved in their own healthcare decisions
What are two patient populations that use the "swing gait" with crutches?
pts who are parapalegic or havr really weak legs
When do we use a sitz bath?
rectal surgery episiotomy painful hemorrhoids
What is a place that an organism can grow and reproduce?
reservoir
What are restraints and why are they used?
restraints can be chemical or physical, they are used to immobilize a pt's extremity
What is serosanguinous drainage?
serous drainage + blood
What can influence sleep?
sickness, meds, lifestyle, sleep patterns, stree, environment, exercise, food
What factors can influence absorption?
surface area, dissolution rate, blood flow, lipid solubility,
What kind of tablets or capsules have to be given in original form?
sustain release tablets
What is a word that means an infection is present?
symptomatic
How are respirations regulated via the nervous system?
the CNS controls RR, R depth, and R rhythm - this why we see CNS changes when the concentration of the extracellular electrolyte Na+ is too high or low in the blood
What are endogenous receptors?
the body's own receptors = the normal points of control e.g. neurotransmitters like serotonin, hormones, norepinephrine, epinephrine endo = within the body
How should we as nurses think about a legal record?
the chart is a legal record
What is minimum effectiveness?
the least amount you can give to illicit a response
The higher the obstruction is........
the quicker the symptoms
What is the role of the urethra in urinary elimination?
urine travels from the bladder and exits through the urethral meastus
What are the different pain measurement scales?
Wong - baker scale - uses faces OR Numerical pain scale which seperates the segments into Mild (1-3), Moderate(4-6), and Severe(7-10) ex: tynenol for mild pain, perquecet for moderate pain, morphine for severe pain
Why are flowsheets and & graph records important?
allows the nurse to see pt trends and decreases time used for narrative notes
What is included in a psychosocial assessment?
biological/social/psychological details, fx abilities, self efficacy, relationships, interpersonal communication, understanding about illness, coping mechanisms, spirituality, health priorities
What does parenteral mean?
by injection, not PO, med route other than oral
What does CAUTI mean?
catheter associated urinary tract infection *** high r/f infection
How should you evaluate fluid excess interventions?
check to see if their BP is less than 130, the pt should have clear lungs sounds, their weight should be coming down, and the output should be greater than their inout
what are drugs?
chemicals that produce an effect by interacting with other chemicals
What are some examples of things a nurse looking into a pt's current condition can find?
chief complaint, physical findings, dx like labs and x-rays, vital signs, pt's ability to swallow
How is hyperlipidemia managed by the nures in children?
•> 2 years - a risk assessment screening is done based on family history •Guidelines recommend universal screening between 9 - 11 yrs and again between 18 - 20 yrs Lipid screening (fasting): Total chol > or equally 200 = elevated LDL > or equal to 130 = elevated
What are some factors that affect body temp?
•Age •Exercise •Hormone level •Circadian rhythm •Stress •Environment •Temperature alterations
How is acute rheumatic fever managed by the nurse?
•Antibiotic therapy - full 10 day PO course of penicillin therapy and then give it for 5 years as a prophylactic, sometimes they can get Penicillin G qmonth IM following initial illness until adulthood •Corticosteroids - decrease inflammation in vavles •Rest - strict! •Pain management •Cardiac Complications - Aortic stenosis, leaking mitral valve -> can cause on going cardiac probs for life •Education to child/family
What is the criteria to recieve renal transplants?
•Candidate Selection Criteria -Free of medical problems that would complicate procedure -Age 2-70 usual age -Exclusions: •Advanced, uncorrectable heart disease •Metastatic cancer - must be CA free for 2 - 5 yrs before transplant •Severe psychological issues - no alcoholics or chemical dependence
What is congenital heart disease (peds)?
•Child is born w/ it •Rate is approximately 1 % of live births or 32,000 annually •Nearly 1/2 of all cases are diagnosed during 1st week of life (some could be picked up in utero, fetal ECHO) •28 % occur along w/ a syndrome or chromosomal defect (down syndrome, diGeorge syndrome, marfan syndrome)
What is FASDs?
•Fetal Alcohol Spectrum Disorders (FASDs) -> "don't drink at all" -> pattern of fetal anomalies r/t alcohol abuse •Prenatal alcohol use •Effects: developmental/cognitive/behavioral disabilities •Birth defects - commonly heart, kidneys, bones •No safe level, life long, affects 40,000 newborns/yr
What is acquired heart disease (peds)?
•Happens after birth •Complication of CHD usually r/t an autoimmune type response, infection in the ❤
What are some variations in the heart structure & fx? (Peds)
•Heart size - size of their fist (thin vessels, superficial) -> Children under 7 - heart lies more horizontally, apex (point of maximally impulse) is higher & found a@ 4th intercostal space (left side) -> As lungs grow - heart displaced downward -> By age 6-10 years - heart 10X birth size & grows more vertically (apex at 5th IC space) -> Adolescence - the heart grows in size w/ teen's rapid growth spurt •Compliance - less in infants & young children (stretchability of the ❤ muscle is low in infants so the only way they can ⬆ CO is to ⬆ HR) •Heart rate: higher in infants (average 120) - teens (average 60's) athletes tend to be lower *HR is sensitive, murmurs are mostly innocent
What are some examples of nursing interventions specific to psychosocial problems?
■Therapeutic relationship ■Encourage independence ■Monitor for/discourage negative self talk ■Positive language ■Supportive accepting but don't invade space ■Role model ■Refer to self help groups
What are some lab and diagnostic testing for peds neuro patients?
▪ EEG - seizure d/o ▪ CT, MRI, PET scan - tumors, injuries, bleeding/swellinng of the brain ▪ CBC or tox screen - drugs, infection, meds ▪ Lumbar puncture - assess for ICP & infection, done before antibiotics, do it in a timely manner, they have to stay still, safety first, needle in the subarchnoid space, can measure pressure levels (NV: 5 - 20 cm), need to be still & flat on their back ▪ Septic workup when they have fever - rule out meningitis, urine/blood culture + lumbar puncture included
What are some s/s of hypokalemia?
❤️ dysrhythmias Leg cramps Decreased GI motility
What is the benefit of CPOE?
decreases errors, makes sure that providers include all necessary information necessary to make an order legal
What is the difference b/t dehiscence and evisceration?
dehiscences - wound separation evisceration - organs fall out of surgical incision
What is a high concentration of RBCs a sign of?
dehydration, polycythemia vera
What are some examples of issues in healthcare ethics?
quality of care, genetic screening, care at the end of life, access to care
What are two kinds of medical errors?
execution - e.g. amputated the wrong leg, wrong drug calculation, wrong med to the worng pt. planning - e.g. doing MONA for a pt. heart attack pt
What is justice?
fairness
What is the amount of oxygen you can get using an oxygen concentrator?
for @ home use and up to 5 L/min of oxygen
What are some examples of nursing problems that can impact med admin?
impaired swallowing, knowledge deficit, noncompliance
When do dreams occur?
in BOTH NREM and REM sleep
What do the terms intracardiac, intraarticular, intrathecal mean?
in the heart, joint, and spinal canal
What is Coronary Artery Dz?
includes: - chronic stable angina - ACS = acute coronary syndromes
What is sleep deprivation?
lack of sleep d/t emotional stressm meds, environment
How do we want drugs to interact with specific receptors?
like a lock and key, wee want the drug to target specific receptors and not others
When should VAC therapy NOT be used?
malignant wounds, necrotic tissue, bleeding disorders, untreated wound infections, untreated osteomyelitis
How does food affect drug toxicity?
may have an additive effect, like caffeine foods like this ADD to the drugs effects
How does food impact drug action?
may lessen the drugs response like coumadin and green leafy veggies that essentially causes an antidotal effect
What are some interventions that address temp?
meds (antipyretics), nonpharmocological (fan, ice, change of clothes), teaching, blood/urine cultures, min heat production, max heat loss, satisfy metabolism needs, promote comfort, control environment
What are prescriptions?
meds to be taken outside of the hospital
How do you protect a pt during a seizure?
note time and duration of seizure, stay w. pt, call for help, cradle head, don't move pt., clear surroundings, remove pillows, raise side rails, loosen clothing, after the seizure: place the pt. on their left side, suction secretions, reorient and comfort them, physical assessment (especially their oral cavity)
What's the difference between stop and discontinue in regards to med admin?
stop means the order is able to be reinstated while discontinue means the order needs to be stopped and it can not be revisited
What is the hypothalamus?
part of the brain that regulates body temp
What is core temperature?
temp of the deep tissue of the body, vital organs
How should meds be admin before and after food (meals)?
the *med* should be admin: - 1 hour before meals - 2 hours after meals Always "med FOOD med" *food* should be given 1hr after or 2hr before
What does a written prescription include?
the 7 rights plus the prescribers DEA# and the pt's name, address, age, and DOB
What is the basic pathophysiolgy of CAD?
the heart is starved of oxygen due to the arteries being blocked by a build up of plaque or a clot and this leads to necrosis which is an irreversible consequence
What is ventilation?
the movement of gases in and out of the lungs
what does inhibitory mean?
the opposite of potentiative, the reduction of adverse and therapeutic effects 2 types of inhibitory actions - > antagonisitc - antidote > incompatible - deterioration
what is a unit does?
the ordered dose of meds the client receives at a prescribed hour
When a nurse is giving oral meds what should she record?
the pt administers the ordered WEIGHT of the drug administered not the milliliters or number of tablets
How would the nurse know the heparin is working?
the s/s of DVT, PE improve or the DVT or PE are absent
What is clinical pharmacology?
the study of drugs in humans
What is pharmacodynamics?
the study of what drugs do and how they do it, understanding this helps us make PRN decision, communicate with physicians, and educate our pts and decide whether or not a drug's dose is therapeutic, not therapeutic or toxic to our pt
When a patient is on warfarin which lab result should we focus on?
their INR = international normalized ratio
When a pt is on heparin which lab result should we focu on?
their aPTT = activated partial thrombin time
Why are some abbreviations not being used?
they can cause errors
what are the only two things drugs can do at receptors?
they can only mimic or block an action the body would have already done on it's own, they can NOT make the body perform an new f(x)
What is a summary of a nurse's responsibilities regarding med admin?
they should be able to interpret orders, gather info about the drug they are going to admin, identify their pt, admin the right drug and dose at the right time, they should be able to educate the pt on their meds, and minitor their pt after the admin of their meds
What should you know about the urine drainage bag?
they should be placed lower than the bed (nonmovable part of the bed) not in the bed and not on the floor uriometer - measure directly other types of bags use a graduated cylinder
Why shouldn't pts use tennis balls?
they slide, to prevent fall or further injury
What is purulent drainage?
thicker than serous, contains pus with leukocytes and bacteria, yellow.orange
What is tunneling?
tissue destruction that forms narrow passages under intact skin, it can extend in any direction
What is undermining?
tissue destruction that forms pockets underneath intact skin along wound margin, often develops from shearing forces
what does potentiative mean?
to *increase* therapeutic effect or *increase* side effects
what does extravasation mean?
to leak around the IV site
What does potentiate mean?
to make something more powerful or more potent
Whay are dressings used?
to protect wounds and absorb drainage
What is the intended therapeutic effect of drug therapy?
to provide maximum benefit and minimum harm
What does contaminate mean?
to render unclean or unsterile
what is the medical definition of precipitate?
to solidify, to form particles in the sol'n
Why is a patient receiving low molecular weight heparin aka Lovenox aka enoxaparin?
to t(x) or p(v) DVT or PE
Why is a patient receiving warfarin?
to t(x) or p(v) DVT, PE
Why is a patient receiving factor Xa inhibitor? i.e. Arixtra, fondaparinux, Pradaxa
to treat or prevent DVT or PE
Why is a patient receiving rivaroxaban (Xarelto)?
to treat or prevent DVT or PE, doesn't require frequent monitoring, home tx
What is the nurses role in informed consent?
to witness the client signing the document > make sure the client is not be forced to sign, the signature should be real, the client should be compotent - the nurse does NOT explain the procedure to the pt - students are NOT allowed to obtain consent forms - concerns = go to physcian or supervisor
What is the role of the ureters in urinary elimination?
transports urine from the kidneys to the bladder
What is veracity?
truthfulness, honesty
What does TCDB mean?
turn, cough, deep breathe every 2 hours, respiratory intervention
What is narcolepsy?
uncontrollable sleep attacks
How far up should crutches go?
up to about 2 - 3 fingers below the armpits, 1 - 1.5 inches to prevent nerve damage and to help weight distrubution to the hand grips
What is transport?
ventilation + perfusion how well can the hemoglobin carry oxygen
What is osmosis?
water moving from a low conc to a high conc
What is dosage strength?
weight or amount of drug provided in a specific unit of measurement e.g. 600 mg, 500 mg
what does additive mean?
when 2 drugs work together with similiar actions e.g. when a pt is prescribed 2 different BP meds to control their hypertension
What does "now" mean?
when a med needs to be given now, but not STAT
What is diffusion?
when respiratory gases are exchagned in the alveoli and capillaries
When to use a VAC?
when routine wound care is not effective
What is onset?
when the drug 1st starts to illicit a response
When should time critical meds be given?
within 30 minutes before or after the scheduled time
Can a change in the level of consciousness manifest in both hyponatremia and hypernatremia?
yes
If a nurse attempts to aspirate blood from an IV site and no blood is returned, can the nurse use the IV site?
yes, as long as there are no signs of infiltration or extravasation
What is the general pathophysiolgy of HTN?
you have increased blood/fluid volume or your vessels constriction cause you to have high pressure in your vessels and this makes your heart work harder
What is granulation tissue?
young connective tissue, blood vessels,"beefy red", a good thing
What are some examples of federal issues in nursing?
· Americans with Disabilities Act · Emergency Medical Treatment and Active Labor Act · Mental Health Parity Act as Enacted Under PPACA · Advance Directives (Living will, HC Proxies or Durable Power of Attorney for HC) · Uniform Anatomical Gift Act · Health Insurance Portability and Accountability Act · Health Information Technology Act (HITECH) - Self Determination act of 1991
What are some examples of state issues in nursing?
· Licensure · Good Samaritan Laws · Public Health Laws · Uniform Determination of Death Act · Autopsy · Death with Dignity or Physician-Assisted Suicide
Who is more likely to have severe, persistent hypernatremia?
people who can't drink voluntarily
What are some conditions that can impact chest wall movement?
pregnancy, obesity, neuromuscular dz, musculoskeletal abnormalities (e.g. scolios, kyphosis, barrel chest), trauma (e.g. pneumothorax), CNS alterations
What are some factors that affect grief/loss?
prior losses, relationships, spiritual/ cultural, EOL decisions
What are the components of the nursing diagnosis/patient problem?
problem + etiology/cause + evidence (subjective/objective data) OR potential problem + risk factors
What is the maximum you can inject into a muscle for an IM injection?
3 mL
What is the normal WBC count?
5,000-10,000
What is supply dosage?
Dosage strength + form aka concentration or ratio or %age e.g. 600 mg per tablet or 10 g per ml
How can a nurse prepare different forms of medications?
PO, tablets, capsules, liquid, PEG, NJ, NG
What is disuse atrophy?
When cells and tissues reduce in size due to disuse
How can gastric ulcers occur?
When there is an impairment in gastric mucosal defenses so they no longer protect the epithelial lining from the gastric contents > pain
How does ulcerative colitis (UC) look like ?
Widespread inflammatory process that produces Ulceration that start in the rectum and go to the secum Autoimmune disorder that to overreacts to normal bacteria in the digestive tract and the immune system fails to shut down and causes inflammation damaging the digestive tract and causing the symptoms More pronounced in caucasians and Jewish and more in females Etiology: unknown ((Note to self: looks like thrush in rectum))
Can partial doses of a pill or tablet be given?
Yes, if the pill or tablet is scored
What 2 labs are affected by antacids?
calcium and Mg
What is Kawasaki dz?
• Acute systemic vasculitis occurring mostly in young children • Peak age 1-2 years • 80% less than 4 years of age • Most frequently in males and Asian children • Cause remains unknown • Diagnosis is determined by clinical symptoms
What is orthostatic hypotension?
↓ in syst >20+ or diast BP > 10 mm Hg within 3 minutes of changing to upright position
What is laryngotracheobronchitis "spasmodic coup"?
"C's up 3's up" "Spasmodic Croup" - Inflammation of larynx, trachea, and bronchus - Viral - Inflammation, edema & mucus obstruct the airway - Hoarseness, "barky cough", inspiratory stridor - Young child (3 months to 3 years) - Occurs suddenly, at night worse - Treated with humidified air in shower or cold air -> Don't put them in shower, just put them next to it and let them breathe the steam Teaching guidelines - Child needs to be quiet - Try to keep them from crying - it increases risk of spasm - Holding them makes them feel less anxious - Fluids if possible - Corticosteroids as directed - Tachypnic, retractions, difficulty breathing, they need to be seen - If stridor does not improve, they may need to go to ER - Restlessness, confusion, child starts to drool/can't swallow can be complications
How are K+ levels regulated?
"K for Kidneys" adequate kidney f(x) required for function Note: Dialysis pts struggle with K+ regulation
What does sedentary lifestyle mean?
"coach potato" "sitting" a lot
In what order do you don and doff PPE?
"on - GREG" "off - GEGR" | putting on - gown, respirator/mask, eye mask/googles, gloves | taking off - gloves, eye mask/googles, gown, mask/respirator
What is potency?
"the more potent a drug the less drug you need to administer" Potency = *AMOUNT* compares the amount of the drug to the effect, so the smaller the dose the more potent a drug is
What are some causes of hyperglycemia?
(160 - 190 BG) - sick pancreas - overeating - stress response - not exercising enough - sickness - steroids
What is the function of the liver?
* all of the fx(s) of liver aren't fully mature until about 3 mos of age - Blood coagulation - conjugation of bilirubin - storage of fat soluble vitamins i.e. A, D, E, K - Carb metabolism - Iron storage - Detox
What is the benefit of delayed cord clamping?
* only delayed for a few minutes - ⬆ blood volume - ⬆❤ status - ⬆ BP - ⬆ O2 - ⬇ anemia
What are the s/s of carcinoma of the larynx?
** (2wks+) persistent hoarseness > call HCP - harsh - raspy - low in pitch - cough/sore throat - pain and burning in throat often when consuming hot food & citrus - dysphagia, maybe not - ear pain, maybe not
What is important to know about Alpha II Adrenergic Agonists?
** + try to give @ night due to drowsiness, can be given by transdermal patch, it should lower BP, SEs = rebound hypertension if stopped abruptly
What is that we need to know about ACEs, ARBs, Ca2+ Channel blockers, Cardio selective and non- Cardio selective Beta blockers?
** = Always do pt. ed., look at vitals, renal f(x), and safety w/ these meds - ACEs = -pril, tx HTN & ❤ fail, watch out for cough + **, it should ↓ BP & there shouldn't be any ❤ events, SEs = first dose effect + angioedema e.g. "A-C-E" = lisonopril, Captopril, Enalopril - ARBs = -sartan, tx HTN & ❤ fail, watch their **, it should ↓ BP & there shouldn't be any ❤ events, SEs = angioedema e.g. "CAD" = Cozaar, Atacand, Diovan Ca2+ Channel Blockers = -pine, tx HTN, watch their bowels + **, it should ↓ BP & there shouldn't be any ❤ events, SEs = ❤ block, postural hypotension, EKG changes e.g. amlodipine, diltiazem, verapamil Beta Blockers (Cardio Selective) = -lol, tx HTN & ❤ fail, watch their RR + HR, it should ↓ BP + HR, SEs = brady❤ e.g. "CAM" = cardioselective atenolol metopropolol Beta Blockers (non- Cardio Selective) = -lol, tx HTN & ❤ fail, watch their RR + HR, it should ↓ BP + HR, SEs = brady❤, bronchoconstriction so NO to COPD, Asthma, or Emphysema pts. e.g. propanolol, carvedilol, labetolol
What are the 5Cs and how do they relate to the nursing profession?
**"5 C's" - the SSC student learning outcomes 1. Caring - we are not judges 2. Communication = always communicate with your charge nurse (for students that is your clinical instructor), includes patient education 3, Collaboration and management of care - working with auxillary staff and other deparments like physical theraphy 4. Commitment to professionalism = example, shred documents to protect privacy, follow HIPAA 5. Clinical competence and decision making
What labs and assessments are we doing w/ pts receiving aspirin?
**+ H/H, BUN, Creatinine (0.6 - 1.2 men, 0.5 - 1.1), Ax for bleeding, ototoxicity, gastric ulcer "GOB"
What are Maslow's Hierarchy of Needs as it relates to nursing prioritization?
*ABC*DEFG - Airway, Breathing, Circulation, Do-Do (Sleep), Elimination, Food (Nutrition), Go (Activity + Exercise) >> Safety + Pain >> Psychosocial
What is the difference b/t acute care and restorative care?
*Acute care* - Meet basic needs, ↑ risk for (RF): Dehydration, malnutrition, Healthcare acquired infections, Incontinence, Skin breakdown. Falls *Restorative care* - Improving independence, ADLs, Instrumental ADLs, Maximal function
What is the difference b/t acute & chronic pain?
*Acute* - less than 6 mos., transient, warning that something is wrong, readily alleviated, self limited, generally well confined & identified, High BP, High HR, High Respirations | *Chronic* - Ex: low back pain, arthritis, fibromyalgia - more 6 mos in duration, the pain is seemingly meaningless, mostly continuous, but can be intermittent, indistinct + Body adapts, vitals resume to norm; pain does not decrease (resolves to baseline) + relief not possible
What are some factors that determine the intensity of drug responses?
*Administration* - poor adherence by the pt due to incomplete instructions on when + how to take the drug, medication errors from medical personnel like wrong dose/time/route/drug which can lead to toxicity or t(x) failure *Pharmacokinetics* - drug [absorption + distribution + metabolism + excretion], how the body impacts drugs *Pharmacodynamics* - how drugs impact the body when they reach their sites of action ex: pt f(x)nal state might impact how the pt's body responds to the drug or placebo effects
What are some different types of breathing pattern alterations?
*Bradypnea* = Rate of breathing is regular but abnormally slow (less than 12 breaths/min). *Tachypnea* = Rate of breathing is regular but abnormally rapid (greater than 20 breaths/min). *Hyperpnea* = Respirations are labored, increased in depth, and increased in rate (greater than 20 breaths/min) (occurs normally during exercise). *Apnea* = Respirations cease for several seconds. Persistent cessation results in respiratory arrest.. *Hyperventilation* = Rate and depth of respirations increase. Hypocarbia sometimes occurs. *Hypoventilation* = Respiratory rate is abnormally low, and depth of ventilation is depressed. Hypercarbia sometimes occurs.
What are some differnet types of baths?
*Complete bed bath* - for completely dependent pts *Partial bed bath* - only wash the most important parts hands + face + underarms + peri care +/- washing back or back rub *Sponge bath* - bath in chair at sink, pt needs help with only hard to reach areas, keep call light w/in reach *Tub bath* - common in LTC, full immersion in tub, may be used with a dependent pts using a lifting device *Shower* - pt can sit or stand under a continuous stream of water, be cautious of pt fatigue - Can use disposable presoaked cloths (surfactant+emolient) or CHG bath (antimicrobial bath wipe)
What is an EGD aka upper endoscopy? What does it do?
*Esophagogastroduodenoscopy:* Helps physical with a lighted scope, visualize the esophagus and duodenum to see bleeding, ulcers (eg. Peptic ulcer disease), inflammation, strictures, lining of the stomach, can look to see if there are tumors and biopsy/testing. If the patient has cancer, they can also see it because it looks hard and black with the lighted scope. **normal to have a sore throat/coarse after*
What's the difference b/t generic or brand drugs?
*Generic* = lower case, there's only one generic name for a particular drug ex: aspirin *Trade* = brand name = uses the trademark symbol and is capitalized ex: Bayer, Bufferin, Aleve, Advil
What's the difference between brand and generic names of drugs?
*Generic* = lower case, there's only one generic name for a particular drug ex: aspirin *Trade* = brand name = uses the trademark symbol and is capitalized ex: Bayer, Bufferin, Aleve, Advil
What is the difference between medical and surgical asepsis when it comes to barrier equipment?
*Medical asepsis* uses the same principle as protective isolation (protect yourself/other pts from the infected patient) using PPE, timing and dating sol'n bottles. *Surgical asepsis* uses the same principle as "reverse isolation" (protect the pt from a transmittable disease from you/environment), so that means "gown and glove," mask, eye protection
What are some pharmacological interventions for pain?
*Prevent* constipation from use of high doses of pain meds, use prophylatically laxatives/ stool softeners, *Non-opioids* like aspirin, tynenol, NSAIDS, Advil, Aleve, *Opioids* like morphine, oxycodone, hydromorphone, *Adjuvants* - meds that supplement the pain meds ex: antianxiety meds, antihistamines, antiemetics, antidepressants | The nurse can give 24 hr dosing/PCA v. PRN, Topical pain meds, epidural analgesia
What characteristics of respirations should the nurse take note of?
*Rate* = # of respiratory cycles per minute *Rhythm*= pattern of respirations and intervals b/t - Regular/Normal/ Eupnea or Irregular *Depth* = Normal, Shallow, Deep
How should stitches be removed?
cut the knot and pull the stitches as you go
What is torts?
*civil" wrong made against a person or property 2 types: *Intentional* - deliberate act > Assault - actual/threatened > Battery - touching without consent > false imprisonment - restraining without justification *Quasi-Intentional* - intent was lacking, but action happened > invasion of privacy - a nurse can NOT reveal dx to pts > defamation of character > slander - verbal lies > libel - written lies *Unintentional* - > negligence - actions are below standards of care > malpractice = professional negligence - actions fall below standard of care (risk of harm to pt is known)
What are the three sources of law?
- *Statutory* aka federal (congress)/ state; common (protects society)/civil (protects the rights of the individual) > *Regulatory* aka administrative law = BON (disciplinary actions, NCLEX, approve curriculums, regulate nurses aids) > *Common law* = negligence, malpractice
What are some factors that can affect the accuracy in obtaining vital signs?
- *Temperature*: Not using the same site to measure a pt's temp every time can impact accuracy of temp. patterns - *Pulse*: Counting the pulse for a longer period of time yields more accurate results for irregular pulse - *Respirations*: letting the pt know you are counting their respirations can affect accuracy - *BP*: when assessing changes in BP over time BP should be taken @ the same time everyday to get accurate BP patterns - *Oxygen Sat*: pt movement, fake nails, nail polish, edema, poor perfusion, bright lights, jaundice, CO, dark skin, intravascular dyes may affect the accuracy of the O2 sat reading
What are some examples of oral items we can give to a pt is hypoglycemia?
- 15g CHO fast acting/ conc. - 3 - 4 glucose tabs - 4 - 6 oz of juice/ reg soda - don't drink on an empty stomach (alcohol pv liver glucose production)
What are some characteristics of term NBs?
- 38-42 weeks - Less morbidity and mortality - Best outcomes - Best ability to deal with stressors - Still require much education - Adaptation of family
What are the s/s of hyperglycemia?
- 3P's - fatigue - weight loss - slow-healing wounds - dry scratchy skin - paresthesia in feet - blurry vision Seen w/ DKA and HHS pts: - Kussmaul respirations - acetone/ fruity breath - dehydration
What are the s/s of hyperglycemia?
- 3P's - fatigue - weight loss - slow-healing wounds - dry scratchy skin - paresthesia in feet - blurry vision Seen w/ DKA and HHS pts: -Kussmaul respirations - acetone/ fruity breath - dehydration
What are some immune system adaptions in newborns?
- 80% of their circulating antibodies = IgG - IgG can cross the placenta, G = GO as in "GO across the placenta" - IgA and IgM can't cross the placenta - IgA antibodies that responds first in GI and respiratory infections - IgA = high in breastmilk "Breastmilk is A1" immunity boost from mom - IgM responds in infections in general - 9 mos - 1 year antibodies reach adult levels
What is calcium's nv?
- 9.0 - 10.50 mg.dl (serum) = total dissolved Ca2+ - 4.0 - 5.0 mg/dl (ionized) - mostly in bone and teeth - inverse relationship with phosphorus fx: - enzyme activation - excitation in bones + heart muscle - PTH + vit D + calcitonin - determine serum Ca2+ levels - PTH > due to low Ca2+ > Ca2+ moves from bones to plasma > inc GI tract + renal tubules absorption - PTH can't make Ca2+ absorption in GI tract increase unless vit D is present - high Ca2+ > thyroid release calcitonin > inhibits Ca2+ release from bones > lowers Ca2+ leves - vit D required for Ca2+ absorption - 1000 - 1200 mg (yogurt, milk, yogurt, cheese, tofu, spinach)
When should the nurse take vital signs?
- @admission - During home care visits- as ordered by HCP or facility policy - Before and after invasive & dx procedures- Before & after med admin if impact HR, R, or temp f(x) - Change in clinical status or pt reports nonspecific symptoms - Before & after nursing interventions - ex: 60 mins after oral analegiscs or 30 mins after IV analgesics - Before, After, & During blood product admin.
What is nasopharyngitis?
- A cold, young children more likely to get them until they've had exposure - 7 - 10 days duration, clear to yellow thin nasal secretions (cause by ↑ WBC that go to site to fight infection) = Hoarseness with sore throat, dry cough - Fatigue, decreased appetite, +/- fever (sometimes they have it, sometimes they don't) - Can be complicated by secondary bacterial infections - Symptomatic relief -> To help: we can do nasal washes w/ saline drops, bulb suctioning (prior to feeding bc they are obligate nose breathers), humidified air, promote comfort (shower steam, hydration), cool mist vaporizer to loosen secretions - Care with combination cold remedies -> Contain acetaminophen and phenylephrine (not many studies on children)
What is traction? different types? How do we care for traction patients?
- A force applied by weights to tx bone or muscular d/o, slow guide bones back in place - Can be used to keep alignment and reduce pain before surgeries - Types: Skin (Bryant - femur or congenital probs, Balance/Thomas- older kids), Skeletal (Halo -skull pins, 90 - 90 - bedside procedure) - Weight must be freely hanging - Adjust them in bed w/ weights still intact - Meticulous skin care bc of bed rest - Care for the pin sites - high risk for infections bc they go directly into the bone - Pin care 2 -3 x a day when it first inserted bc of drainage, CHG, antbacterial solution, sterile water - Pin care qday after the first 48 hrs - Complications: clots, constipation, skin breakdown, slow movement even while immobile - Frequently baths & diaper changes, monitor temp - Neurovascular - notice changes bc it could be an emergency
What is rickets? What do find upon assessment of a pt w/ rickets? What do you find in a physical exam? What are the s/s of rickets? How we manage rickets?
- A preventable softening or weakening of born due to nutritional deficiencies or limited sun exposure leading to bone pain, dental deformities, bowlegs, fracture - Risk factors: ▪ Inadequate nutrition ▪ Chronic renal or GI dz - malabsorption, imbalance of Ca2+ in bone & blood ▪ Limited sun ▪ Dark skin tone ▪ Prematurity - specific type, Ca2+ is laid down in the bones during the third trimesters, risk - Vitamin D (400 IU qday), Ca2+ phosphorus, supplements needed + nutrition education - fish, live, fortified milk or juices, portabella mushrooms, salmon S/S: - Bowlegging - Decreased muscle tone - Bone pain - Dental deformities - Decreased serum phosphorus & Ca2+ - Increased in ALP - alkaline phospahtase - indicates bone dz - On x-ray widened growth plate - If not treated can have permanent bowleging, skeletal deformities, short stature
How is Na+ regulated?
- ADH - RAAS - thirst
What is acidosis?
- Abnormal increase in H+ concentration - Excess Acid - Loss of HCO3, loss of base - When you are acidotic you have a lot of H+ ions outside of the cell and a lot of K+ inside of the cell and your body compensates by leaking K+ outside of the cell as a buffering system causing you to become hyperkalemic and the H+ go into the cell
What are the signs that death has occured?
- Absence of breathing and pulse - Pupils become fixed and dilated - Eyes may remain open - Skin is waxen - Body temperature drops - Muscles and sphincters relax - Urine and stool may be released - Jaw may fall open - Observers may hear trickling of fluids internally
What is apnea?
- Absence of breathing for > 20 seconds ALTE (Acute Life-Threatening Event) - Some combination of apnea, color changes, muscle tone changes, coughing or gagging - If they come into ER, they'll do a workup to ensure they have no infection, and often find out they don't have issues other than maybe reflux. they reflux stomach contents, causes a vagal response and some of these symptoms. T- hey'll go home with an apnea monitor (even w/reflux) and parents need to be educated on its purpose. If it goes off, look at the baby first, don't mess with the monitor
What do we look at when assessing fractures? How do we manage fractures?
- Accidents #1 cause of morbidity & mortality in peds - Found out how any accidental injuries happen, rule out abuse - Does the injury make sense for the age of the child? Be skeptical, be very detailed until feel good about the answers - Current s/s - how much pain? ROM? Redness? Swelling? warm? - Visual deformity - Any open skin - Palpate along the born, but there will be point tenderness and can indicate where the fracture is vs soft tissue injury - CMS check - Check for s/s of compartment syndrome to avoid loss of fx or nerve damage - hx of potential risk factors: ricketts, osteogenesis imperfecta, renal dz often have causes PTH to be released and pulls Ca2+ from the bone into the blood leading to fractures, activities they are participating - they may need protective equipment to pv repeat fractures - Most commonly distal forearm & hand from falling
What is metabolic acidosis? What is the cause of Metabolic Acidosis? What are some interventions for Metabolic Acidosis?
- Accumulation of excess H+ ions/metabolic acids, not carbonic acids, not respiratory-related, or loss of HCO3 CAUSES: - Salicylate Intoxication = Ingesting an excessive amount of aspirin (salicylic acid) - Hypoxia, shock, sepsis -> lactic acid build-up, basically, you are in a situation where you aren't getting enough perfusion to your tissues and causes the cells to work with anaerobic metabolism instead of aerobic metabolism producing a by-product called lactic acid - DKA -> ketoacidosis or starvation, there's no insulin to deliver the glucose to the cells, cellular starvation cause fat to break down and produces the fatty acid called ketones - Bicarbonate (base) loss: > Renal failure - the kidney makes and reabsorbs bicarbonate, if this process malfunctions the bicarbonate is not around as much or you can't excrete bicarbonate causing a build-up > Stool - contains bile, bilirubin, and bicarbonate so a diarrhea episode can cause a massive loss of bicarbonate INTERVENTIONS: - tx the cause - Oxygen + fluids especially for the shock pt to reestablish perfusion - Fluids helps the pt get of anaerobic metabolism and back to aerobic metabolism - Monitor e+lytes (K) - If the K+ levels are too high -> dialysis - Sodium Bicarb - for the renal failure pt bc they are having an issue w/ making & reabsorbing the bicarb & letting go of acid, giving sodium bicarb via IV is the last resort tx as in something like a code they probably were in cardiac/respiratory arrest (anaerobic metabolism), not a first-line drug for fixing metabolic acidosis bc there's a high risk making the patient alkalotic - Dialysis - gives bicarbonate as part of the tx - Antidiarrheal meds (stop bicarb loss) bc bicarb is in your stool, slow down peristalsis - Diuretics (⬆ H+ loss) - i.e. Loop diuretic or a thiazide diuretic NOT a spiralolactone or K+ sparring, not for the shock patient s/s: - Hyperkalemia (rare in respiratory acidosis) - Dysrhythmias (vfib, PVCs) - Confusion
What is hydrocephalus? How does it manifest? How do you manage hydrocephalus?
- Accumulation off CSF in the ventricles of the brain - Health history & risk factors Identify early! - Can be congenital or acquired - Prognosis depends on the cause and damage - Symptoms: ▪ Increased head circumference ▪ Increased ICP ▪ Developmental delay ▪ Separation of the sutures - CT or MRI - Nursing management ▪ ***Maintain cerebral perfusion*** -> Assess VS & neuro status -> Promptly identify shunt problems!!! VP (ventroperitoneal space) - more common, VA (Ventroarterio) - increased r/f infection -> Manage external ventricular device (EVD) -> Shunt has to be replaced for size, blockage, malfx, infection (happens commonly during the 1st 2 mos) ▪ Minimize shunt complications -> Infection - local inflammation, decreased LOC, warmth at the site, fever, vomiting, poor feeding -> Malfunction - no drainage - ICP s/s ▪ Promote growth and development ▪ Educate child and family - s/s of infection or ICP
What are some renal surgery complications?
- Acute Tubular Necrosis (ATN) Delay in transplanting organ Need dialysis until UO ↑ and ↓ BUN & ↓ creatinine may need 2 - 3 wks to fx properly after transplantation - Thrombosis of renal vessel → emergent surgery First 48-72 hours post op Impaired perfusion → sudden ↓ UO
How is heart failure managed by the nurse in a child?
- Adequate nutrition -> small frequent meals -> increased calories - Provide oxygen - Improve cardiac output/ heart fx -> Digoxin (IV): helps strengthen the heart & increases contractility, slows the heart and helps the heart beat at a more regular rate -> Furosemide (IV) Lasix: Removes excess fluid to decrease the workload of the heart -->> Daily weights and monitor electrolytes - Promote rest - Transition meds from IV to PO when the pt becomes less systematic
What are the interventions a nurse should implement for a pt w/ hypervolemia?
- Administer diuretics as prescribed - Fluid restrictions - Monitor vital signs, lung sounds, & labs - Daily weights (same way/ same clothes) - low sodium diet
What are some risk factors for developing a VTE that may lead to PE?
- Age = veins become insufficient, less elastic - Prior hx of DVT - Surgical and invasive procedures e.g. hip and knee surgery - Coagulation abnormalities = hypercoaguability - Oral contraceptives due increased estrogen - Pregnancy due to ↑ blood volume, ↑ weight, ↑ pressure on the vessels - Heart failure = poor cardiac output - Obesity increases the pressure on the vessels - Immobility = stasis, ↓ circulation - Trauma caused impaired integrity of vessels - Autoimmune disorders - Sepsis caused by pelvic abscess, infected IV catheter, illegal drug injections - Advanced neoplasms - cancer which can also lead to hypercoaguability
What is the difference b/t agonist and antagonist?
- Agonist = *mimics* what the body would do = high affinity (high attraction to receptor), high intrinsic activity (illicits a response after binding) - Antagonist = *blocks* the actions of the endogenous regulators, e.g. narcan = affinity (high attraction to receptor), low intrinsic activity (does NOT illicit a response post binding)
What is involved when preparing to move the body to the morgue?
- All physicians notified - Funeral home release - Body placed in shroud - ID band on wrist & toe tag in place - Zipper closes at foot - ID sticker or tag on bag or zipper
How are ABG blood sample obtained?
- An arterial blood sample taken from generally the brachial area. They feel for the brachial pulse and go straight down into the arterial vessel. - Respiratory Therapy does it - Results come back in about 15 mins - The reading tells us pH, PaCO2, HCO3, PaO2 - PaO2 is not needed for ABG interpretation, tells oxygenation status systemic throughout your body, not the same as pulse ox which measures Hgb saturation in that one area
What are some interventions for orthostatic hypotension?
- Anti-embolism socks (when pts are immobile blood will pool in the legs) - mobilize pts ASAP - Raise bed to Fowler's position, before ambulatory pts have them sit up for 5 minutes first before movement - dangle legs over the side of the bed - increase fluids = loosens/breaks up secretions - stretch and flex calf muscles - squeeze buttock muscles - Watch the pt for S/S of orthostatic hypotension - assist client to stand = ambulated pt with assistance
What types of meds are admin to pts w/ cerebral palsy?
- Anticonvulsants - seizures - Benzodiazepines - decrease spasticity - Baclofen - for severe spasticity, skeletal muscle relaxant - Anticholinergics - abn movement, pv drooling - Botulin toxin - block neuromuscular conduction, decrease spasticity
What are some different chemotherapy drug categories?
- Antimetabolites > fake metabolites > impaired cellular division - Antitumor antibiotics > cause cell damage - Alkylating Agents > messed up cellular DNA by making the CA DNA stick realy close 2gether - Topoisomerase Inhibitors > disrupt enzyme fx > DNA damage > cell death - Misc. agents - Combo drugs > high success rate + high SEs
What does a nurse check for during an environmental assessment or beginning procedures?
- Are the appropriate number of side rails up? i.e. if all 4 side rails are up = restraint, use only 2 siderails - Bed in lowest setting. i.e. safety first - Call light/phone/remote/bedside table within reach. ex: minimize fall risk - Make sure water is available - Clear clutter, watch out for wires - Assess for client comfort i.e. do they have enough blankets, do they need socks, heated blankets - Privacy ex: close curtains, close doors
What is epilepsy? How do you diagnosis a patient w/ epilepsy? What do you find during a physical exam of a patient w/ epilepsy?
- Areas of the brain that are firing abnormally - Certain features give us an idea of what area is involved - Epilepsy Dx: 2 or more unprovoked seizures occuring > 24 hrs apart - Types: Partial or Generalized or unknown cause - Some partial seizures are more subtle like staring episodes or twitching or drooling - Generalized - sudden loss of consciousness + loss of muscle tone - Ax: ▪ Known or unknown seizure UNKNOWN ▪ Basic hx - how long did the seizure last? what was the child doing? movement types ▪ Rule out other causes ▪ Check for risk factors, family hx, signs of infection, any recent trauma, hx of dvlpmtal delays KNOWN ▪ Age of onset ▪ Seizures meds that work or haven't worked ▪ Seizure classification ▪ Frequency ▪ Aura occurs - that let's them know a seizure is coming on ▪ Meds compliance ▪ Postictal state - tired, wiped out, may not remember the event, sleepy, drowsy - Dx: ▪ e+lytes ▪ Glucose levels ▪ EEG right away - to determine type of seizure ▪ May be hooked up to telemetry
How do we diagnose the patient ulcers?
- Assessment (PPQQRSTU) - physical assessment - labs [H&H, WBC, hemoccult (for stool), electrolytes for weight loss or haven't eaten much] - EGD = upper endoscopy to see the lining of stomach. Allows for direct visualization of site and see gastric analysis. They can biopsy and do tests while they are in there **may have order for GAS X, or Tums** AVOID: SPICY , CAFFEINE AND ALCOHOL GOAL: ADDRESS PAIN AND DECREASE THE AMOUNT OF ACID BEING PRODUCED, AND GIVE MEDS TO RELIEVE SYMPTOMS
What is meningitis? How do you assess for meningeal irritation? What would you find in the CSF of a meningitis patient? How would you manage bacterial meningitis? What is aseptic meningitis? How do you manage aseptic meningitis?
- Ax: ▪ Health history and risk factors - sudden onset of fever, photophobia, HA, irritability, neck pain, w/ infant poor sucking or high pitch cry ▪ Medical emergency! ▪ Neuro changes ▪ Nuchal rigidity - how to test it - stiff neck ▪ Petechial rash - pv by MCV4, can kill in 24 hrs, no blanching, can lose limbs, virulent type ▪ LP, CBC, blood & urine cultures ▪ CSF pressure increased w/ increased proteins and WBCs increased & glucose decreased due to BBB damage & bacteria feeding on glucose ▪ Bacterial vs Aseptic (viral) - similar appearances, bacterial looks worse ▪ Meningeal irritation - Brudzinski sign - lift head knees jerk up from pain, Kernig's sign - bend knee to 90 degrees + bend leg at hip - they try to stretch their leg out ▪ At risk for stroke, brain damage, tetanus, loss of limbs ▪ Vaccines decrease meningitis incidence (11 -12 y/o)- HiB, PCV13, MCV4 - Management (bacterial meningitis): Antibiotics ASAP for at least 3 days ▪ ***Maintain cerebral perfusion -> Frequent neuro assessment -> Reduce ICP - elevate HOB, burr holes, -> Quiet environment -> Reduce fever & pain ▪ Prevent injury from seizures ▪ Prevention -> Droplet precautions -> Post-exposure prophylaxis -> Vaccination ▪ Corticosteroids to decrease inflammation of the meninges - Ax (aseptic meningitis): ▪ Most common type of meningitis, better prognosis ▪ Caused by virus - self-limiting ▪ Once cultures come back and it's viral d/c antibiotics Child usually less ill ▪ Majority < 5 years of age - Nursing management ▪ Aggressive treatment to start ▪ Droplet precautions until identified ▪ Supportive care
How do implement continuing and restorative care for pts w/ problems with bowel elimination?
- BM schedule - diet - fluids, fiber - exercise - manage hemorrhoids - maintain skin integrity
What are normal and abnormal BP, P, & R findings?
- BP: 120/80 - P: Normal = 60 -100 bpm, regular rhythm Abnormal = <60 bradycardia, >100 tachycardia w/ regularly irregular or irregularly irregular rhythm = dysrhythmias - R: 12 - 20 per min.
What are some surgical considerations to have w/diabetic pts?
- BS should be monitored frequently - use sliding scale insulin while NPO - hang D10W post op due to NPO b4 surgery - schedule surgeries early - regular food/insulin schedule b4 surgery - long acting > intermediate acting insulin (1- 2 days b4 surgery) - IV w/ dextrose b4 surgery - check BS during long surgeries - continue IV after surgery
When should you perform hand hygiene?
- Before and after patient contact - Before and after contact with pt environment - Before and after procedures - After body fluid exposure - Before and after gloving
What is Metabolic Alkalosis? What are some treatments for Metabolic Alkalosis?
- Bicarb excess caused by too much oral/IV sodium bicarbonate or loss of excess acid CAUSES: - Ingesting too much bicarbonate or antacids, i.e. TUMS - Admin of excessive sodium bicarb - Loss of hydrochloric acid from the stomach, i.e. vomiting, NG tube can remove too much acid, you can avoid this by leaving the NGT but reduce/stop the acid production so it doesn't get sucked out in the first place by admin Proton Pump Inhibitor (PPI) or H2 antagonist, NGT can cause hypokalemic - Diuretic therapy (H+ ion loss) - i.e. loop or thiazide diuretics, overprescribing it TREATMENT: - tx the underlying cause - Stop bicarb ingestion/admin - Stop loop or thiazide diuretic, monitor fluids & e+lytes - Admin antiemetic - Fluid & e+lyte replacement s/s: - Hypokalemia (High H+ ions inside the cells draws K+ inside the cell causing low K+ in the blood) - Anxiety or irritability - Dizziness (hypotension) - Mental confusion - Numbness & Tingling (toes & fingers) - Muscle twitching - Tetany & seizures *Check e+lyte check for low Ca2+ bc hypocalcemia can cause this same s/s
What is bilirubin & a neonates high r/f jaundice?
- Bilirubin is a byproduct of RBC hemolysis - Bilirubin has 2 forms: > unconjugated & conjugated Unconjugated: fat soluble, toxic to body tissues, unable to be excreted - ⬆ eating+drinking = ⬆ excretion Conjugated: transformed by liver, water soluble, non-toxic, excreted in urine & stool NB is @ high r/f jaundice: > Immature liver unable to keep up with bilirubin production > Fetal RBCs - shorter lifespan → faster break-down > Delay in meconium excretion through bowel ⬆ prematurity = shorter RBC lifespan + ⬆ liver immaturity
How would a hypoglycemic neonate manifest?
- Blood glucose level <40 mg/dL - 40+ = good * hypoglycemia + hypothermia = married Risk factors: maternal DM, prematurity, inadequate calorie intake, sepsis, asphyxia, hypothermia Assessment: -Listlessness/lethargy - Weak cry, poor feeding - Tremors, irritability - Apnea - Cyanosis - HYPOTHERMIA! Sometimes the way we notice the HR dipping > ⬇ temp
What is a pulmonary contusion? Clinical manifestations?
- Bruising of the pulmonary vascular system/ parenchyma - associated w/ flail chest - Sometimes deadly - vary
What is the difference between bulk-forming, emollient, osmotic, and stimulant laxatives and cathartics?
- Bulk-forming - absorbs liquid and swell, can work for both diarrhea and constipation, not habit-forming •Psyllium, methylcellulose - Emollient - *detergents* that soften stool •Docusate sodium - Osmotic - draw water into the stool •Saline, magnesium citrate, polyethylene glycol - Stimulant = cathartic increases intestinal motility •Bisacodyl, castor oil, casanthranol
What is malignant lymphomas?
- CA of the lymphocytes - solid tumors in lymphoid tissue - painless unless severe case
What labs & dx testing is typical with cardiac conditions?
- CBC, Blood gas - RBC count - ECG - Chest X-Ray - Echocardiography - not invasive or painful - Cardiac CATH
What are some variations in peds neuro A&P?
- CNS = brain + spinal cord when dvlping it is all one tube & starts dvlping at 3 - 4 wks gestation - Neural tube splits into the brain & spinal column - Things that can alter dvlpmt = fetal infections, teratogen exposure, trauma, perinatal asphyxia - Premature infants have more fragile capillaries in the brain & puts them at risk for intraventricular hemorrhage > r/f neurologic deficits - Immaturity of the CNS leads to delayed motor skill, difficulty coordinating sucking & swallowing, periods of apnea, can't regulate their temp. - Cranial borns are unfused in NBs for an easier birthing process and brain growth - Cervical spine is very mobile = increased r/f injury, e.g. shaken baby syndrome - Increased injury r/t motor vehicle accidents - Dvlpmtal milestones r/t dvlpmt of CNS this process is called MYELINIZATION = increases the speed and accuracy of nerve impulses, this makes dvlpmtal milestones happen in a predictable pattern, complete @ 2 -3 yrs - All nerve cells are present at birth but the connectivity is not there at birth - Head is the fastest-growing part of the body, 1/4 of the body size of infants unlike adults which 1/8 the size of their body
What are some s/s of hyponatremia?
- CNS changes (seen commonly in elderly, they come in with confusion due to low Na+ levels) - seizures - coma - death - muscle weakness - increased GI motility which leads to cramping, diarrhea, nausea - changes in cardiac output
What will be included in the assessment of a pt with an indwelling catheter?
- COCA - assess the pt's urethral meatus and catheter - Is the pt experiencing fever, chills, burning, flank, back pain, hematouria, change in mental status? - assess the pt's knowledge for catheter care
What is a pnemothorax? s/s? (simple pnemo)
- Can be diagnosed w/ CXR, graded using percentages Words that can describe your hair: - spontaneous - absence of trauma > pts w/ blebs = extra air released/ruptured into pleural space > common w/ emphysema pts - chest injury related - open > chest wall is open to atmospheric air due to a stabbing/penetration of the chest wall/ GSW, there's air going in and out of the chest wall, the trachea shifts toward the pneumo due inconsistent pressure (e.g. car with an open window, spaceship w/ open door), the skin acts as an one-way valve - closed > chest wall is not open to atmospheric air and the trachea shifts away from the pneumothorax - small/slow dvlping > asymptomatic (5 - 10%) - large/rapid dvlping > pleuritic pain, tachypnea, ⬆ restlessness = classic signs of respiratory distress - Major s/s: > NO chest moving on pneumo side > Subq emphysema = crepitus > air trapped under skin > issue when issue gets worse > ⬇ BS
What is club foot? How do you treat it?
- Can be found neuromuscular dz or healthy babies - Unilateral or bilateral - Can be really dramatic especially if found on both feet - Caused by tightening of ligaments - Tx: serial casting - manipulated & recasted q2wks or surgery (partial bone removal, achilles tendon lengthening, tendon transfers, may need multiple surgeries or placement or plates & screws) - Goal = fxnal foot, tx don't always make it 100% - Same cast care education
What is continuous renal replace therapy (CRRT)?
- Can run 12 - 24 hrs depends on HCP - Temporary measure for circulatory overload & uremia - For AKI pts or pts w/ no access from previous dialysis tx, so a temporary cath would be placed - Clotting is complication - Fluids would be given - Flushing required, may use citrate, saline, or heparin dpendds on the hospital Advantages Better tolerated for critically ill patients Avoids rapid shift of fluid & electrolytes with hemodialysis - Requires ICU care - Once patient stabilized → long term dialysis or kidney function may return
What is included in discharge planning - education after birth?
- Car seat & crib - sizing, they should tolerate it w/out desaturating - Never leave unattended on bed or sofa (may fall) - no loose sheets - Choking hazards, toys from other siblings - Hot bath water - r/f burning - Co-sleeping - r/f asphixiation - Sleep up to 15-20 hrs/day - Sleep on back, no pillows or fluffy animals, pv SIDS - No bottles in crib - Cord care & bathing - Diaper changes - Feeding (breast or bottle) - How and when to introduce solid foods - Elimination patterns - Frequency & schedule of pediatric visits - Immunization schedule - Recognize signs of illness - How to take temperatures - When to call the Healthcare Provider (fever >100.4°F or 38°C) - high or low can indicate sepsis
What is Respiratory Alkalosis? What are the causes of Respiratory Alkalosis? What are some interventions for Respiratory Alkalosis? What are the s/s associated with Alkalosis (Metabolic/Respiratory)?
- Carbonic acid is being let go too fast by blowing off too much CO2 via hyperventilation or alveoli gas exchange CAUSES: - Fever - Pain - Anxiety INTERVENTIONS: - tx underlying cause ANXIETY - Relaxation techniques - Antianxiety meds - Brown paper bag - reabsorbing CO2 PAIN - opioids - can cause respiratory depression -> acidosis FEVER - high metabolism from using a lot of O2 and the by-product is CO2 and the release CO2 cause alkalotic - Antipyretic - i.e. Tylenol Goal - retain CO2 s/s: - Hypokalemia (High H+ ions inside the cells draws K+ inside the cell causing low K+ in the blood) - Anxiety or irritability - Dizziness (hypotension) - Mental confusion - Numbness & Tingling (toes & fingers) - Muscle twitching - Tetany & seizures *Check e+lyte check for low Ca2+ bc hypocalcemia can cause this same s/s
What factors influence cancer dvlpmt?
- Carcinogens - Genetics - Immunity - pv dvlpmt of non-self cells, dvlp NK cells + T cells - Advancing age - due to reduced immunity
What are the guidelines for measuring vital signs?
- Check for appropriate size and functionality of equipment - Know when to delegate - only delegate if the pt is stable, *it is the nurse's responsibility to analyze+interpret vitals to determine appropriate interventions if necessary* - Know how to tell abnormal values from normal values - Know the pt's baseline - ex: a COPD pt is normally hypoxic so they won't have a high oxygen sat - Know the pt's med. history, Tx, Rx meds - review the chart - some conditions cause predictable changes in vital signs - Minimize impacting factors in the environment - Be organized, cluster your care, use a system - Communicate significant findings - ask another nurse to repeat the measurements + report changes to nurses during hand- off communication - Use the vital sign findings if they indicate further interventions like med admin. - Document and analyze findings - Pt. education
What are some important implications for the care of skin?
- Check for wrinkled sheets to prevent tearing/ shearing, use a draw sheet - Assess for flaky skin due to nutritional deficiencies - Check for rubbing/irritiation from machinery - Keep mositurized to prevent crack and breaks in the skin, use emolients - Too much moisture can promote the formation of ulcers, so keep sheets dry - Too much perspiration and oil harbor microorganisms
How are families educated regarding cystic fibrosis patients?
- Chest physiotherapy and postural drainage - Proper caloric intake and diet - Correct used and cleaning of equipment - at least weekly - Early signs of infection, complications - When to seek medical care
What are some examples of equipment used for asthma meds delivery?
- Children get much better delivery/release of med when using a spacer - Using a Nebulizer to Delivery the Medication -> Nebulizer uses a machine that makes a mist of medicine to breathe in through face mask or mouthpiece - your childs dr/nurse will tell you how much to put in -> For best results when using one with a facemask follow these steps: --->>> Wash hands thoroughly --->>> Place face mask on nebulizer container --->>> Attached one end of tubing to the bottom of nebulizer container --->>> Attach other end to the nebulizer machine --->>> Open plastic vile of medicine and pour into nebulizer container --->>> Put on face mask covering nose and mouth - machine on flat, steady surface --->>> Take slow deep breaths with mask on, treatment takes 6-10min --->>> You'll know its complete when sounds changes to sputtering noise --->>> Wipe face, and rinse mouth out and don't swallow the water - Metered Dose Inhaler (MDI) Without the Use of a Spacer -> Patient stands or sits as straight as possible -> Take cap off, shake it 6-10 times -> Hold head in neutral position or tilt back slightly -> Exhale out all the way to empty the lungs -> Place inhaler between teeth, over the tongue, with lips sealed tightly around mouthpiece -> Aim inhaler at the back of the throat -> Patient begins to inhale slowly while firing/pressing down on canister once -> Firing should occur immediately after inhaling begins -> Keep drawing air through month until breathing in stops -> Keep inhaler in mouth throughout inhalation -> Hold breath and count slowly to 10 -> Release breath slowly, relax and breath normal - How to Use an MDI with a Spacer -> Shake the inhaler for 10 seconds -> Take cap off inhaler and attach to spacer -> Sit up straight, place mask over nose and mouth, press down on inhaler --->>> This puts medicine in spacer -> Breathe in and out 5-10 times -> If you need another puff of medicine, wait a minute and repeat process
What is asthma?
- Chronic, reversible inflammatory airway disorder -> Leading cause of chronic illness in children, often underdiagnosed or undertreated - Airway is hyper-reactive to triggers (like pollen, or their specific allergy) - Obstruction (bronchoconstriction) -> Swelling that causes decreased area for air flow
How are peritoneal dialysis pts selected and what is contraindicated for PD?
- Client selection Cannot tolerate anticoagulation Vascular access problem Used until fistula matures Treatment of choice Flexibility with frequent status change Can complete in home or hospital - Contraindications Peritoneal adhesions or membrane fibrosis Extensive abdominal surgeries
When is it sinusitis instead of a cold?
- Cold symptoms not improving after 7-10 days - New onset fever and/or cough - Halitosis - bad breath - Eyelid edema Facial pain may be present but is a poor indicator Would have antibiotics but also would continue symptomatic treatment from cold
What does ABG compensation mean? What does it mean for patient w/ metabolic acidosis, respiratory acidosis, metabolic acidosis, respiratory alkalosis?
- Compensation - moving the pH back to the normal range of 7.35 - 7.45 - Compensate = assist lungs will compensate for imbalances caused by metabolic issues & kidneys will compensate for imbalances caused by respiratory issues METABOLIC ACIDOSIS - pH = < 7.35 (⬆ H+, high acid like lactic acid) + low base (HCO3) RESPIRATORY compensation = ⬆ rate & depth of respirations -> Kussmal's respiration = rapid, deep respirations that blow off CO2 RESPIRATORY ACIDOSIS - pH = < 7.35 + high PCO2 - (High H+, Carbonic acid, High CO2) METABOLIC compensation = kidneys produce more bicarbonate or reabsorbs it METABOLIC ALKALOSIS - pH = > 7.45 + high base (HCO3) RESPIRATORY compensation = retain CO2 by ⬇ respiration rate and depth RESPIRATORY ALKALOSIS - pH = > 7.45 + low PCO2 (low H+ ions, low carbonic acid, low CO2) METABOLIC compensation = kidneys excrete bicarbonate via urine - If the pH is norm but < 7.4 then the original problem was acidotic - If the pH is norm but > 7.4 then the original problem was alkalotic
If you were a pharmaceutical manufacturer, in order to reduce med errors would you make all your packaging more consistent or make sure that the names you pick out for meds didn't sound alike?
- Consistent packaging causes more errors, therefore, you should make the names you choose for your meds sound different and use tall man lettering to prevent a med error
What is included as routine NICU care?
- Continuous cardiac and respiratory monitoring - Neutral thermal environment (NTE) - isolettes - Low stimulation - cluster care "feed & grow", q6hours for care - Fluid management, I&O, daily weights - Nutritional support; glucose level maintenance - Infection prevention - Handwashing - Screening visitors - Prone position (increases resp, decreases stress) - Parental education and participation in care
How would a tension pneumothorax be treated?
- Cover chest wall deficit w/ nonporous dressing - chest tube in the 4th intercoastal space/ in the field large-bore needle inserted in the 2nd intercostal space midclavicular line to release pressure - semi fowler's = 30 - 45 degrees - O2 - VS - ❤ abn rhythms - palpate for subq emphysema/crepitus - ventilation
How can food affect drug absorption and metabolism?
- Dairy/fiber can DECREASE absorption ("the gut", the stomach, the GI tract) - Prescence of food can INCREASE absorption Metabolism happens in the liver e.g. statins, BP meds, and grapefruit can block the breaking down of drugs and lead to a high concentration of drug in the blood and lead to toxicity
Why are corticosteroids used for "rescue" situations?
- Decrease inflammation to treat obstruction - Lowest dose to avoid side effects - prednisolone -> Given orally - methylprednisolone sodium -> Given IV for hospitalized patients - Patients who get oral steroids in a drs office will get a dose and then need to come back in 24hrs to see if they are better, often are - Dosing is 1-2mg/kg/day divided q 12 hours - max per day 60mg
What are the causes of hypernatremia?
- Dehydration - Diuretic therapy (I.e. meds that increase excretion)
What are the causes of hypernatremia?
- Dehydration - Diuretic therapy (I.e. meds that increase excretion) - kidney failure
How would a small for gestational age (SGA) baby look upon assessment?
- Disproportionately large head - Thin extremities and trunk - Reduced subcutaneous fat stores - Thin umbilical cord (less blood flow, less nutrients) - Loose, dry skin
What are the core measures for warfarin pt education?
- Document that written ed on dosing of warfarin i.e. pamphlets, leaflets - Written ed on dietary restrictions including sample menus - Written ed on frequency of PT/INR lab draws & which HCP will monitor their results - Demonstrate an overlap of heparin or enoxaparin (Lovenox) tx along w/ warfarin until INR is w/in tx range
What are the labs that can be caused by renal failure?
- ESRD - high Mg - low Ca - high K - high BUN - high creatinine "kidneys fx in the excretion of Mg and K" = high Mg + K
What are some special considerations with oral hygiene?
- Even unconscious pts need oral care bc they cannot swallow when secretions accumulate in their mouth it can lead to aspiration, pneumonia - Increased risk for infection, the nurse shouldn't put their fingers in the pt's mouth - Talk to the pt when providing them with oral care - Watch out for signs of xerostomia (dry mouth), Oral infections, ans stomatitis (inflammation =/ redness of the mouth and the lips) - Lubricate the lips with a water soluble lubricant
What are some causes of hyponatremia?
- Excess body water - ❤️ failure - inadequate intake - dilutional fluid overload
How is diabetes diagnosed?
- Fasting Plasma Blood Glucose (FBG) test - done as part of an annual exam - Random/ Casual Plasma Glucose test - done when pt comes in w/ s/s, > 200 = positive for diabetes - OGTT = oral glucose tolerance test - the pt drinks a syrupy drink before test, > 180 positive for diabetes - Islet Cell Antibodies (ICAs) - looks for beta cell damage as seen with Type 1 diabetics - Hemoglobin A1c - blood glucose over the past 200 days/ trend over the past 3 mos - Early screening = pv of full-blown diabetes > glycosylated hemoglobin > glycated hemoglobin NV: 4 - 6% Pred-diabetic = 6%+ Diabetic Goal <7% - Screen for ppl who are over 45 + overweight OR under 45 + overweight + other r/factors
What is developmental dysplasia of the hip? What are the risk factors? What are the complications? What do you find in the physical exam of a patient with this condition? How do you manage this condition?
- Females > Males - Can be unilateral or bilateral - They head of femur doesn't fit in the acetabulum - Happens more in native americans - Can happen w/ other congenital issues - Screening - find early the least invasive the procedure - Complications: ▪ Necrosis of the femoral head ▪ Loss of ROM ▪ Femoral nerve palsy ▪ Leg length discrepancy ▪ Early osteoarthritis - Physical exam: ▪ Asymmetry of the thigh fold ▪ Unequal knee heights ▪ Limited hip abduction ▪ Trendelenburg gait - pelvis drops when they lift their leg - Test: ▪ Barlow - thigh adduction, outward pressure on the femoral head causing it to be dislocated ▪ Ortolani - flex knees and abducted hips, relocate femoral head back into the acetabulum ▪ US of hip -Tx: ▪ Early ID ▪ Postioning - similar to spica cast ▪ Pavlik harness - consistent use 23 ot of 24 hrs for 3 mos, used for kids <6mos old -> Edcuate about how to apply and remove -> No skin breakdown or redness -> Should be underneath the clothing -> No thick clothes ▪ Older than 6 mos - spica cast for 12 weeks, close reduction plus brace for 2 months ▪ May need skin or skeletal traction first ▪ Older than 2 yrs - open reduction and casting = surgery
What is pathologic jaundice - hemolytic disease of the newborn (HDN)?
- First 24 hours Rh incompatibility (Isoimmunization): -> Mother is Rh - & baby is Rh + -> Mother's anti-Rh antibodies (initially IgM) do not cross placenta - repeat encounter will produce IgG antibodies that do cross -> Effects subsequent pregnancies ABO incompatibility: -> Mother is type O & baby is A, B, or AB -> Mother's anti-A & anti-B antibodies (IgG) attack baby's RBCs by crossing placenta -> Less serious rxn -> Can happen in 1st baby -> Doesn't get more severe in subsequent pregnancies
What is OME?
- Fluid produced during ear infection, doesn't go away - They don't have fever or pain, but may have feeling of fullness in ear and muffled sound - Older child could tell you they can't hear as well - Since many ear infections occur during 12-36 months period (when learning to talk) they need to be able to hear to successfully do so, if fluid remains for > 3 months or failed hearing test, may need tube to keep effusion drained -> Doesn't decrease ear infections, just drains fluid so they can hear
What are the characteristics of a gastric ulcer?
- Gastric ulcer usually in body of the stomach - may have normal gastric secretion or hypogastric secretion - delayed gastric emptying because of pyloric sphincter dysfunction and gastric contents can be in there too long - H Pylori bacteria - increased rate of gastric secretion - incompetent pyloric sphincter and expose mucosal tissue - pain (usually 30-60 mins after meals and can be relieved with food) - vomiting blood is common = hematemesis
What is cystic fibrosis genetically?
- Gene mutation causes dysfunction of the exocrine glands or pt has allele from both parents -> Exocrine glands secrete products into ducts compared to endocrine glands which secrete into the bloodstream and affect a distant organ -> Some of the exocrine glands: salivary mammary, pancreatic, and bile - Chloride transport across cells is interrupted so water transport abnormalities occur -> Water follows chloride (and sodium) --->>> Results in drier, thick "secretions in sweat glands, GI tract, pancreas, respiratory tract and other exocrine tissues." (Ricci) -> Difficult for the body to clear secretions -> High levels of chloride in sweat causes salty taste
What are the systemic effects of immobility?
- Glucose intolerance > high blood glucose - decreased calcium absorption > bone breakdown (osteoporosis) - decreased peristalsis > fecal impaction/ constipation - muscle breakdown > negative nitrogen balance > fatigue - atelectasis (collapsed alveoli) - pts can 't expand their lungs as often > can't move secretions out of their respiratory track > secretions can end up in their lungs > hyperstatic pneumonia - decreased metabolic activity, metabolize protein in the muscles - orthostatic hypotension, decreased cardiac output, blood clots due to reduced circulation, ischemia > necrosis, tachycardia - urine can stay in the pelvic area and lead to renal calculus aka kidney stones - urinary retention > infection - pressure ulcers - psychosocial issues - depression, anxiety
What does an excellent prep consist of?
- Greater than 90% of the mucosa is visualized - Stool is liquid - Minimal suctioning is needed
What are some different types of fractures?
- Greenstick - happens in kids due to incomplete calcification of bones leading to bending - Buckle - compression type of injury - Complete - 2 distinct pieces, sometimes can be open fracture - Bowing deformity - can't see the line like with greenstick, so there's a bend but no break, microscopic fractures - Bucket handle fractures - red flag for child abuse - Usually only need to be put in a cast for immobilization & comfort for 2 - 3 wks - May need open reduction & internal fixation, plates, screws to help with the more complicated fractures - Open fracture may need antibiotics, tetanus shot - Suspicious if fractures are found in infants bc they are doing a lot - Spiral fractures implies a twisting motion w/ a lot of pressure to femur or humerus = Suspicious - Most common fracture in kids is types 2 where the metaphysis & physis are injured - Type 5 - crush injuries very rare - Salter - Harris = classification of injuries to the growth plate - Complications, avascular necrosis, infection, bone shortening, fat embolism, osteoarthritis, compartment syndrome
What are the characteristics of a duodenal ulcer?
- H Pylori bacteria - rapid rate of gastric emptying (can be because sphincter is incompetent) - pain is usually epigastric (90 mins -3 hours after meals-sometimes wakes up at night—eating food usually helps food goes away)
What is hydrogel and when should it be used?
- H2O, used to provide a moist environment - lasts 3 -4 days, it helps cells to grow - only for clean & open wound beds - NOT for infected wounds - used for ulcers
What are some s/s of HTN?
- HA - Dizziness - Vertigo - Syncope - Blurred Vision - Flushed face - papilledema
What is HCO3 and how does it r/t the metabolic system & pH?
- HCO3 - bicarbonate aka bicarb is a BASE, it's basic can make us alkaline *B for Base - NV 22 - 26 mm Hg > 26 mm Hg = alkalosis, too much base < 22 mm Hg = acidosis, loss of base
What is included in a urinary assessment?
- HPI - assess their hydration status - do they have flank pain? - palpate bladder for distension - assess the urinary meatus - COCA for urine - Urinanalysis - Urine C&S - KUB - kidney, ureter, bladder - CT - IVP - ultrasound - cystoscopy
What is the hematopoietic stem cell transplantation?
- HSCT - aka bone marrow transplantation (BMT) - standard tx for leukemia, lymphoma, multiple myeloma, aplastic anemia, sickle cell dz - bone marrow = source of leukemic cells Criteria: - closely matched donor - temp remission after induction tx - marrow is cleaned or conditioned 1st - new cells implanted > hematopoiesis > cure - failure to graft = failure of implant cells to grow - GVFHD = donor cells are rejected - Veno-occlusive = blood vessels in the liver are blocked from clots, up to 30 days after transplant
What is spastic cerebral palsy? How do nurses manage cerebral palsy?
- Health history (risk factors & birth history) - uterine infection, trauma, multiple births, respiratory issues - Symptoms: ▪ Poor feeding, decreased growth patterns ▪ Seizures ▪ Vision and hearing deficits ▪ Delayed development ▪ Persistent primitive reflexes ▪ Spasticity, hypertonicity ▪ Cognitive disabilities - Metabolic or genetic testing - US/MRI of the brain - Determine degree of involvement - Management: ▪ Manage medications ▪ Promote mobility -> Orthotics and braces -> Wheelchair use -> Skincare - pv breakdown/redness ▪ Promote nutrition -> Special diet, upright positioning -> G-tube for weight management, aspiration issues -> Increased caloric needs -> Speech therapist - Track weight gain & I&Os - Strain on finances ▪ Prevent contractures - early intervetion ▪ Provide support/education
What do we assess in children w/ musculoskeletal disorders?
- Health hx ▪ birth trauma - shoulders, clavicles, were they breech? ▪ Milestones - what age did they perform certain milestones? subtract for how premature they were? ▪ Hx of prematurity - issues at birth, episodes asphyxia, posturing ▪ Acute injuries for older kids - sports, what were they doing? muscle weakness, decreased muscle tone, redness, limping - DX: ▪ Sed rate ▪ CRP ▪ Imaging: x-ray, for soft tissue & ligaments CT or MRI
What is a capsule endoscopy? What does it do?
- Helps us visualize the small intestine that standard scopes can't reach for diagnosing unexplained bleeding or other abnormalities. (Can see stomach, colon, small intestine, rectum) - It's 1.2 inches long - The patient fasts prior to swallowing the capsule - They swallow the capsule and it takes pictures while it's passing. It transmits signals, and once it goes throughout the digestive system, its not reusable, and it comes out the rectum. (Wireless record on waist) (mini video camera) - Takes about 8 hours - Part of jejunum and ileum not visible. - Advantages: painless, no sedation, provides 3D color images of small intestine without surgery, allows doctors to make early accurate diagnosis of problems so they can recommend most appropriate tx. Pre procedure: bowel prep, NPO After procedure: can start clear liquids (see HCP first)
What are some adverse rxns of heparin?
- Hemorrhage (serious bleeding) - HIT (due to the higher molecular, heparin has a higher r/f HIT than Lovenox)
How are steroids + hormone theraphy, and weight loss used to treat CA?
- Hormonal therapy = ↑ r/f clotting + blood clot formation - ⬇ hormonal growth stimulation - not a cure, can slow the growth, ⬆ survival time - SEs feminine s/s in men and masculinizing in women
What is an example of intermediate-acting insulin? What is it used for? Nursing Implications?
- Humulin N · Onset = 1 to 3 hours · Peak = 8 hours · Duration = 12 to 16 hours · Cloudy in color · administered SQ · agitated before administration
What is an example of short-acting insulin? What is it used for? Nursing Implications?
- Humulin R (clear) · Onset = 30 to 60 minutes · Peak = 2 to 4 hours, give them a snack about 2 - 4 hrs post meal · Duration = 5 to 8 hours · Clear solution · Most common insulin that can be given IV · Give 30 minutes before eating or even after eating · Give 15g carbohydrate snack at peak of insulin
What do we do before a cardiac cath?
- Hx & Physical Exam - Allergies to shellfish/ iodine - Mark pedal pulses - Education
What are the main concerns with chest injuries?
- Hypoxia - low O2 sats - Hypovolemia/hypovolemic shock - ❤ failure - impaired ventilation/ perfusion, acute respiratory failure (ARF) - shock > death
What are some important nursing implications and adverse rxns of warfarin?
- INR = normal values = 0.8 - 1.1 but pt's on anticoags should be around 1.5 - 2x the control/normal value > H/H - hemoglobin (12 -16 women & 14 -18 men) and hematocrit (37 - 47% women and 42 -52% men) > diet - vitamin K e.g leafy greens = in moderation - adverse rxn = hemorrhage
What is contrast-induced nephropathy (CIN)?
- IV contrast dye is nephrotoxic and in some ppl can cause acute tubular necrosis or acut kidney injury and is usually reversible or temporary - Increased r/f ^ OA, reanl pts w/ GFR less than 60, CHF pts, diabetics, those with hypotension, anyone recieving recent contrast media - IV saline given at 0.9% is given before AND after contrast media and is the most effective method to prevent CIN - Urine output should be adequate post contrast media administration, if there's a decline HCP must be notified immediately - If a patient is on metformin generally it would be stopped 24 hours before admin and 48 hrs after - When renal fx has decline after metformin is given there's a higher risk for lactic acidosis Creatinine increases >25% within 3 days of IV contrast Cardiac catheterization CT scan MRI Surgical procedures Anticipate an order to increase IV/PO fluids before contrast is administered to dilute contrast and speed urinary elimination
What are some peds variations of the musculoskeletal system?
- Immature - Since the CNS is still immature their are skeletal fx that aren't present yet - Can't coordinate certain movements yet as an infant - Muscle mass is only 25 % of their body weight, they aren't using their muscles as much, so they aren't as large - As the get used more the growth rate increases - Bone healing - increased amount of cartilage, more flexible & porous they can absorb shock or trauma better bc it's less calcified & it can bend but not break, may buckle or bend in some injuries, bone healing happens quicker thatn in adults takes 1/2 the time - curvature of the spine is more pronounced (buddha belly) a natural alteration to support the big head compared to their body, lordosis is normal, they might have kyphosis, girls are usually than the boys & may feel akward so they have a bent posture - Positional alterations ▪ Metatarsus adductus (intoeing) r/t how the baby is inutero, not club foot bc there's no resistance ▪ Genu varum (bowlegs) - when they are first starting to walk, will resolve by 3 yrs ▪ Genu valgum (knock-knees) - "gum in b/t their knees", resolves by 8 yrs ▪ Flat feet until their arches start to dvlp'd - Ossification is the process of cartilage turning into bone, not complete until the end of adolescence, one of the last system that is fully dvlp'd, tanner stage 5 - Long bones grow from the ends, damage that happens at the growth plate can lead to early or partial closure which means that later on the bone isn't going to grow how it needs to & lead to limb deformity - Thick & strong periosteum
What is involved in the nursing care of a fracture?
- Immobilize the limb above and below the injury - minimize further injury and increase comfort - Don't try to straighten the injury, especially if it's a bad deformity like open fractures - Ice - w/in the 48 hrs, numbs the area, decrease swelling - Elevation - above the level of the heart, difficult w/ knee or ankle injuries - Pain - get ahead of it, strongest meds you have, around the clock pain meds - CMS checks!!! q2h - DTap, Tetanus - Education to prevent future fractures, anticpatory guidance
How are renal transplants care for at home?
- Importance of immunosuppressive therapy - Monitor for graft rejection - Monitor for complications - Renal diet - Activity level Na + H20 retention avoid wash foods light exercise high protein low NA intake
What are the s/sx of impending death?
- Increased sleeping → unresponsive - Coolness of extremities - Mottling - Shallow, slowed respirations/Cheyne Stokes - Death rattle (may require family teaching) - Slowing pulse - oliguria to anuria - Decreased muscle tone - Hearing is the last sense to go
What are some long term transplant complications?
- Infection - mahor cause of death Immunosuppressive drugs S/S of infection may be lessened - low grade fevers may be significant or high or low WBCs - Transplant related renal artery stenosis Elevated BP Fluid retention Doppler flow study
What is otitis externa?
- Infection of the external ear canal - Bacterial growth from moisture - Gets inflamed bc of WBC coming to fight it Symptoms - Itching of canal - Drainage - Pain - may need narcotics Treatment - Antibiotic/antifungal ear drops - Drying canal well to decrease recurrence - No swimming for about 10 days - Warm compresses can help
What is myelomeningocele? What is involved in the initial pre-op care? Nutrition? Education? post-op? long-term care? long-term education?
- Initial pre-op care nursing management*** ▪ Prevent trauma ▪ Prevent infection - saline/sterile dressings ▪ Prevent hypothermia - more heat loss, make sure warmer doesn't dry out dressing ▪ Must be prone ▪ Avoid stool & urine ▪ Surgx w/in 24 - 48 hrs - Promote adequate nutrition - hydration, check glucose - Educate/support child and family - lifelong care - Post-op nursing management ▪ Positioning - prone, don't damage suture line ▪ Wound care - dry intact ▪ Nutrition - assist w/ PO feedings, might get NG feedings, encourage breastfeeding, freeze breastmilk - Long-term care (multidisciplinary) ▪ Promote urinary elimination - neurogenic bladder, catheterized qfewhrs, as they get older they have to learn to cath themselves, teach family, s/s of UTI, meds to increase bladder capacity ▪ Promote bowel elimination - bowel training, enema, suppositories ▪ Promote mobility - they might partial sensation, may use braces, worry about pressure sores on butt/sacral area ▪ Latex-free environment - r/f allergy, medic alert bracelet ▪ Meticulous skin care - mobility devices can cause breakdown too - Educate/support child and family - referrals, and respite care
What do we look in a physical exam of peds pts regarding the MS system?
- Inspection/ Observation ▪ Playing/activity level ▪ Gait, symmetrical movement ▪ Symmetrical muscle strength/ROM ▪ Skin integrity - situations w/ trauma, mobility limitations w/ braces/casts - PRIORITY - preserve neurovascular fx " CMS" or "5P's" ▪ Circulation - pulses distal to the injury site, cap refill ▪ Movement - what can they do on their own? assess limitations and extent of damage ▪ Sensation - tricky in kids, are they able to feel? be attentive, have them tell you which body part you are touching, some may not be able to say it feels numb ▪ Pain ▪ Pulselessness ▪ Parasthesia ▪ Pallor ▪ Paralysis - Palpation ▪ ROM against resistance ▪ Muscle strength/tonicity - check for head lag, hyper/hypotonia ▪ Thumb in palm is sign of neuro deficit ▪ Injury - observe first, ask them about it, before palpating the injure site, check for crepitus, be hands on last bc of guarding
What is an example of long-acting insulin? What is it used for? Nursing Implications?
- Insulin glargine (Lantus) · Onset = 1 hour · Peak = None · Duration = 20 to 26 hours · Cannot be given in combination with other insulin's · must use separate syringe
What is an example of long-acting insulin? What is it used for? Nursing Implications?
- Insulin glargine (Lantus) · Onset = 1hour · Peak = None · Duration = 20 to 26 hours · Cannot be given in combination with other insulin's · must use separate syringe
What do we look for during a peds Glasgow scoring?
- LOC: ▪ earliest/most sensitive indicator of improvement or deterioration of neuro status, be very focused on it & check it often ▪ Children w/ concussions get woken up q2h to make sure they can be arosed & are responsive ▪ Observe their behavior: listless (child just doesn't feel like it) v. lethargy (they are not able to play/interaction), listless less severe than lethargy - Pediatric Glasglow (modified for children <2y/o who are nonverbal) 3 parts ▪ Lowest score = 3 ▪ Highest score = 15 ▪ Eye opening = 1 - 4 pts ▪ Motor response = 1 - 6 pts ▪ Verbal response = 1 - 5 ▪ Higher score = responsive and alert ▪ < 12 = concerning ▪ Less than 8, intubate = s/s of severe injury - Pupil checks ▪ not included in Glasgow ▪ 1st check are they responding to your verbal commands, responding to chest rub or a pinch? ▪ Are they localizing pain, pulling away from pain, any abnormal posturing? ▪ Are they crying? grunting? ▪ *** the lower the glasgow score the more important the pupil check, tells you what's going on in the brain ▪ when they are unconscious - PERRLA - check size 1st are they equal? Ligh reflex - brisk, sluggish or no response(unilateral or bilateral - emergency!); sedation, anethesia can effect this pupillary response
What is scoliosis? What are some risk factors for scoliosis? What do you find in the physical exam of a patient with this condition?
- Lateral curvature of the spine > 10 degrees of vertebral rotation - S curve - Recent growth spurts - Females > males - Early ID ▪ Females check @ 10 - 12 ▪ Males check @ 13 - 14 - Physical exam: ▪ Palpate along the spine ▪ Shoulder & back asymmetry ▪ Scapula & ribs will be higher on one side ▪ Neuro deficits ▪ Shoulder height discrepancy ▪ Hip discrepancy ▪ Coordination issues, muscle strength issues ▪ Leg length discrepancy - Degrees is measured by x-ray - Tx: ▪ 10 degrees + = scoliosis ▪ Less than 25 degrees - physical theraphy, stretching, postural exercises, serial exercises to monitor improvement ▪ 25 - 40 degrees = bracing - specifically molded for the pt, must be warn consistently, sleep in it only take it off to shower, body image issues ▪ 45+ degrees - surgery, bone grafting, rod placement, need distractions like music theraphy, neurovascular checks, *manage pain - morphine drip & PCA pump, blood loss assessment, bedrest/log rolling, foley care/ strict I&Os, physical therapy, not ligting, learn proper bending & walking, they'll appear taller, abd distention - get them up & walking bc of the gas, they should tolerate the PO well before going home
What is toxic megacolon?
- Life-threatening complication - It causes the intestine to become enlarged and atonic - Atonic (flaccid muscle) means it occurs with infection or inflammation - Can produce peritonitis and can cause the patient to be very sick Patient will have pain: - Pain - Constipation OR Liquid fecal incontinence - Abdominal distention - s/s of bowel obstruction/perforated bowel IBD complication
What is polycythemia vera (PV)? s/s? tx?
- MPN - high RBC count - hyperviscous blood > moves slow > clots - high RBC production, high WBC, high platelets - r/f thrombosis - rapid cell turnover - impaired O2 capacity - hypoxia - poor clotting - Hct = > 55% males > 50% females - genetic mutation or too much growth factor - increased histamine - cellular debris + ⬆ K+ Tx: - Apheresis - removal of some RBCs & then return it, multiple tx - 3L of liquids - no tight clothes - call HCP s/s infection - Anticoags - electric shaver - do not floss
When taking a pt's oral temperature what are some important instructions to give to the pt?
- Make the thermometer is underneath the tongue (sublingual space/pocket) - Keep your lips closed
What the goals of pulmonary management goals?
- Maximize Lung Function - Minimize Pulmonary Complications -> Lungs are normal at birth -> CPT 2-4 times/day when well; more when sick (to get secretions moving and out of lungs) --->>> How do we manage young children? Medications - Bronchodilators - open bronchus and small airways - Inhaled corticosteroids - decrease inflammation - Inhaled antibiotics - infection is in lungs, inhaling puts it right where it's needed - Inhaled mucolytics dornase alpha
What is the baclofen pump? Why is g-tube feeding necessary?
- Minimizes risks of aspiration - Reocurring pneumonia/lung infections - Pump for severe spasticity is under the skin to decrease spascity and improve mobility, can last 6 - 7 years, refillable, continually muscle relaxant admin - Nerve blocks, tendon/muscle releases may be needed, osteotomies as well
What is important to note about metformin (Glucophage)?
- Monitor for signs & symptoms of diarrhea, nausea, vomiting, decreased appetite
What is important to note about metformin (Glucophage)?
- Monitor for signs & symptoms of diarrhea, nausea, vomiting, decreased appetite - Biguanide
What does a good prep consist of?
- More than 90% of mucosa seen - stool mostly liquid - significant suctioning
What is a Nurse Practice Act?
- NPA is unique to each state - each state has their own board of nursing - peer based (7 out of 8 are nurses on the board)
What is the diet like to treat IBD?
- NPO initially, for severe s/s - fluids if problems with electrolytes or dehydration - low residue (similar to low fiber diet, it restricts stuff that increases bowel activity) - high protein, high-calorie diet (losing a lot of nutrients) - restriction of: Spicy food Alcohol Caffeine Dairy Raw fruits and vegetables No prune juice Goal: fewer BMs a day
How would describe normal newborn heart rate, blood volume, and blood components?
- NV HR = 110 - 160, * sensitive indicator - You may hear a benign or fxnal murmur because it can take some time for the fetal vessels to close -> get a 2nd set of ears to make sure the murmur is not indicative of anything more serious * neonates are HR dependent bc the ❤ muscle is stiff & can't expand ∴ in order to ⬆ CO the HR must ⬆ - Neonatal BV NV 80 - 85 ml/kg in term NBs - Fetal RBCs live for about 80 - 100 days due to ⬆ hemolysis, but premie RBCs last 35 - 50 days - Increased HR (tachy❤) can be caused by: > fever > crying > pain > drug w/drawal > volume depletion > ❤/RR dz - Decreased HR (brady❤) can be caused by: > hypothermia > hypoxia, ⬇ O2 (they don't have stroke volume or ❤ compliance to compensate, their ❤ tired out, it happens after tachy❤) > hypoglycemia > sedation probs > apnea ____________________________ - Fetal RBCs are immature until about 1 y/o _____________________________ - Leukocytosis, not r/t infection, r/t birth trauma
What are the anticipated labs of AKI?
- Nephron damage likely: ↑ BUN & Creatinine ↑ K ( *dysrhythmias, tx: kayexalate > feves or D50W to shift K intracellularly), Mg & Phosphorous (when phos is high, Ca2+ is low) ↓ Ca (not being absorbed in the gut, d/t inactive vit D being made in the kidney) ABG (metabolic acidosis) ↓ pH, ↓ CO2, ↓ HCO3 ↓ Hgb (reduced EPO production) - Urine ↓ creatinine clearance ↑ protein Urine may be dilute or concentrated - These pts are at increased risk of uremic s/s, but their BUN maybe at 180 - 200 before these s/s dvlp - GFR is not an accurate measurement of kidney fx during AKI, it can be effected by treatment making it unreliable sources, so monitor & trend the BUN & creat levels instead
What is NTE?
- Neutral Thermal Environment - maitain the NB's temp w/out energy i.e. glucose or O2 use - NO cold stress or overheating
What is cerebral palsy? What are the different types of cerebral palsy?
- Nonprogressive brain dysfunction - primarily a motor disorder - spasticity, muscle weakness, ataxia ▪ Associated with anoxia, usually perinatal occurrence ▪ Spastic type - most common - Associated w/ birth trauma, prenatal infections - Multidisciplinary treatment - Types: ▪ Spastic*** most common ▪ Athetoid ▪ Ataxic ▪ Rigidity ▪ Tremor - Types of spastic cerebral palsy: ▪ Monoplegia ▪ Hemiplegia ▪ Diplegia ▪ Quadriplegia
What are febrile seizures? (What would a nurse find upon assessment?) How does a nurse manage a patient with febrile seizures?
- Nursing Assessment ▪ Rapidly climbing fever, spike in temp ▪ Children < 5 years old ▪ Neuro assessment ▪ Most common 1 - 1.5 y/o ▪ Good prognosis, benign, complications are rare, no meds usually, perform EEG to make sure this is not the first for epilepsy, family hx - Nursing Management ▪ Parental support & education ▪ Fever management ▪ Make sure it's a one time deal, no cognitive deficiency risk
What are the effects of opioids on newborns?
- Opioid receptors are concentrated in CNS and GI tract - Signs and symptoms of withdrawal: -> CNS irritability - may last for 7-8 months -> Autonomic over-reactivity -> Gastrointestinal tract dysfunction
What are some complications of endoscopic procedures?
- Over sedation (opioid-dependent needs more sedation, and can need more opioid narcotics) - Hemorrhage (can happen if something nicked or torn) - Aspiration - Perforation - Infection (look for these when assessing post-procedure)
How are blood gases (ABGs) interpreted? What is paCO2 and how does it r/t the respiratory system and the pH?
- PaCO2 - found in your arterial blood not venous - Normal range is 35 - 45 mmHg - Remember CO2 is related to carbonic acid > 45 = acidosis < 35 = alkalosis = loss of acid *the C in PaCO2 looks like a 3, so remeber PaCO2 = 35 - 45 - CO2 is r/t your breathing ∴ CO2 is r/t your respiratory system STEPS: 1. Look @ pH, if < 7.35 = acidotic, < 7.45 = alkalotic 2. Look @ PCO2 - Match up the respiratory or metabolic component to the pH problem 3. Look @ HCO3 - Match up the respiratory or metabolic component to the pH problem *Respiratory - CO2 *Metabolic - HCO3 4. Determine if the other system has compensated (moved in the right direction to create balance) OR is uncompensated (Is still in the normal range, not assisting)
General points about pain
- Pain can cause poor wound healing, hospitals must have a pain t(x) policy and have options that are nonpharmacologic - Pain can make it so that pts don't want to move/get out of bed which can lead to embolism or skin breakdown, they need to ambulate after surgery etc. - Worry more about how the pain is impacting the patient not so much on the number on the pain scale - Pain can cause anxiety and anxiety can heighten pain - Pain is the most common reason for seeking care
What is the basic pathophysiology of diabetes?
- Pancreas is supposed to produce alpha and beta cells that secrete glucagon and insulin respectively - When you eat a meal the beta cells secrete insulin and act as a key to transport glucose into the cell for energy, when there's no insulin the glucose can't be transported into the cells to be converted into energy
What is the basic pathophysiology of diabetes?
- Pancreas is supposed to produce alpha and beta cells that secrete glucagon and insulin respectively - When you eat a meal the beta cells secrete insulin and act as a key to transport glucose into the cell for energy, when there's no insulin the glucose can't be transported into the cells to be converted into energy - glucagon = raises blood glucose - insulin = blood glucose regulation - Delta cells > secretes somostatins (enzyme), inhibits insulin production
How does that pancreas and the liver work together for glucose homeostasis?
- Pancreas produces Glucagon and Insulin - You eat a meal > Pancreas secretes insulin > Insulin uptakes the glucose into the cells or takes it to the liver to be stored as glycogen = ⬇ blood sugar Blood sugar is low > pancreas secretes glucagon > liver breaks down glycogen = ⬆ blood sugar
What is Fetal Growth Restriction (FGR)?
- Pathologic counterpart of SGA - @ risk for lifelong dvlpmtal deficits - Failure to thrive in fetus
How can you screen for cystic fibrosis carriers prenatally or natally?
- Patient tests negative, no need to test partner -> Patient would be to be positive to donate the allele - Patient tests positive, test the partner -> If partner is negative, baby cannot get it but can be a carrier - Patient and partner both test positive -> If pregnant, can do chorionic villus sampling or an amniocentesis to see if the fetus has cystic fibrosis -> If not pregnant but trying to be, discuss options with the obstetrician --->>> Fertility treatment to avoid the CF gene --->>> Adoption
What type of patients should the nurse identify as being at risk for fluid volume deficit?
- Patients who are NPO - Patient's with diarrhea - Patient's who are bleeding - Patients who are very old - Patient's who are very young
What are some factors that influence hygiene?
- Personal preferences i.e. timing, night or day shower - Body image - Socioeconomic status e.g. homelessness, unaffordable dental care - Cultural variables - modesty, wanting a same-sex caregiver - Dvlpmental stage i.e. what can they do fo themselvesm they may need assistance
How would hyperbilirubinemia be managed by the nurse?
- Phototherapy - Parental education - Exchange transfusion - Counseling for future pregnancies
How is a DVT diagnosed?
- Physical exam/ Ax = noticing s/s i.e. SOB/dyspnea, anxiety, change in LOC, stabbing chest pain, cough, tachypnea, tachycardia, crackles, petechiae over chest, syncope, JVD, cyanosis - Duplex Ultrasonography = Venous Doppler - used to document the prescence of VTE - Venogram = invasive & requires consent - D- dimer = blood test that measures the degradation of fibrin, doesn't 100% verify that the pt has a DVT, must be used in conjuction w/ Venous Doppler, it cost less so it is used to rule out DVT, a negative result means the pt most likely doesn't have a PE
What do we look for during a peds physical exam? (Neuro)
- Physical exam: ▪ Vital signs - catch subtle changes in neurological status, watch our trends ▪ Kushing's triad = sign of neuro issues = decrease HR (bradycardia), decreased RR, systolic BP increasing - some of the 1st things you'll see in trauma & swelling of the brain ▪ Skull shape & suture/fontanels - missing parts, palpate for injuries you can't see due to hair, injuries from blows to the head, swelling/bulging fontanels (check for all kids less than 3 yrs) ▪ Symmetry of face & eyes - nystagmus ▪ Head circumference (< 3 yrs) - get a baseline, compare qfewhrs ▪ Neck ROM - don't do this if r/t trauma - 1st protect the C-spine, C-spine must be cleared by x-ray ▪ Check reflexes - should disappear by 10 mos, if there's posturing, sign of neuro injury ▪ Muscle strength & tone - check it bilaterally, hypertonicity = BAD ▪ Symmetry of movements ▪ Motor fx - are they able to move, chech gait, is their gait even ▪ Sensory fx - numbness, decreased sensation ▪ Cranial nerves & postural reflexes - should be more relaxed, gag and swallow should still be present - 9 & 10 check during suction, ax for nerve compression, is their facial dropping, Decorticate - better prognosis than decerbrate bc it indicates damage to brain stem
How do you apply, care for, and remove a cast?
- Plaster takes time to dry, don't use your fingers to manipulate or press into it - Needs to dry for 24 - 48 hrs - Swelling can still continue for 24 - 48 hours or the cast might be on too tight so do neurovascular checks qfewhrs - can check refills, visually inspect, some movement/sensation checks you can do - Educate family to do CMS checks at home - Uses a sock to avoid pressure on the distal points of a plaster cast - Elevation & ice consistently (24 - 48 hrs) - Removal - educate pt about the saw, distraction, tell them how it works - Nothing should go in the cast, can cause breakdown and possible infection - Notify HCP about any fever, warmth, odor or drainage
What are the long-term outcomes of NAS?
- Poor cognitive, perceptual and memory skills - Hyperactivity and impulsivity - Short attention span - Poor verbal and performance skills - Vision and hearing problems - At higher risk for child abuse and neglect - Risk for future substance abuse - Sleep disturbances * r/f abuse due to the high pitch cry
What are some examples of pathological influences on mobility?
- Postural abnormalities - e.g. scoliosis, lordosis, kyphosis, club foot, knock knee - Damage to CNS - spinal cord injuries, MS = multiple sclerosis - Musculoskeletal Trauma - Impaired muscle dvlpmt - muscular dystrophy - decreased flexibility
What is the focus of DVT tx?
- Prevention of: - complications i.e. PE - new thrombi = use anticoagulants *the anticoagulant Heparin doesn't breakdown already formed clots, but it does prevent them - ↑ thrombus size = p(v) of s/s exaggeration
What are the different healthcare levels?
- Primary/ preventive = ROUTINE, generalist, OB/GYN, no referral needed, psychologist - Secondary - usually need a REFERRAL, specialist for a specific body system, e.g. orthopedics, cardiologist - Tertiary - ACUTE CARE, hospital, surgery, psychology ward - Restorative = REHAB, speech therapy, tx duration - depends on *insurance* and condition > OT - waist up > PT - waist down - Continuing care = LTC, ALF, hospice
What should we teach families about worsening s/s of nasopharyngitis?
- Prolonged or new fever -> May have bacterial infection on top of virus (ear infection, sinusitis) - Increased throat pain or lymphadenitis (indicative of bacterial throat infection) - Worsening cough or lasting > 10 days and/or chest pain, dyspnea - need to be seen - Earache, headache, sinus pain - Irritability
How is an NB w/ NAS managed by the nurse?
- Promote comfort - Low stimulation, low lighting (quiet, calm, no loud noises) - Swaddle, pacifier, calm approach - Meet nutritional needs - Frequent small feedings - Benefits of breastfeeding for the baby are good, even with Mom in treatment/i.e. methadone -Strict I&O, daily weight - Prevent skin breakdown, weight loss, dehydration - Administer meds based on NAS scores (>8) -->> Opioid (morphine, buprenorphine or methadone) -->> 50-80% of infants get pharmacological management -->> Phenobarbital to control breakthrough symptoms - Promote parent-newborn interactions, educate & refer
How would we diagnose a PE?
- Pt. Hx - meds, allergies - EKG/ CXR - shows irregularities in the heart & early signs of a heart attack - D- Dimer - Pulmonary angiography - invasive procedure, can be used to pull out the clot - Ventilation perfusion (VQ) scan - positive test would show a pt that is ventilating but not perfusing - Spiral CT scans - 3D scan - more precise than conventional CT scans and uses dye to outline the pulmonary arteries via IV
What is involved in perineal care?
- Pts may be incontinent - There may be different odors from bodily fluids - Always wear gloves and wash your hands before and after - Provide privacy (close the door and the curtain) - Special considerations: > Male - retract foreskin and then put it back > Female - wipe front to back - Don't take anything personal - Provide catheter care e.g. paint the catheter tube with CHG - the pt may ask for a same - sex caregiver
What are some special circumstances to consider with hygiene?
- Pts with dementia may be violent, have pain, cold, fear, and have loss of control - Morbidly obese pts have folds that need to be cleaned and thoroughly dried in order avoid skin breakdown and fungus - OAs tend to have thin skin, decreased sensations, *prevent drying + injury to skin* - the pt's family members want to be involved in the care of the pt - Hygiene time is good time to perfom ROM exercises
What is the Critical Congenital Heart Disease (CCHD) screening?
- Pulse oximetry screening 24-48 hours of age recommended - Decreased morbidity & mortality w/ implementation - make sure the two values are in range of each other
How does a nurse manage a pediatric patient w/ epilepsy?
- Pv injury - swimming/drowning, falling, hitting their head, need to be supervised - Kids w/ a hx of seizure diagnosis - use seizure padding, siderails raised, O2 & suction on the bedside - Be calm, make sure they are safe - Remove hazards - Stay w/ the child - Time the seizure, observe the characteristics of it - Tx: ▪ Don't stop meds abruptly ▪ Fewest drugs w/ the fewest side effects ▪ Phenytoin/ Phenobarbital (sedative) - negative interactions, Carbon mazipine (can be toxic), CBD oil w/ no THC ▪ Anticonvulsant meds ▪ Vagal nerve stimulator = stimulate the vagal nerve, pacemaker for the brain, reduce severe forms of seizures ▪ Ketogenic diet - high fats, low carbs & proteins, effect cellular mediators in the brain - decreases brain excitation, must be weened off the meds 1st at the hospital - Education: ▪ Medica alert bracelet ▪ Notify school staff
What are some other meds to tx anemia?
- RBC transfusion - platelet transfusion - Procrit/Epogen
What are the causes of AKI?
- Rapid loss of kidney function that can happen w/in hours to days, can be reversed if caught early - More likely to occur in older adults and individuals with comorbidities like diabetes, HTN, chronic kidney dz, and liver dz - can asymptomatic and only reveal itself only on labs and urine output initially - if left untreated it can lead to kidney failure or chronic kidney dz (most common) Prerenal: Conditions that decrease blood flow to the kidney -> Hypotension/overtx of HTN -> Hypovolemia -> Heart failure -> Severe dehydration ALL of these cause decreased cardiac output which cause decreased blood flow to kidneys Intrarenal/ intrinsic: Tissue damage to the kidney -> Acute glomerulonephritis (inflammation of glomeruli or of the small blood vessels in the kidneys, it can be caused by infection e.g. a strep infection that originated in the throat that then cause inflammation in the kidney) -> Acute tubular necrosis - most common - tubular cells slough off and cause debris and blockage in the tubules and causes decrease in filtration and blood flow in nephron ->> vasoconstriction occurs secondary to this > nephron death, kidneys can recover if the offending toxins are removed -> Diabetes -> Toxins, drugs (including contrast media/immunoglycoside/anesthetics- meds get adjusted based on creatinine clearance) Postrenal: Obstruction of the urine collecting system -> Renal calculi -> Obstruction (ureter or urethral strictures/clots) -> BPH
What's included in the respiratory ax of NB?
- Rate, rhythm, ease - difficulty breathing? - Things other than infection that can cause tachypnea are heart and lung disease, anemia (they're trying to get more oxygen that are carried on RBC to places it needs to go) - Bradypnea: respiratory/liver failure - Often a cough: we need to know timing, what it sounds like, how often - what illness may a cough represent? - Pediatric illnesses often have distinct types of coughs -> Barky, wheezy, stridorous? -> Does it matter what time of day? Yes for early asthma pts who have been diagnosed with it. Nocturnal coughing is earliest sign for child who will be diagnosed with asthma - Do they have chest pain, cyanosis, symptoms of resp infections (respiratory tract is from nose to the lungs) cervical lymphadenopathy is a sign
What is vasospatic disorder?
- Raynaud's Phenomenon - arteries spasm - occurs mostly in women 16 - 40 in the winter months - fingers turn white and mottled and then it resolves itself - tx includes: > stop smoking > keep hands and feet warm, wear gloves - ca2+ channel blockers
What are the functions of sodium?
- Regulates water balance - controls extracellular fluid volume - increases cell membrane permeability - stimulates conduction of nerve impulses - helps maintain neuromuscular irritability - controls contractility of muscles *Most abundant extracellular electrolyte*
How are pediatric patient w/ epilepsy cared for at home?
- Remain calm, stay with child, remove hazards - Seizure activity > 5 minutes, call 911 - even w/ known seizure d/o - Administer benzodiazepine: ▪ Rectal diazepam (Valium) ▪ Intranasal midazolam (Versed) or Lorazepam (Ativan) - Status epilepticus ▪ One seizure > 30 minutes or series of seizures without regaining consciousness in b/t seizures or one long seizure ▪ Medical emergency - airway, anticonvulsants
What is involved in port mortem care?
- Remove all lines and tubes if hospitalized > Unless autopsy or Medical Examiner case - Close patient's eyes - Insert dentures as applicable - May need to bath, clean secretions - Pillow under head, raise HOB, straighten sheets - Make sure ID band in place - Place pads under buttocks - Gather belongings for family - Provide privacy and seating next to bed
How are respirations initiated in newborns? What is surfactant? How would you describe newborn respirations?
- Respirations are initiated when the infant's lungs fill with air for the first time instead of fluid. Once the cord is clamped it becomes necessary for the infant to become self-sufficient because the mother is not supplying oxygen and nutrients anymore. ___________________________________________ - Surfactant is a lipoprotein that starts to be produced at 24 weeks of gestation and completes production at 34 weeks. This is why HCP are especially concerned about premies who are less than 24 weeks because their lungs are not fully developed & they don't have enough surfactant to keep their alveoli (where gas exchange occurs) open outside of the uterus. _____________________________________ - It is thought that vaginal delivery is better than c-section because the extra "squeeze" infants get coming out of the birth canal allows for more of the amniotic fluid to come out of the lungs leading to a ⬇ risk for TTN in newborns. ________________________________________ - NV RR = 30 - 60, shallow & irregular w/ periods of apnea. These periods of apnea can be described as "pauses" because they last <10 secs & don't have HR changes or color changes - Real apnea which is mostly seen with premies is accompanied by HR changes and color changes and last for 20+ secs with signs of decomp ___________________________________________ - During premature labor mothers can receive betamethasone to help speed up the dvlpmt of the lungs if <34 wks ______________________________________________ - Outside of the uterus premies can also receive surfactant directly into their lungs in a liquid form, you should make sure the med is dispersed, intially you will see sats go down and s/s of decomp _______________________________________________ Respiratory distress = color changes (dusky/purple), grunting, retractions, ⬇ RR/effort or no RR at all __________________________________________ When premise have true apnea they sometimes "forget" to breathe and require stimulation to wake up, this is why they are likely on caffeine
What is perinatal asphyxia? RFs? Tx? Complications?
- Respiratory distress - hypoxemia - acidosis - bradycardia Inability to successfully transition to extrauterine life -> Perinatal acidosis -> Most common clinical insult in perinatal period Risk factors: -> Birth trauma -> Intrauterine asphyxia (cord compression, maternal HTN) -->> come out blue/ not breathing -> Meconium aspiration -> Sepsis -> Malformation (congenital anomalies) -> Hypovolemic shock (from abruptio, cord rupture) - Early ID of risk, early recognition of symptoms, early intervention = improved perinatal outcomes - 10% require active resuscitation attempts: -> Dry newborn quickly, place under radiant heater -> Suction nose/mouth -> Begin resuscitation procedure -> Continue until newborn has pulse >100 with good respiratory effort and pink tongue Complications: -> Cerebral palsy (was the cord around the neck?), mental retardation, speech disorders, hearing and/or visual impairment, and learning disabilities
What are the s/s of a tension pneumothorax?
- Respiratory distress, agitation, cyanosis > difficulty breathing/ ventilation + ⬇ O2 sats - tracheal deviation + asymmetry of thorax + ↓ BS + hyperresonance + JVD > ⬆ intrathoracic pressure - ⬇❤ sounds + ⬇BP + tachy❤ + shock > ↓ venous return to the ❤ - subq emphysema > air trapped under skin
What are the interventions for an existing DVT?
- Rest & elevation of extremity = don't put pillows under the popliteal space, use alternating pressure mattress - NO rubbing/ massaging = pv dislodging of the clot - NO SCD stocking or ROM exercises = it is okay to put the SCD on the unaffected extremity - Apply compression stocking - Neurovascular ax = cap refill, extremity temp - IVC filter = captures the clot, used as a last resort for pts who have repeated DVTs/PEs, sometimes they are coated in an anticoagulant - Priority: - Anticoagulation tx = discourage clot growth - Fibrinolytic tx - Oxygen therapy - Monitor for changes in status
What are the manifestations of PE?
- SOB - Stabbing chest pain - Anxiety/ apprehension - Chnage in LOC - confusion - Cyanosis - Tachycardia - Tachypnea - Cough (dry or productive)/ Hemoptysis
How can we prevent CAUTI?
- STRICT aseptic technique, maintain STERILITY - Be safety conscious - secure the catheter to the pt's leg to prevent impaired skin integrity/ skin breakdown - use closed drainage systems - drainage bag BELOW the bladder and NOT on the ground - pv obstruction of urinne flow - empty urine bag when 1/2 full, clean tip with alcohol > empty before ambulation - perform perineal and catheter care
What is a tonsillectomy?
- Side-lying immediately postoperatively - until fully awake - Blood tinged mucus expected -> Frank (bright red) blood indicates bleeding from the surgical site - not expected - May hemorrhage up to 10 days after surgery - parents need to know what to do - To avoid trauma to the surgical site, discourage - Coughing - Blowing the nose/using straws - Clearing the throat
What are some newborn integumentary adaptions?
- Skin makes up 13% of their bodyweight as compared w/ adults at 8% of bodyweight - protective barrier against pathogens - dry, thin, peeling, can easily tare, be careful not to use adhesive/tape on their skin bc it's sensitive - bc the skin is thin & they have little to no body fat the capillaries are closer to the surface making topical meds easily absorbed through the skin - starts to dvlp mid gestation and is fully formed by 32 wks - thremoregulation - physical trauma protection - limits water loss but ⬆⬆ heat loss
Describe the 1st stage of CKD
- Slight ↓ nephron function but no waste accumulation - Healthy renal cells are able to compensate for diseased cells - No other clinical manifestations - Focus on CVD risk reduction and slowing progression - Assess patient's medications and make sure they aren't taking anythign that can neg effect their kidneys - More apparent when the pt is stressed out or sick Interventions: Control HTN and diabetes Eval and tx cholesterol Avoid kidney fx decreases NO smoking or drinking Adjust med
What is microcephaly?
- Small head circumference ▪ Results in intellectual disability due to lack of brain tissue ▪ No treatment
What are some common misconceptions about pain?
- Some ppl think that pts who abuse substances overreact to pain, but it could be that they have built up a tolerance & need more than a normal person - chronic pain is not psychological, it is that the pain for the pt has become their norm - opiods & analgesics are processed slower in infants & OAs
What is Respiratory Acidosis? What is the cause of Respiratory Acidosis? What are some interventions for Respiratory Acidosis? What are the s/s associated with Acidosis?
- Specifically from carbonic acid, directly from CO2 not being able to get out due to an issue with ventilation (breathing in & out), airway blockage, issue w/ alveoli -> CO2 build-up CAUSES: - Weak resp. muscles, shallow breathing - Severe resp depression (brain dysfx due to brain injury causing slow/irregular breathing or sedation on board) - Obstructed respiratory passage e.g. constrictive asthma (bronchioles), COPD (mucus) - Blocked alveoli gas exchange, e.g. pulmonary edema (fluid being in the way), COPD (floppy alveoli, bronchitis, mucus) INTERVENTIONS: - Increase ventilation & gas exchange > Sit them upright, allow better chest expansion > Oxygen, a tx but not necessarily the problem bc pts like COPPD or asthma pts are @ risk > Meds - bronchodilators (asthma, COPD), opens up the bronchioles > Incentive Spirometer - helps with the alveolar gas exchange by putting positive pressure into the alveoli allowing more time for the CO2 & O2 to exchange/diffuse through the alveolar membrane > Mechanical Ventilation - COPD pts who are too fatigues end up on ventilation support via a non-invasive mask or intubation, can increase the resp rate on vent helping to release more CO2 > Ambulation - helps move pulmonary secretions s/s (caused by CO2/carbonic acid build-up): - Visual disturbances - caused by vasodilation -> cerebral edema -> drowsiness, coma, confusion - HA - Restlessness
What is physiologic fetal anemia?
- Starts at 6 - 8 wks of age > can be caused by: --> hemodilution due to rapid ⬆ blood volume expansion --> ⬇ bone marrow activity --> ⬆ rate of hemolysis
What are some immediate interventions for newborns? (airway)
- Suctions, use bulb syringe, mouth first then nose - dry off w/ towel - Sometimes just drying them with no suction is fine as long as they are able to breathe well, crying + good respiratory effort * airway patency
What are antiembolism stockings?
- Ted stockings, help promote circulation, prevent blood clots - before you put on the stockings the nurse should measure their leg/ calf circumference, knee to heel, thigh circumference, and measure gluteal to bottom of heel - assess skin integrity (make sure it's intact) - remove the stockings at least once a shift pt education: don't touch the stockings, don't roll the stockings - leave toes exposed
What is epiglottitis? s/s?
- The epiglottis is a thin flap of cartilage at the back of the mouth that covers the larynx during swallowing, protects trachea from food going down - Child with epiglottis is very very sick - very rare = Common cause is haemophilus influenza type B - Sudden onset -> They drool, are agitated, don't cough, restless, irritable, sit hunched over (like tripod position bc they feel like they can breathe better) -> May have froggy, muffled voice and substernal retractions - Should not have oral exam done if epiglottis is suspected - could cause distress/occlusion - Need trach equipment at bedside in case complete occlusion occurs
How does a patient sit down and sit up with crutches?
- The patient goes up against the chair and makes sure they can feel the chair with their non-injured leg. They will then move both crutches to the injured side. *Crutches go on the side that needs support.* The patient then uses the handgrips to help guide them while bending the good leg until they are fully in their chair. - The patient takes the crutches on the injured side and uses them to support themselves up. They then move one of the crutches to the uninjured side.
What are some important notes about the liver's fx (carbohydrate metabolism + iron storage) in NBs?
- Their energy needs increase postbirth - @ risk for hypoglycemia *hypothermia > hypoglycemia - NV glucose levels - 40+ mg/dl, <40 may require intervention bc the glucose is needed for brain dvlpmt - They will mainly get energy from the release of glycogen from the liver for the 1st 24hrs (janky feeding schedule), it may take some time to get up to full feedings - If they are full term they will have enough iron stores for 4 - 6 mos from mother since the last trimester is when the mother shares the most iron w/ fetus, how much the fetus gets is dependent on how much the mother consumes - Premies are @ ⬆ risk of anemia - If exclusively breatfed the infant will require iron supplements via diet after 4 - 6 mos, ~ 1 mg/kg/day, ⬆ r/f deficiency
What is involved during and post the pronouncement of death?
- Time of expiration > No audible heart sounds or breath sounds > No palpable pulse > If on cardiac monitor - no electrical pattern - Notifications > Family > Physicians
What is the fx of potassium?
- Transmission of electrical impulses in cardiac & skeletal muscles - Involved in the rate & force cardiac contractions & output - regulation of acid-base hydrogen ions
How do we measure asthma severity?
- Treatment is decided based on "stepwise" approach, we want them on the least amount of medication as possible, but we want it to be treated adequately - Child is more likely to have asthma if one or both parents have it, if they have allergies (esp. Airborne like pollen), or eczema (atopic dermatitis), wheezes w/o a cold Mild intermittent ~ Symptoms < twice/week - Nocturnal < twice/month - Pulmonary function > 80% normal Mild persistent - Symptoms > twice/week, not daily, - Nocturnal > twice/month - Pulmonary function > 80% normal Moderate persistent - Symptoms daily - Nocturnal > 1/week - Pulmonary function 60-80% normal Severe persistent - Symptoms continuous, - Frequently at night, activity limitations (can't run/do normal sports) - Pulmonary function < 60% normal
Why is a patient receiving ARBs? examples?
- Treats HTN, heart failure - losartan (Cozaar) - candesartan (Atacand) - valsartan (Diovan) "-sartan" "CAD"
Why is a patient receiving ACE inhibitors? examples?
- Treats HTN, heart failure - captopril (Capoten) - enalapril (Vasotec) - lisinopril (Prinivil) "-pril" A-C-E
How would a large for gestational age (LGA) baby look upon assessment? Concerns? Risk factors?
- Weight is generally > 9 lbs Risk factors - Maternal diabetes mellitus, prolonged pregnancy, previous LGA baby, maternal obesity Assessment findings - Large body, appears plump, full-faced - Head circumference/body length at upper limits Nursing Concerns - Traumatic birth injuries - shoulder dystocia, clavicle fractures, look for uneven moro response & one arm not being used, look crepitus over their clavicles may indicate fractures - Hypoglycemia - due to ⬆ insulin > somatic growth, look for lethargy tachypnea, irritability, weak cry, jittery -> usually born to diabetic mom -Polycythemia/hyperbilirubinemia - may be caused by cord compression & ⬇ blood flow to the fetus > ⬇ O2 > ⬆ RBC production
What type of equipment is used to monitor lung status? Peak flow? Peak flow family instructions?
- What we are most concerned with is how fast the air moves out of the lungs for a child at the beginning of expiration - These devices help family determine when they are well, how well they can blow out, and what happens when they are sick What does the peak flow reading mean? - Objective measurement of lung function - If child is doing peak flow every day, twice a day and they start to see drops in pulmonary function, they be be able to be alerted they are getting sick - Child can learn to perform the test to help determine status of asthma - Can provide early identification of subtle symptoms - Early treatment can help decrease risk of permanent lung changes (remodeling) Family instructions to use the peak flow meter - Set the arrow on the meter to zero Stand or sit up straight - Deep breath with lips tightly around meter blow out hard and fast - Repeat 3 times and record highest - highest is personal best - Peak flow readings are done twice a day -> Green >80% of expected peak flow -> Yellow 50-80% of expected peak flow -> Red < 50% of expected peak flow - A patient will have a "personal best" that is his/her expected peak flow when well. This helps to determine the severity of their illness when ill.
What is involved generally with oral care?
- When assessing the oral cavity the nurse should look for hydration, lesions, dental carries (black and dark spot in the teeth), how well do their dentures fit?, halitosis - Don't wrap dentures in tissues it can dry them out, dentures should be stored in a container w/ water/sol'n and labeled, clean dentures in a towel lined sink to prevent them from breaking
What are some non mechanical interventions for a BO?
- Will be NPO with NG tube (to help decompress bowel or eating foods can also make obstruction worse) - IV fluids —replace electrolytes - Analgesics (use with caution bc they can further decrease peristalsis and mask the signs of perforation)(Cholic pain to constant pain = BAD) - activity limits because they will have NG and until we see where the obstruction is - assessments (frequent abdominal assessments and measure abdominal girth to see if the stomach is growing and if so then that means its getting worse)
What is the teach back method?
- a chance to see how well the patient understood the information you just taught - a way to assess how well you explain the concept to them - a chance for them to explain in their own words what they need to know or do in a non-shaming way
What is VAC therapy?
- a negative vacuum pressure system that helps wound healing, decrease edema, prepare the wound bed for closure, form granulation tissue and remove infectious materials - uses an open cell polymer that conforms to the wound bed - removes exudate - promotes tissue perfusion - provides moist wound environment - helps draw together wound edges
What is myelodysplastic syndromes?
- abn cells in bone marrow, abn cell regulation s/s: - anemia - neutropenia - thrombocytopenia - pancytopenia risks: - age - chemical exposure - tobacco/smoke - radiation/chemotherapy Tx: - allogenic hematopoietic stem cell transplantation - blood transfusion - ESAs platelet transfusions
What are the clinical manifestations of small bowel obstruction?
- absence of bowel sounds - upper abdominal pain, cramps - upper abdominal distention - nausea and profuse projectile vomiting (can relieve pain) - no bm - severe fluid and electrolyte imbalance - can have fecal vomit **REMEMBER BOTH WILL HAVE AN ABSENCE OF BOWEL SOUNDS. EARLY ON THE BOWEL SOUNDS ABOVE THE AREA OF OBSTRUCTION IS HIGH PITCH, HYPERACTIVE, LOUD, AND FREQUENT AND THEN, LATER ON, THEY GO SILENT. THEY WILL BE HYPOACTIVE BELOW OBSTRUCTION.**
What are the clinical manifestations of a large bowel obstruction?
- absense of bowel sounds - intermittent, diffused, poorly localized lower abdominal pain. MOST WILL NOT BE ABLE TO PINPOINT - lower abdominal distention - infrequent vomiting - minimal F&E+ imbalance - diarrhea around the area of impaction because impaction isn't completely blocking area of the bowel so some stool is still able to get around the obstruction or no BM at all - hyperactive above the obstruction hypoactive below causing a trickling sound at the point of obstruction
How do we help pts w/ CINV(Chemotherapy induced nausea & vomitting)?
- antiemetics - given before during and after chemo - take meds at first sign to pv uncontrollabe N/V - change positions slowly - bland food - cold food
What is a tracheostomy?
- artificial airway - long term airway support - placed in the neck below the larynx
What assessments would the nurse need to complete on Mrs. Nunez during oxygen therapy with a nasal cannula?
- assess for dryness, are their nares dry? - check for sores behind the ears - use gauze or zinc oxide to prevent sores
How can we manage care of post op colonoscopy patient?
- assessment with PQRST - diet (liquids first per HCP) and advance as tolerated - frequent vitals signs - can't drive themselves home (12 - 24 hours no driving, because of IV sedation) - safety - NPO until the sedation wears off - monitor especially o2 stats - look for complaints of severe abdominal pain [eg. Scope pierces colon can cause this), fever, low BP or tachycardia, confusion, rigid abdomen (can be peritonitis so WATCH OUT)]
What are clinical manifestations of ulcers?
- asymptomatic - fullness - pyrosis (heartburn) - hematemesis (vomiting blood, more common with gastric ulcer= bright red (upper GI) or dark tarry blood (lower GI - weight loss (all acid=not much of appetite (anorexia)) - N/V - dyspepsia (indigestion) - pain can radiate to back, when goes through the lining of stomach - Abdominal distention **food makes ulcer feel better**
How would a patient with flail chest present?
- atelectasis (collapse of alveoli) - low O2 in blood (hypoxemia) > cyanosis (late sign) - ↑ WOB/dyspnea/accessory muscle usage > labored breathing - hypercapnia - respiratory acidosis - bruising internally (pulmonary contusion) & externally - chest pain > pain control - oscillation/shifting of mediastinum - compensatory mechanisms = rapid, shallow RR + tachy❤ - ⬇ BP + breath sounds (BS) - low O2 sats > restless, anxiety = humidified O2/TCDB/Early movement to mobilize secretions
Why is a patient receiving dabigatran (Pradaxa)? How do we know it's working and what are the SEs?
- atrial fibrillation aka a fib "You just got a Prada bag so you dab, but it's fake so it turns out you were fibbing." Prada = Pradaxa Dab = dabigatran fibbing = atrial fibrillation, decreases fibrin formation antidote = dialysis - we know it's working if there's no thrombotic events and SEs = bleeding
What is hemolytic anemia? immunohemolytic anemia?
- autoimmune - cells can't recognize their own blood cells - excessive RBC lysis > hydrate + transfuse - G6PD gene
How can a nurse make sure they have the correct dose?
- calculate properly - follow facility policy - use the right equpiment - use guidelines for high alert meds - question multiple tabs, vials, or single doses, increases in dosages - call the pharmacist with any questions
What are some exercises the pt can do to prevent clots or help with orthostatic hypotension?
- calf pumps - extend and flex - foot circles - flex and extend knees
What is the difference between cardiopulmonary and whole-brain death?
- cardiopulmonary death = heart AND respiratory f(x) stop, irreversible - whole-brain death = irreversible stopping of ALL f(x) including the brain stem
What is involved with the care of a patient who is recieving internal radiation?
- cause the pt to emit radiation due to radioactive isotopes - don't directly touch pt waste - no pregnant women or children - nothing leaves the room
What is some common causes of folic acid deficiency anemia? s/s? tx?
- caused by brith control, anticonvulsants, malabsorbtion, not enough leafy greens - normal nervous system - slow dvlpmt dz - sames as pernicious anemia but normal CNS fx Tx: - pv is the best route - scheduled folic acid therapy - diet same as vit B12 diet
What are the results of untreated chronic HTN?
- chest pain - MI - Heart failure - kidney changes - stroke/ CVA
What is flail chest and what complications can it lead to?
- chest stability ⬇ due to ribs/sternum fractured in more than spot > impaired ventilation - paradoxical breathing = when a pt breathes in (inspiration) the lungs don't expand all the way there's a "sucking inward" and when the pt breathes out (expiration) there's "puffing out" = lung below flail segment caves in on inspiration & balloons out on expiration Complications: - pneumothorax = air in pleura space b/t lung + chest wall > destroyed negative pressure > ⬇ vital capacity - hemothorax - pneumonia - fluid/bacteria accumulate to cause infection/ - ARDS = acute respiratory distress syndrome - Shock - like a flag = flail
What clinical manifestations would you see with a perforated ulcer?
- classic rigid board-like abdomen (body walls off abdomen and contracts the muscles to try and prevent the infection from going further when perforation happens, so content doesn't go any further) - change in LOC - s/s of bleeding - severe sudden sharp pain - s/s of shock if bleeding - can cause peritonitis or hemorrhage - darker blood = upper GI **MEDICAL EMERGENCY!!!!!!!!!! SURGERY TO REPAIR AREA**
When is a simple mask contraindicated?
- claustrophic pts - COPD pts. bc it accumulates CO2
What are some different types of enemas?
- cleansing = hypertonic sol'n, tap water soapsuds - oil retention - carminative & kayexalate
What are some nursing implications for the pts on TPN?
- complex - not one way - nutrient absorbtion ability decreases - small frequent meals + nutrient dense + calorie dense - increased nutritional needs for healing
What are the results of the progression of HTN?
- confusion - blurred vision - N&V - orthopnea - paresthesia = numbness & tingling - HA - angina - lethargy/drowsiness - leg edema - dyspnea
What is malpractice insurance?
- contract b/t nurse & insurance company - provides defense for malpractice/negligence cases - while you are working you are covered by the facility's insurance
How is nephropathy managed?
- control BS and BP (the strips are expensive and sometimes they are asymptomatic so they don't check their glucose levels) - ACEIs - ARBs - pv and tx UTIs - low Na+ & protein diet (high protein diet is for pts w/ good kidney fx) - Dialysis - Kidney transplant (good for up to 10 yrs) - Pancreas transplant - avoid contrast dyes, nephrotoxic drugs (not easily filtered out w/ bad kidneys)
What is the f(x) of magnesium?
- controls the absorption of Ca, Na, K, neurochemical activities, ❤ & skeletal muscle, excitability, neuromuscular transmission Mnemonic - "Milk of magnesia, Mg controls Ca absorption", "The M in the magnesium stands for muscle, the fx of Mg is muscle excitability" - inverse relationship b/t sx and hypo and hyper Mg "Mg moves w/ K"
How would we treat hyponatremia?
- correct cause - response monitoring - sodium replacement - hypertonic IV sol'n - increase Na+ intake
How can we treat hypokalemia?
- correct cause - K+ replacement tx - diet changes (e.g. chocolate, OJ, bananas) - cardiac monitoring
How would you treat hypernatreamia?
- correct cause - response monitoring - Na+ restriction (restrict food items like cold cuts, cured meats, pizza, and canned soups) - hypotonic sol'n - water intake
How can we treat hyperkalemia?
- correct cause - sodium polystyrene sulfonate (Kayexalate) - Kayexalate = "K exit" = "K+ is exiting (decreasing)" causes alot of diarrhea, if given PO it should start working 30 - 45 mins post admin and serum levels are checked 2 -3 hrs post admin (can be admin via enema and PO) - cardiac monitoring
What are some s/s of hyponatremia?
- crave salt - CNS changes (seen commonly in elderly, they come in with confusion due to low Na+ levels) - seizures - coma - death - muscle weakness - increased GI motility which leads to cramping, diarrhea, nausea - changes in cardiac output
What are some s/s of hypernatremia?
- crave water - CNS changes - confusion, agitation, lethargy, comatose - seizures - twitching that leads to muscle weakness - decreased DTRs - decreased heart contractility = ↓ BP - tachycardia due to hypovolemia
What are some s/s of hypernatremia?
- crave water - CNS changes - seizures
What are the complications associated with retinopathy? DM
- damage to the blood vessels, vessel rupture, blurry vision - usually the pts complain of needing glasses
How do we help a hospitalized pt get sleep?
- decrease environmental noise - provide uninterrrupted sleep - let pt determine basic care time - cluster care - schedule plan of care
What is the goal of drug therapy in ulcer treatment?
- decrease gastric acidity because we want ulcer to heal - enhance mucosal defenses - heal ulceration - prevent recurrence - eradicate H. Pylori - Relief from pain - stop aspirin if it is the cause
What are some renal changes that occur in newborns?
- decreased GFR therefore they can't excrete fluid fast so we have to be careful when we are feeding them or admin fluids or meds - low specific gravity - they can go into fluid overload easily - their 1st voids will have pink uric acid crystals educate the parents about this - ⬇ ability to reabsorb Na+, fluid loss high - intolerant to fluid imbalance - NV urine output: 1 ml/kg/hr = 6 -8 wet diapers/ day in the 1st few days
What are some physical factors affecting oxygenation? (whaat can affect your ability to oxygenate your tissues?)
- decreased oxygen - carrying capacity, decreased hemoglobin - hypovolemia - decreased blood volume - decreased inspired oxygen concentration (e.g. due to decreased compliance, decreased chest expansion) - increased meatbolic rate
What is leukemia? different types? s/s? tx? causes?
- deregulation of WBCs - acute or chronic - slow onset - too many immature WBCs - lymphocytic or lymphoblastic - unknown cause - normal cells become malignant - high radiation exposure is a cause, genetics - many diff types - can be cured s/s: - petechiae - open infected lesions - bruises - anorexia - bleeding - bone pain - tachycardia - DOE - fatigue - fever tx: - intense chemo - long hospital stay due to inc r/f infection - 3 phases > Induction = induce remission, chemo > Consolidation = intent to cure, combo of chemo or higher dose, make sure you are cured > Maintenance = maintain remission, mons to yrs
How would a Type 2 diabetic manage their condition?
- diet = reduce carb intake, increase veggies & fruit, be minful of protein - exercise - Oral meds include metformin, usually they are prescribed 2 meds if they are non-complinat then they are prescribed insulin
What is the mouth's role in bowel elimination?
- digestion starts in the mouth/ mastication = chewing - esophagus - moves the food into the stomach - stomach stores food, mixes food - small intestine = DJI - large intestine - main organ of primary elimination - anus expels feces and flatus
What are some nursing dx about bowel elimination?
- disturbed body image - bowel incontinence - perceived constipation (OAs) - r/f constipation > sedentary lifestyle > overusing laxatives > inadequate diet - e.g. not enough fiber > inadequate fluids - 24 hr diet recall > pain > psych privacy - diarrhea - nausea - knowledge deficit (perceived constipation r/t knowledge deficit)
What can cause hypokalemia?
- diuresis (also causes hypernatremia) - vomiting and diarrhea - meds (k-wasting diuretics e.g. Lasix) - NPO - inadequate intake
What can cause hypokalemia?
- diuresis (also causes hypernatremia) - vomiting and diarrhea - meds (k-wasting diuretics e.g. lasix)
What is the most important question to ask a patient about rest and sleep?
- do you feel rested when you wake up?
What are some tips to use with restraints?
- don't tie the knot to a moving part of the bed - only use quick release knots - every 15 mins move the restraint, neurovascular check (color, pulse, sweling, numbness) - perform ROM exercises, go to the bathroom, offer food, water, ambulate - need Dr. order to restrain for max 24 hours - reposition
What assessment finding would make a nurse suspect aspiration?
- dyspnea - tachypnea - adventitious breath sounds - tachycardia - fever **big reason why we make them NPO before we test gag reflex** - Make sure head of bed is up - listen carefully - monitor HR - monitor temp - have them on their left side - make sure they don't eat or drink until gag reflex is tested - if aspiration, it goes to the right lung
What are some things that influence urination?
- dz - meds - anesthesia, diuretics, antidiuretics, some meds change the color of urine - med procedure - surgery (being NPO/ fluid loss), trauma - sociocultural factors - psych factors - fluid balance - nocturia, polyuria, oliguria, anuria, diuresis, fever
How does the automated medication dispensing system work?
- each nurse has a security code and they use it plus their finger print to access the unit - these are used as a control mechanism for narcotics - the nurse can choose the drug, dose, and route then the drug is dispensed to the nurse, it's electronically recorded and then charged to the client
What can contribute to fluid loss?
- excessive diuretic therapy - excessive laxative use - excessive sweating - fever - vomiting and diarrhea
What are some things we can teach our pt about sleep hygiene?
- exercise in the morning or afternoon - bedroom is for sleeping and sex - relaxation exercises - use earplugs, eye shades - avoid heavy meals, coffee, alcohol 3 hrs b4 bedtime - quiet activities if u can't sleep - keep a sleep journal and rate ur sleep
What can a nurse do for imbalance nutrition?
- feed 20 mins at a time or until they tired and then gavage the rest, Q3h ______________________________ •Child - high protein/high calorie diet •Infant - high-calorie formula or breast milk fortifier; may use 24-30 cal/oz, oil or carbohydrates added ________________________________ •Limit feedings to 20 minutes every 3 hours •Gavage remainder •Special nipple
What is the portable tank? pros and cons?
- for home use - 15 L/min (100%) - refillable - O2 is combustible - dangerous, can blow up - make sure it's in a caddy because if it falls or cracks it can become a projectile - teach pt that they CANNOT smoke around their oxygen tank - used for short term use - make sure the tank is full
What is a saline lock?
- for pts that don't have continuously running IV fluids - accessed when the pt. needs to have an IV med given
What is a rib fracture and how would a patient present if the had one?
- fracture of the ribs commonly w/ ribs 4 - 10, usually benign + treated minimally - can be caused by direct blunt trauma - rib fractures in ribs 1 - 3 can lacerate subclavian artery or vein - Lower rib fractures = concern w/ laceration of spleen or liver - if splintered and displaced it can cause pneumothorax or hemothorax s/s: - crepitus due to air trapped under skin - splinting of the chest w/ out being instructed (compensatory mechanism) - not taking deep breaths aka shallow breathing > impairs gas exchange
What are risk factors for ulcer disease?
- genetics - GI surgery - H Pylori bacteria must be present unless if ulcers are caused by NSAIDs - Medications such as NSAIDs, aspirin and chemotherapy - hypersecretory states = when the body of the stomach produces too much acid (can happen if sphincter aren't working properly) - stress - smoking (can also slow the healing of existing ulcers) - chronic disease - radiation therapy - alcohol ingestion (GI irritant) - lung disease and kidney disease as well
What are the steps to apply VAC dressing?
- get a Dr. prescription - cleanse would w/ saline and pat it dry - cut the foam to fit in the wound - cover with transparent dressing - place TRAC pad over wound - Secure to skin - insert canister in VAC machine - connect tubing - change dressing every 48 hours - D/C if bleeding noted or wound becomes superficial
What is an incentive spirometer and what is it used for?
- goal set by Dr. - used for lung expansion/ chest cavity expansion - breathe in, use inspiration NOT expiration - teach the pt to breathe in and when the reach max hold, they should hold for 3 seconds then exhale slowly in a controlled manner - keep going until the pt can't tolerate, make sure the pt doesn't get dizzy - they should do it 5 to 10x an hour - make sure the device stays close to the pt's bedside - make sure the pt is able to demonstrate - they should be in high fowler's - pt ed: "breathing through a straw", use controlled breaths
What is Transient Tachypnea of the Newborn (TTN)? What are the risk factors for it?
- gradual onset - risk factor is c-section bc they don't get the thoracic squeeze - Self-limiting respiratory disorder - Mild respiratory distress - Cause: retention of fluid in lungs or transient pulmonary edema - Fluid in fetal lung eliminated slowly or incompletely - Occurs within a few hours of birth, resolves by 72 hours - Risk factors: cesarean birth, prolonged labor, male, maternal asthma, fetal macrosomia, maternal meds
What does a fair prep consist of?
- greater than 90% of mucosa is seen - stool is liquid and semiliquid - can be suctioned and irrigated
What are some GI adaptions in newborns?
- gut is sterile until the first feeding - sterile means the gut has not been colonized and is susceptible to infection - colonizes in 24 hrs - the stomach is rigid (1st 48 hrs) & can only hold 30 -90 ml, in the first 24 hours it can only hold 10 - 20 ml - immature gastroesophageal sphincter > "spit up" - after the 1st feeding when the gut is no longer sterile vitamin K begins synthesis - maternal breastmilk > provides protection against bacterial infections of the gut > contains WBCs & antibodies > protects the gut flora - term babies lose 5-10% of their birth weight and gain it back w/in 10 - 14 days -Meconium is greenish black tarry stool = tissue+blood+intestinal secretions, babies eliminate w/in 24hrs of birth > if it's delayed, r/f cystic fibrosis/ hirschsprung dz, associated w/ delayed BM > concerning if they pass meconium inutero - transitional stool (greenish- brown/yellow, seedy) >> Milk stool (yellow) *early feeding = ⬆ stools + elimination of bilirubin
What is alopecia in regards to CA pts?
- hair loss - pv strategies don't exist - help pt become comfortable with it
What is the treatment for arterial disorders?
- hang the extremity below the heart - exercise - STOP SMOKING - Meds = PARC/ TAXP - surgery - thrombectomy and by-pass graft aka revascularization
What are hypertonic sol'ns and when are they used?
- has more solutes than water - highly concentrated sol'n - use when the inside of the cell has a low concentration of solutes and the fluid needs to move from the cells to the vascular space - higher osmolality than blood cellular shrinking 6 types of sol'ns: - D10W, D20W, 3% NS, D5W w/ (NS, 1/2 NS, 1/4 NS) - decrease peripheral edema, stabilize BP, increase urine output
What are hypertonic sol'ns and when are they used?
- has more solutes than water - highly concentrated sol'n - use when the inside of the cell has a low concentration of solutes and the fluid needs to move from the cells to the vascular space - higher osmolality than blood cellular shrinking 6 types of sol'ns: - D10W, D20W, 3% NS, D5W w/ (NS, 1/2 NS, 1/4 NS) - decrease peripheral edema, stabilize BP, increase urine output
What are the s/s of chemotherapy toxicity?
- hemorrhagic cystitis - ❤ muscle damage - ⬇ bone density - anemia > ⬇ RBCs + platelets > hypoxia + fatigue > impaired clotting > ⬆ bleeding ⬇ immunity > bone marrow suppression - neutropenia - mucositis > mouth sores, oral cryotherapy, oral hygiene, no mouthwash, inc water intake, pain meds, saline wash mouth, antibiotics, water based moisturizer - alopecia > hair loss, sunscreen, heat coverings, body image issues - thrombocytopenia (r/f bleeding under 20K) - N/V - stomatitis > tissues of the oral cavity - anorexia
What is the difference b/t high BUN levels and low BUN levels?
- high BUN, accompanied by high creatinine = renal failure, high protein diet = more protein for your liver to metabolize = high BUN - low BUN = malf(x) liver, there won;t be any nitrogen or urea bc BUN is the end product of protein metabolism
What are the risk factors for atherosclerosis?
- high LDL + triglycerides - low LDL - genetics - obesity - diabetes > vessel damage - smoking - sedentary lifestyle - stress = increased cortisol + vessel damage - OAs - AA + Hispanics have higher risk *mnemonic* "A-O-GODSSS" - African American, Hispanic - Old Age - Genetics - Obesity - Diabetes - Stress - Smoking - Sedentary Lifestyle
How do we treat severe diverticulitis? (Acute)
- hospitalization because of lots of pain and high fever - initially, NPO with possible NG tube to give bowel times to rest and stomach to decompress - IV fluids/IV antibiotics (helps decrease inflammatory process and help with pain) - Pain management (possibly opioids) - Surgical treatment If treatment fails... then bowel resection or colostomy
What should you do if a client behaves inappropriately?
- immediately tell client that their behavior is inappropriate - use clear statements - set boundaries - refocus client to their care - report the client
What is iron deficiency anemia? s/s? tx?
- inadequate iron intake > alcoholism, diet, Gastrectomy, infection - most common - fatigue, low exercise tolerance, small RBCs, pallor, weakness, fissures @ mouth corners, pica Tx: - inc iron intake (eggs, red meat, leafy greens) - iron solutions/supplements
What is infiltration?
- inadvertent or accidental admin of IV sol'n into surrounding tissue - commonly occuring - doesn't get detected often s/sx: swelling/edema, taut cool skin, tenderness, stopped or sluggish infusion - assess IV qh by uncovering the site and comparing the extremities to detect complications of the IV site
What is a bone marrow biopsy?
- invasive procedures - bone marrow is aspirated - uses large bore needles - local anesthetic - iliac crest is exposed - 5 - 15 minutes long - admin benzos/ tranqs - pv excess bleeding - cover site with dressing - no aspirin - can confirm cancerous cells
What are some dietary concerns for pts who are managing their diabetes?
- it should be individualized to take into consideration their culture - a dietitian or nutritionist should be consulted - CHO - teach the pt how to read labels - it is a lifestyle change - alcohol > men - 2 drinks w/ food > women - 1 drink w/ food
How do you keep the catheter clean? What is include in catheter care?
- keep free of secretions and incrustations - pericare and cleansing 1sst 4 in. of catheter - perform catheter care q8h - perform catheter care after defecation - use CHG wipes, CDC recommends soap and water - do NOT delegate if pt has had surgery or trauma to area
What are some specific dz conditions that can affect urination?
- kidney dz/ESRD - UTI - diabetes - MS BPH - Alzheimer's - dz that impact mobility
How can a nurse make sure they have the correct time?
- know the difference between tid and q8h - know the difference b/t ac and pc - know how dx testing may impact drug admin time
How would carcinoma of the larynx be diagnosed?
- laryngoscopy, most definitive way to dx cancer = biopsy - CXR - Barium swallow study, evaluate swelling process - CT/MRI - look for metastasis - nuclear imaging
What are some interventions to help pts w/ elimination?
- laxatives - stool softeners - enemas - stool softeners - pv - fluid intake ⬆ - ⬆ rouphage intake
How can the HCW protect themselves from radiation?
- lead shields - if pregnant or going to be pregnant don't do pt care w/ these pts - limit visits - don't touch radioactive surfaces with bare hands - pts are radioactive for up to 48hrs
What happens to the body with a pulmonary contusion?
- leakage of serum proteins and plasma > blood, edema in bronchioles and alveoli > ↓ lung movement > ↓ gas exchange + ventilation > hypoxia + carbon dioxide retention > irritation > ↑ secretion - collapsed alveoli = atelectasis - respiratory failure happens over time
What is an example of rapid-acting insulin? What is it used for? Nursing Implications?
- lispro (Humalog) for Type 1 and Type 2 Diabetes - Onset is 15 mins so food must eaten w/ 15 mins of admin - peak = 30 minutes - Duration 3 to 5 hours - 15 minutes before eating or just after meals
What are some ways to control the pt's HTN and treat CAD and HTN ?
- lose weight - diet low in Na+ - eat more potassium and calcium - stop smoking - manage your BP and your diabetes, monitor - min. alcohol - control your cholesterol - take your meds - exercise at least 75 min a week - remove nitro patches at night, but keep catapres on - avoid OTC meds
What is vitamin B12 deficiency/pernicious anemia? s/s? tx?
- low B12 due to gastrectomy, malabsorbtion, chronic diarrhea, diverticula, bacterial overgrowth - macrocytic anemia - cells get big - low intrinsic factor - pallor, jaundice, glossitis, fatigue, weight loss, paresthesia Tx: - inc Vit B12 (animal proteins, dairy, citrus, leafy greens) - vit supplements - injections bypasses GI tract
What is Heparin Induced Thrombocytopenia?
- low platelet count - low risk of this happening with Lovenox bc it has a low molecular weight - happens when antibodies form against heparin-platelet complex - usually resolves itself w/in 2 - 3 months - 4+ days on heparin increases r/f HIT
What are the benefits of exercise in type 2 diabetes management?
- lowers cardio risk - lowers BS - decrease insulin dose - weight loss - pv or delays T2DM
What are the benefits of exercise in type 2 diabetes management?
- lowers cardio risk - lowers BS - decrease insulin dose - weight loss - pv or delays T2DM - exercise uses up excess glucose
What is calcium alginate wound dressings?
- made of seaweed - soaks 20x their weight - used to pack wounds w/ a lot of drainage like diabetic wounds or full-thickness burns
What is the goal in tx of venous ulcers?
- manage @ home > out-patient hyperbaric oxygenation - emotional support - they will have lifestyle changes and laterd body image - pt ed: > no crossing legs > wear TED hose/ compression stockings > high protein and high zinc diet
What can sleep help us with?
- manage our stress - cognition - memory - decision making - muscle formation - balance - wound healing
What should we know about diuretics (k-wasting)?
- measure I&Os , ax for dehydration, and monitor nutrition + ** - we should see the pt's weight lower, BP lower, and urinary output increase - SEs = electrolyte imbalances, hypokalemia, dehydration
What are some things the nurse must educate on regarding electrolyte disorders?
- meds - diet (consult expert like the dietian so they provide things like sample menus) - follow up appts with the HCP - any s/sx the pt should report to the HCP
What are the signs and symptoms of malignant hypertension?
- morning HAs - blurred vision - dyspnea - uremia
What is the L/min & O2 percentage capacity of a nasal cannula, venturi mask, and simple face mask?
- nasail cannula 1 - 6 L/min 24 -44% - venturi 1 - 12 L/min 24 -50% - simple 6 - 12 L/min 35 - 50%
Summarize the anatomy of the kidney
- nephrons are the fxnal units of the kidneys - each kidney has a glomerulus = cluster of capillaries that surround bowman's capsule which is collection reservoir - proper pressure w/in the nephron is required for filtration to be at its best, this requires adequate BP & blood flow to the kidney - Urine formation -> GF = 1 st step -> GFR = the rate of blood that passes throught the kidney per minute -> decreased GFR = nephron loss or nephrons losing theirfiltering capability - 100% of RBCs, WBCs, platelets, albumin, glucose, and most proteins remain in the blood at the glomerulus bc they are too big to filter through so they are not normally found in the tubules or in excreted urine if found they should be investigated - glucose should be 100% reabsorbed back into the body as should most e+lyte content, bicarb, and water - Hydrogen will also be excreted if not needed - Excretion: nitrogenous waste products, urea from protein breakdown, uric acid, ammonia, and creatinine - creatinine is a skeletal waste product r/t wear and tear on the muscles and should be excreted 100% out of the body - A good way to measure the body's filtering capabilities is to measure a creatinine clearance or 24hr urine collection, this can also be used to measure GFR, as renal fx declines the creatinine increases
What types of complications manifest that are associated w/ the skin and feet? DM
- nerve damage - circulatory probs - poor wound healing - *pt ed, pt should see a podiatrist regularly
What should we know about staples?
- never pull them, it's painful for pts - if edges separate, use a steri strip
What is some general patient education post endoscopic procedure?
- no alcoholic beverages 24 hours after - no driving 12-24 hours - assess for bleeding (may have a little bit, but no bright red or blood clots) - discomfort (because of air to inflate by HCP) - flatulence (walking can help) due to air being used during the procedure - diet (NPO at least 1-2 hours, or until gag reflex comes back) - s/s to report to HCP
How do you administer an enema?
- no need for sterile technique - wear gloves - use lubricant - explain the procedure to the pt - positioning - left lateral sims, aimed towards belly button
What are the advantages and disadvantages to dry heat tx?
- no skin maceration skin the skin isn't being exposed to moisture, but this can lead to increased fluid loss - there's not evaporation so it doesn't cool as fast - decreased risk for burns disadvantages > theres no deep tissue peneration > dries out skin
What is echocardiography?
- noninvasive procedure used to look at the size and shape of the heart - * best for dx of heart failure - determines cardiac EF
What is the analegesics ladder for CA pts?
- nonopioid then weak narcotic then strong narcotic
What should we know about a nasal cannula?
- nostrils should point down - can be very drying - use the humidifier > 4 L/min which uses sterile/distilled water that should be changed evey 24 to 48 hours 1 - 6 L/min - 24 - 44%
What are the pharm tx options for diabetes management?
- oral antidiabetic agents = 1st line of defense e.g. metformin - insulin tx
What are the pharmo tx options for diabetes management?
- oral antidiabetic agents = 1st line of defense e.g. metformin - insulin tx
What are some neurobehavioral responses of newborn to take note of?
- orientation - aka alertness, response to stimuli - habituation - responding and blocking stimuli - motor maturity - controls & coordinates movement, limited but they can kick their feet and bring their hand to their face - consolability - self soothing, 5Ss, start to swaddling (make them feel secure & warm), sucking, swinging, shushing (white noise) - social behaviors - pos response to interaction e.g. cuddling
What are some behavioral sx as death approaches?
- out of character requests or statements - performing repetitive tasks - restlessness
What are some clinical manifestations of DVT?
- pain in the area of thrombus - sudden onset, unilateral edema - red, warm , indurated (hardened) vein
What are some s/s of anemia?
- pallor - cool tto the touch - orthostatic hypotension - tachycardia - DOE - low O2 sats - fatigue - HA * heart attack *angina/ chest pain
What causes non mechanical BO? Bowel obstruction
- paralytic ileus —> Decreased peristalsis (can happen when there is surgery of the bowel and it's being manipulated a lot) - neurogenic disorders (lazy bowels or nerves not functioning properly) - manipulation disorders - vascular disorders (such as vascular insufficiency where you can get a clot/emboli and causes the bowel to infarct/die) - electrolyte imbalance (eg. Low k+ can slow down GI motility) - inflammatory response (eg. septic, peritonitis) - bowels are sensitive to touch
How is ventricular septal defect (VSD) tx?
- patch closure - cardiovascular patch - watch out for arrhythmias
What is transparent wound dressing used for?
- peels off - used for IV Sites and little tears
What are post op complications & nursing interventions for gastric surgery?
- perforation - hemorrage - nutritional - NPO and then advance as tolerated - assess I&O and bowel sounds at least every 4 hours and PRN - may be a good candidate for PARENTERAL NUTRITION or TPN (total parenteral via IV) - care for NG tube - pernicious anemia
How do we diagnose a bowel obstruction?
- physical assessment - history - abdominal ultrasound - radiologic exams: X-ray to see free air or gas - endoscopic exams - lab tests
What are some general characteristics of blood?
- plasma + cells - RBCs = no nucleus, produce Hgb > needs iron to carry 4 O2 molecules - RBCs produced during erythropoiesis - EPO produced by kidney - no O2 = hypoxia - WBCs = inflammation + immunity - BENMM = inflammation - B cells = antibodies/plasma/memory - Cell - mediated immunity = T cells/ NK cells - Platelets = clotting - spleen (blood destruction +immunity) + liver (blood clotting) = blood production - pH = 7.35 - 7.45
What are some important nursing implications and adverse rxns of Lovenox?
- platelets (150k - 400k) > H/H = hemoglobin = 12 - 16 Women, 14 -18 Men & hematocrit - 37 -47% Women or 42 -52% Men - hemorrhage and HIT (less risk than regular heparin)
What is liquid oxygen?
- portable - some battery powered - electric tank - refillable - uncommon - up to 6 L/min
What are some expected outcomes for pt's dealing with their psychosocial issues appropriately?
- positive self concept - verbalize self acceptance - social interaction - adequate self care - eye contact - adapting - demonstrate understanding of teaching
What is the nursing care for surgery: CD & UC?
- pre-op care - routine pre-op surgical prep - if ostomy needed, meet with ET nurse for mapping - emotional support - bowel prep - correction of fluid/electrolyte imbalances corrected - nutritional assessment (48 dietary recall or calorie count)
What is involved in the nursing care of the immunosuppressed patient?
- protect the pt from the HCWs - total pt ax - skin + mucous membrane inspection - inspect venous access device insertion sites - ax q4h - pt teaching = report pimples, sores, rash, open sores - report cough, burning on urination - wash hands -aseptic technique - no common area equipment - change wound dressing qd culture suspicious areas - visitors = healthy adults - monitor WBCs - avoid indwelling catheters - private rooms w/ no fresh plants - monitor temps = > 100 degree - anti-infective/antibiotic/antifungal drugs
How is self-monitoring used w/ pts?
- pt controlled - e.g. Accucheck, Lifescan, One-Step systems - still requires periodic follow up - Type 1 pts should check the BS a.c. h.s. - Type 2 pts BS check depends on them - keep a logbook @ home to detect spikes & dips - check BG after hypo/hyperglycemic events OR when meds/activity/diet are changed, stress, illness - use urine strips to check for ketones (type 1) - ketones should be tested if BS is >300 - ketones in urine = BAD
What is the nurse's role in monitoring anticoagulants?
- pt ed - carefully check dosage, use IDV = independent double verification (a second nurse that verifies the dose) - monitor: > bleeding > vitals e.g. tachycardia, tachypnea > labs e.g. INR, aPTT - admin antidote > Protamine Sulfate = inject slowly via IV, immediate binding within 2 hrs - use pressure over IV sites - always ask in the pt is on anticoagulants BEFORE taking out IVs
What are isotonic sol'ns and when are they used?
- pts who are hypotensive, dehydrated, have a low blood volume (hypovolemic), pts who are vomitting or have diarrhea, surgical pts who have blood loss - doesn't cause a fluid shift - same concentration as blood - NS = Normal Saline = 0.9% NS and D5W is isotonic sol'n b4 it enters the body, Lactated Ringers - expands extracellular fluid (ECF) "replaces what was lossed"
What are isotonic sol'ns and when are they used?
- pts who are hypotensive, dehydrated, have a low blood volume (hypovolemic), pts who are vomitting or have diarrhea, surgical pts who have blood loss - doesn't cause a fluid shift - same concentration as blood - NS = Normal Saline = 0.9% NS and D5W is isotonic sol'n b4 it enters the body, Lactated Ringers - expands extracellular fluid (ECF) "replaces what was lossed"
What is a positive to using the nasal cannula as opposed to other oxygen administering devices?
- pts. can eat and still recieve their oxygen
What are some types of temp alterations?
- pyrexia = fever = cellular metabolism ( up 10% for every degree) and oxygen consumption rises (HR + R go up) > the more use energy, the more heat we produce > since the body is producing heat,, we sweat and increase our breathing rate which increases our fluid loss > pyrogens > febrile/ afebrile > FUO - heat exhaustion - hyperthermia = >104 F - malignant hyperthermia (anesthesia rxns, "have you ever had a severe rxn to/complication with anesthesia?") - hypothermia (frostbite, water in cells crystallize)
What are some nursing dx associated w/ impaired skin integrity and wounds?
- r/f for infections - imbalanced nutrition: less than body requirements - acute/ chronic pain - impaired physical mobility - impaired skin integrity - r/f/ impaired skin integrity - ineffective peripheral perfusion - impaired tissue integrity
What are some patient transfer techniques?
- raise bed to working or waist height - Have a wide base of support with one foot closer to the bed in front of the other foot - use the pt's bent knee on the side away from you as an "arrow" to guide the pt's body to a side lying postion - have the pt help you ask much possible e.g. ask them to reach for the side rail or have them hug themselves when using the draw sheet to move them - use a pillow to prevent the pt's head from hitting the headboard - don't stand too fast, allow the pt to sit at the side of the bed and flex their feet/dangle to promote vasoconstriction and prevent symptoms of orthostatic hypotension - use a gait/transfer belt - when transferring to a chair palce on the pt's strong side @ 45 degrees - do each step on the count of 3 - use teachback for pt and family education - when supporting a joint always support the areas proximal and distal adjacent to the joint - try to reduce friction i.e. use a slide board
What are some different types of insulin tx?
- rapid acting = injected insulin - short acting = insulin pens - intermediate acting = insulin pumps * most common - very long acting = inhaled insulin
What is chemo brain/chemo fog?
- reduced ability to concentrate - memory loss difficulty learning new info - common in women - cognitive training resources - dec alcohol intake + rec drugs + head injury risks
What is Peripheral Venous Dz?
- refers to the altered blood flow in the veins due to thrombus, defective valves, or skeletal muscles not contracting - Basically a clot, pt valves not working, or their voluntary muscles are unable to work to help their blood circulate - PVD = circulation problem
What are some newborn neurologic adaptions to consider?
- reflexes - the absence, persistence, or reappearance of reflexes can indicate brain pathology *early detection - sensory capabilities include: > hearing - fully dvlped at birth > taste - sweet & sour @ 72 hrs > smell - distinguishes mom breastmilk > touch - pain, responds to tactile stimuli > vision - incomplete @ birth, focuses @ 8-15 in, ☑ black & white toys, color vision is at 4 mos., they like human faces, nearsighted, distance&tracking @ ~ 7 mos.
What is included in patient education for pt's with diabetes?
- regularly monitor glucose, especially newly diagnosed pts. - perform foot care - H&P - if the BG is >250, <80 or if they have ketones in urine, do NOT exercise - carry easily absorbed carbs
What is included in patient education for pt's with diabetes?
- regularly monitor glucose, especially newly diagnosed pts. - perform foot care - HCP: if the BG is > 250 for 24hrs+, <80 or if they have ketones in urine, do NOT exercise - carry easily absorbed carbs
What is some of the characteristics of ulcerative colitis (UC)?
- remissions and exacerbations - autoimmune component - widespread, diffuse, continuous inflammatory process = damage to digestive tract causing the symptoms
Why would we use a chest tube?
- remove air or fluid from pleural space - pv air from getting sucked in the thoracic cavity - immediate relief - nurses assist w/ bedside placement
What are the causes of hyperkalemia?
- renal failure - burns - crush injuries - meds (k- sparing diuretics) - increased ingestion of K+ (primary way we get K+ is via diet)
What are the causes of hyperkalemia?
- renal failure - burns - crush injuries - meds (k- sparing diuretics)
What are the fx of the kidneys?
- secrete EPO - stimulate the production of RBCs - convert vitamin D from inactive to active form so that Ca2+ can be absorbed from the gut - dysfx of the kidneys interferes with urinary/bowel elimination and homeostasis of fluid volume and BP through the RAAS system, this effects e+lyte levels and waste excretion in the form of creatinine is also effected - Acid -base imbalance can occur with kidney dysfx as well - issues with bicarb and inability to filter waste products that are acidic > decrease in pH
What can a nurse do for ineffective tissue perfusion? ❤ lecture
- semifowler's to expand - humidification - watch out for skin breakdown when a patient - assess vital signs - pulse ox - @ risk for fluid overload
What are some oncologic emergencies?
- sepsis > death > due to impaired immunity, fever 100.4 first sign - impaired clotting > bleeding = DIC = Disseminating Intravascular Coagulation > use heparin to break up excess clot formation - SIADH > excess water retention due to ADH, fluid restriction, inc Na+ intake - spinal cord compression - Tumor Lysis Syndrome = pos sign of tx, hydration - SVC syndrome = painful, blockage of venous return - hypercalcemia > anorexia, n/v, kidney stones, bone pain, ALOC
What are SCDs?
- sequential compression devices - they inflate and deflate (sequentially) - massages upward towards the heart - before you leave the patient watch it for a full cycle = inflate & deflate - used to prevent blood clots
What are some s/s of hypoglycemia?
- shaky/trembling - tachycardia/ palpitations - sweaty - dizzy - anxious/nervousness - blurry vision - fatigue - irritable - HA
What are some s/s of hypoglycemia?
- shaky/trembling - tachycardia/ palpitations - sweaty (diaphoresis) - dizzy - anxious/nervousness - blurry vision - fatigue - irritable - HA - pallor - adrenergic in nature sympathetic BELOW 40 Blood Glucose = ↓ brain fx - Confused, HA, Lethargic, unconscious , ALOC *Pt Ed. - beta blockers mask cardiac s/s of hypoglycemia so they don't have tachy ❤
What can cause abandonment and assignment issues?
- short staffing - high nurse to pt ratio - floating - nurse may be floated to a different floor and not be familiar with the equipment or pt population - physcian orders - nurses should question a Dr orders
What should know about routine urine testing? (types/precautions)
- should use universal precautions - GLOVES - clean catch/ midstream - straight cath/ sterile catheter - 24 hour - throw away the first void and collect the urine for 24 hrs
What is the first thing that a nurse should do if they believe that an IV site has either an infiltration, phlebitis, or extravasation?
- shut the IV pump off - stop med admin
What are some ways to minimize skin damage after radiation?
- skin care - don't remove ink markings, if they indicate exactly where the beam needs to be aimed - wash irritated areas - don't rub skin - non-aluminum deodorant - no washcloths - use only Rx powders, lotions, ointments - soft clothes - avoid sun/heat on exposed area > skin is photosensitive no belts, straps, buckles
What are some cultural aspects that can affect urination?
- some pts require same gender - privacy - may require interpreters - hygiene knowledge - female circumsion - family involvement
How is cancer generally diagnosed and treated?
- surgx - radiation > high energy radiation > local tx > CA DNA is damaged which leads to cellular regulation todeath > most common uses gamma rays > Beta particles can be used - chemo - immunotherapy - hormonal tx - combo
How do we prevent hypoglycemia? (patient education)
- teach s/s of hypoglycemia - check BG AC/HS/PRN - prep for exercise - take a snack before & after, take scheduled insulin - travel w/ supplies - Medic Alert bracelet
What are some safety guidelines for hot and cold tx?
- teach the pt - provide a timer - assess q20mins - have the call light within reach - clean the equipment - trend the vitals, report abnormals - determine frequency based on your patients conditions
What is important to teach our pts generally about warfarin?
- teach them s/s of bleeding and to report to HCP - safety e.g. easy bruising - labs - to be used for adjusting dose - take as directed - tell providers that you are on warfarin - Avoid NSAIDS, OTC meds, Salicylates = increases affect of coumadin
What type of mask can provide the highest amount of oxygen to a pt without mechanic ventilation?
- the nonrebreather and partial rebreather masks 60 - 90% oxygen 10-15 L/min
If a nurse attempt to flush a peripheral IV and is unable to infuse the saline, what course of action should they take?
- the nurse needs to problem solve, make sure all clamps are open - never force IV fluid through a saline lock, this can cause embolus, if the fluid can NOT flow through they should restart the IV
How can a nurse tell a pt could potentially have a blood clot?
- the pt reports pain - there's swelling - hot to the touch - tender *the nurse should report to the provider and elevate the legs*
What are the advantages and disadvantages of moist heat tx?
- the skin doesn't dry out, buut if you leave on too long can lead to maceration - compress conforms to area and to keep constant heat add a layer of plastic wrap, but it will cool fast d/t evaporation - penerates deep tissue which is a good thing, but increases your risk for burn injury
What are some negative to a fever?
- the stress of a fever can exacerbate an cardio or respiratory problem - since the fever cause increase energy use the pt becomes fatigued - increased temp = increase 02 which can lead to cellular hypoxia - decreased oxygen to the heart leads to chest pain while decreased oxygen to the brain produces confusion - due to the s/sx onne of the interventions during fever is oxgen therapy
What is Nadir effect?
- the time when bone marrow activity & WBC count are @ their lowest post cytotoxic drug tx - avoid using drugs that have the same nadir time to pv reduced immunity and immunosuppression too much
What type of pt is a candidate for home enoxaparin (Lovenox) therapy?
- their DVT/ PE is stable - they're reliable - r/f bleeding low - good renal f(x)ing - stable vital signs - able to monitor & report bleeding
How does the narcotic control system work?
- these drugs are locked up, there's an inventory sheet, narcotics are dispensed by the pharmacy, the nurse counts the supply and signs the inventory - before the nurse admins the drug they must check when the pt last had their med - chart the med admin - follow up w/ a pian assessment - co-signing or a witness is required when wasting a med - @ the end of a shift two nurses have to count the narcotics, the going and coming nurse
What is important to teach the pt regarding vitamin K consumption and warfarin?
- they can eat vitamin K but need to keep their diet consistent so they don't have spikes of vit K, practice moderation
What is the nurse's role in med admin?
- they make sure the are giving the right med - they assess the pt's ability to self administer - use their judgement to hold or pass a med - adminster med correctly - monitor a pt after the admin of a med - pt. education
How would you describe the blood vessels of a hyperglcemic patient?
- thick/ concentrated/ high osmolarity blood - clogged vessels - sharp glass-like molecules (sugar) that leads to ⬇ perfusion & damaged blood vessels in the eyes, kidney failure
When malignant HTN progresses how will it manifest in a patient?
- think malignant = deadly, serious - LV heart failure - stroke - kidney failure
What is bone marrow harvesting?
- tissue typing - OR procedure - 500 to 1000 ml of bone marrow HARVESTING - marrow is filtered donor is monitored for fluid loss, anesthesia complications, & pain - same - day procedure - pain can be severe - keep dressing dry & intact - from iliac crest
Why is a patient receiving loop diuretics? examples?
- to ↓ BP and ↑ fluid volume excretion, heart failure - furosemide (Lasix) - bumetanide (Bumex) *K+ wasting
Why is a patient receiving diuretics? i.e. Thiazide diuretics, examples?
- to ↓ BP and ↑ fluid volume excretion, heart failure - e.g. hydrochlorothiazide (Hydrodiuril)
What are some alternative wound dressings?
- topical ointments - enzymatic, for necrotic tissues - hydrogen peroxide, to help slough/dead tissue
How do we treat a hyperglycemic patient?
- treat the cause - take insulin - follow sliding scale (rapid-acting insulin) - oral meds - exercise - uses all the insulin - check for ketones (fat breakdown) if BG > 300
What is nitroglycerin (Nitro)?
- treats hypertension and angina - vasodilates > decreased BP - always ask pts if they are taking meds like Viagra/ ED meds bc they lower BP - Replace q6months - admin sublingually, if it doesn't tingle then it's not activated - nurse should use gloves when admin the paste version of med - may cause headaches so HCP may also prescribe Tylenol - standard order is 1 pill q5mins up to 3x with BP and pain assessment in between each admin - always assess BP before admin, if BP is low then consider holding med
What is TNM staging? How is cancer classiifed using this system?
- tumor, node, metastasis - determines prognosis - not useful in leukemia + lymphomas - PRIMARY TUMOR (T) Tx (can not be assessed), T0 (no tumor), Tis, T1 - T4 (size based) - REGIONAL LYMPH NODES (N) Nx - N3 - DISTANT METASTASIS (M) Mx - M1 - tnm helps w/ communication among HCWs - everybody's on the same page - helps dvlp protocols
Why is a patient receiving alpha II adrenergic agonists? examples?
- tx HTN - methyldopa (Aldomet) - clonidine (Catapres) Mnemonic: think of the II in "alpha II adrenergic agonists" like speed bumps or roadblocks if you stop abruptly you get rebound HTN
Why is a patient receiving vasodilators? examples
- tx HTN and chest pain - isosorbide (Isordil) - hydralazine (Apresoline) - nitroglycerin (Nitro) Mnemonic: Vasodilators are in a group called "NIA"
Why is a patient receiving cardio selective beta-blockers?
- tx HTN and heart failure - atenolol (Tenormin) - metoprolol (Lopressor) "-lol"
Why is a patient receiving non-cardio selective beta-blockers? examples?
- tx HTN and heart failure - carvedilol (Coreg) - labetolol (Trandate) - propanolol (Inderal)
What falls under the umbrella term: inflammatory bowel disorders?
- ulcerative colitis - Crohns disease - diverticula disorders
How can we diagnose diverticular disease?
- upper GI series (where they look at small bowel to see if they see any pouches) - barium enema (BE) where they give enema with barium in the large bowel. (EXCEPT FOR IN ACUTE PHASE BECAUSE IT CAN RUPTURE) - CT of abdomen to show areas of bowel that has becomes thickened because of the diverticula - flat plate of abdomen (looks for free air or fluid=means pouches have perforated) - colonoscopy (has to be done 4-8 weeks after acute phase of illness or it will cause inflamed diverticula to rupture)
How can a nurse make sure she has the right patient? Follow through with "Right Patient"?
- use 2 pt identifiers - compare armband w/ MAR - ask the pt to use their full name - use tech but don't become dependent on it - be familiar with the clients that have the same last name - Ask about allergies - ed. pt. about med - remember that pts have the right to refuse by giving them the name of the drug, dosage, and use of med
What are safey precautions put in place for nurses and pts during chemotherapy?
- use PPE = double gloving, chemo gloves - oral and IV chemo = toxic - dispose expired/DC oral chemo
What are some things to consider as a nurse regarding administering meds to treat electrolyte disorders?
- use an IV pump - they may use capsules - no faster than 10 mEq per hr for K+ - Kayexalate = diarrhea, diarrhea!
What are some ways to keep accuracy during med admin?
- use clinical judgement - document - only admin meds you prepare - avoid distractions - follow a routine - ADHERE TO THE 6 RIGHTS
What are the stages of pressure ulcers?
- use the braden scale to determine the r/f pressure ulcers, Bates- Jensen Wound Ax - "once a pressure ulcer, always a pressure ulcer" you can't go from a 3 to a 2 pressure ulcer 1 - nonblanchable, redness 2 - partial thickness, epidermis, dermis 3 - full thickness, visible fat 4 - visible bones, tendons, and muscle unstageable = unkn depth deep tissue injury = unkn depth, suspicion, blisters
How should a client use a quad cane?
- use the cane on the affected leg - should be at hip length - the cane goes out first, then the weak leg then the strong leg
How can a nurse make sure they have the correct route?
- use your resources - change or clarify form or routes due to nausea, NPO status, NG tube, time released tabs or enteric coated meds
What is the role of the healthcare provider or pharmacist?
- uses distribution systems to make the precribed meds has the correct proper dosage, amount and a correct label - verifies the accuracy and validity of Rx - provides the pt. with info about side effects, toxicity, interactions, and incompatibilities
What is important to note about Thiazolidinedione?
- usually taken in conjunction w/ metformin
How would a hemothorax pt present and how would we treat them?
- vary by size - remove blood > chest tube - pv infection - respiratory distress - ↓ BS - Blood loss s/s = abn heart sounds, hypotension > blood transfusions/ IV fluids + ❤ monitoring + VS + I&Os (monitor organ fx) - Dull sound on percussion bc there's fluid not just air - blood seen in CXR/thoracentesis - open thoracotomy 1500 - 2000+ ml off blood
What are the therapeutic effects of cold?
- vasoconstriction - local anesthetic - decreases cell metabolism - increase blood viscosity - decreas muscle tension - reduces inflammation - *pv* edema, if the site is already edematous say NO to COLD - reduces pain - reduces oxygen needs of tissues - promotes blood coag
What is the therapeutic effect of heat?
- vasodilation - decrease blood thickness - decrease muscle tension - increase tissue metabolism - increase cap permeability - improve blood flow - increase delivery of WBC & antibiotics - decrease pain - help remove waste
How should we treat hypoglycemia w/ a conscious pt?
- verify w/ a fingerstick, immediately if symptomatic - 15g concentrated carbs - recheck BS q15mins - repeat if still <74 - if you can't do a fingerstick treat anyway it's easier treat now then when the pt is unconscious
How should we treat hypoglycemia w/ a conscious (A+O) pt?
- verify w/ a fingerstick, immediately if symptomatic - 15g concentrated carbs (CHO) - recheck BS q15mins - repeat if still <74 - if you can't do a fingerstick treat anyway it's easier treat now then when the pt is unconscious - follow hypoglycemic protocol
How should we treat a hypoglycemic pt who is unconscious?
- verify w/ fingerstick - NPO - IV D50W - 1 mg Glucagon injection - Medic Alert bracelet
How should we treat a hypoglycemic pt who is unconscious?
- verify w/ fingerstick - NPO - IV D50W, 25 - 50mL (IV Push) > flush w/ saline . check in 15-20 min if less than 100, q15 until over 100 --> hard on veins, consider IV location - 1 mg Glucagon Subq OR IM injection - takes 20 min to work not a common choice, given when there's no IV access - Medic Alert bracelet
What are some things a nurse will monitor for electrolyte disorders?
- vitals - labs (electrolyte panel) - cardiac rhythm - I&Os (is the pt over or under hydrated?) weight (use the same clothing and do it at the same time everyday)
What causes mechanical BO?
- volvulus (compression/stricture/twisting of intestine) (90% of all obstructions) - tumors (can grow inside intestine and block off package) - hernia - fecal impactions (haven't gone to the bathroom and fecal content keeps getting packed up) - emboli - cancer (most common cause of large intestine obstruction) - adhesions (most common cause of small intestine obstruction, when you have prior surgery and clump of tissue or overgrowth of tissue can cause obstruction)
How are aldosterone receptor blocker potassium sparing diuretics different from loop or thiazide diuretics?
- we don't admin potassium supplements like with thiazide or loop diuretics - SEs = HYPERkalemia not hypokalemia - conserves K+ - we should expect the BP and weight to go down and urinary output to go up, the K+ should remain stable
What is important to know about a nursing students role?
- when a student's action cause harm to patients the liability falls on them, their school, the hospital, and their instructor - nursing students MUST separate their role as a CNA from their role as a student
What is considered malignant HTN?
- when the BP is 200/150 + or 200/130 + w/ a prior condition
What are the 3 times a nurse should check a med against the MAR or order?
- when you come into the contact with the drug from the draw or shelf - before you prepare or calculate the drug - before admin of med @ the pt's bedside or before putting the drug back on the shelf
When can non-critical med be given?
- within 1 to 2 hrs before or after scheduled time, always follow facility policy
What is Duchenne Muscular Dystrophy? How is it diagnosed? What are the s/s of DMD? How do you treat it?
- x linked recessive, males > females - Muscle wasting & weakness - Live fore 20 -25 yrs - Late walkers - Clumsy - Lack of coordination - Pseudohypertrophy - big calf muscles - Gowers sign - severe muscle weakness, keep their leg straight to get up - Dx: ▪ EMG - muscle probs not nerve issue ▪ Muscle biopsy - abscence of dystrophin need for maintenance muscle fx -Tx: ▪ no cure ▪ Long term corticosteroid - slowed the progression of the dz - protects muscle fiber damage ▪ Ca2+ & Vit D supplements ▪ Supportive care ▪ Emotional support
Why is a patient receiving Statins? examples? SEs? Nursing implications?
- ↓ cholesterol, triglycerides & LDL and ↑ HDL and to lower the synthesis of cholesterol in liver - e.g. HMG-CoA statins = lovastatin, atorvastatin, rosuvastatin, simuvastatin = Mevacor, Lipitor, Crestor, Zorcor LARS = MLCZ - no grapefruit juice - admin at night - monitor cholesterol - LFTs q 3 -6 months - SEs = myalgia, arthralgia, and hepatotoxicity
How can cancer be prevented?
- ↓ fat intake - ↓ deli meats - ↓ red meats - minimize alcohol consumption - ↑ bran intake - ↑ leafy green intake - ↑ vit A + C intake - avoid known carcinogens - screening - vaccination
What are the complications associated w/ nephropathy? DM
- ↓ kidney fx - ESRD - edema - labs askew - arrhythmias - damage is irrevsible, early detection is key EDUCATE the PATIENT
What are some s/s of hypokalemia?
- ❤️ dysrhythmias - shallow RR - Leg cramps, muscle weakness that leads to paralysis - Decreased GI motility, N&V, constipation that leads to distention - altered mental status - diminished reflexes
What are the s/s of hyperkalemia?
- ❤️ dysrhythmias/ EKG changes - muscle weakness and paresthesia (abnormal tingling) that progresses to muscle weakness and paralysis - increased GI motility = diarrhea, increased bowel sounds - bradycardia - irritability
What are the s/s of hyperkalemia?
- ❤️ dysrhytmias - muscle weakness - increased GI motility
What is Epoetin Alfa? how does it work? side effects? adverse effects? nursing implications?
- ⬆ EPO > erythropoiesis in bone marrow - HA, Body aches, diarrhea, irritated injection site - chest pain, dyspnea, ↑ BP, rapid weight gain, edema, MI - watch H/H + vitals (before and throughout tx) - tx anemia - subq or IV - takes awhile to work
Why would fluid loss be high in neonates?
- ⬆ insensible loss due to ⬆ metabolism - ⬆ water loss due to RR
What is an ERCP? What does it do?
-*Endoscopic retrograde cholangiopancreatography=ERCP* - This allows us to go further and see liver, gallbladder, bile ducts and pancreas. - Used more to relieve obstructions (&symptoms) than for diagnosis. (eg. Gall stones, gall bladder disease) - Can cause discomfort, n/v, yellowing of the skin (if bile duct isn't drained properly), sore throat and horseness. - **remember the common bile duct itself is attacked to the liver, pancreas and gallbladder.** Monitor for fever & n/v after medical intervention
What are some examples of nursing dx pertaining to psychosocial problems?
-Disturbed Body Image -Caregiver Role Strain -Disturbed personal identity -Parental Role Conflict -Chronic Low Self-Esteem -Ineffective Individual Coping -Risk for Loneliness -Social Isolation -Risk for Violence -Impaired Social Interactions
What are some complications with bowel obstruction?
-dehydration (most likely to vomit with small bowel obstruction) (measure I&O!!!!!) < persistent vomiting (measure vomit) -electrolyte imbalance (measure I&OS!!!!!) < persistent vomiting (measure vomit) -metabolic alkalosis (losing a lot of hydrochloride acid)(NG suck out stomach acids as well) - metabolic acidosis (alkaline not being reabsorbed in the colon)
What is hyperventilation?
-lungs remove CO2 faster than it is produced by cellular metabolism -increase CO2 level stimulates increase in rate & depth of RR -s/s are rapid RR, numbness, tingling hands/feet, light-headedness, loss consciousness
What is the difference b/t thrombocytopenia & thrombocytosis?
-penia = bleeding, decreased platelet count -tosis = clot risk, increased production of prostaglandins which leads to platelet aggregation
What are some nursing problems for diabetes pts?
-r/f infection - r/f injury - safety - fear - knowledge deficit
What is some of the characteristics of Crohn's disease?
-remissions and exacerbations -autoimmune component -cobblestone appearance;inflammatory, spotty, sporadic, process may occur anywhere in the GI tract
What is the diff b/t high and low creatinine levels?
0.6 - 1.2 mg/dL men 0.5 - 1.1 mg/dL women Note: extremely muscular ppl normally have elevated values and NR is higher in men than in women bc they have more muscle mass and OAs have low creatinine bc they have low muscle mass low creatinine - caused by malnutrition - low muscle mass high creatinine - dehydration - kidney failure - kidney disorders - rhabdomylosis
What is the normal range for creatinine?
0.6-1.2 mg/dL for males and 0.5 - 1.1 mg/dL for females
How many liters can a nasal cannula deliver?
1 - 6 L/min, 24 - 44%
What is the maximum you can inject into subq tissue?
1 mL
How long can we leave a turniquet on for?
1 min or less to pv hemoconc.
How long should you leave a tourniquet on?
1 minute or less
What are some important therapeutics bed positions?
1. *Fowler's* *45* - 60 degrees = oral meds + food, semi sitting, nasotrach suctioning, promotes lung expansion, bed may be raised @ knee 2. *Semifowler's* *30* - when pt has gag reflex, ventilator- assisted pts, bed may be raised @ knee 3. *High fowler's* 90 degrees - not for pregnant women, not for pt's with gastritis 4. *Trendelenburg* - head down, feet upm postural drainage, good for venous return 5. *Reverse Trendelenburg* - feet down, head up, use it for pt who can't move their legs, i.e. parapalegics, not common used, prevents esophageal reflux 6. Sims' position - for rectal exams, relieving pressure, rectal temp, suppositories 7. Prone - on stomach 8. Side lying - lateral 9. *Supine* - lying on the back 10. Dorsal recumbent - gyno/pelvic exam =, on the back with knees bent up
How is pH regulated in the body?
1. Carbonic Acid - Bicarbonate Buffer System - the most beneficial and the one we monitor clinically - Carbonic acid = H2CO3 (CO2 & H2O), weak acid > When interpreting ABGs only the CO2 is measured > CO2 and H2O are directly reflective of each other, so it's a direct reflection of carbonic acid in the arterial blood > CO2 can accumulate when it can't be released via the respiratory system or by eating carbohydrates or when you have a fever - Bicarbonate (base) = HCO3 i.e. When we have high acid then we'd want the HCO3 to increase and bind with the acid - Respiratory controls CO2 changes and it's faster the renal system bc it can make these changes in seconds to minutes > pH acidic (< 7.35) -> ⬆ (resp rate & depth) > pH alkaline (> 7.45) -> ⬇ (resp rate & depth) - Renal regulation can take several hours to days > pH acidic (< 7.35), excrete H+ in urine > pH alkalinity (> 7.45), excrete HCO3 in urine 2. Phosphate Buffer System 3. Protein Buffer System
How do you categorize pain by location?
1. Cutaneous - ex: paper cut aka supercial, 2. Visceral - ex: menstrual camps, aka deep organ pain, 3. Deep somatic pain - ex: arthritis aka bone pain, 4. Radiating pain - follows a nerve, 5. Referred pain - ex: chest pain referred to arm, distant area, 6. Phantom pain - ex: amputees, 7. psychogenic
How does a nurse care for a client in restraints?
1. They must verify that there's a HCP order and the order must specifiy the type+location+specific duration+circumstance for use of the restraint, 2. According to hospital policy the HCP order is limited to 8-24 hrs for adults and a face to face assessment is req'd w/in 1-4 hrs of order
What are the goals of PVD tx and how do we reach those goals?
1. healing > wound vac, hyperbaric oxygenation (HBO), enzymes, occulsive hydrocolloid dressings, diet high in protein, zinc, vitmain A and C 2. pv infection > antibiotics 3. promote venous return > elevation above heart, TED hose/ compression socks 4. ↓ edema
what are the 3 possible outcomes of 2 drugs interact?
1. intensification - one drug intensifies the action of the other 2. reduction - one drug decreases the action of the other 3. mystery - unknown rxn we haven't seen before
How can we minimize drug-drug interactions?
1. keep an eye pts who are on drugs with a low/narrow therapeutic index (riskier, less safe) 2. take a drug hx and reconcile meds 3. do a review of pt meds in order to minimize the number of meds the pt is taking 4. look out for pt using recreational meds 5. watch med timing this may impact absorption
What is the difference b/t hypomagnesemia and hypermagnesemia?
1.3 - 2.1 mEq/L, controls the absorption of Ca, Na, K, neurochemical activities, ❤ & skeletal muscle, excitability Mnemonic - "Milk of magnesia, Mg controls Ca absorption", "The M in the magnesium stands for muscle, the fx of Mg is muscle excitability" inverse relationship b/t sx and hypo and hyper Mg "Mg moves w/ K" hypomagnesemia - caused by "m'am" = malnutrition, alcohol, malabsorption - hyperactive DTRs - tachycardia - muscle cramps - anorexia - seizures hypermagnesemia - caused by the excessive use of antacids, ESRD - bradycardia - hypoactive DTRs - decreased depth of respirations - bradypnea
How is CKD prevented and how prevelant is it?
11% of adults in the US have CKD Black patients are more likely to develop ESKD Also prevalent in Hispanics, Native Americans, and Pacific Islanders Occurs more often in males - Control HTN (encourages hardening of the arteries, known as nephrosclerosis, goal: <140/90, may need more than one BP med) and DM - Promote CV risk reduction - May need statins, fat/lipid lowering meds
What is the normal range of sodium?
136 - 145 mEq/L
According to the CDC what is the recommended amount time it should take to perform hand hygiene?
15 - 20 secs
What is the CDC 2 tier approach to preventing transmission?
1st tier aka Standard precautions - use with all patients all the time = "foam in, foam out", use PPE when appropriate, cough/sneeze using your inside elbow, dispose of sharps, needles, syringes in the proper containers. 2nd tier is used when the pt is suspected of or is infected and we use one of the three transmission based categories of precaution: airborne, droplet, or contact precautions depending on the patients infection.
What are CDC's guidelines for preventing transmission?
2 Tier Approach Tier one = *Standard Precautions* = use with every pt every time or ALL pts ALL the time - #1 prevenative method - hand hygiene before after and in between pt contact, wash hands if they are visibly soiled, before and after gloving, don't use sanitizer for spore forimg bacteria like C. diff or B. anthracis - use cough etiquette/sneezing - wear PPE like gloves when you can be exposed bodily fluids like blood, urine, secretions, excretions Tier two = *Transmission - based precautions* AIRBORNE - used with chickenpox, measles, TB = private room, negative pressure w/HEPA (6-12 exchanges per hour, N-95/mask CONTACT - used for VRE/MRSA, C. difficile, shigella, major wounnds = gown and glove, private OR cohort room DROPLET - used with pneumonia, pertussis, mumps, strep pharyngitis = private OR cohort, gown and glove PROTECTIVE ENVIRONMENT - allogeeic hematopoietic stem cell transplants = private room, positive airflow, HEPA (12+ exchanges per hr)
What is the minimum daily requirement of sodium for an average adult?
2 g = 2,000 mg
What are some general characteristics of hyperbilirubinemia (jaundice)?
2 types - mild & severe - Most common reason for hospital readmission - Results from imbalance in rate of bilirubin production & elimination (immature NB hepatic system) - Essential data: age of NB (in hours) to determine rate of progression of condition, cause & tx
What is the difference between penerating and blunt chest trauma injuries?
2 types: - penetrating > GSWs > Stabbing - blunt aka nonpenetrating > MVAs = rapid acceleration and decleration > Air bags getting deployed > Compression e.g. getting crushed > explosions/ bombs/ gas leak
What are the three times to check medication against the MAR?
3 P's when you pull the med, when you prepare the med and when you pass the med
How much saline should you use to flush an IV site?
3 ml, do NOT reuse prefilled saline flush syringes
What are some behavioral patterns to take note of in newborns?
4 periods 1. reactivity - 1/2 hrs to 2 hrs, alert, moving, ⬆HR/RR, bonding, eye contact w/ parent, start breastfeeding 2. ⬇ responsiveness - 1 - 2 hrs, sleepy, ⬇ activity, no no interest in sucking, difficult to arouse NB 3. 2nd reactive period - 2 -8 hrs, awake, interest in surroundings, ⬆HR/RR, meconium, voiding, bonding, pt. ed can start 4. Stability - sleep & wake cycle stable after 24hrs
What is the normal range of RBC?
4.2 - 5.4 million/microliters for females and 4.7 - 6.1 million/microliters
At what grade level is health information (pamphlets/ videos/brocherues) typically written in to facilitate patient teaching?
4th to 5th grade level
What is early clinical manifestations of dumping syndrome?
5-30 mins after eating - cramping - pain - weak/faint - abdominal fullness - discomfort - heart palpitations - sweating - discomfort - nausea
How many liters of oxygen can a simple mask deliver?
6 - 12 L/min, no valves or reservoirs
What is the normal range of calcium?
9 - 10.5 mg/dL
What are late symptoms of dumping syndrome?
90 mins to 3 hours after eating **due to excessive amounts of insulin excreted** Sounds like hypoglycemia!! - Tachycardia - Shakiness - Anxiety - Confusion - Fluid and electrolyte imbalance - Diaphoresis
What is hyperphosphatemia?
<4.5 mg/dl Causes: - Acute/chronic renal failue > can't chemotx - too much milk - antacids - too much vit D - hypoPTH > low Ca2+ > high phosphorus in blood s/s: - result from hypocalcemia - calcified deposits in soft tissues > parasthesia + muscle spasms + EKG changes + anorexia + N/V tx: - treat underlying cause - low phosphorus diet - laxative - dialysis - calcium supplements - phosphate binding agents
What is digital removal of stool?
> use if enema fails > last resort > provider's order req'd > r/f cardiac dysrhythmia
What can a nurse use to administer drugs parenterally?
A 3 ml syringe, refilled single dose syringe, insulin syringe, 1 ml syringe, safety syringe, IV syringe
What is used to measure most liquids for oral meds?
A 30 ml medicine cup and a volume less than 2.5 ml should not be measured using this device
What can a nurse use to administer meds orally?
A medicine cup, calibrated dropper, or pediatric oral device
What is the Morse Fall Risk Assessment?
A tool nurse's can use to determine a pt's fall risk it takes into account history of falls (subjective data), any secondary diagnoses, if a pt uses an ambulatory aids (crutches/canes/walkers), the pt's mental status (do they forget their own limitations?), and gait | the higher their score the higher their risk for a fall
What does a nurse ax for when the concern is hyperlipidemia?
AAP recommendations: Screening > age 2 years •Interpretation: less 110 LDL = good less than 170 Total = good Health history - if they have a strong history, smoking, diabetes, HTN, hyperlipidemia under 55 y/o (early onset) = red flag, cardiac disease Plot weight and height the sooner you find it the soon you treat
When should you treat and when should you watch AOM?
AAP recommends "watchful waiting" for some - Observation 6 months to 2 years -> Unilateral -> Symptoms not severe (temp of 102.2 or moderate to severe pain for 48 or > hrs) -> No ear drainage - Observation > 2 years -> Unilateral or bilateral -> Symptoms are not severe -> No ear drainage
What are your 4 intervention priorities?
ABCD - Airway, Breathing, Circulation, and Safety
What are some complications of diabetes? (acute/chronic)
ACUTE - hypoglycemia = <70 mg/dL (ER) = BAD below <40 = SEVERE -- causes = OA, too much insulin + not enough fluid, fail to recognize s/s, ↓ kidney fx, can't see labels, skipping meals, too much exercise - hyperglycemia which can lead to DKA & HHS CHRONIC - microvascular - impedance, blurred vision, foot pain = retinopathy, nephropathy, neuropathy - macrovascular - whole body, systemic, coronary, CAD, cerebrovascular Dz, PVD, decreased immunity
What are some complications of diabetes?
ACUTE -hypoglycemia = <74 mg/dL, causes = OA, incorrect med, fail to recognize s/s, ↓ kidney fx, can't see labels, skipping meals - hyperglycemia which can lead to DKA and HHS CHRONIC - microvascular - impedance, blurred vision, foot pain = retinopathy, nephropathy, neuropathy - macrovascular - whole body, systemic, coronary, CAD, cerebrovascular Dz, PVD, decreased immunity
How are ADH, ANP, and RAAS related?
ADH is the opposite of a diuretic (i.e. alcohol), it is produced by the posterior pituitary gland and regulated by the brain, it helps you retain fluid causing concentrated urine and low UO while ANP is producesd by the heart when the atria are overstretched due to fluid retention RAAS aka Aldosterone is produced by the adrenal cortex and regulates sodium and potassium levels
What is considered an SGA, AGA, LGA baby?
AGA •Weight is 10% - 90% for gestational age •Lower morbidity and mortality rates - generally, term NBs (38 - 42 wks gestation, 6- 8 lbs.) SGA <2500 g (5lbs 8oz) at term •Weight is <10% for gestational age (growth charts) LGA >4000 g (8lbs 13oz) @ term •Weight is >90% for gestational age (growth charts)
What are two types of nursing diagnoses (ND)/ problems?
Actual ND which can be validated by clinical data from assessing the pt VS. Risk ND things that may happen to a vunerable pt. ex: risk for "impaired skin integrity" it hasn't happened yet, but maybe the patient is immobile is at risk for pressure ulcers.
What is insomnia?
Adjustment sleep disorder (acute insomnia), Inadequate sleep hygiene, Behavioral insomnia of childhood, Insomnia caused by medical condition
What are some vital sign indications of orthostatic hypotensions?
After a fall, Lightheadedness or Symptomatic, As part of a routine admission assessment (know your policy), When a patient is on a medication that may cause orthostasis and has other risk factors for falls, Provider Order
Where should crutches be placed?
Against the body not the armpits
What are some risk factors that make a person more susceptible to disease?
Age - very old or very young, underdeveloped immune system, Stress, Medical therapies - chemotherapy, not using proper sterile technique when administering meds, Unclean medical equipment - ex: unclean feeding tubes or catheters, Smoking, Alcohol, Unhealthy eating, Environmental hazards - work environment, Unaffordability of medical care
What are some factors that affect both BP and Pulse?
Age, stress, pain, meds, smoking, activity
What are some types of transmission non-contact?
Airborne - droplet nuclei in the air | Vehicle - contaminated source | vector- borne - transmission via insect or animal (ex: zika virus, malaria)
What precautions are used for the airborne category of transmission?
Airborne precautions are used when the infectious agents can be transmitted into the air when the patient breathes or through the vents. This means that a negative pressure room gets used to isolate the agents to one room. Since the particles can be very light, fit/mask testing is done for employees to get fitted for **N-95 respirator masks, pt's have private rooms
What is the 1 ml syringe?
Aka the TB/ tuberculin syringe, used for small doses, calibrated in hundredths I.e. .2, .21, .22, .23, .24, .25, preferred for dosages less than .5ml
Hwo is GER managed by the nurse?
Alter feeding techniques - initial treatment - Small, frequent feedings - Upright positioning for 30-45 minutes after all feedings -> Bc aspiration is biggest concern - Thickened formula -> Add rice cereal, less likely for huge amount of reflux Medications - Histamine 2 blockers (pepcid, tegamed, cimetidine) -> Decrease gastric acidity - Proton pump inhibitors (-zole, lansoprazole, omeprazole) -> Reduce gastric acid production - Prokinetics - help stimulate GI motility so stomach will empty faster Nissen fundoplication - They take the upper portion of stomach and wrap around lower esophageal sphincter and tighten it up - hard for them to vomit after or get fluid up because it is tightened close
What is hypoventilation?
Alveolar ventilation inadequate to meet the body's oxygen demand or to eliminate sufficient carbon dioxide AKA can't get enough O in or CO2 out slow and shallow breath
What is involved with eye and ear hygiene/care?
Always clean eyes from inside out, use artificial tear for unconscious pts that have eyes that remain open, be careful with hearing aids, don't use soap on the face unless the pt wants it, pts may not be able to insert and remove their own eye contacts
What is SPICES?
An acronym that summarizes geriatric syndromes. | *S*- Sleeping problems/disorders (suspicion increase when a pt doesn't get restful sleep, nocturia might be a reason for sleep problems, caffeine - diuretic before bed can cause nocturia ) *P*- Problems with eating and feeding (anorexia, their thirst center is not a strong) *I*- Incontinence (bladder prolapse, weak pelvic floor, it can be a bowel issue, use a schedule) *C* - Confusion (infection are a risk, delirium = acute illness) *E* - Evidence of Falls (orthostatic hypotension, dehydration) *S* - Skin breakdown (skin is thin and can tear very easily), skin can breakdown due to laying bed too long
What is hypostatic pneumonia?
An infection of the lungs associated with immobility caused by pts not being able to take deep breaths or cough
What is the difference b/t anticoags, fibrinoltyics, & platelet inhibitors?
Anticoags = interrupt blood clotting cascade, no existing clot breakdown, direct thrombin inhibitors, indirect thrombin inhibitors, Vit K antagonists, e.g. lovenox Fibrinolytics = break down fibrin threads, plasminogen to plasmin > plasmin attacks fibrin, used for small/localized clots Platelet inhibitors = pv aggregation of platelets, e.g. aspirin, plavix, Clopidogrel
What are nursing interventions?
Any action taken to get the pt from where they are to the goal/outcomes ex: meds. chemo, pt education, support
How would you describe the diagnosis component of the nursing process?
Ask yourself, "How is this medical diagnosis/condition/disease actually impacting my patient?" The diagnosis component of the NP is the IDing of the pt's broad health problem and matching the s/s with the defining characteristics
When should a nurse assess for pain?
Assess: At the beginning of every shift, before + after potentially painful procedures ot t(x), before and after pain interventions (60 minutes after oral analgesic OR 30 minutes after IV analgesic administered), every time you take a full set of vital signs, assess when the patient reports pain
What are some nursing considerations for a pt receiving narcotics?
Assess: if the pt's RR is less than 12 hold meds + call MD with complete set of vitals | Interventions: medicate 30 - 60 mins prior to painful procedures & PRN | Evaluate: monitor, make sure the pt is safe (narcotics + strange environment + CNS alterations = safety risks, look out for changes in LOC Always check on the pt 60 mins after oral pain meds and 30 mins after IV pain meds.
What happens during the evaluation stage of the NP?
Assessing if the goal/ outcome has been met- it's either met, partially met, not met. Evaluations will take note of patient progress and indicate if changes need to be made
What happens during the evaluation stage of the NP?
Assessing if the goal/ outcome has been met- it's either met, partially met, not met. Evaluations will take note of patient progress and indicate if changes need to be made.
What would an ax in a pt w/ potential physiologic jaundice include & how would you treat it?
Assessment: -> Ax skin, sclera, body fluids for yellow color -> Labs: polycythemia, Rh incompatibility (or ABO w/ pathologic jaundice), bilirubin, Coombs test (RBC antibody screening) Treatment: -> Promote early and frequent breastfeeding -> Monitor serial bilirubin levels -> Phototherapy (aka bili lights) care (can tx w/ indirect sunlight vitamin D): - Eyeshield -> NTE - frequent temperature monitoring -> Strict I&O - daily weight - hydration ax -> Monitor stool frequency & appearance -> Positioning to maximize skin exposure -> Meticulous skin care - no lotions -> Parental support & education take off lights for feedings
How is a newborn with Neonatal Abstinence Syndrome (NAS) assessed? What are the types of s/s found?
Assessment: -> Review maternal history and risky behaviors -> Obtain urine, blood, meconium toxicology screens -> Assessment tools -->> Finnegan NAS scoring system - S/S withdrawal disturbances in the: -->> Central Nervous System -->> Metabolic vasomotor/respiratory, systems -->> Gastrointestinal system
How can a nurse help parents deal with perinatal loss?
Assisting parents to cope -> Convey concern and acknowledge parental loss -> Use active listening -> Give parents a sense of control -> Provide privacy as needed -> Assist parents to make memories (hand/footprints) -> Respect and incorporate cultural interventions -> Help family with grieving process Supporting the family afterwards give them all the time they need death during pregnancy - up to 1 month after birth
How does pain present itself in a non-verbal patient?
Assume patients have pain, assess for atypical manifestations such as fearful expressions or combativeness. They maybe grimacing, moaning,or rubbing. Keep pain low bc it is difficult to decrease pain from severe back to low or moderate. Use EBP tools tools to assess for pain and understand that vital signs aren't sensitive indicators, consider around the clock pain care.
What are the roles of a professional nurse?
Autonomous = independent, ex: has to follow doctor's orders, but use knowledge to take action when appropriate Accountability Caregiver = * most trusted profession Advocacy = speak for the patient and make sure that the patient's wants are being considered Educator = teachers, teach everyone on all levels, patient education Communicator = with both patients and other staff Manager = delegation of tasks
What is Avastin and Tarceva?
Avastin = non-small cell lung CA - it doesn't kill the tumor - slows the growth of new blood vessels that feed the tumor = angiogenesis inhibitor - GI perf, bleeding, hypertensive crisis - impaired wound healing due to impeding of blood vessels of a wound - nonspecific - avoid pregnancy = use two types of birth control - in combo of other meds = carboplatin and paclitaxel - "A for Angio" Tarceva - it does suppress tumor - well-tolerated - 1 hr A.C or 2 hr B.C - if pt takes coumadin to make increase bleeding - Double birth control - Rash + N/V + diarrhea + liver/kidney issues - "T for tumor"
What are the parts of a informed consent patient agreement?
BAR C = benefits, alternatives, risks, consequences of refusal
What are the parts of a BP measurement?
BP is the measure of the force exerted by the flow of blood on large arteries. The top # in BP is the systolic pressure = peak pressure/ intial flow/ventricles contracting/ the flow of blood is upwards, the bottom number is the diastolic pressure = minimal pressure/ ventricles resting
How does a nurse assess for orthostatic hypotension?
BP should be the same when you lie down and when you stand up, so to assess orthostatic hypotension the nurse should take the pt's BP lying down, sitting, and standing
What is the foucs of a preterm NB ax?
Ballard Scale - - Physical characteristics: (assessed w/ in 1st 2 hrs of life) -> Skin - transparent, minimal subcutaneous fat; plentiful vernix caseosa -> Lanugo - sparse -> Plantar creases-absent to few on soles & palms -> Breast tissue - not developed -> Eyelids fused, poorly formed ear pinna -> Genitals - undescended testes/clitoris prominent - Neuromuscular characteristics - poor muscle tone and flexion, increased flexibility - minimal resistance when performing neuromuscular assessments - General - scrawny appearance, head disproportionately larger than chest -> flexed = term neonates -> assessed w/in 1st 24 hrs as long as neonates is stable
What is the focus of postterm NB ax?
Ballard Scale -common physical characteristics - Skin - dry, cracked, peeling, wrinkled - Lanugo - absent, minimal vernix caseosa - Plantar creases - cover the entire soles of feet - Breast tissue - measureable - Eyes - fully developed, ears firm and stand away from head - Genitals - creases on scrotum, descended testis, labia majora covers labia minora - Neuromuscular characteristics: increased flexion and resistance to range of motion; less flexibility - General - abundant hair on scalp, thin umbilical cord, meconium-stained skin/nails; longer nails
How is the transposition of the greater vessels tx?
Balloon Septostomy - admin Prostin to keep PDA open - create an opening in the ventricular septum by performing ER interventional cardiac catherization -> force a catheter through the foramen ovale to allow mixing of blood -> let them stabilize and then go back in to fix the defect by switching the greater vessels to their correct place, can be as soon as 24 hours
How is a intussusception peds pt managed by the nurse?
Barium or air enema Surgical repair Pre/post-op care
What are some common nursing problems related to hygiene?
Bath/hygiene self-care deficit Dressing/grooming self-care deficit Risk for impaired skin integrity Impaired skin integrity Impaired oral mucous membranes
What is BSC?
Bed rest with bedside commode, usually with assistance
When are you supposed to wash your hands?
Before and after gloving, before and after patient contact, before and after going into a patient room/ touching equipment in the room, *wash your hands with soap and water (NOT foam/sanitizer) when dealing with C.Diff. to get rid of spores*, and use common sense if you can see your hands are dirty go wash your hands
How do you manage the GI tract in a patient with cystic fibrosis?
Before every meal and snack - pancrelipase - pancreatic enzyme -> Action: breaks down fats, proteins, and carbs -> If their pancreas functioned normally, it would secrete 8 cups of pancreatic juice into duodenum a day (containing pancreatic enzymes) but they don't, because it can't get their because of the secretions -> Children take 5-6 of the pills (depending on weight) with every meal and snack so that food can be broken down and absorbed -> Cannot give broken down or chewed because it causes irritation to the mucosa - may need to open capsule into applesauce/pudding for children who can't swallow pills - High-calorie, high-protein diet -> Additional G-tube feeds at night -> TPN feeds - Supplemental water soluble ADEK vitamins
What is intestinal bowel obstruction? (IBO)
Blockage of movement in the intestines. Can happen in the large of small intestines The most common types happen in the small intestine. 2 types of intestinal bowel obstructions: mechanical or paralytic. - Mechanic: something is blocking the bowel. = surgery - Paralytic: where peristalsis stops. That part of the bowel is just not responding, the nerve and muscle tissues aren't responding either so it's not pushing anything through.
What comes first blood cultures or antibiotics?
Blood cultures
What is a nursing intervention for glucose?
Blood glucose monitoring
What is renal rejection?
Body treats transplant as foreign body Types of Rejection Hyperacute- requires immediate removal, body treats kidney as foreign, occurs w/in hours, pain, elevated BP, increased temp, oliguria Acute- occurs w/in days or 3 months, tx corticosteroid, same s/s as hyperacute, but not treated w/ removal Chronic- after 3 months, gradual nature, tx gradually, dialysis as needed, may have fatigue or no s/s at all "Chronic Allograft Nephropathy" - most common, poor matching or nephrotoxic drugs, comorbidities like HTN or hyperlipidemia
What are some complications of UC and CD?
Both have: - hemorrhage - perforation - abscess - nutritional deficiency - bowel obstruction EXCEPT: Crohn's need for surgery is FREQUENT: As you get the areas of ulcers and cobblestones, they can be so bad that they have to have those disease areas cut out because they can cause fistulas & Ulcerative colitis the need for surgery is INFREQUENT
What is intussusception?
Bowel telescopes into a distal segment - Folds in on itself, could be edema or imparied circulation -> Edema and impaired blood circulation -> Partial or total bowel obstruction Occurs in children < 2, they can't really tell you what's happening/how they feel If there is lack of circulation to the intestine before parents realize what's going on, that portion of the bowel may die and need to be removed In order to diagnose it, air emena is usually done - which can also allow the telescoped bowel to pull itself out. If not, surgery will be needed
What is sanguineous drainage?
Bright red; indicates active bleeding
What are the effects of mechanical ventilation on preemies?
Bronchopulmonary Dysplasia (BPD) •"Chronic Lung Disease" - neonates treated with mechanical ventilation and oxygen > 28 days -> lung damage, gets better as they grow •Results in fibrosis, atelectasis, increased pulmonary resistance, decreased lung compliance, pulmonary hypertension & edema •Medications: bronchodilators, corticosteroids, diuretics Retinopathy of prematurity (ROP) •Separation/fibrosis of retina, can lead to blindness (caused by high O2 levels) •Damage to immature retinal blood vessels thought to be caused by high oxygen levels or low birth weight (low 90s) •Prevention: vitamin E, avoid high concentrations of oxygen •Cryosurgery may reduce long-term complications ween O2 asap
What is included in the post-op nursing care of a cleft lip patient?
C - Calming techniques - prevent crying to avoid suture pulling L - Lie on back - so they can't rub lip on something E - Evaluate airway F - Feeding - special feeders, still have cleft palate T - Teaching L - Lip protection (Logan bow) - tape and metal bar (added protection) I - Infection - clean site daily (don't want crust to form) apply vaseline P - Parent bonding - Arm restraints used continually for the first 10 days, can take off a little bit every few hours (maybe one side at a time) if you are there for direct supervision - Around the clock pain management For cleft palate: - Most of the same interventions, but will be more painful - Since we are working in mouth, we worry about swelling at back of throat - For the first 3 weeks after cleft palate repair, goal is to protect the suture line at top of mouth. These pts will be on liquids for 1st 2-3 weeks, use spoon to feed -> Can introduce soft things baby 2nd week, nothing too hot or hard (applesauce, pudding, baby food, etc) and water after to clean palate - Arm restraints to avoid them touching or getting hands in mouth
What are some characteristics of C. Diff.? How is it prevent and transmitted?
C. diff is characterized by watery diarrhea/stool, bad smell, frequently seen with prolonged use of antibiotics and elderly, NO FOAM, use soap and water (friction gets rid of the spores), *gown and gloves*, contact precautions, isolation, private room with dedicated equipment, fecal-oral route
What are the 7 warning signs of cancer?
CAUTION: Change in bowel or bladder habits A sore that does not heal Unusual bleeding or discharge Thickening or lump in breast or other area Indigestion or difficulty swallowing > dysphagia/ dyspepsia Obvious change in a wart or mole > skin CAs Nagging cough or hoarseness
How is lung cancer treated and what is the goal of tx? meds?
CURE Dx + tx early pt and provider work together depends on cell type, stage of dz, health status - Chemotherapy - typically after surgx - Radiotherapy = done to shrink tumor size before and or after surgx - thoracotomy/lobectomy (lobe is removed)/pneumonectomy (whole lung removed)
How is lung cancer diagnosed?
CXR CT MRI PET Thoracentesis Bronchoscopy Biopsy PFTs/ABG (pH + %O2 + %carbon dioxide) = arterial blood gases Sputum cytology Staging = TNM system
What would a nurse find upon assessment of a newborn w/ TTN? How would a nurse treat it?
CXR - will see hyperairation Assessment: retractions, expiratory grunting, cyanosis "REC", usually normal pH, mild hypoxemia Treatment: supportive - Supplemental oxygen - Frequent assessment - Thermal regulation and NTE - IV fluids or gavage feedings until stable respiratory status Airway before feeding in terms of priority usually NPO until ⬆ respiratory status
How do we treat mild diverticulitis?
Can be treated at home if caught early enough - antibiotics (PO) - Antispasmodics to calm down (PO) - analgesics (PO) - stool softeners (PO) - Bulk-forming laxatives - Probiotics - Rest - Diet: initially = clear liquid, low fiber When they feel better, they will progress to high fiber (increase transit time of food through the colon), low-fat diet. - hydrate - avoid seeds
What is the diuresis phase of AKI?
Can last 1 -2 wks + Kidneys are beginning to regain function Gradual increase in urine output Output up to 10L/day of dilute urine Fluid loss & electrolyte changes > may lead to dehydration and HYPOkalemia Decrease in Cr and BUN - Interventions Monitor I/O Electrolyte replacement and monitoring
What subjective data can a nurse collect as part of her respiratory assessment on a pt?
Can the pt cough? Does the pt have SOB? Does the pt have angina w/ breathing? (maybe pleuritic) Does the pt have a hx of respiratory disease? (Asthma, COPD) Does the pt smoke?
What does a poor prep consist of?
Can't really see anything, and probably will not have the colonoscopy. HCP will probably give GOLYTELY and you will then go heavily (watery stools and risk for electrolyte imbalance). - procedure canceled - can't be suctioned or washed
What is palliative care?
Care that focuses on prevention and reduction of symptoms, not curative
What are some different types of medications that can help with bowel elimination?
Cathartic - irritates the mucosa, the lining of the colon Laxative - softens the stool, "fluff up" the stool Antidiarrheal agents - > OTC meds e.g Dulcolax, Pepto > opiates - can cause constipation, use w/ adjuvants
What is aplastic anemia?
Causes: - myeloplastic agents - radiation viral infection e.g. EBV, Hep B, cytomegalovirus - impaired cellular regulation of bone marrow - severe anemia s/s - macrocytic anemia, leukopenia, thrombocytopenia Tx: - blood transfusions - dc blood transfusions as soon as RBCs start to be produced in the marrow - splenectomy
What are some early indicators of acute illness?
Changes in mental status due to infection, pneumonia, or UTIs | dehydration | anorexia | loss of f(x) | dizziness, this can cause falls bc they don't realize they are dizzy until it's too late | incontinence
What are characteristics of IDM?
Characteristics of IDM: •Distended abdomen •Wide shoulders •Rosy cheeks •Excessive subcutaneous fat on extremities •Short neck
What is involved with the care of feet and nails?
Check for cap refill, look at the heel and assess for pressure ulcers, nurses don't cut toe nails that task is normally done by podiatrist especially for pt's with diabetes, nail care usually requires a Dr.'s order, Remove antiembolitic stockings, always check in between toes
How do you assess a pt for potential signs of an infection?
Check intactness of skin, check drainage - color, odor, consistency, amount (COCA) + check wound - Redness, edema, drainage, approximation - edges are together, well approximated (REDA) (local infection), Labs: less than 2000 WBCs per microliter of blood - immunocompromised, ***5000-10000 - normal WBC count, *** 16000< infection
What is the role of small intestine?
Chemically takes pieces of food and converts it to energy, glucose and bile and send reminents to the colon.
What objective data can a nurse collect as part of her respiratory assessment?
Chest shape (e.g. barrel shape = continuous over inflation of the lungs, kyphosis) Positioning (tripod, laying down using pillows due to orthopnea) Color ( cyanotic, pallor) Symmetric expansion (do they have fractured ribs or pneumothorax?) WOB (are they using accessory muscles?) Sputum color ( e.g. pink = heart failure, clear = cold, bronchitis, yellow/green = bacterial infection)
What are some physiological and mental changes related to the aging process?
Chronic conditions, Dental problems, Lifestyle, Falls/Orthostatic hypotension, Sensory impairment, Pain, Nutrition
How does Crohn's disease (CD) look like ?
Classic cobblestone look Mucosa being swollen Ulcers have fissures Autoimmune disorder that is an overreaction to cells in the GI tract Can involve the whole GI tract from mouth to anus and affects all layers of the mucosa
What is cleft lip and cleft palate?
Cleft Lip and Palate - common congenital craniofacial anomalies Pathophysiology - Develops early on in gestation - form around 5-9 weeks of life - Could have unilateral (more common) or bilateral Complications - Potential for aspiration, feeding difficulties - Altered dentition - Greater risk for ear infections - Could have long term issues which speech and language development Medical Management - multidisciplinary approach - Surgeons/nurses/ENT specialists - Language/speech pathologists - Orthodontist - Geneticist is associated with another syndrome - Social worker to help family navigate what they will have to go through Cleft lip is repaired first and earlier at around 3-6 months of age Palette not usually done until 6-12 months of age - ideally before they are learning to talk
What are some characteristics of FAS?
Clinical findings: *Microcephaly (small head > small brain) *Low nasal bridge *Small eyes *Fetal Growth Restriction *Thin upper lip *Delayed motor skills *Missing philtrum *Mental retardation *Narrow forehead *Cardiac defects *Micrognathia (small chin/jaw) *Poor eye-hand coordination dx criteria: - must have @ least 3 of facial abnormalities - < 10% percentile for growth - CNS abnormality - microcephaly OR documented dvlpmtal delay
What are some potential safety hazards in a pt's environment?
Clutter, tubing, cords,
What is coarctation of the aorta?
Coarctation of the Aorta •⬆BP & bounding pulses in upper extremities compared to lower extremities •Must check femoral pulses in infants! (weak or absent pulses) •In older children - epistaxis, HAs, leg pain w/ activity usually located where the PDA was tx: cardiac CATH procedure w/ balloon to dilate vessel, doesn't last long, may stenosis again Tx: big deal bc your putting suture lines in the aorta so keep their BP low
What is the surgical treatment for diverticulitis? (Severe)
Colon resection and colostomy (stoma to bag)
How does a nurse evaluate their pain interventions?
Compare pain level from before to the pain level after intervention, the best way to evaluate is to use what a pt reports
What is involved in the pre-op care of a renal transplant?
Compatibility Studies - Human leukocyte antigens (HLA) - Blood typing Preop teaching Dialysis 24 hours prior to procedure Blood transfusion from the donor Donor - Living - commonly family members - Cadaveric - brain death pts - Non-heart beating - sudden cardiac arrest
What is CBR?
Complete Bed Rest, pt uses a bedpan
What are some complications that can occur with cardiac catherization?
Complications: *bleeding, infection (delayed), arrhythmia (caused by ❤ irritation)
What is Evidence Base Practice (EBP)?
Constant learning + based on research not past/ old ways of doing something + use your expertise + listen to the patient's wants = Evidence Based Practice (EBP)
What is CPAP?
Continuous Positive Airway Pressure
What are some common mistakes in blood pressure assessment?
Cuff is too big = false low reading, Cuff too small = false high reading, not wrapping the cuff too loose = false high reading
What are the 5 stages of grief?
DABDA Depression, anger, bargaining, denial, acceptance
What's the difference b/t DKA & HHS?
DKA - - sick pancreas > no beta cells > no insulin > fat cell breakdown > ketone/acidosis in blood & urine - rapid onset - BG >300 (not set in stone) - H+ ions ↑ > ↑ acid (blood pH >7.35 > ↑ RR to breathe off CO2 > ↓ acid) - commonly caused by infection - undx Type 1 - unmanaged Type 1 diabetes s/s: - Thirsty - N/V - Flushed - Fruity breath - High fever - ALOC - kussmaul's RR - high WBC + osmolarity - 3 P's Glucose Tx: - ICU admission **IV FLUIDS** - BOLUS 0.1 units units/kg IV push + IV drip 0.1 units/kg/hr - insulin drip, glucose checks q1h - once glucose gets to 250 insulin dc = subq sliding scale/bicarbonate normalized or transition + dextrose to fluid, e.g. D5.+45NS - 150 BG check q4h Key Difference: Glucose doesn't get as high as in the case of HHS, ketones are produced, common with Type 1 diabetes HHS - - gradual onset - over several days - decreased thirst center - NOT acidotic, blood pH or 7.35 -7.45 (normal) - commonly caused by infection, drugs (diuretics/steriods), undx diabetic s/s: - Polydipsia - Polyphagia - Polyuria - Extreme dehydration due to high osmolarity (320+) > ↑ blood thickness > r/f clots - High glucose levels - electrolye disturbances - 10 - 20 L of fluid loss > ↓ volume > ↓ BP + tachy❤> Perfusion to Kidneys > elevated BUN + creatinine - ALOC Tx: - treat slowly if not = cerebral edema (s/s = ALOC, coma, abn neuro checks), fluid = .9 or 045 NS 1L/hr - once BP is over 100 systolic ↓ fluid to 100-200 ml/hr - BOLUS IV push Reg insulin NOT humalog or lantus = 0.15 units/kg > IV drip 0.1 units/kg - GOAL: lower BG by 50-70 to pv osmolarity shifts to fast - 250 BG = check q2h > dc IV drip > sliding scale humalog subq Key Difference: Glucose gets to extremely high levels (e.g. 600+), no ketones produced (no ketosis), insulin is still produced, common w/ Type 2 diabetes Notes: - Multiple IV Access (20G) - If pt can't eat/swallow/can't take oral fluids = NO dc insulin IV drip - Don't tx hyperkalemia if insulin is admin bc insulin shift K+ into the cell > ↓ K+ levels - If hypok+, UO (urine output) should be 30 ml+, min 60 ml/hr in/o to tx - Crackles + wet cough = circulatory overload - labs + I&Os frequently - consider psychosocial issues w/ type 1 pts - remember ABC + e+ ax
What are some common ways to non- pharmalogically intervene for clients experiencing pain?
Deep breathing techniques, accupressure, accupressure, biofeedback, TENS, aromatheraphy, relaxation, distraction, decrease external stimuli, guided imagery (good for anxiety), meditation, laughter, visitiations, repositioning, use what worked in the past, patient education
What are mixed cardiac defects?
Defects in which mixing of blood is essential to the survival of the NB: •e.g #1 Transposition of the great arteries (TGA/TGV) e.g #2 Hypoplastic left heart syndrome (HLHS)
What is the difference b/t dementia, delirium, and depression?
Delirium - temporary, should resolve when the underlying condition is treated, can be caused by electrolyte imbalance, hypoglycemia, surgery, pneumonia, UTIs | Dementia - slow + progressive worsens with loss of f(x) and mental status, lead to them not being able to perform ADLs, cognitive decline, can't draw a clock | Depression - mental disorder
What is the pathophysiology of CKD?
Diabetes and other comorbidities increase inflammation in the body increasing r/f CKD occurence Progressive, irreversible kidney damage Azotemia Collection of nitrogenous wastes in the blood Uremic syndrome (uremia) CKD 4 or 5 Azotemia with clinical manifestations End Stage Renal Disease (ESKD)- CKD 5 Kidneys unable to sustain life
What are some potential causes of hyperglycemia?
Diabetes, steroids, TPN
What is acute rheumatic fever, how do it present?
Diagnosis - based on Jones Criteria: either 2 major or 1 major and 2 minor criteria complication from group A strep syndenham - CNS component common in 5 - 15 y/o elevated CRP or ESR
What is the key to management of GI disorders?
Diagnosis is the key, then interventions
How is celiac disease managed in peds pts?
Dietary alterations: - Strict gluten-free diet for life - Vitamins if malnourished - Referral to dietician Teaching Guidelines - Potatoes, rice, soy, bean flour, buckwheat good - Close monitoring of growth - After they are put on this diet they should have a follow up where labs are rechecked, make sure anemia is going in right direction, lessening of steatorrhea
What are some types of transmission contact?
Direct = touch, Indirect = from surface to person, Droplet = small particles, suctioning, sneezing, coughing
Where can CKD start from and what causes it?
Disease can initiate in the following areas: Glomerular - connective tissue d/o, hepatitis, diabetes, HIV Tubular - infection or drugs Vascular - HTN, renal artery stenosis Urinary tract - BPH or obstructive source ^^^^^^Don't need to memorize ^^^^^^
What is respiratory distress syndrome (RDS)? Risk factors? Assessment?Treatment?
Disorder from lung immaturity and lack of surfactant Risk factors: preterm, maternal Diabetes Mellitus Assessment: Grunting, nasal flaring, retractions, increasing atelectasis and cyanosis Treatment: supportive -> PEEP ventilation (weened of vent) -> Administration of exogenous surfactant therapy -> Mechanical ventilation if needed -> Prevention: single dose betamethasone -->> ID due date in order to admin betamethasone to mom. be proactive
What is diverticular disease? And what does it consist of under its umbrella term?
Diverticulosis are the abnormal amount pouches/herniations (diverticula) in the wall of the intestine. Mostly in the sigmoid colon. Constipation can be the cause. As we age, the muscle gets weak. Also can be if we dont eat a lot of fiber can affect the muscle. We can have the patient increase fiber and/or take Metamucil. Diverticulitis is the inflammation of one or more of one of those pouches. Food gets in the pouches (can be bacteria of any kind in the pouches) and they become inflamed.
What are the ending procedures after assessing vital signs?
Document measurements, compare findings to the pt's normal values, ID trends/patterns, safety 1st (i.e. bed in lowest position, brakes on bed, clear clutter), opens privacy curtain, "foam in foam out"
How can you avoid equipment related accidents?
Don't operate equipment when you don't know how to, make sure equipment has been inspected, keep pt room clutter free, follow your facilities regarding equipment use
How are you to use side rails?
Don't use all four side rails if the pt is not restraints. Use only two side rails, 4 = restraint. For confused pts keep bed on the lowest setting, keep wheels locked. Always keep a safe exit from bed.
What are Over the Counter Drugs (OTC)?
Drugs that can be purchased without a prescription, they must be easily understood by the consumer, have large font, plain language, include friendly consumer information
What is the gestational age assessment?
Dubowitz/Ballard Score 2 categories Physical maturity + Neuromuscluar maturity Physical maturity = "Please Beg" = PLS BEG: Plantar creases (hands/feet, ⬆ creases = ⬆ level of maturity) Lanugo (soft downy hair, fine hair usually on shoulders & back) Skin texture (color, opacity, vernix) Breast tissue (⬇ in premies) Eyes & ears (eyes fused closed until 26 - 28 wks, if born before then eyes will still be fused, look for recoil to sound, how much cartilage is there? << indicates maturity) Genitals (males, @ 36 wks testes are in scrotal sac females, labia menora prominent as ⬆ age labia majora will cover menora) Neuromuscular maturity floppy baby ⬆⬆ flexibility = premie flexing = term baby
What are TOF spells? (Hypercyanotic "TET" spells)
Dvlp suddenly w/ agitation - leads to ⬆ cyanosis, hypoxemia, dyspnea Nursing Care - Calm approach •Place infant or child in knee-chest position (⬆ systemic vascular resistance & improves pulmonary blood flow) •Provide supplemental O2 •Admin morphine sulfate (relaxes pulmonary artery, ⬇ resp. demands) •Supply IV fluids (when it gets bad not an intital intervention) •IV propranolol (Inderal) - only in very severe cases, maybe on PO propanolol prophylatically tx: surgx repair can be done all in one surgx, repair stenosis in pulmonary valve, close VSD, they can do well long term You will see polycythemia in these in order to compensate against the hypoxia
How would a pulmonary contusion present and be diagnosed?
Dx: CXR, CT scan ABG + Pulse ox > low O2 sats s/s: - Starts off asymptomatic - dyspnea/tachypnea - restless/agitation/ change in mentation + sensorium = early sign of hypoxia + impaired gas exchange - Crackles/wheezing/ decreased breath sounds due to edema+damage parenchyma + leakage of serum protein and plasma - pt teaching = monitor themselves and have family members monitor them > Are they becoming restless? > Are they not themselves? > Is their breathing becoming labored?
What are some late and early signs of increased intracranial pressure (PRIMARY INTERVENTION)?
EARLY - kushing's triad trending vital signs, ALOC, HA, vomiting, blurred vision, dizziness, decreased pupillary response, seizure, unequal pupil response, for INFANTS their fontanels will be bulging & have high pitched/irritable cry, sunset eyes, dialted scalp veins LATE - not responsive, not responsive painful stimuli, decreased motor & sensory responses, truly bradycardic, cheyne-stokes, fixed & dilated pupils Tx: to prevent brain herniation - craniotomy, burr holes
What is the difference between AKI and chronic kidney disease (chronic)?
ESKD = < 15% of kidney fx left, retention of kidney waste, requires dialysis and replacement therapies
What is a tension pneumothorax? How is it caused?
Emergency = ❤ + RR issue! - Air goes in (inspiration) but can't get out (expiration) > closed pneumo > trachea goes away from affected side - ⬆ pressure in chest cavity = intrathoracic pressure (e.g. balloon or tire that keeps getting inflated) > collapsed lung on that side > tracheal shift to the other side eventually causing the collapse of the other lung - ⬇ venous return to ❤ > impaired perfusion and ⬇ circulation Causes: - Blunt chest trauma - Breathing tubes w/ PEEP set to high, listen to alarms - Chest tube insertion for other conditions by allowing air into the pleural space - Central line insertion
What are some nursing interventions that address sleep?
Environmental controls Promoting bedtime routines Promoting safety Promoting comfort Establishing periods of rest and sleep Stress reduction Bedtime snacks Pharmacological approaches
What are some immediate interventions for newborns? (Meds admin)
Erythromycin for the eyes to pv blindness from chlamydia and gonorrhea, pv opthalmia neonatorum conjunctivitis, admin even w/ c-section babies, admin 1 - 2 hrs after birth > 0.5% 1cm ribbon applied bilaterally to conjunctival sacs w/out touching the applicator to the eyes Hep B within 12 hours If mom was positive Hep B, the baby receives Hep B AND immunoglobulin within 12 hours If mom negative then the Hep B vaccine can be delayed for 1 - 2 months or at first pediatrician visit Vitamin K is administered to help pv bleeding since the gut is sterile and is not synthesizing clotting factors, admin to vastus lateralis
What is the maximum you can inject into the deltoid?
Even though this is an IM injection, it is the exception and should only receive a max injection of 1 ml the same as a subq injection
When do we use the nursing process?
Every time we make contact with a pt, it becomes an unconscious part of the work a nurse does, it is just our way thinking
What are some EBPs related to infection?
Evidence shows that patients develop infections in the hospital because healthcare personnel don't use proper hand hygiene. Hand hygiene is the #1 way to prevent infection and standard precautions should be used with every patient every time because 90,000 patients die every year due to HCAIs.
What are some factors that can influence pain in older adults?
Ex: older adults will lose muscle and gain fat, decrease muscle decreases body water and this can cause higher concentration of drugs, morphine is water soluble so an older person taking morphine will have a higher [ ] of the drug | OAs take multiple meds and this can increase the chance of drug interactions, Low albumin increases risk for side effects/toxic effects.(albumin is protein bound and older adults may have less protein which affect how the drug works), Longer time to metabolize and excrete drugs (drugs are metabolized by the liver and excreted by the kidney), Thin skin can increase absorption of topical medications
How can drugs potentially cause harm?
Example: opiods can cause respiratory depression/arrest Drugs can cause harm when herbal therapies and OTC are misused and when providers prescribe unnecessary meds
What do the terms exogenous, endogenous, and iatrogenic mean when discussing HCAIs?
Exogenous - Infection caused by microbes found outside of the body | Endogenous - Infection caused by microbes that lives within us/normal flora, the normal flora overgrows | Iatrogenic - infection that occurs due to some kind of treatment/procedure that did not happen in the hospital (long term care facility or outpatient clinic)
What are the guidelines for documentation?
FACTO Factual Accurate Complete Timely Organized
What is Fetal Alcohol Syndrome?
FETAL ALCOHOL SYNDROME (FAS) -> there's no screening for this -> severe end of spectrum •Effects: growth restriction, craniofacial structure malformations, CNS dysfunction •Clinical features: delayed motor development, dysmorphic facial features, cognitive/developmental dysfunction, growth restrictions, kidney defects
What are some newborn screening tests we perform in preparation for discharge?
FL state-required 53 disorder test screening via heel stick that includes galactosemia, SCD, thalassemia, PKU, congenital hypothyroidism done 24 hours after the first feeding hearing testing - most common disorder of NBs, all NBs are screened, parents may refuse Critical Congenital Heart Defects (7 Complex Congenital Heart Defects) - CCHD > Pulse-ox readings of right hand & either foot > Completed after 24 hours
What is the most commonly reported incident in hospitals and LTCs?
Falls
What are the clinical manifestations of orthostatic hypotension?
Falls, Fainting/dizziness, Blurred vision
What are the different categories that risks can fall into?
Falls, equipment-related accidents (ex: burn caused by oxygen and bovi use in surgery), fires and electrical hazards, restraints (choking, therapy interruptions)
What is kawasaki dz dx criteria?
Fever of at least 5 days duration and the presence of at least 4 of the following 5 conditions: 1) Bilateral conjunctival injection - red eyes, not infected, clear water drainage 2) Changes of lips/oral mucosa (dry, red fissured lips, strawberry tongue, or oropharyngeal erythema) 3) Changes of peripheral extremities (erythema of palms/soles, edema of hands/feet, with subsequent desquamation) 4) Polymorphous rash 5) Cervical lymphadenopathy Illness not explained by other known disease processes
How to teach an older adult?
Find out when is the best time to do the CPF (mid day) / pt. teaching use laymen's terms, give them time to process, minimize distractions, involve the family, evaluate their understanding, make pt. teaching relevant to ADLs, link new knowledge to past experience
What are fontanels? sutures?
Fontanels - soft membranous gaps between skull bones - should not be bulging or sunken may indicate hydrocephalus or dehydration respectively Sutures - fibrous joints occurring only in the skull the anterior fontanel takes longer to close (12 mos.) than the posterior (2 mos.)
What is the 3 point walk with crutches?
For a patient with a non-weight bearing leg 2 crutches + 1 leg bent
What are some GI variation in pediatric children?
GI tract is immature until about 2 years old GI tract includes all structures from mouth to anus - Primary functions are digestion and absorption of nutrients and water - Elimination of waste products Mouth - common portal of entry for infections - Bc of their behaviors, everything they find/pick up will go in their mouths Esophagus - Bottom of esophagus is the lower esophageal sphincter (prevents backflow of stomach content into esophagus) - In children there's an ↑ incidence of reflux and can last until about 1, bc the sphincters muscle tone is underdeveloped Stomach - small at birth and will continue to grow - At birth can only hold about 1 ounce of fluid - By 2 months, can hold about 2 ounces - Hydrochloric acid levels don't mature until about 6 months of age - Pyloric sphincter (allows partially digested food into small intestine) Intestines - smaller and still growing - Less than half of what it will be as an adult - Removal of part of the intestine can accuse lifelong problems with absorption Liver and pancreas are not apart of the GI tract but contribute to the breakdown of nutrients - Liver is a little larger at birth - may be able to palpate - functionally immature - Pancreas - pancreatic enzymes which help break down food don't reach adult level until about 2 years of age
How does cystic fibrosis effect your GI tract and lungs?
Gastrointestinal - Malabsorption - bc of pancreatic insufficiency -> Pancreatic enzymes in pancreas can't go through the duct because of thickened secretions - they can't go out of pancreas through common bile duct, to get to duodenum, to break down food so child can absorb the food Fatty stools Poor growth Lungs - Clogged airways - Leads to obstruction, inflammation leading to chronic infection, tissue damage, respiratory failure - Secretions in lungs and wheeze like asthma - Secondary bacterial infections - Staphylococcus aureus, Pseudomonas aeruginosa - If we don't treat these children and their lungs aggressively, they will have damage leading to the need for a lung transplant
What are some different types of hypotension?
General hypotension is a BP of less than 90/ less than 60 mmHg = confusion, decrease urine, increased HR, clamminess orthostatic hypotension = <20+/ < 20+ change in BP within 1- 3 mins. of sitting up than standing = caused by anemia, dehydration, inability to vasoconstrict, blood loss, happens a lot in the morning
What are the normal and abnormal temperature findings?
Generally 96.8 - 100.4 is normal depending on the site used to obtain the value. Avg. axillary - 97.7 < Avg. oral/tympanic - 98.6 < Avg. rectal - 99.5
How can nurses identify newborns that may be at risks using variations in birthweight & gestational age?
Gestational age is inversely correlated w/ the r/f physical, neuro, dvlpmtal challenges, ⬆ maturity = ⬇ challenges - Variations in BW or GA ⬆ neonatal risk factors - Know how to ID NBs @ risk - Classification methods: - Birthweight - Birthweight & gestational age - Gestational age ___________________________ BW & Gestational age: - AGA = appropriate for gestational age - SGA = small for gestational age - LGA = large for gestational age BW (associated w/ premies: - Low BW - Very low BW - Extremely low BW
What does STAT mean?
Given IMMEDIATELY in emergencies, it's a single dose
When should you wear gloves?
Gloves = soiled linen/equipment, wounds, open sores, body fluids,impaired skin NO gloves - outside of patient room, no reusing gloves and no washing gloves
How would we treat carcinoma of the larynx and what is the goal of the theraphy?
Goal: ** early detection, it can be cured, if not caught early die w/in 2 yrs - goal = safe, save swallowing/voice - pv trach Tx: - based on grade, location - surgical resection (8+ hr surgx) - radiation > used to reduced tumor size before or after surgx - chemo Pt. Education: TOTAL LARYNGECTOMY = pt w/ large stage tumors w/ cartilage and soft tissue > perm trach > no voice post-surgx > can swallow after healing > can't aspirate HEMILARYNECTOMY = VERTICAL PARTIAL LARYNGECTOMY = up and down vertical incision > temp trach > no swallow for 7 - 10 days, not long term issue > short term PEG, TPN+Lipids, IV fluids > Slight or minimal voice change SUPRAGLOTTIC (ABOVE THE VOCAL CHORDS) HORIZONTAL PARTIAL LARYNGECTOMY > no swallow for 2 - 3 wks > aspiration precautions > temp trach > voice stays the same RADICAL NECK DISSECTION > jaw bone to collar bone GONE > sternocloid mastoid + trapezius + lymph nodes + larynx GONE > ICU @ first > min suture tension > Semi-fowler's (30-45 degrees) > get up & move > drainage 👀 > 300 ml 16 hrs post op > I&Os > infection/air leak 👀 (due to drain displacement or incision not closed completely) **pt education = done before surgx
How do you start a pt goal?
Goals must be patient centered, so you always start a goal with "Patient will" or "Client will"
What is the difference between measurable and nonmeasurable goals and interventions?
Goals that aren't measurable have no starting point and desired point, it's abitrary and open to interpretations. Measurable goals have a baseline and a specific outcome in mind and progress can be evaluated using these types of goals. The interventions specifically work towards the goal.
What are some common causes and sites of HCAIs?
HCAIs are caused by improper sterile technique when doing procedures and not practicing proper hand hygiene. Common sites urinary tract - catheters, surgical sites - skin is not intact, blood stream - central lines
What is hodgkin's & non-hodgkin's lymphoma? s/s? dx?
HL = reed-sternberg cells, orderly spread NHL = no reed - sternberg cells, 65 y/o, not orderly unknown causes > group of dz dx: - biopsy/ LFTs/ CBC nursing interventions: - focus on acute s/s of tx - tx pancytopenia - tx N/V - tx radiation rash - tx constipation - biotherapy
How does a nurse palpate for the radial pulse?
Hand hygiene > Identify/ verify pt > provide privacy > get pt into supine or sitting position > extend pt arm > use tips of 1st 2 fingers to palpate for the pt's pulse on the radial or thumb side of the pt's wrist > adjust wrist through flexion downward > use moderate pressure to not impair blood flow, use watch with second hand to count pulse rate for 30 secs & multiply by 2 or count pulse rate for 60 seccs
Who do we suspect has cystic fibrosis?
Health History - Meconium ileus - one of the first signs -> We want baby to stool w/in 24hrs of birth, if they don't, CF is a concern - Steatorrhea - Chronic cough - Activity intolerance - Significant constipation -> Decreased transport of water - Poor weight gain despite eating well -> Patients with CF need to eat a lot, usually 5,000 calories a day, to maintain weight
What is included in the nursing ax of a peds pt with appendicitis?
Health History - Right lower quadrant pain - Nausea and vomiting - Frequent small soft stools - Fever Assessment - McBurney's Point - Rebound tenderness -> Pain on release/removal of pressure Labs - CT scan or ultrasound
What is included in a GI nursing assessment? (health hx, dx testing)
Health history - Growth patterns - what percentile for weight height? - Dietary concerns - feeding issues? - Toilet training and bowel patterns - Patient history - medical/surgical issues r/t GI tract - Family history Diagnostic testing: - Esophageal pH probe - to determine if they have gastroesophageal reflux --->>> Probe down nose, placing at the bottom of the esophagus, not quite into the stomach (above esophageal sphincter) --->>> Xray to ensure correct placement and will be left in for 24 hours --->>> Will go from basic to acidic every time there's stomach reflux up into esophagus - then looks at 24 hour data to see how many times it occurred - Ultrasound (abdominal) - if there's issues of pain/mass - KUB - Barium studies - only for imaging test for GI tract --->>> Barium swallow: to see how esophagus is doing, if there's any aspiration --->>> Upper GI with small bowel follow through or barium enema if you need to see large intestinal structures --->>> After use of barium, important to encourage a lot of water because if caught in system it can cause more constipation - Stool studies --->>> Hemoccult - blood in stool --->>> Cultures: O&P - test for ova and parasites
What will a nurse expect to see in a peds pt with celiac disease?
Health history & symptoms: - Anemia -> Iron, folate, and vitamin B12 unable to be absorbed - Steatorrhea -> Fat isn't being properly absorbed Poor weight gain Physical Exam: - Risk for malnutrition long term - Abdominal distention - Thin extremities - Poor muscle tone -> Not getting nutrients they need - Can be diagnosed by small bowel biopsy bc it will show that the villi are atrophied
What is included in the nursing ax of peds pts w/ GER?
Health history and symptoms - Failure to thrive/ weight loss -> Or lack of weight gain Respiratory problems - Severe reflux - could be aspirating which could lead to pneumonia, etc Hungry/ irritability - Not getting fully satisfied, they are throwing it all up "Wet burps" or vomiting after feeds Infant: Pain with feeding/posturing Older child: dental erosion Physical Exam - Make note of weight - Check respiratory status - Look for sandiford syndrome (arches back in pain)
What is important to note about fetal heart dvlpmt?
Heart begins to dvlp shortly after conception and is completed by 8 weeks -> w/ fxing chambers Heartbeat begins at about 2 - 3 weeks gestation* (not a fxnal ❤ beat) -> @ 18 days that is simply the cardiac electricity from the ❤ cells that are being heard as a ❤ beat Risk factors for disruption of normal development: -> Maternal substance use = alcohol (FAS, 50% chance of having CHD r/t alcohol abuse) -> drugs (cocine/heroin/meth) -> meds (e.g. seizure meds/acne meds) - Maternal exposure to viruses (German measles, rubella, cytomegalovirus, toxoplasmosis in mother) - Maternal diabetes - Family hx of CHD In most instances there is no known cause
What are some risk factors for pulse alterations?
Heart disease, cardiac dysrhythmias, acute pain, sudden chest pain, cardio dx tests, surgery, IV fluid, hemorrhaging, dehydration, meds admin., & history of PVD
How can you apply heat and cold therapies?
Heat: - sitz baths - warm soaks - warm compress Cold: - ice bags or collars - cold soaks - cold compresses Soaks/ compresses = 20 minutes on and 2 min off Ice packs = on 30 minutes, off 1 hour
What is the normal hgb/hct count?
Hgb Females: 12 - 16 Males: 14 - 18 Hct Male: 42 - 52% Female: 37 - 47%
What are the teaching guidelines of allergic rhinitis, hx/ax, RFs?
History -> Symptoms of allergy - when it happens & what has been done to try and alleviate symptoms -> Seasonal component -> Medications used and response Risk factors - FH atopic disease - Tobacco smoke - Dust mites - pillow/mattress covers help, washing sheets weekly in hot water, minimal stuffed animals, blinds instead of curtains - Pollution - Recurrent viral infections - Early introduction of certain foods?
What two different types of evacuation?
Horizontal and Vertical, Horizontal = same floors, just move to a safe location (fire compartments), Vertical = moving down at least 2 floors below a fire
What are some important things to know about Digoxin?
Hypokalemia increases the effect of Dig
What are schedule I and schedule V drugs?
I = high potential for abuse with not medicinal value V = lowest potential for abuse
What labs do you need to keep an eye on when admin warfarin?
INR and H/H and watch their diet
What are the different routes of medications used to tx CA?
IV Intrathecal - spinal cord Intraventricular - ventricles of the brain Intraperitoneal - abd cavity, ovarian CA Topical - skin lesions Intra-arterial - high dose locally - most absorbed via skin + mucous membranes - Complications: > extravasation (PREVENT IT! + MONITOR SITE) > infiltration > severe tissue damage that may require surgx > pain + infection + tissue loss
What are the 2 ways potassium can NOT be given?
IV push (NO) or IM, irritating to the veins, KCl is caustic
What are the 2 ways potassium can NOT be given?
IV push or IM, irritating to the veins
What is a peripheral IV?
IV that is started in a pt. hand or somewhere in their arm
How is AKI managed?
Identify underlying etiology, and treat early Monitor for circulatory overload If not responsive to diuretic dose or IV fluids will need dialysis Monitor for circulatory overload: BP and lung sound changes Frequent I/O assessment Daily weights** - best indicator for overall fluid status, 2.2 lbs. of weight gain = 1 L of fluid Lab/ABG monitoring Diet considerations
How can you recognize the clinical appearance of a patient with an infection? (Clinical Manifestation)
If it's a local infection the pt will most likely experience the symptoms of inflammation (RHSP), they may experience some immobility, and some drainage. If it's a systemic infection - a pt will have an elevated temp., they might experience fatigue/malaise, nausea/vomiting, increase HR and respiration, but decreased BP, and an altered level of consciousness.
What is immunosuppressive therapy?
Immunosuppressants Drugs: Anti-rejection induction agents- Basilixumab (a monoclonal antibody) Maintenance immunotherapy agents- Tacrolimus (a calcineurin inhibitor) Corticosteroids-Prednisone High risk for opportunistic infections Death from cardiac disease is most common Take them daily for life
What can cause orthostatic hypotension?
Inability to vasoconstrict vessels of older adult, Medication, Dehydration
What are the stages of an infection?
Incubation - from the time the pathogen enters the body to the manifestation of the first symptoms > >Prodromal - the "off"/ vague/malaise feelings that happen before actual symptoms, onset of nonspecific symptoms to specific symptoms >> Illness - full blown specific symptoms, acute symptoms >> Convalescence - from the time where the acute symptoms disappear to complete healing, "when you start to feel better"
When is a urinary catheter indicated & contraindicated?
Indicated: - when you need to obtain sterile specimen (straight cath, goes in and comes out after urine collection) because a clean catch is not sterile - pt is unable to void - hourly monitoring - surgical procedures e.g. c-section, abdominal surgery Contraindicated: - incontinence or nurse convenience
What are some respiratory A&P considerations of pediatric patients?
Infants are obligate nose breathers -(until about 4 weeks) - They only breathe through their nose except when they are crying - They have little mucus in their noses to help prevent infection, but when they do have excess mucus their small airways can be obstructed making it more difficult to breathe Large tongues and tonsils - Large tongues in relation to oral pharynx which can lead to airway obstruction - As they get a little older, they have big tonsils and adenoids even when they are not sick. When they do get throat infection, tonsils can get so red and enlarged they touch each other which can occlude their airway Small trachea - 4mm in diameter compared to 20mm as an adult - Anything that causes swelling, such as bronchospasm, or increase mucus causes resistance to airflow to the lungs Underdeveloped larynx - Cartilage surrounding it allows it to narrow, which can cause aspiration risk Lower respiratory structures - Bifurcation of the trachea, where it splits to go right/left so it can go to lungs - Because of where its located in young children (3rd thoracic vertebrae compared to 6th in adults), there's an increased risk for aspiration - Nurses should be aware of where they branch off so they know how far down they can safely suction in children Lower airways - Narrower bronchi and bronchioles - makes swelling a bigger issue (bronchiolitis/asthma) - Fewer alveoli - where air exchange happens so if they have fewer to get oxygen, it puts them at higher risk for developing hypoxia and CO2 retention -> Continue to develop alveoli until about 8 years old Chest wall - underdeveloped - Muscles between ribs (which help move chest wall) are undeveloped and not supportive of lung expansion -> Chest movement dependent on the diaphragm
What is bronchiolitis? RFs? s/s? Dx? Tx?
Inflammation of bronchioles Risk factors - Low socioeconomic status, crowded living conditions - Older siblings in school, or they are in daycare - Not breastfeeding (they don't get the protective antibodies) - The season the virus are more prominent, usually fall/winter - Healthy children can get it easily, those with congenital heart or chronic lung diseases are at high risk (usually preterm babies) or those with compromised immune system Symptoms - Kids have a clear, runny nose for 2-3 days, followed by coughing and eventually leading to the wheezing sound. Can have a low grade fever, don't appear too sick in the early days of it, until they get the wheezing - Usually have hypoxia: s/s like blue tinged, tachypnea Diagnosis = With an NP wash and chest xray Treatment = Initially, hydration. Suck from bottle if possible, if not they need an IV - Nasopharyngeal suctioning, they produce a lot of mucus - Oxygen and bronchodilator treatment
What is pharyngitis? Dx? Manifestations?
Inflammation of the pharynx - Viral - most common -> Occurs with cold symptoms -> Self-limited -> Only symptomatic care is needed - Bacterial -> Occurs without cold symptoms - all of the sudden get fever/red, sore throat -> Group A Streptococcus -> Treated with penicillin for 10 days - Diagnosis -> Only by throat culture, not inspection Manifestations: - Abrupt onset - Dysphagia +/- fever +/- HA +/- abdominal pain Inspect for: - Exudate. pus - Petechiae on the palate - Strawberry tongue - Lymphadenitis in neck - Scarlatiniform rash - certain strep strains cause it, not contagious
What is meconium aspiration syndrome? RFs? Ax? Tx?
Inhalation of meconium-filled amniotic fluid (thick tarry stool) Risk Factors: post-term pregnancy, maternal DM, prolonged labor; breech presentation, forceps or vacuum-assisted births,, maternal smoking or drug abuse Assessment: tachypnea, respiratory distress, grunting, cyanosis, uneven pulmonary ventilation Treatment: (if mom comes in w/ ROM, what color is?) -> Assess for green-stained amniotic fluid -> Hyperoxygenation or oscillatory ventilation (dilation pulmonary vasculature) -> Pulmonary vasodilators and surfactant PRN -->> Aggressive suction > intubation -->> CXR shows infilitrate + hyperairation -->> atelectasis -> Acidosis, pH changes, acidotic - diluted meconium may not be as big of an issue - in severe cases may need to be can nitrous oxide or ECHMO/life support
What are some potential causes of hypoglycemia?
Insulin rxn, inadequate/ insufficient intake,
What are some interventions for Pre/Intra/Postrenal Etiologies?
Interventions to re-establish kidney function: - IV fluid bolus for prerenal or intrarenal - Remove obstruction for postrenal - What happens following the fluid bolus? possible respiratory stress r/t fluid overload, s/s: pulmonary edema, dependent edema, SOB, and increased weight - if pt is not urinating accurately fluid will build up and cause circulatory overload at that point diuretics may be given - Diuretics should only be given to pt who are physically able to produce urine SEs of diuretics: dehydration & further kidney injury - diuretics only release excess fluid and electrolytes they don't kidney injury, e.g. furosemide w/ o w/out thiazide When urine output does not improve: Assess for circulatory overload Diuretics may then be given, if appropriate If not responsive to (or not able to have) diuretic dose, will need dialysis
What is the main characteristic of cardiac obstructive disorders?
Involve "stenosis" or narrowing in a vessel
What are the behavioral effects of pain?
It can make pts can't sleep, agitiated, irritable, angry,anxious, restless, and unable to speak or open eyes. Patient guard the body part that is in pain. They may clench teeth, pace, groan, cry, gasp, or grunt.
How does Maslow's Hierarchy of Needs relate to the nursing process?
It helps prioritize nursing care. Priority 1 is physiological - ex: oxygen, fluids, body temp, ABC | 2 is physical/psychological safety - ex: falls/injury | 3 is love and belonging | 4 is self-esteem | 5 is self-actualization
What is the nursing process?
It is NOT the chart and it is NOT the care plan, it IS the way the nurse thinks to work through a problem with a patient from gathering data, to figuring out the priority problems and the causes of said problems, to making a plan and setting a goal. Then it involves setting the plan in motion and then evaluating if it's working by assessing the pt and adjusting until the problem is resolved.
Why does potassium have to be diluted?
It is irritating to the veins so it must be diluted 10 mEq in 100 mL and you can only give 10 mEq an hour
What is important to know about a prefilled syringe?
It is used only once and then discarded and any extra meds should be discarded BEFORE injection
What is the pathology behind the development of atherosclerosis?
It's a combination of platelet and lipid accumulation that progresses for years before effects are seen.
Who determines the internal standards of care?
J-CO/ TJC
What is an easy way to memorize the common metric system prefixes?
KHDBDCM so stop M it = Kilo Hecto, Deka, Unit, Deci, Centi, Milli, Micro
What are the diet recommendations for a AKI pt?
LOW K+, Phos, & Sodium (<2 grams) LOW protein intake, UNTIL prescribed dialysis, than the patient will switch to HIGH protein Possible fluid intake restriction (especially if in circulatory overload) Ammonia is a byproduct of protein breakdown, so the protein the more ammonia Fluid restriction calculation: 24 hr urine output + 500 mL = daily allowance
What is the controlled substance act of 1970?
Law that passed that regulates the making, selling, and importing of addictive drugs and it categorized drugs into classes. Class 1 drugs being the most addictive with no medicinal value ex: LSD, Heroin and Class 5 being limited abuse potential like antidiarrheals or cough suppresants with codeine. Class 4 drugs include antianxiety meds, sedatives like Valium, Xanax
What is connected to the common bile duct?
Liver, gallbladder and pancrease
What are some examples of advance directives?
Living Will (post death) Healthcare proxy/ Durable power of attorney - make decision for the pt DNR - written doc that allows natural death
What do the terms local/systemic, primary/secondary, acute/chronic, colonization, and latent refer to in the infectious process?
Local - infection stays in one place v. Systemic aka sepsis- whole body, can go from local to systemic due to nontreatment | Acute - sudden onset, get infection and get sick right away, short duration v. Chronic - slow development, long duration, ex: bone infections | Colonization - microbes (not normally part of our normal flora) becomes integrated into our resident/normal flora, ex: typhoid mary | Latent - asymptomatic, person doesn't know it | Primary - initial infection v. secondary - occurs after the treatment of another infection, ex: presents with strep throat > gets treated and antibiotic kills normal flora > yeast infection
What are some common healthcare acquired infections (HCAIs) that are drug resistant?
MRSA - Methicillin Resistant Staphylococcus Aureus, VRE - Vancomycin Resistant Enterococcus, and C.Diff. - Clostridium Difficile
What are some characteristics of MRSA infection?
MRSA - resistant to beta lactim antibiotics, (2 types: HA = healthcare associated-immunocompromised pts or CA = community acquired- intact immune systems), use **contact precautions**, no sharing equipment/items, "gown and glove" + use standard precautions, mainly transmitted via the hands (skin to skin or skin to equipment), so have dedicated equipment for the pt and sanitize linens and surfaces
What is macrosomia (LGA)? What are the concerns associated with IDM - LGA?
Macrosomia (LGA) - due to maternal hyperglycemia and fetal response of hyperinsulinemia which leads to somatic growth Nursing Concerns: Hypoglycemia Birth Trauma - injury occurring during birth (shoulder dystocia/clavicle fractures) Respiratory Distress Syndrome (RDS) - ⬆ insulin levels inteferes w/ surfactant production Polycythemia & hyperbilirubinemia Hypocalcemia (tremors, hypotonia, apnea, high-pitched cry, seizures) - cord compression, hypocalcemia
What are the risk factors of venous dz (PVD)?
Make a connection: - "As future nurses we will be standing for long periods of time which puts us a risk for PVD especially if we don't where our compression socks to aid in venous return." - "Being overweight or pregnant puts pressure on our vascular system which can also lead to PVD." - "If we smoke we cause our vessels to constrict and have less elasticity which can lead to HTN (prolonged) which can lead to PVD" - "Having a hx of thrombophlebitis which is inflammation of the vessels that leads to a clot which then leads to PVD."
What are some active/specific ways to prevent infection besides hand hygiene?
Make sure that drainage systems stay below the pt (fluid flows in the direction of gravity), wet linens or wrinkled linens can cause skin breakdown - imparied skin integrity = portal of entry for infectious agents, keep skin/lips (use water soluble chapstick) moisturized, be cautious of tubing (stabilize tubing with catheters, make sure pt isn't laying on top of them, avoid them if possible), perineal care
What are some immediate interventions for newborns? (ID)
Make sure they have all of their ID bands, including the security band (alarm) to prevent anyone from leaving certain areas with the child the NB + mom + S/O get ID bracelets NB gets 2 Same ID numbers on all of them
What is maximal efficacy?
Maximum effect = the *largest* effect a drug can produce
What is involved in medical asepsis or clean technique?
Medical asepsis = clean technique = standard precautions = universal precautions = used with ALL pts ALL the time = protective isolation (protects medical personnel from infection)
What is the difference between medical and surgical asepsis? Explain the continuum.
Medical asepsis is general clean technique while surgical asepsis is sterile technique. Surgical asepsis is cleaner than medical asepsis on the continuum.
What is the difference between medical and surgical asepsis when it comes to barrier equipment?
Medical asepsis uses the same principle as protective isolation (protect yourself/other pts from the infected patient) using PPE, timing and dating sol'n bottles. Surgical asepsis uses the same principle as "reverse isolation" (protect the pt from a transmittable disease from you/environment), so that means "gown and glove," mask, eye protection
How is kawasaki dz tx and managed by the nurse?
Medications: - Intravenous Immunoglobulin (IVIG) - Aspirin - high dose while febrile (80-100 mg/kg/day QID), then decreased dose (3-5 mg/kg/dayQD) as the sx goes down, the only exception to the rule -->> be aware of toxicity s/s: - HA - confusion - tinnitus - GI issues Promote comfort - Acetaminophen, Quiet environment, IV fluids - pay attn to I&Os Consult Infectious Disease Specialist and Cardiologist - they have r/f heart failure Labs - nonspecific - increased ESR, leukocytosis, thrombocytosis, anemia Education Avoid live vaccines (Measles, varicella) for 11 mo after high dose IVIG (admin slowly, decrease the incidence of coronary artery aneurysm, reduces inflammation in conjunction with acetaminophen) Regular cardiac F/U - Echo at diagnosis, 3 wks and 8 wks after treatment, then at discretion of cardiologist
What are 4 types of acid-base disturbances? What is the main difference between them?
Metabolic Acidosis/Alkalosis - problem in metabolism, systemic problem Respiratory Acidosis/ Alkalosis - respiratory problem, ventilation or alveoli gas exchange problem
What are hypotonic sol'ns and when are they used?
Mnemonic - hyPO = hipPO = makes the cell look like a hippo, "thirsty cells" cellular dehydration - more water than solutes therefore it draws water from the the blood vessels into the cells - lower osmolality than blood - 1/2 NS = .45% NS, D5W once the dextrose is metabolized - ECF has a low concentration of solutes while the ICF is high in solutes cause the fluid to shift into the cell - used with patients who have high glucose levels, DKA/ Kussmal's pts
What are hypotonic sol'ns and when are they used?
Mnemonic - hyPO = hipPO = makes the cell look like a hippo, "thirsty cells" cellular dehydration - more water than solutes therefore it draws water from the the blood vessels into the cells - lower osmolality than blood - 1/2 NS = .45% NS, D5W once the dextrose is metabolized - ECF has a low concentration of solutes while the ICF is high in solutes cause the fluid to shift into the cell - used with patients who have high glucose levels, DKA/ Kussmal's pts
What are some skin variations you may find in an H2T ax?
Mongolian spots - may be mistaken for bruising, document them well, bluish spots on lower back, buttock, upper outer thigh, common in dark skin/AA babies, may or may not go away Vernix caseosa - thick white substance that protects skin when in the uterus, dealy bath bc it acts as a moisturizer Stork bites - aka salmon patches, superficial vascular areas on nape of neck, eyelids or b/t eyes goes away in a year Nevus flammeus aka Port-wine stain (permanent), will not fade with time, usually on face or head area, more to childhood CAs, best to treat (lighten w/ laser) before the age of 1 Acrocyanosis (⬇ APGAR score) - doesn't indicate cold temp, baby is getting adjusted to self-circulation > cyanosis becomes an issue when it is central cyanosis, cyanosis of the head/around the mouth Milia - unopened sebaceous glands on the nose, goes away in 2 - 4 wks Epstein pearls -milia formed in the mouth, goes away in few moths Erythema toxicum - benign papular-pustular rash, chest or back Harlequin sign aka Clown suit - dilation of blood vessels on one side of the body, not common usually resolves itself Nevus vasculosus aka strawberry mark/hemangioma - may darken, disappear by age 3
What are the interventions for stage 4 CKD?
Monitor and/or Treat Sodium Potassium Magnesium Calcium & Phosphorus Calcitriol (active vitamin D)- Increase Ca absorption Phosphate-lowering agents (binders) -Calcium acetate (PhosLo) or Calcium carbonate (Os Cal)- Increases calcium, lowers Phos - contraindicated in pts w/ elevated Ca2+ levels or have kidney stones -Sevelamer (Renagel) (mostly in dialysis only)- decreases Phos only (no effect on Ca) - Ca2+ salts can also be given but they need to be given w/ meals and require Vitamin D for absorbtion - avoid mylanta and maylock - Anemia results from nutritional deficiencies needed to make RBCs, decrease EPO, and a shortened RBC lifespan. Anemia and General Wellness: Ferrous sulfate (Feosol) Iron supplement (loss during dialysis) Folic acid (post dialysis) Multivitamin Epoetin alfa (Epogen, Procrit) Stimulates RBC production Given in non-dialysis or dialysis patients
Describe the 4th stage of CKD
More metabolic waste Higher BUN & Creatinine Kidney ↓ urine output possible Clinical manifestations present Vary depending on urea level Electrolytes more severely abnormal Follow closely with specialist Refer to vascular access surgeon (dialysis) for fistula or graft
What is involved in a basic hygiene care schedule for both Acute + LTC settings?
Mornings - offer bedpan/urinal when they wake up and after breakfast, washes hands+face, oral care, provide "complete AM care" i.e. change pt gown/PJs, peri care, foot/nail/ oral care, change linens, straighten up pt room, back rub Afternoon care - wash hands + face, oral care, offer bedpan/urinal + straighten ben linen PM care - sleep promotion, change soiled linens, back rub, bedpan/urinal, change gown/ PJs
What is a fall risk assessment that could be used in a clinical setting?
Morse Fall Risk Assessment
How is cystic fibrosis managed?
Multidisciplinary approach - CF clinic every 2-3 months -> Monitoring of growth and development --->>> Are they taking care of themselves at home? --->>> Are they taking their pancreatic enzymes? Stools will be fatty if they are not Assessment of lung function with PFTs Assessment of GI tract for malabsorption symptoms - Pancreatic enzyme administration Monitoring for complications of treatment Assessment of psychosocial issues - Child is young and don't realize they have a fatal illness but parents know child will likely die before they do
What are the metabolic changes that can occur due to immobility?
Muscle atrophy (cells and tissue decrease in size due to immobility), protein muscles breakdown into amino acids, amino acids breakdown into nitrogen. The pt basically loses more nitrogen then they can intake > protein supplements Can lead to anorexia (not hungry, no appetite) and fatigue
What are some special dietary considerations to have w/ diabetes pts?
NPO - Frequent BS monitoring - Titration of insulin dosing - IV Dextrose - Procedures scheduled early am if possible Tube feedings - Frequent BS monitoring - Evaluating insulin dose with changes in the tube feeding Clear liquid diet - Frequent BS monitoring - Give sugar free clear liquids Parenteral Nutrition - Frequent BS monitoring - Sliding scale insulin w/ continuous feeding do glucose checks q4h
What are the 5 stages of CKD? (GFR)
NV GFR: 125+ ml/min Stage 1: At risk (GFR ≥90 mL/min), no s/s, diminshed renal reserve Stage 2: Mild CKD (GFR 60-89 mL/min), renal insufficiency Stage 3: Moderate CKD (GFR 30-59 mL/min) Includes 3a & 3b, moderate chronic kidney dz Stage 4: Severe CKD (GFR 15-29 mL/min), severe Stage 5: End Stage Kidney Disease (GFR < 15 mL/min) or chronic renal failure, on dialysis bc they have lost 90 - 95% of glomerular fx
What is neonatal sepsis and how does it present?
Neonatal Sepsis - Presence of bacterial, fungal, or viral microorganisms (or toxins) in blood or other tissues - most common Group B Strep - early onset sepsis, onset birth to 1 wk, infection from birth canal - Presents as: septicemia, pneumonia, meningitis - Congenital infection - present @ birth, infection directly from the mother, TORCH, contracted in utero - Late-onset sepsis - onset beyond 1 week, maternal or external source of infection - 50% mortality rate in untx
Depending on each body system uremia can manifest differently. What are the s/s of uremia according to each system?
Neurological Lethargy/LOC change Paresthesias Cardiac Fatigue Pericarditis > tamponade > dysrhythmiaas > decreasd CO > death, s/s: severe chest pain, tachycardia, fever Respiratory Dyspnea (acidosis) Integumentary Uremic pruritus/ Itching (crystals) - found on face, forhead, scalp, groin, and axilla Pigment changes Gastrointestinal Stomatitis Halitosis Metallic taste N/V Anorexia Gastritis Diarrhea loss of appetite Musculoskeletal Muscle cramps Hiccups
Are incident reports included in the pt record?
No
What are some contraindication to hot and cold therapies?
No cold for: - edema - neuropathy - if pt is shivering - impaired circulation No heat for: - active bleeding - inflammation - cardiovascular pt
What are the classifications of BP for adults?
Normal = <120/<80 | Prehypertension 120-139/80-89 | Stage 1 Hypertension 140-159/90-99 | Stage 2 >or equal to 160/ > or equal to 100
Why should nurses understand pharmacodynamics?
Nurses have to communicate with other members of the healthcare team, they have to make PRN decisions, they have to educate the patient, they have decide whether a dose is therapeutic, not therapeutic, or toxic
What are some things a nurse can do to help with orthostatic hypotension?
Nursing Actions (can be used with any pt ex: pt who have recently had surgery): - Change position slowly, Dangle before rising, Stand prior to ambulation
What is the nursing process?
Nursing Process = ADPIE *A* - assesment = data collection = labs, interviews, family members, look at the pt as a whole no assumptions, no judgment *D* - diagnosis = problem = analysis, 75% of diagnosis comes from pt history *P* - plan = goal- pt outcomes, identify appropriate nursing interventions *I* - implementaton - may involve other members of the healthcare team ex: physical therapy, performance, action *E* - evaluate - was the goal met? --- Continuous process
What are the components of the nursing process?
Nursing Process = ADPIE | *A* - assesment = data collection = labs, interviews, family members, look at the pt as a whole no assumptions, no judgment | *D* - diagnosis = problem = analysis, 75% of diagnosis comes from pt history | *P* - plan = goal- pt outcomes | *I* - implementaton - may involve other members of the healthcare team ex: physical therapy | *E* - evaluate - was the goal met? --- Continuous process
What is the U-100 syringe used for?
ONLY insulin, calibrated to mean 100 units of insulin per 1 ml
What is the Lo-dose U 100 syringe?
ONLY used for insulin, calibrated for very small amounts of insulin, either 50 units of insulin per .5 ml or 30 units of insulin in .3 ml
What are some ways to collect data on a pt?
Observe, interview, examine the pt, you can collect data during nursing admission, or through a focused assessment
What is the pathophysiology of appendicitis?
Obstruction of the appendix - Usually due to fecal material that gets caught in the narrow opening into the appendix - when it gets blocked off there's acute inflammation, then infection, edema, and swelling that can occur, even rupture Increased pressure Edema Bacterial overgrowth Perforation - Infection can move into open abdomen and cause peritonitis
What is Virchow's Triad?
One or more of these factors must be present for a DVT to form: - Stasis = static, pooling of blood - Endothelial damage = inside of the vein is damaged due to central lines, IV catheters, atherosclerosis - Hypercoaguability = when a pt is more prone to clots due to some kind of dz state e.g. cancer, autoimmune disorder
What are the different ways a nurse can take body temperature? How does one asses body temperature?
Oral/ Tympanic/Rectal/Axillary Temperature = heat produced - heat lost - Devices used to take temp are usually shared amongst patients, make sure clean the device in between pts. - Before you take the pt's temp ask them, "when was the last time you smoked or had something cold or hot to drink?" - Use the plastic caps and make sure the thermometer is placed in the sublingual space and the pt's lips are closed.
What is OOB with assistance?
Out of bed with assistance
What are some head variations you may find in an H2T ax?
Overlapping sutures plates/molding/"conehead" - elongated head shape to accommodate birth canal Cephalhematoma - Localized effusion of blood beneath the periosteum of the skull (does not cross suture lines) - no tx, but ax it - can contribute to jaundice bc there's more RBCs to breakdown - caused by difficult birth - may take weeks to months to resolve - fills w/in the 1st few hrs of birth - blood takes longer to be reabsorbed Caput succedaneum - Localized serous, soft tissue swelling (crosses suture lines) - like edema w/ pitting - not associated w/ jaundice - easier to absorb, take 3- 5 days to resolve w/ no tx - not generalized to one side - commonly observed after prolonged/ dificult birth/ labor - may see petechiae, bruising
What is the diff b/t diaphragmatic and pursed lip breathing?
PLB - release trapped air in the lungs - prolongs exhalation to slow the breathing rate diaphragmatic breathing - using the diaphragm to increase oxygen inhalation
What should a nurse ask about in order to assess a pt's pain?
PP, QQ, RR, S, T, U
How can you start to assess GI disorders?
PQRST P: precipitating or palliative Q: quality or quantity R: region or radiation S: severity scale T: timing & Physical assessment Inspection Auscultation Percussion Palpation
What is the best intervention for fires?
PREVENTION
What are the pro's and con's of an external female catheter?
PROS: no UTIs comfortable no skin breakdown better sleep CONS: confused pt's may remove it may slip out of very thin women
What are some common discomforts of dying pts?
Pain Dyspnea Anorexia Nausea & vomiting Constipation Fatigue Pressure ulcers Confusion Depression Stress Grief
What are some common concerns of the family?
Pain and other symptoms Fluid and nutrition Mobility Family providing care Planning for the death
What is Hirshsprung Disease?
Patho - lack of ganglionic cells in the bowel which cause inadequate motility - The ganglionic cells are the little cells that assist in peristalsis - so where they do not exist there is not peristalsis to move things along Risk factors - not passing meconium in first 24 hours; male - Mostly diagnosed in early infancy or within first 3 years of life - Diagnosed with a rectal suction biopsy - biopsy of colon and put under microscope which will show absence of ganglionic cells Symptoms: - Abdominal distension and pain, constipation, vomiting Poor weight gain, slow growth - With the constipation, you can often palpate the stool in the quadrant Treatment: Surgical resection of the bowel with reanastomosis; "pull-through" procedure - If a large portion of bowel has to be removed, it will likely have to be done in several stages - may need ostomy for a while - Eventually the goal is to have it reconnected and live without colostomy
What Celiac Disease?
Pathophysiology: - Autoimmune disorder - Inability to digest gluten -> Found in wheat, barley, rye, some oats - Damages villi in small intestine due to immune response to gluten - Malabsorption leading to malnutrition -> Gluten is introduced in diet which causes damage to villi which causes lack of absorption of nutrients Medical management -> Gluten-free diet
What are some examples of a goal (desired outcomes) for a R/F falls diagnosis?
Patient will not fall during their hospitalization., Patient will verbalize understanding of individual risk factors that contribute to the possibility of falls. Pt will be free of hypersensitive responses to allergens.
What are some pain assessment communication barriers?
Patients in advanced age - 85 years or older, pts with emotional/cognitive disturbance, language barriers, patients who are intubated, and patients who are seriously ill are nonverbal
What type of patient should a nurse identify as being at risk for fluid volume overload?
Patients: - on IV therapy - w/ Liver disease - w/ Heart disease - w/ Kidney disease - on Steroid therapy
What are some complications/examples that can arise from chest trauma?
Penetrating: - open pneumothorax - hemothorax - pulmonary contusion Blunt aka non-penetrating - fractured ribs - flail chest - closed pneumothorax - tension pneumothorax - pulmonary contusion Priorities: - ABCs first - Rapid ax - treat life threatening condition
What assessment finding would make a nurse suspect hemorrhage?
Perforation can cause a hemorrhage. Hemorrhage =bleeding - tachycardia (body senses low volume) - tachypnea (because hemorrhage and body becomes hypotensive) - hypotension (losing volume) - Change in LOC (not enough oxygen in red blood cells circulating to brain) - pallor - pain - frank bleeding (bright red blood) - decrease in HBG/HCT (H/H) **NEEDS ATTENTION ASAP! NEED FLUIDS AND/OR BLOOD AND POSSIBLE SURGERY!**
What assessment findings would make a nurse suspect perforation? What is perforation?
Perforation= gone through the muscle (different from penetration) - severe abdominal pain - fever (contents leaked out causing inflammation and infection) - n/v = electrolyte imbalance or dehydration - abdominal distention (because contents are in the stomach) - rigid abdomen or board like (sign of something is perforated) - respiratory rate may go up - altered bowel sounds
What is considered the perinatal period? Neonatal period? Neonatology?
Perinatal period = 28th week of gestation to 7th day after birth Neonatal period = Birth to 28 days after birth, "neonate" = baby > 28 days old Neonatology - subspecialty that deals with mostly sick or premies, neonatologist work in the NICU, high morbidity, goal is to increase survival rate
What is peritoneal dialysis?
Peritoneal catheter inserted Dialysate prescribed by physician depending on patient manifestations & lab data: 1) Fill 1-2L dialysate infused by gravity over 10-20 min 2) Dwell Time physician specific 3) Drain effluent Dialysate, excess water, electrolytes, wastes 4) Repeat whole cycle (the exchange process) per orders - Requires silicon catheter to be placed in the abd cavity - Used because the peritoneal membranes are larger and porous - Can be qd or multiple times a week - ALL depends capillary blood, membrane permeability, and perfusion to peritoneum
What are some complications of PD?
Peritonitis - sterile technique! Cloudy dialysate effluent (early sign) Fever, abdominal tenderness & pain, malaise, N/V Prevention - meticulous sterile technique High risk- Obese, DM, elderly & long term steroid clients Pain Common on inflow (initial treatments) Subsides within 1-2 weeks Warm dialysate for relief - never microwave it, use heating pad Exit site & tunnel infection Teach s/s of infection Culture wound Treatment may be difficult Can lead to peritonitis May need intraperitoneal abx Poor outflow Constipation - prepped w/ enema prior to dwell time or increase fiber or stool softeners Kinked or clamped catheter Catheter displacement - xray needed Clot formation Dialysate leakage Clear fluid around catheter site Use smaller volumes at start Blood tinged outflow *with initial treatments then should clear or pale yellow
What is PPE?
Personal Protective Equipment (PPE) - ex: gown and gloves, mask, eye protection.
What is included in a GI assessment? (physical exam)
Physical Exam: Inspection & Observation - Abdominal size and shape - should be soft, non tense - Look at abdominal musculature - Paleness? Could indicate GI bleed or jaundice indicating liver issues - Protuberance could mean gaseous distention occuring - Depressed abdomen could mean an obstruction/dehydration - May observe umbilical hernia - not uncommon because musculature is still weak so intestines may poke out some. Should be able to be pushed back in Auscultation - always listen before palpate/percuss - Listen in all 4 quadrants - hypo/hyper/normal sounds? Percussion - Usually tympany over most of abdomen - May be dull sounds over organ or colon full of stool Palpation - Lightly first, assess for tenderness (would be abnormal) They do need to be as relaxed as possible, it's invasive for them to have someone lift up their shirt They also could be ticklish/tense which can make their abdomen seem more firm Could have issues with dehydration - should note general appearance like mental status, are they lethargic?, recent weight gain/loss, needs to be addressed first
What are some signs of heart failure in a child?
Poor growth Poor feeding, takes longer to feed Breathing probs (tachypnea, 1st warning sign) Blue color around eyes & mouth (central cyanosis) Sweating Swelling in eyes, hands, feet Tachycardia Tachypnea - think 1st signs of heart failure Signs are subtle so listen to parents when the tell something may be wrong with their child
What is involved in the inpatient nursing care of dialysis?
Pre-dialysis Ensure current labs drawn, reviewed, & on chart Weight & VS Assess the site or s/s infection or bleeding Hold dialyzable medications & antihypertensives, antibiotics (cephalosporins), water-soluble vitamins *OK to give: insulin, phosphate binders, fat soluble vitamins (ADEK) ADLs prior to treatment Monitor pain levels bc pain meds can be dialyzed Post dialysis Monitor v/s, subjective complaints, & assess site bleeding s/s: HA, N/V, hypoTN, muscle cramps, dizziness Avoid invasive procedures for 4-6 hours
What is involved in the pre-op and post-op care of a laryngectomy?
Pre-op: - pt education/expectations - support groups - involve fam Post-op: - AIRWAY - temp trach for 5-10 days - IS - watch out for edema, difficulty breathing + aspiration - NG tube - protein = wound healing - secretions > fluids + movement - monitor lung sounds to pv fluid overload - body image issues - speech therapy - hyperalimentation
How are preterm newborns prepared for discharged?
Prepare for discharge -> Provide parental education -> Teach infant CPR and emergency care (sx to look for) -> Develop appropriate home care environment (social work) -> Establish a medical home and referrals -> Initiate primary care routine -> Celebrate progress and milestones! (expect the neonate/NB to reach late milestones anticipatory guidance)
What are some complications that can arise with clients in restraints?
Pressure ulcers, death, psychosocial concerns, constipation, incontinence, pneumonia
How can you pv bronchiolitis caused by respiratory syncytial virus (RSV)?
Preventative measures - Strict hand washing in day care centers and home - Droplet precautions RSV can survive for hours on hard surfaces (like crib rails) and the person that has it is contagious for 3 - 8 days - Infants can get it more than once Prevention for certain populations - palivizumab (Synagis)
What is the difference b/t primary and 2ndary intention?
Primary - sutures Secondary - heals from the inside out
How are sources of info categorized in regards to med admin?
Primary - the client Secondary - family, chart, and lab Tertiary - literature search
What are three types of health promotion goals?
Primary = preventive, e.g. immunizations, exercise Secondary = screening, "catch it early" e.g mammograms Tertiary = treatment, e.g. rehab, prevent pt from getting worse
What is the difference between primary and secondary HTN?
Primary HTN aka Essential HTN: - no long term damage - no cause is unknown Risk factors include: - smoking - stress - obesity - not exercising - AA higher risk - high Na and caffeine inntake - low K, Ca, and Mg - high alcohol intake - hyperlipidemia - > 60 y/o, post menopausal Secondary HTN: - caused by D&D = drugs and Dz, think issues w/ heart, kidneys, brain - Kidney Dz - Primary aldosteronism, Cushing's Syndrome - Narrowing of aorta - estrogen - pregnacy - Brain tumors & encephalitis
What is sleep apnea?
Primary central sleep apnea, Central sleep apnea caused by medical condition, Obstructive sleep apnea syndromes, Excessive daytime sleepiness
What are some psychological implications of isolation?
Private rooms = loneliness, depression, body image disturbance, as a nurse you educate the patient and explain to them what's going, listen to them, don't be so quick to leave the room, and increase sensory stimulation
What are endoscopic procedures?
Procedures to help diagnose what's going on and can be interventional. They provide direct visualization. They are usually invasive.
How are preterm NBs managed by the nurse?
Promote oxygenation -> Identify asphyxia - prepare for resuscitation -->> ask when is your date in order in order to ID r/f respiratory issues -->> risk determined @ birth -> Administer oxygen (judiciously) to maintain p/ox from high-80s to mid-90s -->> high O2 can cause retinopathy -> Monitor respiratory status and airway patency -> Administer medication (surfactant) Maintain thermoregulation -> Radiant warmer, isolette, kangaroo care, if stable -> Promote nutrition and fluid balance -> Monitor daily weight, strict I&O/calorie count -> Encourage breastfeeding/use of maternal breast milk --> mom is encouraged to pump Prevent infection (low temp, temp instability = 1st sign of infection) -> Monitor changes in vital signs and pulse-ox -> Protect skin (skin is fragile) -> Screen visitors (limit them) Provide appropriate stimulation -> Rocking, swaddling, sucking, massage, holding -> Promote growth and development -> Alter NICU environment; cluster care Manage pain (sedation) Promote parental coping -> Validate feelings -> Encourage frequent visits -> Identify family and community resources After 34 weeks, when they can coordinate suck & breathing/swallow then we can address potential dvlpmtal delays
What are different types of surgical tx available for cancer pts?
Prophylatic > remove tissue to pv CA dvlpmt Diagnostic > Biopsy Curative > remove all CA tissue Cancer control > debulking/decrease size Palliative > not curative but s/s relief Reconstructive > aid in appearance Surgx tx > ↓ fx of organ
What the 7 parts of a drug order?
Pt, frequency, med, dose, route, HCP signature, date, and time they wrote the order
What are some common pediatric respiratory tests?
Pulmonary function tests (PFTs) - Most effective if at least 5 years old - Especially CF and asthma patients Bronchoscopy Nasopharyngeal wash - How we get a sample from the nasopharynx, go in through the nose - Usually done when we suspect a child has influenza or pertussis (or COVID) - Done once then test for all the potentials Apnea-bradycardia monitors Pulse oximetry - Continuously if they have a respiratory illness - Result of pulse ox altered by ambient light (like fluorescent lights on ceiling), best to cover child's foot with sock
What is chvostek's sign?
Push the cheek and it spasms (low calcium) due to hypocalcemia
What are some examples of safety diagnoses/problems?
R/F r/t ____, R/F allergy response r/t ____, impaired physical mobility r/t ______AMB, Impaired home maintenance r/t ___AMB, Knowledge deficit r/t ____AMB, Confusion r/t___AMB___
What is the RAPP assessment?
RA - respiratory activity (breathing/color) P - perfusion P - position (are they limp? moving extremities? flexed?) less formal than APGAR can be done as the baby is coming out
What are the 5 Rights of Med Administration?
RIGHT [( Pt + time) + ( med + dose + route)]
What is the recovery phase of AKI?
Recovery up to 12 mos May need permanent ror temporary dialysis Follow-up care w/HCP Frequent appointments Laboratory monitoring Diet modification Diet will vary based on the level of renal function return @home daily weights needed
What is the difference b/w "rescue" and pv-long-term controller meds?
Rescue medications - To treat acute symptoms and exacerbations -> Short acting ß2-Agonists (albuterol) - treats acute symptoms, causes dilation of bronchus to relieve bronchospasm -> Can't use more than 4 times a day, may need to add oral corticosteroids if it doesn't help Prevention long-term controller medications - To achieve and maintain control of inflammation - Inhaled corticosteroids - Oral leukotriene modifiers
What is an organism that resist disinfection?
Resistant
What are the effects of prematurity on a newborn?
Respiratory → Chronic Lung disease; O2 use can cause retinopathy of prematurity -> infants chest wall is unstable. doesn't have the musculature -> respiratory control center not dvlpd leading to apnea -> they can outgrow some of their respiratory issues, depends on severity -> retinopathy can lead to blindness -> surfactant deficiency can lead to respiratory distress syndrome = RDS is a syndrome specific to premies w/ ⬇ surfactant, starts production @ 24 wks and completes it @ 34 wks -> generally respiratory distress simply means the baby is not breathing well Cardiovascular → persistent fetal circulation; anemia -> hypoxia -> happens bc areas in the ❤ that need to close do not -> impaired BP regulation > ⬆ r/f intracranial pressure Gastrointestinal - Uncoordinated suck, swallow -> Shunting of blood to vital organs; NEC - due to ⬇ blood flow to intestines > bacterial infection in the intestines -> require enteral/parenteral feedings until they coordinate breathing & swallowing Renal → decreased GFR -> fluid retention -> caution! fluid overload -> electrolyte imbalance > ⬆ r/f toxicity Immune → IgG deficiency; infection, septicemia Central Nervous System -> Mental/motor/developmental delays -> Intraventricular hemorrhage (IVH) -> trouble w/ thermoregulation -> issues w/ hypoglycemia > dvlpmtal delays
What are the benefits of rest?
Rest is not the same as sleep Rest can be anything relaxing to the pt, i.e. reading, watching TV, prayer, neditation Mental relaxation Freedom from anxiety
What are some complications that can arise from Group A streptococcus pharyngitis?
Rheumatic fever - Caused by untreated strep - 1-5 weeks after - Arthritis in larger joints - Rheumatic heart disease requiring valve replacement Post streptococcal glomerulonephritis - Proteinuria - Facial and peripheral swelling - Decrease urine output with dark brownish urine Post streptococcal reactive arthritis - Reaction to infection in a different part of the body, often large joints, sacroiliac, and lower limbs - Requires antibiotic treatment Tonsillar abscess Drainage or surgery
What is included in the nursing ax & management of a hypertrophic pyloric stenosis pt?
Risk Factors - More often males than females - Family hx common (usually dads) Health history and symptoms: - Non-bilious emesis 30-60 minutes after feeding -> Because with the sphincter preventing the food from getting to intestine, it will only be the food coming back up - Hungry and crying despite having been fed - they are throwing it all up - Progressive weight loss Physical Exam: - "Olive shaped" mass in upper abdomen - the thickening muscle - Progressive dehydration Fluid and electrolyte management Parental education Pre & Post-op care Resume feedings
What is included in the nursing ax of cleft lip/palate?
Risk factors - More common in males Health history Physical exam - Can often be seen in US but if not, upon delivery - If not cleft lip deformity, the palette will be checked upon examination in 1st assessment - they'd be able to palpate the defect - Another sign is baby choking, gagging, aspirating during first feed Family education - Kids will go home with assist devices for feeding - Family should know CPR in case of aspiration
What are some risk factors associated w/ an SGA baby?
Risk factors: - Maternal smoking/drug use - Genetics - Multiple gestations - HTN (mom's blood volume is mostly going to be used for mom & less going to baby) - Maternal illness
What are some pain descriptors?
SQT : [mild, moderate, severe, use pain scale to assess Severity], [words like aching, crushing, burning, gnawing, stabbing, sharp, dull, and throbbing assess for Quality of the pain], [When assessing for timing ask about onset (when does the pain happen?), frequency (how often does the pain occur?), and duration (how long does the pain last?)]
What are 2 types of syringes that prevent needle stick injuries?
Safety (use a shield) syringes and needless IV syringes
What is hypertension? (Peds)
Screening should begin at 3 years - BP norms are based on gender, age & height; based on 3 separate readings at 3 different visit Primary hypertension - associated with BMI and waist circumference, obesity, seen commonly in older kids, fast food, type 2 diabetes Secondary hypertension - frequently related to renal or cardiac disease Healthy People 2020 Objective: Reduce the proportion of children & adolescents with hypertension persistently above 95th percentile for their gender, height, and weight Normal falls under the 90th percentile - family hx? - get BP on all 4 extremities - they don't have any other risk factors than it maybe 2nd HTN Rule out tests: - BUN - ECHO - Creat
What are some characteristics of VRE infection?
Seen frequently in immunocompromised/high risk pts, pts who are in the hospital long term, intestinal infection, "gown and glove" + standard precautions, **contact precautions**, limit the transporting of these pts
Describe the 3rd stage of CKD
Separated - 3a (45-59); 3b (30-44) Metabolic wastes apparent ↑ BUN & Creatinine Microalbuminuria + Polyuria may continue Initial electrolyte imbalances Control co-morbidities strictly Other clinical manifestations may appear Nephrologist consult Fatigue and sluggishness
What are some rules a diabetic patient should follow during their sick days?
Sick day rules = BG q4h + test for ketones if BG > 240 + take insulin/antidiabetes meds + drink sugar free fluids (8-12 oz.) + eat @ reg times Note: - if BG ,70 add sugar to drinks - call the doc if NVD, ketones, post 2 supp insulin doses, fever 101.5 over 24hrs
What's included in the newborn H2T ax?
Skin - color, jaundice, cyanosis Head - size & shape, circumference, skull deformity? Vag birth? Muscle tone & activity Chest, abdomen - respiratory effort, HR, bowel sounds Reflexes Safety - managing temp, ID pt, stable, transition to extrauterine life Parental interaction & teaching - new parents? older kids, need refresher? breastfeeding education
Based on the site what would you expect to be the radiation effects?(Scalp, Head & Neck, Chest & Lungs, Abdomen, Pelvis + Bone marrow)
Skin > Radiation Dermatitis > redness > rash Scalp > perm hair loss Head & Neck > Late effects = hypothyroidism + xerostomia + dental caries, acute = taste changes + oral herpes + candidiasis Chest & Lungs > taste changes, pneumonia, esophgitis, pharyngitis, fibrosis (late sign) Abdomen > anorexia, N/V, Diarrhea Pelvis & Bone marrow > bowel injury (late effects)
Describe the 2nd stage of CKD
Some waste accumulation ↓ Creatinine clearance Slight increase BUN/Cr Microalbuminuria (possible) ↓ Ability to concentrate urine Nocturia & polyuria possible No other clinical manifestations Can see this as a normal part of the aging process UA should be performed periodically, especially diabetic pts (early on in management)
What is the difference between sterilization, disinfection, and cleaning?
Sterilization means kill all the microbes and remove the spores. Disinfection - the creation of a bacteriostatic environment through the use of chemicals like bleach and betadine. Cleaning refers to general cleanliness, regular soap and water.
What is the form of the drug?
Structure and composition of drug e.g. solid, injectable, oral sol'n
What kind of data can a nurse collect?
Subject or objective data that doesn't include assumptions, opinions or conclusions
What is the difference between subjective and objective data and conclusions?
Subjective = whatever the patient tells you, whatever the "patient states," ex: "I feel short of breath', "I feel like my throat is burning", "I took my temp at home and it was 102 degrees" | Objective = observations that you can see, "Nurse/caregiver Observes", test and measurements that you took, Numbers/labs - important because they can be used as a baseline, Be specific "paint a picture"
When assessing what are some subjective and objective data you can collect to determine a pt's fall risk?
Subjective data may include health history, any allergies, meds history, history of falls | Objective data includes gait, balance, muscle mass/strength, confusion/orientation
What reflexes do you assess during an H2T ax?
Sucking Rooting Moro aka starle reflex Grasp (palmer + plantar) Stepping Babinski Tonic neck (fencing reflex) "after you drink tonic you want to fight" Truncal incurvation (Galant reflex) - disappears with 4wks, ventral suspension/prone, firm pressure down spine stroking will cause pelvis to flex towards stimulated side T2 to S1 innervation, lack of response indicates neuro or spinal cord problem Gag & cough reflex - ax especially in head injuries
What is included in the nursing ax of a pt with intussusception?
Sudden onset intermittent pain - Babies will often pull up legs when in pain - Bilious emesis - will have bile in the emesis - "Currant jelly" stools - mucus and blood mixed Physical exam - Lethargy - "Sausage"-shaped mass Emotional support
What are some sites that can predispose a patient to infection?
Surgical wounds - impaired skin integrity, the respiratory tract (airborne pathogens - port of entry), Genitourinary tract (ex: bladder is sterile so inserting equipment with improper technique can introduce infection), Invasive Devices (ex: ventilator acquired infections, catheter), Bloodstream (ex: central lines have to be cleaned a specific way, catheters can also introduce pathogens), TPN (outside of GI Tract = high sugar content = favorable microbe growth environment), Enteral (used inside the GI Tract), Implanted Prosthetic Devices (metal/ foreign objects)
What is AOM? s/s? PMH? RFs? Tx? complications?
Symptoms - Fever - Otalgia - PAIN - Fussiness - Poor feeding - Night awakening *Tugging at ears - by itself, doesn't mean much *Fluid draining from ear PMH - Young age - unusual after 5 or 6 - Recent URIs -> It's not the ear infection that gets brought home, but the virus that precipitates it - Day care attendance/school - Previous AOM or OME Risk factors - Age -> 1st episode of AOM before the age of 3 months -> will probably have repeated ear infections - Possibly allergies - Craniofacial anomalies - Exposure to passive smoking - NOT having been breastfed - it's a protective factor (passive immunity) - Crowded living and day care attendance - spreads germs easier - Should not be laying down to be fed, need to be sitting up at 45 degree angle or so -> Laying down and drinking from bottle can cause formula/breastmilk to track up eustachian tube and get into middle ear, provides food to bacteria
What are some s/s of respiratory infection? (Age, Size, Seasons, Decreased Resistance)
Symptoms Fever, coughing sputum, red throat, bad breath (clues as to what they could have) Age - Important because they have maternal antibody protection until 3 months - 3 - 6 months those antibodies are weaning, they are developing their own immune system - still at risk for getting sick - With age and exposure to others that have illnesses, child will develop memory to those if they get sick - repeated virus exposure causes memory in their immune system Size (of airways) - Edema and secretions are issue for the small airways Seasons - Certain illnesses that occur with seasons: influenza and respiratory syncytial virus are fall/winter - mycoplasma/pneumonia are summer Decreased resistance - A child who has immune deficiency, malnutrition, allergies, asthma, or cystic fibrosis have a harder time fighting infection
How do you know it's acyanotic heart dz - ventricular septal defect (VSD) and not patent ductuc arteriosus (PDA)?
TRPP MH •Murmur •Tachypnea* •Heart failure •Poor growth •Respiratory infections (more fluid in the lungs) •Peripheral edema* possible to close on their own Oxygenated blood goes through the lungs a 2nd time clear infections before surgx
What are some different types of thracic surgx and what is involved in their preop + postop?
Teaching always start in pre-op: - expectations - goals Post-op: - promote ventilation - IS - CT - Protein for healing - Lung expansion > ↑ endurance - Splinting - how to get out of bed - S/S bleeding - pain control - Empyema (pus in the lung) - pv using TCDB + early ambulation - pv bronchopleural fistula = allows air into pleural space
What would you tell a patient to educate them about infection control and prevention?
Tell them about how susceptible they are to infection, clean up reservoirs, protect skin (portal of entry), hand hygiene, promote healthy habits like sleep, minimize stress, vaccinations, no smoking, minimal drinking
How does cyanotic heart lesions - teratology of fallot (TOF) manifest?
Tetralogy of Fallot (TOF) •Cyanosis - Desaturated blood enters the peripheral circulation •Polycythemia - results from chronic hypoxia •Right-to-left shunt (unoxygenated blood mixes with oxygenated blood) *pulmonary artery stenosis syndrome that has VSD (hole in the heart), misaligned aorta, right ventricular hypertrophy decreases the stroke volume & bc there's stenosis the high pressure area is in the RIGHT ventricle baseline sats are b/t 75 - 85%, know their specific baseline
Who comes up with the standards for safe nursing practice?
The ANA comes up with the legal and ethical considerations for nursing practice including licenses, MD orders, clear policy statements, code of ethics
What is the Simple Occupancy Theory?
The SOT says that the more receptor spaces and the more receptors a drug occupies the more intense a drug's response max effect = all receptors on a cell are occupied
What is an indication that the VAC machine doesn't have a secure seal?
The VAC sounds an alarm or you can hear the motor running
What is perfusion?
The ability of the cardiovascular system to pump oxygenated blood to the tissues and return deoxygenated blood to the lungs -poor peripheral *perfusion* is characterized by cold extremities, poor cap refill, decreased hair growth, cyanosis, or pallor
What kind of scientific knowledge is needed to safely administer meds?
The administer of the drug must know the timing or how often they must give the drug because they can make the pt toxic if not given in timely manner
What are the psychological effects of pain?
The patient can't concentrate or be taught, they have a decreased interest in activities, social gatherings, or old routines
What are effects of pain?
The patient can't concentrate or be taught, they have a decreased interest in activities, social gatherings, or old routines, physical deconditioning, slow recovery, lose sleep, can't work
What are the swing gait patterns for crutches?
The patient moves the two crutches forward at the same time and then they either move/swing their feet to the point of where the crutches are or beyond it
Who/what can be a source of data when assessing a pt?
The pt themselves, family, lab, previous health records * make sure the source of information is reliable
What are Korotkoff sounds?
The sounds you hear when you slowly deflate the BP cuff, they are divided into 5 phases. The 1st sound is systolic pressure in the 1st phase and the last sound in the 5th phase is the diastolic pressure
What are some newborn cardiovascular adaptions? (fetal to neonatal circulation)
There are 3 vessels that the fetus uses to circulate their blood Ductus arteriosus which shunts blood from the pulmonary artery to the aorta Foramen ovale shunts blood from the right to left atrium this bypasses the lungs since the lungs are not fxing intrauterine Ductus venosus shunts blood by bypassing the hepatic vessels to vena cava this becomes a ligament once the placenta is clamped _______________________ Transition from fetal to neonatal circulation happens in steps Inutero - the O2 and nutrients is provided to the fetus via the umbilical veins and the waste is removed via the umbilical arteries 1. ⬆ O2 in lungs (lungs inflate) 2. All blood vessels open up 3. ⬇ pulmonary vascular resistance, the pressure to get into the lungs ⬇ 4. blood flows into the lungs 5. right atrial pressure ⬇ 6. ⬆ pressure in the left atrium 7. Foreman ovale closes 8. Ductus venosus becomes a ligament/occluded 9. ⬆ aortic pressure 10. Ductus arteriosus becomes a ligament/occluded
What are the limitations in the phases of drug dvlpmt?
There are drugs already on the market where we haven't identified certain side effects, there's limited testing on women therefore child bearing age and children consequently don't always know the effect on these populations.
What are the stages of new drug dvlpmt?
There are two parts preclinical and then clinical *Preclinical* = animal testing = 1-5 years- after sufficient data can apply for clinical testing + Toxicity, pharmacokinetics, possible useful biologic effects *Clinical* = humans = 4 phases, Phase 1— healthy volunteers or volunteer patients with the disease + pharmacokinetics, Phase 2 and 3 - trials tested on patients determine therapeutic effects, range, safety, effectiveness, After phase 3 manufacturer applies to FDA for conditional approval, Phase 4 - new drug released to general population + post market surveillance
What are the different types of isolation?
There are two types of isolation. Protective isolation is about protecting ourselves from the infected patient. "Reverse" isolation is about protecting the patient from us, this type of isolation is used for immunocompromised patients and it involves not reusing gowns/gloves, using a mask, standard precautions, and the use of private rooms. Nurses with active infections won't be assigned these pts.
What are the signs of Peripheral Neuropathy ? Vascular Insufficiency?
These diseases put diabetes pts at risk for amputations. *PERIPHERAL NEUROPATHY* - lower extremity wasting, no deep tendon reflexes, foot deformities, infections, abnormal gait *VASCULAR INSUFFICIENCY* - Arterial blood supply to tissues is inadequate, or venous return is impaired, causing decreased circulation to extremities. Tissue ischemia and breakdown often occur. Risk for infection is high. foot infection, poor wound healing, thickened nails, shiny appearance of the skin, decreased hair growth
What are the physiolgical effects of pain?
These signs are mostly seen in acute pain: Changes in HR + BP, Increased Blood Glucose (flight v fight), Diaphoresis (sweating), Pupil dilation, Gastrointestinal motility decreases, Nausea/Vomiting (happens bc the body is trying to reserve the blood to area that actually need it)
Why are ALL pts at risk for falls at a healthcare facility?
They are all outside of their normal environment, they are debillitated from illness/pain, the healthcare environment can be hazardous, t(x) may cause imbalance/vertigo. Pts may be in a emotional state, confused, or suffering consequences of their disease.
How are drugs classified and categorized?
They are categorized into two classes therapeutic and pharmacologic some drugs belong to more than one class *Therapeutic* - most of the time starts with "anti-", but not all the time ex: antihypertensive, antihistamine, antidepressant, therapeutic refers to the therapeutic effect of the drug i.e. it lowers blood pressure, it lowers depression *Pharmacologic* - refers to the drug's mechanism of action ex: beta blocker, ace inhibitor, if there's no pharmacologic class that means there's no other drug that does what this drug does
What is special to note about Alpha-glucosidase inhibitors?
They are especially effective among Latinos and AAs
What does Erikson's developmental theory say about older adults?
They are in integrity v. despair, they are in a time of their lives where they are looking back at their lives. They have to learn to accept losses like loss of muscle, tone, teeth, f(x) and independence. They have to transition into retirement (ppl who prepared well deal wiht this better), changing roles, and death
How are drugs named?
They are named based on their chemical composition or molecular structure, they can be named by the manufacturer who 1st dvlps them after approval of the USAN council, or they can be given a trade name which a manufacturer uses to market the drug to the public, It's important to know that drugs can't be named something that implies that it will work
How does nurse recognize that pain if the 5th vital sign?
They assess pain status every time they take a full set of vital signs, reassess after interventions, encourage the patient to self-report pain
What are some clinical manifestations of CD? And UC?
They both have: - abdominal cramping, distention - anorexia, weight loss - leukocytosis, anemia - electrolyte imbalances - fever, weakness EXCEPT Ulcerative colitis has malaise, diarrhea = *10-20 diarrheal stools a day* Mnemonic "UC up to Colon" & Crohn's disease has malaise, stool= *5-6 loose stools a day* Mnemonic "complete digestive (CD) system"
What are some assessment activities that nurses can do to identify a pt's safety status
They can perform a Morse Fall Risk Assessment, they can ask questions like, "Are you thinking about hurting yourself or others?"
How do facilities avoid fires and electrical accidents?
They have smoke free facilities, they use a specific code to notify staff about potential fires, pratice fire drills, educate staff on escape routes
What are Erikson's Dvlpmental tasks for adults?
They have to keep with their health + physical strength as they age regardless of disease, they have plan their llving arrangements (are they safe living alone?), they to deal with redefining relationships (when the child becomes the caregiver), they look back at the quality of their lives (pt. perspective)
What are some factors that can affect an older adult's safety?
They may slower rxn times (use grab bars), visual and hearing changes, decreased ROM, memory impairments (they should take notes), nocturia (urinating frequently at night), incontinence (uncontrolled urination), polypharmacy (taking multiple meds)
When writing a nursing diagnosis statement where would signs/symptoms be?
They should follow the cause/etiology and the phrase or abbr AMB/AEB
When writing a nursing diagnosis statement where would signs/symptoms or defining characteristics be?
They should follow the cause/etiology and the phrase or abbr AMB/AEB
What does affective learning entail?
Think affective = affection = feelings Feelings and emotions domain, values, reactions, how we listen, "feely"
What are the stages of AKI?
Three Stages of AKI Severity **For all 3 AKI stages, creatinine generally increases from baseline and urine output declines Stage 1: UOP <0.5 ml/kg/hr x 6-12 hours Stage 2: UOP <0.5 ml/kg/hr x 12 hrs+ Stage 3: UOP <0.3 ml/kg/hr x 24 hrs+ OR anuria 12 hrs+ - NV UO: 0.5 - 1.0 ml/kg/hr - Oliguria = <400 ml in 24 hours - Anuria = 50 - 100 ml in 24 hours *Non-oliguric AKI - some patients have increased urine output but waste is still building (are still experiencing AKI effects) - If AKI resolves, the patient enters the Diuresis phase next, followed by the Recovery phase - Azotemia = the gradually accumulation of nitrogenous waste products in the blood such as ammonia, urea, uric acid, and creatnine, to trend azotemia we follow the BUN (Blood UREA NITROGEN) as urea is one the waste products - elevated BUN means that less urea is being excreted causing uremia, this can be falsely high if the blood concentration is low as is the case of dehydration this is why it's always read with the creatinine level. When the BUN and creatinine levels increase together and the ration reamins constant this indicates renal dysfx.
What are some complications of of AV access?
Thrombosis or clotting of AV access High Risk for Disequilibrium Syndrome (Rare) - can occur d/t rapid shift in fluid and BUN > increased ICP > HA, N/V, changes in LOC > seizures & coma Infectious Disease - most common infection - staph aureus from contamination during cannulation, use sterile technique always Inject TPA to dissolve the clot or use ballon angioplasty to remove stricture
Why may a patient get a bowel prep?
To be able to see tissue, blood vessels, ulcers, inflammation, and tumors when getting a colonoscopy.
What is one thing nurses forget to do when taking blood?
To initial and date samples
Why are restraints only done temporarily?
To maintain pt safety, depending on the restraint it can dangerous to the pt (it can become a choking hazard), the restraint can interrupt t(x)
What is the surgical treatment for UC? Ulcerative colitis
Total colectomy with ileostomy - Drastic surgery that cuts remove the colon and brings the ileum (small intestine) to the surface of the skin and is permanent. They then will have a bag they have to live with forever. Curative
What are the different types of incontinence?
Transient - come and go, temporary, e.g. newly dx pt w/ diabetes or pt prescribed a strong diuretic Functional - e.g. pt who can't their get clothes off fast enough to go to the bathroom due something like arthritis, they should wear easy to remove clothing Chronic - caused by chronically distended bladder Stress - e.g. pregnancy, weakened pelvic floor muscles, intervention - kegels Urge or Urgency - aka overactive bladder/detrusor muscle overactivity, having the sense of emergent need to use the bathroom, OAs, bladder canver pts, UTIs, parkinson's pts Reflex - spinal injuries, the urine builds up and overflows
How would neonatal hypoglycemia be treated or prevented?
Treatment: - Early recognition & intervention - Immediate & frequent feedings w/in 1st hr - Frequent glucose monitoring - IV glucose for severe condition - bolus + D10W Prevention: - Early initiation of feedings - Frequent ax of high-risk newborns - NTE - thermoregulation
What is the difference between Type 1 Diabetes and Type 2 Diabetes?
Type 1 Diabetes: - autoimmune disorder - beta cells are damaged or there aren't any - 1st gen family members are @ risk, family hx, viral, age - tx: diet, exercise, insulin, insulin pump*, insulin injection for homeless population - usually diagnosed under the age of 40 - often described as brittle or unstable - lethargic, hyperglycemic Type 2 Diabtes: - progresses slower - insulin can be produced (decreased amounts) but isn't usable - metabolic syndrome - risk factors include: > 30 y/o, ethnicity/race, family hx, obesity, smoking, high cholesterol, hypertension, sedentary lifestyle
What is the difference between Type 1 Diabetes and Type 2 Diabetes?
Type 1 Diabetes: - autoimmune disorder, in most cases - beta cells are damaged by T lymphocytes or there aren't any - the body uses fat cells as a source of energy > produces ketones from increased acid - 1st gen family members are @ risk, family hx, viral, age - tx: diet, exercise, insulin, insulin pump*, insulin injection for homeless population - usually diagnosed under the age of 40 + children - often described as brittle or unstable - lethargic, hyperglycemic - ppl can be diagnosed at older ages due to pancreatic damage Type 2 Diabetes: - progresses slower - insulin can be produced (decreased amounts) but isn't usable/ ⬆ insensitivity - metabolic syndrome = obesity (waist circumference > 40 in. men and > 35 in. women) = HTN + Hyperlipidemia + Insulin resistance - risk factors include: > 30 y/o, ethnicity/race, family hx, obesity, smoking, high cholesterol/atherosclerosis, hypertension sedentary lifestyle - average age of dx = 50 - sometimes genetic
Which type of diabetes will you see ketone production in?
Type 1 not Type 2 bc they do produce a small amount of insulin
What is a Unlincensed Assistive Personnel?
UAP = unlicensed assistive personnel = support staff, be respectful of techs, tasks are delegated to these individuals by the RN *team based
What are some restraint alternatives?
Use a pt. sitter, bed alarms, reorient pt. to environment, ankle/wrist bracelets, distractions, TV, music, place pt near nurse's station, bed on the lowest setting+mat on floor, keep light on
What are some things a nurse must take into consideration when placing a restraint on a pt?
Use quick release knots, don't tie restraints to a bedrails, always have bandage scissors to cut off restraints, make sure restraints are properly placed and not too tight, keep the bed in the lowest position w/ the call light w/in reach
What is dangle on the side of bed?
Used with hypotensive pts, pts who have had major surgery
What are the general principles of sterile technique?
Used with invasive/surgical procedures such as phlebotomy, central IV lines, catheters, nasotracheal suctioning, "sterile to sterile" = only sterile equipment/tools can touch other sterile objects or field. Keep sterile objects in your field of vision and above the waist. Sterile field is no longer sterile if it has been exposed to air too long or has touched a wet contaminated surface. Edges of sterile field (1" border) = contaminated, go around a sterile field not across it.
What is involved in surgical asepsis or sterile technique?
Used with invasive/surgical procedures such as phlebotomy, central IV lines, catheters, nasotracheal suctioning, "sterile to sterile" = only sterile equipment/tools can touch other sterile objects or field. Keep sterile objects in your field of vision and above the waist. Sterile field is no longer sterile if it has been exposed to air too long or has touched a wet contaminated surface. Edges of sterile field (1" border) = contaminated, go around a sterile field not across it.
What are some mistakes you can make when writing a nursing diagnosis statement?
Using medical diagnoses, going beyond a nurse's scope of practice, not looking at the S/S, including evidence when the problem is a risk not an existing problem, including more than one problem
Describe a hemodialysis catheter
Venous Access (Temporary use) - Dual lumen or Triple lumen - non-tunneled , AKI, need immmediate dialysis, ready for us immediately - Internal Jugular, femoral, subclavian - tuneled not used for meds or infusions requires heparin flushes sterile dressing
What is acyanotic heart dz?
Ventricular septal defect (VSD) - more blood is going into the pulmonary artery as opposed to the ventricle that is why the pt is Acyanotic Patent ductus arteriosis (PDA) •Heart murmur •Sx of CHF Left-to-Right Shunt = there's a hole b/t the right & left atrium, and the blood going from the area of high pressure/left side to the area of low pressure/right side
How do we generally intake potassium?
Via diet
What are the 2 types of pneumonia?
Viral Most often in young children, not as sick Bacterial - Abrupt onset often after an upper respiratory illness (URI) - Will be ill-appearing -> Fever, tachypnea, cough, chest pain, malaise -> Often present with fever and abdominal pain (unlike pharyngitis which it may or may not have fever & abd pain) -->> Usually in young children, because their lungs meet abdomen & they perceive lung pain as abd pain - listen to their lungs Treatment: supportive and education - Multiple episodes of bacterial pneumonia may indicate an underlying problem such as CF or undiagnosed immune deficiency
What is pernicious anemia?
Vitamin B12 deficiency You need intrinsic factor (IF). IF is made by parietal cells in a health stomach lining. Mucosa isn't producing the IF so that's why you have a B12 deficiency.
What is the responsibility of the descending colon?
Water is taken out of extrement to form stool and then shifted to outside of the body as waste
How do we diagnose someone with IBD? (Inflammatory bowel disorders)
We need to isolate exactly what's going on - history - recent weight loss - pain and how long did it last - what made it better - what made it worse - previous dx - physical exam to see any findings that aren't normal - radiological exam: CT scan, enema?, KUB (kidneys, ureter, bladder) - colonoscopy, sigmoidoscopy - increased WBC - increased erythrocytes sedimentation rate (ESR) = tells us inflammation in the body - electrolyte imbalances =may have chronic diarrhea - decreased H&H - common in whites and jews
What is involved with beard and mustache care?
We shouldn't forget beards and mustaches bc food particles can get caught in them, don't shave the pt w/out permission, to prevent razor burn shave in the direction of hair growth, use an electric razor for pts on blood thinners
What would be involved in the care of a client experiencing infection issues?
We would use the CDC's two tier approach to prevent the transmission of the infectious agent from that particular pt experiencing the issue to other patients by following isolation protocols, using proper precautions, making sure to communicate and use proper techniques when performing procedures for the pt.
What is involved in the nursing of a PD pt in the hospital?
Wgt & Assessment before and after PD VS before, q 15-30 min during, & after Assess for signs of resp. distress, pain, or discomfort Assess site dressing for wetness Monitor glucose levels Ensure outflow > inflow, record I&O Diet- see renal diet table Low. Phos, nl K+, Na <2 gram, high protein, generally no fluid restriction
What is a baseline?
What was their functional status was before the injury? A pt's normal values
What are some hand washing guidelines?
What's important to note with handwashing is that it is the #1 way to prevent the spread of infection, you should use warm water not hot water because hot water can make your hands more susceptible to cracks by breaking down oils in your hands, clean beneath jewelry, and time: 15 seconds for non- surgical and 2-6 mins for surgical settings.
When can you score a tablet to give a patient a partial dose?
When a tablet is scored. Only when a tablet is scored can a partial dose of a tablet can be administered.
What is a pulmonary embolism?
When an embolus (clot, can be blood = most common, air, any particulate) blocks blood flow in the lungs this leads to: - ↓ gas exchange - ↓ oxygenation - lung tissue hypoxia - ↓ perfusion - death Causes: - DVT = inappropriate clotting forming venous thromboembolism (VTE) in the legs or pelvis > clot breaks off > vena cava ( right side of the heart) > pulmonary artery or its branches > platelets collect on embolus > vasoconstriction > pulmonary ↑ BP > hypoxemia (sometimes)
What are some causes of equipment related accidents?
When bed alarms don't work or aren't set up correctly, the malf(x) of suction and infusion devices, when personnel don't transport oxygen cylinders properly and not using the lock mechanisms on wheelchairs and bed wheels
When coughing or sneezing how should you do it?
When coughing or sneezing do not do so in your hands, do it into a tissue or cover your mouth and nose with your arm sleeve.
How can you apply the general principles of isolation when working in isolation rooms?
When delegating tasks make sure to communicate, notify team members, Be a good steward of supplies and only take in what you need/minimize waste, cluster your care, and be prepared you shouldn't need to walk in and out of the room bc you forgot equipment, properly dispose of PPE, never wear PPE out on the floor, keep the pt's door closed.
How are drugs dvlpd in relation to randomized controlled trials?
When drugs are being dvlpd the experiments include controls, randomization, and single or double blind studies. After animal testing then there's testing in humans first there's a determination of who gets the drug and who doesn't, *control* means they aren't getting the t(x), *experimental* means the group is getting the drug, this process is randomized the researcher can't chose which pt go in a particular group. The experiment can be conducted as a single blind study which means the participants don't know whether they got the placebo or the actual drug, but the researcher does. Double blind means both the participant and the researcher are oblivious to who got the drug v. the placebo
When do we try surgical treatment with ulcers? What kind of surgery do we do?
When meds (conservative method) are working correctly ... then surgery Vagotomy: the branches of the vagus nerve is cut to disrupt the acid production, so the stomach can produce less acid Pyloroplasty: when the pyloric sphincter is closed we do surgery to enlarge the opening between the stomach and small intestine, so stomach content can empty
How does a nurse select the correct cuff size?
Width of cuff = ~ 40% of arm circumference, Bladder enclosed should be ~ 80% of the upper arm
What precautions are used for droplet category of transmission?
With a pt on droplet precautions a mask (heavy droplets) or respirator(light droplets) is used. The pt's may be in private rooms or may share a room with a patient w/ the same condition (cohorts).
What is WOB?
Work of Breathing = inspiration + expiration = expansion and contraction of lungs - when a pt has increased WOB you may see them using accessory muscles such as supraclavicular muscles, suprasternal, substernal, intercoastal, subcoastal or nose flaring - when there is decreased surfactant in the lungs this may lead to atelectasis = collapsed alveoli > decreased gas exchange in the lungs - decreased compliance > pt has a decreased ability to expand their lungs
What is the 2 point walk with crutches?
Works for ptss with gait issues Crutch and the OPPOSITE leg go together i.e. right crutch goes with leg leg, 1, 2, 1, 2
What are the specific steps involved with planning?
Write a nursing care plan w/ specific interventions and you should start discharge planning as soon as they are admitted all the way until post hospitalization, Setting goals and outcomes for the pt that will be used to evaluate care and nursing inverventions
When shoud you wash your hands with soap and water v. sanitizer?
You can always perform hand hygiene using sanitizer EXCEPT for when your hands are visibly soiled, when you come into contact with bodily fluids, or when you suspected exposure to spores like C. Diff or B. anthracis
When can mixed acid-base imbalance happen?
You can have Respiratory acidosis and Metabolic acidosis occurring at the same time, e.g respiratory arrest -> CO2 build up -> carbonic acid build -> respiratory acidosis, the same pt is not receiving O2 -> anaerobic metabolism -> lactic acid build-up -> metabolic acidosis
What are some things to take into consideration when doing the planning stage of the nursing process?
You prioritize the pt's health problem using Maslow, Order nursing care, high>intermediate>low, remember that priorities can change and S = make your goal specific to the client
How should you open packages during a sterile procedure?
You should open the tabs horizontally to you 6 inches above the sterile drape. Don't let your arms pass over the sterile field and don't let your ungloved hands touch the other sterile objects within the field.
What are the RFs, s/s, complications, and nursing management of Foreign Body Aspiration?
[Acute Noninfectious D/O] - Solid or liquid is aspirated into the respiratory tract, can be life threatening if something goes into the lungs. Smooth, small objects are often ones that are aspirated. -< Any toy that fits in a toilet paper roll can be aspirated (1 ¼ inches) Risk factors - Young children - around 6 months (because they are starting to put things in their mouth) to about 4 years. Toddlers most common and those that are developmentally delayed (don't understand they can't put things in their mouth) - Most commonly boys (more inquisitive), 1 - 3 age range, usually food aspirated Symptoms - Sudden onset of coughing, wheezing - Parent witnessed it - Stridor means its in upper airway - may be able to cough it out -> If it goes into bronchus or lower, theyll have wheezing or decreased air movement Complications - The need for a bronchoscopy to go get it - needs to be done right away - Can develop pneumonia, especially from a liquid - Could go into respiratory distress/failure or even death Nursing management - Most important = education -> Small toys/legos need to be picked up & out of reach of the younger child -> Latex balloons/gloves can be aspirated
What is the difference b/t perennial and seasonal allergic rhinitis?
[Chronic Respiratory D/Os] - "Allergic nose" is an intermittent inflammatory caused by IgE. The offending allergen gets in the child's nose and the mucosa mounts an immune response. The antigen binds to IgE of certain cells and releases histamine - why antihistamines work - Associated with atopic dermatitis, recurrent sinusitis, asthma, AOM Perennial - Year round and indoor environments - Pets, dust mites, cockroach antigens, molds Seasonal - Different seasons and outdoor elements - Pollens, trees, weeds, fungi, molds
What should we know about applying heat and cold therapies?
a DR. order is required - assessment includes: > looking out for the client's skin integrity > monitor pt's response to stimuli > be cautious of the equipment being used > lookout for pt's w/ nerve dame, spinal injuries, neuropathy
What is a syndrome?
a group of symptoms that occur together, it is not a disease
What is selectivity?
a highly desirable trait for drugs, the more selective a drug is the less side effects a pt will experience e.g. chemotheraphy - chemotx is not selective and therefore causes systemic effects and doesn't hone in on a specific target
What is the process in regards to the giving of medications?
a nurse should assess pts before passing meds, plan the adminstration of meds, implement the admin or meds and then evaluate the pt after the admin if the med or meds
What is a host?
a person who has a compromised immunity or is susceptible
What does sexual identity mean?
a person's perception of his or her gender, gender identity, gender role, and sexual orientation
What is the bristol scale?
a scale to type a patient's BM, 1-7 Good = type 3 - 5, 4 is the best
What is Trousseau's sign?
a sign of hypocalcemia where a blood pressure cuff is used as turniquet and the pt experiences their hand contracting in on itself
What is pulse oximetry?
a way to measure arterial blood oxygen saturation = the % of hemoglobin that is bound w/ oxygen in your arteries
What is a standing or routine order?
administered until the dosage is changed or another med is prescribed, keep administering the until it is canceled by the physician or until a renewal is required.
When is it appropriate to use a restraint?
after nonrestrictive methods have been unsuccessful, when it is to maintian the safety of the pt and other pts, and when there's an HCP order, if they are a high fall risk, if they are removing life support equipment, if they keep interrupting their t(x)/therapy
What are some factors that affect bowel elimination?
age - very old and very young diet - OA lose their lthirst center "couch potato" pt's are immobile position during defecation pain - hemorrhoids (varicose veins in the anus) pregnancy surgery - listen for those bowel sounds
What is sundowning?
aka "Late Day Confusion" The suggestion is the nurse keep the lights on, use validation therapy for dementia pts when they are scared, ensure safety, when confusion and agitation get worse in afternoon or evening
What is the Florida State Board of Nursing?
aka BON, testing (NCLEX-RN), require CEU 24 hours for renewal of license every 2 years/24 months -> Some are mandatory courses such as HIV or human trafficking
What is a nosocomial infection?
aka HealthCare Acquired Infections, pts acquired these infections in healthcare facilities these are associated with higher costs of healthcare, it is a *leading cause of death, and it's preventable with good hand hygiene and sterile technique (+Ex: no neck ties, pinned up hair, disposable BP cuffs)
What are the pro's and con's of an external male catheter?
aka condom catheter PROS: - independent - no suction required - no tape required if brand use silicon CONS: - leakage - tape may cause injury - need to be careful w/ uncircumcised men's foreskin
What is slough?
aka fibrin, yellow necrotic tissue, that can sometimes be hard to remove, mucousy, stringy
What is the incident report?
aka occurence report it is not apart of the pt record, confidential, completed by the person who witnessed the event
What is therapeutics?
aka pharmacotherapeutics, the use of drugs to diagnose, prevent, or treat disease or to prevent pregnancy
What are the standard precautions for infection control?
aka universal precautions, performed with every time with every pt or with ALL pts ALL the time: hand hygiene, wear gloves when necessary ex: if a pt has wounds or if there's risk of bodily fluids transfer, clean pt care equipment
What does a nurse look for during info gathering before and after med admin?
allergies, other meds (side effects), diet (take with or without food), pt adherence to therapy (social factors), can a pt self-administer, knowledge of the meds
What are some aspiration precautions to med admin?
allow self-admin, look out for dysphagia, assess pt's ability to swallow, pt should be upright, thicken fluids, avoid use of straws, have the pt hold their cup, change the route of admin, crush meds if necessary, give only pill at a time
What are some examples of magnesium rich foods?
almonds, avocado, and spinach
What are some activities a pt can participate in to prevent blood clots?
ambulation, flexing your fett, calf pumps, foot circles, "spell your name", extend knees
What kind of complications can preventing pressure ulcers avoid?
amputations, sepsis, cellulitis, bone & joint infections, and cancer
What is diarrhea?
an increased passage of stools
What is hemoglobin?
an oxygen-carrying protein, the normal range for hemoglobin is 12-16 g/dl for females and 14 -18 g/dl for males
If RBCs, Hct, and Hgb are all low what coiuld this mean?
anemia or circulatory overload
What types of drugs can cause problems with sexual health?
antihypertensives
What is a disinfectant that is usually safe for use on skin?
antiseptic
What are some nursing dx addressing sleep?
anxiety, compromised family coping, fatigue, ineffective coping, insomnia, acute confusion, ineffective breathing patten, readiness for enhanced sleep
What is pharmacology?
any chemical that affect a living process, pharmocology = study of drugs, therapeutic has a beneficial purpose, clinical purpose
What are drugs?
any chemical that can affect living processes, for our purposes we will focus on drugs that have therapeutic applications
What is your level of consciousness when your drive to sleep is highest?
at it's lowest
How long should you clean the saline lock with your alcohol pad?
at least 30 secs
How do we thermoregulate?
behavioral actions
What are the benefits of hygiene?
better health + self-esteem, sex-appeal, lower healthcare costs, sex-appeal
What is incontinence in regards to bowel elimination?
can't control feces or gas
What types of cells does chemotherapy affect?
cancer cells rapid growth tumors effects healthy cells as well
What is impaction?
caused by unrelieved constipation, can lead to blockage
in what pattern do infants typically grow?
cephalocaudal = head to toe proximal-distal = center to periphery
What is serous drainage?
clear, watery plasma, slightly pink
What is the ANA?
code of ethics nurse advocates health and wellness of nurses
What are the 3 domains of learning?
cognitive, affective, psychomotor = CAP
How is patent ductus arteriosus tx?
coil embolization of PDA -> cardiac CATH procedure -> may pv open ❤ surgx
How is a consent obtained in an emergency?
consents do NOT have to be obtained in an emergency since the law assumes the pt would have wanted the tx
What is the difference between continuous and intermittent stitches?
continuous stitches require you to cut each end and pull as you go intermittent stitches are individual each one has their own knot
What is important to know regarding the relationship between excretion and the kidneys?
delayed excretion can be beneficial when drugs compete to be excreted they increase their tx duration
What are the stages of grief?
denial, anger, bargaining, depression, acceptance
What are some mental illnesses that can affect sexuality?
depression - decreases interest hypomanic or manic - increase interest psychosis - frankness, lack of touch w/ reality
What are some examples of wounds VAC therapy is used for?
diabetic ulcers, pressure ulcers (stage 3 or 4), non-healing wounds, flaps or grafts, surgical wounds
What is conduction?
direct heat transfer
What is exudate?
drainage from a wound
What is autoimmune thrombocytopenic purpura (ATP)? dx? tx? s/s?
dx: - low platelets even though production is normal - large bruises - petechial rash - altered mental status tx: - platelet transfusion = risky - splenectomy = r/f bleeding - pv platelet clumping - remove plasma/ replace w/ fresh plasma - immunosuppressive tx - unk cause/ autoimmune - limit blood draws & IM injections
How would a rib fracture be diagnosed and treated?
dx: CXR, CT scan tx: - pain control, can be OTC > may require pt teaching - Get moving/ambulation - rarely need surgery - IS - pain usually subsides within 5 -7 days - healing could be 3 -6 wks depending on other comorbidities
What are some physical S/S that indicate alteration in cardic fx?
dyspnea, fatigue, chest pain, orthopnea, syncope, palpitations, edema, cyanosis, pallor of skin
What are the different ways orders can be written?
electronically, verbally, over the phone, written
When a patient is dehydrated what lab result would a nurse expect to see?
elevated serum sodium level
What is radiation?
emission of EMR, transfer of heat through indirect contact
What are some factors (ex: culture) of care when a pt is experiencing pain?
emotions - stoic facial expressions, age, communication & cognitive impairments, pain behaviors and coping with pain (ex: some pts are stoic therefore rely on what the pt says), some patients don't ask for help
What is the difference b/t enteral and parenteral?
enteral = PO, slower absorption, can be retrieved via nausea and vomitting, barriers to vascular system (BBB, placenta, albumin) parenteral = everything other than PO, can not be retrieved, bypasses the gut, IV/IM/ Subq, large volumes can cause fluid overload, instantaneous/ rapid absorption, water soluble, good in ER, no barriers to absorption
What is the difference b/t ethics and values?
ethics - what's good or bad for society at large values - *personal* beliefs that influence *individual* behavior
How often should a nurse reassess a pt with a restraint?
every 1-2 hrs. during the reassessment check for agitation, check if they need to use the restroom, do a neurovascular check (assess color, temp, sensation, and pulse), check for nutritional/fluid needs. When restraints are removed reposition the pt, provide comfort, perform ROM exercises
What are some factors that can influence the character of respirations?
exercise, acute pain, anxiety, smoking, body position, meds, neuro injury, hemoglobin fx
What are fx of the pancreas?
exocrine fx: digestion *endocirne fx: glucose regulation Islets of Langerhans > Alpha cells - secrete glucagon > Beta cells - secretes insulin
What is fidelity?
faithfullness, accountability
What is flatulence?
farting, accumulation of gas in the intestines
What is duration?
from 1st therapeutic response to last therapeutic response
Where are cultures taken from in wounds?
from the base not the drainage
What's the diff b/t hypocalcemia and hypercalcemia?
fx = "BB" Blood clotting and Bone & teeth formation + muscle contractions & bone pain nerve impulses 9 - 10.5 mg/dL Note: Ca has an inverse relationship with phosphate, regulated by the PT gland hypocalcemia - hypoPTH, renal failure, low Ca and Vit D in diet - numbness and tingling - weak bones - C&T signs hypercalcemia - metastatic CA, hyperPTH, immobility, antacids - bone pains, breaks - constipation - lethargy
What are some examples of urinary problems?
fx urinary incontinence (UC) stress UC Urge UC r/f infection toileting self care deficit impaired skin integrity impaired urinary elimination urinary retention
What are the two types of ulcers?
gastric and duodenal
What is a single (one-time) order?
given one time only for a specific reason and usually given for preop drugs or dx tests
What does prn mean?
given when the pt requires it, as needed, usually a minimal interval for the time of admin is given
What is the professional nursing code of ethics?
guidelines that help professional groups make decisions about practitioner behavior
If a patient is unconscious how is a consent obtained?
healthcare proxy, durable power of attorney, person legally authorized to give consent on the pt's behalf
What are some pharmacological interventions that address sleep?
herbal/supplements like valerian, chamomille, melatonin, kava hypnotics/sedatives like valium, xanax, ambien, lunesta (dangerous in OAs)
What is a hematological sign of sickle cell anemia?
high RBCs + low Hemoglobin
What are some things that cause a pt to have a "risk for falls" problem or nursing diagnosis?
history of previous falls, gait/balance/ mobilitiy issues, sensory impairment, urinary+bladder dysf(x), chronic illness, drug use+interactions, poor lighting and clutter
What are some interventions/"nurse will" statements/actions for a R/F falls niagnosis?
hourly rounds, make sure the call light is close to the pt, orient pt to envirnment, put disoriented pts near nurse's station, bed in lowest position, no skid slippers/colored socks, evaluate meds, use locking mechanisms
What is intrinsic activity?
how well a drug can activate a receptor have it has binded high intrinsic activity (meaning the drug was attracted to the receptor and the receptor is activated) = high maximal efficacy
What is self concept?
how you view yourself includes your identity, body image, role performance, self-esteem
What is the difference b/t hypomagnesemia and hypermagnesemia?
hypomagnesemia caused by: - m'am" = malnutrition, alcoholism, malabsorption - DD = diarrhea and diuretics Mnemonic = "m'am has double DDs" s/sx: - hyperactive DTRs - tachycardia/ dysrhythmias - muscle cramps - numbness - anorexia, decreased motility, nausea, constipation, paralytic ileus - tingling that progresses to seizures - tremors - tetany - twitching - lethargy hypermagnesemia caused by: the excessive use of antacids, ESRD, renal failure, low consumption s/sx: - bradycardia - hypoactive DTRs - decreased depth of respirations - bradypnea - low BP - drowsy, lethargy, coma - weak muscle contractions that progress to cessation
What part of our brain controls our temp, sleep regulation, sex drive, thirst, hunger?
hypothalamus
What are some s/s of hypovolemia? hypervolemia?
hypovolemia - oliguria - low BP - tachycardia - tachypnea - significant weight loss in a short period - dark urine - orthostatic hypotension - dehydration - thirst - dry mucus membranes hypervolemia - pitting edema - crackles - bounding pulse - JVD - dependent edema - tachycardia - dyspnea - hemoconcentration of labs
What are some s/s of hypovolemia? hypervolemia?
hypovolemia - oliguria - low BP - tachycardia - tachypnea hypervolemia - pitting edema - crackles
How do we manage risks?
identify possible risks, analyze risks, act to reduce the risks, evaluate steps taken
What are some factors that influence self concept?
identity/body image/role performance/self esteem stressors
What is the criteria that would warrant a client necessitating restraints?
if they are a high fall risk, if they a danger to others, if they are removing life support equipment, if they keep interrupting their t(x)/therapy
What 2 factors can influence how well a drug can enter a cell?
increased dissolution and increased absorption
What is important to know regarding the relationship between metabolism and the liver?
increased metabolism = increased renal excretion may increase/ decrease toxicity involved in drug inactivation prodrugs can be activated in the liver
What are some kawaskai s/sx?
increased platelets need a STAT ECHO increased sed rate "they just don't feel good"
What pt populations are at risk for dehydration?
infants, elderly, confused, bedridden, comatose
What is peritonitis?
inflammation of the peritoneum (can be because scope pierced peritoneum)
What are some examples of intake? output?
intake - oral fluids - tube feedings - IV infusions - blood transfusion Output - urine - diarrhea - gastric suction - wound drainage - emesis
What does ISBAR stand for?
introduction, situation, background, assessment, recommendation
What is urinary incontinence?
involuntary leakage of urine
What is a suprapubic catheter?
is used for long- term continuous drainage. This type of catheter is inserted surgically through a small incision above the pubic area - it doesn't get removed - the nurses job is to make sure it stays clean and heals nicely
Why is the simple mask contraindicated for COPD patients?
it accumulates CO2
What happens when a med order is incomplete?
it becomes an illegal order
Why shouldn't pts consume grapefruit and their meds?
it can cause a build up of the drug in their blood because it interferes with the metabolism of the drug in our GI tract
Whatt can happen if a nurse fails to document med admin?
it can lead to over or under medication
What are clinical protocols?
it is legal protection for nurses that allows them to administer meds without having to contact the prescriber every time the patient's condition changes e.g. insulin sliding scales and IV heparin protocol
What is the role of the bladder in urinary elimination?
it is the reservoir for urine until the urge to urinate dvlps, the bladder can hold 600 - 1000 mL, the urge is b/t 400 - 600 mL
Where should the crutch's hand grips stop on the body?
it should be about level with the hip line
How is magnesium regulated?
kidneys and GI tract
What is hypoxia?
lack of oxygen in *tissues* @ cellular level early hypoxia RAT = restlessness, agitation, tachycardia + PATH = pallor, apprehension, tachypnea, hypertension late hypoxia BED C = bradycardia, extreme restlessness, dyspnea, cyanosis + CAHS = Cardiac arrhythmias, hypotension, stupor (confusion)
If a drug is more potent do you give more or less of that drug?
less drug, the more potent a drug the less drug you have to give
What is the diff b/t leukocytosis and leukocytopenia?
leukocytosis - high WBCs - dz of BM - infection - drug rxn - immune system disorder leukopenia - low WBCs - *viral* infection - cancer - low BM - meds.
What is hypophosphatemia?
levels <3.0 mg/dl causes: - malnutrition - malabsorbtion - inadequate intake - TPN w/ out adequate phosphate - alcoholism + withdrawal - refeeding after starvation - diuretics - osmotic diuresis (e.g. DKA/diabetes) - anabolic metabolism s/s: - muscle weakness - in organs too > respiratory failure - malaise - anorexia - seizures - coma (late sign) - myalgia - rhabdomylysis - ALOC - low O2 sats tx: - phosphorus replacement = nitraphos - diet high in phosphorus (dairy, dried beans, whole grains) - Na phosphorus (IVPB) - K phosphorus (IVPB)
What are some acute care nursing implementation for bowel elimination problems?
make a BM schedule - e.g. 1 hr after a meal sitting position psych privacy position the pt proper on the bedpan - HOB should at 30 degrees+
What is a simple face mask?
mask that fits over nose and mouth to provide higher concentration of O2 *good for pts that are mouth breathers *can also be humidified to prevent drying out of mucous membranes - 35 - 50% of oxygen at 6 - 12 L/min - contraindicated for pt who are claustrophobic - there's no reservoir bag as is seen with nonrebreathing and partial rebreather masks
What is peak?
max therapeutic response
What are 3 areas for stocking and dispensing meds?
med rooms, computerized med cabinets, med carts
What is heat stroke?
medical emergency to extreme heat
What is included in discharge summary forms?
meds, ER contacts, leaflets, follow up care, discharge teaching and diet instructions
What is voiding?
micturation = urination = voiding q 2-4 hrs for the average adult
What are some non-pharma interventions that address sleep problems?
mindfulness, meditation, relaxation, quiet zones, massage
What are standards of care?
minimum expected nursing care, expected nursing knowledge and skills
What are the functions of sodium?
mnemonic: "CHRIS" C Controls extracellular fluid and plasma volume Controls BP (kidneys f(x) in BP regulation also) Controls contractility of muscles (both cardiac and skeletal) H Helps maintain neuromuscular irritability R Regulates water balance (water distribution, where Na+ goes water follows) I Increases cell membrane permeability S Stimulates conduction of nerve impulses Most abundant extracellular electrolyte
What is the impact of federal, state, and instituitional drug policy?
more regulations, now drugs have to be properly labeled and can't be put on the mkt with false claims and they must go through extensive testing, everyone can't prescribe meds, everyone can longer dispense drugs, they aim to make drugs safer for the public
Why is hypertension often referred to as the "the slient killer"?
most pts are asymptomatic even in severe cases
What are the three drug distribution systems we are expected to know?
narcotic control system, LTC unit dose system, automatic medication dispensing system (AMDS), unit dose csyste
What does vasoconstriction do?
narrowing of the blood vessels
What are some accompanying S/S of pain?
nausea, headache, dizziness, constipation, depression, restlessness, anxiety, insomnia
How does our body produce heat?
neural and vascular control
Should you use preventive blood clot movements when the pt is suspected of having a DVT?
no movement/massage because it may dislodge the blood clot signs of a DVT inlude pain, swelling, warmth
What is a transplanted kidney?
nonfxnal kidneys are usually left in place
What is the difference between a normal and complicated death?
normal (ADA) = anticipatory, disenfranchised, ambiguous complicated (EDM) = exaggerated, delayed, masked
What is involved with hair care?
normally a beautician/barber comes in and brushes the pts hair, during hair hygiene a nurse can assess for lice, scaliness, dandruff, pattern, and condition of the hair, always protect the pt's eyes when shampooing, you can use a shampoo cap which uses no rinse shampoo
What is constipation?
not a dz, it is a sx, difficulty eliminating or infrequent stool that is hard, dry
Which arm should be used for blood draw?
not above the IV site and not on the arm on the same side as a masectomy bc no lymph nodes
When is cotton gauze contraindicated?
not for inside of wounds because it sticks to the wound
How can an error occur during the transferring of care for a pt?
not giving adequate report
What are some nursing interventions specific to OAs for urinary elimination problems?
offer toileting q2h empty bladder before & after meals and bedtime (bladder retraining) water water water - 6 - 8 glasses except for 2hrs before bed
What is hospice care?
philosophy of care for the terminally ill that involves supporting the quality of life as long as possible comfort + dignity + QOL support
What is the difference between polyuria and diuresis?
polyuria is associated with a disease process diuresis is getting off excess water to get back to normal, temporary
What are the two different types of pulse oximeters?
pulse oximeters use photodetector to calculate SpO2 = peripheral capillary oxygen saturation | Portable device = intermittent assessment | Continuous oximeter = stays connected to pt
What are some abbreviations used when writing a nursing diagnosis statement?
r/t = related to followed by etiology/ cause | AMB or AEB = as evidenced by or as manifested by followed by S/S/defining characteristics of the problem
What is REDA and COCA?
redness, edema, drainage, approximation color, odor, consistency, amount
What is important to educate the family on in regards to hyperlipidemia in children?
reduce fat talk to nutrition learn to read labels medications (statins) - older school age - adolescent kids 60 mins of exercise a day look for fat free items goal is to decrease levels by 50%
What happens when heat is applied for 1 hour or more?
reflex vasoconstriction
What are some factors that affect sexuality?
religion, lifestyle, and sexual knowledge > don't assume your client's knowledge level > may need to use street language > introduce correct terminology at the same time
What is the role of the kidneys in urinary elimination?
removes wastes from the blood to form urine (urea, creatinine, electrolytes), EPO
When is dialysis indicated?
renal failure that can't be controlled with meds like lasix etc uremic syndrome w/ ESRD severe electrolyte/ fluid abnormalities
What are some examples of different types of gauze?
rolled, net, and elastic gauze
What are the rounding rules for electronic IV pumps?
round to the nearest whole number or round to the tenths using normal mathematic rounding rules
What is a urinary tract infection?
s/s: can cause frequency and burning and delirium in OAs from systemic infection, urgency, cysitis, dysuria pts are more at r/f UTI from catheters because it is a portal of entry pt. education: > Fluids! Fluids! Fluids! > void/ empty bladder at regular intervals > looser clothes > minimize bubble baths > wipe from front to back, women
What is oliguria?
scant urine, <30 ml/hr for two or more hours
What does independent mean when discussing older adults?
self sufficient, self reliant does not mean living alone but rather being able to do ADLs
What is masceration?
skin breakdown due to prolonged exposure to moisture
How do our bodies lose heat?
skin temp regulation = radiation, convection, evaporation, and conduction
How can we check for hydration status?
skin turgor - tenting = undesired outcome
What are some signs of sleep deprivation?
slurred speech irritability slower thoughts overeating yawning excessively
What are some psychosocial changes related to aging?
social isolation, death, changes in sexuality, retirement, changes in their housing + environment
What is a system error?
something happens in a facility across the entire system
What are the 5 factors we should know about our pt's urinanalysis?
specific gravity should 1.005 -1.030 - sugar imbalance - fluid balance - kidney f(x) - infection "SIKF"
What is an example of a potassium sparing diuretic?
spironolactone (Aldactone) = aldosterone receptor blocker
How do you protect a pt during a seizure?
stay w. pt, call for help, cradle head, don't move pt., clear surroundings, remove pillows, raise side rails, loosen clothing, after the seizure: place the pt. on their left side, suction secretions, reorient and comfort them
What are some nursing interventions specific to urinary elimination?
strengthen pelvic floor muscles/ kegels bladder retraining - put the pt on a schedule, bathroom q2h habit training - q 3-4 h while awake, empty completely (use bladder scanner) self catheterization - clean technique maintain skin integrity promotion of comfort 6 -8 glasses of water, less caffeine, avoid drinking 2hrs before pv UTI - watch out for the bubble baths and tight jeans quit smoking
How would a pulmonary contusion be treated?
supportive tx: - patent airway/ ABCs - maintain ventilation + O2 > nasal cannula or mask - pain control in order to do TCDB/Incentive Spirometry (nursing intervention, you don't need an order, encourage usage and teach) - Hydrate to mobilize secretions to pv bacterial growth - splinting (the pt hugs a pillow to make TCDB easier) - get them moving - mechanical ventilation to pv respiratory distress syndrome used when pt is approaching respiratory failure > may require PEEP (Positive End Expiratory Pressure) to maintain inflation
What is bowel diversion?
surgically created/ artificial opening for elimination of digestive waste products, can be temporary or permanent = stoma, cleaned with just water surgical opening in the ileum or colon = ileostomy, colostomy
What are the different patterns of fever?
sustained - temp stays the same intermittent - it increases and decreases remittent - spikes and falls but nvr goes to an acceptable range relapsing - decreases for a long period of time and then spikes
Why do pts receive heparin?
t(x) or p(v) of DVT or PE
How can a nurse approach communication barriers to pain?
take your time with the pain assessment, use the self-report of the patient pain, take note of the painful conditions/t(x)/procedures, what is the family saying? physiological measures, use a pain tool, rely on behavioral/ objective pain indicators
Other than calling the provider or physcian, what can a nurse do if she can't read an order?
talk to the patient, they are the primary source, they know their meds most of the time.
What does sustaining mean?
temp stays the same
What is affinity?
the level of attraction a drug has to a specific receptor the higher the affinity the higher the attraction towards the recptor = higher potency
What is the MAR?
the medication administration order - it inlcudes the drug order, the correctt dosage, and it's used to document or record drug admin
What can be given to patients who have clots that are caught early?
thrombolytic meds
How are organisms are carried about?
through a mode of transmission
What are some factors specific to older adults when it comes to pain?
use PAINAD even though it is not as accurate as patient report use it for non verbal pts
What are soome ways a facility can prevent falls?
use night lights, keep floors dry, keep rooms clutter free, educate family, indicate the pt is fall risk using wrist bands/colored socks, use side rails (not all 4), communicate that the pt is a fall risk in during handoff report
What is a trochanter roll?
used to prevent external rotation of the hips, it is simply a towel/blanket rolled and is the length of the pt's thigh's and it place parallel to the pt's thigh
How should a wound be measerd?
using the widest part and the longest part, using the "clock" method
What is the difference between visions and hallucinations?
visions - aren't harmful and don't cause the client distress, no interventions needed hallucinations - anxiety producing, may need to medicate pt bc it causes fear or stress
What are some things you should watch out for when using the nasal cannula?
watch out for skin breakdown behind the ears, nostrils, and face watch out for dryness after 4L you should humidify the oxygen and the container should have distilled water and the water should be changed q 24 - 48 hours
What is included in the assessment regarding bowel elimination?
what are the pt's bowel habits? what meds are they takinng? any recent illness? fecal occult aka hemoccult - check for blood in the stool, you turn the urine hat around and collect a sample CT scan Endoscopy MRI Barium Swallow/ Enema Stressors? Palpate the abdomen Stool C&S
What is pharmacodynamics?
what do drugs do to the body
What is pharmacokinetics?
what the body does to the drug ADME A - absorption - from admin to blood D - distribution - from blood to tissue (site of action) M - metabolism - occurs in the liver E - excretion - occurs in the kidney
What is first pass effect?
when a drug is extensively metabolized it's first pass through the liver
What is persistent fetal circulation?
when the ducts don't close off like they are supposed to e.g. arterial septal defect, patent ductus arteriosus
What is masecation?
when you overpack a wound and the liquid from the dressing sits on the surrounding skin it softens the skin and causes it to tear
When should round the clock antibiotics be given?
within 30 minutes before or after the scheduled time
What is dumping syndrome?
— Classic with bypass or gastric surgery — The body says "we need to get food to the fluid". Then the body pulls the fluid from the vascular space causing them to become hypotensive. Because its a short pouch, it has a short stay. Sugary/high carb food leave the stomach quickly and DUMPS to small intestine—> "lots of calories" = pancreas sends insulin—>causing symptoms of low blood sugar—> nausea + gets sweaty +n/v + diarrhea and increased HR (at the same time, the intestine swells causing cramping and pain) = dont drink fluid with food, so drink fluid one hour before food because short pouch, short stay. There isn't enough room for food and fluid. It can occur during the meal or 5-30 mins after the meal. When they drink the fluid before, it helps hydrate the vascular space. They usually eat a low carb diet and try to *avoid pure sugar*
How do you know it's acyanotic heart - dz - patent ductus arteriosus and not (VSD)?
• Continuous murmur •Respiratory infections •Poor growth •Heart failure •Widened pulse pressure = ⬇diastolic pressure * (difference b/t your systolic & diastolic)
What are the main manifestations of hypoplastic left heart syndrome?
•Increasing cyanosis •Circulatory collapse/ SHOCK very severe congenital defect requires transplant palliation requires 3 open heart surgx left-side of the heart is not formed , the pumping chamber is not formed 1st shunt from aorta to pulmonary artery to allow for consistent blood flow , within the first week of life 2nd procedure @ 4- 6 months 3rd procedure @ 9 mos to 3 y/o these procedure are palliative bc eventually the right side will fail bc it's not meant to pump @ that pressure hypoplastic = underdvlpd
What would you look for in the physical examination of a peds cardiac pt?
•Inspection- general appearance, color, sweating, dysmorphic features (e.g. lower set ears), edema •Palpation - quality and amplitude of pulses (upper & lower extremities, compare them), hyperactive precordium/thrill, hepatomegaly, femoral pulse is a critical ax in infants (raised/enlarged sternum, can you see movement in chest?) we don't do carotid arteries bc infants don't have much of a neck, when they get older & it becomes more valuable, don't check both @ the same time •Auscultation (normal vs. abnormal) A - L 2nd IC space P - R 2nd IC space E - R 3rd IC space T - R 4th IC space M - R 5th IC space -> Apical pulse for a full min -> Rate & Rhythm - Murmur (most common finding) -> Location, quality & intensity -> Relationship to cardiac cycle -> Variation w/ position Arterial Blood Pressure -> Blood pressure should be obtained in upper & lower extremities >50% of NBs have an innocent systolic murmur - usually normal EKG & CXR murmur - turbulent/abn blood flow
What can a nurse do for r/f infection? ❤ lecture
•Maintain strict hand hygiene •Assess VS - temperature •Avoid contact with ill persons •Ensure up-to-date immunization status** •Administer prophylactic antibiotics prior to dental or minor procedures (30 - 60 mins before procedure): Infective Endocarditis - IV antibiotics 4 - 6 weeks PREVENTION is key They are given RSV vaccine/ synagis bc they can't risk getting bronchiolitis
How is HTN managed by the nurse? (peds)
•Monitor BP & symptoms •Education to child & family •Healthy diet •Increase physical activity •Weight reduction •Antihypertensive medications PRN •Keep follow-up appointments
What can a nurse do for decreased cardiac output?
•Monitor VS •Assess cardiac status •Administer medications: Digoxin and Furosemide
What do we do after a cariac cath?
•Monitor for complications •VS (q15mins for 1 hr and then q30mins for next 2hrs ) & O2 sat, I & Os •***Ax neurovascular status of affected extremity*** (cool temp? is the pulse there?) •Ax dressing (before they put the dressing on they will apply pressure for 20 - 30 mins), reinforce PRN (vein or artery?, ax w/ covers off, keep dressing exposed) •Bedrest w/ extremity extended (4 -6 hrs) •Pain management •Education -> diagnostic go home afterward -> interventional stay overnight -> come back if it's red, swollen, fever, warm = s/s of infection
When obtaining a health hx for a peds pts what would you be looking out for?
•Present illness Sx - activity intolerance (eating/feeding wears them out), failure to thrive (Poor weight gain), tachypnea, color change (when the baby gets tired/cries), sweating around the head w/ feeds, delayed growth & dvlpmnt • Pregnancy Hx - maternal infections, mds, illness •Family History - CHD in the family (siblings have a 3% recurrence risk), sudden death @ an early age •Risk factors - DM, obesity, hyperlipidemia, other associated genetic defects
What can a nurse do for interrupted family processes? ❤ lecture
•Provide support for child and family •Encourage parents to participate in child's care •Provide anticipatory guidance •Encourage parents to hold and touch child - they might be afraid •Encourage play with familiar toys - bring toys from home •Explain plan of care- recognize overprotectiveness = vulnerable child syndrome
What is the transposition of the greater vessels? main manifestations?
•Severe cyanosis w/out murmur + SHOCK •Diagnosed early/ right away, if they give oxygen their sats will not improve
What is involved in the post-op care of a renal transplant pt?
•Urologic management -Large indwelling foley catheter - remove 3 -5 days postop -Hourly urine output x 48 hours -Daily urinalysis, may appear blood tinged or pink following the procedure for the first few days -Diuretic agents, as needed -May have diuresis → ↓K+ & Na++, ↓BP •Low perfusion will threaten graft survival
What complications can arise from the use of surgx to treat CA?
↓ organ fx ↓ appearance + activity level Grief ↓ enjoyment of life Depression
What are some basics about pH? e.g. H ions, alkalinity, acidosis
▪ pH is measured on a scale of 1 - 14 ▪ Normal/ideal/neutral pH is right in the middle at 7.35 - 7.45 ▪ Not in normal range = negative impacts e+ balance, ❤ conduction, nerve impulse, muscle activity, hormone and enzyme function ▪Associate pH with Hydrogen ions pH > High Hydrogen ions = ⬇ pH = acidosis/acidotic < 7.35 > Low Hydrogen ions = ⬆ pH = alkalosis/alkalotic > 7.45 Think: Hydrogen ions are acids, the more H ions there are the more acidic and the less pH you have Acid = Compounds that breaks H+ ions free > ⬆H = ⬇ pH Base = Compounds binds H+ ions creating a buffer in the body > ⬇H = ⬆ pH
