Semester 3 Test 1, Sem 3 Unit 2, Sem 3 Unit 3, Sem 3 Test 4, Sem 3 Unit 5, Sem 3 Unit 6

Regarding Types of Dysrhythmias, Atrial Flutter ECG Characteristics

- Atrial rate is 200 to 350 beats/minute - Ventricular rate is > or <100 beats/min and may be regular or irregular - Atrial rhythm is regular and ventricular rhythm is usually regular. - P wave is flutter (F) waves (sawtoothed pattern); more flutter waves than QRS complexes; may occur in a 2 : 1, 3 : 1, 4 : 1, etc., pattern - PR interval is variable and not measurable. - QRS complex is usually normal. Because the

Regarding Nonpharmacologic Strategies to Encourage Relaxation and Relieve Pain, Paced Breathing Techniques

- Cleansing Breath: Relaxed breath in through nose and out through mouth. Used at the beginning and end of each contraction. - Slow-Paced Breathing (Approximately 6 to 8 Breaths Per Minute): IN-2-3-4/OUT-2-3-4/IN-2-3-4/OUT-2-3-4... - Modified-Paced Breathing (Approximately 32 to 40 Breaths Per Minute): IN-OUT/IN-OUT/IN-OUT/IN-OUT... - Patterned-Paced or Pant-Blow Breathing (Same Rate as Modified): 3 : 1 Patterned breathing IN-OUT/IN-OUT/IN-OUT/IN-BLOW (repeat through contraction)

Types of Heat Loss in Neonate

- Convection - Radiation - Evaporation - Conduction

hypertensive crisis treatment

- If ingestion is recent, gastric lavage and charcoal may be helpful. - Pyrexia is treated with hypothermic blankets or ice packs. - Fluid therapy is essential, particularly with hyperthermia. - A short-acting antihypertensive agent such as nitroprusside, nitroglycerine, or phentolamine may be used. - Intravenous benzodiazepines are useful for agitation and seizure control.

Herbs to avoid while trying to conceive include

- licorice root, - yarrow, wormwood, - ephedra, - fennel, - goldenseal, - lavender, - juniper, - flaxseed, - pennyroyal, - passionflower, - wild cherry, - cascara, - sage, - thyme, - periwinkle.

Cirrhosis Diagnostic Studies

- liver function tests - Enzyme levels, including alkaline phosphatase, AST, ALT, and γ-glutamyl transpeptidase (GGT), are initially elevated - in end-stage liver disease, AST and ALT levels may be normal due - decreased serum total protein and albumin, - increased serum bilirubin. globulin levels, and prolonged prothrombin time. - decreased cholesterol levels. - liver ultrasound (not a reliable diagnostic test for cirrhosis) - Ultrasound elastography (Fibroscan) (used to quantify the degree of liver fibrosis) - A liver biopsy (percutaneous needle) (gold standard for a definitive diagnosis of cirrhosis.)

facial features of fetal alcohol syndrome

- low nasal bridge - minor ear abnormalities - indistinct philtrum - micrognathia - thin upper lip - epicanthal fold - short palpebral fissures - flat midface and short nose

ADHD Psychobiological Interventions (meds)

- stimulant drugs: often dramatic and can quickly increase attention and task-directed behavior while reducing impulsivity, restlessness, and distractibility - Methylphenidate (Ritalin and others) and the mixed amphetamine salts (Adderall) are the most widely used stimulants because of their relative safety and simplicity of use. - A nonstimulant selective norepinephrine reuptake inhibitor, atomoxetine (Strattera) - Two centrally acting alpha-2 adrenergic agonists, clonidine (Kapvay) and guanfacine (Intuniv) Risk of taking meds when not needed

Regarding Types of Dysrhythmias, Premature Atrial Contraction Clinical Significance and symptoms

- Patients may report palpitations or a sense that their hearts "skipped a beat." - In persons with heart disease, frequent PACs may indicate enhanced automaticity of the atria or a reentry mechanism. Such PACs may warn of or start more serious dysrhythmias (e.g., supraventricular tachycardia).

Hemophilia Drug Therapy for children

- Replacement Factors - desmopressin acetate (also known as DDAVP) - Corticosteroids are given for hematuria, acute hemarthrosis, and chronic synovitis. - Oral administration of ε-aminocaproic acid (Amicar) prevents clot destruction (use is limited to mouth trauma or surgery with a dose of factor concentrate given first.)

Regarding Chronic Kidney Disease, Dyslipidemia Drug Therapy

- Statins (HMG-CoA reductase inhibitors), such as atorvastatin (Lipitor), are used to lower LDL cholesterol levels - Statins should be used in patients with CKD (especially patients with diabetes) not yet on dialysis. - Fibrates (fibric acid derivatives), such as gemfibrozil (Lopid), are used to lower triglyceride levels

Glomerulonephritis causes

- Strep, - lupus, - hypertension, - autoimmune disorder, - bacterial/viral infection, - illegal drug use

the first stage of labor two phases:

- The latent phase - The active phase

Ways to Monitor Oxygen Therapy

- Transcutaneous monitoring (TCM) - Pulse oximetry

MI Ongoing monitoring includes

- Treat dysrhythmias - Frequent vital sign monitoring - Bed rest/limited activity for 12-24 hours

The patient who has esophageal and/or gastric varices should avoid ingesting

- alcohol, - aspirin, - nonsteroidal antiinflammatory drugs (NSAIDs).

Regarding Drug Therapy for Infertility

- clomiphene (Clomid) - Pergonal, Repronex, Humegon - urofollitropin (Bravelle), follitropin (Gonal-f) - cetrorelix (Cetrotide), ganirelix - leuprolide (Lupron), nafarelin (Synarel) - Pregnyl, Profasi, Novarel

Regarding Types of Dysrhythmias, Paroxysmal Supraventricular Tachycardia Treatment

- vagal stimulation and drug therapy. - Common vagal maneuvers include Valsalva, carotid massage, and coughing. - IV adenosine is the drug of choice to convert PSVT to a normal sinus rhythm. This drug has a short half-life (10 seconds) and is well tolerated. - IV β-blockers and calcium channel blockers (diltiazem and verapamil [Calan]) can also be used. - If vagal stimulation and drug therapy are ineffective and the patient becomes hemodynamically unstable, synchronized cardioversion is used.

Pulmonary embolism (PE) Clinical Manifestations

- varied and nonspecific, making diagnosis difficult. - depend on the size and extent of emboli - Small emboli may go undetected or produce vague, transient symptoms. - Dyspnea is the most common presenting symptom - A mild to moderate hypoxemia - Tachypnea, cough, chest pain, hemoptysis, crackles, wheezing, fever, accentuation of the pulmonic heart sound, tachycardia, and syncope. - Massive emboli may produce a sudden change in mental status, hypotension, and feelings of impending doom.

to relieve symptoms of Superficial Vein Thrombosis include telling the patient to

- wear graduated compression stockings or bandages, - elevate the affected limb above level of heart, - apply topical NSAIDS, - perform mild exercise such as walking.

Preterm birth is any birth that occurs between

20 0/7 and 36 6/7 weeks of gestation

The development of dependent edema or a sudden weight gain of more than

3 lb (1.4 kg) in 2 days is often a sign of ADHF

Children who are infected with RSV are usually contagious for how long? How about if the pt has a weakened immune system?

3 to 8 days, but some infants and patients with weakened immune systems can be contagious for as long as 4 weeks

The test specific for hemophilia plasma includes

- factor VIII and factor IX assay - Carrier detection is possible in classic hemophilia using deoxyribonucleic acid (DNA) testing and is an important consideration in families in which female offspring may have inherited the trait.

Obesity Basic laboratory studies include a

- fasting lipid panel; - fasting insulin level; - fasting glucose hepatic enzymes, including γ-glutamyltransferase (GGT); - in some institutions, hemoglobin A1c.

Bulimia Abnormal laboratory parameters

- hypokalemia, - metabolic alkalosis, - elevated serum amylase, all may occur with frequent vomiting

Fetal complications from preterm PROM are primarily related to

- intrauterine infection, - cord prolapse, - umbilical cord compression associated with oligohydramnios, - placental abruption.

Alcohol withdrawal in infants Signs and symptoms include

- jitteriness, - increased tone and reflex responses, - irritability. - Seizures are common.

The average American adult's daily intake of sodium ranges from 7 to 15 g. A commonly ordered diet for a patient with HF is a

2-g sodium diet

Normal End-tidal carbon dioxide (ETCO2) values are

30 to 43 mm Hg, which is slightly lower than normal PCO2 of 35 to 45 mm Hg.

Normal Infant Respirations

30-60

Respiratory Syncytial Virus (RSV) Signs and Symptoms

Initial • Rhinorrhea • Pharyngitis • Coughing/sneezing • Wheezing • Possible ear or eye drainage (OM and conjunctivitis) • low-grade fever/Intermittent fever With Progression of Illness it becomes a lower respiratory tract infection • Increased coughing and wheezing • Tachypnea and retractions • Cyanosis Severe Illness • Tachypnea, >70 breaths/min • Listlessness • Apneic spells • Poor air exchange; decreased breath sounds

Diet for HF

Recommend Dietary Approachesto Stop Hypertension (DASH) diet

Manifestations of Estrogen Deficiency

Vasomotor • Hot flashes • Night sweats Genitourinary • Atrophic vaginitis • Dyspareunia (Painful intercourse) secondary to poor lubrication • Incontinence Psychologic • Emotional lability • Change in sleep pattern • Decreased REM sleep Musculoskeletal • Increased fracture rate, especially vertebral bodies but also humerus, distal radius, and upper femur Cardiovascular • Decreased high-density lipoproteins (HDLs) • Increased low-density lipoproteins (LDLs) Other • Diminished collagen content of skin • Breast tissue changes

Regarding Chronic HF drug therapy, For patients who are unable to tolerate ACE inhibitors,

angiotensin II receptor blockers (ARBs) are recommended

SSRIs are frequently the first-line treatment in

depression.

Fetal fibronectin (fFN) has been studied extensively and is marketed in the United States as a fFN is a The presence of fFN during the late second and early third trimesters of pregnancy may be related to Often the test is used to predict who will

diagnostic test for preterm labor. glycoprotein "glue" found in plasma and produced during fetal life. (appears in cervical and vaginal secretions) placental inflammation, which is thought to be one cause of spontaneous preterm labor. not go into preterm labor, because preterm labor is very unlikely to occur in women with a negative result

People who survive an episode of Sudden cardiac death (SCD) require a

diagnostic workup to determine whether they have had an MI. Serial analysis of cardiac biomarkers and ECGs are done

Approximately 10% of patients with massive Pulmonary embolism (PE)

die within the first hour.

Patients taking a digitalis (digoxin) preparation are at risk for Whats a cause?

digitalis toxicity. Hypokalemia, secondary to the use of potassium-depleting diuretics (e.g., thiazides, loop diuretics), is one of the most common causes of digitalis toxicity.

Regarding infants and children with HF, Written instructions regarding correct administration of

digoxin are essential including an explanation regarding signs of toxicity.

Regarding Chronic Stable Angina drug therapy, Calcium channel blockers enhance the action of What should be monitored? And taught?

digoxin by increasing serum digoxin levels Therefore serum digoxin levels should be closely monitored after starting calcium channel blockers. Teach the patient the signs and symptoms of digoxin toxicity.

During systolic failure, the LV becomes

dilated and hypertrophied.

The demands of the drug-exposed infant on the caregiver are What is important to do as a nurse?

enormous and unrewarding in terms of positive feedback. - The infants are difficult to comfort, and they cry for long periods, which can be especially trying for the caregiver after the infant's discharge from the hospital. Long-term follow-up to evaluate the status of the infant and family is very important

This system, which is based on the clinical and electroencephalographic manifestations of seizures, divides seizures into two major classes:

generalized and focal (partial)

Thrombotic Thrombocytopenic Purpura is almost always associated with

hemolytic-uremic syndrome (HUS), it is often referred to as TTP-HUS.

Incomplete Miscarriage Symptoms Management

involves the expulsion of the fetus with retention of the placenta. Symptoms: - Heavy, profuse bleeding - Severe cramping - Yes Passage of Tissue - Yes dilation, with tissue in cervix Management: - May or may not require additional cervical dilation before curettage. - Suction curettage may be performed. (D&C)

Since hyperthyroidism may be precipitated by __________________________________________________, those who are at-risk for hyperthyroidism should be monitored closely after ________________________________________

iodinated contrast media used in CT scans and other radiological studies, iodinated contrast media exposure

Regarding Types of Dysrhythmias and Atrial Fibrillation Treatment, If drugs or cardioversion does not convert atrial fibrillation to normal sinus rhythm, what should be done? Alternatives?

long-term anticoagulation therapy is needed - Warfarin is the drug of choice, and patients are monitored for therapeutic levels (e.g., international normalized ratio [INR]). - Alternatives to warfarin are available for anticoagulation therapy in patients with nonvalvular atrial fibrillation. Examples include dabigatran (Pradaxa), apixaban (Eliquis), and rivaroxaban (Xarelto). These drugs do not require routine laboratory testing.

Regarding cirrhosis, Peripheral edema occurs in the Ascites is the

lower extremities and presacral area accumulation of serous fluid in the peritoneal or abdominal cavity - manifested by abdominal distention with weight gain

Oxygen masks are available in pediatric sizes but What can be used?

may not be well tolerated in children, because a snug fit is required to ensure adequate oxygen delivery. A face tent or bucket is often better tolerated because this soft piece of plastic sits beneath the child's chin and allows oxygen to be directed to the mouth and nose without enclosure (rarely used today in developed countries. Oxygen concentration is difficult to control, and the child's clothing can become saturated with water from the humidification and cause hypothermia.)

Respiratory acidosis (carbonic acid excess) occurs whenever the Other causes?

person hypoventilates • Mechanical hypoventilation • Pulmonary edema • Chronic respiratory disease (e.g., COPD) • Barbiturate or sedative overdose • Chest wall abnormality • Severe pneumonia • Atelectasis • Respiratory muscle weakness

In addition, some cultural practices such as cupping or coin rubbing may mimic

physical abuse. Normal variants, such as mongolian spots and congenital anomalies of genitalia, can be mistaken for abuse.

Irritable and hyperactive infants are likely to respond to Give example

physical comforting, movement, and close contact - Wrapping infants snugly and rocking and holding them tightly limit their ability to self-stimulate. - Arranging nursing activities to reduce the amount of disturbance helps decrease exogenous stimulation.

When the count drops below 20,000/µL (20 × 109/L), what can happen

spontaneous, life-threatening hemorrhages (e.g., intracranial bleeding) can occur

Regarding the second stage of labor two phases, During the active pushing phase, Physiologic management of this phase involves A nurse should encourage

spontaneous, rather than directed, pushing. Instead of giving instructions, caregivers encourage the woman to push when she feels the urge to do so shorter bearing down efforts using open-glottis pushes

Antifibrinolytic therapy (tranexamic acid [Cyklokapron] and epsilon-aminocaproic acid) agents are used to

stabilize clots in areas of increased fibrinolysis, such as the oral cavity, and in patients with difficult episodes of epistaxis and menorrhagia (Topical thrombin and fibrin sealants may also be used for mucosal bleeding.)

The RIFLE classification is used to describe the It stands for

stages of AKI - Risk, the first stage of AKI, is followed by Injury, which is the second stage. - Then AKI increases in severity to the final, or third, stage, Failure. - The two outcome variables are Loss and End-stage renal disease. (Risk, Injury, Failure, Loss, End-stage Renal Disease)

For patients with STEMI, reperfusion therapy is Reperfusion therapy includes The goal in the treatment of STEMI is to What else can be used?

started. emergent PCI (preferred) or thrombolytic therapy for STEMI. save as much heart muscle as possible. Dual antiplatelet therapy and heparin are also used.

Regarding Cirrhosis Management of ascites, A paracentesis is a In the patient with cirrhosis, this procedure is reserved for the person with

sterile procedure in which a catheter is used to withdraw fluid from the abdominal cavity impaired respiration or abdominal discomfort caused by severe ascites who does not respond to diuretic therapy.

When bacterial cervical or urinary tract infections are present, the risk for

preterm birth increases.

Bacterial Meningitis Nursing Implementation Acute Care for the patient with delirium

- additional low lighting may be necessary to decrease hallucinations - Make every attempt to minimize environmental stimuli and prevent injury - A familiar person at the bedside may have a calming effect

Criteria guidelines for bariatric surgery include

- having a BMI of 40 or more - a BMI of 35 or more with other significant co-morbidities (e.g., hypertension, type 2 diabetes mellitus, heart failure, sleep apnea).

The school-age period is the time when children have

"best friends" with whom they share secrets, private jokes, and adventures; they come to one another's aid in times of trouble. In the course of these friendships, children also fight, threaten each other, break up, and reunite.

Cognitive changes during and after treatment, especially with chemotherapy, can occur in patients with cancer. This phenomenon is called These changes include difficulties in

"chemobrain." concentration, memory, focus, and attention

The most common surgical options for operable breast cancer are

(1) breast conservation surgery (lumpectomy [segmental mastectomy]) (2) mastectomy with or without reconstruction.

Three important factors (called Virchow's triad) in the etiology of venous thrombosis are

(1) venous stasis, (2) damage of the endothelium (inner lining of the vein), (IV cath) (3) hypercoagulability of the blood

Seizure Disorders for Primary Generalized Seizures

(Involve both hemispheres of brain) • Tonic-clonic seizures • Absence seizures (simple or complex) • Typical • Atypical • Absence with special features • Myoclonic seizures • Tonic seizures • Atonic seizures (akinetic) • Clonic seizures

Realistic outcomes for autism

- follow simple rules of interactive games - Direct messages appropriately - Express emotions

Regarding Types of Dysrhythmias, Third-Degree AV Block Treatment Whats not effective?

- symptomatic patients, a transcutaneous pacemaker is used until a temporary transvenous pacemaker can be inserted - drugs such as dopamine and epinephrine is a temporary measure to increase HR and support BP until temporary pacing is started - Patients need a permanent pacemaker as soon as possible. - Atropine is not an effective drug for this dysrhythmia.

When do patients develop Heparin-Induced Thrombocytopenia

5 to 10 days after the onset of heparin therapy

average age for menopause

52 years, but the age can vary from 40 to 58 years.

Blood is slightly alkaline and has a normal arterial pH of If the pH drops If the blood pH is greater

7.35 to 7.45 below 7.35, a person has acidosis than 7.45, the person has alkalosis

Regarding spinal anesthesia (block) side effects? What can be given?

A bolus of IV fluid (usually 500 to 1000 mL of lactated Ringer's or normal saline solution) may be administered 15 to 30 minutes before induction of the anesthetic to decrease the potential for hypotension caused by sympathetic blockade (vasodilation with pooling of blood in the lower extremities decreases cardiac output) - the initiation of spinal anesthesia should not be delayed in order to deliver a fixed volume of fluid

Combination therapy with hydralazine and isosorbide dinitrate (Bidil) may be helpful in

African American patients with HF who are getting optimal therapy with ACE inhibitors and β-blockers. The same benefit is not found in white patients. The combination of the two drugs is also associated with a significant improvement in LV EF and exercise tolerance

Men who test positive for a BRCA gene mutation should receive These men should also begin

BSE training starting at the age of 35, a CBE every 6 months starting at the age of 35, and a baseline mammogram beginning at the age of forty. prostate screening at the age of 40 as they also have an increased risk of developing prostate cancer

Side effects of opioids administered by the epidural and intrathecal routes include nausea, vomiting, diminished peristalsis, pruritus, urinary retention, and delayed respiratory depression. How to relieve these symptoms?

Antiemetics, antipruritics, and opioid antagonists (naloxone or metoclopramide may be administered.)

first recognized indicator of RSV infection in very young infants (younger than 1 month of age)

Apnea

Nursing Alert Avoid taking what on affected breast side?

Avoid taking blood pressure, giving injections, or taking blood from the arm on the affected side.

What is used if the acute esophageal or gastric variceal hemorrhage cannot be controlled on initial endoscopy?

Balloon tamponade

Before induction of the spinal anesthetic (block), what is assessed? After?

Before: - maternal vital signs are assessed and a 20- to 30-minute electronic fetal monitoring (EFM) strip is obtained and evaluated - woman's fluid balance After: - maternal blood pressure, pulse, and respirations and FHR and pattern must be assessed and documented every 5 to 10 minutes. - If signs of serious maternal hypotension (e.g., a drop in systolic blood pressure to 100 mm Hg or less or below 20% of the baseline blood pressure) or fetal distress (e.g., bradycardia, minimal or absent variability, late decelerations) develop, emergency care must be given

Complementary & Alternative Therapies Herbs and Supplements for Menopause and its Nursing Implications

Black cohosh: • Generally well tolerated in recommended doses for up to 6 mo. • Should not be used in people with a liver disorder. Soy: • Women with a history of breast, ovarian, or uterine cancer or endometriosis should consult with their HCP before using soy or soy products. • Soy may interact with warfarin. Patients taking warfarin should consult with their HCP before using soy or soy products.

Regarding Respiratory Secretion Specimens, nasopharyngeal swabs to diagnose

Bordetella pertussis and throat cultures.

Clinical Manifestations of Immune Thrombocytopenia (Idiopathic Thrombocytopenic Purpura)

Easy Bruising • Petechiae • Ecchymoses • Most often over bony prominences Bleeding From Mucous Membranes • Epistaxis • Bleeding gums • Internal hemorrhage evidenced by the following: • Hematuria • Hematemesis • Melena • Hemarthrosis • Menorrhagia • Hematomas over lower extremities

Regarding Nicotine Replacement Agents, Nicotine Patch (OTC) (NicoDerm CQ, Habitrol, Nicotine transdermal system) Common Side Effects Considerations

Common Side Effects Transient itching, burning, and redness at patch site. Insomnia, nausea, headache Considerations - Provides steady level of nicotine and is easy to use. - Cannot be used by those with adhesive allergies. - Rotate site to diminish skin irritation.

Preterm labor Lab test

CBC (note WBC), Blood type, STI test, Group B strep test, urinalysis, possible urine culture

What are the Serum cardiac biomarker after a MI

Cardiac-specific troponin Creatine kinase MB (CK-MB) Myoglobin

Patients with CKD have a high incidence of CV complications. A higher percentage of patients will die from CV disease than live to need dialysis. When a patient is diagnosed as having CKD, therapy is aimed at treating the

CV disease in addition to slowing the progression of kidney disease

Early Decelerations Causes Clinical Significance Nursing Interventions

Cause Head compression resulting from the following: • Uterine contractions • Vaginal examination • Fundal pressure • Placement of internal mode of monitoring Clinical Significance Normal pattern; not associated with fetal hypoxemia, acidemia, or low Apgar scores Nursing Interventions None required - Little said to preform sterile vaginal exam to see if head is compressed

Chronic Kidney Disease Clinical Manifestations for Gastrointestinal System

Cause: excessive urea - Stomatitis with exudates and ulcerations, a metallic taste in the mouth, and uremic fetor (a urinous odor of the breath) - Anorexia, nausea, and vomiting may develop if CKD progresses to ESRD and is not treated with dialysi - Diabetic gastroparesis (delayed gastric emptying) for patients with diabetes - GI bleeding because of mucosal irritation and the platelet defect - Constipation (Limitations on fluid intake and physical inactivity)

most common form of maltreatment

Child neglect

Medication to sedate a child during CT or MRI Propofol is a good sedation agent for diagnostic procedures because of its short induction and recovery time, but this medication should be used with caution because

Chloral hydrate or benzodiazepines have been used - Other sedative agents have been used safely, alone and in combination, for children and include intravenous (IV) sodium pentobarbital (Nembutal), IV fentanyl (Sublimaze), IV midazolam (Versed), and intranasal midazolam (Arlachov & Ganatra) it can cause respiratory depression and apnea with little warning

FHR Tachycardia Nursing Interventions

Dependent on cause; - reduce maternal fever with antipyretics as ordered and cooling measures; - oxygen at 10 L/min by nonrebreather face mask may be of some value; - carry out health care provider's orders based on alleviating cause.

Regarding Primary Generalized Seizures, with Tonic-clonic What may accompany the seizure In the postictal phase, the patient usually has

Cyanosis, excessive salivation, tongue or cheek biting, and incontinence muscle soreness, feels tired, and may sleep for several hours. Some patients may not feel normal for several hours or days after a seizure. The patient has no memory of the seizure.

Pica complications

Eating nonfood items can also be dangerous. - Paint may contain lead and result in brain damage. - Objects that cannot be digested such as stones can result in intestinal blockage. - Sharp objects such as paperclips can result in intestinal damage or laceration. - Bacteria from dirt or other soiled objects can result in serious infection. - Tooth decay may result from stomach acids.

The majority of these trafficking slaves are

women and children, and many women have some interaction with health care providers.

Glomerulonephritis Management

Decrease inflammatory process, prevent complications • Corticosteroids • Dialysis • Plasmapheresis • Dietary Restrictions (Protein, K+, NA+) • Strict I&O and Daily Weight

Regarding the second stage of labor two phases, During the latent phase: Descent, station Spontaneous bearing-down efforts Vocalization Maternal behavior

Descent, station: 0 to +2 Spontaneous bearing-down efforts: Slight to absent, except at peak of strongest contractions Vocalization: Quiet Maternal behavior: - Experiences sense of relief that transition to second stage is finished - Feels fatigued and sleepy - Feels a sense of accomplishment and optimism because the "worst is over" - Feels in control

For Energy Conservation the preterm infant should have what type of environment?

Diminishing environmental noise levels and shading the infant from bright lights also promote rest

Regarding Common Bacterial Infections of the Skin, Furuncle (boil) Etiology and Pathophysiology Clinical Manifestations Treatment and Prognosis

Etiology and Pathophysiology: • Deep infection with staphylococci around hair follicle • Often associated with severe acne or seborrheic dermatitis • Larger lesion with more redness and swelling at a single follicle Clinical Manifestations: • Tender erythematous area around hair follicle that is painful • Draining pus and core of necrotic debris on rupture • Most common on face, back of neck, axillae, breasts, buttocks, perineum, thighs Treatment and Prognosis: • Incision and drainage (possibly with packing), antibiotics, meticulous care of involved skin, frequent application of warm, moist compresses • Lesion should never be squeezed • heal with scar formation

Regarding Chronic Kidney Disease Nutritional Therapy, Phosphate Restriction

For hyperphosphatemia: - By the time a patient reaches ESRD, phosphate is limited to approximately 1 g/day - Foods that are high in phosphate include meat, dairy products (e.g., milk, ice cream, cheese, yogurt), and foods containing dairy products (e.g., pudding) - Many foods that are high in phosphate are also high in protein. Since patients on dialysis are encouraged to eat a diet containing protein, phosphate binders are essential to control the phosphate level.

Drug Alert Varenicline (Chantix) and Bupropion (Zyban)

For smoking cessation • Serious neuropsychiatric symptoms such as changes in behavior, hostility, agitation, depressed mood, suicidal thoughts and behavior, and attempted suicide can occur. • Advise patients to stop taking these drugs and contact the HCP immediately if they experience any of these manifestations.

The two modes of Electronic Fetal Monitoring are

External mode: which uses external transducers placed on the maternal abdomen to assess FHR and uterine activity (UA), - Ultrasound transducer for Fetal Heart Rate - Tocotransducer for Uterine Activity Internal mode: - which uses a spiral electrode applied to the fetal presenting part to assess the FHR -an intrauterine pressure catheter (IUPC) to assess UA and uterine resting tone.

The Heart Failure Society of America (HFSA) developed the acronym

FACES (Fatigue, limitation of Activities, chest Congestion/cough, Edema, and Shortness of breath) to help teach patients to identify early HF symptoms

temporary side effects of external radiation therapy

Fatigue, skin changes, and breast edema

FDA-approved antidepressant for treating bulimia nervosa Other drugs? People with BN may benefit from

Fluoxetine (Prozac) - Topiramate, an antiepileptic agent, and the selective serotonin antagonist ondansetron have demonstrated some benefit in treating patients with BN (for binge suppression) - Tricyclic antidepressants help reduce binge eating and vomiting - psychotherapy, - antidepressant medications, - combination of antidepressant medication and psychotherapy

The diagnosis of menopause

Follicle-stimulating hormone (FSH) levels may be done to confirm a diagnosis of menopause. (The FSH levels are increased in menopause.) - not indicated until the woman has stopped menstruating for 12 months.

Regarding the second stage of labor two phases, During the active pushing phase: Frequency Duration Descent, station Spontaneous bearing-down efforts Vocalization Maternal behavior

Frequency Every 2-3 minutes progressing to every 1-2 minutes Duration 40-60 seconds Descent, station +2 to +4; rate of descent increases Ferguson reflex is activated; fetal head becomes visible at introitus, and birth occurs Show: color and amount Significant increase in dark red bloody show; bloody show accompanies emergence of head Spontaneous bearing-down efforts Increased urge to bear down; becomes stronger as fetus descends to vaginal introitus and reaches perineum Vocalization Grunting sounds or expiratory vocalizations; announces contractions; may scream or swear Maternal behavior - Senses increased urge to push and describes increasing pain; describes ring of fire (burning sensation of acute pain as vagina stretches and fetal head crowns) - Expresses feeling of powerlessness - Shows decreased ability to listen to or concentrate on anything but giving birth - Alters respiratory pattern: has short 4- to 5-second breath holds with regular breaths in between, 5-7 times per contraction - Frequent repositioning - Often shows excitement immediately after birth of head

Cushing Syndrome Clinical Manifestations

From Hypersecretion of glucocorticoids (excess): - Hyperglycemia - Weight gain - Truncal obesity - Rounding of face (moon face) - Fat deposits on back of neck and shoulders (buffalo hump) - Muscle wasting in extremities, weakness - Osteoporosis and back pain - Delay in wound healing. - Purplish red striae (usually depressed below the skin surface) appear on the abdomen, breast, or buttocks - Petechial hemorrhages, bruises Mineralocorticoid excess: - Hypokalemia (if on digoxin, watch for digoxin toxicity) - Hypertension - Edema, Alkalosis. - Increased BP Adrenal androgen excess: - Severe acne - Virilization in women - Feminization in men - Menstrual disorders and hirsutism in women, Enlargement of clitoris - Gynecomastia and impotence in men, Testicular atrophy

Common Signs of Digoxin Toxicity in Children

Gastrointestinal: Nausea Vomiting Anorexia Cardiac: Bradycardia Dysrhythmias

Complementary & Alternative Therapies for CHF

Hawthorn

Regarding hormonal therapy, Trastuzumab (Herceptin) is a monoclonal antibody to The most common side effects are? Other side effect?

HER-2. Monoclonal antibody is a immunotherapy for HER-2 positive pt. flu-like symptoms (fever, chills, myalgia) - more serious side effect, is damage to the heart.

Clinical Manifestations of Down Syndrome Head and Eyes Nose and Ears Mouth and Neck Chest and Heart Hands and Feet Musculoskeletal and Skin Other

Head and Eyes - Separated sagittal suture - Brachycephaly - Rounded and small skull - Flat occiput - Enlarged anterior fontanel - Oblique palpebral fissures (upward, outward slant)* - Inner epicanthal folds - Speckling of iris (Brushfield spots) Nose and Ears - Small nose* - Depressed nasal bridge (saddle nose)* - Small ears and narrow canals - Short pinna (vertical ear length) - Overlapping upper helices - Conductive hearing loss Mouth and Neck - High, arched, narrow palate* - Protruding tongue - Hypoplastic mandible - Delayed teeth eruption and microdontia - Abnormal teeth alignment common - Periodontal disease - Neck skin excess and laxity* - Short and broad neck Chest and Heart - Shortened rib cage - Twelfth rib anomalies - Pectus excavatum or carinatum - Congenital heart defects common (e.g., atrial septal defect, ventricular septal defect) - Abdomen and Genitalia - Protruding, lax, and flabby abdominal muscles - Diastasis recti abdominis - Umbilical hernia - Small penis - Cryptorchidism - Bulbous vulva Hands and Feet - Broad, short hands and stubby fingers - Incurved little finger (clinodactyly) - Transverse palmar crease - Wide space between big and second toes* - Plantar crease between big and second toes* - Broad, short feet and stubby toes Musculoskeletal and Skin - Short stature - Hyperflexibility and muscle weakness* - Hypotonia - Atlantoaxial instability - Dry, cracked, and frequent fissuring - Cutis marmorata (mottling) Other - Reduced birth weight - Learning difficulty (average intelligence quotient [IQ] of 50) - Hypothyroidism common - Impaired immune function - Increased risk for leukemia - Early-onset dementia (in one-third)

When a benzodiazepine (diazepam or lorazepam) is ineffective for status epilepticus what is used

IV phenytoin or IV fosphenytoin or IV phenobarbital is given as the next line of treatment. This combination of therapy places the child at high risk for apnea; therefore respiratory support is generally necessary.

Regarding cirrhosis, Because of alterations in immune function associated with cirrhosis, patients with ascites are at risk for What is it?

spontaneous bacterial peritonitis (SBP) SBP is a bacterial infection of the ascitic fluid (Escherichia coli)

Heart Failure primary risk factors What other risks?

Hypertension and Coronary Artery Disease (CAD) (Other issues that are a risk are diabetes, metabolic syndrome, advanced age, tobacco use, and vascular disease)

Regarding Primary Generalized Seizures, what precipitates absence seizures?

Hyperventilation and flashing lights

Some individuals with autism spectrum disorder may have low These areas include This is a condition known as

IQs yet are brilliant in specific areas musical, visual-spatial, or intellectual abilities such as the ability to complete complex mathematical calculations or photographic memory recall. savant syndrome.

Screening for Victims of Human Trafficking

If human trafficking is suspected, the nurse should ask simple questions that are not threatening and that mostly require a "yes" or "no" response, as follows: • Is the place where you sleep clean? • Do you have enough food? • Have you been threatened or harmed physically? Has your family been threatened? • Are you free to talk to people outside of your home or job? • Are you free to come and go as you please? • Are you ever forced to have sex? • Are you ever forced to work?

Regarding Hyperthyroidism Drug Therapy, antithyroid drugs (propylthiouracil and methimazole (Tapazole)) Improvement begins when and results? How long is the therapy for? What can happen if discontinued?

Improvement usually begins 1 to 2 weeks after the start of drug therapy. Good results are usually seen within 4 to 8 weeks. Therapy is usually continued for 6 to 15 months to allow for spontaneous remission, which occurs in 20% to 40% of patients. Abruptly discontinuing drug therapy can result in a return of hyperthyroidism.

Regarding infants with HF, feeding position should be What can help sucking?

Infants should be well supported and fed in a semiupright position. may need to have the jaw and cheeks stroked to encourage sucking.

Fentanyl Citrate (Sublimaze) - Opioid agonist analgesic Indication Dosage Adverse Effects Nursing Considerations

Indication Moderate to severe labor pain and postoperative pain after cesarean birth Dosage and Route IV: 50 to 100 mcg every hour IM: 50 to 100 mcg every hour PCA Pump: (sample setting) 50 mcg incremental dose with a 10 minute lockout and no basal rate. Adverse Effects Sedation, respiratory depression, nausea, and vomiting Nursing Considerations - Assess for respiratory depression; naloxone should be available as an antidote - use of side rails and assistance with ambulation - Because of its short duration of action, frequent dosing will be necessary when given intravenously. - Maximum total dose for labor is usually 500 to 600 mcg.

Regarding Hyperthyroidism Drug Therapy, How is Iodine (saturated solution of potassium iodine (SSKI) and Lugol's solution) given?

Iodine is mixed with water or juice, sipped through a straw, and given after meals.

Regarding Cultural & Ethnic Health Disparities of Heart Failure, _______________________________________ is used for the treatment of HF in African Americans.

Isosorbide dinitrate/hydralazine (BiDil) (This combination drug is approved for use only in this ethnic group.)

Regarding Clinical Manifestations of Myocardial Infarction, usually last how long compared to angina

It usually lasts for 20 minutes or longer and is more severe than usual anginal pain.

Regarding Stages of Chemotherapy, The first stage, induction therapy, is the Induction is aggressive treatment that seeks to Risk for?

attempt to bring about a remission destroy leukemic cells in the tissues, peripheral blood, and bone marrow to eventually restore normal hematopoiesis on bone marrow recovery Bleeding and infection

Regarding CAUSATION INFLUENCING FACTORS: LATER ONSET OF MENOPAUSE EARLIER ONSET OF MENOPAUSE

LATER ONSET OF MENOPAUSE - Age of mences cessation - Family history - Increased BMI - History of more than one pregnancy EARLIER ONSET OF MENOPAUSE - Smoking - Never being pregnant

Nursing Assessments in First-Stage Labor

Latent Labor Phase - Every 30-60 minutes: Maternal blood pressure, pulse, and respirations *Uterine activity *Fetal heart rate (FHR) and pattern Presence of bloody show - Every 30 minutes: Changes in maternal appearance, mood, affect, energy level, and involvement of partner or coach - Every 2-4 hours: Temperature (every 4 hours until membranes rupture, then every 2 hours) - As needed: Vaginal examination to identify progress in labor Active Labor Phase - Every 15-30 minutes: Maternal blood pressure, pulse, and respirations FHR and pattern Uterine activity Presence of bloody show - Every 5-15 minutes: Changes in maternal appearance, mood, affect, energy level, and involvement of partner or coach - Every 2-4 hours: Temperature (every 4 hours until membranes rupture, then every 2 hours) - As needed: Vaginal examination to identify progress in labor

serum glucose levels are frequently elevated after

MI

In addition to ST segment elevation, a pathologic Q wave may be seen on the ECG in patients with

MI (following the P wave)

To compensate for metabolic acidosis, the kidneys What can the patient develop?

attempt to excrete additional acid and the lungs increase CO2 excretion. The patient often develops Kussmaul respirations (deep, rapid breathing).

Regarding the second stage of labor two phases, Careful monitoring with assurance of normal fetal status should be used during delayed pushing. If descent is slow and the woman becomes anxious, she can

be encouraged to try squatting or sitting, as both of these positions may be of benefit when the second stage is prolonged.

A patient with severe HF may

be on bed rest with limited activity. A patient with mild to moderate HF can be ambulatory with restriction of strenuous activity

A small minority of children have seizures while playing video games. Only these children need to

be restricted from playing video games.

When the birth of a preterm infant is anticipated, the Infants who do not require resuscitation are

NICU is alerted, and an interprofessional care team including a neonatologist, an advanced practice nurse, a staff nurse, and a respiratory therapist are usually present for the birth. immediately transferred in a heated incubator to the NICU, where they are weighed and IV lines, oxygen therapy, and other therapeutic interventions are initiated as needed. - PREHEAT THE INCUBATOR AND BLANKET

Regarding HF, The body's attempts to maintain balance are demonstrated by several counterregulatory processes. What are the two

Natriuretic peptides: - atrial natriuretic peptide [ANP] - brain [b-type] natriuretic peptide [BNP] are hormones produced by the heart muscle.

Signs of Neonatal Abstinence Syndrome Neurologic Gastrointestinal Autonomic Respiratory Miscellaneous

Neurologic • Irritability • Seizures • Hyperactivity • High-pitched cry • Tremors • Exaggerated Moro reflex • Hypertonicity of muscles Gastrointestinal • Poor feeding • Diarrhea • Dehydration • Vomiting • Frantic, uncoordinated sucking • Gastric residuals Autonomic • Diaphoresis • Fever • Mottled skin Respiratory • Tachypnea (>60 breaths/min) • Nasal flaring • Nasal stuffiness Miscellaneous • Disrupted sleep patterns • Diaphoresis • Excoriations (knees, face) • Temperature instability loose stools; tachycardia; fever; projectile vomiting; crying; nasal stuffiness; and generalized perspiration, which is unusual in newborns.

Regarding Alcohol Withdrawal, Wernicke-Korsakoff Syndrome occurs when (a specific issue) Wernicke's may clear up within a few weeks or may progress into Another problem is Korsakoff's syndrome, a chronic condition with a recovery rate of Treatment of Korsakoff's syndrome is also

People with a heavy use of alcohol for many years may suffer from short-term memory disturbances - One memory-reducing problem is Wernicke's (alcoholic) encephalopathy, an acute and reversible condition. Korsakoff's syndrome, the more severe and chronic version of this problem. only about 20% thiamine for 3 to 12 months. - Most patients with Korsakoff's syndrome never fully recover

Regarding fertility, How to help male infertility What lubricant should be used if needed? Wear what type of underwear? Avoid what?

Only water-soluble lubricants should be used during intercourse because many commonly used lubricants contain spermicides or have spermicidal properties. Instead of wearing briefs, the male should wear boxer shorts and loose pants because these tend to decrease scrotal temperature Avoid High scrotal temperatures can be caused by daily hot tub baths or saunas

Signs of Intimate Partner Violence

Overuse of health services. Vague non-specific complaints. Missed appointments. Unexplained injuries. Untreated serious injuries. Injuries not matching description. Intimate partner never leaving patient's side. Intimate partner insisting on telling story of the injury.

Patients with ACS may undergo coronary revascularization with

PCI or CABG surgery

Acid-Base Values in Arterial Blood during pregnancy values

PO2, mm Hg: 104-108 (increased) PCO2, mm Hg: 27-32 (decreased) Sodium bicarbonate (HCO3), mEq/L: 18-31 (decreased) Blood pH: 7.40-7.45 (slightly increased, more alkaline)

Prevention of Respiratory Syncytial Virus Infection Who are candidates?

Palivizumab (Synagis), a monoclonal antibody, which is given monthly in an IM injection to prevent hospitalization associated with RSV. - candidates for palivizumab include infants in their first year of life born before 29 weeks of gestation and infants in their first year of life with chronic lung disease of prematurity (<32 weeks, 0 days of gestation) who needed less than 21% oxygen for at least 28 days after birth.

Manifestations of Perimenopause and Postmenopause

Perimenopause • Irregular menstrual cycles • Occasional vasomotor symptoms (e.g., hot flashes) • Mood changes • Sleep disturbances • Vaginal dryness Postmenopause • Cessation of menses • Vasomotor instability (e.g., hot flashes and night sweats) • Atrophy of genitourinary tissue (e.g., vaginal epithelium) • Stress and urge incontinence • Breast tenderness • Atrophy of genitourinary tissue with decreased support • Osteoporosis

Regarding Special Diagnostic Procedures, Magnetic resonance imaging (MRI) Purpose Comment

Permits visualization of morphologic feature of target structures - MRI is noninvasive procedure except when IV contrast agent is used. - No exposure to radiation occurs. - Patient may require sedation. - Parent or attendant can remain in room with child. - MRI does not visualize bone detail or calcifications. - No metal can be present in scanner.

Regarding ADHD, CBT is used to

change the pattern of misconduct by fostering the development of internal controls and working with the family to improve coping and support. - Development of problem solving, conflict resolution, empathy, and social skills is an important component of the treatment program.

Chronic angina pain usually does not

change with position or breathing and is rarely described as sharp or stabbing.

Regarding Chronic Kidney Disease, CKD-MBD Drug Therapy

Phosphate binders: - Calcium carbonate (Caltrate) - Calcium acetate (PhosLo) - lanthanum carbonate (Fosrenol), - sevelamer carbonate (Renvela), - Sevelamer hydrochloride (Renagel) - iron-based, calcium-free phosphate binders such as sucroferric oxyhydroxide (Velphoro) and ferric citrate (Auryxia)

Regarding infants and children with Hypoxemia, Treatment of a hypercyanotic spell

Place infant in knee/chest position Use a calm, comforting approach. Administer 100% "blow-by" oxygen. Give morphine subcutaneously or through an existing IV line. Begin IV fluid replacement and volume expansion if needed. Repeat morphine administration.

Monoamine oxidase inhibitors (MAOIs) The inability to What to do about this or what will happen? A transdermal patch, selegiline (EMSAM), does not require

break down tyramine sufficiently can result in a serious problem. People taking these drugs must reduce or eliminate their intake of foods and drugs that contain high amounts of tyramine. Individuals who take MAOIs and eat these foods are at risk for a hypertensive crisis, which is severe high blood pressure that can lead to a cerebrovascular accident. strict dietary restrictions.

Regarding ACS (UA and MI) patients, during the first 3 days after CABG surgery

Postoperative dysrhythmias, especially atrial dysrhythmias (e.g., atrial fibrillation [AF]), are common

Breast Cancer Diagnostic Assessment Prediagnosis Postdiagnosis

Prediagnosis • Mammography • Ultrasound (if indicated) • Breast MRI (if indicated) • Biopsy • confirmed by needle aspiration, a core needle biopsy, or surgical excision Postdiagnosis • Lymph node analysis (examined to determine if cancer has spread) • Estrogen and progesterone receptor status • Cell-proliferative indices (indirectly measure the rate of tumor cell proliferation, high S-phase fractions have a higher risk for recurrence) • Genomic Assay for HER-2 marker (prognostic indicator: greater risk for recurrence, and a poorer prognosis in breast cancer) • Genetic assays (e.g., MammaPrint or Oncotype DX)

Primary means of supporting a patient with hemophilia

Replacement of deficient clotting factors

Attention-Deficit/Hyperactivity Disorder (ADHD) Diagnosis

Require home assessment AND school assessment - overactive - may display disruptive behaviors that are impulsive, angry, aggressive, and often dangerous. - difficulty with maintaining attention in situations - behaviors negatively impact their ability to develop fulfilling peer and family relationships - often in conflict with others, are noncompliant, do not follow age-appropriate social norms, and may use inappropriate ways to meet their needs.

Bacterial Meningitis precaution

Respiratory isolation (Droplet) until the cultures are negative. - Meningococcal meningitis is highly contagious, whereas other causes of meningitis may pose minimal to no infection risk with patient contact.

RSV drug treatment for hospitalized children? When should it be used?

Ribavirin, an antiviral agent (synthetic nucleoside analog), is the only specific therapy approved for hospitalized children. - Due to potential toxic effects of the medication to exposed health care staff and conflicting results of efficacy, the American Academy of Pediatrics recommends against routine use of ribavirin to treat RSV. - ribavirin should be reserved for treatment in patients at high risk for mortality related to the infection, such as infants and transplant recipients

HEALTH EFFECTSOF MENOPAUSE SHORTTERM LONGTERM

SHORTTERM - Hot flashes - Sleep disturbances - Vaginal dryness - Sexual dysfunction - Depression LONGTERM - Osteopenia - Osteoporosis - Alzheimer's - Cardiovascular

STEMI patients usually have a complete coronary occlusion. What does the 12‐lead ECG Findings look like

ST elevation is first seen on the 12-lead ECG. Within a few hours to days, T wave inversion and pathologic Q waves develop.

Regarding chronic stable angina, A 12-lead electrocardiogram (ECG) often shows

ST segment depression and/or T wave inversion indicating ischemia The ECG returns to baseline when the pain is relieved.

Regarding The Alcohol Use Disorders Identification Test (AUDIT): Self-Report Version, Score for further assessment

Score: 8 or more in men; 7 or more in women needs further assessment.

Substance Use Screening is a simple effective way to identify patients who need further assessment. The

Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach can be used

Regarding Hyperthyroidism in Children, Children being treated with propylthiouracil or methimazole must be

carefully monitored for side effects of the drug. Because sore throat and fever accompany the grave complication of leukopenia - Call HCP if such symptoms occur. - Parents and children should be taught to recognize and report symptoms immediately.

Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Substance Use Single-Question Tests Two-Question Tests

Single-Question Tests Use one of the following questions to screen for the presence of alcohol, drug, or tobacco use. • How often in the past year have you had 5 (men) or 4 (women) or more drinks in a day? • How many times in the past year have you used illegal drugs or prescription medications for nonmedical reasons? • In the past year, how often have you used tobacco products? Two-Question Tests Use the following two questions to screen for alcohol or drug use. • In the past year, have you ever drunk or used drugs more than you meant to? • Have you felt you wanted or needed to cut down on your drinking or drug use in the past year?

Regarding epilepsy and seizures, for a child the The Ketogenic Diet is rigorous. All foods and liquids that the child consumes must be The diet is deficient in

carefully weighed and measured. vitamins and minerals; therefore vitamin and mineral supplementation is necessary

Emergency Treatment Maternal Hypotension With Decreased Placental Perfusion Signs and Symptoms Interventions

Signs and Symptoms - Maternal hypotension (20% decrease from preblock baseline level or ≤100 mm Hg systolic) - Fetal bradycardia - Absent or minimal FHR variability Interventions - Turn woman to lateral position, or place pillow or wedge under hip to displace uterus - Maintain intravenous (IV) infusion at rate specified, or increase administration per hospital protocol - Administer oxygen by nonrebreather face mask at 10 to 12 L/minute or per protocol. - Elevate the woman's legs. - Notify the primary health care provider, anesthesiologist, or nurse anesthetist. - Administer IV vasopressor (e.g., ephedrine 5 to 10 mg or phenylephrine 50 to 100 mcg) per protocol if previous measures are ineffective. - Remain with woman; continue to monitor maternal blood pressure and fetal heart rate (FHR) every 5 minutes until her condition is stable or per primary health care provider's order.

Patient Teaching Signs of Postpartum Blues, Depression, and Psychosis

Signs of baby blues (these should go away in a few days or 1 week): • Sad, anxious, or overwhelmed feelings • Crying spells • Loss of appetite • Difficulty sleeping Signs of postpartum depression (can begin any time in the first year): • Same signs as baby blues, but they last longer and are more severe • Thoughts of harming yourself or your baby • Not having any interest in the baby Signs of postpartum psychosis: • Seeing or hearing things that are not there • Feelings of confusion • Rapid mood swings • Trying to hurt yourself or your baby When to call your health care provider: • The baby blues continue for more than 2 weeks • Symptoms of depression get worse • Difficulty performing tasks at home or at work • Inability to care for yourself or your baby • Thoughts of harming yourself or your baby

Regarding Chronic Kidney Disease Nutritional Therapy, Sodium and Potassium Restriction

Sodium: - advised to restrict sodium - Sodium-restricted diets may vary from 2 to 4 g/day - Instruct the patient to avoid high-sodium foods, such as cured meats, pickled foods, canned soups and stews, frankfurters, cold cuts, soy sauce, and salad dressings Potassium: - Potassium restriction depends on the kidneys' ability to excrete potassium. - Salt substitutes should be avoided in potassium-restricted diets because they contain potassium chloride. - Dietary restrictions for potassium range from about 2 to 3 g (39 mg = 1 mEq). - Teach patients receiving HD which foods are high in potassium and to avoid them - Patients using Peritoneal Dialysis do not usually need potassium restrictions and may even be prescribed oral potassium supplementation because of the loss of potassium with dialysis exchanges.

Clinical Manifestations of Bacterial Meningitis in newborn

Specific Signs • Child well at birth but within a few days begins to look and behave poorly • Refuses feedings • Poor sucking ability • Vomiting or diarrhea • Poor tone • Lack of movement • Weak cry • Full, tense, and bulging fontanel may appear late in course of illness • Neck usually supple Nonspecific Signs That May Be Present • Hypothermia or fever (depending on infant's maturity) • Jaundice • Irritability • Drowsiness • Seizures • Respiratory irregularities or apnea • Cyanosis • Weight loss

Stages of Chronic Kidney Disease, whats the GFR? what is done? Stage 1 Stage 2 Stage 3a Stage 3b Stage 4 Stage 5

Stage 1: Kidney damage with normal or ↑ GFR GFR is ≥90 Stage 2: Kidney damage with mild ↓ GFR GFR is 60-89 Stage 3a: Moderate ↓ GFR GFR is 45-59 Stage 3b: Moderate ↓ GFR GFR is 30-44 Stage 4: Severe ↓ GFR GFR 15-29 Preparation for renal replacement therapy (dialysis, kidney transplant) Stage 5: Kidney failure GFR is <15 (or dialysis) Renal replacement therapy (if uremia present and patient desires treatment)

Regarding ADHD, Stimulant drugs

Stimulant drugs: - Amphetamine - Dexmethylphenidate - Dextroamphetamine - Lisdexamfetamine dimesylate - Methamphetamine - Methylphenidate HCL

Serotonin Syndrome: Signs and Interventions

Symptoms • Hyperactivity or restlessness • Tachycardia → cardiovascular shock • Fever → hyperpyrexia • Elevated blood pressure • Altered mental states (delirium) • Irrationality, mood swings, hostility • Seizures → status epilepticus • Myoclonus, incoordination, tonic rigidity • Abdominal pain, diarrhea, bloating • Apnea → death Interventions • Remove offending agent(s) • Initiate symptomatic treatment: - Serotonin-receptor blockade with cyproheptadine, methysergide, propranolol - Cooling blankets, chlorpromazine for hyperthermia - Dantrolene, diazepam for muscle rigidity or rigors - Anticonvulsants - Artificial ventilation - Induction of paralysis

Chemical pleurodesis drug therapy

Talc is the most effective agent for pleurodesis. Other agents such as doxycycline and bleomycin can also be used.

What sports would not be good for a child with ADHD?

Team sports (swimming is the best, soccer and baseball not so much)

Laboratory Results for Hyperthyroidism

Thyroid-stimulating hormone (TSH): Decreased T4 (thyroxine): Increased Low-density lipoproteins (LDLs): Decreased Basal metabolic rate (BMR): Increased Everything else is normal

Anorexia Pharmacological Interventions

The selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac), however, has proven useful in reducing obsessive-compulsive behavior AFTER the patient has reached a maintenance weight.

Late Decelerations Nursing Interventions (yes again)

The usual priority is as follows: 1. Discontinue oxytocin if infusing. 2. Assist woman to lateral (side-lying) position. 3. Administer oxygen at 10 L/min by nonrebreather face mask. 4. Correct maternal hypotension by elevating legs. 5. Increase rate of maintenance intravenous solution. 6. Palpate uterus to assess for tachysystole. 7. Notify physician or nurse-midwife. 8. Consider internal monitoring for more accurate fetal and uterine assessment. 9. Assist with birth (vaginal assisted or cesarean) if pattern cannot be corrected.

NSTEMI or UA patients usually have transient thrombosis or incomplete coronary occlusion. What does the 12‐lead ECG Findings look like

These patients often develop ST depression or T wave inversion on the initial ECG. They usually do not develop pathologic Q waves

Cushing syndrome is a clinical condition that results from

chronic exposure to excess corticosteroids, particularly glucocorticoids

Regarding Cirrhosis Management of ascites, with a low sodium diet what drug can help hyponatremia

Tolvaptan (Samsca)

The most common causes of cirrhosis in the United States are

chronic hepatitis C infection and alcohol-induced liver disease

Regarding Types of Dysrhythmias, Second-Degree AV Block, Type II Treatment

Transcutaneous pacing or the insertion of a temporary pacemaker may be necessary before the insertion of a permanent pacemaker if the patient becomes symptomatic

Defibrillation is the treatment of choice to end

VF and pulseless VT

Kidney Transplant Recipient Postoperative Care for Live Donor

Types of surgery: open (conventional) or laparoscopic nephrectomy - monitor renal function to assess for impairment - monitor the hematocrit to assess for bleeding. - Donors usually experience more pain than the recipient. - Donors who had an open approach are usually discharged from the hospital in 4 or 5 days and return to work in 6 to 8 weeks. - With a laparoscopic approach, donors are discharged from the hospital in 2 to 4 days and return to work in 4 to 6 weeks. - The donor is seen by the surgeon 1 to 2 weeks after discharge.

The appearance of variable decelerations differs from those of early and late decelerations, which closely approximate the shape of the corresponding UC. Instead variable decelerations have a

U, V, or W shape

The presence of Serum cardiac biomarkers helps to differentiate between a diagnosis of

UA (negative biomarkers) and NSTEMI (positive biomarkers).

Management for ONLY Acute Decompensating Heart Failure

Unstable pt go into ICU, stable in hosp • High Fowler's position for dyspnea • O2 by mask or nasal cannula • Assess vital signs and urine output at least every hour if in ICU, 4 hours for normal hospitalization • Noninvasive positive pressure ventilation • Circulatory assist device: intraaortic balloon pump • Endotracheal intubation and mechanical ventilation • Continuous ECG and pulse oximetry monitoring • Hemodynamic monitoring (e.g., intraarterial BP, PAWP, CO) • Possible cardioversion (e.g., atrial fibrillation) • Ultrafiltration

Regarding Special Diagnostic Procedures, Computed tomography (CT) scan Purpose Comment

Visualizes horizontal and vertical cross-section of brain - Requires IV access if contrast agent is used. - Patient may require sedation.

Patient & Caregiver Teaching Cirrhosis

When teaching the patient and caregiver about management of cirrhosis, do the following. 1. Explain that cirrhosis is a chronic illness and requires continual health care. 2. Teach the symptoms of complications and when to seek medical attention to enable prompt treatment. 3. Teach the patient to avoid potentially hepatotoxic over-the-counter drugs, because the diseased liver is unable to metabolize them. 4. Encourage abstinence from alcohol because continued use increases the rate of liver disease progression and risk of liver complications. 5. Instruct the patient with esophageal or gastric varices to avoid aspirin and NSAIDs to prevent hemorrhage. 6. Teach the patient with portal hypertension and varices that straining at stool, coughing, sneezing, and retching and vomiting may increase the risk of variceal hemorrhage.

Drug Therapy Replacement Factors for Hemophilia For Von Willebrand

Vonvendi

FITT Activity Guidelines After Acute Coronary Syndrome (UA and MI)

Warm-Up/Cool-Down Perform mild stretching for 3-5 min before the physical activity and 5 min after the activity. Activity should not be started or stopped abruptly. Frequency Perform physical activity on most days of the week. Intensity Activity intensity is determined by the patient's HR. HR of the patient recovering from an MI should not exceed 20 beats/min over the resting HR. Type of Physical Activity Select physical activity that is regular, rhythmic, and repetitive, using large muscles to build up endurance (e.g., walking, cycling, swimming, rowing). Time Physical activity sessions should be at least 30 min long. Begin slowly at personal tolerance (perhaps only 5-10 min) and build up to 30 min.

Pleural effusion is an

abnormal collection of fluid in this space It is not a disease but rather an indication of disease.

Who are candidates for this Amnioinfusion Risks of amnioinfusion are

Women with an abnormally small amount of amniotic fluid (oligohydramnios) or no amniotic fluid (anhydramnios) overdistention of the uterine cavity and increased uterine tone.

Hemophilia is an

X-linked recessive genetic disorder caused by a defective or deficient coagulation factor.

Alcohol withdrawal syndrome (AWS) can develop in The onset of AWS is variable depending on the

a hospitalized patient when the use of alcohol abruptly stops. quantity, frequency, pattern, and duration of alcohol use

International Index of Erectile Function (IIEF) identifies

a man's response to five key areas of male sexual function: - erectile function, - orgasmic function, - sexual desire, - intercourse satisfaction, - overall satisfaction

During DIASTOLIC HEART FAILURE, what is the ejection fraction?

a normal EF

Acute alcohol toxicity occurs when This leads to

a person has a high level of alcohol in his or her blood, generally after the ingestion of a large amount of alcohol. - behavior changes and alcohol-induced CNS depression, resulting in respiratory and circulatory failure. - Unconsciousness, coma, and possibly death can occur. - hypokalemia, hypomagnesemia, and hypoglycemia.

Regarding Types of Dysrhythmias, Second-Degree AV Block, Type II often progresses to third-degree AV block and is associated with

a poor prognosis. - The reduced HR frequently results in decreased CO with subsequent hypotension and myocardial ischemia. - permanent pacemaker.

As adults, affected by Fetal Alcohol Syndrome individuals tend to have

a short stature

After a Induced abortion, teach the patient the signs and symptoms of possible complications, such as stress to the patient that as Instruct patients to refrain from Oral contraception can be started when?

abnormal vaginal bleeding, severe abdominal cramping, fever, and foul-smelling drainage. soon as 1 week after having an abortion she is able to become pregnant again. intercourse and putting anything into the vagina for 1 week after the abortion. (The one exception is for women who use NuvaRing birth control.) the day of the abortion or 1 to 2 weeks after the procedure, depending on the patient's needs and desires. Normal menstruation returns in 4 to 6 weeks.

Most women abused before pregnancy will be

abused during pregnancy, and the incidence may escalate. (Abuse also may happen for the first time during pregnancy)

In both types of alkalosis, symptoms usually result from an Which one? What are the symptoms

accompanying electrolyte abnormality rather than the alkalosis. Hypocalcemia occurs due to increased calcium binding with albumin, lowering the amount of ionized, active calcium. Therefore, muscle cramping, tingling and numbness of the fingers, and tetany occur

Regarding Focal (partial) seizures, Patients with complex focal seizure may continue an How long do they last? What happens after

activity started before the seizure, such as counting coins or choosing items from a grocery shelf, but after the seizure they do not remember the activity performed during the seizure. These seizures usually last between 30 seconds and 2 minutes. Patients may be tired or confused following the seizure and may not return to normal activity for hours.

Regarding surgical removal of a pituitary adenoma, an adrenal tumor, or one or both adrenal glands, Cushing syndrome Nursing Implementation for Postoperative Care, If corticosteroid dosage is tapered too rapidly after surgery, Symptoms? What should be done?

acute adrenal insufficiency may develop. - Vomiting, increased weakness, dehydration, and hypotension are signs of hypocortisolism. - In addition, the patient may complain of painful joints, pruritus, or peeling skin and may experience severe emotional disturbances. Report these signs and symptoms so that drug doses can be adjusted as necessary. The patient is usually maintained on bed rest until the BP stabilizes

A major priority of nursing care of a child suspected of having meningitis is to

administer antibiotics as soon as they are ordered. - The child is placed on respiratory isolation for at least 24 hours after initiation of antimicrobial therapy.

Regarding Types of Dysrhythmias, Sinus Bradycardia may be a normal sinus rhythm in It also occurs in response to

aerobically trained athletes and in some people during sleep. carotid sinus massage, Valsalva maneuver, hypothermia, increased intraocular pressure, vagal stimulation, and certain drugs (e.g., β-blockers, calcium channel blockers).

In women, the risk for infertility begins around

age 30. - By the time a woman reaches the age of 40, the chances of conceiving are 10% or less

ED affects men of all ages and can be chronic or transient in nature. ED is positively correlated with

age, cardiovascular conditions, risk factors, physical inactivity, alcohol use, smoking, and obesity; these conditions impact vascular perfusion, which is necessary for penile erection.

Regarding Hyperthyroidism Drug Therapy, Propylthiouracil is generally used for patients who Propylthiouracil is considered first-line therapy in An advantage of propylthiouracil is that it

are in the first trimester of pregnancy, had an adverse reaction to methimazole, or require a rapid reduction in symptoms. thyrotoxicosis, since it also blocks the peripheral conversion of T4 to T3. achieves the therapeutic goal of being euthyroid more quickly. However, it must be taken three times per day.

Women with OCD are afraid they will harm their infants, but Women with postpartum psychosis who have the same thoughts are

are unlikely to do so. more apt to actually cause harm

Tocolytics are medications given to the rationale for giving these medications is to

arrest labor after uterine contractions and cervical change have occurred. delay birth long enough to allow time for maternal transport to a Level III or Level IV neonatal care center and for corticosteroids to reach maximum benefit to reduce neonatal morbidity and mortality

Regarding Types of Dysrhythmias, Atrial Fibrillation atrial rate may be

as high as 350 to 600 beats/minute.

Thoracentesis is

aspiration of intrapleural fluid for diagnostic and therapeutic purposes.

For patients with UA and NSTEMI, what drugs are recommended

aspirin and heparin (UH or LMWH), and glycoprotein inhibitor Dual antiplatelet therapy (e.g., aspirin and clopidogrel) (Table 33-11) and heparin are recommended for NSTEMI patients

The patient with thrombocytopenia should avoid

aspirin and other medications that affect platelet function or production.

Thrombolytic (fibrinolytic) therapy is indicated only for patients with a STEMI. Advantages include the Treatment of STEMI with thrombolytic therapy aims to The goal is to give the thrombolytic within

availability and rapid administration in agencies that do not have an interventional cardiac catheterization laboratory or when one is too far away to transfer the patient safely. limit the infarction size by dissolving the thrombus in the coronary artery and reperfusing the heart muscle. 30 minutes of the patient's arrival to the ED.

If a survivor of intimate partner violence chooses to leave, shelters or safe houses (for both sexes) are

available in most communities. They are open 24 hours a day and can be reached through hotline information numbers, hospital emergency departments, YWCAs, or the local office of the National Organization for Women. The address of the house is usually kept secret to protect abused individuals from attack by the perpetrator.

It is unsafe to use scissors to remove dressings or tape from the extremities of very small and immature infants because it is easy to snip off tiny extremities or nick loosely attached skin. Solvents used to remove tape are

avoided because they tend to dry and burn the skin.

Regarding substance abuse, For depressants Common sedative-hypnotic and Antianxiety agents include Sedative-hypnotic and Antianxiety drugs do what Their use produces a tolerance may not develop to the brainstem-depressant effects. As a result, an increased dose may

barbiturates, benzodiazepines, and barbiturate-like drugs depress the CNS, causing sedation at low doses and sleep at high doses. - Craving is a typical feature euphoria and intoxication that resembles that of alcohol. - slurred speech, incoordination, unsteady gait, nystagmus, impaired thinking, Coma, Inappropriate aggression and sexual behavior, mood fluctuation, and impaired judgment trigger hypotension and respiratory depression, resulting in death.

Regarding infants and children with congenital heart defects, about educating about the disorder Preschoolers need School-age children benefit from Preadolescents and adolescents often appreciate

basic information about what they will experience more than what is actually occurring physiologically a concrete explanation of the defect. a more detailed description of how the defect affects their heart

Treatment to prevent spontaneous abortion is limited. What is recomended?

bed rest and avoidance of vaginal intercourse

early pregnancy losses occur A late miscarriage, sometimes called a second-trimester loss, occurs

before 12 weeks of gestation between 12 and 20 weeks of gestation.

For children with CI, Discipline must

begin early - Limit-setting measures need to be simple, consistently applied, and appropriate for the child's mental age.

Regarding preterm infants, Ample evidence indicates that human milk is the Mothers who wish to breastfeed their preterm infants are encouraged to Despite its benefits, LBW infants (<1500 g [3 lbs 5 oz]) who are fed unfortified human milk exclusively demonstrate Because fortifiers do not contain

best source of nutrition for term and preterm infants. (once they can swallow) express breast milk until their infants are sufficiently stable to tolerate breastfeeding. decreased growth rates and nutritional deficiencies even beyond the hospitalization period. (Specially designed supplements for human milk have been developed to address these deficits.) sufficient iron, an exogenous source must be administered after enteral feedings

In interviewing the child and family for abuse, the nurse must be careful to avoid

biasing the child's retelling of the events. Some experts suggest that health care professionals limit the interview to the child's physical and mental health concerns and leave topics of the family's social, legal, or other problems to law enforcement or Child Protective Services

Patients on any medical floor are at risk for Alcohol Withdrawal Delirium after What is the goal for this? How to do so?

cessation of heavy drinking for 3 days and are a danger to themselves and others. - hepatitis or pancreatitis may increase the likelihood of alcohol withdrawal delirium Prevention of alcohol withdrawal delirium is the goal - Oral diazepam (Valium) may be useful in the symptomatic relief of acute agitation, tremor, impending or acute delirium tremens - Chlordiazepoxide (Librium) may keep your patient out of danger. - once delirium appears, intravenous lorazepam (Ativan) is used to treat these severe symptoms.

The third stage of labor lasts from the

birth of the fetus until the placenta is delivered - The placenta normally separates with the third or fourth strong uterine contraction after the infant has been born.

For ACS (UA and MI) patients having CABG surgery who have complications from the cardiopulmonary bypass (CPB), Focus your care on assessing the patient for

bleeding (e.g., chest tube drainage, incision sites), hemodynamic monitoring, checking fluid status, replacing blood and electrolytes as needed, and restoring temperature (e.g., warming blankets).

Varenicline (Chantix) is a drug used to aid smoking cessation. If the person does resume smoking, its antagonist action Bupropion (Zyban), an antidepressant drug, reduces the

blocks the effects of nicotine at another subtype of nicotinic receptor, making smoking less enjoyable. urge to smoke, reduces some symptoms of withdrawal, and helps prevent weight gain associated with smoking cessation.

Regarding Intimate Partner Violence, After birth, the mother may be so physically and emotionally drained that she may have difficulty

bonding with her infant. She may be at risk for becoming an abusive mother whether or not she remains in the abusive relationship.

Stool Softeners (colace) prevents straining and the resultant vagal stimulation from the Valsalva maneuver. Vagal stimulation produces

bradycardia and can provoke dysrhythmias.

Some SSRIs are transferred into

breast milk.

Infants with RSV infection often have copious nasal secretions, making

breathing and breastfeeding or bottle feeding difficult. - This engenders concerns that the child will lose weight or stop breastfeeding altogether. - Breastfeeding mothers are encouraged to continue feeding the infant or, if feedings are contraindicated because of the acuity of the illness, mothers should pump their milk and store it appropriately for later use

Regarding Primary Generalized Seizures, The typical clinical manifestation of a simple absence seizure is a In complex absence seizures, what can be displayed? When untreated, seizures may occur how often?

brief staring spell resembling "daydreaming" that lasts less than 10 seconds, so it often goes unnoticed. the blank stare is accompanied by some type of movement (e.g., blinking, chewing, hand gestures) and can last up to 20 seconds. up to 100 times a day

When youth are not well accepted by their peers, they are vulnerable to

bullying; physical disabilities, obesity, and sexual orientation can be risk factors creating vulnerability.

Regarding ACS (UA and MI) patients with CABG, The patient with radial artery harvest should take a

calcium channel blocker for approximately 3 months to reduce the incidence of arterial spasm at the arm or anastomosis site.

Regarding Acute kidney injury (AKI) phases and the Oliguric Phase, Uncontrolled hyponatremia or water excess can lead to

cerebral edema. - Excessive intake of sodium should be avoided

Complete Miscarriage Symptoms Management

cervix has already closed after all products of conception were expelled Symptoms: - Slight bleeding - Mild cramping - Yes Passage of Tissue - No dilation (cervix has already closed after products of conception passed) Management: - No further intervention may be needed if uterine contractions are adequate to prevent hemorrhage and no infection is present. - Suction curettage may be performed to ensure no retained fetal or maternal tissue.

Although radiographic examinations are not painful, the appearance of the machinery is often so frightening that the child protests because of anxiety. This is especially true of CT and MRI, both of which require that the What can be used? The nurse can explain these events to a child by comparing them to

child's head be placed within a special immobilizing device. Chin and cheek pads are sometimes used to prevent the slightest head movement, and straps are applied to the body to prevent a slight change in body position. an astronaut's preparation for a space flight. IT IS NOT PAINFUL!

Down syndrome is the most common

chromosomal abnormality of a generalized syndrome

Chronic Stable Angina (type of CAD) is a chronic and progressive disease. Patients may be asymptomatic for many years or may develop

chronic stable chest pain.

Patients who have had HIT should never be given heparin or low-molecular-weight heparin (LMWH). This should be

clearly marked in the patient's medical record.

Bulimia Therapy

combination of - psychologic counseling (i.e., cognitive behavioral therapy) - nutritional counseling is essential.

Internal and external modes of monitoring may be

combined (i.e., internal FHR with external UA or external FHR with internal UA) without difficulty.

Bronchiolitis is a

common, acute viral infection with upper respiratory symptoms and lower respiratory infection of the bronchioles due to inflammation

Emergent PCI is the first line of treatment for patients with Whats the goal?

confirmed STEMI (i.e., ST-elevation on the ECG and/or positive cardiac biomarkers). to open the blocked artery within 90 minutes of arrival to a facility that has an interventional cardiac catheterization laboratory.

Cannabis intoxication Delirium results in marked impairment in cognition and performance. Physical symptoms of intoxication include

conjunctival injection (red eyes from vessel dilation), increased appetite, dry mouth, and tachycardia.

Regarding Focal (partial) seizures, In a simple focal (partial) seizure, patients remain They may experience

conscious and alert but experience unusual feelings or sensations that can take many forms. - sudden and unexplainable feelings of joy, anger, sadness, or nausea. - They also may hear, smell, taste, see, or feel things that are not real.

Moderate variability is Moderate variability presence reliably predicts a

considered normal predicts a normal fetal acid-base balance (absence of fetal metabolic acidemia).

Regarding Peritoneal Dialysis, Peritonitis results from To determine if the peritoneal effluent is cloudy,

contact contamination or an exit site or tunnel infection. drain the effluent and place the drained bag on reading material such as a newspaper. If you cannot read the print through the effluent, it is cloudy.

Regarding epilepsy Complications, Status epilepticus (SE) is a state of It is defined as The longer a seizure lasts, the

continuous seizure activity or a condition in which seizures recur in rapid succession without return to consciousness between seizures. any seizure lasting longer than 5 minutes. less likely it is to stop without drug therapy

Regarding Oxygen Therapy, Prolonged exposure to high oxygen tensions can Whats the most vulnerable?

damage some body tissues and functions. This is called oxygen toxicity. The organs most vulnerable to the adverse effects of excessive oxygenation are the retinas of extremely preterm infants and the lungs of people at any age.

Regarding childbirth pain, Fatigue can

decrease a woman's ability to cope effectively with contraction pain

Most pulmonary emboli arise from

deep vein thrombosis (DVT) in the deep veins of the legs.

Venous thromboembolism (VTE) is the preferred term to describe the spectrum of pathologic conditions from

deep vein thrombosis (DVT) to Pulmonary embolism (PE)

For a thoracentesis, A chest x-ray or ultrasound images are used to

determine the optimal puncture site.

Isometric activities involve the Examples

development of tension during muscular contraction but produce little or no change in muscle length or joint movement. Lifting, carrying, and pushing heavy objects are isometric activities. HR and BP change rapidly during isometric work, isometric exercises should be limited

Infants and children who have serious heart disease are at risk for

developmental delays The American Heart Association recommends that all children with CHD be developmentally screened, evaluated, and reevaluated, because this may identify deficits and allow therapies and education to assist academic, behavioral, and psychosocial functioning.

Regarding Respiratory Secretion Specimens, Nasal washings are usually obtained to

diagnose an infection of RSV.

Regarding Primary Generalized Seizures, In atypical absence seizure, the staring spell is accompanied by other signs and symptoms, such as

eye blinking or jerking movements of the lips. The patient may be somewhat responsive during seizure activity.

Those with binge-eating disorder do not have a

distorted body image and are often overweight or obese.

Regarding Types of Dysrhythmias, Sinus tachycardia Clinical Significance and symptoms

dizziness, dyspnea, and hypotension because of decreased CO. Increased myocardial O2 consumption is associated with an increased HR. Angina or an increase in infarction size may accompany sinus tachycardia in patients with coronary artery disease (CAD) or an acute MI.

Nitrous oxide is administered in a 50 : 50 mix with oxygen using a blender device and a mask held by the woman. Women report that nitrous oxide Side effects?

does not completely relieve pain but reduces their perception of pain. - It causes a feeling of euphoria and decreases anxiety. nausea and dizziness.

Regarding Deceased (cadaver) kidney donors, Even if the donor carried a signed donor card, permission from the

donor's legal next of kin is still requested after brain death is determined. - That is why it is important for you to talk with your family about your wishes before losing the capacity to convey your desires.

If seizure control is not achieved with a single drug, what may be changed?

dosage or timing of administration may be changed or a second drug may be added. - About one third of patients require a combination regimen for adequate control. (Patients should discuss emerging treatments with their HCPs to provide the best control with the least amount of medication.)

Regarding Systemic lupus erythematosus (SLE), Patients taking hydroxychloroquine should have

eye examinations by an ophthalmologist every 6 to 12 months. - Retinopathy can develop with high doses of these drugs, but it generally reverses when they are discontinued.

Newborn urine, hair, or meconium sampling may be required to identify Meconium sampling for fetal drug exposure is reported to provide Urine toxicology screening reflects only Meconium and hair testing for drug metabolites has the advantages of being

drug exposure and implement appropriate early interventional therapies aimed at minimizing the consequences of intrauterine drug exposure more screening accuracy than urine screening because drug metabolites accumulate in meconium. recent substance intake by the mother noninvasive, more accurate, and easy to collect.

Regarding Cushing Syndrome, When the patient is a poor candidate for surgery or prior surgery has failed, then Whats the goal?

drug therapy may be attempted. Goal: suppress the synthesis and secretion of cortisol from the adrenal gland (medical adrenalectomy).

The primary treatment of hyperthyroidism during pregnancy is What is done?

drug therapy. The medications most often prescribed in the United States are propylthiouracil (PTU) or methimazole (MMI).

Regarding Bariatric Surgical Therapy and Combination of Restrictive and Malabsorptive Surgery, A complication of the Roux-en-Y Gastric Bypass (RYGB) is Patients are discouraged from eating what after surgery to prevent this Patients need to take a

dumping syndrome, in which gastric contents empty too rapidly into the small intestine, overwhelming its ability to digest nutrients sugary foods after surgery to avoid dumping syndrome. multivitamin with iron and calcium supplements. - Chronic anemia caused by cobalamin deficiency may also occur. This problem can usually be managed with parenteral or intranasal cobalamin.

FHR decelerations are categorized as

early, late, variable, or prolonged.

The female athlete triad is a syndrome in which The triad is seen in

eating disorders, amenorrhea, and osteoporosis are present females participating in sports that emphasize leanness and low body weight.

Although most angina pain occurs substernally, it may radiate to other locations, including the jaw, neck, shoulders, and/or arms. Many people with angina complain of

indigestion or a burning sensation in the epigastric region. The sensation may also be felt between the shoulder blades

Heavy cocaine exposure has reported to result in (for the infant)

elevated or irregular heart rate after birth

ST-Elevation Myocardial Infarction (STEMI) is what type of situation In order to limit the infarct size, the artery must be How is this done?

emergency situation. opened within 90 minutes of presentation. This can be done either by PCI or thrombolytic (fibrinolytic) therapy.

Regarding cellulitis, Red man syndrome is an

infusion-related reaction peculiar to vancomycin (kidneys are involved)

Regarding Types of Dysrhythmias, Clinical Significance and symptoms

end-stage heart disease or has a prolonged arrest and cannot be resuscitated.

Hormone therapy can block the effect and source of Ovarian ablation can be accomplished how

estrogen, thus promoting tumor regression. surgically or by using luteinizing hormone releasing hormone (LHRH) analogs such as goserelin (Zoladex) or leuprolide (Lupron).

Regarding infants and children with congenital heart defects, Another issue that may develop within family relationships is the child's overdependency. This is often the result of parental fear that the child may die. Parents need guidance to recognize the

eventual hazards of continuing dependency and protectiveness as the child grows older, and the nurse can assist parents in learning ways to foster optimum development. Unless parents are shown what activities the child can do, they may focus on physical limitations and encourage dependency.

Pulsatile blood flow is the primary physiologic factor that influences accuracy of the pulse oximeter. In infants, reposition the probe at least

every 4 to 8 hours to prevent pressure necrosis; poor perfusion and very sensitive skin may necessitate more frequent repositioning.

Acute thyrotoxicosis (also called thyrotoxic crisis or thyroid storm) is an acute, severe, and rare condition that occurs when

excessive amounts of thyroid hormones are released into the circulation Although considered a life-threatening emergency, death is rare when treatment is initiated early.

Bronchial drainage is indicated whenever

excessive fluid or mucus in the bronchi is not being removed by normal ciliary activity and cough.

Regarding Clinical manifestations of hyperthyroidism, ophthalmopathy, a term used to describe abnormal eye appearance or function. A classic finding in Graves' disease is

exophthalmos, a protrusion of the eyeballs from the orbits that is usually bilateral

Assisted reproductive technology (ART) can be used to help women who are

experiencing difficulty becoming pregnant. - ART includes fertility medications, artificial insemination, and surrogacy

For individuals with hoarding disorder, this purging would have been Nearly all hoarders (75%) also experience

extremely distressing major depressive and/or anxiety disorders

Regarding monitoring oxygen therapy, Sensors are not placed on

extremities used for blood pressure monitoring or with indwelling arterial catheters because pulsatile blood flow may be affected.

Neglect is generally defined as the

failure of a parent or other person legally responsible for the child's welfare to provide for her or his basic needs and an adequate level of care.

Heparin-Induced Thrombocytopenia (HIT) should be suspected if the platelet count

falls by more than 50% or falls to below 150,000/µL. As many as 3% of patients on heparin therapy develop HIT

Depending on other characteristics of the FHR tracing, absent or minimal variability is classified as either abnormal or indeterminate. It can result from

fetal hypoxemia and metabolic acidemia. - fetal sleep cycles, fetal tachycardia, extreme prematurity, medications that cause central nervous system depression, congenital anomalies, and preexisting neurologic injury

FHR Tachycardia can be considered an early sign of tachycardia can be caused by

fetal hypoxemia, especially when associated with late decelerations and minimal or absent variability - maternal or fetal infection (including chorioamnionitis) - Maternal fever - Fetal cardiac arrhythmias - maternal hyperthyroidism or fetal anemia; or - Maternal hyperthyroidism - in response to medications such as atropine, hydroxyzine (Vistaril), terbutaline (Brethine), or illicit drugs such as cocaine or methamphetamines

Regarding ST-Elevation Myocardial Infarction (STEMI), PCI is the

first-line treatment if a hospital is capable of performing PCI.

GTPAL

gravida, term births, preterm births, abortions, living children

Tachycardia is a baseline FHR of

greater than 160 beats/min for 10 minutes or longer

Regarding Trichophagia, This ingestion may lead to

hair masses, or trichobezoar, in the gastrointestinal system. - The masses can be fatal if they progress to abdominal obstruction or perforation. - You may be interested to know that the masses of digested hair are also referred to as the Rapunzel syndrome.

Regarding Chronic Stable Angina drug therapy, The main side effect of all nitrates is what? What can the patient take for it?

headache and Orthostatic hypotension Tell patients to take acetaminophen (Tylenol) to relieve the headache Monitor BP after the first dose

After the epidural has been initiated, the obese woman is positioned preferably on What should be available?

her side; so that the uterus does not compress the ascending vena cava and descending aorta, which can impair venous return, reduce cardiac output and blood pressure, and decrease placental perfusion - alternated from side to side every hour. - Oxygen if hypotension occurs despite maintenance of hydration with IV fluid and displacement of the uterus to the side. - Ephedrine or phenylephrine (vasopressors used to increase maternal blood pressure) and increased IV fluid infusion may be needed

Regarding Hyperthyroidism Nursing Implementation for Postoperative Care, Laryngeal stridor (harsh, vibratory sound) may occur during Laryngeal stridor may also be related to what? How do you treat it?

inspiration and expiration because of edema of the laryngeal nerve. tetany from hypocalcemia, which occurs if the parathyroid glands were removed or damaged during surgery. - To treat tetany, IV calcium salts (e.g., calcium gluconate) should be available.

Long-term alcohol use can lead to the development of Short-term, excess alcohol use Effects of Chronic Alcohol Use

high BP, heart disease, stroke, liver disease, and digestive problems. increases the risk of injury from motor vehicle crashes, falls, firearms, assault, drowning, and burns - Alcoholic dementia, - Wernicke-Korsakoff syndrome - Depression, anxiety, attention deficit, labile moods, seizures, insomnia - Increased susceptibility to infections, depressed immune function - Bone marrow depression, anemia, leukopenia, thrombocytopenia, blood clotting abnormalities - Myopathy, osteoporosis, gout - Hypertension, atrial fibrillation, cardiomyopathy, stroke - Diabetes mellitus

Regarding Hyperthyroidism, With the increased metabolic rate in hyperthyroid patients, there is a high potential for the patient to have a nutritional deficit. What diet should be followed? How should this be done?

high-calorie diet (4000 to 5000 cal/day) may be needed to satisfy hunger, prevent tissue breakdown, and decrease weight loss. can be accomplished with six full meals a day and snacks high in protein, carbohydrates, minerals, and vitamins. - Protein content should be 1 to 2 g/kg of ideal body weight. - Increase carbohydrate intake to compensate for increased metabolism. (Carbohydrates provide energy and decrease the use of body-stored protein.)

Pregnant adolescents are abused at

higher rates than are adult women; thus they should be considered at high risk. - Battering during pregnancy in teenagers constitutes a particularly difficult situation. - Adolescents may be more trapped in the abusive relationship than adult women because of their inexperience. - They may ignore the violence because the jealous and controlling behavior is interpreted as love and devotion

What can a parent do about the infant having copious nasal secretions and feeding them?

instill normal saline drops into the nares and suction the mucus before feedings and before bedtime so the child may eat and rest better. A bulb syringe can be used for suctioning in the home setting.

Risk for suicide is increased when depression is accompanied by

hopelessness, substance use problems, a recent loss or separation, a history of past suicide attempts, and acute suicidal ideation

Regarding Menopause Drug Therapy, effective alternative to HRT to reduce hot flashes manage vasomotor symptoms during menopause Drug to prevent bone loss without the negative effects that include risk for endometrial hyperplasia.

hot flashes: - SSRI antidepressants, - paroxetine (Paxil, Brisdelle), - fluoxetine, - venlafaxine (Effexor XR) vasomotor: - Clonidine (Catapres), an antihypertensive drug, - gabapentin (Neurontin), an antiseizure drug Selective estrogen receptor modulators (SERMs), such as raloxifene (Evista)

Regarding Chronic Stable Angina drug, when using Coronary computed tomography angiography (CCTA) Patients with chronic kidney disease need What should be monitored

hydration pre- and postprocedure. A baseline serum creatinine level should be obtained as the IV contrast dye can cause or worsen renal dysfunction.

Regarding Cardiac catheterization and coronary angiography for angina, Patients with chronic kidney disease need

hydration pre- and postprocedure. A baseline serum creatinine level is obtained because the IV contrast dye can cause or worsen renal dysfunction. Monitor renal function closely after the procedure

The behaviors and symptoms associated with ADHD can include Peer relationships are strained due to They may be unable to

hyperactivity, impulsivity, inattention - may exhibit high degrees of distractibility and disorganization difficulty taking turns, poor social boundaries, intrusive behaviors, and interrupting others complete challenging or tedious tasks, become easily bored, lose things frequently, or require frequent prompts to complete tasks.

Pregnancy is considered a

hypercoagulable state in which women are at a five- to six-fold increased risk for thromboembolic disease

However, one third of all epilepsy cases are Whats this caused

idiopathic, meaning they are not attributable to a specific cause. These cases are known as idiopathic generalized epilepsy (IGE).

Regarding Nonpharmacologic Strategies to Encourage Relaxation and Relieve Pain, Effleurage is

ight stroking, usually of the abdomen, in rhythm with breathing during contractions. It is used to distract the woman from contraction pain. - As labor progresses, hyperesthesia (hypersensitivity to touch) may make effleurage uncomfortable and thus less effective.

Systolic failure, also known as HFrEF, results from an

inability of the heart to pump blood forward effectively.

Diastolic failure, or HFpEF, is the

inability of the ventricles to relax and fill during diastole, resulting in decreased stroke volume and CO

Infertility is the

inability to conceive after at least 1 year of regular unprotected intercourse if less than 35 years old or after 6 months if the woman is older than 35 years of age.

Individuals with attention-deficit/hyperactivity disorder (ADHD) show an

inappropriate degree of inattention, impulsiveness, and hyperactivity

During cardiopulmonary resuscitation (CPR), Normal End-tidal carbon dioxide (ETCO2) values consistently below 15 mm Hg indicate

ineffective compressions or excessive ventilation. (Changes in waveform and numeric display follow changes in ventilation by a very few seconds and precede changes in respiratory rate, skin color, and pulse oximetry values.)

Separation anxiety is a normal part of

infant development that begins around 8 months of age, peaks about 18 months, and begins to decline after that

Regarding Post-Op Kidney Transplant Recipient, Not only do immunosuppressants suppress the immune system to prevent rejection, but they also suppress the ability to fight The most common types of cancer after transplant are

infection and the production of abnormal cells such as cancer cells. - Avoid the sun (1) skin cancers: basal and squamous cell carcinoma and melanoma (2) posttransplant lymphoproliferative disorder (PTLD).

Regarding Hemodialysis, Temporary catheters have high rates of A patient should not be

infection, dislodgment, and malfunction. discharged from the hospital with a temporary catheter in place.

Regarding ED with Penile Implants, The main complications associated with penile prostheses are

infection, erosions, and rarely, mechanical failure.

Regarding Acute alcohol toxicity, Obtain as accurate a health history as possible and assess for

injuries, diseases, and hypoglycemia

Variability of the FHR can be described as

irregular waves or fluctuations in the baseline FHR of two cycles per minute or greater - It is a characteristic of the baseline FHR and does not include accelerations or decelerations of the FHR.

Deceased (cadaver) kidney donors are relatively healthy individuals who have suffered an The brain-dead donor must have effective

irreversible brain injury and are declared brain dead CV function and be supported on a ventilator to preserve the organs.

Regarding biological interventions for anxiety, A Gamma Knife® creates

irreversible damage known as lesions to certain areas of the brain, resulting in a disconnect of overactive circuits or regions.

Regarding Acute Coronary Syndrome (UA and MI) physical activity, The basic categories of physical activity are

isometric (static) and isotonic (dynamic). Most daily activities are a mixture of the two.

Problems with the ETCO2 monitoring system can include a

kink in the sample line or disconnection. In general, check the patient first and then the equipment.

For women who have had a difficult and painful previous birth experience, anxiety and fear from this past experience may

lead to increased pain perception.

Regarding Chronic Kidney Disease, Insulin and glucose metabolism may improve (but not to normal values) after the initiation of dialysis. Patients with diabetes who develop uremia may require

less insulin than before the onset of CKD.

Regarding substance abuse, For depressants Withdrawal from sedative-hypnotics can be Early, the patient may experience Since the patient may experience delirium, seizures, and respiratory and cardiac arrest within 24 hours after the last dose, Withdrawal Treatment consists of

life threatening - manifestations are nearly identical to those of alcohol withdrawal weakness, anxiety, insomnia, fever, orthostatic hypotension, and disorientation. closely monitor the patient. - administering a long-acting benzodiazepine or phenobarbital in a tapered dose. - IV diazepam is an option for severe manifestations. - Supportive care includes implementing patient safety and comfort measures, frequently assessing neurologic status and vital signs, and providing reassurance and orientation.

Regarding Hyperthyroidism Therapeutic Management for Children, When affected children exhibit signs and symptoms of hyperthyroidism (e.g., increased weight loss, pulse, pulse pressure, and blood pressure), their activity should be

limited to classwork only. Vigorous exercise is restricted until thyroid levels are decreased to normal or near-normal values.

As children interact with peers who see the world in ways that are somewhat different from their own, they become aware of the

limits of their own point of view.

Kava is used as a sedative with antianxiety effects. In 2010 the FDA issued a warning regarding its risk of

liver damage. - This inhibition could result in liver failure, especially when taken along with alcohol or other medications such as central nervous system depressants (antianxiety agents fall into this category).

Invasive (infiltrating) lobular carcinoma begins in the

lobules (milk-producing glands) of the breast and accounts for approximately 10% to 15% of invasive breast cancers. - The cancer cells can break out of the lobule and have the potential to metastasize to other areas of the body. - not detected by mammography.

Regarding breast cancer and External Radiation Therapy, When radiation therapy is a primary treatment, it is usually performed after surgery for the breast cancer. The decision to use radiation therapy after mastectomy is based on the probability that In traditional whole breast (and regional lymph nodes in some cases) radiation treatment, the area is radiated how often

local residual cancer cells are present 5 days per week over the course of about 5 to 7 weeks.

Early pregnancy loss is a term used to describe the

loss of a pregnancy before 20 weeks gestation

Postrenal causes of Acute kidney injury (AKI) involve The most common postrenal causes are

mechanical obstruction in the outflow of urine - benign prostatic hyperplasia, - prostate cancer, - calculi, - trauma, - extrarenal tumors.

For older adults and substance abuse, The effects of alcohol and drug use can be mistaken for Because of the higher rate of co-existing medical problems, older adults are at greater risk for Physiologic changes may lead to Nursing interventions

medical conditions common among older adults (e.g., insomnia, depression, hypertension, dementia). medical problems associated with substance use. - Common problems include liver damage and cardiovascular, GI, and endocrine problems. - may cause confusion, delirium, memory loss, and neuromuscular impairment toxicity at levels that may not have been a problem at a younger age. - discuss all drug and alcohol use with older adult patients, including OTC, herbal, and homeopathic drug use. - Assess the patient's knowledge of currently used medications. - Common screening questionnaires may not identify an older adult with a substance use problem. - The Short Michigan Alcoholism Screening Test-Geriatric version (SMAST-G) is available as a short-form alcoholism-screening instrument for older adults

Thrombotic Thrombocytopenic Purpura is a

medical emergency because bleeding and clotting occur simultaneously.

Any child who is ill and develops a purpuric or petechial rash may have

meningococcemia and must receive medical attention immediately.

Invasive (infiltrating) ductal carcinoma is the most common type of breast cancer accounting for approximately 80% of all invasive breast cancers. It starts in the

milk ducts and then breaks through the walls of the duct, invading the surrounding tissue. - From there it may metastasize to other parts of the body.

Breastfeeding infants whose mothers are taking SSRIs should be

monitored for sleep disturbances, irritability, and poor feeding

Isotonic activities involve changes in Examples

muscle length and joint movement with rhythmic contractions at relatively low muscular tension. Walking, jogging, swimming, bicycling, and jumping rope Isotonic exercise can put a safe, steady load on the heart and lungs and improve the circulation in many organs.

Angina, or chest pain, is the clinical manifestation of

myocardial ischemia.

Regarding drug therapy for leukemia, Imatinib (Gleevec) and other tyrosine-kinase inhibitors target the BCR-ABL protein that is present in Thus this drug kills

nearly all patients with Chronic Myelogenous Leukemia (CML) only cancer cells, leaving healthy cells alone.

the Special Olympics continues to require that all athletes with Down syndrome receive

neck x-rays prior to sports participation, because neck x-ray is the only screen available (incase of atlantoaxial instability)

Either of two types of behavior may emerge as a result of the effects of cocaine on fetal development:

neurobehavioral depression or excitability

Sometimes the psychomotor slowing and cognitive effects of depression lead others to believe that the older adult is developing a

neurocognitive disorder such as Alzheimer's disease. - This condition is referred to as pseudodementia, a problem that can be reversed when the underlying depression is treated and eliminated.

Stressing moral lessons is

of little value to a child who lacks the cognitive skills to learn from self-criticism or evaluation of previous mistakes

Regarding Types of Dysrhythmias, Pulseless electrical activity (PEA) is a situation in which

organized electrical activity is seen on the ECG, but there is no mechanical heart activity and the patient has no pulse. - It is the most common dysrhythmia seen after defibrillation.

Regarding breast cancer, Brachytherapy (internal radiation) is used for Because the radiation is concentrated and focused on the area with the highest risk for tumor recurrence, internal radiation only requires

partial-breast radiation as an alternative to traditional external radiation treatment for some patients with early stage breast cancer 5 days

Hepatic encephalopathy can occur after

placement of transjugular intrahepatic portosystemic shunt (TIPS)

Regarding giving propylthiouracil (PTU) or methimazole (MMI) during pregnancy for hyperthyroidism, PTU readily crosses the what? What can this do?

placenta and may cause fetal hypothyroidism, which is characterized by goiter, bradycardia, and intrauterine growth restriction (IUGR)

Regarding Nonpharmacologic Strategies to Encourage Relaxation and Relieve Pain, Transcutaneous electrical nerve stimulation (TENS) involves the During a contraction, the woman can

placing of two pairs of flat electrodes on either side of the woman's thoracic and sacral spine - electrodes provide continuous low-intensity electrical impulses or stimuli from a battery-operated device. increases the stimulation from low to high intensity by turning control knobs on the device. - High intensity should be maintained for at least 1 minute to facilitate release of endorphins.

Indication of a possible empyema include the manifestations of

pleural effusion as well as fever, night sweats, cough, and weight loss.

dilated cardiomyopathy (DCM) is a condition in which How is there ejection fraction? other issues?

poor systolic function is further compromised by a dilated LV that is unable to relax - These patients often have extremely low EFs (less than 35%), high pulmonary pressures, and biventricular failure (both ventricles are dilated and have poor filling and emptying capacity).

Regarding Postpartum psychosis, The mother may think the infant is

possessed by the devil, has special powers, or is destined for a terrible fate. - Some women will insist that something is wrong with the baby or accuse nurses or family members of hurting or poisoning their child.

Regarding cervical insufficiency, The cerclage is removed if

premature rupture of membranes or advanced preterm labor that puts pressure on the stitch occurs. - If the pregnancy progresses without further complications, the cerclage is removed when the woman reaches 36 weeks of gestation

Some children develop OCD along with a

postinfectious autoimmune syndrome.

Toys are selected for their

recreational and educational value.

Prerenal causes of Acute kidney injury (AKI) are factors that Prerenal conditions contribute to

reduce systemic circulation, causing a reduction in renal blood flow. intrarenal AKI. - If decreased perfusion persists for an extended time, the kidneys lose their ability to compensate and damage to kidney parenchyma occurs (intrarenal damage).

Regrading Alcohol withdrawal syndrome (AWS), Alcohol withdrawal delirium is a Death may result from

serious complication that can occur from 2 to 3 days after the last drink and last 2 to 3 days. - The greater the patient's dependence on alcohol, the greater the risk of alcohol withdrawal delirium - hyperthermia, - sepsis, - aspiration pneumonia, - peripheral vascular collapse

One rare and life-threatening event associated with SSRIs is The symptoms are many:

serotonin syndrome. - too high a dose or interaction with other drugs - abdominal pain, - diarrhea, - sweating, - fever, - tachycardia, - elevated blood pressure, - altered mental state (delirium), - myoclonus (muscle spasms), - increased motor activity, - irritability, hostility, and mood change. - Severe manifestations can induce hyperpyrexia (excessively high fever), cardiovascular shock, or death.

Safety Alert Administering nifedipine and magnesium sulfate simultaneously can cause nifedipine should not be given along with or immediately following a

skeletal muscle blockade. beta2-adrenergic agonist (e.g., terbutaline) because of effects on maternal heart rate and blood pressure (

excoriation disorder Trichotillomania Trichophagia Both of the activities are irresistible to the individual who typically tries to Risk factors for both

skin picking disorder hair pulling disorder secretly swallowing the pulled hair hide the activity having OCD

Human trafficking is actually a form of

slavery in which people are forced into the United States in order to become part of the unpaid labor force, usually in sweatshops or in domestic work, or in order to serve as sex slaves

Perhaps most important, the parents should have what before transporting the infant

some contact with the infant before the transport.

children become increasingly sensitive to the

social norms and pressures of the peer group.

Regarding Cushing Syndrome, If the underlying cause is a pituitary adenoma, the standard treatment is

surgical removal of the pituitary tumor (cushing disease) using the transsphenoidal approach Radiation therapy is an option for patients who are not good surgical candidates.

Regarding substance abuse with opioids, in treatment Because buprenorphine is a long-acting drug, once patients have been stabilized, they can sometimes

switch to alternate-day dosing instead of dosing every day.

Regarding Chronic HF drug therapy, The most common side effects of ivabradine include Tell patients to call their HCP if they experience

symptomatic bradycardia, high BP, atrial fibrillation, and vision disturbance (i.e., flashes of light) symptoms of an irregular HR, their heart is pounding or racing, or have chest pressure or worsened dyspnea. Low HR is a common side effect of ivabradine and can be serious. Patients should tell their HCP if they experience dizziness, weakness, or fatigue

Acute decompensated HF (ADHF) is defined as

the sudden onset of signs and symptoms of HF, requiring urgent medical care.

Regarding Surgical Therapies for infertility, Hysterosalpingography is useful for identification of

tubal obstruction and also for the release of blockage

In children with HF, digoxin (Lanoxin) is What is the dose calculated in? During initiation, the child is monitored by

used almost exclusively because of its more rapid onset. Note the dose is calculated in micrograms (1000 mcg = 1 mg). means of an ECG to observe for the desired effects (prolonged PR interval and reduced ventricular rate) and detect side effects, especially dysrhythmias.

Most SCDs result from

ventricular dysrhythmias, specifically VT or VF.

Regarding Hyperthyroidism, Radioactive iodine (RAI) therapy is the treatment of choice for What does it do?

most nonpregnant adults RAI damages or destroys thyroid tissue, thus limiting thyroid hormone secretion

Early intervention for children with autism spectrum disorder can greatly enhance

their potential for a full, productive life. - many families with a child with an autism spectrum disorder may not seek help early.

If a patient survives a cardiac arrest, start

therapeutic hypothermia (also known as targeted temperature management) as soon as possible

An early intervention program is a systematic program of

therapy, exercises, and activities designed to address developmental delays in children with disabilities to help achieve their full potentials

Automated peritoneal dialysis (APD) is the most popular form of PD because it allows patients to How?

while they sleep. Alarms and monitors are built into the system to make it safe for the patient to sleep while dialyzing. - The patient disconnects from the machine in the morning and usually leaves fluid in the abdomen during the day.

Bronchiolitis infection occurs primarily in

winter and early spring.

Antenatal Glucocorticoid Therapy With Betamethasone or Dexamethasone Action Indication Dosage and Route Maternal Effects Fetal Effects Nursing Considerations

Action • Stimulates fetal lung maturation Indication • To prevent or reduce the severity of neonatal respiratory distress syndrome Dosage and Route • Betamethasone: 12 mg intramuscular (IM) for two doses 24 hours apart • Dexamethasone: 6 mg IM for four doses 12 hours apart Maternal Effects • Transient (lasting 72 hours) increase in white blood cell (WBC) and platelet counts • Hyperglycemia Fetal Effects • Transient (typically lasting 48 to 72 hours after the last dose) decrease in fetal breathing and body movements Nursing Considerations • Give deep IM in ventral gluteal or vastus lateralis muscle. • Medication must be given by IM injection; oral administration is not an acceptable alternative. • Injection is painful. • Medication should not affect maternal blood pressure. • Assess blood glucose levels. Women with diabetes whose blood sugars have previously been well controlled may require increased insulin doses for several days.

Regarding Common Bacterial Infections of the Skin, Carbuncle (multiple boils) Etiology and Pathophysiology Clinical Manifestations Treatment and Prognosis

Etiology and Pathophysiology: • Multiple, interconnecting furuncles Clinical Manifestations: • Many pustules appearing in erythematous area • Most common at nape of neck Treatment and Prognosis: • Treatment same as for furuncles (Incision and drainage (possibly with packing), antibiotics, meticulous care of involved skin, frequent application of warm, moist compresses) • Often recurrent despite production of antibodies • Heal slowly with scar formation • Lesion should never be squeezed

Regarding Common Bacterial Infections of the Skin, Impetigo Etiology and Pathophysiology Clinical Manifestations Treatment and Prognosis

Etiology and Pathophysiology: • Group A β-hemolytic streptococci, staphylococci, or combination of both • Associated with poor hygiene • Contagious Clinical Manifestations: • Vesiculopustular lesions that develop thick, honey-colored crust surrounded by erythema • Pruritic • Most common on face as primary infection • Begins as a reddish macule then becomes vesicular • Ruptures easily • Exudate dries to form heavy, honey-colored crusts • Systemic effects: Minimal or asymptomatic Treatment and Prognosis: Topical: • Wound care with warm saline or aluminum acetate soaks followed by soap-and-water removal of crusts and application of topical antibiotic cream or ointment (mupirocin [Bactroban], retapamulin [Altabax]) • Meticulous hygiene essential • Topical bactericidal ointment (mupirocin) or triple antibiotic ointment • Oral or parenteral antibiotics (penicillin) in cases of severe or extensive lesions • Vancomycin for methicillin-resistant Staphylococcus aureus (MRSA) Systemic: • Systemic antibiotics (e.g., cephalosporins, amoxicillin, clindamycin) for widespread infections or systemic manifestations

Regarding Common Bacterial Infections of the Skin, Furunculosis Etiology and Pathophysiology Clinical Manifestations Treatment and Prognosis

Etiology and Pathophysiology: • Increased incidence in patients who are obese, diabetic, chronically ill, or regularly exposed to moisture, pressure Clinical Manifestations: • Lesions as above • Malaise, regional adenopathy, elevated body temperature Treatment and Prognosis: Topical: • Incision and drainage of painful nodules • Warm, moist compresses to erythematous plaques • Measures to reduce surface staphylococci include antimicrobial cream to nares, armpits, and groin and antiseptic to entire skin. • Meticulous personal hygiene Systemic: • Systemic antibiotic effective against MRSA pending culture and sensitivity results • Often recurrent with scarring

Regarding Common Bacterial Infections of the Skin, Cellulitis Etiology and Pathophysiology Clinical Manifestations Treatment and Prognosis

Etiology and Pathophysiology: • Inflammation of subcutaneous tissues • Possibly secondary complication or primary infection • Often following break in skin • Staphylococcus aureus and streptococci usual causative agents • Deep inflammation of subcutaneous tissue from enzymes produced by bacteria • Involvement of regional lymph nodes Clinical Manifestations: • Hot, tender, erythematous, and edematous area with diffuse borders • Chills, malaise, and fever Treatment and Prognosis: Topical: • Moist heat, immobilization, and elevation • Rest and immobilization of both affected area and child Systemic: • Systemic antibiotic therapy • Hospitalization if severe for IV antibiotic therapy (dalbavancin [Dalvance], vancomycin, linezolid [Zyvox], ceftaroline fosamil [Teflaro], daptomycin [Cubicin]) • Progression to gangrene possible if untreated

Manifestations and Treatment of Alcohol Withdrawal For Alcohol Withdrawal Delirium Manifestations Interprofessional Care

Manifestations • Disorientation • Visual, tactile, or auditory hallucinations • Seizures • can result in death in 20% of untreated patients (caused by pneumonia, renal disease, hepatic insufficiency, or heart failure) Interprofessional Care • Continued use of benzodiazepines (once delirium appears, intravenous lorazepam (Ativan) is used to treat these severe symptoms) • Carbamazepine (Tegretol) or valproate (Depakote) to treat seizures • Antipsychotic agents (e.g., chlorpromazine [Thorazine], haloperidol [Haldol]) • Chlordiazepoxide (Librium) if psychosis persists after benzodiazepine administration • Seclusion may be necessary. • Treat dehydration with IV fluid

Manifestations and Treatment of Alcohol Withdrawal For Alcohol Withdrawal Syndrome Manifestations Interprofessional Care

Manifestations • tremulousness, commonly called the shakes or the jitters • Agitation • Anxiety • ↑ Heart rate • ↑ BP • Sweating • Nausea • Tremors • Insomnia • Hyperactivity Interprofessional Care • Chlordiazepoxide (Librium) is useful for tremulousness and mild to moderate agitation. • Benzodiazepines (e.g., lorazepam [Ativan], Diazepam (Valium), or midazolam [Versed]) to prevent seizures and delirium • Thiamine to prevent Wernicke-Korsakoff syndrome • Multivitamins (e.g., folic acid, B vitamins) • Magnesium sulfate to treat low serum magnesium • IV glucose solution to treat hypoglycemia • β-blockers (e.g., propranolol) or α2-agonists (e.g., clonidine) to stabilize VS • Respiratory support

Regarding the first stage of labor two phases, The active phase is defined as the period during

which the greatest rate of cervical dilation occurs, which begins at 6 cm, and ends with complete cervical dilation at 10 cm

Regarding Breast cancer Diagnostic Studies, for Estrogen and Progesterone Receptor Status Receptor-negative tumors

(1) are often poorly differentiated histologically, (2) have a high incidence of aneuploidy (abnormally high or low DNA content) and higher proliferative indices, (3) frequently recur, (4) are usually unresponsive to hormone therapy. Ploidy status correlates with tumor aggressiveness.

Breast cancer can be classified as

(1) ductal or lobular or other (2) noninvasive or invasive

Epidural side effects

- Hypotension - Urinary retention and stress incontinence during post partum - Pruritus (itching) (if fentanyl) - nausea

Who are at high risk for contracting meningitis

- Older adults - persons who are debilitated - College students living in dormitories - individuals living in institutions (e.g., prisoners)

Acute kidney injury (AKI) Nutritional Therapy

- Sodium is restricted as needed to prevent edema, hypertension, and HF. - Dietary fat intake is increased - Fat emulsion IV infusions given as a nutritional supplement provide a good source of nonprotein calories - The patient treated with parenteral nutrition may need daily HD or CRRT to remove the excess fluid

Cold Stress Signs

- Tachypnea - Grunting - Cyanosis (acrocyanosis is normal tho)

Lactate Ringers is an isotonic crystalloid. It is used for

- acute blood loss; - hypovolemia from third-space fluid shifts; - electrolyte imbalance; - metabolic acidosis.

For preterm hypogylcemia, what is given?

- colostrum with bottle - IV dextrose (especially if they cant suck)

Laboratory findings for hyperthyroidism in pregnant women typically include

- elevated free thyroxine (T4) and triiodothyronine (T3) levels - greatly suppressed thyroid-stimulating hormone (TSH) levels

Regarding cirrhosis, Portal hypertension is characterized by

- increased venous pressure in the portal circulation, - splenomegaly, - large collateral veins, - ascites, - gastric and esophageal varices.

Chemotherapy is often divided into three stages:

- induction, - postinduction or postremission (consolidation), - maintenance.

side effect while taking stimulant (adderall/ritalin) medications for ADHD

- insomnia - appetite suppression, - headache, - abdominal pain, - lethargy. - Treating with the minimum effective dose is essential.

Predisposing factors of Infection such as

- moisture, - obesity, - atopic dermatitis, - systemic corticosteroids and antibiotics, - chronic disease such as diabetes mellitus increase the likelihood of infection.

Cirrhosis Drug Therapy

- no specific drug therapy for cirrhosis, drugs are used to treat symptoms - octreotide (Sandostatin) and vasopressin: Hemostasis and control of bleeding in esophageal and gastric varices - propranolol (Inderal) and nadolol (Corgard) for esophageal variceal bleeding - lactulose: trapping of ammonia - rifaximin (Xifaxan) neomycin sulfate: reducing formation of ammonia - magnesium sulfate: Magnesium replacement - Vitamin K: Correction of clotting abnormalities - Diuretics

Classifications of analgesic drugs used to relieve the pain of childbirth include

- opioid (narcotic) agonists - opioid (narcotic) agonist-antagonists.

The primary drugs to treat generalized tonic-clonic and focal (partial) seizures are

- phenytoin (Dilantin), - carbamazepine (Tegretol), - phenobarbital, - divalproex, - primidone (Mysoline)

QRS Complex Normal Duration (sec)

0.06-0.12 sec 1.5-3 boxes

Regarding ADHD meds, Administering the medication no later than

4:00 in the afternoon or lowering the last dose of the day helps the insomnia side effect

Regarding infants with HF, what can be done to the nipple for feeding?

A soft preemie nipple or a slit in a regular nipple to enlarge the opening decreases the infant's energy expenditure while sucking.

Comparison of Acute Kidney Injury and Chronic Kidney Disease Onset Most common cause Diagnostic criteria Reversibility Primary cause of death

Acute Kidney Injury: Onset - Sudden Most common cause - Acute tubular necrosis Diagnostic criteria - Acute reduction in urine output and/or Elevation in serum creatinine Reversibility - Potentially Primary cause of death - Infection Chronic Kidney Disease Onset - Gradual, often over many years Most common cause - Diabetic nephropathy Diagnostic criteria - GFR <60 mL/min/1.73 m2 for >3 mo and/or Kidney damage >3 mo Reversibility - Progressive and irreversible Primary cause of death - Cardiovascular disease

Regarding Types of Leukemia, Chronic Myelogenous Leukemia (CML) Age of Onset Clinical Manifestations Diagnostic Findings

Age of Onset Increase in incidence with advancing age with median age at diagnosis of 65. Rare in children Clinical Manifestations - No symptoms early in disease. - Fatigue and weakness, fever, sternal tenderness, weight loss, joint pain, bone pain, massive splenomegaly, increase in sweating - chronic stable phase, followed by the development of a more acute, aggressive phase referred to as the blastic phase Diagnostic Findings - Low RBC count, Hgb, Hct. - High platelet count early, lower count later. - ↑ banded neutrophils and myeloblasts and often basophils, normal number of lymphocytes, and normal or low number of monocytes. - Nucleated red cells are common. - Low leukocyte alkaline phosphatase. - Presence of Philadelphia chromosome

Regarding Types of Leukemia, Acute Lymphocytic Leukemia (ALL) Age of Onset Clinical Manifestations Diagnostic Findings

Age of Onset Peak prevalence occurs between ages 2 and 5 and after age 50. Clinical Manifestations - may appear abruptly with bleeding or fever, or they may be insidious with progressive weakness, fatigue, bone and/or joint pain, and bleeding tendencies. - pallor - anorexia, weight loss - Bone, joint, and abdominal pain. - Generalized lymphadenopathy, - infections, hepatosplenomegaly, headache, - mouth sores, - neurologic manifestations: CNS involvement, increased intracranial pressure (nausea, vomiting, lethargy, cranial nerve dysfunction) Diagnostic Findings - Low RBC count, Hgb, Hct, platelet count. - Low, normal, or high WBC count. - High LDH. - Transverse lines of rarefaction at ends of metaphysis of long bones on x-ray. - Hypercellular bone marrow with lymphoblasts. Lymphoblasts also possible in cerebrospinal fluid. - Presence of Philadelphia chromosome

Regarding Late-Preterm Infant Assessment and Interventions, Jaundice Assessment Interventions

Assessment: - Observe for jaundice in first 24 hours. - Evaluate maternal-fetal history for additional risk factors that may cause increased hemolysis and circulating levels of unconjugated bilirubin (Rh, ABO, spherocytosis, bruising). - Assess feeding method, voiding and stooling patterns. Interventions: - Monitor transcutaneous bilirubin, and note risk zone on hour-specific nomogram

Regarding abuse, Interview Guidelines

Do • Conduct the interview in private. • Be direct, honest, and professional. • Use language the patient understands. • Ask the patient to clarify words not understood. • Be understanding. • Be attentive. • Inform the patient if you must make a referral to Children's or Adult Protective Services, and explain the process. • Assess safety and help reduce danger (at discharge). Do Not • Try to "prove" abuse by accusations or demands. • Display horror, anger, shock, or disapproval of the perpetrator or situation. • Place blame or make judgments. • Allow the patient to feel "at fault" or "in trouble." • Probe or press for answers the patient is not willing to give. • Conduct the interview with a group of interviewers.

Emergency Management Tonic-Clonic Seizures Interventions

INITIAL: • Ensure patent airway. • Protect patient from injury during seizure. Do not restrain. Pad side rails. • Remove or loosen tight clothing. • Establish IV access. • Stay with patient until seizure has passed. • Anticipate administration of phenobarbital, phenytoin (Dilantin), or benzodiazepines (e.g., diazepam [Valium], midazolam [Versed], lorazepam [Ativan]) to attempt to abort seizures. • Suction as needed. • Assist ventilations if patient does not breathe spontaneously after seizure. • Anticipate need for intubation if gag reflex absent. ONGOING MONITORING: • Monitor vital signs, level of consciousness, O2 saturation, Glasgow Coma Scale results, pupil size and reactivity. • Reassure and orient patient after seizure. • Never force an airway between patient's clenched teeth. • Give IV dextrose for hypoglycemia.

Remifentanil Hydrochloride (Ultiva) - Opioid agonist analgesic Indication Dosage Adverse Effects Nursing Considerations

Indication Moderate to severe first-stage labor pain Dosage and Route PCA Pump: 0.5 mcg/kg every 2 to 3 minutes with no basal rate Adverse Effects Sedation and hypoventilation with oxygen desaturations Nursing Considerations - Close maternal monitoring (suggested 1 : 1 nurse/patient ratio) - continuous oxygen saturation monitoring are required. - Can be given to patients with impaired renal or hepatic function. - does cross the placenta but is metabolized rapidly in the fetus so that it does not cause neonatal depression

Clinical Manifestations of Necrotizing Enterocolitis

Specific Signs • Distended (often shiny) abdomen • Blood in stools or gastric contents • Gastric retention (undigested formula) • Localized abdominal wall erythema or induration • Bilious vomitus

Septic Miscarriage Symptoms Management

Symptoms: - Varies, usually malodorous bleeding - Usually dilation - Can have blood or tissue passage or not - fever and abdominal tenderness. Management: - Immediate termination of pregnancy by method appropriate to duration of pregnancy. - Cervical culture and sensitivity studies are performed, and broad-spectrum antibiotic therapy (e.g., ampicillin) is started. - Treatment for septic shock is initiated if necessary.

The implantable cardioverter-defibrillator (ICD) sensing system monitors the HR and rhythm and identifies After the sensing system detects a lethal dysrhythmia, the device

VT or VF delivers a 25-joule or less shock to the patient's heart. If the first shock is unsuccessful, the device recycles and can continue to deliver shocks.

Superficial Vein Thrombosis consequence If untreated

clot may extend to deeper veins and VTE may occur.

BNP levels correlate positively with the

degree of LV failure.

Females between the ages of 18 and 34 experience the highest rate of

intimate partner violence.

Dressler syndrome is The patient experiences

pericarditis and fever that develop 1 to 8 weeks after MI. chest pain, fever, malaise, a pericardial friction rub, and arthralgia.

Graves' disease is characterized by

remissions and exacerbations, with or without treatment. It may progress to destruction of the thyroid tissue, ultimately causing hypothyroidism

Regarding Types of Dysrhythmias, with a Third-Degree AV Block, Syncope from third-degree AV block may result from

severe bradycardia or even periods of asystole.

Preterm births are divided into two categories:

spontaneous and indicated

Children with CI often have greater success in individual and dual sports than in

team sports and enjoy themselves most with children of the same developmental level.

Regarding Pleural effusion, A chest x-ray and CT reveal the

volume and location of the effusion

Regarding Nonpharmacologic Strategies to Encourage Relaxation and Relieve Pain, Sensory Stimulation Strategies

• Aromatherapy • Breathing techniques • Music • Imagery • Use of focal points

Dopamine Drug Alert

• Monitor IV site for signs of extravasation. • Tissue necrosis with sloughing can occur with drug extravasation. • High dosages may produce ventricular dysrhythmias.

Regarding Pharmacologic Control of Discomfort by Stage of Labor and Method of Birth, First stage of labor methods

• Opioid agonist analgesics • Opioid agonist-antagonist analgesics • Epidural (block) analgesia • Combined spinal-epidural (CSE) analgesia • Nitrous oxide

Bacterial Meningitis Management

• Rest • IV fluids • Hypothermia

Erectile Dysfunction Devices and Implants

• Vacuum erection device (VED) • Intraurethral medication pellet • Intracavernosal self-injection • Penile implants

Metabolic Acidosis Manifestations

(↓ HCO3−) - Dysrhythmias (related to hyperkalemia from compensation) - Lethargy - Confusion - Dizziness - Headache - Coma - ↓ BP

Respiratory Alkalosis Manifestations

(↓ PaCO2) - Dizziness - Light-headedness - Confusion - Seizures - Dysrhythmias (related to hypokalemia from compensation) - Hyperventilation (lungs are unable to compensate if there is a respiratory problem)

Regarding Breast cancer Diagnostic Studies, for Estrogen and Progesterone Receptor Status Receptor-positive tumors

(1) commonly show histologic evidence of being well differentiated, (2) frequently have a diploid (more normal) DNA content and low proliferative indices, (3) have a lower chance for recurrence, (4) are frequently hormone dependent and responsive to hormone therapy.

Respiratory Acidosis Manifestations

(↑ PaCO2) - Ventricular fibrillation (related to hyperkalemia from compensation) - Lethargy - Confusion - Dizziness - Headache - Coma - ↓ BP - Seizures - Hypoventilation with hypoxia

Regarding infants and children, Three groups of drugs are used to enhance myocardial function in HF: What are the benefits?

(1) digitalis glycosides (digoxin), which improve contractility, (2) angiotensin-converting enzyme (ACE) inhibitors, which reduce the afterload on the heart and thus make it easier for the heart to pump, (3) beta blockers. increased cardiac output, decreased heart size, decreased venous pressure, and relief of edema.

Oximetry offers several advantages over TCM. Such as:

(1) does not require heating the skin, thus reducing the risk for burns; (2) eliminates a delay period for transducer equilibration; (3) maintains an accurate measurement regardless of the patient's age or skin characteristics or the presence of lung disease.

Left-sided HF results either from the inability of the left ventricle (LV) to

(1) empty adequately during systole (2) fill adequately during diastole

Coronary revascularization with CABG surgery is recommended for patients who

(1) fail medical management, (2) have left main coronary artery or three-vessel disease, (3) are not candidates for PCI (e.g., blockages are long or difficult to access), (4) have failed PCI and continue to have chest pain. CABG may also be the option for patients with diabetes, LV dysfunction, or chronic kidney disease

If Cushing syndrome has developed during the course of prolonged administration of corticosteroids (e.g., prednisone), the following alternatives may be tried: How are corticosteroids stopped?

(1) gradually discontinuing corticosteroid therapy, (2) reducing the corticosteroid dose, (3) converting to an alternate-day regimen Gradual tapering of the corticosteroids is necessary to avoid potentially life-threatening adrenal insufficiency. In an alternate-day regimen, twice the daily dosage of a shorter-acting corticosteroid is given every other morning to minimize hypothalamic-pituitary-adrenal suppression, growth suppression, and altered appearance.

The implantable cardioverter-defibrillator (ICD) is an important technology for patients who

(1) have survived SCD, (2) have spontaneous sustained VT, (3) have syncope with inducible VT or VF during EPS, (4) are at high risk for future life-threatening dysrhythmias (e.g., have cardiomyopathy).

Different types of Assisted reproductive technology (ART) include

(1) in vitro fertilization (IVF); (2) gamete intrafallopian transfer (GIFT); (3) zygote intrafallopian transfer (ZIFT); (4) donor gametes; (5) freezing of ova - in vitro fertilization-embryo transfer (IVF-ET), - ovum transfer (oocyte donation), - embryo adoption, - embryo hosting and surrogate motherhood, therapeutic donor insemination (TDI), - ICSI, assisted embryo hatching, - preimplantation genetic diagnosis (PGD).

Regarding Chronic Kidney Disease, CKD-MBD is a common complication of CKD and results in skeletal complications, vascular and soft tissue (extraskeletal) complications. Skeletal complications include

(1) osteomalacia (results from demineralization from slow bone turnover and defective mineralization of newly formed bone) (2) osteitis fibrosa (decalcification of the bone and replacement of bone tissue with fibrous tissue).

Three risk factors are commonly identified in child abuse:

(1) parental characteristics (Younger parents, Single-parent families, unrelated partner, Parents with substance-abuse problems, low self-esteem and little knowledge of appropriate parenting skills) (2) characteristics of the child (Children from birth to 1 year of age are at highest risk, parental or caregiver fatigue that results in abuse, Children with disabilities, Premature infants) (3) environmental characteristics (divorce, poverty, unemployment, poor housing, frequent relocation, alcoholism, and drug addiction)

Various behavioral techniques for patients engaged in a weight loss program include

(1) self-monitoring (keeping a record of the type and time food was consumed) (2) stimulus control (separating events that trigger eating from the act of eating) (3) rewards (incentives for weight loss)

Hemophilia Clinical Manifestations and Complications

(1) slow, persistent, prolonged bleeding from minor trauma and small cuts; (2) delayed bleeding after minor injuries (the delay may be several hours or days); (3) uncontrollable hemorrhage after dental extractions or irritation of the gingiva with a hard-bristle toothbrush; (4) epistaxis, especially after a blow to the face (hemorrhage from the nostril) (5) GI bleeding from ulcers and gastritis; (6) hematuria and potential renal failure from GU trauma and splenic rupture resulting from falls or abdominal trauma; (7) ecchymoses and subcutaneous hematomas and possible compartment syndrome; (8) neurologic signs, such as pain, anesthesia, and paralysis, which may develop from nerve compression caused by hematoma formation; (9) hemarthrosis (bleeding into the joints), which may lead to joint injury and deformity severe enough to cause crippling (most commonly in knees, elbows, shoulders, hips, and ankles).

Seizure Disorders for Focal (partial) Seizures

(Involve one hemisphere of brain) • Simple focal (partial) seizures (no impairment of awareness/consciousness) • Complex focal (partial) seizures (impairment of awareness/consciousness) • Focal (partial) seizures evolving to secondary generalized seizures

neutropenic count thrombocytopenia count

(absolute neutrophil count <500/mm3) antipyretic action of acetaminophen may mask a fever (platelet count <50,000/mm3) NSAIDs are contraindicated

Anhedonia refers to the

(an "without" + hedone "pleasure" = inability to feel happy) absence of happiness or pleasure in aspects of life that once made them happy.

Chronic Kidney Disease Clinical Manifestations for Hematologic System

- Anemia (require iron supplementation) Due to ↓ production of erythropoietin - Patients on dialysis may require IV iron to restore iron levels. - Folic acid must be supplemented in the diet (folic acid 1 mg/day) - Bleeding Tendencies - Infection

How to help Nausea and Vomiting during chemotherapy?

- 5-Hydroxytryptamine-3 receptor antagonists are the antiemetics of choice - ondansetron (Zofran) - Ondansetron in combination with dexamethasone has been more effective than ondansetron alone - Dronabinol helps control nausea and vomiting and also is an effective appetite stimulant

Regarding Chest physical therapy (CPT), Common techniques used in association with postural drainage include manual percussion of the chest wall and percussion with mechanical devices, such as a high-frequency handheld chest compression device. What should be the result

- A "popping," hollow sound, not a slapping sound, should be the result. - The procedure should be done over the rib cage only and should be painless. - Percussion can be performed with a soft circular mask (adapted to maintain air trapping) or a percussion cup marketed especially for the purpose of aiding in loosening secretions.

What history should be obtained from a overweight or at risk child?

- A family history of obesity, diabetes, coronary heart disease, and dyslipidemia - any problems with nighttime breathing and sleep, daytime sleepiness, joint pain, inability to keep up with family activities and peers at school

Regarding Cushing syndrome in Children and its Postoperative complications and how to solve them

- Anorexia and nausea and vomiting are common and may be improved with the use of nasogastric decompression - Muscle and joint pain may be severe, requiring use of analgesics. - The psychologic depression can be profound and may not improve for months. Parents should be aware of the physiologic reasons behind these symptoms in order to be supportive of the child.

Regarding Types of Dysrhythmias, First-degree AV block ECG Characteristics

- HR is normal and rhythm is regular. - P wave is normal - PR interval is prolonged (greater than 0.20 second) - QRS complex usually has a normal shape and duration

Regarding Types of Dysrhythmias, Paroxysmal Supraventricular Tachycardia clinical significance and symptoms

- A prolonged episode and HR greater than 180 beats/minute will cause decreased CO because of reduced stroke volume. - Manifestations include hypotension, palpitations, dyspnea, and angina.

Cirrhosis Acute Care Edema and ascites interventions

- Accurate calculation and recording of intake and output, - daily weights, - measurements of extremities and abdominal girth help in the ongoing assessment of the location and extent of the edema. - Mark the abdomen with a permanent marker so that the girth is measured at the same location

Immune Thrombocytopenia (Idiopathic Thrombocytopenic Purpura) Management for a child

- Activity is restricted at the onset - Treatment for acute presentation is symptomatic and has included prednisone, intravenous immunoglobulin (IVIG), and anti-D antibody. - patients who are treated with prednisone may first undergo a bone marrow examination to rule out leukemia - use of anti-D antibody and IVIG alleviates the need for a bone marrow examination - Premedication with acetaminophen 5 to 10 minutes before the infusion is recommended. - Splenectomy is for patients who have chronic ITP that is not responsive to pharmacologic management - Before splenectomy is considered, it is recommended to wait until the child is older than 5 years of age because of the increased risk for bacterial infection - The child also receives penicillin prophylaxis after splenectomy for a minimum of 3 years - Administration of pneumococcal, meningococcal, and H. influenzae vaccines are recommended before splenectomy

The incidence of triple-negative breast cancer is higher in These patients tend to have more aggressive tumors with a poorer prognosis because these tumors Best treatment?

- African Americans, - Hispanics, - premenopausal women, - those with a BRCA1 mutation. do not respond to treatment. Chemotherapy (NO HORMONE THERAPY)

What can interfere with readings from a oxygen sensor? What can be done about this?

- Ambient light from ceiling lights and phototherapy, - high-intensity heat and light from radiant warmers The sensor should be covered to block these light source

Menopause Nutritional Therapy

- An adequate intake of calcium and vitamin D helps maintain healthy bones and counteracts loss of bone density - Postmenopausal women not taking supplemental HRT should have a daily calcium intake of at least 1500 mg. - Women taking estrogen replacement need at least 1000 mg/day. - Calcium supplements are best absorbed when taken with meals.

Systemic Lupus Erythematosus Diagnostic Studies

- Anti-DNA antibodies - anti-Smith (Sm) antibodies - antiphospholipid antibodies - Antibodies to histone (drug-induced SLE) - Elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are not diagnostic of SLE but may be used to monitor disease activity and effectiveness of therapy. - C3 and C4 will be low (more susceptible to clotting) - Antinuclear antibody: abnormal titer (present) (not specific to LSE) • Complete blood cell count • Serum complement • Urinalysis • X-ray of affected joints • Chest x-ray • ECG to determine cardiac involvement

Venous Thromboembolism Drug Therapy

- Anticoagulants Three major classes of anticoagulants are available: (1) vitamin K antagonists (VKA), (2) thrombin inhibitors (both indirect and direct), (3) factor Xa inhibitors - treatment option for patients with a thrombus is catheter-directed administration of a thrombolytic drug (e.g., urokinase, tPA)

Binge-Eating Disorder Pharmacological Interventions Common side effects include

- Antidepressants are probably still a better option to try first - Lisdexamfetamine dimesylate (Vyvanse): Vyvanse is a stimulant and can be misused dry mouth and insomnia, but more serious side effects can occur.

postpartum psychosis Medical Management It is usually advantageous for the mother to have

- Antipsychotics, mood stabilizers, benzodiazepines are the treatments of choice. - Other psychotropic medications such as antidepressants may be used based on the underlying diagnosis (e.g., bipolar mania, bipolar depression). - Electroconvulsive therapy (ECT) bilaterally administered - Psychotherapy is indicated after the period of acute psychosis has passed. contact with her baby if she so desires, but visits must be closely supervised.

How anxiety impacts labor?

- Anxiety is common - Mild anxiety is considered normal for a woman during labor and birth. - Excessive anxiety and fear cause more catecholamine secretion, which increases the stimuli to the brain from the pelvis because of decreased blood flow and increased muscle tension. This magnifies pain perception. - If excessive The woman's confidence in her ability to cope with pain will be diminished, potentially resulting in reduced effectiveness of the pain relief measures being used.

Chronic Stable Angina drug therapy

- Aspirin (previously discussed) is given in the absence of contraindications - Sublingual Nitroglycerin or translingual spray (Nitrolingual) - Nitrates, such as isosorbide dinitrate (Isordil) and isosorbide mononitrate - Nitropaste is a 2% NTG topical ointment - Transdermal Controlled-Release Nitrates - ACE inhibitor - β-Adrenergic Blockers. - Calcium Channel Blockers (Verapamil, verapamil [Calan], diltiazem [Cardizem]) - Ranolazine (Ranexa) - Flu vaccination

Conservative management for a PDPH (spinal headache) includes

- administration of oral analgesics and methylxanthines (e.g., caffeine). - An autologous epidural blood patch is the most rapid, reliable, and beneficial relief measure for PDPH (the best for severe headache) **woman's blood (i.e., 20 mL) is injected slowly into the lumbar epidural space, creating a clot

What are the most appropriate nursing interventions for an infant in heart failure with Decreased Cardiac Output?

- Assess and record heart rate, respiratory rate, blood pressure (BP), and any signs or symptoms of decreased cardiac output every 2 to 4 hours and as necessary. - Administer cardiac drugs on schedule. Assess and record any side effects or any signs and symptoms of toxicity. Follow hospital protocol for administration. - Keep accurate record of intake and output. - Weigh George on same scale at same time of day as previously. Document results, and compare to previous weight. - Administer diuretics on schedule. Assess and record effectiveness and any side effects noted. - Offer small, frequent feedings to George's tolerance. - Organize nursing care to allow George uninterrupted rest.

What are the most appropriate nursing interventions for an infant in heart failure with Impaired Breathing Pattern?

- Assess and record oxygen saturation every 2 to 4 hours or more often as needed. - Elevate head of bed at a 30- to 45-degree angle. - Assess and record respiratory rate, breath sounds, and any signs or symptoms of ineffective pattern every 2 to 4 hours and as needed. - Administer humidified oxygen in correct amount and route of delivery. Record percent of oxygen and route of delivery. Assess and record George's response to therapy. - Suction if George has ineffective cough or is unable to manage secretions. Assess and record amount and characteristics of secretions.

Regarding Types of Dysrhythmias, Second-Degree AV Block, Type I ECG Characteristics

- Atrial rate is regular, but ventricular rate may be slower because of nonconducted or blocked QRS complexes resulting in bradycardia - progressive lengthening of the PR intervals until another QRS complex is blocked - Ventricular rhythm is irregular. - P wave has a normal shape. - QRS complex has a normal shape and duration.

Regarding Types of Dysrhythmias, Second-Degree AV Block, Type II ECG Characteristics

- Atrial: Normal and regular - Ventricular: Slower and irregular - P wave has a normal shape, More P waves than QRS complexes (2: 1, 3 : 1) - PR interval normal or prolonged but consistent for every QRS - QRS complex is usually greater than 0.12 second, Widened QRS, preceded by ≥2 P waves, with nonconducted (blocked) QRS complex

Regarding Types of Dysrhythmias, Third-Degree AV Block ECG Characteristics

- Atrial: Regular but may appear irregular due to P waves hidden in QRS complexes - Ventricular: if it is in the AV node, the rate is 40 to 60 beats/minute, and if it is in the His-Purkinje system, it is 20 to 40 beats/minute and regular - P wave has a normal shape. - PR interval is variable, and there is no relationship between the P wave and the QRS complex. - QRS complex is normal if an escape rhythm is initiated at the bundle of His or above. It is widened if an escape rhythm is initiated below the bundle of His.

Regarding Clinical Manifestations of Myocardial Infarction, Cardiovascular Manifestations show

- BP and HR may be elevated initially. Later, the BP may drop because of decreased cardiac output (CO). - severe, this may result in decreased renal perfusion and urine output. - Crackles, if present, suggest LV dysfunction. - Jugular venous distention, hepatic engorgement, and peripheral edema may indicate RIGHT ventricular dysfunction. - abnormal sounds suggest LV dysfunction are S3 and S4. - a loud holosystolic murmur may develop.

What lab test are ordered with Vancomycin

- BUN and Creatine - peak and trough

screening tools for depression

- Beck Depression Inventory, - the Hamilton Depression Scale, - the Geriatric Depression Scale - The Patient Health Questionnaire-9 (PHQ-9)

Hyperthyroidism Nursing Implementation for Thyroid Surgery

- Before surgery, antithyroid drugs, iodine, and β-adrenergic blockers may be given to achieve a euthyroid state. - Iodine also reduces the vascularization of the thyroid gland, reducing the risk of hemorrhage - Preoperatively, teach the patient about routine postoperative care and comfort and safety measures. - Teach the patient the importance of performing leg exercises. - Instruct the patient how to support the head manually while turning in bed, since this maneuver minimizes stress on the suture line after surgery. - The patient should practice range-of-motion exercises of the neck. - Tell the patient that talking is likely to be difficult for a short time after surgery.

Cushing syndrome Diagnostic Studies

- Begins with confirming elevated plasma cortisol levels (1) midnight or late-night salivary cortisol, (2) low-dose dexamethasone suppression test, (3) 24-hour urine cortisol: levels higher than the normal range of 80 to 120 mcg/24 hr indicate Cushing syndrome. - CT scan or MRI of the pituitary (cushing disease) and adrenal (cushing syndrome) glands can detect a tumor. - High or normal ACTH levels indicate Cushing disease, whereas low or undetectable levels indicate an adrenal or medication etiology. - Complete blood count (CBC) with WBC differential (NOT DIAGNOSTIC) - Blood chemistries for sodium, potassium, glucose (NOT DIAGNOSTIC)

Pulmonary Embolism Interprofessional Care

- Begins with prevention of DVT. DVT prophylaxis includes the use of sequential compression devices, early ambulation, and anticoagulant medications. - prevent further growth or extension of thrombi in the lower extremities - prevent embolization from the upper or lower extremities to the pulmonary vascular system - provide cardiopulmonary support if indicated. - Supportive therapy for the patient's cardiopulmonary status varies according to the severity of the PE (O2 can be given via mask or cannula, endotracheal intubation and mechanical ventilation) - Respiratory measures such as turning, coughing, deep breathing, and incentive spirometry are important to help prevent or treat atelectasis - If manifestations of shock are present, IV fluids are administered followed by vasopressor agents - If heart failure is present, diuretics are used

Regarding Bronchial (Postural) Drainage, it is done how? How long for?

- By positioning the child to take maximum advantage of gravity facilitates removal of secretions. - It is carried out three or four times daily and is more effective when it follows other respiratory therapy, such as bronchodilator or nebulization medication. - Performed before meals (or 1 to hours after meals) to minimize the chance of vomiting and is repeated at bedtime. - Duration of treatment depends on the child's condition and tolerance; it usually lasts 20 to 30 minutes.

Chronic Kidney Disease Clinical Manifestations for Musculoskeletal System

- CKD mineral and bone disorder (CKD-MBD) (As kidney function deteriorates, less vitamin D is converted which decreases calcium) - Results in: Skeletal complications (osteomalacia, osteitis fibrosa) and Soft tissue complications (vascular calcifications) - hypocalcemia - Hyperphosphatemia also results from decreased phosphate excretion - CKD-MBD is a common complication of CKD and results in skeletal complications, vascular and soft tissue (extraskeletal) complications. - "Uremic red eye" is caused by the irritation from calcium deposits in the eye

Regarding Types of Dysrhythmias, Treatment

- CPR with initiation of ACLS measures. - These include definitive drug therapy with epinephrine and/or vasopressin, and intubation.

chronic stable angina surgical treatment

- Cardiac Catheterization (maybe with with an elective percutaneous coronary intervention (PCI)) - balloon angioplasty - stent

Chronic Kidney Disease Clinical Manifestations for Cardiovascular System

- Cardiovascular disease - Hypertension: lead to left ventricular hypertrophy and HF - Leading causes of death are myocardial infarction, ischemic heart disease, peripheral arterial disease, HF, cardiomyopathy, and stroke - susceptible to cardiac dysrhythmias that result from hyperkalemia and decreased coronary artery perfusion. - Uremic pericarditis can develop and occasionally progresses to pericardial effusion and cardiac tamponade. - Pericarditis is typically manifested by a friction rub, chest pain, and low-grade fever.

Breast cancer Clinical Manifestations

- If palpable, breast cancer is characteristically hard and may be irregularly shaped, poorly delineated, nonmobile, and nontender. - occurs most often in the upper, outer quadrant of the breast - nipple discharge (clear or bloody) - Nipple retraction may occur. - Peau d'orange may occur due to plugging of the dermal lymphatics - infiltration, induration, and dimpling (pulling in) of the overlying skin

Breast Cancer Prevention

- Chemoprevention - Tamoxifen and raloxifene (block the effect of estrogen on breast tissue)

Regarding Children admitted to the hospital with suspected RSV infection, what precautions are taken?

- Children are usually assigned separate rooms or grouped with other RSV-infected children. - Droplet and Standard Precautions are used, including hand washing, not touching the nasal mucosa or conjunctiva, and using gloves and gowns when entering the patient's room; - Contact Precautions are also recommended. - nurses assigned to children with RSV infection are not caring for other patients who are considered high risk.

Cirrhosis Acute Care If the jaundice is accompanied by pruritus, carry out measures to relieve itching:

- Cholestyramine or hydroxyzine (Atarax) - baking soda or moisturizing bath oils (Alpha Keri), - lotions containing calamine, antihistamines, soft or old linens, and control of the temperature (not too hot and not too cold). - Keep the patient's nails short and clean. - Teach patients to rub with their knuckles rather than scratch with their nails when they cannot resist scratching. - When jaundice is present, the urine is often dark brown and the stool is gray or tan.

Maternal complication of preterm PROM

- Chorioamnionitis (most common) - placental abruption, - retained placenta and hemorrhage, - sepsis - death

ECG leads consist of an electrode pad fixed with electrical conductive gel. Before placing these on the patient, you must properly prepare the skin. How should you do that?

- Clip excessive hair on the chest wall with scissors. - Gently rub the skin with dry gauze until slightly pink. - If the skin is oily, wipe with alcohol first. - If the patient is diaphoretic, apply a skin protectant before placing the electrode.

Bacterial Meningitis Nursing Implementation Acute Care for head and neck pain

- Codeine - Assist the patient to a position of comfort, often curled up with the head slightly extended. The head of the bed should be slightly elevated - A darkened room and a cool cloth over the eyes relieve the discomfort of photophobia.

Metabolic Alkalosis Manifestations

- Irritability - Confusion - Tachycardia - Dysrhythmias (related to hypokalemia from compensation) - Hypoventilation (compensatory action by lungs)

Types of Spontaneous Abortion - Complete abortion: - Incomplete abortion: - Inevitable abortion: - Infected (septic) abortion: - Missed abortion: - Threatened abortion:

- Complete abortion: All products of conception (POC) are expelled - Incomplete abortion: Parts of POC are retained (will need D&C) - Inevitable abortion: Cervix is open and pregnancy loss cannot be prevented - Infected (septic) abortion: Endometrium (uterine lining) and POC become infected - Missed abortion: Fetus has died but has not been expelled - Threatened abortion: Unexplained bleeding with or without pain. Suggests pregnancy loss may occur

Early Signs Suggestive of Cognitive Impairment

- Dysmorphic syndromes (e.g., Down syndrome, fragile X syndrome [FXS]) - Irritability or nonresponsiveness to environment - Major organ system dysfunction (e.g., feeding or breathing difficulties) - Gross motor delay - Fine motor delay - Language difficulties or delay - Behavior difficulties

Complications of MI

- Dysrhythmias - Heart Failure - Cardiogenic Shock - Papillary Muscle dysfunction - Ventricular Aneurysm - Pericarditis - Dressler Syndrome

Venous Thromboembolism Diagnostic Studies

- D-dimer: Elevated results suggest venous thromboembolism (VTE) Normal results: <250 ng/mL (<250 mcg/L) - Fibrin monomer complex: Presence is evidence of thrombus formation and suggests VTE. Normal results: <6.1 mg/L - Venous compression ultrasound Normal finding: Veins collapse with application of external pressure. Abnormal finding: Veins fail to collapse with application of external pressure. Failure to collapse suggests a thrombus. - Duplex ultrasound: determine location and extent of thrombus - Computed tomography venography (CTV) - MRI - Contrast venography (phlebogram)

Preterm Lifestyle Modifications and Teachings

- DO NOT RECOMMEND Bedrest, hydration, and limited work - Recommend modified bed rest (allowed bathroom privileges for toileting and showering and can be up to the table for meals.) - Teach restriction of sexual activity, sometimes called pelvic rest - woman's environment can be modified for convenience by using tables and storage units around her bed or daytime resting place to keep essential items within reach - Ensuring that the bed or couch is near a window and the bathroom - Covering the bed with an eggcrate mattress can relieve discomfort. - Women often find that a daily schedule of smaller, more frequent meals, activities (e.g., paying bills, planning and helping with meal preparation, hobbies), limited naps, and hygiene and grooming (e.g., shower, dressing in street clothes, applying makeup) reduces boredom

Nonpharmacological treatment for depression

- Electroconvulsive Therapy - Transcranial Magnetic Stimulation - Vagus Nerve Stimulation - Deep Brain Stimulation - Light Therapy - St. John's Wort - Exercise

VTE Nursing Implementation what to monitor and do?

- Depending on anticoagulant ordered, monitor INR, aPTT, ACT, anti-factor Xa levels, complete blood count (CBC), creatinine, factor X levels, hemoglobin, hematocrit, platelet levels, and/or liver enzymes. - Monitor platelet counts for patients getting UH or LMWH to assess for HIT - Titrate doses of UH, warfarin, and direct thrombin inhibitors based on results of blood studies - Direct thrombin inhibitors may need adjustment for patients with renal or liver disease. - Monitor for and reduce the risk of bleeding - Be aware that the risk of bleeding is greater in people receiving LMWH or UH with an active gastroduodenal ulcer, prior bleeding history, low platelet count, hepatic or renal failure, rheumatic disease, cancer, or age greater than 85 years - warfarin with an INR of 5.0 or more are also at increased risk for bleeding - In event of anticoagulation above target goals, give reversal agents (e.g., protamine, vitamin K) or make dosage adjustments as ordered - In the event of major VKA-related bleeding, rapid treatment with four-factor prothrombin complex concentrate and IV vitamin K is recommended over fresh frozen plasma. - For patients with acute VTE with severe edema and limb pain, bed rest with limb elevation may initially be prescribed.

Regarding Patient Teaching Smoking and Tobacco Use Cessation Methods

- Develop a Quit Plan - Use Approved Nicotine Replacement Systems - Non-nicotine therapy options include the antidepressant bupropion (Zyban) (helps with withdrawal) - Support and Encouragement - Dealing With Urges to Use Tobacco - Avoiding Relapse - Behavioral therapy (helps with withdrawal) - Hypnosis (helps with withdrawal) - Clonidine (Catapres) (helps with withdrawal)

Regarding surgical removal of a pituitary adenoma, an adrenal tumor, or one or both adrenal glands, Cushing syndrome Nursing Implementation for Ambulatory Care (Outpatient care)

- Discharge instructions are based on the patient's lack of endogenous corticosteroids and resulting inability to react physiologically to stressors - Consider a home health nurse referral, especially for older adults, because of the need for ongoing evaluation and teaching - Instruct the patient to wear a Medic Alert bracelet at all times - Carry medical identification and instructions in a wallet or purse - Teach the patient to avoid exposure to extreme temperatures, infections, and emotional disturbances - Teach patients to adjust their corticosteroid replacement therapy in accordance with their stress levels - Consult with the patient's HCP to determine the parameters for dosage changes if this plan is feasible - If the patient cannot adjust his or her own medication or if weakness, fainting, fever, or nausea and vomiting occur, the patient should contact the HCP for a possible adjustment in corticosteroid dosage - Many patients require lifetime replacement therapy. - Patients should be prepared for it to take several months to adjust the hormone dose satisfactorily.

Regarding substance abuse, For depressants opioid toxicity Nursing interventions

- First-line treatment administer naloxone (Naloxone reverses respiratory depression, coma, and other manifestations of toxicity.) - Monitor the patient closely because naloxone has a shorter duration of action than most opioids. (Repeated doses of naloxone may be required)

Regarding Hemodialysis, Surgical creation of an arteriovenous access for Hemodialysis has several risks, including

- development of distal ischemia (steal syndrome) - pain because too much of the arterial blood is being shunted or "stolen" from the distal extremity

Chronic HF drug therapy

- Diuretics: USE LOWEST DOSE Loop: bumetanide [Bumex] Thiazide diuretics - Renin-Angiotensin-Aldosterone System Inhibitors ACE inhibitors (Captopril) Patients unable to tolerate ACE inhibitors, angiotensin II receptor blockers (ARBs) are recommended Combination therapy with valsartan/sacubitril (Entresto), an ARB/neprilysin inhibitor, is recommended for HF patients with reduced EF. Spironolactone (Aldactone) and eplerenone (Inspra) are aldosterone antagonists. - β-Adrenergic Blockers for HFrEF Carvedilol (Coreg) metoprolol succinate (Toprol XL) - Vasodilators: Nitrates (can treat Erectile Dysfunction) Combination therapy with hydralazine and isosorbide dinitrate (Bidil) may be helpful in African American - Digitalis (digoxin) - Cardiac Sinus Node Inhibitor Ivabradine (Corlanor)

Drug therapy is essential in treating ADHF, This includes what drugs and why?

- Diuretics: for volume overload. This allows the LV to pump more efficiently. Loop diuretics (e.g., furosemide [Lasix]) can be given by IV push and act rapidly in the kidneys. - Vasodilators: IV nitroglycerin: monitor BP frequently (every 5 to 10 minutes) to avoid hypotension. Sodium nitroprusside (Nitropress) is a potent IV vasodilator Nesiritide, given IV, main adverse effect is symptomatic hypotension, monitor BP closely. - Morphine for dyspnea - Positive Inotropes: β-agonists (e.g., dopamine, dobutamine, norepinephrine [Levophed]) Dobutamine preferred for short-term treatment of ADHF Milrinone Adverse effects include dysrhythmias, thrombocytopenia, and hepatotoxicity. Digitalis

Legal Tip Reporting Requirements for Domestic Violence

- Domestic violence is considered a crime in all states, but it varies by state between being a misdemeanor or a felony offense; in the majority of states, domestic violence is a misdemeanor. - Forty states and the District of Columbia have laws that mandate reporting by health care providers in situations in which the woman has an injury that may be caused by a deadly weapon. - Some states also require reports when there is a reason to believe that the woman's injury may have resulted from an illegal act or act of violence. - Because of the wide variation from state to state in mandatory reporting, nurses must be knowledgeable about the reporting requirements of the state in which they practice.

Superficial Vein Thrombosis Diagnostic/Drug therapy

- Duplex ultrasound is used to confirm the diagnosis (clot 5 cm or larger) and to rule out clot extension to a deep vein. - subcutaneous fondaparinux (Arixtra) reduces symptomatic VTE, - If the superficial vein thrombosis affects a very short vein segment (less than 5 cm) and is not near the saphenofemoral junction, anticoagulants may not be necessary and oral NSAIDs can ease symptoms.

Regarding Acute Coronary Syndrome (UA and MI) Treatments

- Emergent PCI - Thrombolytic Therapy - Coronary Surgical Revascularization

Complications of Peritoneal Dialysis

- Exit Site Infection - Peritonitis - Hernias - Lower Back Problems (Orthopedic binders and a regular exercise program) - Bleeding (common for the PD effluent drained after the first few exchanges to be pink or slightly bloody) - Pulmonary Complications (Atelectasis, pneumonia, and bronchitis) (Frequent repositioning and deep-breathing exercises) - Protein Loss

Bacterial meningitis Clinical Manifestations

- Fever, - severe headache, - nausea, - vomiting, - nuchal rigidity (neck stiffness) Photophobia, a decreased LOC, and signs of increased ICP may also be present Coma is associated with a poor prognosis Seizures Headache becomes progressively worse

Regarding Chronic Kidney Disease Nutritional Therapy, Protein Restriction

- For Pre-ESRD get low protein (0.6-1.0 g/kg/day), HD gets normal - For the patient who is undergoing dialysis, protein is not routinely restricted - For CKD stages 1 through 4, many HCPs encourage a diet with normal protein intake. Teach patients to avoid high-protein diets and supplements because they may overburden the diseased kidneys - During Peritoneal Dialysis, protein intake must be high enough to compensate for the losses.. The recommended protein intake is at least 1.2 g/kg of ideal body weight (IBW) per day. - For patients with malnutrition or inadequate caloric or protein intake, commercially prepared products that are high in protein but low in sodium and potassium are available (e.g., Nepro, Amin-Aid). - As an alternative, liquid or powder breakfast drinks may be purchased at the grocery store.

Gambling Disorder Treatment

- Gamblers Anonymous (GA) is a 12-step program (involves public confession, peer pressure, and peer counselors) - Hospitalization may help by removing patients from gambling environments. - selective serotonin reuptake inhibitors, - bupropion (Wellbutrin), - mood stabilizers (lithium), - anticonvulsants such as topiramate (Topamax - Naltrexone

Early recognition of preterm delivery includes

- Gestational age between 20 and 37 weeks - Uterine activity (contractions) - Progressive cervical change • Effacement of 80% • Cervical dilation of 2 cm or greater

Regarding Postoperative Care, Special Considerations for Bariatric Surgery

- Give pain medications as necessary during the immediate postoperative period (first 24 hours) - Be aware that pain could be from an anastomosis leak rather than typical surgical pain. - Abdominal wounds require frequent observation for the amount and type of drainage, condition of the incision, and signs of infection. - Protect the incision against undue straining that accompanies turning and coughing. - water and sugar-free clear liquids are given (30 mL every 2 hours while awake) - Before discharge, instruct patients on a measured amount of a high-protein liquid diet - patient is taught to eat slowly, stop eating when feeling full, and not consume liquids with solid food. - Vomiting is a common complication during this time

Regarding Types of Dysrhythmias, Sinus tachycardia ECG Characteristics

- HR is 101 to 200 beats/minute, regular rhythm - P wave is normal, precedes each QRS complex, and has a normal shape and duration. - PR interval is normal and the QRS complex has a normal shape and duration.

Regarding Types of Dysrhythmias, Paroxysmal Supraventricular Tachycardia ECG Characteristics

- HR is 150 to 220 beats/minute and rhythm is regular or slightly irregular. - P wave is often hidden in the preceding T wave - PR interval normal - QRS complex is usually normal.

Regarding Types of Dysrhythmias, Ventricular Tachycardia ECG Characteristics

- HR is 150-250 beats/min and regular or irregular - P wave is not usually visible - PR interval is not measurable - QRS complex is distorted in appearance and wide (greater than 0.12 second in duration).

Regarding Types of Dysrhythmias, Premature Atrial Contraction ECG Characteristics

- HR is 60-100 beats/min and irregular rhythm - P wave may be hidden in the preceding T wave. - PR interval is normal - The QRS complex is usually normal. If the QRS interval is 0.12 second or more, abnormal conduction through the ventricles occurs.

Regarding Types of Dysrhythmias, Sinus Bradycardia ECG Characteristics

- HR is less than 60 beats/minute, regular. rhythm - P wave precedes each QRS complex and has a normal shape and duration. - The PR interval is normal and the QRS complex has a normal shape and duration.

Menopause Drug Therapy

- Hormone replacement therapy (HRT) using estrogen, with or without progesterone - Nonhormonal Therapy (Because of the risks associated with HRT some women choose to use nonhormonal and nonpharmacologic interventions to manage their symptoms)

Bronchiolitis treatment How about fluids?

- Humidified oxygen maintain adequate oxygenation (SpO2) at or above 90% as measured by pulse oximetry. - Infants with abundant nasal secretions benefit from regular suctioning, especially for feeding. - Fluids by mouth may be contraindicated because of tachypnea, weakness, and fatigue; therefore IV fluids may be used until the acute stage of the disease has passed. - Nasogastric fluids may be required if the infant is unable to tolerate oral fluids and a peripheral IV is difficult to establish. - Medical therapy for bronchiolitis is primarily supportive and aimed at decreasing airway hyperresonance and inflammation and promoting adequate fluid intake. - Racemic epinephrine helps ventilation status. - The use of systemic corticosteroids is controversial but may be used in some centers. - antibiotics should not be part of the treatment of bronchiolitis unless there is a coexisting bacterial infection, such as OM or pneumonia - encourage breastfeeding, - avoid passive tobacco smoke exposure, - promote preventive measures, including hand washing and the administration of palivizumab (Synagis) to high-risk infants - no longer recommends a trial dose of a bronchodilator to be used for patient with bronchiolitis (Ralston et al.). Routine chest percussion and postural drainage (formerly chest physiotherapy [CPT]) are not recommended for children who have bronchiolitis.

Chronic Kidney Disease Clinical Manifestations for Electrolyte and Acid-Base Imbalances

- Hyperkalemia (fatal when serum potassium level reaches 7 to 8 mEq/L (7 to 8 mmol/L)) - Hypermagnesemia is generally not a problem unless the patient is ingesting magnesium (e.g., milk of magnesia, magnesium citrate, antacids containing magnesium) - Metabolic Acidosis (Plasma bicarbonate level usually falls to approximately 16 to 20 mEq/L (16 to 20 mmol/L)) - If large quantities of water are retained, dilutional hyponatremia occurs - Dilutional hyponatremia may occur (Edema, Hypertension, HF)

Acute Kidney Injury Complications for children

- Hypertension: is controlled with antihypertensive drugs. Other measures that may be used include limiting fluids and salt. - Anemia: transfusion is not recommended unless the hemoglobin drops below 6 g/dL. Transfusions, if used, consist of fresh, packed RBCs given slowly - Seizures from uremia are managed with antiepileptic drugs. - Cardiac failure with pulmonary edema is almost always associated with hypervolemia. Treatment is directed toward reduction of fluid volume, with water and sodium restriction and administration of diuretics.

Possible Diagnostic Findings of Cushing syndrome

- Hypokalemia, (digoxin toxicity) - Hyperglycemia, - Dyslipidemia, - Polycythemia, - Granulocytosis, - Lymphocytopenia, - Eosinopenia. - ↑ plasma cortisol, - ↑ salivary cortisol. - High, low, or normal ACTH levels. - Abnormal dexamethasone suppression test. - ↑ Urine free cortisol, - 17-ketosteroids. - Glycosuria, - Hypercalciuria. - Osteoporosis on x-ray

Acute Coronary Syndrome (UA and MI) Drug therapy

- IV Nitroglycerin (initial treatment, monitor BP, can benefit from an IV fluid bolus.) - Morphine (Monitor patients for signs of bradypnea or hypotension, which are conditions to avoid in myocardial ischemia and infarction) - β-Adrenergic Blockers (continued indefinitely) - ACE inhibitors (continued indefinitely) - Antidysrhythmic Drugs - Lipid-Lowering Drugs (indefinitely, unless contraindicated) - Stool Softeners (colace)

Preterm Delivery DRUG MANAGEMENT

- IV access—maternal hydration - Monitor FHR & uc's closely - Tocolytic therapy—brethine first line then MgSO4 to decrease uc's( effects of these medications on mother/fetus) - Corticosteroids to promote fetal lung maturity - Antibiotic therapy(Group B Streptococcus infection status) - Labs-CBC, RPR,UA, ? type & hold

Bacterial Meningitis Nursing Implementation Acute Care Overall:

- If seizures occur, make appropriate observations and take protective measures. Administer antiseizure drugs such as phenytoin (Dilantin) or levetiracetam (Keppra) - Fever must be vigorously treated • Acetaminophen or aspirin can be used • if the fever is resistant to aspirin or acetaminophen, more vigorous means are necessary, such as a cooling blanket. Take care not to reduce the temperature too rapidly. • Diaphoresis further increases fluid losses, which should be noted on the output record. - Supplemental feeding (e.g., enteral nutrition)

Immune Thrombocytopenic Purpura Drug therapy

- If the patient is asymptomatic, therapy may not be used unless the patient's platelet count is below 10,000/µL - Corticosteroids (e.g., prednisone, methylprednisolone) used initially - High doses of IV immunoglobulin (IVIG) and a component of IVIG, anti-Rho(D) (anti-D, WinRho), may be used in the patient who is unresponsive to corticosteroids or splenectomy - Rituximab (Rituxan) lyse activated B cells - Splenectomy may be indicated if the patient does not respond to the above treatments. - Romiplostim (Nplate) and eltrombopag (Promacta) are used for patients with chronic ITP who have had an insufficient response to the other treatments - Danazol, an androgen, may be used along with corticosteroids in some - Immunosuppressive therapy may be used in refractory cases - Platelet transfusions in cases of life-threatening hemorrhage (not be administered prophylactically) - Epsilon-aminocaproic acid (EACA, Amicar), an antifibrinolytic agent, may be used for severe bleeding.

Regarding Types of Dysrhythmias, Premature Atrial Contraction can result from

- In a normal heart, a PAC can result from emotional stress or physical fatigue or from the use of caffeine, tobacco, or alcohol. - A PAC can also result from hypoxia; electrolyte imbalances; and disease states such as hyperthyroidism, chronic obstructive pulmonary disease (COPD), and heart disease, including CAD and valvular disease.

Regarding Venous Thromboembolism Drug Therapy, Thrombin inhibitors include Whats the values?

- Indirect thrombin inhibitors are divided into two major classes: UH and LMWHs. UH (e.g., heparin) Heparin can be given subcutaneously for VTE prophylaxis or by continuous IV infusion for VTE treatment. One serious side effect of heparin is heparin-induced thrombocytopenia (HIT) Another side effect of long-term heparin therapy is osteoporosis. - Direct thrombin inhibitors are classified as hirudin derivatives or synthetic thrombin inhibitors Hirudin derivatives (e.g., bivalirudin [Angiomax]) are given by continuous IV infusion. Bivalirudin is approved for patients with or at risk for HIT having a percutaneous coronary intervention. Argatroban, a synthetic direct thrombin inhibitor, inhibits thrombin. Good for HIT and PCI also Dabigatran (Pradaxa), an oral direct thrombin inhibitor, is used for VTE prevention after elective joint replacement, for stroke prevention in nonvalvular atrial fibrillation, and as a treatment option in VTE. Activated partial thromboplastin time (aPTT) Normal Value: 25-35 sec Therapeutic Value: 46-70 sec Activated clotting time (ACT) Normal Value: 70-120 sec Therapeutic Value: >300 sec

Nursing Alert of oxygen therapy

- Inspect all toys for safety and suitability (e.g., vinyl or plastic, not stuffed items that absorb moisture and are difficult to keep dry). - The high-level oxygen environment makes any source of sparks (e.g., mechanical or electrical toys) a potential fire hazard.

Pulmonary Embolism Nursing Implementation

- Keep the patient on bed rest in a semi-Fowler's position to facilitate breathing - Administer O2 therapy as ordered - Assess the patient's cardiopulmonary status with careful monitoring of vital signs, cardiac rhythm, pulse oximetry, ABGs, and lung sounds - Maintain an IV line for medications and fluid therapy - Monitor laboratory results to ensure therapeutic ranges of INR (for warfarin) and aPTT (for IV heparin). - Monitor the patient for complications of anticoagulant and fibrinolytic therapy (e.g., bleeding, hematomas, bruising). - Provide appropriate interventions related to immobility and fall precautions, once the patient is permitted out of bed. - Patient is usually anxious because of pain, inability to breathe, and fear of death. Carefully explain the situation, the medications, and provide emotional support and reassurance to help relieve the patient's anxiety. - Patient teaching regarding long-term anticoagulant therapy is critical. Anticoagulant therapy continues for at least 3 months. Patients with recurrent emboli may be treated indefinitely with anticoagulants. INR levels are drawn at intervals and warfarin dosage is adjusted

Bacterial Meningitis Care Management for children

- Keep the room as quiet as possible, and keep environmental stimuli at a minimum - Most children are more comfortable without a pillow and with the head of the bed slightly elevated - A side-lying position is more often assumed because of nuchal rigidity. - avoid actions that cause pain or increase discomfort such as lifting the child's head - Evaluating the child for pain (Acetaminophen with codeine is used) - evaluate if a patient is febrile before giving acetaminophen or ibuprofen because either of these medications may mask a fever - Observation of vital signs, neurologic signs, LOC, urinary output - observed carefully for signs of the complications just described, especially increased ICP, shock, or respiratory distress - Frequent assessment of the open fontanels is needed in the infant because subdural effusions and obstructive hydrocephalus can develop - The child with dulled sensorium is usually kept NPO. Other children are allowed clear liquids initially and, if these are tolerated, progress

Bacterial Meningitis Complications

- Most common: Increased ICP (cause of an altered mental status) - Residual neurologic dysfunction - Hemiparesis, dysphasia, and hemianopsia (usually resolve over time. If they do not, a cerebral abscess, subdural empyema, subdural effusion, or persistent meningitis is suspected) - Acute cerebral edema may cause seizures, CN III palsy, bradycardia, hypertensive coma, and death. - Headaches (implement pain management for chronic headaches.) - Noncommunicating hydrocephalus (surgical implantation of a shunt is the only treatment) - Waterhouse-Friderichsen syndrome - DIC and shock

Breast Diagnostic Studies

- Mammography is a method used to visualize the breast's internal structure using x-rays - Digital mammography is a technique in which x-ray images are digitally coded and stored in a computer - Three-dimensional (3D) mammography, or tomosynthesis mammography, produces a 3D image of the breast - Ultrasound is used in conjunction with mammography to differentiate a solid mass from a cystic mass, to evaluate a mass in a pregnant or lactating woman, and to locate and biopsy a suspicious lesion. - MRI is recommended as a screening tool in addition to mammography for women who are at risk for breast cancer - Biopsy techniques include fine-needle aspiration (FNA), core (core needle), vacuum-assisted, and excisional biopsies. - FNA biopsy is performed by inserting a needle into a lesion to sample fluid - A core (core needle) biopsy involves removing small samples of breast tissue using a hollow "core" needle. - Vacuum-assisted biopsy is a version of core biopsy that uses a vacuum technique to help collect the tissue sample. - An excisional biopsy is performed in an operating room.

Thrombocytopenia Clinical Manifestations

- Many pt are asymptomatic. - most common symptom is bleeding, usually mucosal or cutaneous. - Mucosal bleeding may manifest as epistaxis and gingival bleeding - large bullous hemorrhages may appear on the buccal mucosa - Bleeding into the skin is manifested as petechiae, purpura, or superficial ecchymoses - Prolonged bleeding after routine procedures such as venipuncture or IM injection - hemorrhage (major issue!) cerebral or Insidious

cervical insufficiency diagnosis

- Measurement of cervical length - speculum and digital pelvic examinations (allow identification of an opening at the internal cervical os, prolapsed fetal membranes, or both) - transvaginal ultrasound examination (reveal an abnormally short (<25 mm) cervix, accompanied by cervical funneling (beaking))

Regarding opioid (narcotic) agonist analgesics, these include

- Meperidine, - fentanyl, - remifentanil

Cushing syndrome Nursing Implementation for Acute care

- Monitor vital signs, daily weight, and glucose. - Assess for possible infections(inflammation (e.g., fever, redness) may be minimal or absent, assess for pain, loss of function, and purulent drainage) - Monitor for signs and symptoms of thromboembolic events such as pulmonary emboli (e.g., sudden chest pain, dyspnea, tachypnea) - Give emotional support (The patient may feel unattractive, repulsive, or unwanted) so remaining sensitive to the patient's feelings and offering respect and unconditional acceptance. - Reassure the patient that the physical changes and much of the emotional lability will resolve when hormone levels return to normal.

Acute Kidney Injury Nursing Assessment

- Monitor vital signs, weight, and fluid intake and output. - Daily monitoring of a patient's urine output - Examine the urine for color, specific gravity, glucose, protein, blood, and sediment - Assess the patient's general appearance, including skin color, edema, neck vein distention, and bruises - If a patient is receiving dialysis, observe the access site for inflammation and exudate. - Evaluate the patient's mental status and level of consciousness. - Examine the oral mucosa for dryness and inflammation. - Auscultate the lungs for crackles and wheezes or diminished breath sounds. - Monitor the heart for an S3 gallop, murmurs, or a pericardial friction rub. - Assess ECG readings for dysrhythmias.

Regarding Chronic Kidney Disease, for Anemia Iron administration safety

- Oral iron should not be taken at the same time as phosphate binders - Tell the patient that iron may make the stool dark in color. - Most patients receiving Hemodialysis are prescribed IV iron sucrose injection (Venofer) or sodium ferric gluconate complex in sucrose injection (Ferrlecit). - Supplemental folic acid (1 mg/day) is usually given because it is needed for RBC formation and is removed by dialysis.

Regarding cervical insufficiency, Follow-Up Care after cerclage

- NO NEED FOR BED REST - Progesterone therapy, given either intramuscularly or vaginally - Decisions about physical activity and intercourse are individualized and determined by digital and ultrasound examination - need for close observation and supervision for the remainder of the pregnancy - watch for and report signs of preterm labor, rupture of membranes, and infection. - know the signs that would warrant an immediate return to the hospital, including strong contractions less than 5 minutes apart, preterm premature rupture of membranes, severe perineal pressure, and an urge to push

Systemic Lupus Erythematosus Drug Therapy

- NSAIDs, especially for patients with mild arthralgia or arthritis (monitoring during long-term NSAID use must include potential GI and renal effects) - Antimalarial agents such as hydroxychloroquine and chloroquine are often used to treat fatigue and skin and joint problems (reduce occurrence of flares) (dapsone may be used.) - tapering doses of IV methylprednisolone may manage severe flares of polyarthritis. (Use of corticosteroids should be limited) - Steroid-sparing immunosuppressants such as methotrexate can serve as an alternative treatment for corticosteroids (prescribed with folic acid) - Immunosuppressive drugs such as azathioprine and cyclophosphamide may be used to reduce the need for long-term corticosteroid therapy. (anticoagulants such as warfarin may be prescribed.) - Tacrolimus (Protopic, Prograf) and pimecrolimus (Elidel) for the skin, affecting the butterfly rash and possibly discoid lesions. (Topical immunomodulators) - Lenalidomide can improve cutaneous lupus • NSAIDs for mild disease • Steroid-sparing drugs (e.g., methotrexate) • Antimalarials (e.g., hydroxychloroquine [Plaquenil]) • Corticosteroids for flares and severe disease (predisone) take with food • Immunosuppressive drugs (e.g., cyclophosphamide, mycophenolate mofetil [CellCept])

The use of epidural or intrathecal opioids without the addition of a local anesthetic agent during labor has several advantages. Such as:

- Opioids administered in this manner do not cause maternal hypotension or affect vital signs. - woman feels contractions but not pain - Her ability to bear down during the second stage of labor is preserved

Currently, the only treatments recommended for overweight children are Children and adolescents should avoid

- diet, - exercise, - behavior modification, - in some situations pharmacologic agents, such as orlistat. fad diets.

To diagnose a child with ADHD symptoms must be

- present in at least two settings (e.g., at home and school) - occur before age 12.

Clinical Manifestations of Myocardial Infarction

- Pain (Severe chest pain not relieved by rest, position change, or nitrate administration) - Sympathetic Nervous System Stimulation (release of glycogen, diaphoresis, increased HR and BP, and vasoconstriction AND patient's skin may be ashen, clammy, and cool to touch.) - Cardiovascular Manifestations (BP and HR may be elevated initially. Later, the BP may drop because of decreased cardiac output (CO)) - Nausea and vomiting

Hallucinogen intoxication Intoxication is characterized by clinically significant psychological and behavioral changes. That includes, Treatment for hallucinogen intoxication includes

- Paranoia, - impaired judgment, - intensification of perceptions, - depersonalization, - derealization - talking the patient down. (reassurance that the symptoms are caused by the drug and that the symptoms will subside.) - In severe cases an antipsychotic such as haloperidol (Haldol) or a benzodiazepine such as diazepam (Valium) can be used in the short term.

Obesity Risk Factors

- Parental BMI - Family and cultural eating patterns - racial/ethnic minorities, immigrant and refugee communities, and socioeconomic status, with differences often becoming apparent before 6 years of age. - Genetic influence - Institutional factors (School vending machines) - Many parents use food as a positive reward for desired behaviors. This practice may become a habit, and the child may continue to use food as a reward, a comfort, and a means of dealing with depression or hostility - Frequency of family meals - Lack of exercise

In patients at risk for VTE, a variety of interventions are used. Such as:

- Patients on bed rest should change position at least every 2 hours - Teach patients to flex and extend their feet, knees, and hips at least every 2 to 4 hours while awake - Patients who can get out of bed need to be in a chair for meals and walk at least four to six times per day - Graduated compression stockings (e.g., thromboembolic deterrent [TED] hose) - Knee-length stockings seem to be as effective as thigh-length stockings in the prevention of VTE - Intermittent pneumatic compression devices (IPCs) - Anticoagulation and mechanical prophylaxis are not recommended for acutely ill medical patients at low risk for VTE. But good if used with compression socks.

Tricyclic Antidepressants (TCAs) Contraindications

- People who have recently had a myocardial infarction (or other cardiovascular problems), - those with narrow-angle glaucoma or a history of seizures, - women who are pregnant

Leukemia Diagnostic Studies

- Peripheral blood evaluation (contains immature forms of leukocytes) and bone marrow examination (Definitive diagnosis with infiltrate of blast cells) are the primary method - Morphologic, histochemical, immunologic, and cytogenetic methods are all used to identify leukemic cell types and stages - lumbar puncture and CT scan can detect leukemic cells outside of the blood and bone marrow. - for CML, the finding of the Philadelphia chromosome is an important diagnostic indicator.

Chronic Kidney Disease Clinical Manifestations for Neurologic System

- Peripheral neuropathy - restless legs syndrome - central nervous system (CNS) becomes depressed, resulting in lethargy, apathy, decreased ability to concentrate, fatigue, irritability, and altered mental ability. - Seizures and coma may result from a rapidly increasing BUN and hypertensive encephalopathy. - Muscle twitching, jerking, asterixis (hand-flapping tremor), and nocturnal leg cramps - In patients with diabetic neuropathy, symptoms can be compounded by uremic neuropathy - Dialysis should improve general CNS manifestations and may slow or halt the progression of neuropathies. - Altered mental status, a late manifestation of CKD stage 5, rarely occurs unless the patient has chosen not to have renal replacement therapy.

Precipitating Factors of Angina

- Physical Exertion - Temperature Extremes - Strong Emotions - Consumption of Heavy Meal (e.g., holiday meals) - Tobacco Use and Environmental Tobacco Smoke - Sexual Activity - Stimulants (e.g., cocaine, amphetamines) - Circadian Rhythm Patterns

Sequelae of prenatal cocaine exposure include

- preterm birth, - a smaller head circumference, - decreased birth length, - decreased weight.

Regarding Types of Dysrhythmias, Ventricular Tachycardia Treatment

- Precipitating causes (e.g., electrolyte imbalances, ischemia) must be identified and treated - monomorphic and the patient is clinically stable (i.e., pulse is present) and has preserved left ventricular function, IV procainamide, sotalol, or amiodarone is used - Polymorphic VT with a prolonged baseline QT interval is treated with IV magnesium, isoproterenol, phenytoin (Dilantin), or antitachycardia pacing. Cardioversion is used if drug therapy is ineffective - VT without a pulse is life-threatening. Treated as VF. Cardiopulmonary resuscitation (CPR) and rapid defibrillation are the first lines of treatment, followed by the administration of vasopressors (e.g., epinephrine) and antidysrhythmics (e.g., amiodarone) if defibrillation is unsuccessful

PQRST Assessment of Angina

- Precipitating events: What events or activities precipitated the pain or discomfort (e.g., argument, exercise, resting)? - Quality of pain: What does the pain or discomfort feel like (e.g., pressure, dull, aching, tight, squeezing, heaviness)? - Region (location) and radiation of pain: Can you point to where the pain or discomfort is located? Does the pain or discomfort radiate to other areas (e.g., back, neck, arms, jaw, shoulder, elbow)? - Severity of pain: On a scale of 0 to 10, with 0 indicating no pain and 10 being the most severe pain you could imagine, what number would you give the pain or discomfort? - Timing: When did the pain or discomfort begin? Has it changed since this time? Have you had pain/discomfort like this before?

Risk for Situational Depression

- Problems at work/school - Illness - Death of loved one - Relationship problems, like divorce or fighting - Situational changes such as: retirement, going away to school (college), or divorce - Negative financial situations, such as money problems or losing a job - Life or death experiences such as physical assult, combat, or natural disaster - Existing mental health problems - Several difficult life circumstances happening at once - Biological factors including abnormalities in brain structures and chemistry, hormonal abnormalities, changes in genetics

Regarding Chronic Kidney Disease, Nutritional Therapy includes

- Protein Restriction - Fluid Restriction - Sodium and Potassium Restriction - Phosphate Restriction

Regarding Chronic Kidney Disease, Phosphate binders safety - lanthanum carbonate (Fosrenol), - sevelamer carbonate (Renvela), - iron-based, calcium-free phosphate binders such as sucroferric oxyhydroxide (Velphoro) and ferric citrate (Auryxia)

- administer phosphate binders with each meal. - Constipation is a frequent side effect of phosphate binders, and stool softeners may be needed.

Acute Kidney Injury Ambulatory Care (Outpatient care)

- Protein and potassium intake should be regulated - Regular evaluation of kidney function through appropriate follow-up - Teach the patient the signs and symptoms of recurrent kidney disease. - Emphasize measures to prevent the recurrence of AKI. - The long-term convalescence of 3 to 12 months may cause psychosocial and financial hardships for the patient, caregiver, and family - If the kidneys do not recover, the patient will need to transition to life on chronic dialysis or possible future transplantation.

Laboratory Results in Hemophilia

- Prothrombin time: Normal - Thrombin time: Normal. - Platelet count: Normal. - Partial thromboplastin time: Prolonged - Bleeding time: Prolonged in von Willebrand disease because of structurally defective platelets. Normal in hemophilia A and B because platelets not affected - Factor assays: Reductions of factor VIII in hemophilia A, factor IX in hemophilia B, vWF in von Willebrand disease

Regarding Types of Dysrhythmias, Atrial Flutter Treatment

- Radiofrequency catheter ablation is the treatment of choice - calcium channel blockers and β-blockers - Electrical cardioversion in an emergency and electively - Antidysrhythmia drugs (e.g., ibutilide [Corvert], amiodarone, flecainide, dronedarone [Multaq])

Teach a patient with Chronic Stable Angina:

- Reassure the patient with a history of angina that a long, active life is possible - Help the patient to identify factors that precipitate angina - Tell the patient how to avoid or control these factors. For example, teach the patient to avoid exposure to extremes of weather and eating large, heavy meals. - If a heavy meal is eaten, tell the patient to rest for 1 to 2 hours after the meal because blood is shifted to the GI tract to aid digestion and absorption. - Help the patient to identify personal risk factors for CAD - Teach the patient and caregiver about diets that are low in salt and saturated fats - Maintaining ideal body weight - tell patients that walking briskly on a flat surface at least 30 minutes a day, most days of the week is recommended. - teach the patient and caregiver the proper use of NTG (may be used prophylactically before an emotionally stressful situation, sexual intercourse, or physical exertion) - If needed, arrange for counseling to assess the psychologic adjustment of the patient and caregiver

Drug therapy for Hemophilia and von Willebrand disease

- Replacement Factors - Antifibrinolytic therapy (tranexamic acid [Cyklokapron] and epsilon-aminocaproic acid) - Desmopressin acetate (also known as DDAVP) for hemophilia A and von Willebrand disease

Hemophilia Nursing Implementation

- Reproductive concerns and long-term effects are issues that you should include in the patient's care plan. - Stop topical bleeding as quickly as possible by applying direct pressure or ice, packing the area with Gelfoam or fibrin foam, and applying topical hemostatic agents such as thrombin. - Administer specific coagulation factor to raise the patient's level of the deficient coagulation factor. Monitor the patient for signs and symptoms, such as hypersensitivity. - When joint bleeding occurs, in addition to administering replacement factors, totally rest the involved joint to prevent crippling deformities from hemarthrosis. Pack the joint in ice. Give analgesics (e.g., acetaminophen, codeine) to reduce severe pain. Aspirin and aspirin-containing compounds should never be used. As soon as bleeding ceases, encourage mobilization of the affected area through range-of-motion exercises and physical therapy. Weight bearing is avoided until all swelling has resolved and muscle strength has returned. - Manage any life-threatening complications that may develop as a result of hemorrhage or side effects from coagulation factors. Examples include nursing interventions to prevent or treat airway obstruction from hemorrhage into the neck and pharynx, recognition of compartment syndrome in an extremity, and early assessment and treatment of intracranial bleeding. - pt can be referred to a local chapter of the Hemophilia Federation of America to encourage associations with other individuals who are dealing with the problems of hemophilia - Teach the patient to recognize disease-related problems and to learn which problems can be resolved at home and which require hospitalization - Immediate medical attention is required for severe pain or swelling of a muscle or joint that restricts movement or inhibits sleep and for a head injury, swelling in the neck or mouth, abdominal pain, hematuria, melena, and skin wounds in need of suturing. - Teach the patient to perform daily oral hygiene without causing trauma - Advise the patient to participate only in noncontact sports (e.g., golf) - Teach pt to wear gloves when doing household chores to prevent cuts or abrasions from knives, hammers, and other tools - patient should wear a Medic Alert tag

Chronic Kidney disease complications in children

- Retention of waste products, especially BUN and creatinine - Water and sodium retention, which contributes to edema and vascular congestion - Hyperkalemia - Metabolic acidosis - Calcium and phosphorus disturbances (growth arrest - renal osteodystrophy) - Growth disturbance, probably caused by such factors as renal osteodystrophy - more susceptible to infection, especially pneumonia, UTI, and septicemia

Regarding Acute Coronary Syndrome (UA or MI) Obtain IV access for drug administration. Give

- SL NTG - 162 to 325 mg of aspirin (chewable) if not given before arrival at the ED. - A high-dose statin (atorvastatin [Lipitor]) is started if not already taking prior to the hospitalization. - Morphine sulfate is given for pain unrelieved by NTG.

Anxiety Pharmacological Interventions

- SSRIs are considered the first line of defense in most anxiety and obsessive-compulsive-related disorders. - Monoamine oxidase inhibitors (MAOIs) - Benzodiazepines are most commonly used because they have a quick onset of action. - Buspirone (BuSpar) is an alternative antianxiety medication that does not cause dependence

Situation depression Symptoms

- Sadness - Hopelessness - Lack of enjoyment in normal activities - Regular crying - Constant worrying or feeling anxious or stressed out - Sleeping difficulties - Disinterest in food - Trouble focusing - Trouble carrying out daily activies - Feeling overwhelmed - Avoiding social situations and interactions - Not taking care of important matters like paying bills or going to work - Thoughts of suicide

Assessment of male infertility

- Semen analysis - Hormone analysis - Scrotal ultrasound

Chronic kidney disease Management in children What to do for sodium, phosphorus, calcium?

- Sodium and water are not usually limited unless there is evidence of edema or hypertension, and potassium is not usually restricted. - Dietary phosphorus is controlled through reduction of protein and milk intake to prevent or correct the calcium-phosphorus imbalance. - Phosphorus levels can be further reduced by oral administration of calcium carbonate preparations or other phosphate-binding agents - Treatment with (inactive) 25-OH vitamin D and/or (active) 1, 25-dihydroxy vitamin D is begun to increase calcium absorption and suppress elevated parathyroid hormone levels

Kidney Transplant Recipient Preoperative Care

- Stress that there is a chance the kidney may not function immediately, and dialysis may be required for days to weeks. - Review the need for immunosuppressive drugs and measures to prevent infection. - an ECG, chest x-ray, and laboratory studies are ordered - Dialysis may be required before surgery for fluid overload or hyperkalemia - Because dialysis may be required after transplantation, the patency of the vascular access must be maintained - The vascular access extremity should be labeled "dialysis access, no procedures" to prevent use of the affected extremity for BP measurement, blood drawing, or IV infusions. - A patient on PD must empty the peritoneal cavity of all dialysate solution before going to surgery and have the PD catheter capped.

Regarding substance abuse, Opioid abuse General treatment

- Support groups such as Narcotics Anonymous (NA), a 12-step program, are excellent sources of help - Methadone (Dolophine, Methadose) is used to decrease the painful symptoms of opiate withdrawal (will eventually need to be withdrawn due to dependence) - Neonatal withdrawal is usually mild and can be managed with paregoric. - Buprenorphine is used to help people reduce or quit their use of heroin or other opiates such as pain relievers like morphine. - Naltrexone (Vivitrol) is indicated for the prevention of relapse to opioid dependence, following opioid detoxification. (ReVia, is given once a month.)

Hyperthyroidism Clinical Manifestations

- Sweating - Weight loss - Emotional ability, Exophthalmos - Appetite increase - Tremor, Tachycardia - Intolerance to heat, Irritability - Nervousness - Goiter, GI issues (diarrhea) - Ophthalmopathy (exophthalmos) - Acropachy (clubbing of the digits)

VTE Nursing Implementation teaching includes

- Teach the patient and caregiver the importance of physical activity and assist the patient to ambulate several times a day - teaching on modification of VTE risk factors, importance of monitoring laboratory values, dietary and drug instructions, and guidelines for follow-up. - tell the patient to stop smoking and avoid all nicotine products - Instruct the patient to avoid constrictive clothing. - If appropriate, tell women with a history of VTE to stop oral contraceptives or HT. - Teach patients to limit standing or sitting in a motionless, leg-dependent position. - When traveling long distances, tell patients to frequently exercise the calf muscles, take short walks, and drink nonalcoholic, noncaffeinated beverages - For those at high risk for VTE who are planning a long trip, recommend properly fitted, knee-high graduated compression stockings during travel to decrease edema - Aspirin or anticoagulant use is not suggested for long-distance travelers - Teach the patient and caregiver about signs and symptoms of PE such as sudden onset of dyspnea, tachypnea, and pleuritic chest pain. - Teach the patient and caregiver about drug dosage, actions, and side effects; the need for routine blood tests; and what symptoms need immediate medical attention (Devices are available for home monitoring of INR.) - Teach patients taking LMWH or fondaparinux and their caregivers how to give the drug subcutaneously - Active or young patients need to avoid contact sports and high-risk (for trauma) activities (e.g., skiing) - Tell the patient and caregiver to apply pressure for 10 to 15 minutes if bleeding occurs (e.g., nosebleed). - Tell the patient to avoid excessive amounts of vitamin E and alcohol - Encourage proper hydration to prevent additional hypercoagulability of the blood

Sodium polystyrene sulfonate safety and teaching to patient

- Tell the patient to expect some diarrhea - Never give sodium polystyrene sulfonate to a patient with a hypoactive bowel (paralytic ileus) because fluid shifts could lead to bowel necrosis. - observe the patient for sodium and water retention - dialysis may be required to remove excess potassium if heart changes are noted

Cellulitis nursing interventions

- Temperature monitoring Q4H - Get wound care - Give antipyretic - Give antibiotic - Elevate extremity

Regarding ADHD, To control aggressive behaviors, pharmacological agents including

- stimulants, - mood stabilizers (lithium and anticonvulsants) - alpha-adrenergic agonists (clonidine and guanfacine) - antipsychotics are used.

Venous Thromboembolism (VTE) Clinical findings (Clinical Manifestations)

- Tenderness to pressure over involved vein, induration of overlying muscle, venous distention. - dilated superficial veins, a sense of fullness in the thigh or the calf, paresthesias, warm skin, erythema - systemic temperature greater than 100.4° F - unilateral Edema. - May have mild to moderate pain, deep reddish color to area caused by venous congestion. - If the inferior vena cava is involved, both legs may be edematous and cyanotic (Some patients may have no obvious physical changes in the affected extremity.) - About 5% to 10% of VTEs involve the upper extremity veins and may extend into the internal jugular vein or superior vena cava.

Superficial Vein Thrombosis Clinical findings

- Tenderness, itchiness, redness, warmth, pain, inflammation, and induration along the course of superficial vein. - Vein appears as a palpable cord. - Edema rarely occurs. - mild temperature elevation and leukocytosis may be present - Lower extremity superficial vein thrombosis often involves one or more varicose veins.

Regarding Intimate Partner Violence, A three-phase cycle includes

- Tension building - Abusive incident - Honeymoon phase

The United Network for Organ Sharing (UNOS) distributes deceased donor kidneys using an objective computerized point system. The only exception to the previous plan is if a patient

- The ABO group, - HLA typing, age, - antibody level, - length of time waiting needs an emergency transplant or if a donor and recipient match on all six HLA antigens (zero antigen mismatch). - The patient meeting either one of these criteria goes to the top of the list.

Tools to identify women at risk for eating disorders

- The SCOFF questionnaire - Psych eval

Cirrhosis Ambulatory Care (outpatient care)

- proper diet, rest, - avoidance of potentially hepatotoxic OTC drugs such as acetaminophen in high doses, - abstinence from alcohol - Referral to a community or home health nurse may sometimes be necessary to ensure patient adherence to prescribed therapy.

Regarding Types of Dysrhythmias, Sinus tachycardia Treatment

- The underlying cause of tachycardia guides the treatment. For example, if the patient is experiencing tachycardia from pain, effective pain management is important to treat the tachycardia. - In clinically stable patients, vagal maneuvers can be attempted. In addition, IV β-blockers (e.g., metoprolol [Lopressor]), adenosine (Adenocard), or calcium channel blockers (e.g., diltiazem [Cardizem]) can be given to reduce HR and decrease myocardial O2 consumption. - In clinically unstable patients, synchronized cardioversion is used.

Regarding Types of Dysrhythmias, Premature Atrial Contraction Treatment

- Treatment depends on the patient's symptoms. - Withdrawal of sources of stimulation such as caffeine or sympathomimetic drugs may be needed. - β-Blockers may be used to decrease PACs.

cervical insufficiency treatment

- Treatment of choice is the Cervical cerclage placement due to cervical weakness. - The McDonald technique is often the procedure of choice because of its proven effectiveness and ease of placement and removal - Pelvic rest - Progesterone shots/suppositories - Trendelenburg until cerclage is placed

Regarding Types of Dysrhythmias, Premature Ventricular Contractions (PVC) ECG Characteristics

- Underlying rhythm can be any rate, regular or irregular rhythm, PVCs occur at variable rates - P wave is rarely visible and is usually lost in the QRS complex of the PVC. - PR interval is not measurable - QRS complex is wide and distorted in shape, lasting more than 0.12 second. - T wave is generally large and opposite in direction to the major direction of the QRS complex.

Chronic Kidney Disease Clinical Manifestations for Urinary System

- Uremia - increasing difficulty with fluid retention and require diuretic therapy

Regarding Erectile Disorder, While most men occasionally experience this problem, it is only a disorder if it happens o

75% of sexual occasions and lasts for at least 6 months.

Regarding Acute kidney injury (AKI) phases, Oliguric Phase manifestations

- Urinary Changes (oliguria (reduction in urine), anuria (no urine output) - Fluid Volume (Hypervolemia before treatment, Hypovolemia (volume depletion) after dialysis) ) - Metabolic Acidosis - Sodium Balance (cannot conserve sodium) - Potassium Excess (hyperkalemia) - Hematologic Disorders (Leukocytosis) - Waste Product Accumulation (BUN and serum creatinine levels are elevated) - Neurologic Disorders (mild as fatigue and difficulty concentrating, and escalate to seizures, stupor, and coma)

Cirrhosis Acute Care Meticulous skin care is essential because the edematous tissues are prone to breakdown. What can be done?

- Use an alternating-air pressure mattress or other special mattress. - A turning schedule (minimum of every 2 hours) must be adhered to rigidly. - Support the abdomen with pillows. - If the abdomen is taut, cleanse it gently. - The patient will tend to avoid moving because of abdominal discomfort and dyspnea. - Range-of-motion exercises are helpful. - Implement measures such as coughing and deep breathing to prevent respiratory problems. - The lower extremities may be elevated. - If scrotal edema is present, a scrotal support provides some comfort.

Necrotizing Enterocolitis Care Management

- Vital signs, including BP, are monitored for changes that might indicate bowel perforation, septicemia, or cardiovascular shock - avoid rectal temperatures because of the increased risk for perforation - avoid pressure on the distended abdomen - infants are often left undiapered - infants are positioned supine or side-lying. - Assessment of high-risk infants includes checking the appearance of the abdomen for distention, measuring abdominal girth, measuring residual gastric contents before feedings, and listening for bowel sounds. - Conscientious attention to nutrition and hydration needs is essential - antibiotics are administered as prescribed. - Feeding is usually reestablished using human milk if available. - control of infection. (Strict hand hygiene is the primary barrier to its spread, and confirmed multiple cases of NEC are isolated.) - nurse should be continually alert to signs of complications such as septicemia, DIC, hypoglycemia, and other metabolic derangements.

Regarding Venous Thromboembolism Drug Therapy, Vitamin K antagonists include Whats the values?

- Warfarin: for long-term or extended anticoagulation - Warfarin begins to take effect in 48 to 72 hours. - The level of anticoagulation is monitored daily using the international normalized ratio (INR) - Do not give antiplatelets or NSAIDs with warfarin - Avoid green leafy vegetables - Many other drugs, vitamins, minerals, and dietary and herbal supplements also interact with warfarin INR: - Normal value: 0.75-1.25 - Therapeutic Value: 2-3

Chronic Kidney Disease Clinical Manifestations for Metabolic Disturbances

- Waste Product Accumulation: As GFR ↓, BUN and serum creatinine levels ↑ - Altered Carbohydrate Metabolism (Mild to moderate hyperglycemia and hyperinsulinemia) - Patients with diabetes who develop uremia may require less insulin than before the onset of CKD - Elevated Triglycerides (dyslipidemia)

Regarding Chronic Kidney Disease Nutritional Therapy, Fluid Restriction

- Water and any other fluids are not routinely restricted in patients with CKD stages 1 to 5 who are not receiving Hemodialysis - diuretics are often used - Patients on Hemodialysis have a more restricted fluid intake than patients receiving Peritoneal Dialysis. - Foods that are liquid at room temperature (e.g., gelatin, ice) should be counted as fluid intake. - Patients are advised to limit fluid intake so that weight gains are no more than 1 to 3 kg between dialyses (interdialytic weight gain). - Hemodialysis: Urine output plus 600-1000 mL - Pre-ESRD: As desired or depends on urine output - Peritoneal Dialysis: Unrestricted if weight and BP controlled and residual renal function

Bariatric Surgery Home care

- Weight loss is considerable during the first 6 to 12 months - The diet generally prescribed should be high in protein and low in carbohydrates, fat, and roughage and consist of six small feedings daily. - Fluids should not be ingested with the meal, and in some cases, fluids should be restricted to less than 1000 mL/day - Fluids and foods high in carbohydrate tend to promote diarrhea and symptoms of the dumping syndrome. - calorically dense foods (foods high in fat) should be avoided - Peptic ulcer formation, dumping syndrome, and small bowel obstruction may be seen late in the recovery and rehabilitation stage - Some patients express guilty feelings that weight loss was achieved by surgical interventions rather than by the "sheer willpower"... support them - result of bariatric surgery is the return of fertility in women

Pain relief during a dilation and curettage (D&C) is usually achieved by Before surgery the nurse should

- administering analgesics or sedatives intravenously or orally (conscious sedation) - A paracervical block using a local anesthetic may also be administered reinforces explanations, answers any questions or concerns, and prepares the woman for surgery.

Regarding esophageal and/or gastric varices, Supportive measures during an acute variceal bleed include

- administration of fresh frozen plasma and packed RBCs, vitamin K, and proton pump inhibitors (e.g., pantoprazole [Protonix]). - Lactulose and rifaximin (Xifaxan) may be administered to prevent hepatic encephalopathy from breakdown of blood and the release of ammonia in the intestine. - Antibiotics are given to prevent bacterial infection.

Chronic Kidney Disease Clinical Manifestations for Respiratory System

- With severe acidosis, the respiratory system may attempt to compensate with Kussmaul breathing - Dyspnea may occur as a manifestation of fluid overload, pulmonary edema, uremic pleuritis (pleurisy), pleural effusions, and respiratory infections (e.g., pneumonia).

Regarding Nonpharmacologic Strategies to Encourage Relaxation and Relieve Pain, Tub hydrotherapy may be contraindicated for some women. Such as

- Women who require continuous electronic fetal heart rate (FHR) monitoring are not candidates for hydrotherapy unless waterproof monitors are available - Women with fever (≥38° C/100.4° F), - infectious diseases (e.g. HIV+, active herpes simplex virus), - vaginal bleeding greater than a normal bloody show - preterm labor (gestational age <37 weeks)

Bacterial Meningitis Diagnostic Studies

- a blood culture (When a patient has manifestations suggestive) - CT (When a patient has manifestations suggestive) - Diagnosis is usually verified by doing a lumbar puncture with analysis of the CSF - A lumbar puncture should be completed only after the CT scan has ruled out an obstruction - Specimens of the CSF, sputum, and nasopharyngeal secretions are taken for culture before the start of antibiotic therapy - A Gram stain is done to detect bacteria - X-rays of the skull may demonstrate infected sinuses - CT scans and MRI may be normal in uncomplicated meningitis - CT scans may reveal evidence of increased ICP or hydrocephalus.

Regarding Hemodialysis, with Arteriovenous Fistulas what can be felt/heard? Arteriovenous grafts (AVGs) need how long to heal and are more likely to have what happen to them?

- a thrill (buzzing sensation) can be felt by palpating the fistula, - a bruit (rushing sound) can be heard with a stethoscope - An interval of 2 to 4 weeks is usually necessary to allow the graft to heal but may be used earlier. - Because grafts are made of artificial materials, they are more likely than AVFs to become infected, and they also have a tendency to be thrombogenic

Variability is quantified in beats per minute and is measured from the peak to the trough of a single cycle. Four possible categories of variability have been identified

- absent, - minimal, - moderate, - marked

By combining the acute and chronic categories with the cell type involved, one can identify four major types of leukemia:

- acute lymphocytic leukemia (ALL), - acute myelogenous leukemia (AML), - chronic myelogenous (granulocytic) leukemia (CML), - chronic lymphocytic leukemia (CLL)

Breast Cancer Ambulatory Care (outpatient care)

- advise the patient to report symptoms such as fever, inflammation at the surgical site, erythema, postoperative constipation, and unusual swelling - Other changes to report are new back pain, weakness, shortness of breath, and change in mental status, including confusion. - For women who have had a mastectomy without breast reconstruction: garments such as camisoles with soft breast prosthetic inserts or a fitted prosthesis with bra, Should the woman choose a breast prosthesis, a certified fitter can help her select a comfortable, more permanent weighted prosthesis and bra, generally at 4 to 8 weeks postoperatively - A woman taking hormone therapy may have a decreased sexual drive or vaginal dryness. She may need to use lubrication to prevent discomfort during intercourse - After treatment for breast cancer, the patient will have ongoing survivorship care - advise breast cancer survivors to perform monthly BSE and chest wall self-examination - Breast cancer survivors should have an annual mammogram

Chronic kidney disease Management in children

- allowed unrestricted activity and is allowed to set his or her own limits regarding rest and extent of exertion. - School attendance is encouraged as long as the child is able. When the effort is too great, home tutoring is arranged. - Diet regulation is the most effective - Dietary protein intake is limited only to the reference daily intake (Recommended Dietary Allowance [RDA]) for the child's age. (Restriction of protein intake below the RDA is believed to negatively affect growth) - regular dental care is important in these children.

Regarding Alcohol Withdrawal, Wernicke's encephalopathy is characterized by Wernicke's encephalopathy responds rapidly to

- altered gait, - vestibular dysfunction, - confusion, - several ocular motility abnormalities (horizontal nystagmus, lateral orbital palsy, and gaze palsy). large doses of intravenous thiamine two to three times daily for 1 to 2 weeks

The most serious reaction to the MAOIs is Therefore routine monitoring of

- an increase in blood pressure with the possible development of intracranial hemorrhage, - hyperpyrexia, - convulsions, - coma, - death. - hypertensive crisis is a constant concern blood pressure, especially during the first 6 weeks of treatment, is necessary.

For preterm infants, The three primary methods for maintaining a neutral thermal environment are the use of close observations required with a high-risk infant are best accomplished if the infant remains Skin-to-skin (kangaroo) contact between a

- an incubator - a radiant warming panel, - an open bassinet with cotton blankets. partially unclothed stable preterm infant and parent is also a viable option for interaction because of the maintenance of appropriate body temperature by the infant.

Regarding hormonal therapy, Aromatase inhibitor drugs include do not block the production of estrogen by the ovaries. Thus they are of little benefit and may be harmful in Possible side effects

- anastrozole, - letrozole (Femara), - exemestane (Aromasin). premenopausal women. (use of an aromatase inhibitor for 10 years in postmenopausal women who are hormone receptor-positive) - osteoporosis and bone fractures - increase cholesterol - night sweats, nausea, arthralgias, and myalgias. - use caution if driving or using machinery because this medication may cause drowsiness or dizziness

There is strong evidence that childhood bullies are at risk of developing

- antisocial behaviors as adults - likely to have more criminal convictions and traffic violations than their less aggressive peers.

Hyperthyroidism Nursing Implementation If exophthalmos is present, there is a potential for corneal injury related to irritation and dryness. To relieve eye discomfort and prevent corneal ulceration:

- apply artificial tears to soothe and moisten conjunctival membranes - Salt restriction may help reduce periorbital edema - Elevate the patient's head to promote fluid drainage from the periorbital area. The patient should sit upright as much as possible. - Dark glasses reduce glare and prevent irritation - If the eyelids cannot be closed, lightly tape them shut for sleep. - To maintain flexibility, teach the patient to exercise the intraocular muscles several times a day by turning the eyes in the complete range of motion - Good grooming can help reduce the loss of self-esteem from an altered body image. - If the exophthalmos is severe, treatment options include corticosteroids, radiation of retroorbital tissues, orbital decompression, or corrective lid or muscle surgery.

Therapeutic treatment options for empyema include

- appropriate antibiotic therapy (necessary to eradicate the causative organism), - percutaneous drainage, - tube thoracostomy, - VATS, - intrapleural fibrinolytic therapy (instilled via the chest tube) to dissolve fibrous adhesions, - decortication, and open window thoracostomy.

Procedure for Hemodialysis Before beginning treatment Nursing interventions While the patient is on dialysis, take vital signs

- assess fluid status (weight, BP, peripheral edema, lung and heart sounds), - condition of vascular access, and temperature. - The difference between the last postdialysis weight and the present predialysis weight determines the ultrafiltration or the amount of weight (from fluid) to be removed. at least every 30 to 60 minutes because rapid BP changes may occur.

Acute alcohol toxicity nursing interventions

- assess for injuries, diseases, and hypoglycemia - No antidote for alcohol is available. - Implement supportive care measures to maintain airway, breathing, and circulation (the ABCs) until the alcohol metabolizes - Treat alcohol-induced hypotension with IV fluids. - Patients with hypoglycemia may receive glucose-containing IV solutions. - IV thiamine may be given before or with IV glucose solutions to prevent Wernicke-Korsakoff syndrome, which can cause seizures and brain damage - patients may have low serum magnesium levels and other signs of malnutrition, so HCPs frequently add multivitamins and magnesium to the IV fluids. - Assess the patient for increasing belligerence and a potential for violence - patient is at risk for injury because of lack of coordination and impaired judgment, use protective measures.

Signs of a spinal headache

- assuming an upright position triggers or intensifies the headache whereas assuming a supine position achieves relief - The resulting headache, auditory problems (e.g., tinnitus), and visual problems (e.g., blurred vision, photophobia) begin within 2 days of the puncture and may persist for days or weeks.

Regarding Types of Dysrhythmias, Atrial Fibrillation ECG Characteristics

- atrial rate may be as high as 350 to 600 beats/minute - Ventricular rate > or <100 beats/min and irregular - P waves are replaced by chaotic, fibrillatory waves - PR interval is not measurable - QRS complex usually has a normal shape and duration

Teaching during labor regarding position

- avoiding the supine position because it can cause hypotension, which impairs placental perfusion and fetal oxygenation. - Instead the woman should be encouraged to maintain the side-lying or semi-Fowler's position with a lateral tilt to the uterus. - nurse should instruct the woman to keep her mouth and glottis open and to let air escape from her lungs as she pushes.

Regarding esophageal and/or gastric varices, how to prevent rebleeding

- band ligation (Endoscopic variceal ligation (EVL, or "banding" around the base of the varix (enlarged vein)) - sclerotherapy of varices (injection of a sclerosing solution into the swollen veins)

After the pacemaker has been inserted, the patient can do what? What should a nurse check for? When can they be discharged?

- be out of bed once stable. Limit arm and shoulder activity on the operative side to prevent dislodging the newly implanted pacing leads. - Observe the insertion site for signs of bleeding, and check that the incision is intact. - Note any temperature elevation or pain at the insertion site and treat as ordered. - Most patients are discharged the next day if stable.

Regarding Cycle of Violence, The tension-building stage

- begins with minor incidents such as pushing, shoving, and verbal abuse. - victim often ignores or accepts the behavior due to fear of escalation. - Abusers rationalize that their behavior is acceptable. - tension builds, both try to reduce it. Abuser may try to reduce the tension with the use of alcohol or drugs, and Victim may try to reduce the tension by minimizing the importance of the incidents ("I should have had the house neater).

Treatment plans for Autism include

- behavior management with a reward system, - teaching parents to provide structure, rewards, consistency in rules, - expectations at home to shape and modify behavior and foster the development of socially appropriate skills.

Risk factors for a second-trimester loss (late miscarriage) include

- being a member of a racial or ethnic minority group, - poor outcomes in previous pregnancies, - extremes of maternal age - severe dietary deficiencies, - morbid obesity, - regular or heavy alcohol use, - excessive (about 500 mg daily) caffeine intake

Regarding Types of Dysrhythmias, Ventricular Tachycardia Clinical Significance and symptoms What can happen?

- can be stable (patient has a pulse) or unstable (patient is pulseless). - results in hypotension, pulmonary edema, decreased cerebral blood flow, and cardiopulmonary arrest. - must be treated quickly, even if it occurs only briefly and stops abruptly. - may recur if prophylactic treatment is not started. - VF may also develop.

Chronic Kidney Disease Clinical Manifestations for Reproductive System

- can experience infertility and a decreased libido - Patients who become pregnant while receiving dialysis have been able to carry a fetus to term, but there is significant risk to the mother and infant. - Sexual dysfunction - peripheral neuropathy can cause impotence in men and anorgasmy in women - low sperm count

When the crisis of the immediate suicide attempt has been resolved, what should a nurse do

- careful questioning to determine lethality is in orde - consider admission to an inpatient psychiatric unit if talking about doing it again - if the patient is talking about future plans and about staying "for the sake of the children," outpatient referrals are appropriat

Regarding ACS (UA and MI) patients, Nursing care for the patient with a CABG involves

- caring for the surgical sites (e.g., leg, chest, arm). - Care of the leg incision is minimal since endoscopy is used to harvest the vein. - Chest incisions are usually closed with Dermabond and do not require dressings. - Management of the chest wound, which involves a sternotomy, is similar to that of other chest surgeries - Care of the radial artery harvest site includes monitoring sensory and motor function of the hand. - manage pain - prevent venous thromboembolism (e.g., early ambulation, sequential compression device) - respiratory complications (e.g., use of incentive spirometer, splinting during coughing and deep-breathing exercises)

Clinical manifestations of Hepatic encephalopathy are Changes may occur

- changes in neurologic and mental responsiveness; - impaired consciousness; - inappropriate behavior, forgetfulness, poor concentration, personality change - ranging from sleep disturbances to trouble concentrating to deep coma - asterixis (flapping tremors) - apraxia (inability to construct simple figures) - hyperventilation, - hypothermia, - tongue fasciculations, - grimacing and grasping reflexes. - Fetor hepaticus (musty, sweet odor of the patient's breath) - depression (1) suddenly because of an increase in ammonia in response to bleeding varices or infection (2) gradually as blood ammonia levels slowly increase.

Regarding infants with HF, To minimize disturbing the infant,

- changing bed linens and complete bathing are done only when necessary. - Feeding is planned to accommodate the infant's sleep and wake patterns. - The child is fed at the first sign of hunger, such as when sucking on fists, rather than waiting until he or she cries for a bottle because the stress of crying exhausts the limited energy supply.

Women with generalized anxiety disorder may experience

- chest tightness, - shortness of breath, - tachycardia - dizziness or lightheadedness, - sweating, - trembling, - nausea, - abdominal pain, - fatigue, - constant worry, - sense of doom, - difficulty concentrating

chronic stable angina Diagnostic Studies

- chest x-ray - 12-lead ECG - echocardiogram - exercise stress test with or without echocardiography or nuclear imaging may be ordered - For patients with physical limitations in walking, a pharmacologic (adenosine [Adenocard] or dipyridamole [Persantine]) stress test with nuclear imaging, or a pharmacologic (dobutamine [Dobutrex]) stress echocardiogram may be ordered. - electron beam computed tomography (EBCT) scan - Coronary computed tomography angiography (CCTA)

Prenatal diagnosis of Down syndrome is possible through

- chorionic villus sampling and amniocentesis (because chromosome analysis of fetal cells can detect the presence of trisomy or translocation.) - recent advances in development of noninvasive prenatal testing (NIPT) is a measurement of cell-free deoxyribonucleic acid (DNA)

Cirrhosis Nutritional Therapy

- cirrhosis without complications is high in calories (3000 cal/day) with high carbohydrate content and moderate to low levels of fat - Protein restriction may be appropriate in some patients immediately after a severe flare of symptoms (i.e., episodic hepatic encephalopathy). (NOT persistent hepatic encephalopathy) - For alcoholic cirrhosis: Oral nutritional supplements containing protein from branched-chain amino acids... Parenteral nutrition or enteral nutrition therapy may be required, although rarely used, and only reserved for severe cases of malnutrition. - The patient with ascites and edema is put on a low-sodium diet. (sodium is present in baking soda and baking powder) (Seasonings such as garlic, parsley, onion, lemon juice, and spices may make food more appetizing suggest these)

Regarding down syndrome, Measures to lessen respiratory problems include

- clearing the nose with a bulb-type syringe, - rinsing the mouth with water after feedings, - increasing fluid intake, a - using a cool-mist vaporizer to keep the mucous membranes moist and the secretions liquefied. - changing the child's position frequently, - practicing good hand washing, - properly disposing of soiled articles, such as tissue

Several physical problems are associated with Down syndrome

- congenital heart malformations, the most common being septal defects. - Respiratory tract infections are prevalent and, when combined with cardiac anomalies, are the chief causes of death (especially during the first yr of life) - Hypotonicity of chest and abdominal muscles and dysfunction of the immune system - thyroid dysfunction, especially congenital hypothyroidism, - increased incidence of leukemia.

Side Effects of Immunotherapy and Targeted Therapy What is given for this? What to monitor

- constitutional flu-like symptoms, including headache, fever, chills, myalgias, fatigue, malaise, weakness, photosensitivity, anorexia, and nausea. - capillary leak syndrome, which can result in pulmonary edema - Acetaminophen administered every 4 hours, as prescribed, often reduces the severity of the flu-like syndrome - IV meperidine (Demerol) has been used to control the severe chills or rigors monitoring vital signs and temperature, planning for periods of rest for the patient, assisting with activities of daily living (ADLs), and monitoring for adequate oral intake.

For a patient with ACS (UA and MI) a nurse should monitor

- continuous ECG monitoring - Dysrhythmias must be identified quickly and treated (During the initial period after MI, ventricular fibrillation is the most common lethal dysrhythmia) - Monitor the patient for reinfarction or ischemia by monitoring the ST segment for shifts above or below the baseline of the ECG - Silent ischemia can occur without subjective symptoms (e.g., chest pain). It is noted by ST segment changes only - Notify the HCP if you see ST segment changes without any clinical symptoms - Assess heart and breath sounds and any signs of early HF (e.g., dyspnea, tachycardia, pulmonary congestion, distended neck veins) - monitor intake and output at least once a shift. - patient's oxygenation status

Regarding the loss of estrogen, Changes most critical to a woman's well-being are the increased risks for Other changes include a

- coronary artery disease (CAD) (↑ Rate of atherosclerosis) - osteoporosis (secondary to bone density loss) - redistribution of fat, - a tendency to gain weight more easily, - muscle and joint pain, - loss of skin elasticity, - changes in hair amount and distribution, - atrophy of external genitalia and breast tissue. - Vasomotor instability (hot flashes) and irregular menses - thinning of the vaginal mucosa and disappearance of rugae

Phencyclidine intoxication (Hallucinogen) PCP intoxication is a medical emergency that can result in PCP Treatment

- dangerous and violent side effects - belligerent, assaultive, impulsive, and unpredictable - nystagmus (involuntary eye movements), - hypertension, - tachycardia, - diminished response to pain, - ataxia (loss of voluntary muscle control), - dysarthria (unclear speech), - muscle rigidity, seizures, - coma, - hyperacusis (sensitivity to sound). - Hyperthermia - seizure activity - cannot be talked down and may require restraint and a calming medication such as a benzodiazepine. - Mechanical cooling may be necessary for severe hyperthermia.

Regarding Types of Dysrhythmias, Atrial Fibrillation results in a

- decrease in CO because of ineffective atrial contractions (loss of atrial kick) and/or a rapid ventricular response. - Thrombi (clots) form in the atria because of blood stasis. - An embolized clot may develop and move to the brain, causing a stroke. Atrial fibrillation accounts for as many as 17% of all strokes

Symptoms associated with autism spectrum disorder include

- deficits in social relatedness, which are manifested in disturbances in developing and maintaining relationships - stereotypical repetitive speech or body movements - obsessive focus on specific objects, - overadherence to routines or rituals, - hyperreactivity or hyporeactivity to sensory input (tag on shirt), - extreme resistance to change - language delay - may not communicate effectivity, repeat question instead of answering - lack of social interaction, failure to share enjoyment or emotions - abnormal eye movements or gestures - prefer symmetry

Bulimia Complications can include

- dehydration - electrolyte imbalance, - gastrointestinal abnormalities, - cardiac dysrhythmias

When survival is in doubt, parents may be reluctant to establish a relationship with their infant. They prepare themselves for the infant's death while continuing to hope for recovery. This anticipatory grief and hesitancy to embark on a relationship are evidenced by behaviors such as

- delay in giving the infant a name, - reluctance in visiting the nursery (or when they do visit, focusing on equipment and treatments rather than on their infant), - hesitancy to touch or handle the infant when given the opportunity.

Key Assessment Findings of depression

- depressed mood and anhedonia - Anxiety - dwell on and exaggerate their perceived faults and failures and are unable to focus on their strengths and successes - Feelings of worthlessness, hopelessness, guilt, anger, and helplessness

Decreasing blood serum estrogen levels can cause an array of physical and cognitive changes during menopause that include

- depression, - irritability, - insomnia, - memory loss.

Regarding substance abuse with opioids, with treatment Some serious side effects may occur while taking methadone. Patients should be instructed to seek medical care if they experience

- difficulty breathing or shallow breathing, - feel lightheaded or faint, - experience chest pain or a fast or pounding heartbeat. - Hives, rash, or swelling of the face, lips, tongue, or throat - Hallucinations or confusion should also be reported

Chronic Kidney Disease Diagnostic Studies

- dipstick evaluation of protein in the urine or evaluation for albuminuria - urine of patients with diabetes must be examined for albuminuria if no protein is detected on routine urinalysis - persistent proteinuria (1+ protein on standard dipstick testing two or more times over a 3-month period) should have further assessment of risk factors and a diagnostic workup with blood and urine tests to evaluate for CKD - A urinalysis can detect RBCs, WBCs, protein, casts, and glucose. - An ultrasound of the kidneys is usually done to detect any obstructions and determine the size of the kidneys - A kidney biopsy may be necessary to provide a definitive diagnosis. - Serum creatinine alone poorly reflects kidney function. - GFR is the preferred measure to determine kidney function. • Identification of reversible kidney disease • BUN, serum creatinine, and creatinine clearance levels • Serum electrolytes • Lipid profile • Protein-to-creatinine ratio in first morning voided specimen • Hematocrit and hemoglobin levels

Regarding breast cancer nurse implications, Post mastectomy nursing implications

- discharged from the hospital within 24 to 48 hours after a mastectomy - Restoring arm function on the affected side after breast cancer surgery is a key nursing goal - Postoperative arm and shoulder exercises, which are started gradually - administering analgesics regularly when the patient is in pain and about 30 minutes before initiating exercises - When the patient is able to shower, the warm water on the involved shoulder often relaxes the muscle

Medical treatment of infants with confirmed Necrotizing enterocolitis (NEC) consists of

- discontinuation of all oral feedings; - institution of abdominal decompression via NG suction; - administration of IV antibiotics; - correction of extravascular volume depletion, electrolyte abnormalities, acid-base imbalances, and hypoxia - Replacing oral feedings with parenteral fluids - If severe surgical treatment and Intestinal transplantation

Sexualized behavior is one of the most common symptoms of sexual abuse in children. Younger children may have precocious sexual knowledge, may

- draw sexually explicit images, or demonstrate sexual aggression. - One telling clue is when a child acts out sexual interactions in play, for example, with dolls. - Masturbation may be excessive in sexually abused children. - In older children, sexual promiscuity is one of the most common symptoms of sexual abuse, and there is a strong connection between sexual abuse and later promiscuity.

Management of epilepsy has four treatment options:

- drug therapy, - the ketogenic diet, - vagus nerve stimulation (VNS), - epilepsy surgery.

tricyclic antidepressants (TCAs) side effects How about for older people?

- dry mouth, blurred vision, tachycardia, constipation, urinary retention, and esophageal reflux are common - urinary retention and severe constipation warrant immediate medical attention - The most serious effects of the TCAs are cardiovascular: dysrhythmias, tachycardia, myocardial infarction, and heart block. Because the cardiac side effects are so serious, TCA use is considered a risk in older adults and patients with cardiac disease. Postural hypotension can lead to dizziness and increase the risk of falls. For this reason older patients on TCAs must be monitored carefully for dizziness and falls.

Pleural effusion Clinical Manifestations

- dyspnea - cough - occasional sharp, nonradiating chest pain that is worse on inhalation - Physical examination of the chest may indicate decreased movement of the chest on the affected side, dullness to percussion, and diminished breath sounds over the affected area.

Regarding ADHF, Clinical manifestations of pulmonary edema

- dyspnea - orthopnea (unable to lie flat due to shortness of breath) - Jugular venous distention - anxious, pale, and possibly cyanotic - skin is clammy and cold from vasoconstriction - wheezing and coughing with the production of frothy, blood-tinged sputum - HR is rapid, and an abnormal S3 or S4 heart sound may be auscultated - BP may be elevated or decreased depending on the severity of the HF - absence of crackles does not rule out ADHF

Regarding Chronic Stable Angina drug therapy, Instruct the patient in the proper use of NTG (Nitroglycerin), this includes: How is it strored? How is it used?

- easily accessible to the patient at all times. - store the tablets away from light and heat sources, including body heat, to protect them from degradation - Tablets are packaged in light-resistant bottles with metal caps. Once opened, the tablets lose potency, and should be replaced every 6 months. - Tell the patient to sit down and place a NTG tablet under the tongue and allow it to dissolve. - If using the spray, the patient should direct it on the tongue, not inhale it. - Caution the patient to change positions slowly after NTG use because orthostatic hypotension may occur.

How to Prevent Crippling Effects of Bleeding in children As a result of repeated episodes of hemarthrosis, incompletely absorbed blood in the joints, and limitation of motion, bone and muscle changes occur that result in flexion contractures and joint fixation. During bleeding episodes, the joint is

- elevated and immobilized. - Active range-of-motion exercises are usually instituted after the acute phase. This allows the child to control the degree of exercise according to the level of discomfort. - If an exercise program is instituted in the home, a physical therapist or public health nurse may need to supervise compliance with the regimen. - Rarely, orthopedic intervention (e.g., casting, application of traction, or aspiration of blood) may be necessary to preserve joint function - Diet is also an important consideration because excessive body weight can increase the strain

Regarding Peritoneal Dialysis, Preparation of the patient for catheter insertion includes Once the catheter incision site is healed, the patient may Daily catheter care varies. Some patients just Teach all patients to examine their catheter site for

- emptying the bladder and bowel, - weighing the patient, - obtaining a signed consent form. shower and then pat the catheter and exit site dry - wash with soap and water and go without a dressing, whereas others require daily dressing changes. signs of infection. Showering is preferred to bathing.

The drugs used to treat absence and myoclonic seizures include

- ethosuximide (Zarontin), - divalproex, - clonazepam (Klonopin).

Regarding Types of Dysrhythmias, Sinus tachycardia is associated with physiologic and psychologic stressors such as

- exercise, fever, pain, hypotension, hypovolemia, anemia, hypoxia, hypoglycemia, myocardial ischemia, heart failure (HF), hyperthyroidism, anxiety, and fear. - It can also be an effect of drugs such as epinephrine, norepinephrine (Levophed), atropine, caffeine, theophylline, or hydralazine. - over-the-counter cold remedies have active ingredients (e.g., pseudoephedrine [Sudafed]) that can cause tachycardia.

Anorexia criteria for hospitalization

- extreme electrolyte imbalance - weighs below 75% of ideal body weight - less than 10% body fat, - a daytime heart rate of less than 50 beats per minute, - a systolic blood pressure of less than 90, - a temperature of less than 96, - arrhthymias.

Anorexia nervosa clinically manifests as

- extreme thinness, - Sinus bradycardia - unwillingness to maintain a healthy weight, - intense fear of gaining weight, - Hypotension - distorted body image, - lanugo (soft, downy hair covering the body except the palms and soles), - refusal to eat, - continuous dieting, - hair loss, - sensitivity to cold, - compulsive exercise, - dry and yellowish skin, - constipation, - absent or irregular menstruation in women of childbearing age - Bloating - Evidence of muscle wasting (cachectic appearance) - Bone pain with exercise - acrocyanosis - breast atrophy

Economic abuse may take the form of

- failure to provide for the needs of the victim when adequate funds are available. Bills may be left unpaid by the person in charge of finances, which may result in disconnection of the heat or electricity. - In the case of spousal abuse, the perpetrator may prevent the victim from pursuing education or finding a job, thereby ensuring dependency.

Regarding substance abuse, Stimulant Withdrawal The patient may be depressed and experience Supportive care includes

- fatigue, - prolonged sleep, - vivid dreams - irritability, - increased appetite, - disorientation. - suicidal thoughts - maintaining a quiet environment and allowing the patient to sleep and eat as desired. - If a patient has severe depression, initiate suicide precautions and refer for further treatment. - depression can be treated with antidepressants such as bupropion (Wellbutrin) - Individual, family, and group therapy - Antipsychotics may be prescribed for a few days - if no psychosis, diazepam (Valium) is useful in treating agitation and hyperactivity. - Unscheduled urine drug testing is usually warranted.

One of the most distressing side effects of several chemotherapy drugs is gastrointestinal mucosal cell damage, which results in ulcers anywhere along the alimentary tract. Some interventions that are helpful when oral ulcers develop are (Stomatitis, Mucositis, Esophagitis)

- feeding a bland, moist, soft diet; - using a soft sponge toothbrush (Toothette) instead of a toothbrush; - frequently rinsing the mouth with chlorhexidine mouthwash or sodium bicarbonate and salt mouth rinses (using a solution of 1 tsp of baking soda and tsp of table salt in 1 quart of water); - using sucralfate; - administering local anesthetics without alcohol, such as a solution of diphenhydramine and Maalox (aluminum and magnesium hydroxide) - A satisfactory method of cleaning the gums is to wrap a piece of gauze around a finger; soak it in saline or plain water; and swab the gums, palate, and inner cheek surfaces with the finger - Children should perform mouth care routinely before and after any feeding and as often as every 2 to 4 hours - Drinking can usually be encouraged if a straw Avoid agents such as lemon glycerin swabs and hydrogen peroxide because of the drying effects

Postpartum depression symptoms

- feelings of doom - lack of joy - difficulty concentrating - extreme anxiety - intense anger - emotional numbness - feeling like you should have never became a mother - feeling unable to care for yourself or you baby - thoughts of hurting yourself or your baby - desire to withdraw from others including you baby - guilt - exhaustion

Kidney Transplant Recipient Postoperative Care for Kidney Transplant Recipient

- first priority is maintenance of fluid and electrolyte balance - kidney transplant recipients spend the first 12 to 24 hours in the ICU - Urine output is replaced with fluids milliliter for milliliter hourly for the first 12 to 24 hours. - Central venous pressure readings are essential for monitoring - Dehydration must be avoided - Electrolyte monitoring to assess for the hyponatremia and hypokalemia often associated with rapid diuresis is critical. - Treatment with potassium supplements or infusion of 0.9% normal saline may be indicated. - IV sodium bicarbonate may also be required if the patient develops metabolic acidosis - Acute tubular necrosis (ATN) in the transplanted kidney can occur because of prolonged cold times - While the patient is in ATN, dialysis is required to maintain fluid and electrolyte balance. - Other patients have oliguric or anuric ATN. These patients are at risk for fluid overload and must be assessed closely for the need for dialysis. - A sudden decrease in urine output in the early postoperative period is a cause for concern. It may be due to dehydration, rejection, a urine leak, or obstruction (blood clot) - If blood clots are suspected, gentle catheter irrigation (if ordered) can reestablish patency. - With a hospital length of stay averaging 4 to 5 days, discharge planning and teaching needs must be identified and addressed early in the hospital course. - Teach to recognize signs of rejection, infection, and any complications of surgery

Substance abuse Acute Intervention

- first priority of care is supporting the patient's ABCs, especially respiratory status. - assessing neurologic status and vital signs, - administering IV fluids to prevent dehydration, - orienting to time and place, - implementing patient safety measures. - Although blood and urine tests will help identify the substances, treatment is started while waiting for the test results - patient in this situation would usually receive naloxone. (If the patient does not respond to a total dose of 10 mg of naloxone, it is unlikely opioids are involved.) - If the substance used is a barbiturate or another CNS depressant, naloxone will not help the patient, but it will not hurt the patient either. - promote behavior change

Chemical pleurodesis steps

- first requires chest tube drainage of the effusion. - Once the fluid is drained, a chemical slurry is instilled into the pleural space. - The chest tube is clamped for 8 hours while the patient is turned in different positions to allow the chemical to contact the entire pleural space. - After 8 hours the chest tube is unclamped and attached to a drainage unit. - Chest tubes are left in place until fluid drainage is less than 150 mL/day and no air leaks are noted.

How to prevent or assess for complications for a pacemaker?

- prophylactic IV antibiotic therapy before and after insertion, - postinsertion chest x-ray to check lead placement and to rule out a pneumothorax, - careful observation of insertion site, - continuous ECG monitoring of the patient's rhythm.

ADHD Behavioral Therapy

- focuses on the prevention of undesired behavior - identify new appropriate contingencies and reward systems to meet the child's developing needs - Parents receive instruction in effective parenting skills, such as delivering positive reinforcement, rewarding small increments of desired behaviors, and providing age-appropriate consequences (e.g., time-out, response cost) - use of organizational charts for completing self-care activities and the use of a word processor instead of manually writing assignments are emphasized

Regarding Venous Thromboembolism Drug Therapy, Factor Xa inhibitors include How is it monitored? What if bleeding occurs?

- fondaparinux (Arixtra) given subcutaneously - rivaroxaban (Xarelto) oral drug - apixaban (Eliquis) oral drug - edoxaban (Savaysa) oral drug All are used for both VTE treatment and prophylaxis. Although coagulation monitoring or dose adjustment is not needed, the drug's anticoagulant activity can be measured using anti-Xa assays If uncontrollable bleeding occurs, recombinant factor VIIa may be useful.

Regarding Electronic Fetal Monitoring, The IUPC can objectively measure the

- frequency, - duration, - intensity of UCs and uterine resting tone.

For ADHD, The most common side effects of atomoxetine are Key aspects to assess/monitor? Patients and their families should be Atomoxetine should be used with extreme caution in those patients with

- gastrointestinal disturbances, - reduced appetite, - weight loss, - urinary retention, - dizziness, - fatigue, - insomnia. - liver injury in some patients - a small increase in blood pressure and heart rate. Ongoing monitoring of vital signs and regular screening of liver function are key aspects of assessment. clearly educated on the risks and benefits of treatment before starting this medication comorbid depression since its use has been associated with an increased suicidal ideation.

Anxiety disorders are common during the postpartum period; these include Whos at greatest risk for postpartum anxiety

- generalized anxiety, - panic, - obsessive-compulsive, - social anxiety disorders. Women with a history of anxiety disorder are at greatest risk.

Regarding Types of Dysrhythmias, for the patient with Sinus Bradycardia and symptoms, treatment consists of

- giving IV atropine (anticholinergic drug). - If atropine is ineffective, transcutaneous pacing or a dopamine or epinephrine (Adrenalin) infusion is considered. - Permanent pacemaker therapy may be needed

Nursing Management for Erectile Dysfunction

- great deal of emotional support for both himself and his partner. (Reassure the patient that confidentiality will be maintained.) - Conducting routine health assessments on men seeking any form of medical treatment places you in a unique position. - Be aware that increasing numbers of men are seeking alternate methods for obtaining medications to treat their ED. This can include compounding pharmacies and online pharmacies. Seeking alternate methods can be due to both the cost of these medications and lack of insurance coverage for ED.

Advantages of LMWH over unfractionated heparin include

- greater bioavailability, subcutaneous administration, and longer duration of therapeutic effect; furthermore, monitoring the aPTT is not necessary or useful with LMWH. - Unfractionated IV heparin can be as effective but is more difficult to titrate to therapeutic levels.

Characteristics of adult separation anxiety disorder include

- harm avoidance, - worry, - shyness, - uncertainty, - fatigability, - a lack of self-direction

Tobacco Cessation Nursing Intervention

- help people stop smoking or using tobacco - Patients who receive even brief advice and intervention from you are more likely to quit than those who receive no intervention. - Use these brief clinical interventions, called the "5 As," with each patient encounter. (help you identify tobacco users, encourage them to quit, determine their willingness to quit, assist them in quitting, and arrange for follow-up.)

The two major types of hemophilia, which can occur in mild to severe forms, are

- hemophilia A (classic hemophilia, factor VIII deficiency) - hemophilia B (Christmas disease, factor IX deficiency).

0.9% Normal Saline is one of the most common IV fluids, it is used in

- hemorrhage, - vomiting, - diarrhea, - hemorrhage, - drainage from GI suction, - metabolic acidosis, - shock - hyponatremic, probably NS because it replaces sodium and doesn't pull fluids into or out of the vascular space.

Regarding Hyperthyroidism and nutritional therapy, Teach the patient to avoid

- highly seasoned and high-fiber foods because these foods can further stimulate the already hyperactive GI tract. - caffeine-containing liquids such as coffee, tea, and cola to decrease the restlessness and sleep disturbances associated with these fluids. (recommend a dietitian)

There is increasing evidence that marijuana can cause problems with neurologic development including

- hyperactivity, - lower cognitive function, - attention problems

0.45 Normal Saline is hypotonic and used to treat

- hypernatremia - diabetic ketoacidosis. - You can't give it to patients with burns, trauma, or liver disease because it pulls fluid.

Regarding Chronic Kidney Disease, A focus on stages 1 through 4 before the need for dialysis (stage 5) includes the control of

- hypertension, - hyperparathyroid disease, - CKD-MBD, - anemia, - dyslipidemia.

selective serotonin reuptake inhibitors (SSRIs) Signs of withdrawal in infants An increased risk for

- hypertonia, - tremulousness, - wakefulness, - high-pitched crying, - feeding problems. persistent pulmonary hypertension

Regarding excitability from cocaine, The behaviors of an excitable neonate can include

- hypertonicity, irritability, - an inability to be consoled, - an intolerance to changes in routine

Regarding Acute kidney injury (AKI) phases and the Diuretic Phase, Patients who develop an oliguric phase will have greater diuresis as kidney function returns. Large losses of fluid and electrolytes require the patient be monitored for Near the end of this phase, the patient's what stabilizes?

- hyponatremia, - hypokalemia, - dehydration acid-base, electrolyte, and waste product (BUN, creatinine) values stabilize.

Complications of Hemodialysis

- hypotension, - muscle cramps, - loss of blood, - hepatitis

Regarding Hyperthyroidism Nursing Implementation for Postoperative Care, what are the complications

- hypothyroidism, - damage to or inadvertent removal of parathyroid glands, causing hypoparathyroidism and hypocalcemia, - hemorrhage, - injury to the recurrent or superior laryngeal nerve, - thyrotoxicosis, - infection

Child with autism in hospital Nursing interventions

- ideally should stay with the child as much as possible - Nurses should recognize that not all children with ASD are the same and that they require individual assessment and treatment. - Decreasing stimulation by using a private room, avoiding extraneous auditory and visual distractions, and encouraging the parents to bring in possessions the child is attached to may lessen the disruptiveness of hospitalization - physical contact often upsets these children, minimal holding and eye contact may be necessary to avoid behavioral outbursts - Take care when performing procedures on, administering medicine to, and feeding these children because they may be either fussy eaters who willfully starve themselves or gag to prevent eating, or indiscriminate hoarders who swallow any available edible or inedible items, such as a thermometer - Eating habits of ASD children may be particularly problematic for families and may involve food refusal accompanied by mineral deficiencies, mouthing objects, eating nonedibles, and smelling and throwing food - visits with staff caregivers kept short whenever possible (ASD need to be introduced slowly to new situations) - Because these children have difficulty organizing their behavior and redirecting their energy, they need to be told directly what to do. - Give concrete explanations - Explore childs behaviors of family and vice verse - teach how to create a safe environment

Risk factors for Pulmonary embolism (PE)

- immobility or reduced mobility, - surgery within the last 3 months (especially pelvic and lower extremity surgery), - history of DVT, - malignancy, - obesity, - oral contraceptives, - hormone therapy, - cigarette smoking, - prolonged air travel, - heart failure, - pregnancy, - clotting disorders.

Neutropenic precautions (reverse isolation) Notify your nurse or HCP if you have any of the following:

- immunocompromised, - strict hand washing, - private room, - no flowers - no raw veggies/fruits or undercooked foods - daily baths, - visitors are restricted - no water that has been standing longer than 15 min (use bottles water) - Avoid crowds - vital signs Q4H - Do not perform gardening or clean up after pets. Feeding and petting your dog or cat are fine as long as you wash your hands well after handling. - Maintain some daily activity as instructed by your health care team. This may include walking and moderate exercise while avoiding crowds - Brush your teeth with a soft toothbrush four times daily. You may floss once daily if it does not cause excessive pain or bleeding. Avoid alcohol-based mouthwashes. Notify your nurse or HCP if you have any of the following: • Fever ≥100.4° F (38° C)* • Chills or feeling hot • Redness, swelling, discharge, or new pain on or in your body • Changes in urination or bowel movements • Cough, sore throat, mouth sores, or blisters

Regarding hemophilia, When joint bleeding occurs what should a nurse do

- in addition to administering replacement factors, totally rest the involved joint to prevent crippling deformities from hemarthrosis. - Pack the joint in ice. - Give analgesics (e.g., acetaminophen, codeine) to reduce severe pain. - Aspirin and aspirin-containing compounds should never be used. - As soon as bleeding ceases, encourage mobilization of the affected area through range-of-motion exercises and physical therapy. - Weight bearing is avoided until all swelling has resolved and muscle strength has returned.

Regarding Acute Coronary Syndrome (UA and MI), Resumption of Sexual Activity

- include sexual counseling for heart patients and their partners - Most patients change their sexual behavior not because of physical problems, but because they are concerned about sexual inadequacy, death during intercourse, and impotence - "Sexual activity, like other forms of activity, should be gradually resumed after MI. If your ability to perform sexually is concerning you, the energy you use is no more than walking briskly." - Tell the patient that the inability to perform sexually after MI is common and that sexual dysfunction usually disappears after several attempts. - many male patients may be interested in using drugs to correct erectile dysfunction. Warn the patient that these drugs are not to be used with nitrates because severe hypotension and even death have been reported. - It is common for a patient who experiences chest pain on physical exertion to have some angina during sexual stimulation or intercourse. - patient may be told to take NTG prophylactically. - Tell the patient to delay sex after a heavy meal or excessive intake of alcohol, when extremely tired or stressed, or with unfamiliar partners. - Patients should also avoid anal intercourse because of the likelihood of eliciting a vasovagal response. - It is generally safe to resume sexual activity 7 to 10 days after an uncomplicated MI.

Monitoring of Patients With Pacemakers:

- infection and hematoma formation at the insertion site, - pneumothorax, - failure to sense or capture, - perforation of the atrial or ventricular septum by the pacing lead, - appearance of "end-of-life" battery power on testing the pacemaker

Electroconvulsive Therapy Procedure for depression To ensure that patients experience a seizure over the entire brain, a

- informed consent is obtained if the patient is being treated voluntarily. - patient treated involuntarily, permission may be obtained from the next of kin although in some states treatment must be court-ordered - patient is usually given a general anesthetic to induce sleep and a muscle-paralyzing agent to prevent muscle distress and fractures. - Benzodiazepines should be discontinued as they will interfere with the seizure process. blood pressure cuff may be inflated on the lower arm or leg before administration of the paralytic agent.

Regarding substance abuse, For depressants Opioid withdrawal Manifestations include Treatment focuses on

- intense drug craving, - diaphoresis, - GI distress, - restlessness, - fever, - insomnia, - watery eyes, - tremors, - muscle aches, - runny nose, - altered mood. - relieving symptoms and often requires medications. - Management includes GI medications (e.g., loperamide [Imodium], Zofran, prochlorperazine [Compazine]), - acetaminophen for muscle aches and fever, - benzodiazepines for acute anxiety and sleep disturbances.

Laboratory test for Thrombocytopenia

- prothrombin time (PT) and aPTT, can be normal - Bone marrow examination to rule out production problems as the cause of thrombocytopenia - Specific assays, such as ITP antigen-specific assay, platelet activation/function assay, or PF4-heparin complex for HIT, - In TTP, testing for deficiency of ADAMTS13 is not always diagnostic, so an increase of lactate dehydrogenase (LDH) may help establish the diagnosis - Bone marrow analysis is performed if other test results are inconclusive

Regarding Lupus and Pregnancy, Medical (drug) therapy during pregnancy

- kept to a minimum in women who are in remission or who have a mild form of SLE. - Occasional doses of nonsteroidal antiinflammatory drugs (NSAIDs) can be given to treat arthralgia. - Low-dose aspirin can be used throughout pregnancy - Glucocorticoids such as prednisone are often used to treat SLE during pregnancy, either as maintenance therapy or as short-term treatment for flares (small risk for fetal cleft lip and palate if glucocorticoids are used during the first trimester) - Glucocorticoids increases the risk for maternal bone loss, gestational diabetes, hypertension and preeclampsia, and adrenal suppression - hydroxychloroquine (Plaquenil), an antimalarial drug, may be the best medication for maintenance SLE therapy during pregnancy (better than steriods)

Regarding Cushing Syndrome, Drug therapy includes What should a nurse be careful of?

- ketoconazole, - aminoglutethimide, - mitotane. These are used cautiously because they are often toxic at the dosages needed to reduce cortisol secretion. - Hydrocortisone or prednisone may be needed to avoid adrenal insufficiency. - Mifepristone (Korlym) may be used to control hyperglycemia in patients with endogenous Cushing syndrome who have type 2 diabetes.

Pudendal nerve block: administered when? useful if an? does not relieve the pain from When should it be given? What is the side effect?

- late in the second stage of labor - can also be administered during the third stage of labor if an episiotomy or lacerations must be repaired episiotomy is to be performed or if forceps or a vacuum extractor are to be used to facilitate birth. uterine contractions, it does relieve pain in the lower vagina, the vulva, and the perineum administered 10 to 20 minutes before perineal anesthesia is needed. the bearing-down reflex is lessened or lost completely (does not change maternal hemodynamic or respiratory functions, vital signs, or the FHR)

Regarding neurobehavioral depression from cocaine, The behaviors of a depressed infant include

- lethargy, - hypotonia, - difficulty in arousing

Hyperthyroidism Diagnostic Studies

- low or undetectable TSH levels (<0.4 mU/L) - elevated free thyroxine (free T4) levels - Total T3 and T4 levels may also be assessed, but they are not as definitive. (determine both free and bound (to protein) hormone levels.) - Radioactive iodine uptake (RAIU) test is used to differentiate Graves' disease from other forms of thyroiditis (patient with Graves' disease shows a diffuse, homogeneous uptake of 35% to 95%, whereas the patient with thyroiditis shows an uptake of less than 2%) (Ophthalmologic examination if eye issues)

Regarding bulimia, signs of frequent vomiting, such as

- macerated knuckles, - enlargement of the parotid glands - swollen salivary glands, - broken blood vessels in the eyes, - dental problems - Distinctive hand lesions (Russell sign) have been observed; the backs of the hands are often scarred and cut from repeated abrasion of the skin against the maxillary incisors

Systemic lupus erythematosus (SLE) Ambulatory care (outpatient care)

- maintain regular medical supervision and seek attention quickly during illness or before elective surgical procedures, such as dental extraction, because of potential needs for increased steroids or prophylactic antibiotics. - People with SLE should carry medical alert identification for their disease and steroid dependence.

Acute Kidney Injury Acute Care

- managing fluid and electrolyte balance during the oliguric and diuretic phases - Observe and record accurate intake and output - Take daily weights with the same scale at the same time each day to detect excessive gains or losses of body fluid (1 kg is equivalent to 1000 mL of fluid) - Assess for the common signs and symptoms of hypervolemia (in the oliguric phase) or hypovolemia (in the diuretic phase), potassium and sodium disturbances, and other electrolyte imbalances - infection is the leading cause of death in AKI, meticulous aseptic technique is critical - Be alert for local manifestations of infection (e.g., swelling, redness, pain) as well as systemic manifestations (e.g., fever, malaise, leukocytosis). - If antibiotics are used to treat an infection, the type, frequency, and dosage must be carefully considered because the kidneys are the primary route of excretion for many antibiotics - Dosages may be altered depending on the patient's level of kidney function - Perform skin care and take measures to prevent pressure ulcers as mobility may be impaired. - Mouth care is important to prevent stomatitis, which develops when ammonia (produced by bacterial breakdown of urea) in saliva irritates the mucous membranes.

Chronic Kidney Disease Nursing Implementation Ambulatory Care (Outpatient care)

- many medications, a pillbox organizer or a list of the drugs and the times of administration may be helpful. - Instruct the patient to avoid over-the-counter medications such as NSAIDs and aluminum- and magnesium-based laxatives and antacids. - Teach the patient to take daily BP readings - identify signs and symptoms of fluid overload, hyperkalemia, and other electrolyte imbalances. - The patient can complete an evaluation for a kidney transplant prior to the need to initiate dialysis. Patients may receive a transplant before ever having to start dialysis - Inform the patient that even while on dialysis, transplant remains an option - It is important to respect the patient's choice to not receive treatment. Focus the discussion on moving from the curative approach to promotion of comfort care and consideration of hospice care.

leukemia Nursing Implementation

- maximizing the patient's physical functioning, - teaching patients that acute side effects of treatment are usually temporary, - encouraging patients to discuss their quality-of-life issues - helping the patient and family understand the complexities of treatment decisions and manage the side effects and toxicities. - help reverse feelings of abandonment and loneliness by balancing the demanding technical needs with a humanistic, caring approach. - Observe for life-threatening results of bone marrow suppression (neutropenia, thrombocytopenia, and anemia) require aggressive nursing interventions. - Observe for complications of chemotherapy may affect the patient's GI tract, nutritional status, skin and mucosa, cardiopulmonary status, liver, kidneys, and neurologic system. - Review all drugs being administered - chemotherapy is administered to patients with leukemia even if they have severe myelosuppression - Vocational retraining - Reproductive concerns

leukemia Ambulatory Care (outpatient care)

- monitor for signs and symptoms of disease control or relapse - teach the patient and caregiver the importance of continued diligence in disease management and the need for follow-up care - teach them about the drugs, self-care measures, and when to seek medical attention. - Involving the patient in survivor networks and support groups or services may help the patient adapt to living after a life-threatening illness - physical therapy personnel may be asked to develop an exercise program to prevent posttreatment deficits caused by drug-induced peripheral neuropathy - Most patients should receive a pneumococcal vaccine and an annual influenza vaccine

Cirrhosis Acute Care When the patient is taking diuretics, monitor

- monitor the serum levels of sodium, potassium, chloride, and bicarbonate. - Monitor renal function (blood urea nitrogen [BUN], serum creatinine) routinely and with any change in the diuretic dosage. - Observe for signs of fluid and electrolyte imbalance, especially hypokalemia. - Hypokalemia may be manifested by cardiac dysrhythmias, hypotension, tachycardia, and generalized muscle weakness. - Water excess (hyponatremia) is manifested by muscle cramping, weakness, lethargy, and confusion.

Balloon Tamponade Nursing care includes

- monitoring for complications of rupture or erosion of the esophagus, regurgitation and aspiration of gastric contents, and occlusion of the airway by the balloon. - If the gastric balloon breaks or is deflated, the esophageal balloon will slip upward, obstructing the airway and causing asphyxiation. - If this happens, cut the tube or deflate the esophageal balloon. - Keep scissors at the bedside. - Minimize regurgitation by oral and pharyngeal suctioning and by keeping the patient in a semi-Fowler's position. - The patient is unable to swallow saliva... Encourage the patient to expectorate, and provide an emesis basin and tissues. - Frequent oral and nasal care provides relief from the taste of blood and irritation from mouth breathing.

Gerontologic Considerations: Chronic Kidney Disease

- most common diseases leading to renal disease in older people are hypertension and diabetes - PD causes less hemodynamic instability than HD but does require self-care or assistance from another person, which may not always be available. - Most individuals 65 years of age or older select treatment with in-center HD because of a lack of assistance in the home - Establishing vascular access for HD may be a concern in an older adult because of atherosclerotic changes. - Although transplantation is an option, older adults must be carefully screened to ensure that the benefits of transplantation outweigh the risks - The most common cause of death in older ESRD patients is CV disease (myocardial infarction, stroke), followed by withdrawal from dialysis - Ethical issues to consider in this situation include patient competency, benefit versus burden of treatment, and futility of treatment.

Complications of Cellulitis

- necrotizing fasciitis, - septicemia, - septic shock - endocarditis (if gets into heart) - osteomyelitis - meningitis (if gets into spinal cord) - lymphopenia (give lymphopenia sleeve) - gangrene (lack of blood supply)

ADHD Appropriate Classroom Placement

- need an orderly, predictable, and consistent classroom environment with clear and consistent rules - Homework and classroom assignments may need to be reduced, and more time may need to be allotted for tests - Verbal instructions should be accompanied by visual references, such as written instructions on the blackboard - Schedules may need to be arranged so that academic subjects are taught in the morning when the child is experiencing the effects of the morning dose of medication - Low-interest and high-interest classroom activities should be intermingled to maintain the child's attention - Regular and frequent breaks in activity are helpful - Computers are helpful for children who have difficulty with writing (dysgraphia) and fine motor skills; in such children, handwriting will not improve. (find alternatives to physical competition that requires coordination of movement.) - If the child has a learning disability, special training activities may be accomplished in self-contained classes limited to six to eight children, in special resource rooms with equipment and teaching teams, by mobile consultants who move from room to room to provide assistance to teachers and children, and in special first-grade programs in which high-risk children receive special attention to prevent or reduce the need for services as they progress

For skin care for preterm infants, Because of its increased sensitivity and fragility

- no alkaline-based soap that might destroy the acid mantle of the skin is used. - All skin products (e.g., alcohol, chlorhexidine, povidone-iodine) should be used with caution; the skin is rinsed with water afterward because these substances can cause severe irritation and chemical burns - No using adhesive tape or bandages. (Pectin barriers and hydrocolloid adhesives may be useful instead) - minimal adhesive tape, backing the tape with a skin barrier or hydrocolloid dressing, and delaying adhesive removal until adherence is reduced - Emollients such as Eucerin or Aquaphor have been used to promote skin integrity and prevent dry, cracking, and peeling skin in infants at risk for skin breakdown. - nurses are alert to the subtle signs that indicate zinc deficiency

Regarding obesity, Most dietitians and nutrition experts recommend a diet with

- no trans fats, - low-saturated fat, - moderate total fat (≤30%), - low sodium, - at least nine servings of fruits and vegetables daily - promoting high-fiber foods

Regarding esophageal and/or gastric varices, Because of the high incidence of recurrent bleeding with each bleeding episode, continued therapy is necessary. Long-term management of patients who have had an episode of bleeding includes

- nonselective β-blockers, - repeated band ligation of the varices, - portosystemic shunts in patients who develop recurrent bleeding.

Breastfeeding is encouraged in mothers who are breastfeeding promotes mother-infant bonding, and small quantities of methadone or buprenorphine passed through breast milk is

- not using illicit substances, - do not have HIV infection, - are compliant with a treatment program; not harmful

Regarding children with HF taking digoxin, nurses should teach the parents how and in what ways?

- nurse watches the parent measure the elixir in the dropper and stresses the level mark as the meniscus of the fluid that is observed at eye level. - Parents are also advised of the signs of toxicity. - According to the practitioner's preference, they may be taught to take the pulse before giving the drug. - A return demonstration of the procedure - Their level of anxiety in counting the pulse is assessed

Continuous renal replacement therapy (CRRT) Specific nursing interventions include

- obtaining weights and monitoring and documenting laboratory values daily to ensure adequate fluid and electrolyte balance. - Assess hourly intake and output, vital signs, and hemodynamic status. - Although reductions in central venous pressure and pulmonary artery pressure are expected, there should be little change in mean arterial pressure or cardiac output. - Assess and maintain the patency of the CRRT system. Care for the patient's vascular access site to prevent infection.

Anorexia Nervosa Diagnostic/lab studies often show

- osteopenia or osteoporosis, - iron-deficiency anemia, - an elevated blood urea nitrogen level from marked intravascular volume depletion, - abnormal renal function - potassium deficiency - Leukopenia, hypoglycemia, hyponatremia, hypomagnesemia, and hypophosphatemia may be present.

Regarding Types of Dysrhythmias, Paroxysmal Supraventricular Tachycardia is associated with

- overexertion, emotional stress, deep inspiration, and stimulants such as caffeine and tobacco. - rheumatic heart disease, digitalis toxicity, CAD, and cor pulmonale.

Regarding Hemodialysis, Classic manifestations of steal syndrome are

- pain distal to the access site, numbness or tingling of fingers that may worsen during dialysis, and poor capillary refill. - Aneurysms can also develop in the arteriovenous access and can rupture if left untreated.

Recurrent (habitual) early miscarriage is three or more spontaneous pregnancy losses before 20 weeks of gestation. The most widely accepted causes of recurrent miscarriage are

- parental chromosomal abnormalities, - antiphospholipid antibody syndrome, - certain uterine abnormalities

Mild to Moderate Levels of Anxiety Nursing Intervention

- patient can be helped to focus and solve problems when you use specific nursing communication techniques such as asking open-ended questions, giving broad openings, and exploring and seeking clarification. - Closing off topics of communication and bringing up irrelevant topics can increase a person's anxiety, making the nurse, not the patient, feel better. - Avoid closing off avenues of communication that are important for the patient. Focus on the patient's concerns. - Reducing the patient's anxiety level and preventing escalation to more distressing levels can be aided by providing a calm presence, recognizing the anxious person's distress, and being willing to listen - Help the patient identify anxiety. "Are you comfortable right now?" - Anticipate anxiety-provoking situations. - Use nonverbal language to demonstrate interest (e.g., lean forward, maintain eye contact, nod your head). - Encourage the patient to talk about his or her feelings and concerns. - Ask questions to clarify what is being said. "I'm not sure what you mean. Give me an example." - Encourage problem solving with the patient.∗ - Assist in developing alternative solutions to a problem through role play or modeling behaviors.

Bacterial Meningitis Ambulatory Care (Outpatient care)

- patient requires several weeks of convalescence before resuming normal activities - stress the importance of adequate nutrition, with an emphasis on a high-protein, high-calorie diet in small, frequent feedings. - Progressive range-of-motion exercises and warm baths are useful for Muscle rigidity - Residual effects can result in sequelae such as dementia, seizures, deafness, hemiplegia, and hydrocephalus. Assess vision, hearing, cognitive skills, and motor and sensory abilities after recovery

What happens during Heparin-Induced Thrombocytopenia (HIT) What is done?

- platelet destruction and vascular endothelial injury are the two major responses to an immune-mediated response to heparin. - Platelet factor 4 (PF4) (protein made and released by platelets) binds to heparin. - This PF4-heparin complex then binds to the platelet surface, leading to further platelet activation and release of more PF4, thus creating a positive feedback loop - Antibodies are created against the PF4-heparin-platelet complex, and they are removed prematurely from circulation, leading to thrombocytopenia and platelet-fibrin thrombi.

Regarding infants and children with Hypoxemia, Over time, two physiologic changes occur in the body in response to chronic hypoxemia:

- polycythemia and clubbing. - Hypercyanotic spells Polycythemia, an increased number of red blood cells, increases the oxygen-carrying capacity of the blood Clubbing, a thickening and flattening of the tips of the fingers and toes

Older adults Risk Factors for abuse

- poor mental or physical health or are disruptive due to disorders such as Alzheimer's disease. - typical victim is female, over 75 years of age, Caucasian, living with a relative, and experiencing a physical and/or mental impairment.

Regarding cervical insufficiency, Indications for cerclage placement are A cerclage may be placed either

- poor obstetric history (three or more previous early preterm births or second-trimester losses), - a short (<25 mm) cervical length identified on transvaginal ultrasound, - an open cervix found on digital or speculum examination prophylactically or as a therapeutic or rescue procedure after cervical change

Major complications of cirrhosis are

- portal hypertension, - esophageal and gastric varices, - peripheral edema, - abdominal ascites, - hepatic encephalopathy (mental status changes, including coma), - hepatorenal syndrome - Splenomegaly

Regarding infants and children with HF, Reduce Respiratory Distress in what ways?

- positioned to encourage maximum chest expansion, with the head of the bed elevated; they should sit up in an infant seat or be held at a 45-degree angle - Safety restraints, such as those used with infant seats, are applied low on the abdomen and loosely enough to provide both safety and maximum expansion. - Children prefer to sleep on several pillows and remain in the semi-Fowler's or high-Fowler's position during waking hours. - The infant or child is often given humidified supplemental oxygen via oxygen hood or tent, nasal cannula, or mask

Regarding Preoperative Care, Special Considerations for Bariatric Surgery

- prepare for urinary catheter, IV catheter, and sequential compression device or compression stockings. - patient must understand that he or she will be assisted with ambulation soon after surgery and encouraged to cough and deep breathe to prevent pulmonary complications. - Liquids will be started early, but only after the patient is fully awake and there is no evidence of any anastomosis leaks.

Postpartum depression Nursing interventions

- provide individualized flexible postpartum care - screen using Edinburgh Postnatal Depression Scale - Provide supportive interactions and ongoing assessment - Involve partners and family members in the care for postpartum mothers experiencing depression - Facilitate opportunities for peer support - Promote self-care activities - educate patient and families of symptoms of postpartum depression (often undiagnosed or labeled as maternal fatigue) - Women may hide their feeling because of shame, guilt, and feelings of inadequacy. It is important to have them understand they have done nothing wrong and need help - Refer postpartum patients as necessary for follow up with mental health professionals - Assess for self harm ideation/behavior

Regarding Intimate Partner Violence, It is imperative that the woman has knowledge of resources available to her and a plan of action if she stays with the battering partner. First, the nurse should

- provide services and telephone numbers of a hotline and the battered women's shelter or other safe haven. - woman can be offered use of a telephone to call the shelter if this is an option she chooses. - If she chooses to go back to the abuser, a safety plan includes necessities for a quick escape: a bag packed with personal items for an overnight stay (can be hidden or left with a neighbor), money or a checkbook, an extra set of car keys, and any legal documents for identification. - Legal options such as those for restraining orders or arrest of the perpetrator also are important aspects of the safety plan. A restraining order can be obtained from the county court or police department 24 hours a day. Shelters also can be helpful with assistance in obtaining orders of protection.

Regarding giving propylthiouracil (PTU) or methimazole (MMI) during pregnancy for hyperthyroidism, Both medications work well in and are well tolerated by most women. The most common maternal side effects of both PTU and MMI are

- pruritus - skin rash. - MOST SEVERE: Agranulocytosis Other possible side effects include drug-related fever, bronchospasm, migratory polyarthritis, a lupuslike syndrome, and cholestatic jaundice

Treatment options for Postpartum depression include

- psychotherapy (for mild cases) - antidepressant medication (used with psychotherapy for moderate to severe cases) SSRI - Sleep deprivation must be resolved; 4 to 5 hours of uninterrupted sleep for several days - hormone therapy, complementary or alternative therapies (herbs, dietary supplements, massage, aromatherapy, acupuncture, exercise, bright light therapy), - electroconvulsive therapy (ECT).

Postpartum Anxiety disorders may be treated with Medications include

- psychotherapy; - CBT - exposure response prevention (ERP) SSRIs and antianxiety drugs, although it can take 2 weeks for these medications to be effective. - Benzodiazepines provide short-term relief from anxiety symptoms, but should be used judiciously as they can be addictive.

postpartum psychosis is characterized by

- rapid onset of bizarre behavior, - auditory or visual hallucinations, - paranoid or grandiose delusions, - elements of delirium or disorientation, - extreme deficits in judgment accompanied by high levels of impulsivity that can contribute to increased risk for suicide or infanticide - Auditory hallucinations that command the mother to kill the infant can occur in severe cases. - usually occurs in first 4 weeks after birth

Hemophilia Management for children Ages of responsibility?

- recommend a regular program of exercise, and physical therapy (Physical activity within reasonable limits strengthens muscles around joints) - most children are treated at home - Home treatment is highly successful, and the rewards, in addition to the immediacy, are less disruption of family life, fewer school or work days missed, and enhancement of the child's self-esteem and independence. - Prophylactic therapy is periodic factor replacement for children with severe hemophilia - On-demand factor replacement may be a cost-effective alternative to primary prophylaxis - family is taught the technique of venipuncture and to administer the AHF to children older than 2 to 3 years of age. - The child learns the procedure for self-administration at 8 to 12 years of age

After mastectomy jackson pratt drainage information:

- red or pink is normal and becomes clear over time, - removed after drainage is less that 30mL, - measure fluid changes - measure and empty 2-3 times a day

Chronic Kidney Disease Clinical Manifestations for Integumentary System

- refractory pruritus - Uremic frost is an extremely rare condition in which urea crystallizes on the skin; this is usually seen only when BUN levels are extremely elevated (e.g., over 200 mg/dL).

Severe to Panic Levels of Anxiety Nursing interventions

- remember unable to solve problems and may have a poor grasp of what is happening in the environment - provide for the safety of the patient and others and to meet physical needs (e.g., fluids, rest) to prevent exhaustion - Anxiety-reduction measures may take the form of guiding the person to a quiet environment. - use of medications and restraints/seclusion may have to be considered. As always, both medications and restraints should be used only after other less-restrictive interventions have failed to decrease anxiety to safer levels. - techniques suggested for communicating with people with mild to moderate levels of anxiety are not as effective at more severe levels. - they need to know they are safe from their own impulses - Always remain with the person experiencing an acute severe to panic level of anxiety. - Minimize environmental stimuli. Move to a quieter setting, and stay with the patient. - Use clear and simple statements and repetition. - Use a low-pitched voice; speak slowly. - Reinforce reality if distortions occur (e.g., seeing objects that are not there or hearing voices when no one is present). - Because safety is an overall goal, physical limits may need to be set. Speak in a firm, authoritative voice: "You may not hit anyone here. If you can't control yourself, we will help you." - Provide opportunities for exercise (e.g., walk with nurse, punching bag, ping-pong game). - When a person is constantly moving or pacing, offer high-calorie fluids.

Rumination Disorder Interventions include

- repositioning infants and small children during feeding - Improving the interaction between caregiver and child and making mealtimes a pleasant experience - Distracting the child when the behavior starts - Family therapy may be required

Hyperthyroidism Nursing Implementation for Acute Thyrotoxicosis

- requires aggressive treatment, often in an intensive care unit - Administer medications - Monitor for cardiac dysrhythmias and decompensation - Ensure adequate oxygenation - Give IV fluids to replace fluid and electrolyte losses (especially for diarrhea and vomiting) - Ensure adequate rest may be a challenge because of the patient's irritability and restlessness. Provide a calm, quiet room because increased metabolism and sensitivity of the sympathetic nervous system causes sleep disturbances. - Place patient in a cool room away from very ill patients and noisy, high-traffic areas - Use light bed coverings and changing the linen frequently if the patient is diaphoretic - Encourage and assist with exercise involving large muscle groups (tremors can interfere with small-muscle coordination) to allow the release of nervous tension and restlessness

Complications of Preterm Birth

- respiratory distress syndrome (RDS) and hyaline membrane disease (severe lung disease) - bronchopulmonary dysplasia (BPD) (chronic lung disease) - Meconium Aspiration Syndrome - Apnea of Prematurity - Pneumothorax - Persistent Pulmonary Hypertension of the Newborn - Retinopathy of Prematurity - RDS - Thermoregulation - Hypoglycemia - Feeding Problems - Jaundice - Neurodevelopmental problems - Infection

Cocaine-exposed infants Nursing and Medical Interventions

- respond to swaddling - Positioning, - infant massage - limited tactile stimulation - Significant amounts of cocaine have been found in breast milk therefore mothers should be cautioned regarding this hazard to their infants. - Referral to early intervention programs, including child health care, parental drug treatment, individualized developmental care, and parenting education

Regarding Chronic Kidney Disease, Hyperkalemia Drug Therapy

- restriction of high-potassium foods and drugs - IV glucose and insulin or IV 10% calcium gluconate - Sodium polystyrene sulfonate, a cation-exchange resin, is commonly used to lower potassium levels in stage 4 CKD and can be administered on an outpatient basis (Tell the patient to expect some diarrhea!!!) - Patiromer (Veltassa) not be used in emergency situations to treat hyperkalemia because of its delayed onset

Regarding Hyperthyroidism Drug Therapy, Iodine is available as

- saturated solution of potassium iodine (SSKI) - Lugol's solution

Depression Pharmacological treatment

- selective serotonin reuptake inhibitors (SSRIs) - The serotonin norepinephrine reuptake inhibitors (SNRIs) - norepinephrine dopamine reuptake inhibitor (NDRI) - noradrenergic and specific serotonergic antidepressant (NaSSA) - tricyclic antidepressants (TCAs)

Regarding Nitrous oxide, what are the steps given How to protect nurse?

- self-administer the gas. - nurse teaches the woman how to correctly position the face mask to create a seal. - When inhalation stops, the valve closes, which prevents accidental overdosing - The woman is the only person allowed to hold the mask. - Special equipment collects the woman's exhalations to protect health care workers from repetitive occupational exposure to nitrous oxide

Regarding Systemic lupus erythematosus (SLE), Disease management is most appropriately monitored by

- serial anti-DNA titers and serum complement. - Simpler, less costly tests such as ESR or CRP may also be helpful.

Autism Diagnosis

- severe impairments in social interactions and communication skills, often accompanied by stereotypical behavior, interests, and activities - intellectual disability (IQ <85), which will impact their academic performance as well. - severity of the impairment is evident in the degree of responsiveness to or interest in others, the presence of associated behavioral problems (e.g., head banging), and the ability to bond with peers

In acute thyrotoxicosis, all the symptoms of hyperthyroidism are prominent and severe. Manifestations include

- severe tachycardia, - heart failure, - shock, - hyperthermia (up to 106° F [41.1° C]), - agitation, - delirium, - seizures, - abdominal pain, - vomiting, - diarrhea, - coma.

Lactate Ringers is an isotonic crystalloid. It has

- sodium chloride, - potassium chloride, - calcium chloride, - sodium lactate All in sterile water

Cirrhosis Management of ascites focuses on

- sodium restriction: Patients may be encouraged to limit sodium intake to 2 g/day... Patients with severe ascites may need to restrict their sodium intake to 250 to 500 mg/day. - diuretics - fluid removal. - not on restricted fluids unless severe ascites develops - Albumin infusion - Paracentesis (if indicated) - TIPS (if indicated)

On inspection, preterm infants are

- soft cranium - very small and appear scrawny because they have minimal subcutaneous fat deposits (or none in some cases) and a proportionately large head in relation to the body - skin is bright pink (often translucent, depending on the degree of immaturity), smooth, and shiny - fine lanugo hair is abundant over the body (depending on gestational age) but is sparse, fine, and fuzzy on the head - ear cartilage is soft and pliable - soles and palms have minimal creases, resulting in a smooth appearance. - bones of the skull and the ribs feel soft, and the eyes may be closed - Reflex activity is only partially developed; sucking is absent, weak, or ineffectual; swallow, gag, and cough reflexes are absent or weak; - unable to maintain body temperature, have limited ability to excrete solutes in the urine, and have increased susceptibility to infection - Male infants have few scrotal rugae and the testes are undescended - girls the labia and clitoris are prominent.

If there is a language barrier, the nurse should

- speak slowly and clearly in English, without using jargon, and allow time for the response. - If the patient speaks no English, provide a trained medical interpreter. - A family member should not be used as an interpreter to ensure confidentiality and protect the person from future retaliation.

In kidney failure, a urinalysis may show a specific gravity fixed at what? urine osmolality?

- specific gravity fixed at around 1.010 and - urine osmolality at about 300 mOsm/kg (300 mmol/kg) - Urinary specific gravity (measure of the concentration of solutes in the urine) is normally 1.003 to 1.030. - Urine osmolality range is 300 to 1300 mOsm/kg.

The effectiveness of splenectomy is based on four factors:

- spleen contains macrophages that destroy platelets. - structural features enhance the interaction between antibody-coated platelets and macrophages. - some antibody synthesis occurs in the spleen; thus antiplatelet antibodies decrease after splenectomy. - the spleen normally sequesters approximately one third of the platelets, so its removal increases the number of platelets in circulation.

Systemic lupus erythematosus (SLE) Complications

- subacute cutaneous lupus (persistent lesions, photosensitivity, and mild systemic disease) - at risk for secondary antiphospholipid syndrome - Anemia, leukopenia, thrombocytopenia, and coagulation disorders (excessive bleeding or clotting) (benefit from high-intensity treatment with warfarin.) - increased susceptibility to infection

Regarding Types of Dysrhythmias, Second-Degree AV Block, Type I Treatment If the patient is symptomatic If the patient is asymptomatic

- symptomatic, atropine is used to increase HR, or a temporary pacemaker may be needed, especially if the patient has had an MI. - asymptomatic, the rhythm is closely observed with a transcutaneous pacemaker on standby. Bradycardia is more likely to become symptomatic when hypotension, HF, or shock is present.

Bulimia Criteria for inpatient hospitalization include

- syncope - serum potassium of less than 3.2 mEq/L - serum chloride of less than 88 mEq/L - esophageal tears - arrhythmias - intractable vomiting - hematemesis (vomiting blood). - Suicide risk in this population also requires hospitalization.

Regarding hormonal therapy, Estrogen receptor blockers include

- tamoxifen, - toremifene (Fareston), - fulvestrant (Faslodex).

Regarding Cycle of Violence, acute battering stage

- tension peaks. - triggered by an external event or by the abuser's emotional state. - Some experts believe that the victim may actually provoke the incident to remove the tension and fear and to move on to the honeymoon phase.

The second stage of labor is composed of two phases:

- the latent phase - the active pushing phase

Regarding Hyperthyroidism and its Ambulatory (outpatient) Care, The patient and caregiver must be aware that

- thyroid hormone balance should be monitored periodically - Most patients experience a period of relative hypothyroidism soon after surgery - administration of thyroid hormone is avoided - To prevent weight gain, caloric intake must be substantially reduced below the amount that was required before surgery. - Adequate iodine is necessary to promote thyroid function, but excesses can inhibit the thyroid gland. - Seafood once or twice a week or normal use of iodized salt should provide sufficient iodine intake - Encourage regular exercise to stimulate the thyroid gland. - Teach the patient to avoid high environmental temperatures because they inhibit thyroid regeneration. - Regular follow-up care is necessary. The patient should see the HCP biweekly for a month and then at least semiannually to assess thyroid function. - Tell the patient who had a complete thyroidectomy about the need for lifelong thyroid hormone replacement. - Teach the patient the signs and symptoms of thyroid failure and to seek medical care promptly if these develop.

Most sufferers may experience mildly obsessive-compulsive behavior such as nagging doubts as to whether a door is locked or the stove is turned off. These doubts require the person to go back to check the door or stove. Mild compulsions about

- timeliness, - orderliness, - reliability

For a patient with ACS (UA and MI) a nurse should teach

- to check their HR (patient should know the limits within which to exercise) - Tell the patient the maximum HR that should be present at any point. If the HR exceeds this level or does not return to the resting HR within a few minutes, tell the patient to stop and rest - tell the patient to stop exercising and rest if chest pain or shortness of breath occurs. - The ideal training target HR is 80% of maximum HR - patient who has been physically inactive and is just starting an exercise program should do so under supervision whenever possible - The more important factor is the patient's response to physical activity in terms of symptoms rather than absolute HR, especially since many patients are taking β-blockers and may not be able to reach a target HR. This point cannot be overstressed.

The management of pleural effusions is to

- treat the underlying cause (treatment of heart failure with diuretics and sodium restriction may result in a decreased incidence of pleural effusion) - treatment of pleural effusions secondary to malignant disease represents a more difficult problem. These types of pleural effusions are frequently recurrent and reaccumulate quickly after thoracentesis. - Chemical pleurodesis

Neonatal abstinence syndrome (NAS) When Neonatal abstinence syndrome (NAS) is identified, nursing care is directed toward

- treating the presenting signs, - decreasing stimuli that can precipitate hyperactivity and irritability (e.g., dimming the lights, decreasing noise levels), - providing adequate nutrition and hydration, - promoting mother-infant attachment.

Thrombolytic therapy for VTE treatment includes

- treatment option for patients with a thrombus is catheter-directed administration of a thrombolytic drug (e.g., urokinase, tPA) - dissolves the clot(s), reduces the acute symptoms, improves deep venous flow, reduces valvular reflux, and may help to decrease the incidence of PTS - Catheter-directed thrombolysis is recommended for select patients who are at a low bleeding risk and present with an acute, extensive, symptomatic, proximal VTE - Systemic anticoagulation is recommended before, during, and after catheter-directed thrombolysis

ED Clinical Manifestations

- typical symptom of ED is a patient's self-report of problems associated with erectile activity, describing an inability to attain or maintain an erection. - Problems with ED can lead to a number of personal issues, including anger, anxiety, and depression.

Acute kidney injury (AKI) Diagnostic Studies

- urine output and serum creatinine known diagnostic indicators - rate of increase in serum creatinine is also important as a diagnostic indicator in determining the severity of injury. - Urinalysis is an important diagnostic test - Urine sediment containing abundant cells, casts, or proteins suggests intrarenal disorders - urine osmolality, sodium content, and specific gravity help in differentiating the causes of AKI - In intrarenal problems, hematuria, pyuria, and crystals may be seen - A kidney ultrasound is often the first test done - A renal scan can assess abnormalities in kidney blood flow, tubular function, and the collecting system - A CT scan can identify lesions, masses, obstructions, and vascular anomalies. - A renal biopsy is considered the best method for confirming intrarenal causes of AKI.

Hypersensitivity reactions to these chemotherapeutic agents are characterized by Nursing responsibilities include If a reaction is suspected, the nurse

- urticaria, - angioedema, - flushing, - rashes, - difficulty breathing, - hypotension, - nausea or vomiting. prevention, recognition, and preparation for serious reactions. discontinues the drug, flushes and maintains the IV line with saline, and monitors the child's vital signs and subsequent responses.

Regarding Systemic Lupus Erythematosus, Specific instructions for avoiding exposure to the sun and UVB light, such as

- using sunscreens, - wearing sun-resistant clothing, - altering outdoor activities, all must be provided with great sensitivity to ensure compliance while minimizing the associated feeling of being different from peers.

Cirrhosis Acute Care What to do for paracentesis? (before/after, monitor)

- witness informed consent - Monitor CBC, CMP, PT/INR - Immediately before a paracentesis have the patient void to prevent puncturing of the bladder during the procedure (tell patient to stay still) - When the paracentesis is completed, have the patient sit on the side of the bed or place him/her in high Fowler's position - weight and measure girth of abdomen - monitor for hypovolemia (Monitor I&O) and electrolyte imbalance - Check and monitor BP and heart rate following the procedure. - Check the dressing for bleeding and/or leakage of ascitic fluid. - Send drainage to lab if infection

The procedure for synchronized cardioversion is the same as for defibrillation with the following exceptions: What are the joules?

-If synchronized cardioversion is done on a nonemergency basis (i.e., the patient is awake and hemodynamically stable), the patient is sedated (e.g., IV midazolam) before the procedure. - Strict attention to maintaining the patient's airway is critical. - If a patient with supraventricular tachycardia or VT with a pulse becomes hemodynamically unstable, synchronized cardioversion should be performed as quickly as possible. - Start the initial energy for synchronized cardioversion at 50 to 100 joules (biphasic defibrillator) and 100 joules (monophasic defibrillator), and increase if needed. If the patient becomes pulseless or the rhythm changes to VF, turn the synchronizer switch off and perform defibrillation.

P Wave Normal Duration (seconds)

0.06-0.12 seconds 1.5-3 boxes

PR Interval Normal Duration (sec)

0.12-0.20 sec 3 boxes-5 boxes

RSV infection is the most frequent cause of hospitalization in children younger than

1 year of age

Evaluation for infertility should be offered to couples who have failed to become pregnant after

1 year of regular intercourse if less than 35 years old or after 6 months if the woman is older than 35 years of age

Regarding cognitive therapy for depression, Beck found that people with depression process information in negative ways, and tend to ignore positive aspects of their lives. He believed that automatic, negative, repetitive, unintended, and not-readily-controllable thoughts perpetuate depression. Three assumptions constitute Beck's cognitive triad:

1. A negative, self-deprecating view of self 2. A pessimistic view of the world 3. The belief that negative reinforcement (or no validation for the self) will continue in the future

The Five As for Users Who Desire to Quit Tobacco

1. Ask: Identify all tobacco users at every contact. 2. Advise: Strongly urge all tobacco users to quit. 3. Assess: Determine willingness to make a quit attempt. 4. Assist: Develop a plan with the patient to help the patient quit (e.g., counseling, medication). 5. Arrange: Schedule follow-up contact.

Assessment Guidelines Autism Spectrum Disorder

1. Assess for developmental delays, uneven development, or loss of acquired abilities. Use baby books and diaries, photographs, videotapes, or anecdotal reports from nonfamily caregivers. 2. Assess the child's communication skills (verbal and nonverbal), sensory, social and behavioral skills (including presence of any aggressive or self-injurious behaviors) 3. Assess the parent-child relationship for evidence of bonding, anxiety, tension, and fit of temperaments. 4. Assess for physical and emotional signs of possible abuse. Be aware that children with behavioral and developmental problems are at risk for abuse. 5. Ensure that screening for comorbid intellectual disability has been completed. 6. Assess the need for community programs with support services for parents and children including parent education, counseling, and after-school programs.

Patient and Family Teaching: Antianxiety Drugs

1. Caution the patient: - Not to change dose or frequency of medication without consultation with the prescriber. - These medications may make it unsafe to handle mechanical equipment (e.g., cars, saws, and machinery). - Avoid alcoholic beverages and other antianxiety drugs, due to unsafe depressant effects when combined. - Avoid drinking beverages containing caffeine because they decrease the desired effects of the drug. - Review prescription medications and doses that may cause or increase anxiety (e.g., thyroid hormones, steroids, decongestants). 2. Discuss the risks to the fetus and the risk of untreated anxiety disorders with prescriber should pregnancy occur or be considered. 3. Advise the patient to discuss breastfeeding with prescriber because these drugs are excreted in the milk and could have adverse effects on the infant. 4. Teach a patient who is taking monoamine oxidase inhibitors about the details of a tyramine-restricted diet (refer to Chapter 3). 5. Teach the patient that: - Cessation of benzodiazepine use after 3 to 4 months of daily use may cause withdrawal symptoms such as insomnia, irritability, nervousness, dry mouth, tremors, convulsions, and confusion. - Medications should be taken with or shortly after meals or snacks to reduce gastrointestinal discomfort. - Drug interactions can occur: Antacids may delay absorption; cimetidine interferes with metabolism of benzodiazepines, causing increased sedation; central nervous system depressants, such as alcohol and barbiturates, cause increased sedation.

Children with ADHD demonstrate one of three subtypes

1. Combined type—Six (or more) symptoms of inattention and six (or more) symptoms of hyperactivity-impulsivity that persist for at least 6 months. Most children and adolescents with ADHD have the combined type. 2. Predominantly inattentive type—Six (or more) symptoms of inattention (but fewer than six symptoms of hyperactivity-impulsivity) that persist for at least 6 months. 3. Predominantly hyperactive-impulsive type—Six (or more) symptoms of hyperactivity-impulsivity (but fewer than six symptoms of inattention) that persist for at least 6 months. Inattention may often still be a significant clinical feature in such cases.

Patient & Caregiver Teaching Chronic Kidney Disease

1. Dietary (protein, sodium, potassium, phosphate) and fluid restrictions. 2. Difficulties in modifying diet and fluid intake. 3. Signs and symptoms of electrolyte imbalance, especially high potassium. 4. Alternative ways of reducing thirst, such as sucking on ice cubes, lemon, or hard candy. 5. Rationales for prescribed drugs and common side effects. Examples: • Phosphate binders (including calcium supplements used as phosphate barriers) should be taken with meals. • Calcium supplements prescribed to treat hypocalcemia should be taken on an empty stomach (but not at the same time as iron supplements). • Iron supplements should be taken between meals. 6. The importance of reporting any of the following: • Weight gain >4 lb (2 kg) • Increasing BP • Shortness of breath • Edema • Increasing fatigue or weakness • Confusion or lethargy 7. Need for support and encouragement. Share concerns about lifestyle changes, living with a chronic illness, and decisions about type of dialysis or transplantation.

Regarding Nursing Interventions for the Person Experiencing Psychosis, Depression, hopelessness, and despair Nursing Interventions

1. Engage in connecting regularly with the patient. 2. Actively convey empathy. "Sometimes having a mental illness can feel very discouraging...I wonder how you are feeling?" 3. If he cannot identify his feelings, suggest those that may apply. "Sometimes it's hard to say what you're feeling. Do you feel sad, frustrated, or lost?" 4. Validate the feeling is understandable and that he is not alone. Identify options for coping with those feelings such as keeping a journal. 5. Teach activities that reduce depression: physical activity, self-nurturing (such as taking a relaxing bath or listening to uplifting music), seeking support from others, and spending more time in outside if possible.

Patient & Caregiver Teaching Implantable Cardioverter-Defibrillator (ICD)

1. Follow up with an HCP for routine checks of the function of the ICD. This is often done by interrogating the device using a telephone. 2. Report any signs of infection at incision site (e.g., redness, swelling, drainage) or fever to your HCP immediately. 3. Keep incision dry for 4 days after insertion or as instructed. 4. Avoid lifting arm on ICD side above shoulder until approved. 5. Discuss resuming sexual activity with your HCP. It is usually safe to resume sexual activity once your incision is healed. 6. Avoid driving until cleared by your HCP. This decision is usually based on the ongoing presence of dysrhythmias, the frequency of ICD firings, your overall health, and state laws regarding drivers with ICDs. 7. Avoid direct blows to ICD site. 8. Avoid large magnets and strong electromagnetic fields because these may interfere with the device. 9. You should not have magnetic resonance imaging (MRI) unless the ICD is approved as MRI safe or there is a protocol in place for patient safety during the procedure. 10. Travel is not restricted. Inform security (e.g., airport, train station, public buildings) of presence of ICD because it may set off the metal detector. If hand-held screening wand is used, it should not be placed directly over the ICD. Manufacturer information may vary regarding the effect of metal detectors on the function of the ICD. 11. Avoid standing near antitheft devices in doorways of stores and public buildings. You should walk through them at a normal pace. 12. If your ICD fires, call your HCP immediately. 13. If your ICD fires and you feel sick, contact the emergency response system (ERS). 14. If your ICD fires more than once, contact ERS. 15. You should obtain and wear a Medic Alert ID device at all times. 16. Always carry the ICD identification card and a current list of your drugs. 17. Consider joining an ICD support group 18. Caregivers should learn cardiopulmonary resuscitation (CPR).

Patient & Caregiver Teaching Radiation Skin Reactions Include the following instructions when teaching the patient and caregiver to clean and protect the skin in a radiation treatment area. (With radiation therapy, Erythema may develop followed by dry desquamation)

1. Gently cleanse the skin in the treatment field using a mild soap (Ivory, Dove), tepid water, a soft cloth, and a gentle patting motion. Rinse thoroughly and pat dry. 2. Apply nonmedicated, nonperfumed, moisturizing lotion or cream, such as calendula ointment, aloe gel, Aquaphor, or Biafine cream, to alleviate dry skin. Over-the-counter hydrocortisone cream 1% may reduce itching. 3. Rinse the area with saline solution. Expose the area to air as often as possible. If copious drainage is present, use astringent compresses (such as Domeboro solution) and nonadhesive absorbent dressings (they must be changed as soon as they become wet). Observe the area daily for signs of infection. 4. Avoid wearing tight-fitting clothing such as brassieres and belts over the treatment field. 5. Avoid wearing harsh fabrics, such as wool and corduroy. A lightweight cotton garment and expose the treatment field to air. 6. Use gentle detergents such as Dreft and Ivory Snow to wash clothing 7. Avoid direct exposure to the sun. If treatment area is exposed to the sun, wear protective clothing such as wide-brimmed hat and apply sunscreen lotion. 8. Avoid all sources of excessive heat (hot water bottles, heating pads, sunlamps) on the treatment field. 9. Avoid exposing the treatment field to cold temperatures (ice bags or cold weather). 10. Avoid swimming in saltwater or in chlorinated pools during the time of treatment. 11. Avoid the use of potential irritants (e.g., perfumes, powders, or cosmetics) on the skin, review use of other topical medications or lotions with your health care provider during treatment. 12. Also avoid tape, dressings, and adhesive bandages unless permitted by the radiation therapist. Avoid shaving the hair in the treatment field. 13. Continue to protect sensitive skin after the treatment is completed. Do the following: • Avoid direct exposure to the sun. A sunscreen agent and protective clothing must be worn if the potential of exposure to the sun is present. • Use an electric razor if shaving is necessary in the treatment field. 14. Avoid constricting garments, rubbing, harsh chemicals, and deodorants, since they may traumatize the skin

Patient & Caregiver Teaching Pacemaker

1. Maintain follow-up care with your HCP to begin regular pacemaker function checks. This is often done by interrogating the device using a telephone. 2. Report any signs of infection at incision site (e.g., redness, swelling, drainage) or fever to your HCP immediately. 3. Keep incision dry for 4 days after implantation, or as ordered. 4. Avoid lifting arm on pacemaker side above shoulder until approved by your cardiologist. 5. Avoid direct blows to pacemaker site. 6. Avoid close proximity to high-output electric generators, since these can interfere with the function of the pacemaker. 7. You should not have magnetic resonance imaging (MRI) unless the pacemaker is approved as MRI safe or there is a protocol in place for patient safety during the procedure. 8. Microwave ovens are safe to use and do not interfere with pacemaker function. 9. Avoid standing near antitheft devices in doorways of department stores and public libraries. You should walk through them at a normal pace. 10. Travel is not restricted. Inform security (e.g., airport, train station, public buildings) of presence of pacemaker because it may set off the metal detector. If hand-held screening wand is used, it should not be placed directly over the pacemaker. Manufacturer information may vary regarding the effect of metal detectors on the function of the pacemaker. 11. Monitor pulse and inform HCP if heart rate drops below predetermined rate. 12. Carry pacemaker information card and a current list of your drugs at all times. 13. Obtain and wear a Medic Alert ID device at all times. 14. Consider joining a pacemaker support group

Nursing interventions for current seizure

1. Monitor airway, breathing, and circulation (CABs) closely. 2. Monitor and record characteristics, onset, and duration of each episode including motor effects, alterations in consciousness, and postictal state. 3. Do not attempt to stop the seizure; ease patient to the floor if upright. A child in a wheelchair usually has adequate support and padding and does not need to be removed. Side rails should be padded for a child on a stretcher. 4. Place patient in a side-lying position; suction the oral cavity and posterior oropharynx as needed. 5. Administration of antiepileptic medications • During transport: buccal or intranasal midazolam, buccal lorazepam, rectal diazepam • Upon arrival to the hospital: Intravenous (IV) lorazepam, valproate, or levetiracetam 6. Closely monitor vital signs including temperature, respirations, heart rate, and blood pressure. 7. If possible, isolate patient from view of others by closing door or curtain.

Regarding Types of Dysrhythmias, Different forms of Ventricular Tachycardia (VT) exist, depending on QRS configuration 1. QRS complexes that are the same in shape, size, and direction 2. QRS complexes gradually change back and forth from one shape, size, and direction to another over a series of beats 3. polymorphic VT associated with a prolonged QT interval of the underlying rhythm

1. Monomorphic VT 2. Polymorphic VT 3. Torsades de pointes

Patient & Caregiver Teaching Thrombocytopenia

1. Notify HCP if manifestations of bleeding occur: • Black, tarry, or bloody bowel movements • Black or bloody vomit, sputum, or urine • Bruising or small red or purple spots on the skin • Bleeding from the mouth or anywhere in the body • Headache or changes in how well you can see • Difficulty talking, sudden weakness of an arm or leg, confusion 2. Ask HCP regarding restrictions in your normal activities, such as vigorous exercise or lifting weights. Generally, walking can be done safely and should be done with sturdy shoes or slippers. If you are weak and at risk for falling, get help or supervision when getting out of bed or chair. 3. Do not blow your nose forcefully; gently pat it with a tissue if needed. For a nosebleed, keep your head up and apply firm pressure to the nostrils and bridge of your nose. If bleeding continues, place an ice bag over the bridge of your nose and the nape of your neck. If you are unable to stop a nosebleed after 10 min, call your HCP. 4. Do not bend down with your head lower than your waist. 5. Prevent constipation by drinking plenty of fluids. Do not strain when having a bowel movement. Your HCP may prescribe a stool softener. Do not use a suppository, an enema, or a rectal thermometer without the permission of your HCP. 6. Shave only with an electric razor. Do not use blades. 7. Do not tweeze your eyebrows or other body hair. 8. Do not puncture your skin, such as getting tattoos or body piercing. 9. Avoid using any medication that can prolong bleeding, such as aspirin. Other medications and herbs can have similar effects. If you are unsure about any medication, ask your HCP or pharmacist about it in relation to your thrombocytopenia. 10. Use a soft-bristle toothbrush to prevent injuring the gums. Flossing is usually safe if it is done gently using the thin tape floss. Do not use alcohol-based mouthwashes, since they can dry your gums and increase bleeding. 11. Women who are menstruating should keep track of the number of pads that are used per day. When you start using more pads per day than usual or bleed more days, notify your HCP. Do not use tampons; only use sanitary pads. 12. Ask your HCP before you have any invasive procedures done, such as a dental cleaning, manicure, or pedicure

The Five Rs for Users Unwilling to Quit Tobacco

1. Relevance: Ask the patient to indicate why quitting is personally relevant (e.g., health). 2. Risks: Ask the patient to identify his or her potential risks/consequences of tobacco use. 3. Rewards: Ask the patient to identify potential benefits of stopping tobacco use. 4. Roadblocks: Ask patient to identify barriers or impediments to quitting. 5. Repetition: Repeat process every clinic visit.

Focal (partial) Seizures nursing steps if occurs

1. Stay calm. Guide patient to safety to prevent injury but do not restrain. 2. Observe for asymmetry of activity and focus on specific actions, such as lip smacking and abnormal movements. 3. Assess patient's level of consciousness and ability to converse and respond appropriately 4. Observe the time the event started and stopped. Pay attention to the time of return to baseline. 5. Provide respect and explanation of occurrence.

Patient & Caregiver Teaching Seizure Disorders Include the following information in the teaching plan for the patient with a seizure disorder.

1. Take antiseizure medications as prescribed. Report any and all drug side effects to the HCP. When necessary, blood is drawn to ensure maintenance of therapeutic drug levels. Schedule regular communication with the HCP to explore additional treatment options. 2. Use nondrug techniques, such as relaxation therapy, to potentially reduce the number of seizures. 3. Be aware of community and online resources for education and help with tracking and explaining seizure activity. 4. Wear a medical alert bracelet or necklace, and carry an identification card. 5. Avoid excessive alcohol intake, fatigue, and loss of sleep. 6. Eat regular meals and snacks in between if feeling shaky, faint, or hungry. 7. Be knowledgeable as a woman of childbearing age regarding antiseizure medications and contraceptive use.

pH 7.30 PaCO2 30 mm Hg HCO3− 16 mEq/L PaO2 95 mm Hg on room air

1. The pH, PaCO2, and HCO3− are abnormal. pH <7.35 indicates acidosis. 2. PaCO2 is low, indicating respiratory alkalosis. 3. HCO3− is low, indicating metabolic acidosis. 4. HCO3− matches the pH, indicating metabolic acidosis is the primary problem. 5. The CO2 is moving in the opposite direction, indicating the lungs are attempting to compensate for the metabolic acidosis. 6. PaO2 is normal and does not indicate hypoxemia. This ABG is interpreted as metabolic acidosis with partial compensation.

What are the steps for thoracentesis

1. The skin is cleansed with an antiseptic solution and injected with a local anesthetic. 2. The thoracentesis needle is inserted into the intercostal space. 3. Fluid is aspirated with a syringe, or tubing is connected to the needle to allow fluid to drain into a sterile container. 4. After the fluid is removed, the needle is withdrawn, and a bandage is applied over the insertion site.

Regarding Maintaining Accurate Records, Especially important in documentation of findings from the initial assessment are:

1. Verbatim statements of who caused the injury and when it occurred. 2. A body map to indicate size, color, shape, areas, and types of injuries with explanations 3. Physical evidence of sexual abuse, when possible. 4. If the abuse has just occurred, ask the patient to return in a day or two for more photographs as bruises may be more evident at that time.

Generalized Tonic-Clonic Seizures nursing steps if occurs

1. When seizure occurs outside the hospital setting, activate ERS if (1) the duration is greater than 5 minutes; (2) events recur without the patient recovering to baseline; (3) the patient is unable to establish a normal breathing pattern, is injured or pregnant; or (4) you do not know if this is a first-time seizure event. 2. Maintain patient safety. Lower the patient to the floor or bed, remove glasses if on, and loosen restrictive clothing. 3. Do not place anything in the patient's mouth. Patient's teeth/dentures may be damaged, and caregiver may be bitten. 4. Position patient on side (if possible) to improve the patient's ability to release oral secretions. 5. Observe the time event started and stopped. Pay attention to the time of return to baseline. 6. Assess for possible injury or any lingering motor weakness.

Regarding initial care after incomplete miscarriage and D&C, After evacuation of the uterus, what meds are given?

1. oxytocin (Pitocin) is often given to prevent hemorrhage 2. For excessive bleeding after the miscarriage, ergot products such as ergonovine (Methergine) or a prostaglandin derivative such as carboprost tromethamine (Hemabate) may be given to contract the uterus 3. Antibiotics are given as necessary. 4. Analgesics such as antiprostaglandin agents (e.g., nonsteroidal antiinflammatory drugs [NSAIDs]) may decrease discomfort from cramping 5. Transfusion therapy may be required for shock or anemia 6. The woman who is Rh negative and is not isoimmunized is given Rho(D) immune globulin

Platelet transfusions are generally not recommended until the count is below

10,000/µL (10 × 109/L), unless the patient is actively bleeding.

When esophageal and/or gastric variceal bleeding occurs, the first step is to

1. stabilize the patient and manage the airway. 2. IV therapy is initiated and may include administration of blood products. 3. Management that involves a combination of drug therapy and endoscopic therapy is more successful than either approach alone.

For amnioinfusion, Likely no more than What should be assessed continually during the procedure Uterine resting tone should not exceed The amount of vaginal fluid return must be

1000 mL of fluid will need to be administered. and can be warmed Intensity and frequency of UCs should be assessed 40 mm Hg estimated and documented during amnioinfusion to prevent overdistention of the uterus

The normal FHR range is

110 to 160 beats/min.

Non-ST-Elevation Myocardial Infarction (NSTEMI) patients do not go to the catheterization laboratory emergently but usually undergo the procedure within

12 to 72 hours if there are no contraindications. Thrombolytic therapy is not indicated for NSTEMI patients.

if the FHR varies between 130 and 140 beats/min over a 10-minute period, the baseline is recorded as

135 beats/min.

Because many drugs, foods, and beverages can cause an increase in blood pressure in patients taking MAOIs, hypertensive crisis is a constant concern. The hypertensive crisis usually occurs within Early symptoms include When a hypertensive crisis is suspected, what is needed?

15 to 90 minutes of ingestion of the contraindicated substance. irritability, anxiety, flushing, sweating, and a severe headache. - anxious, restless, and develops a fever - Eventually the fever becomes severe, seizures ensue, and coma or death immediate medical attention is crucial.

Category I FHR tracings are Category II FHR tracings are Category III FHR tracings are

1: normal and strongly predictive of normal fetal acid-base status at the time of observation. These tracings may be followed in a routine manner and do not require any specific action. 2. indeterminate. Do not meet category I or category III criteria. Category II tracings require continued observation and evaluation 3. abnormal. Immediate evaluation and prompt intervention are required when these patterns are identified

Myoglobin is released into the circulation within ___________ after an MI and peaks in _____________________. Although it is one of the first serum cardiac biomarkers to appear after an MI, it lacks cardiac specificity.

2 hours, 3 to 15 hours

Semen analysis (male factor) can be tested when? Sperm penetration assay (male factor) can be tested when? Scrotal ultrasound may be used to examine the testes for presence of Transrectal ultrasound is used to evaluate the

2-7 days after abstinence After 2 days but ≤1 week of abstinence varicoceles and identify abnormalities in the scrotum and spermatic cord. ejaculatory ducts, seminal vesicles, and vas deferens.

Removal of the epidural catheter within

24 hours later, may help prevent spinal headache. - Hydration and bed rest in the prone position have been recommended as preventive measures but have proven to be of little value

Late-preterm infants are born between Late-preterm infants experience morbidities similar to those of preterm infants, including

34 0/7 and 36 6/7 weeks of gestation. respiratory distress, hypoglycemia requiring treatment, temperature instability, poor feeding, jaundice, and discharge delays as a result of illness. (TREAT THE SAME AS REGULAR PRETERM)

in preterm infants, axillary temperatures of what are normal

36.3° to 36.9° C (97.3° to 98.4° F) - Little said we want baby at 98-99

Regarding Chronic Stable Angina drug therapy, SL NTG or translingual spray (Nitrolingual) usually relieves pain in about If symptoms are unchanged or worse after 5 minutes, tell the patient or caregiver to

5 minutes and lasts approximately 30 to 40 minutes. repeat NTG every 5 minutes for a maximum of three doses and contact emergency response system (ERS) if symptoms have not resolved completely. dose of NTG is one tablet taken sublingually (SL) or one metered spray on the tongue for symptoms of angina.

Regarding Chronic Stable Angina drug therapy, Patients can use NTG (Nitroglycerin) prophylactically before starting an activity that is known to cause angina. In these cases the patient can take a tablet or spray Tell the patient to report to the HCP

5 to 10 minutes before beginning the activity. x any changes in the usual pattern of pain, especially increasing frequency, nighttime angina, or angina at rest.

Regarding Pleural Effusion, The pleural space normally contains

5 to 15 mL of fluid that acts as a lubricant between the chest wall (parietal pleura) and lungs (visceral pleura).

Creatine kinase MB (CK-MB) levels begin to rise about ____________ an MI, peak at about ____________, and return to normal within ____________________________.

6 hours after, 18 hours, 24 to 36 hours

Dysrhythmias are the most common complication after an MI. They occur in What types?

80% to 90% of patients. Ventricular tachycardia (VT) and ventricular fibrillation (VF)

Regarding infants with HF, what feeding schedule is recommended? What is the feeding goal? How long is the feeding?

A 3-hour feeding schedule works well for many infants. (Feeding every 2 hours does not provide enough rest between feedings, and a 4-hour schedule requires an increased volume of feeding, which many infants are unable to take.) A feeding goal of 150 mL/kg/day and at least 120 kcal/kg/day giving an infant about a half hour to complete a feeding is reasonable. Prolonging the feeding time can exhaust the infant and decrease the rest period between feedings.

Regarding Cultural & Ethnic Health Disparities of Heart Failure, Asians have an extremely high risk (15%-50%) for

ACE inhibitor-related cough.

Ventricular remodeling is a risk factor for life-threatening dysrhythmias and sudden cardiac death (SCD). Drug therapies to prevent or reverse remodeling and decrease mortality are recommended. These include

ACE inhibitors, β-adrenergic blockers (β-blockers), and aldosterone antagonists.

Blood or Marrow Transplantation has been used successfully in treating some children with In general, BMT is not recommended for children with Because of the poorer prognosis in children with

ALL and AML ALL during the first remission because of the excellent results possible with chemotherapy (its for those who are high risk or have a poor early therapy response) AML, transplantation may be considered during the first remission when a suitable donor is available

Acute Myelogenous Leukemia is characterized by Acute Lymphocytic Leukemia is characterized by Chronic Myelogenous Leukemia is characterized by Chronic Lymphocytic Leukemia is characterized by

AML: uncontrolled proliferation of myeloblasts, the precursors of granulocytes. ALL: immature small lymphocytes proliferate in the bone marrow; most are of B-cell origin. CML: excessive development of mature neoplastic granulocytes in the bone marrow CLL: the production and accumulation of functionally inactive but long-lived, small, mature-appearing lymphocytes.

Regarding drug therapy for leukemia, arsenic trioxide (Trisenox), which is used to treat what causes what?

Acute Myelogenous Leukemia (AML) and causes DNA fragmentation and cell death - In addition, it inhibits cell proliferation and angiogenesis (new blood vessel growth).

Continuous renal replacement therapy (CRRT) is a method for treating CRRT is contraindicated if a patient has

Acute kidney injury life-threatening manifestations of uremia (hyperkalemia, pericarditis) that require rapid treatment.

Hyperthyroidism (Graves' Disease) Clinical manifestations for Children for a Thyroid Storm

Acute onset: • Severe irritability and restlessness • Vomiting • Diarrhea • Hyperthermia • Hypertension • Severe tachycardia • Prostration May progress rapidly to: • Delirium • Coma • Death

Regarding Types of Leukemia, Acute Myelogenous Leukemia (AML) Age of Onset Clinical Manifestations Diagnostic Findings

Age of Onset Increase in incidence with advancing age after 60 yr 15%-20% of acute leukemia in children and 80% in adults. Clinical Manifestations - Fatigue and weakness, - headache, - mouth sores, - anemia, - bleeding, - fever, - infection, - sternal tenderness, - gingival hyperplasia, - mild hepatosplenomegaly Diagnostic Findings - Low RBC count, Hgb, Hct, platelet count. - Low to high WBC count with myeloblasts. - High LDH. - Hypercellular bone marrow with myeloblasts - hyperplasia of the bone marrow

Regarding Types of Leukemia, Chronic Lymphocytic Leukemia (CLL) Age of Onset Clinical Manifestations Diagnostic Findings

Age of Onset Increase in incidence with advancing age after 65 yr Clinical Manifestations - Frequently no symptoms. - Detection of disease often during examination for unrelated condition, chronic fatigue, anorexia, splenomegaly and lymphadenopathy (Lymph node enlargement), hepatomegaly. - May progress to fever, night sweats, weight loss, fatigue, and frequent infections Diagnostic Findings - Mild anemia and thrombocytopenia with disease progression. - Total WBC count >100,000/µL. - Increase in peripheral lymphocytes and lymphocytes in bone marrow. - May have autoimmune hemolytic anemia, idiopathic thrombocytopenic purpura, and hypogammaglobulinemia

Regarding substance abuse, Stimulant Toxicity Assessment Findings Interventions

Assessment Findings Cardiovascular • Palpitations • Tachycardia • ↑ BP • Dysrhythmias • Myocardial ischemia or infarction Central Nervous System • Feeling of impending doom • Euphoria • Agitation • Combativeness • Seizures • Hallucinations • Confusion • Paranoia • Fever Interventions • Ensure patent airway. • Establish IV access and initiate fluid replacement as appropriate. • Obtain a 12-lead ECG and initiate ECG monitoring. • Treat ventricular dysrhythmias as appropriate with lidocaine, bretylium (Bretylol), or procainamide (Pronestyl). • Hypertension and chest pain may require administration of nitroprusside (Nipride) or phentolamine (Regitine). • Aspirin may be administered to lower the risk of myocardial infarction. • Administer IV diazepam (Valium) or lorazepam (Ativan) for seizures. • Administer IV antipsychotic drugs for psychosis and hallucinations. • Monitor vital signs and level of consciousness. • Initiate cooling measures for hyperthermia.

Emergency Management Depressant Toxicity Assessment Findings Interventions

Assessment Findings • Aggressive behavior • Agitation • Confusion • Lethargy • Stupor • Hallucinations • Depression • Slurred speech • Pinpoint pupils • Nystagmus • Seizures • Cold, clammy skin • Rapid, weak pulse • Slow or rapid shallow respirations • Decreased O2 saturation • Hypotension • Dysrhythmias • ECG changes • Cardiac or respiratory arrest Interventions • Ensure patent airway. • Anticipate intubation if respiratory distress evident. • Establish IV access. • Obtain temperature. • Obtain 12-lead ECG and initiate continuous ECG monitoring. • Obtain information about substance (name, route, when taken, amount). • Obtain specific drug levels or comprehensive toxicology screen. • Obtain a health history, including drug use and allergies. • Administer antidotes as appropriate. • Perform gastric lavage if necessary. • Administer activated charcoal and cathartics as appropriate. • Monitor vital signs, level of consciousness, and O2 saturation.

Regarding Late-Preterm Infant Assessment and Interventions, Respiratory distress Assessment Interventions

Assessment: - Assess for cardinal signs of respiratory distress (nasal flaring, grunting, tachypnea, central cyanosis, retractions) and presence of apnea, especially during feedings. - Assess for hypothermia, hypoglycemia. Interventions: - Perform gestational age assessment. - Observe for signs of respiratory distress; - monitor oxygenation by pulse oximetry; - provide supplemental oxygen judiciously.

Regarding Late-Preterm Infant Assessment and Interventions, Neurodevelopmental problems Assessment Interventions

Assessment: - Assess for respiratory distress, neonatal jaundice, hypoglycemia, and thermal instability. - Assess neurodevelopmental status. - Assess for seizure activity. Interventions: - Perform newborn screening, including hearing test. - Implement individualized developmental care. - Encourage parents to keep follow-up appointments with health care provider for evaluation of growth and development (including cognitive function and achievement of appropriate milestones).

Regarding Late-Preterm Infant Assessment and Interventions, Feeding problems Assessment Interventions

Assessment: - Assess suck-swallow and breathing. - Assess for respiratory distress, hypoglycemia, thermal stability. - Assess latch-on, maternal comfort with feeding method. - Determine weight loss (should be ≤10% of birth weight). Interventions: - Initiate early feedings (human milk or formula). - Ensure maternal knowledge of feeding method and signs of inadequate feeding (sleepiness, lethargy, color changes during feeding, apnea during feeding, decreased or absent urine output).

Regarding Late-Preterm Infant Assessment and Interventions, Infection Assessment Interventions

Assessment: - Evaluate maternal-fetal history for risk factors that may contribute to neonatal septicemia. - Assess for signs and symptoms of neonatal infection Interventions: - Use Standard Precautions, especially hand washing between infants and after contact with surfaces that may harbor bacteria (e.g., keyboards, telephones). - Maintain thermal stability. - Administer hepatitis B vaccine. - Encourage breastfeeding and assist mother-baby pair with breastfeeding. - Encourage parents to decrease infant exposure to respiratory viruses after discharge and obtain vaccines as appropriate to prevent development of respiratory infections (e.g., influenza).

Regarding Late-Preterm Infant Assessment and Interventions, Thermal instability Assessment Interventions

Assessment: - Monitor axillary temperature every 30 minutes immediately after birth until stable; thereafter every 1-4 hours, depending on gestational age and ability to maintain thermal stability. Interventions: - Provide skin-to-skin care in immediate postpartum period for stable infant. - Implement measures to avoid excess heat loss (adjust environmental temperature, avoid drafts). - Bathe only after thermal stability has been maintained for 1 hour.

Regarding Late-Preterm Infant Assessment and Interventions, Hypoglycemia Assessment Interventions

Assessment: - Monitor for signs and symptoms of hypoglycemia. - Assess feeding ability (latch-on, nipple feeding). - Assess thermal stability and signs and symptoms of respiratory distress. - Monitor bedside glucose in infants with additional risk factors (IDM, prolonged labor, respiratory distress, poor feeding). Interventions: - Initiate early feedings of human milk or formula. - Avoid dextrose water or water feedings. - Provide IV dextrose as necessary for hypoglycemia.

Body Mass Index numbers for each category

BMI 18.5 or less—Underweight BMI 18.5 to 24.9—Normal weight BMI 25.0 to 29.9—Overweight BMI 30.0 to 34.5—Obese BMI 35.0 to 40—Very obese

Late Decelerations Causes Clinical Significance Nursing Interventions

Cause Disruption of oxygen transfer from environment to fetus, resulting in transient fetal hypoxemia. Late decelerations are caused by the following: • Uterine tachysystole • Maternal supine hypotension • Epidural or spinal anesthesia • Placenta previa • Placental abruption • Hypertensive disorders • Postterm gestation • Intrauterine growth restriction • Diabetes mellitus • Intraamniotic infection Clinical Significance Abnormal pattern associated with fetal hypoxemia, acidemia, and low Apgar scores; considered ominous if persistent and uncorrected, especially when associated with absent or minimal baseline variability Nursing Interventions The usual priority is as follows: 1. Discontinue oxytocin if infusing. 2. Assist woman to lateral (side-lying) position. 3. Administer oxygen at 10 L/min by nonrebreather face mask. 4. Correct maternal hypotension by elevating legs. 5. Increase rate of maintenance intravenous solution. 6. Palpate uterus to assess for tachysystole. 7. Notify physician or nurse-midwife. 8. Consider internal monitoring for more accurate fetal and uterine assessment. 9. Assist with birth (vaginal assisted or cesarean) if pattern cannot be corrected.

Variable Decelerations Causes Clinical Significance Nursing Interventions

Cause Umbilical cord compression caused by the following: • Maternal position with cord between fetus and maternal pelvis • Cord around fetal neck, arm, leg, or other body part • Short cord • Knot in cord • Prolapsed cord Clinical Significance Variable decelerations occur in approximately 50% of all labors and usually are transient and correctable Nursing Interventions The usual priority is as follows: 1. Discontinue oxytocin if infusing. 2. Change maternal position (side to side, knee chest). 3. Administer oxygen at 10 L/min by nonrebreather face mask. 4. Notify physician or nurse-midwife. 5. Assist with vaginal or speculum examination to assess for cord prolapse. 6. Assist with amnioinfusion if ordered. 7. Assist with birth (vaginal assisted or cesarean) if pattern cannot be corrected.

Accelerations Causes Clinical Significance Nursing Interventions

Causes • Spontaneous fetal movement • Vaginal examination • Electrode application • Fetal scalp stimulation • Fetal reaction to external sounds • Breech presentation • Occiput posterior position • Uterine contractions • Fundal pressure • Abdominal palpation Clinical Significance • Normal pattern: Acceleration with fetal movement signifies fetal well-being representing fetal alertness or arousal states. Nursing Interventions • None required

Regarding Nicotine Replacement Agents, Nicotine Inhaler (Nicotrol nicotine inhalation system) Common Side Effects Considerations

Common Side Effects Cough, mouth and throat irritation, headache, nausea, hiccups Considerations - Requires a prescription. - Simulates smoking with mouthpiece and nicotine cartridge. - May not be advisable for those with asthma or pulmonary disease

Regarding Nicotine Replacement Agents, Nicotine Gum (OTC) (Nicorette) Common Side Effects Considerations

Common Side Effects Hiccups, mouth/jaw pain, mouth ulcers, indigestion, throat irritation, nausea Considerations - Specific 30-min chewing regimen with periods of holding the gum between cheek and teeth. - Take only water 15 min before and during use. - Difficult to use with dentures

Regarding Non-Nicotine Agents, bupropion (Zyban) Common Side Effects Considerations

Common Side Effects Insomnia, dry mouth, irritability, rash, tremors, anorexia Considerations - Contraindicated with history of seizures or eating disorders. - Promotes weight loss. - First choice for smokers with depression

Regarding Nicotine Replacement Agents, Nicotine Lozenge (OTC)(Commit) Common Side Effects Considerations

Common Side Effects Insomnia, nausea, sore throat, hiccups, cough, heartburn, headache, flatulence Considerations - Dissolves in mouth in 20 to 30 min. - Do not chew or swallow. - Avoid food and drink during use. - Occasionally rotate around the mouth.

Regarding Non-Nicotine Agents, varenicline (Chantix Common Side Effects Considerations

Common Side Effects Nausea, sleep disturbances, constipation, flatulence, vomiting, headache Considerations If taken concurrently with nicotine replacement therapy, incidence of nausea, headache, vomiting, dizziness, dyspepsia, and fatigue is increased, but nicotine pharmacokinetics not affected.

Regarding Nicotine Replacement Agents, Nicotine Nasal Spray (Nicotrol NS) Common Side Effects Considerations

Common Side Effects Nose and throat irritation, sneezing, rhinitis, headache, cough Considerations - Requires a prescription. - Provides fastest nicotine delivery. - Do not sniff or inhale while dosing. - Tilt head back slightly for best results.

Systemic lupus erythematosus (SLE) Clinical Manifestations

Constitutional: - Fever, - fatigue, - weight loss, - anorexia - sensitive to sunlight (photosensitivity) Cutaneous: - Erythematosus butterfly rash over bridge of nose and across cheeks, - discoid rash, - photosensitivity, - mucocutaneous ulceration, - alopecia, - periungual telangiectasias Musculoskeletal: - Arthritis, - arthralgia (joint pain) - myositis, - myalgia, - tenosynovitis - increased risk of bone loss and fracture. Neurologic: - Headache, - Cognitive dysfunction (thinking, disorientation, and memory deficits) - Generalized or focal seizures (controlled by corticosteroids or antiseizure drugs) - forgetfulness, - behavior change, - change in school performance, - psychosis, - chorea, - stroke, - cranial and peripheral neuropathy, - pseudotumor cerebri Pulmonary and cardiac: - Pleuritis, - basilar pneumonitis, - atelectasis, - pericarditis, myocarditis, endocarditis Renal: - Glomerulonephritis, - nephrotic syndrome, - hypertension Gastrointestinal: - Abdominal pain, - nausea, vomiting, - blood in stool, - abdominal crisis, - esophageal dysfunction, - colitis Hepatic, splenic, and nodal: - Hepatomegaly, splenomegaly, lymphadenopathy Hematologic: - Anemia, - cytopenia Ophthalmologic: - Cotton wool spots, - papilledema, - retinopathy Vascular: - Raynaud phenomenon, - thrombophlebitis, - livedo reticularis

Patient Teaching How to Distinguish True Labor from False Labor For False Labor: Contractions Cervix (by Vaginal Examination) Fetus

Contractions • Occur irregularly or become regular only temporarily • Often stop with walking or position change • Can be felt in the back or the abdomen above the umbilicus • Can often be stopped through the use of comfort measures Cervix (by Vaginal Examination) • May be soft but with no significant change in effacement or dilation or evidence of bloody show • Is often in a posterior position Fetus • Presenting part is usually not engaged in pelvis

Patient Teaching How to Distinguish True Labor from False Labor For True Labor: Contractions Cervix (by Vaginal Examination) Fetus

Contractions • Occur regularly, becoming stronger, lasting longer, and occurring closer together • Become more intense with walking • Are usually felt in the lower back, radiating to the lower portion of abdomen • Continue despite use of comfort measures Cervix (by Vaginal Examination) • Shows progressive change (softening, effacement, and dilation signaled by appearance of bloody show) • Moves to an increasingly anterior position Fetus • Presenting part usually becomes engaged in the pelvis, which results in increased ease of breathing; at the same time, the presenting part presses downward and compresses the bladder, resulting in urinary frequency

Regarding Peritoneal Dialysis, What can confirm peritonitis? Treatment? Repeated infections may require the

Cultures, Gram stain, and a WBC differential of the peritoneal effluent Antibiotics can be given orally, IV, or intraperitoneally. removal of the peritoneal catheter and a temporary or permanent change of modality to HD.

Regarding Special Diagnostic Procedures, Electroencephalography (EEG) Purpose Comment

Detects spikes, or bursts of electrical activity that indicate the potential for seizures - Patient should remain quiet during procedure; may require sedation. - Minimize external stimuli during procedure.

Regarding hormonal therapy, Raloxifene Hydrochloride (Evista) Dosage Adverse Reactions Nursing Considerations

Dosage 60 mg orally daily for 5 years Adverse Reactions - Common side effects include hot flashes, nausea, peripheral edema, joint pain, leg cramps, flulike symptoms, and sweating. - Serious and life-threatening side effects can occur from existing condition. - Women who have had or are at risk for a heart attack have increased risk for dying from a stroke. - Risk for blood clots in the legs and lungs is increased. - Raloxifene is contraindicated in women with an active or past history of venous thromboembolism. Nursing Considerations - The medication may be taken on an empty stomach or with food. - Missed doses should be taken as soon as possible, but taking two doses at once is not recommended. - The woman should contact her health care provider if leg pain or feeling of warmth in lower legs, swelling of hands and feet, sudden chest pain or shortness of breath, or sudden changes in vision occur. - Calcium 1500 mg plus vitamin D 400 to 800 International Units daily are recommended.

Hyperthyroidism Therapies

Drug Therapy • Antithyroid drugs (methimazole (Tapazole), propylthiouracil) • Iodine (SSKI) • β-Adrenergic receptor blockers (propranolol (Inderal), atenolol (Tenormin) or metoprolol (Toprol)) Radiation Therapy • Radioactive iodine Surgical Therapy • Subtotal thyroidectomy Nutritional Therapy • High-calorie, high-protein diet • Frequent meals

Systemic lupus erythematosus (SLE) Acute Care

During a disease flare: - assess fever pattern, joint inflammation, limitation of motion, location and degree of discomfort, and fatigue. - Monitor the patient's weight and fluid intake and output (important if corticosteroids are prescribed because of related fluid retention and possible renal failure) - Collect 24-hour urine samples for protein and creatinine clearance as ordered. - Observe for signs of bleeding due to drug therapy (e.g., pallor, skin bruising, petechiae, tarry stools). - Carefully assess neurologic function. - Observe for vision problems, headaches, personality changes, seizures, and memory loss. - Psychosis may result from CNS disease or be an effect of corticosteroid therapy. - Nerve irritation of the extremities (peripheral neuropathy) may cause numbness, tingling, and weakness of the hands and feet.

How to Prevent Bleeding in children

During infancy and toddlerhood: - the normal acquisition of motor skills creates innumerable opportunities for falls, bruises, and minor wounds. DO NOT RESTRAIN For older children: - physical limitations in regard to active sports may be a difficult adjustment, and activity restrictions must be tempered with sensitivity to the child's emotional and physical needs. - Use of protective equipment, such as helmets, face masks, shin/wrist/forearm guards, kneepads, and other equipment appropriate for the type of athletic activity Children and adolescents with severe hemophilia may participate in: - noncontact sports, such as aerobic exercise, stretching exercises, swimming, walking, jogging, tennis, golf, fishing, and bowling For all: - To prevent oral bleeding, some readjustment in terms of dental hygiene may be needed to minimize trauma to the gums, such as use of a water irrigating device, softening the toothbrush in warm water before brushing, or using a sponge-tipped disposable toothbrush. - subcutaneous route is substituted for IM injections whenever possible - Venipunctures for blood samples are usually preferred for these children - Acetaminophen is a suitable aspirin substitute

Emergency Treatment for Complex Partial (Focal) Seizure rules/teaching During the Seizure After the Seizure

During the Seizure • Do not restrain child's movements. • Remove harmful objects from area. • Redirect to safe area. • Talk in calm, reassuring manner. • Do not expect child to follow instructions. • Watch to see if seizure generalizes. After the Seizure • Stay with child, and reassure until fully conscious.

Emergency Treatment for Tonic-Clonic Seizure rules/teaching During the Seizure After the Seizure

During the Seizure • Remain calm. • Time seizure episode. • If child is standing or seated, ease child down to floor. • Turn child to one side. • Place pillow or folded blanket under child's head. • Loosen restrictive clothing. • Remove eyeglasses. • Clear area of any hazards or hard objects. • Allow seizure to end without interference. • Do not: • Attempt to restrain child or use force to control his or her movements. • Put anything in child's mouth. • Give any food or liquids. After the Seizure • Time postictal period. • Check for breathing. Check position of head and tongue. • Reposition if head is hyperextended. If child is not breathing, give rescue breathing and call EMS. • Keep child on side. • Remain with child. • Do not give food or liquids until child is fully alert and swallowing reflex has returned. • Look for medical identification, and determine which factors occurred before onset of seizure that may have been triggering factors. • Check head and body for possible injuries. • Check inside of mouth to see if tongue or lips have been bitten.

diagnostic studies used to determine whether a person has UA or an MI include an For STEMI:

ECG and serum cardiac biomarkers For STEMI ONLY: Coronary Angiography

Regarding hormonal therapy, Tamoxifen has been the hormone therapy of choice in The most common side effects of tamoxifen include Nursing Considerations Dosage

ER-positive women with all stages of breast cancer over the past 30 years. - hot flashes, mood swings, vaginal discharge and dryness, and other effects commonly associated with decreased estrogen. - increases the risk of blood clots, cataracts, stroke, and endometrial cancer in postmenopausal women. - The medication may be taken on an empty stomach or with food. - Missed doses should be taken as soon as possible, but taking two doses at once is not recommended. - A barrier or nonhormonal form of contraception is recommended in premenopausal women because tamoxifen may be harmful to the fetus if pregnancy should occur 20 mg orally daily for 5 years

Children who are experiencing an asthma exacerbation, receiving procedural sedation, or who are mechanically ventilated may have

ETCO2 monitoring. Special sampling cannulas are used for nonintubated patients, and a small device is placed between the endotracheal (ET) tube and the ventilator tubing in intubated patients.

Cirrhosis Clinical Manifestations Early Manifestations Late Manifestations

Early Manifestations: - fatigue - an enlarged liver - Blood tests may show normal liver function (compensated cirrhosis) Late Manifestations - liver failure - portal hypertension - Jaundice, peripheral edema, and ascites develop gradually - skin lesions (Spider angiomas, Palmar erythema) - hematologic disorders (thrombocytopenia, leukopenia, anemia, and coagulation disorders) - endocrine disturbances (gynecomastia, loss of axillary and pubic hair, testicular atrophy... amenorrhea, and older women may have vaginal bleeding) - peripheral neuropathies - In the advanced stages, the liver becomes small and nodular. - Liver function is dramatically diminished.

Erectile Dysfunction Drug Therapy Side effects of these drugs include

Erectogenic Drugs: phosphodiesterase type 5 (PDE5) inhibitors • sildenafil (Viagra) • vardenafil (Levitra, Staxyn) • tadalafil (Cialis) • avanafil (Stendra) • Alprostadil (MUSE)∗ penile self-injection and intraurethral suppository headaches, dyspepsia, flushing, and nasal congestion. Additional rare side effects are blurred or blue-green visual disturbances, sudden hearing loss, and an erection lasting more than 4 hours (priapism). (Instruct the patient to seek immediate medical attention if any of these reactions occur.) They are taken orally before sexual activity

Regarding Common Bacterial Infections of the Skin, Folliculitis (pimple) Etiology and Pathophysiology Clinical Manifestations Treatment and Prognosis

Etiology and Pathophysiology: • Usually staphylococci • Present in areas subjected to friction, moisture, rubbing, or oil • Increased incidence in patients with diabetes mellitus • Infection of hair follicle Clinical Manifestations: • Small pustule at hair follicle opening with minimal erythema • Development of crusting • Most common on scalp, beard, extremities in men • Tender to touch Treatment and Prognosis: • Antistaphylococcal soap and water cleansing • Topical antibiotics (e.g., mupirocin) • Warm compresses of water or aluminum acetate solution • Usually heals without scarring • If lesions extensive and deep, possible scarring, loss of involved hair follicles, and treatment with systemic antibiotics • Lesion should never be squeezed

Regarding Chronic Kidney Disease, Anemia Drug Therapy Interventions

Exogenous erythropoietin (EPO) is used to treat anemia: - epoetin alfa (Epogen, Procrit), which can be administered IV or subcutaneously, usually two or three times per week. - Darbepoetin alfa (Aranesp) is longer acting and can be administered weekly or biweekly. - Higher hemoglobin levels (more than 12 g/dL) and higher doses of EPO are associated with a higher rate of thromboembolic events and increased risk of death from serious CV events (heart attack, HF, stroke). - The recommendation is to use the lowest possible dose of EPO to treat anemia. - EPO can increase BP and is contraindicated in uncontrolled hypertension. - Iron supplementation is recommended if the plasma ferritin concentrations fall below 100 ng/mL - Blood transfusions should be avoided in treating anemia - Transfusions increase the development of antibodies, thus making it more difficult to find a compatible donor for kidney transplantation

Anorexia Nervosa and Bulimia Nervosa Nursing intervention

For Anorexia: - provide consistency (avoid any possibility of manipulation or inconsistency) - provide for support of the adolescent, the family, and team members. - The adolescent's efforts should be supported, and positive feedback should be provided for accomplishments made in normalizing eating habits. - A behavioral contract, an agreement that the adolescent makes with others to change a maladaptive behavior, has proved to be effective (Unless the adolescent agrees to its terms, the contract can become the source of a power struggle) - Family-based therapy For Bulimia: - Monitor fluid and electrolyte alterations - observation for signs of cardiac complications - Nutritional consultation - follow-up care are essential - structure the environment to reduce the binging behavior - Avoiding and eliminating trigger foods that would result in binges; - restricting eating to one room of the house; - not engaging in other activities while eating; - substituting exercise, crafts, visualization, and relaxation techniques for binging

Regarding Acute kidney injury (AKI) phases and the Recovery Phase, The recovery phase begins when the Patients who recover may achieve clinically normal kidney function but

GFR increases, allowing the BUN and serum creatinine levels to decrease. remain in an early stage of CKD.

The most common form of hyperthyroidism is

Graves' disease

Recommended Behaviors for Preventing Obesity

In counseling adolescents whose body mass index (BMI) is between the 5th and 84th percentiles, physicians and health care providers should recommend the following steps to prevent obesity: • Limit or avoid consumption of sugar-sweetened beverages. • Consume recommended quantities of fiber, fruits, and vegetables. • Limit screen time to no more than 2 hours per day, and remove television and computers from primary sleeping areas. • Encourage 60 minutes of moderate to vigorous physical activity daily. • Eat breakfast daily. • Limit eating at fast food restaurants. • Have frequent family meals in which parents and youth eat together. • Recognize appropriate child-size portions.

Meperidine Hydrochloride (Demerol) - Opioid agonist analgesic Indication Dosage Adverse Effects Nursing Considerations

Indication Moderate to severe labor pain and postoperative pain after cesarean birth Dosage and Route IV: 25 to 50 mg every 1 to 2 hours. PCA Pump: 15 mg every 10 minutes as needed until birth Adverse Effects Tachycardia, sedation, nausea and vomiting, dizziness, altered mental status, euphoria, decreased gastric motility, delayed gastric emptying, and urinary retention Nursing Considerations - use of side rails and assistance with ambulation - Do not give if birth is expected to occur within 1 to 4 hours after administration because infants born to women who received meperidine during labor may have respiratory depression, peaking at 2 to 3 hours after administration of the drug - Respiratory depression cannot be reversed by naloxone.

Nalbuphine Hydrochloride (Nubain) - Opioid agonist-antagonist analgesic Indication Dosage Adverse Effects Nursing Considerations

Indication Moderate to severe labor pain and postoperative pain after cesarean birth Dosage and Route IV: 5 to 10 mg every 3 hours as needed IM: 10 mg every 3 hours as needed Adverse Effects Sedation, drowsiness, nausea, vomiting, dizziness, respiratory depression, temporary absent or minimal fetal heart rate (FHR) variability Nursing Considerations - May precipitate withdrawal symptoms in opioid-dependent women and their newborns. - Assess maternal vital signs, degree of pain, FHR, and uterine activity before and after administration. - Observe for maternal respiratory depression - Encourage voiding every 2 hours, and palpate for bladder distention. - If birth occurs within 1 to 4 hours of dose administration, observe newborn for respiratory depression.

Naloxone Hydrochloride (Narcan) - Opioid (narcotic) antagonists Indication Adverse Effects Nursing Considerations

Indication Reverses opioid-induced respiratory depression in woman or newborn; may be used to reverse pruritus from epidural opioids Adverse Effects Maternal hypotension or hypertension, tachycardia, hyperventilation, nausea and vomiting, sweating, and tremulousness Nursing Considerations - The woman should delay breastfeeding until medication is out of her system (approximately 2 hours after) - Do not give to the woman or the newborn if the woman is opioid dependent—may cause abrupt withdrawal - If given to the woman for reversal of respiratory depression caused by opioid analgesic, pain will return suddenly - woman must be monitored closely for the return of opioid depression

Regarding infertility drugs, Clomiphene citrate (clomid) Indication Common Side Effects

Indication: Ovulation induction, treatment of luteal-phase inadequacy Common Side Effects: Vasomotor flushes (hot flashes), abdominal discomfort, nausea and vomiting, bloating, headache, blurred vision, mood swing, weight gain, breast tenderness, ovarian enlargement

Methods for Inducing Abortions For Length of Pregnancy and Description Medical vacuum aspiration Suction aspiration (curettage) Dilation and evacuation (D&E) Mifepristone (Mifeprex) with misoprostol (Cytotec)

Medical vacuum aspiration: - Usually up to 2 wk after first missed period - Catheter is inserted through cervix into uterus, and suction is applied. Contents of uterus are aspirated. Suction aspiration (curettage): - Up to 12 wk - Cervix is dilated, uterine aspirator is introduced, and suction is applied, removing contents of uterus. Dilation and evacuation (D&E): - 10-16 wk (approximate) - Cervix is dilated and contents of uterus are removed by vacuum cannula and use of other instruments as needed. Mifepristone (Mifeprex) with misoprostol (Cytotec): - Up to 49-63 days - Mifepristone is administered orally, followed by misoprostol orally 48 hr later.

Regarding Tocolytic Therapy for Preterm Labor, Magnesium Sulfate Medication and Action Dosage and Route Adverse Effects Nursing Considerations

Medication and Action CNS depressant; relaxes smooth muscle, including the uterus Dosage and Route IV fluid should contain 40 g in 1000 mL Adverse Effects Maternal: Hot flushes, sweating, burning at IV insertion site, nausea and vomiting, dry mouth, drowsiness, blurred vision, headache, ileus, generalized muscle weakness, lethargy, dizziness Hypocalcemia, Dyspnea, Transient hypotension Intolerable: (STOP IF OCCURS) (toxicity) Double Vision, diplopia Respiratory rate fewer than 12 breaths/minute Pulmonary edema Absent DTRs Chest pain Severe hypotension Altered level of consciousness Extreme muscle weakness Decreased Urine output Serum magnesium level of 10 mEq/L (9 mg/dL) or greater (Therapeutic is 5-8) Nursing Considerations - Assess woman and fetus to obtain baseline before beginning therapy and then before and after each incremental change; follow frequency of agency protocol. - Drug is almost always given IV but can also be administered IM. - Monitor serum magnesium levels with higher doses; therapeutic range is 4-7.5 mEq/L or 5-8 mg/dL. - Discontinue infusion and notify physician if intolerable adverse effects occur. - Ensure that calcium gluconate or calcium chloride is available for emergency administration to reverse magnesium sulfate toxicity. - Do not give to women with myasthenia gravis. Total IV intake should be limited to 125 mL/hour.

Regarding Patient Teaching Smoking and Tobacco Use Cessation Avoiding Relapse

Most relapses occur within the first 3 months after quitting. Do not be discouraged if you start using tobacco again. Remember, most people try several times before they finally quit. Explore different ways to break habits. You may have to deal with some of the following triggers that cause relapse. • Change your environment. Get rid of cigarettes, tobacco (in any form), and ashtrays in your home, car, and place of work. Get rid of the smell of cigarettes in your car and home. • Alcohol. Consider limiting or stopping alcohol use while you are quitting tobacco. • Other smokers at home. Encourage housemates to quit with you. Work out a plan to cope with others who smoke, and avoid being around them. • Weight gain. Tackle one problem at a time. Work on quitting tobacco first. You will not necessarily gain weight, and increased appetite is often temporary. Eat healthy and exercise. • Negative mood or depression. If these symptoms persist, talk to your HCP. You may need treatment for depression. • Withdrawal symptoms. Your body will go through many changes when you quit tobacco. You may have a dry mouth, cough, or scratchy throat, and you may feel irritable. The nicotine patch or gum may help with cravings • Focus on the benefits of quitting: • Your BP and heart rate will lower almost immediately. • Your risk of a heart attack declines within 24 hours and the blood will become less likely to clot, making dangerous blood clots less likely. • Within a few weeks, you will be less short of breath, cough less, and have more energy. Your ability to smell and taste should improve. • Your immune system will be stronger, so you will be less likely to be sick. • Quitting will improve your night vision and help preserve your overall vision.

Normal BUN levels Normal Neutrophils Normal Bands (immature) Normal WBC Normal Hbg Normal Hct Normal Platelet Normal Creatinine Normal Sodium: Normal Potassium

Normal BUN levels: 10-20 mg/dL Normal Neutrophils: 40-60% Normal Bands (immature): 0-5% Normal WBC: 5,000-10,000 Normal Hbg: male: 13.2-17.3 female: 11.7-15.5 Normal Hct: Male: 42-52% Female: 37-47% Normal Platelet: 150,000-400,000 Normal Creatinine: 0.6-1.2 (if this normal and bun elevated = dehydration) Normal Sodium: 135-145 mEq/L Normal Potassium: 3.5-5

Heart Failure is an abnormal clinical syndrome involving

inadequate cardiac ventricular filling (diastolic dysfunction) or ventricular ejection (systolic dysfunction)

Regarding Disadvantages of spinal anesthesia, Leakage of CSF from the site of puncture of the dura mater (membranous covering of the spinal cord) is thought to be the major causative factor in

PDPH, commonly referred to as a spinal headache. - the needle used for an epidural block has a much larger gauge than the one used for spinal anesthesia and thus creates a bigger opening in the dura, resulting in a greater loss of CSF (i.e., "wet tap").

MI occlusions

Partial occlusion of coronary artery: UA or NSTEMI Total occlusion of coronary artery: STEMI

Inevitable Miscarriage Symptoms Management

Passage of the products of conception occurs. Symptoms: - Moderate bleeding - Mild to severe cramping - Yes dilation Management: - Bed rest if no pain, bleeding, or infection - If rupture of membranes, pain, bleeding, or infection is present, then prompt termination of pregnancy is accomplished, usually by dilation and curettage.

Regarding Primary Generalized Seizures, An atonic seizure (akinetic seizure or drop attack) patient is at risk for

Patients with this type of seizure are at a great risk of head injury and often have to wear protective helmets

Cushing Syndrome Therapies

Pituitary Adenoma • Transsphenoidal resection • Radiation therapy Adrenocortical Adenoma, Carcinoma, or Hyperplasia • Adrenalectomy (open or laparoscopic) • Drug therapy (e.g., ketoconazole, aminoglutethimide, mitotane, mifepristone [Korlym]) Ectopic ACTH-Secreting Tumor • Treatment of the tumor (surgical removal or radiation) Exogenous Corticosteroid Therapy • Discontinue or alter the dose of exogenous corticosteroids

Pulmonary Embolism Surgical Therapy

Pulmonary Embolectomy: Hemodynamically unstable patients with massive PE in whom thrombolytic therapy is contraindicated may be candidates for immediate pulmonary embolectomy. - Embolectomy: removal of emboli to help decrease right ventricular afterload, can be achieved via a vascular (catheter) or surgical approach. Inferior Vena Cava (IVC) Filter: prevent further emboli, an inferior vena cava (IVC) filter may be the treatment of choice in patients who remain at high risk and patients for whom anticoagulation is contraindicated. - Complications associated with this device are rare but include misplacement, migration, and perforation.

Regarding Hyperthyroidism, Radioactive iodine (RAI) therapy response time What should be done because of this?

RAI has a delayed response. The maximum effect may not be seen for up to 3 months. For this reason, the patient is usually treated with antithyroid drugs and propranolol before and for 3 months after starting RAI until the effects of radiation become apparent

As noted, the earlier a bleeding episode is recognized, the more effectively it can be treated. Factor replacement therapy should be instituted according to established medical protocol, and supportive measures may be implemented, such as

RICE, which stands for rest, ice, compression, and elevation

Regarding Acute kidney injury (AKI), Therapies for Elevated Potassium Levels

Regular Insulin IV • Potassium moves into cells when insulin is given. • IV glucose is given concurrently to prevent hypoglycemia. • When effects of insulin diminish, potassium shifts back out of cells. Sodium Bicarbonate • Therapy can correct acidosis and cause a shift of potassium into cells. Calcium Gluconate IV • Generally used in advanced cardiac toxicity (with evidence of hyperkalemic ECG changes). • Calcium raises the threshold for excitation, resulting in dysrhythmias. Hemodialysis • Most effective therapy to remove potassium. • Works within a short time. Sodium Polystyrene Sulfonate (Kayexalate) • Cation-exchange resin is administered by mouth or retention enema. • When resin is in the bowel, potassium is exchanged for sodium. • Therapy removes 1 mEq of potassium per gram of drug. • It is mixed in water with sorbitol to produce osmotic diarrhea, allowing for evacuation of potassium-rich stool from body. Dietary Restriction • Potassium intake is limited to 40 mEq/day. • Primarily used to prevent recurrent elevation. Not used for acute elevation. Patiromer (Veltassa) • Oral suspension that binds potassium in GI tract. • It is used to treat chronic kidney disease. • It should not be used as an emergency drug for life-threatening hyperkalemia. • It has a delayed onset of action.

Patient & Partner Teaching Sexual Activity After Acute Coronary Syndrome

Sexual Activity After Acute Coronary Syndrome Include the following information in the teaching plan for the patient and his/her partner after an acute coronary syndrome: • Sexual activity should be resumed at a level that relates to sexual activity before experiencing ACS. • Physical training may improve the physiologic response to intercourse. Encourage daily physical activity during recovery. • Consumption of food and alcohol should be reduced before intercourse is anticipated (e.g., waiting 3-4 hr after ingesting a large meal before engaging in sexual activity). • Familiar surroundings and a familiar partner reduce anxiety. • Masturbation may be a useful sexual outlet and may reassure the patient that sexual activity is still possible. • Hot or cold showers should be avoided just before and after intercourse. • Foreplay is desirable because it allows a gradual increase in heart rate before orgasm. • Positions during intercourse are a matter of individual choice. • Orogenital sex places no undue strain on the heart. • A relaxed atmosphere free of fatigue and stress is optimal. • Prophylactic use of nitrates to decrease chest pain during sexual activity may be suggested. • Use of erectile agents (e.g., sildenafil) is contraindicated if taking nitrates in any form. • Anal intercourse should be avoided because of the possibility of inducing a vasovagal response.

Regarding surgical removal of a pituitary adenoma, an adrenal tumor, or one or both adrenal glands, Cushing syndrome Nursing Implementation for Postoperative Care

Surgery on the adrenal glands (adrenalectomy): - vascular, the risk of hemorrhage - patient may have a nasogastric tube, a urinary catheter, IV therapy, central venous pressure monitoring, and leg sequential compression devices to prevent emboli. - High doses of corticosteroids (e.g., hydrocortisone [Solu-Cortef]) are given IV during surgery - High corticosteroid levels cause problems with glycemic control, increase susceptibility to infection, and delay wound healing. - Monitor for hypertension (increases risk of hemorrhage) - Critical period for circulatory instability ranges from 24 to 48 hours after surgery - Must constantly be alert for signs of corticosteroid imbalance - Report any rapid or significant changes in BP, respirations, or heart rate - Monitor fluid intake and output - IV corticosteroids are given after - Oral doses are given as tolerated - After IV corticosteroids are withdrawn, keep the IV line open for quick administration of corticosteroids or vasopressors - Obtain morning urine samples at the same time each morning for cortisol measurement to evaluate the surgery's effectiveness. - The patient is usually maintained on bed rest until the BP stabilizes - Be alert for subtle signs of postoperative infection because the usual inflammatory responses are suppressed

Missed Miscarriage Symptoms Management

Symptoms: - None, spotting bleeding - No cramping - No dilation or tissue passing Management: - If spontaneous evacuation of the uterus does not occur within 1 month, pregnancy is terminated by method appropriate to duration of pregnancy. - Blood clotting factors are monitored until uterus is empty. - Disseminated intravascular coagulation (DIC) and incoagulability of blood with uncontrolled hemorrhage may develop in cases of fetal death after the twelfth week if products of conception are retained for longer than 5 weeks. - May be treated with dilation and curettage, or misoprostol (Cytotec) given orally or vaginally.

Threatened Miscarriage Symptoms Management

Symptoms: - Slight, spotting bleeding - Mild cramping Management: - Bed rest is often ordered but has not proven to be effective in preventing progression to actual miscarriage. - Repetitive transvaginal ultrasounds and assessment of human chorionic gonadotropin and progesterone levels may be done to determine if the fetus is still alive and in the uterus. - Further treatment depends on whether progression to actual miscarriage occurs.

Regarding Chronic Kidney Disease, CKD-MBD Diagnosis Interventions for CKD-MBD include

The gold standard for diagnosis is a bone biopsy - Phosphate intake is not usually restricted until the patient requires renal replacement therapy. At that time, phosphate is usually limited to about 1 g/day - limiting dietary phosphorus, - administering phosphate binders, - supplementing vitamin D, - controlling hyperparathyroidism (Calcimimetic agents • Cinacalcet (Sensipar)) - Do not use magnesium-containing antacids (e.g., Maalox, Mylanta) - If hypocalcemia persists even if the serum phosphate levels are normal, then supplemental calcium and vitamin D should be given (Calcitriol) - Assess vitamin D levels to determine the need for supplementation. If the levels are low (serum values less than 30 ng/mL), vitamin D supplementation is recommended in the form of cholecalciferol - Hypercalcemia may occur with calcium and vitamin D supplementation. If hypercalcemia occurs, vitamin D may be withheld and calcium-based phosphate binders replaced with noncalcium-based phosphate binders.

Clinical Manifestations: Chronic Heart Failure

Typical left and right symptoms - Fatigue is one of the earliest symptoms of chronic HF. - Orthopnea - Dyspnea (Paroxysmal nocturnal dyspnea (PND)) - Tachycardia is first responses to compensate for a failing heart is to increase the HR - Edema may occur in dependent body areas (peripheral edema), liver (hepatomegaly), abdominal cavity (ascites), and lungs (pulmonary edema and pleural effusion) - Skin Changes: may be dusky, lower extremities are shiny and swollen, with diminished or absent hair growth, Chronic swelling may brown the skin - restlessness, confusion, and decreased attention span or memory - Chest Pain - Weight Changes: fluid retention

Cardiac catheterization with possible PCI is considered for both

UA and NSTEMI patients once the patient is stabilized and angina is controlled or if angina returns or increases in severity.

Regarding Electronic Fetal Monitoring, The tocotransducer (tocodynamometer) measures The tocotransducer can measure and record the The device is placed over

UA transabdominally frequency and approximate duration of UCs but not their intensity. the fundus above the umbilicus and held securely in place with an elastic belt

Regarding Respiratory Syncytial Virus (RSV) Signs and Symptoms, Infants may have several days of

URI symptoms or no symptoms except slight lethargy, poor feeding, or irritability.

Regarding Bacterial Meningitis Nursing Implementation, if a nurse is trying to lower the fever she would Assess patient for:

Wrap the extremities in soft towels or a blanket covered with a sheet to reduce shivering (which can raise ICP). - If a cooling blanket is not available or desirable, tepid sponge baths with water may be effective in lowering the temperature. - Protect the skin from excessive drying and injury and prevent breaks in the skin. dehydration and adequacy of fluid intake due to increase in the metabolic rate and thus insensible fluid loss

Regarding Systemic lupus erythematosus (SLE), patients being treated with corticosteroids or cytotoxic drugs must

avoid live virus vaccines.

The caloric test is painful and is never performed on

a child who is awake or an individual with a ruptured tympanic membrane.

Regarding Bacterial meningitis Clinical Manifestations, If the infecting organism is a meningococcus, What test can be done?

a skin rash is common, and petechiae may be seen on the trunk, lower extremities, and mucous membrane A Tumbler test can be done by pressing the base of a drinking glass against the rash. - The rash does not blanch or fade under pressure.

Regarding epilepsy and seizures, In vagal nerve stimulation what is done The patient can Vagal nerve stimulation can cause adverse effects such as Battery life is Benefits of this therapy can be seen

a surgically implanted electrode in the neck is programmed to deliver the electrical impulse to the vagus nerve, usually on the left side. activate it with a magnet when he or she senses a seizure is imminent. coughing, hoarseness, dyspnea, and tingling in the neck. 5 to 10 years, and surgical replacement is required. within 24 months after implantation.

Regarding Special Diagnostic Procedures, with computed tomography (CT) and magnetic resonance imaging (MRI) The nurse should not expect cooperation from What is used? What should be done after?

a young child. Sedation may be required. If so, children should be helped through the preparation and administration and assured that someone will remain with them (if possible).

Most people with depression experience anergia, which refers to an Anergia may result in

abnormal lack of energy. psychomotor retardation, in which movements are extremely slow, facial expressions are decreased, and gaze is fixed.

Regarding preterm, Antenatal glucocorticoids, given as intramuscular (IM) injections to the mother to Antenatal glucocorticoids have been shown to significantly reduce the incidence of Recommends that all women between 24 and 34 weeks of gestation be given a single course of antenatal glucocorticoids when What should be given also?

accelerate fetal lung maturity by stimulating fetal surfactant production respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, and death in neonates, without increasing the risk for infection in either mothers or newborns preterm birth is threatened. Betamethasone or Dexamethasone to decreases neonatal respiratory morbidity and surfactant

Regarding Hyperthyroidism Therapeutic Management for Children, Thyrotoxicosis (thyroid "crisis" or thyroid "storm") may be precipitated by What are used for this? For how long?

acute infection, surgical emergencies, or discontinuation of antithyroid therapy. In addition to antithyroid drugs, beta blockers are used to control symptoms until normal thyroid function is achieved. Therapy is usually required for 2 to 3 weeks.

Meningitis is an

acute inflammation of the meningeal tissues surrounding the brain and spinal cord.

Necrotizing enterocolitis (NEC) is an

acute inflammatory disease of the bowel with increased incidence in preterm infants. - COMPLICATION FROM FEEDING A COLD STRESSED BABY

Children taking phenobarbital or phenytoin should receive Phenytoin should not be taken with

adequate vitamin D and folic acid because deficiencies of both have been associated with these drugs. Phenytoin should not be taken with milk.

Regarding epilepsy and seizures, Vagal nerve stimulation, a form of neuromodulation, is used as an

adjunct to drugs when an accessible focal point cannot be identified for surgical removal exact mechanism of action is unknown, but it is thought to interrupt the synchronization of epileptic brain wave activity and stop excessive discharge of neurons

Regarding Cushing Syndrome, Adrenalectomy is indicated for Cushing syndrome caused by What types?

adrenal tumors or hyperplasia - Occasionally, bilateral adrenalectomy is necessary. - A laparoscopic approach is used unless a malignant adrenal tumor is suspected. - An open surgical adrenalectomy is usually performed for adrenal cancer.

Nursing Alert Nurses are advised to be alert for mothers who are

agitated, overactive, confused, complaining, or suspicious. (Postpartum psychosis)

Panic disorder consists of unpredictable, intermittent episodes (attacks) of symptoms similar to those of generalized anxiety disorder. Women with panic disorder may develop

agoraphobia or fear of leaving home because they fear having another panic attack

Regarding ADHD, Two centrally acting alpha-2 adrenergic agonists, clonidine (Kapvay) and guanfacine (Intuniv): They may be used clonidine side effects The most common side effects of guanfacine are

alone or in conjunction with other ADHDA medications clonidine carries more side effects: - somnolence, - fatigue, - insomnia, - nightmares, - irritability, - constipation, - respiratory symptoms - dry mouth, - ear pain guanfacine: - somnolence, - lethargy, - fatigue, - insomnia, - nausea, - dizziness, - hypotension, - abdominal pain.

After a blood patch what should the women be observed for? What should she be instructed to avoid?

alteration in vital signs, pallor, clammy skin, and leakage of CSF for 1 hour avoid coughing or straining for the first day after the blood patch

Regarding Anxiety Pharmacological Interventions, Buspirone (BuSpar) is an what? How long does it take for full effects? Buspirone is not recommended for individuals with The FDA recommends using the drug during

alternative antianxiety medication that does not cause dependence, but 2 to 4 weeks are required for it to reach full effects. impaired hepatic or renal function since in increased plasma levels and lengthened half-life may result. pregnancy and breastfeeding only if clearly necessary.

A fetal weight less than 500 g also may be used to define

an abortion

Regarding substance abuse, Stimulant Withdrawal is usually not Abrupt cessation can

an emergency. lead to a "crash."

Local perineal infiltration anesthesia may be used when Rapid anesthesia is produced by Epinephrine often is added to the solution to

an episiotomy is to be performed or when lacerations must be sutured after birth in a woman who does not have regional anesthesia. injecting approximately 10 to 20 mL of 1% lidocaine or 2% chloroprocaine into the skin localize and intensify the effect of the anesthesia in a region and to prevent excessive bleeding and systemic absorption by constricting local blood vessels (For postbirth repairs)

Pruritus (itching) is a side effect that often occurs with the use of

an opioid, especially fentanyl.

Regarding Pulmonary embolism (PE), Treatment with ____________________________ significantly reduces mortality.

anticoagulants

Regarding Types of Dysrhythmias and Atrial Fibrillation Treatment, If a patient is in atrial fibrillation for longer than 48 hours, what should be done What can be done to make sure this is needed?

anticoagulation therapy with warfarin is needed for 3 to 4 weeks before the cardioversion and for several weeks after successful cardioversion - A transesophageal echocardiogram may be performed to rule out clots in the atria. If no clots are present, anticoagulation therapy may not be needed before the cardioversion.

The victims of bullying often view themselves as outcasts and failures. Victims often display signs of

anxiety and depression in conjunction with isolationism, school absenteeism, loneliness, and suicidal ideation

morphine can help reduce

anxiety and fear. In rare situations, morphine can depress respirations.

Children with ITP should not participate in What can be done instead? Instruct the parent to?

any contact sports, bike riding, skateboarding, in-line skating, gymnastics, climbing, or running. Parents are encouraged to engage their children in quiet activities and to prevent any injuries, especially to the child's head. Instruct the parents to obtain prompt medical evaluation if the child sustains head or abdominal trauma.

Cognitive impairment (CI) is a general term that encompasses

any type of intellectual disability. - CI is used synonymously with intellectual disability.

For preterm infants, Sleep periods should be undisturbed for Twenty-four hour surveillance of sick infants implies maximum visibility and the use of bright lights. Units should establish a

at least 50 minutes to allow complete sleep cycles. - Clustering of care can promote longer uninterrupted periods of sleep night-day sleep pattern by darkening the room, covering cribs with blankets, or placing eye patches over the infant's eyes at night.

Replacement of deficient clotting factors is the primary means of supporting a patient with hemophilia. In addition to treating acute crises, replacement therapy may be given

before surgery and dental care as a prophylactic measure

Regarding chemotherapy, The most beneficial regimen for antiemetic control has been the administration of the antiemetic

before the chemotherapy begins (30 minutes to 1 hour before) and regular (not as-needed) administration for at least 24 hours after chemotherapy.

Regarding Types of Dysrhythmias, Pulseless electrical activity (PEA) Treatment

begins with CPR followed by drug therapy (e.g., epinephrine) and intubation. Correcting the underlying cause is critical to prognosis.

Regarding infants and children with congenital heart defects, The need to maintain discipline and set consistent limits can be difficult for parents. Using what can be helpful?

behavior modification techniques, in the form of either concrete awards (e.g., a favorite activity) or social reinforcement (e.g., approval), can be effective. However, it is most beneficial if used before the child learns to control the family. To prevent later problems, it is necessary to begin discussions with parents while the child is in infancy

Regarding infant and children with HF, The child's apical pulse is always checked before administering digoxin. As a general rule, the drug is not given if the pulse However, because the pulse rate varies in children in different age groups, what should be done?

below 90 to 110 beats/min in infants and young children or below 70 beats/min in older children (the cutoff point for adults is 60 beats/min). the written drug order should specify at what heart rate the drug is withheld.

The honeymoon phase is characterized by a period of

calm and remorse in which the male partner displays kind, loving behavior and pleas for forgiveness. This honeymoon phase lasts until stress or other factors cause conflict and tension to mount again toward another episode of battering.

Regarding infants with HF, what do you feed the infant? What should you be careful of?

caloric density of formulas is frequently increased by concentration and then adding Polycose, medium-chain triglyceride oil, or corn oil. The caloric density of the formula needs to be increased slowly (by 2 kcal/oz/day) to prevent diarrhea or formula intolerance.

A structured exercise program, such as

cardiac rehabilitation (CR), should be considered for all patients with chronic HF. CR has been associated with decreased hospitalizations and reduced mortality.

All patients (e.g., those with ACS, chronic stable angina, heart surgery) need to be referred to a

cardiac rehabilitation program

Regarding Serum cardiac biomarker with MI, Cardiac-specific troponin has two subtypes:

cardiac-specific troponin T (cTnT) and cardiac-specific troponin I (cTnI) (Better than creatine kinase MB (CK-MB))

Regarding infants and children, Diagnosis of HF is made on the basis of

clinical symptoms, such as tachypnea and tachycardia at rest, dyspnea, retractions, activity intolerance (especially during feeding in infants), feeding intolerance, weight gain caused by fluid retention, and hepatomegaly.

Regarding Hemodialysis, When blood comes in contact with a foreign material (such as the dialyzer), it has a tendency to

clot. Heparin is added to the blood to prevent clotting.

Persons with alcohol-related neurodevelopmental disorder (ARND) are likely to have

cognitive and learning disabilities and behavioral problems such as poor impulse control

Neurologic problems in persons with Fetal alcohol syndrome (FAS) can include some degree of They have been shown to

cognitive deficit, ADHD, diminished fine-motor skills, and poor speech lack inhibition, have no stranger anxiety, and lack appropriate judgment skills

Individuals with binge-eating disorder do not regularly use the

compensatory behaviors (e.g., vomiting and laxatives) that are seen in patients with bulimia nervosa. - Although individuals who start binge eating may be of normal weight, repeated binge eating inevitably causes obesity in this cohort.

Regarding breast cancer nurse implications, When the patient's lymphedema is acute what therapy is done What else is done after?

complete decongestive therapy (massage-like technique to mobilize the subcutaneous accumulation of fluid.) - followed by use of compression bandaging and an intermittent pneumatic compression sleeve - Elevation of the arm so that it is level with the heart and isometric exercises - patient may need to wear a fitted compression sleeve during waking hours and preventively during air travel.

Autism spectrum disorder is a

complex neurobiological and developmental disability that typically appears during a child's first 3 years of life.

Regarding cirrhosis, Esophageal varices are a Ruptured esophageal varices are the Gastric varices are located

complex of tortuous, enlarged veins at the lower end of the esophagus. most life-threatening complication of cirrhosis and considered a medical emergency. in the upper portion of the stomach. - These varices are fragile and do not tolerate high pressure, thus they can bleed easily.

During the head-up tilt-test, If the patient's BP and HR responses are abnormal and clinical symptoms are reproduced (e.g., faintness), the test is If after 30 minutes there is no response,

considered positive. the table is returned to the horizontal position and an IV infusion of low-dose isoproterenol may be started in an attempt to provoke a response.

Regarding The patient with a STEMI must undergo

coronary angiography within 90 minutes of presentation or receive thrombolytic therapy within 30 minutes in agencies without PCI capability.

Cardiac catheterization and coronary angiography use radiation and IV contrast dye to provide images of the coronary circulation and identify the location and severity of any blockage. A patient who is allergic to IV contrast dye must be premedicated with

corticosteroids.

Regarding Types of Dysrhythmias, Two consecutive Premature Ventricular Contractions (PVC) are called a

couplet

Regarding Stages of Chemotherapy, During induction therapy, a patient may become Throughout the induction phase, nursing interventions focus on

critically ill because the bone marrow is severely depressed - neutropenia (serious risk factor for life-threatening infection and sepsis) - thrombocytopenia (result in spontaneous bleeding or major hemorrhage.) - anemia, - as well as providing psychosocial support to the patient and family.

Regarding Sedatives, Barbiturates such as secobarbital sodium (Seconal) easily They can cause undesirable side effects including Because of the potential for neonatal

cross the placenta and have a long half-life. respiratory and vasomotor depression, affecting the woman and newborn. central nervous system (CNS) depression, barbiturates should be avoided if birth is anticipated within 12 to 24 hours

von Willebrand disease is a related disorder (to hemophilia) involving a

deficiency of the von Willebrand coagulation protein. Factor VIII is synthesized in the liver and circulates as a complex with von Willebrand factor (vWF).

The fourth stage of labor begins with the During this stage, the woman

delivery of the placenta and includes at least the first 2 hours after birth. begins to recover physically from birth, so it is an important time to observe for complications, such as abnormal bleeding

Electroconvulsive Therapy is the most effective acute treatment for Risk of doing this

depression - risk of suicide and diminished quality of life - heart can be stressed at the onset of the seizure and for up to 10 minutes after, careful assessment and management in hypertension, congestive heart failure, cardiac arrhythmias, and other cardiac conditions is warranted - stresses the brain as a result of increased cerebral oxygen, blood flow, and intracranial pressure.

Regarding down syndrome, The hypotonicity of muscles and hyperextensibility of joints complicate positioning. The limp, flaccid extremities resemble the posture of a rag doll; as a result, holding the infant is Sometimes parents perceive this lack of molding to their bodies as evidence of The extended body position promotes What should be encouraged to the patient?

difficult and cumbersome inadequate parenting. heat loss, because more surface area is exposed to the environment. Encourage the parents to swaddle or wrap the infant snugly in a blanket before picking up the child to provide security and warmth.

Regarding Primary Generalized Seizures, If the patient has cognitive impairment, Atypical Absence Seizure activity may be What is the age for this one?

difficult to distinguish from usual behavior. Atypical absence seizures usually continue into adulthood.

Regarding Acute kidney injury (AKI), Intrarenal causes of AKI include conditions that cause most common intrarenal cause of AKI

direct damage to the kidney tissue, resulting in impaired nephron function - prolonged ischemia, nephrotoxins (e.g., aminoglycoside antibiotics, contrast media), hemoglobin released from hemolyzed red blood cells (RBCs), or myoglobin released from necrotic muscle cells. Acute tubular necrosis (ATN) is the most common intrarenal cause of AKI and is primarily the result of ischemia, nephrotoxins, or sepsis.

Giving propylthiouracil (PTU) or methimazole (MMI) during pregnancy for hyperthyroidism is What can each do? Although the likelihood of maternal and fetal side effects from both drugs is low, a panel convened by the US Food and Drug Administration (FDA) and the American Thyroid Association recommended that PTU be used only in the

effective at controlling symptoms, but both have potentially dangerous maternal and fetal side effects. - PTU can cause hepatic toxicity serious enough to require liver transplantation. - When taken during the first trimester of pregnancy, MMI can cause choanal atresia or esophageal atresia, facial anomalies, hearing loss, developmental delay, and congenital cardiac malformations in exposed fetuses. first trimester of pregnancy. After the first trimester, women requiring drug therapy for hyperthyroidism should be switched to MMI for the remainder of pregnancy

Regarding Primary Generalized Seizures, An atonic seizure (akinetic seizure or drop attack) involves How is the person effected? How long does this last?

either a tonic episode or a paroxysmal loss of muscle tone and begins suddenly with the person falling to the ground. The person usually remains conscious, and normal activity can be resumed immediately. Seizures typically last less than 15 seconds.

Because spinal nerve blocks can reduce bladder sensation, resulting in difficulty voiding, the woman should For this reason, an

empty her bladder before the induction of the block and should be encouraged to void at least every 2 hours thereafter. - nurse should palpate for bladder distention and measure urinary output to ensure that the bladder is being completely emptied. - distended bladder can inhibit uterine contractions and fetal descent, resulting in a slowing of the progress of labor. indwelling urinary (Foley) catheter is often routinely inserted immediately after epidural or spinal anesthesia

For preventing abuse, Nursery and postpartum nurses can foster the attachment process by Nurses in neonatal intensive care units can minimize the effects of separation by Nurses in ambulatory settings can teach parents appropriate methods of

encouraging parents to hold and look at their infant and by teaching coping mechanisms for prolonged crying. encouraging parents to visit and can help parents become comfortable caring for their child. bathing, feeding, toileting, disciplining, and preventing injuries while stressing the normal needs and developmental characteristics of children.

The last stage of kidney disease is called What is needed at this point?

end-stage renal disease (ESRD), occurs when the GFR is less than 15 mL/min. At this point, renal replacement therapy (dialysis or transplantation) is required to maintain life.

One possible predictor of Spontaneous preterm labor is

endocervical length - Women whose cervical length as measured by transvaginal ultrasound is greater than 30 mm in the second and third trimester of pregnancy are unlikely to give birth prematurely

Regarding Sedatives, Benzodiazepines (e.g., diazepam [Valium], lorazepam [Ativan]), when given with an opioid analgesic, seem to Because benzodiazepines cause significant maternal amnesia, however, their use should A major disadvantage of diazepam is that it disrupts Flumazenil (Romazicon) is a

enhance pain relief and reduce nausea and vomiting. be avoided during labor. thermoregulation in newborns, making them less able to maintain body temperature. specific benzodiazepine antagonist that can be administered if necessary to effectively reverse benzodiazepine-induced sedation and respiratory depression

Bulimia nervosa is a disorder characterized by They may abuse

episodes of binge eating, inappropriate behaviors to avoid weight gain (vomiting, laxative abuse, over exercise), and a persistent concern with body image laxatives, diuretics, exercise, or diet drugs.

Regarding cervical insufficiency, The only indication for an abdominal cerclage that has been proven to be of benefit is This procedure is usually done at What is done during labor?

failure of a prior history-indicated transvaginal cerclage, where spontaneous preterm birth occurred before 33 weeks of gestation. 11 to 12 weeks of gestation or before conception by means of a laparotomy. - Suture (Mersilene tape) is placed at the junction of the lower uterine segment and the cervix Suture (Mersilene tape) is placed at the junction of the lower uterine segment and the cervix

Regarding hyperthyroidism in pregnant women, The most severe side effect is agranulocytosis, which occurs rarely and usually develops only in older women and in those taking high doses of the drug. Symptoms of agranulocytosis are What should be done?

fever and unexpected sore throat, which should be reported to the health care provider; and the woman should immediately stop taking the medication

Regarding the ECG, The isoelectric line is

flat and represents those normal times in the cardiac cycle when the ECG is not recording any electrical activity in the heart.

Regarding Chemical pleurodesi, Chest tubes are left in place until

fluid drainage is less than 150 mL/day and no air leaks are noted.

Regarding Acute kidney injury (AKI) phases and the Oliguric Phase, To prevent hypovolemia, Fluid replacement is often sufficient to treat many forms of AKI, especially prerenal causes. When urine output decreases, Hypervolemia symptoms

fluid retention occurs causing hypervolemia - anuria and oliguria can cause the neck veins to become distended with a bounding pulse. - Edema and hypertension may develop. - Fluid overload can eventually lead to heart failure, pulmonary edema, and pericardial and pleural effusions.

Regarding substance abuse, For depressants and Sedative-Hypnotics and Antianxiety toxicity a patient with a benzodiazepine overdose may receive Place the patient on Since there are no antagonists for barbiturates or other sedative-hypnotic drugs, the patient who has overdosed on these agents receives

flumazenil, a specific benzodiazepine antagonist. safety precautions, as flumazenil can cause seizures. treatment to promote drug elimination - Dialysis is used to decrease the drug level and to prevent irreversible CNS effects and death. - If the airway can be maintained, gastric lavage and activated charcoal are options. - If unconscious, an intravenous fluid line should be established

When a patient is taking morphine, monitor

for signs of bradypnea or hypotension, which are conditions to avoid in myocardial ischemia and infarction.

One of the outstanding characteristics of middle childhood is the formation of

formalized groups, or clubs.

Venous thrombosis involves the

formation of a thrombus (blood clot) in association with inflammation of the vein

Regarding Electronic Fetal Monitoring, This integrated monitoring system more accurately measures the Advantages of the device are This type of monitor cannot be used during

frequency, occurrence of peak, and duration of UCs than does the traditional tocotransducer, although it does not provide actual intensity measurement in millimeters of mercury (mm Hg) as an IUPC does. eliminates the need for abdominal belts and frequent readjustment of the tocotransducer and ultrasound transducer hydrotherapy or water birth and may not be readily available for use in all labor and birth settings

Regarding breast cancer nurse implications, If an axillary lymph node dissection (ALND) has been done or if the patient had a mastectomy, drains are Teach the patient and family,

generally left in place, and patients are discharged home with them. with a return demonstration, how to manage the drains at home.

Regarding antiseizure drugs, Common side effects of phenytoin are What should be done about this If extensive what should happen

gingival hyperplasia (excessive growth of gingival tissue) and hirsutism, especially in young adults. Good dental hygiene, including regular tooth brushing and flossing, can decrease gingival hyperplasia. If gingival hyperplasia is extensive, the hyperplastic tissue may have to be surgically removed (gingivectomy) and phenytoin replaced with another antiseizure drug.

Regarding Types of Dysrhythmias, Atrial Fibrillation Treatment

goals of treatment of atrial fibrillation include a decrease in ventricular response (to less than 100 beats/minute), prevention of stroke, and conversion to sinus rhythm - calcium channel blockers (e.g., diltiazem), β-blockers (e.g., metoprolol), dronedarone, and digoxin (Lanoxin). - antidysrhythmia drugs used for conversion to and maintenance of sinus rhythm include amiodarone and ibutilide - Electrical cardioversion

Regarding Clinical manifestations of hyperthyroidism, Palpation of the thyroid gland may reveal a Auscultating the thyroid gland may reveal

goiter. bruits, a reflection of increased blood supply

Polypharmacy and the normal metabolic processes of aging contribute to concerns about prescribing antidepressants for older adults. SSRIs are a first-line treatment for older adults, but this population has the potential for aggravated side effects. Starting doses are recommended to be

half the lowest adult dose, with dose adjustments occurring no more frequently than every 7 days ("start low and go slow").

Life expectancy for those with Down syndrome The majority of individuals with Down syndrome survive to

has improved in recent years but remains lower than for the general population. 60 years of age and beyond

Regarding Hyperthyroidism in Children, Increased metabolic rate may cause What should be done to help this?

heat intolerance and increased food intake in these patients - Heat intolerance may be minimized by the use of light cotton clothing, good ventilation, air conditioning or fans, frequent baths, and adequate hydration - Dietary requirements should be adjusted to meet the child's increased metabolic rate. - Five or six moderate meals throughout the day. (NOT BIG MEALS)

One of the risks associated with the broad and increasing use of heparin is the development of the life-threatening condition called

heparin-induced thrombocytopenia (HIT), also called heparin-induced thrombocytopenia and thrombosis syndrome (HITTS)

5% Dextrose (D5) is administered for Who would not get it?

hypernatremia and to provide free water for the kidneys. If someone was diabetic, we are probably not going to give them D5. You shouldn't use it for fluid replacement.

Nitroglycerin side effects?

hypotension (monitor BP), headache, tachycardia

Regarding Sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra, Staxyn), and avanafil (Stendra), Because these drugs may potentiate the

hypotensive effect of nitrates, they are contraindicated for individuals taking nitrates (e.g., nitroglycerin).

Regarding Types of Dysrhythmias, Ventricular Fibrillation (VF) Treatment

immediate initiation of CPR and advanced cardiovascular life support (ACLS) with the use of defibrillation and definitive drug therapy (e.g., epinephrine, vasopressin).

Regarding Stages of Chemotherapy, Intensification therapy, or high-dose therapy, may be given Consolidation therapy is started The purpose of consolidation therapy is to

immediately after induction therapy for several months. after a remission is achieved with high dose therapy eliminate remaining leukemic cells that may not be clinically or pathologically evident.

Monoclonal antibodies (drugs ending in -mab) are the most successful

immunotherapy

Streptococci cause Lymphangitis. S. aureus causes

impetigo, erysipelas, cellulitis impetigo, folliculitis, cellulitis, and furuncles

The most common approach to preventing a recurrence of Sudden cardiac death (SCD) is the use of an What drug can be used with it?

implantable cardioverter-defibrillator (ICD). It has been shown that an ICD improves survival compared with drug therapy alone Drug therapy with amiodarone (Cordarone) may be used with an ICD to decrease episodes of ventricular dysrhythmias.

Regarding Hyperthyroidism Drug Therapy, Methimazole is given

in a single daily dose.

Regarding Serum cardiac biomarker with MI, Serum levels of cardiac-specific troponin T cTnI and cTnT ________________________ after the onset of MI, peak at ________________________, and return to baseline over _______________. Serial cardiac biomarkers are drawn over ____________________________.

increase 4 to 6 hours, 10 to 24 hours, 10 to 14 days 24 hours (e.g., every 6 hours × 3)

Treatment of status epilepticus requires The drugs most commonly used are what? Why? How about at home or before the hospital?

initiation of a rapid-acting IV antiseizure drug. lorazepam (Ativan) and diazepam (Valium). - Because these are short-acting drugs, their administration is followed with long-acting drugs such as phenytoin or phenobarbital. Buccal midazolam and rectal diazepam are quick, effective, and safe treatments for home or prehospital treatment

Fetal alcohol syndrome is the leading cause of

intellectual disability in the United States

Postpartum depression, also known as PPD without psychotic features, is an It is more serious and persistent than postpartum blues, lasting These symptoms rarely

intense and pervasive sadness with severe and labile mood swings. lasting more than 2 weeks. - Intense fears, anger, anxiety, and despondency that persist past the baby's first few weeks are not a normal part of postpartum blues. disappear without outside help. Most of these mothers seek help only after reaching a "crisis point."

Regarding Stages of Chemotherapy, Terms used to describe postinduction or postremission chemotherapy include

intensification and consolidation.

The broad term child maltreatment includes

intentional physical abuse or neglect; emotional abuse or neglect; and sexual abuse of children, usually by adults.

The characteristic Abusive head trauma (AHT) (shaken baby syndrome) injuries that occur are

intracranial bleeding (subdural hematoma) and in approximately 80% of cases retinal hemorrhages

Regarding Hyperthyroidism Drug Therapy, Assess the patient taking Iodine (saturated solution of potassium iodine (SSKI) and Lugol's solution) for signs of What to do if issues occur?

iodine toxicity, such as swelling of the buccal mucosa and other mucous membranes, excessive salivation, nausea and vomiting, and skin reactions. If toxicity occurs, discontinue iodine administration and notify the HCP.

Regarding Chronic Kidney Disease, Uremia is a syndrome in which Occurs when

kidney function declines to the point that symptoms may develop in multiple body systems the GFR is 15 mL/min or less

Important contributing factors for child neglect are

lack of knowledge of the child's needs, lack of resources, and caregiver substance abuse. For example, neglectful parents often demonstrate poor parenting skills. (They may be unaware that an infant needs to be fed every 3 to 4 hours, may not know what to feed the child, and may have insufficient funds to buy food. The most serious lack of knowledge is failure to recognize emotional nurturing as an essential need of children)

A saddle embolus refers to a

large thrombus lodged at an arterial bifurcation.

If interruption of fetal oxygenation results in metabolic acidemia,

late decelerations may result from direct hypoxic myocardial depression during a contraction

Another cognitive deficit is in short-term memory. Whereas children of average intelligence can remember several words, numbers, or directions at one time, children with CI are Therefore, they need Use what?

less able to do so. simple, one-step directions. - Learning through a step-by-step process requires a task analysis in which each task is separated into its necessary components and each step is taught completely before proceeding to the next activity.

Compared with female victims, male victims are much

less likely to report abuse, and they may suffer much greater emotional harm from incestuous relationships.

Naloxone should be readily available for use if the respiratory rate decreases to Administration of

less than 10 breaths per minute or if the oxygen saturation rate decreases to less than 89%. oxygen by nonrebreather facemask also can be initiated, and the anesthesia care provider should be notified.

Bradycardia is a baseline FHR of

less than 110 beats/min for 10 minutes or longer

Patients with HFrEF (SYSTOLIC HEART FAILURE) generally have an EF of

less than 45%. It can be as low as 5% to 10%. (Decreased left ventricular ejection fraction (EF)) (normal is 50%-60%)

The platelet count is decreased in thrombocytopenia. Any reduction below 150,000/µL (150 × 109/L) may be termed thrombocytopenia. However, prolonged bleeding from trauma or injury does not usually occur until platelet counts are

less than 50,000/µL (50 × 109/L).

Regarding Types of Dysrhythmias, Ventricular Fibrillation (VF) is a

lethal dysrhythmia.

Sometimes patients have such a high WBC count (e.g., 100,000 cells/µL or more) that initial emergent treatment may include The purpose of these treatments is to

leukapheresis and hydroxyurea. reduce the WBC count and risk of leukemia cell-induced thrombosis.

Regarding Primary Generalized Seizures, Tonic-clonic seizure is characterized by

losing consciousness and falling to the ground if the patient is upright, followed by stiffening of the body (tonic phase) for 10 to 20 seconds and subsequent jerking of the extremities (clonic phase) for another 30 to 40 seconds. The patient has no memory of the seizure.

Regarding Primary Generalized Seizures, Clonic seizures begin with

loss of consciousness and sudden loss of muscle tone, followed by rhythmic limb jerking that may or may not be symmetric. Clonic seizures are relatively rare.

Regarding Focal (partial) seizures, In a complex focal seizure, patients have a Some people display During a seizure, some people may do what? what should they be careful of?

loss of consciousness or an alteration in their awareness, producing a dreamlike experience. Their eyes are open and they make movements that may seem purposeful, but they cannot interact with observers. Some people display strange behavior such as lip smacking or other repetitive, purposeless actions (automatisms). do things that can be dangerous or embarrassing, such as walking into traffic or removing their clothes. These patients need to take precautions before a seizure occurs.

Abortion is another term that is used to describe the Abortions are classified as

loss of pregnancy - spontaneous (those occurring naturally [e.g., miscarriage]) - induced (those occurring as a result of medical intervention)

Regarding Stages of Chemotherapy, Maintenance therapy is treatment with Like consolidation or intensification, the goal is to In Acute Myelogenous Leukemia (AML), maintenance therapy is

lower doses of the same drugs used in induction or other drugs given every 3 to 4 weeks for a prolonged period. keep the body free of leukemic cells. rarely effective and therefore rarely administered.

In addition to vaginal atrophy, the woman can experience atrophic changes in the These changes can cause symptoms that mimic a

lower urinary tract. - In menopause, bladder capacity decreases, and the bladder and urethral tissue lose tone. bladder infection (e.g., dysuria, urgency, frequency) when no infection is present.

Regarding Special Diagnostic Procedures, with computed tomography (CT) and magnetic resonance imaging (MRI) The importance of Children unfamiliar with the machines can be

lying still for tests needs to be stressed. shown a picture beforehand.

Regarding breast cancer surgery, Lymphedema (accumulation of lymph in soft tissue) can occur as a result of the The patient may experience What can result from untreated lymphedema

lymph node sampling procedure or radiation therapy (axillary nodes cannot return lymph fluid) heaviness, impaired motor function in the arm, and numbness and paresthesia of the fingers Cellulitis and progressive fibrosis

When preterm birth appears inevitable (i.e., is expected to occur within the next 24 hours), Dose? Labor that has progressed to a cervical dilation of 4 cm or more is likely to nurses must be prepared to handle the emergency birth of a preterm infant, from either

magnesium sulfate may be administered to reduce or prevent neonatal neurologic morbidity (e.g., cerebral palsy) - should not be continued longer than 24 hours if birth has not occurred recommended dose of magnesium sulfate for neuroprotection is a loading dose of 4 grams given intravenously over 30 minutes, followed by a maintenance dose of 1 g/hour lead to inevitable preterm birth. cephalic or breech presentation, without the woman's obstetric health care provider being present.

Nursing care of the patient with hepatic encephalopathy focuses on Patients with hepatic encephalopathy may exhibit Assess the patient's How often? What other nursing interventions?

maintaining a safe environment, sustaining life, and assisting with measures to reduce the formation of ammonia confusion and be at risk for falls or other injuries. (1) level of responsiveness (e.g., reflexes, pupillary reactions, orientation): Institute measures to prevent falls or injuries (2) sensory and motor abnormalities (e.g., hyperreflexia, asterixis, motor coordination), (3) fluid and electrolyte imbalances (4) acid-base imbalances, (5) response to treatment measures. - Assess the neurologic status, including an exact description of the patient's behavior at least every 2 hours. - Monitor ammonia level (especially to see if meds are working) - Encourage fluids, if not contraindicated - Any GI bleeding may worsen encephalopathy. - Assess the patient taking lactulose for diarrhea and excessive fluid and electrolyte losses. - minimize constipation

Safety Alert Opioids decrease

maternal heart and respiratory rate and blood pressure, which affects fetal oxygenation. - maternal vital signs and FHR and pattern must be assessed and documented before and after administration of opioids (Opioids readily cross the placenta.)

The long-term effects of methamphetamine exposure on children remain unclear; however, some studies have shown problems with

mathematics and language skills

Nursing Alert After administration of anti-D antibody, observe the child for a

minimum of 1 hour and maintain a patent IV line. - Obtain baseline vital signs measurements before the infusion and again 5, 20, and 60 minutes after beginning the infusion. - If fever, chills, and headache occur during or shortly after the infusion, the nurse should administer acetaminophen, diphenhydramine (Benadryl), and/or hydrocortisone (Solu-Cortef) as ordered and observe the patient for an additional hour after the reaction.

Fetal chromosomal abnormalities account for many

miscarriages before 8 weeks of gestation. - Other causes of spontaneous abortions include endocrine abnormalities, maternal infection, uterine abnormalities (e.g., uterine fibroids, endometriosis), immunologic factors, and environmental factors.

Fluid restrictions are not commonly ordered for the patient with mild to moderate HF. However, in What can a nurse do to help with the side effect of fluid restriction?

moderate to severe HF and renal insufficiency, fluids are limited to less than 2 L/day Helping patients deal with thirst as a side effect of the drugs is important. Suggest ice chips, gum, hard candy, or ice pops.

Separating the child from the caregiver about abuse may provide a

more reliable history. It is important to ask nonleading, open-ended questions.

End-tidal carbon dioxide (ETCO2) differs from pulse oximetry in that it is

more sensitive to the mechanics of ventilation rather than oxygenation. Hypoxic episodes can be prevented through the early detection of hypoventilation, apnea, or airway obstruction.

Regarding Primary Generalized Seizures, Atypical Absence Seizures commonly lasts

more than 10 seconds (as much as 30 seconds), with a gradual beginning and end.

immune (idiopathic) thrombocytopenic purpura (ITP) is

most common acquired thrombocytopenia is a syndrome of abnormal destruction of circulating platelets

Panic is the

most extreme level of anxiety and results in markedly dysregulated behavior. - Hallucinations, or false sensory perceptions (e.g., seeing people or objects not really there) - erratic, uncoordinated, and impulsive.

Pulmonary angiography is the

most sensitive and specific test for PE. However, it is an expensive and invasive procedure that involves insertion of a catheter through the antecubital or femoral vein, advancement of the catheter to the pulmonary artery, and injection of contrast medium. The accessibility and accuracy of the spiral CT have greatly diminished the need for pulmonary angiography.

Fetal alcohol syndrome (FAS) is the

most severe type of fetal alcohol spectrum disorder (FASD); affected individuals have abnormal facial features (e.g., small eyes or short palpebral fissures, a thin upper lip, a flat midface, and an indistinct philtrum), growth restriction, and neurodevelopmental deficits, with or without a confirmed history of maternal alcohol consumption

To prevent head injuries, children should always wear helmets and other safety devices when participating in sports, such as biking, skiing, skateboarding, horseback riding, and in-line skating. Only children with frequent seizures must Children with epilepsy should avoid activities involving Children should never be left alone in

must avoid these activities. heights, such as climbing on play structures taller than they are. the bathtub, even for a few seconds. Older children and adolescents should be encouraged to use a shower and reminded not to lock the bathroom door when showering. They must have eyes-on supervision at all times when swimming.

Regarding Types of Dysrhythmias, Second-Degree AV Block, Type I is usually a result of

myocardial ischemia or inferior MI. - It is generally transient and well tolerated. - However, in some patients (e.g., acute MI) it may be a warning sign of a more serious AV conduction disturbance (e.g., complete heart block).

The sudden appearance of a fixed and dilated pupil(s) is a

neurologic emergency

Hepatic encephalopathy is a

neuropsychiatric manifestation of liver disease

Unstable angina (UA) is chest pain that is For how long?

new in onset, occurs at rest, or occurs with increasing frequency, duration, or with less effort than the patient's chronic stable angina pattern The pain usually lasts 10 minutes or more.

Regarding Types of Dysrhythmias, Ventricular Tachycardia dysrhythmia can be seen in patients who have

no evidence of heart disease.

Regarding Types of Dysrhythmias, First-Degree AV Block Treatment

no treatment for first-degree AV block. - Changes to potentially causative situations may be considered. - Monitor patients for any new changes in heart rhythm (e.g., more serious AV block).

Many individuals in the early stages of Chronic Lymphocytic Leukemia (CLL) require

no treatment. - Others may be followed closely and receive treatment only when the disease progresses.

Autism spectrum disorder affects the

normal development of social interaction and communication skills.

Perimenopause is a Menstrual changes can include

normal life transition for women that begins with the first signs of change in menstrual cycles and ends after cessation of menses. shorter cycles, less frequent cycles, lighter cycles, or heavier cycles.

An empyema is the collection of It is caused by

purulent fluid in the pleural space. conditions such as pneumonia, TB, lung abscess, and infection of surgical wounds of the chest.

Menopause is a Natural menopause is diagnosed retrospectively after Induced menopause occurs as a result of Postmenopause is a term that refers to the

normal physiologic cessation of menses associated with declining ovarian function that ends in cessation of the menstrual cycle and ovulation. 12 months of no periods surgical intervention to remove the ovaries or from side effects of chemotherapy, radiation therapy, or other drugs. time in a woman's life after menopause.

Regarding down syndrome, The protruding tongue also interferes with feeding, especially of solid foods. Parents need to know that the tongue thrust is Parents are advised to use a

not an indication of refusal to feed but a physiologic response. small but long, straight-handled spoon to push the food toward the back and side of the mouth. If food is thrust out, it should be refed.

Without intensive intervention, individuals with severe autism spectrum disorder may

not be able to live and work independently - Only about one-third achieve partial independence with restricted interests and activities.

Regarding Types of Dysrhythmias, Premature Ventricular Contractions (PVC) are usually What should a nurse do?

not harmful in a patient with a normal heart - Obtain the patient's apical-radial pulse rate, since PVCs often do not generate a sufficient ventricular contraction to result in a peripheral pulse. This can lead to a pulse deficit.

Regarding drug therapy for ADHF, Dobutamine does

not increase SVR and is preferred for short-term treatment of ADHF

Regarding Types of Dysrhythmias, Ventricular Fibrillation (VF) HR is

not measurable. Rhythm is irregular and chaotic.

You will see artifact on the monitor when leads and electrodes are If artifact occurs what should you do

not secure, the conductive gel is becoming dry, and there is muscle activity (e.g., shivering) or electrical interference. (Artifact is a distortion of the baseline and waveforms seen on the ECG) - Check the connections in the equipment. - Replace the electrodes if the conductive gel has dried out.

Regarding Types of Dysrhythmias, First-degree AV block is usually

not serious but can be a sign of higher degrees of AV block. Patients with first-degree AV block are asymptomatic.

When a Prolonged Decelerations occurs a nurse should

notify the physician or nurse-midwife immediately and initiate appropriate treatment of abnormal patterns when they see a prolonged deceleration.

Orlistat, a lipase inhibitor, has been approved for use in side effects of the drug include

obese children 12 years of age and older; - There are currently no drugs approved for use in overweight or obese children younger than 12 years of age fatty or oily stools and possible malabsorption of fat-soluble vitamin

Regarding down syndrome, The child's eating habits may need careful scrutiny to prevent

obesity. - Height and weight measurements should be obtained on a serial basis

Chemical pleurodesis is performed to

obliterate the pleural space and prevent reaccumulation of effusion fluid in both malignant and nonmalignant pleural effusions.

When chemotherapeutic and immunologic agents with known anaphylactic potential are given, it is standard practice to What should also be done?

observe the child for at least 1 hour after the infusion for signs of anaphylaxis (e.g., rash, urticaria, hypotension, wheezing, nausea, vomiting). Emergency equipment (especially blood pressure monitor, bag and valve mask, and suction) and emergency drugs (especially oxygen, epinephrine, antihistamines, aminophylline, corticosteroids, and vasopressors) must be readily available.

A person with severe anxiety may focus on

one particular detail or many scattered details and have difficulty noticing what is going on in the environment, even when another points it out. - Learning and problem solving are not possible at this level, and the person may be dazed and confused. - Somatic symptoms (e.g., headache, nausea, dizziness, insomnia) often increase. Trembling and a pounding heart are common, and the person may experience hyperventilation and a sense of impending doom or dread.

The pain of chronic stable angina usually lasts for subsides when?

only a few minutes and commonly subsides when the precipitating factor is resolved (e.g., resting, calming down, using sublingual nitroglycerin (SL NTG) (Nitrostat)

Realizing that the child may be lonely in the hospital, the nurse makes certain that toys and other activities are provided. The child is placed in a room with other children of approximately the same developmental age, preferably a room with

only two beds to avoid overstimulation.

Practitioners base an abusive diagnosis on What tool can they use?

patterns of injuries to the infant, but this can be subjective. PredAHT, a prediction tool, assists clinicians with an AHT diagnosis by listing six key clinical features of AHT obtained from high-quality publications. PredAHT has high sensitivity and specificity in estimating the probability of AHT when three or more of the six features are present in the patient

Regarding Opioid agonist-antagonist analgesics, Nalbuphine use also has some disadvantages. it is not suitable for use in women with an

opioid dependence, because the antagonist activity could precipitate withdrawal symptoms (abstinence syndrome) in both the mother and her newborn

An opioid antagonist (e.g., naloxone [Narcan]) is contraindicated for

opioid-dependent women because it may precipitate abstinence syndrome (withdrawal symptoms). - same as nalbuphine (Nubain)

Regarding Hyperthyroidism Drug Therapy, Iodine (saturated solution of potassium iodine (SSKI) and Lugol's solution) is used with what and for what? Rapidly giving large doses of iodine maximal effect is usually seen How long to take this?

other antithyroid drugs to prepare the patient for thyroidectomy or for treatment of thyrotoxicosis inhibits synthesis of T3 and T4 and blocks the release of these hormones into circulation and decreases the vascularity of the thyroid gland, making surgery safer and easier within 1 to 2 weeks. Because of a reduction in the therapeutic effect, long-term iodine therapy is not effective in controlling hyperthyroidism.

Normal Arterial Blood Gas Values

pH: 7.35-7.45 PaCO2: 35-45 mm Hg Bicarbonate (HCO3−): 22-26 mEq/L (mmol/L) PaO2: 80-100 mm Hg SaO2: >95% Base excess: ±2.0 mEq/L

Since the S-ICD does not have any electrodes implanted in the heart, it has no

pacing capability

Regarding Types of Dysrhythmias, The clinical significance of sinus bradycardia depends on how the patient tolerates it. Manifestations of symptomatic bradycardia include

pale, cool skin; hypotension; weakness; angina; dizziness or syncope; confusion or disorientation; and shortness of breath.

Panic attacks are the key feature of A panic attack is the sudden onset of Typically, panic attacks come

panic disorder extreme apprehension or fear, usually associated with feelings of impending doom. "out of the blue" (i.e., suddenly and not necessarily in response to stress), are extremely intense, last a matter of minutes, and then subside. - may believe they are losing their minds or having a heart attack.

Regarding breathing techniques during active labor, The woman can control the urge to push by

panting breaths or by slowly exhaling through pursed lips (as though blowing out a candle or blowing up a balloon). - This type of breathing can be used to overcome the urge to push when the cervix is not fully prepared (e.g., less than 8 cm dilated, not retracting) and to facilitate a slow birth of the fetal head.

Regarding Acute kidney injury (AKI), Only sodium polystyrene sulfonate (Kayexalate) and dialysis actually remove potassium from the body. Never give sodium polystyrene sulfonate to a patient with a

paralytic ileus as bowel necrosis can occur.

Significant risk factors for child sexual abuse include

parental unavailability, lack of emotional closeness and flexibility, social isolation, emotional deprivation, and communication difficulties. Most sexual abuse is committed by men and people known to the child, such as family members

Regarding Anxiety Pharmacological Interventions, These SSRIs include

paroxetine (Paxil), fluoxetine (Prozac), escitalopram (Lexapro), fluvoxamine (Luvox), and sertraline (Zoloft). - Fluoxetine and sertraline tend to be the most activating - Paroxetine seems to have a more calming effect than the other SSRIs - Venlafaxine (Effexor) is quite successful in the treatment of several anxiety disorders. - duloxetine (Cymbalta), is effective in the treatment of generalized anxiety disorder. - beta-blockers, antihistamines, anticonvulsants, and antipsychotics

The best predictor of Paternal Postpartum Depression is having a

partner with postpartum depression. Other risk factors are a: - history of depression, - age younger than 25 years, - low socioeconomic status, - being unmarried, - an inadequate support system, - family and social stressors.

Teaching self-care skills also necessitates a working knowledge of the individual steps needed to master a skill. For example, before beginning a self-feeding program, the nurse

performs a task analysis. - After a task analysis, the child is observed in a particular situation, such as eating, to determine what skills are possessed and the child's developmental readiness to learn the task. Family members are included in this process, because their "readiness" is as important as the child's.

The two methods of dialysis available are Generally dialysis is initiated when the GFR is

peritoneal dialysis (PD) and hemodialysis (HD) less than 15 mL/min/1.73 m2.

Regarding epilepsy Complications, during Status epilepticus (SE) As neurons become exhausted and cease to function, what can result

permanent brain damage

Neglect takes many forms and can be classified broadly as

physical or emotional maltreatment. - Physical neglect involves the deprivation of necessities such as food, clothing, shelter, supervision, medical care, and education. - Emotional neglect generally refers to failure to meet the child's needs for affection, attention, and emotional nurturance.

To delay or prevent the effects of cold stress, at-risk newborns are What should be increased during this?

placed in a heated environment immediately after birth, where they remain until they are able to maintain thermal stability (i.e., the capacity to balance heat production and conservation with heat dissipation). Oxygen and nutrition should be increased with heated environment

If the clotting is severe, the most commonly used treatment modalities are

plasmapheresis to clear the platelet-aggregating IgG from the blood, protamine sulfate to interrupt the circulating heparin, thrombolytic agents to treat the thromboembolic events, and surgery to remove clots.

Children who are cognitively impaired have the same need for Therefore, the nurse will need to

play and exercise as any other child. - However, because of the children's slower development, parents may be less aware of the need to provide such activities guide parents toward selection of suitable play and exercise activities.

Regarding down syndrome, During infancy, the child's skin is Skin care involves the

pliable and soft. However, it gradually becomes rough and dry and is prone to cracking and infection. - use of minimum soap and application of lubricants. - Lip balm is applied to the lips, especially when the child is outdoors, to prevent excessive chapping.

Regarding thoracentesis, A chest x-ray may be done after the procedure to assess for During and after the procedure, monitor

possible complications such as pneumothorax. vital signs and pulse oximetry, and observe the patient for any manifestations of respiratory distress.

Regarding Chest physical therapy (CPT), CPT is contraindicated when patients have

pulmonary hemorrhage, pulmonary embolism, end-stage renal disease, increased intracranial pressure, osteogenesis imperfecta, or minimal cardiac reserves.

Pulmonary emboli Complications include

pulmonary infarction (death of lung tissue) and pulmonary hypertension.

Women with a history of obsessive-compulsive disorder (OCD) often find that their symptoms increase during the For some women with no history of OCD, Women with postpartum OCD tend to have In the postpartum period, obsessive thoughts are likely to involve

postpartum period the first episode occurs postpartum. obsessive, intrusive thoughts, and they perform compulsive actions that temporarily reduce or alleviate the distress caused by the intrusive thoughts contamination and fear of germs; women often fear harm will come to the infant, either inflicted by themselves or others

Regarding Hyperthyroidism, Although Radioactive iodine (RAI) is usually effective, 80% of patients have What should be taught because of this?

posttreatment hypothyroidism, resulting in the need for lifelong thyroid hormone therapy. Teach the patient the symptoms of hypothyroidism and to seek medical help if these symptoms occur.

Regarding Sedatives, Metoclopramide (Reglan), an antiemetic, has been found to effectively

potentiate the effects of analgesics.

Regarding treatment for leukemia, Total body radiation may be used to

prepare a patient for bone marrow transplantation, or radiation may be restricted to certain areas (fields) such as the liver and spleen or other organs affected by infiltrates.

Human milk with fortifier (protein, phosphorus, and calcium) is recommended for

preterm infants

The main therapeutic goal for esophageal and gastric varices is to Patients with varices at risk of (what is given for this) Patients with bleeding varices are usually admitted to the

prevent bleeding and variceal rupture by reducing portal pressure. bleeding are generally started on a nonselective β-blocker (nadolol [Corgard] or propranolol [Inderal]) to reduce the incidence of hemorrhage. β-Blockers decrease high portal pressure, which decreases the risk for rupture. ICU

Regarding treatment of Respiratory Distress Syndrome (RDS), Surfactant may be administered at birth as a

preventive or prophylactic treatment of RDS or later in the course of RDS as a rescue treatment

Surfactant deficiency appears to be Deficient surfactant production causes Without surfactant, infants are

principal factor in the development of respiratory distress syndrome (RDS) unequal inflation of alveoli on inspiration and the collapse of alveoli on end expiration. unable to keep their lungs inflated and therefore exert a great deal of effort to re-expand the alveoli with each breath.

Chronic kidney disease (CKD) involves

progressive, irreversible loss of kidney function

Opioid (narcotic) antagonists such as naloxone (Narcan) can

promptly reverse the CNS depressant effects, especially respiratory depression, in most situations. - naloxone cannot reverse the effects of normeperidine

Regarding Hyperthyroidism Drug Therapy, first-line antithyroid drugs are Indications for use include

propylthiouracil and methimazole (Tapazole): inhibit the synthesis of thyroid hormones. Graves' disease in the young patient, hyperthyroidism during pregnancy, and the need to achieve a euthyroid state before surgery or radiation therapy

Regarding substance abuse, Caffeine is the most widely used Used for A large caffeine intake can cause caffeine dependence can result in Treatment consists of

psychoactive substance in the world. - Wakefulness - Headaches - facilitating motor activity grand mal seizures, and respiratory failure may cause death, cardiac dysrhythmias, hypertension, disturbed sleep, and anxiety. muscle pain or stiffness, drowsiness, irritability, and headaches seizure control with benzodiazepines or phenobarbital and supportive care until the effects wear off

The universal finding in ADHF is

pulmonary and systemic congestion due to elevated left-sided and right-sided filling pressures.

Postpartum baby blues usually go away when

quickly in 1-2 weeks

Regarding Hyperthyroidism in Children, Much of these children's care is related to treating physical symptoms before a response to drug therapy is achieved. Children with hyperthyroidism need a

quiet, unstimulating environment that is conducive to rest.

Regarding Intimate Partner Violence, Battering is neither

random nor constant; rather, it occurs in repeated cycles. Health care providers often refer to the "cycle of violence"

Refeeding syndrome is a refeeding syndrome consists of This syndrome can be avoided with

rare but serious complication of refeeding programs. cardiovascular, neurologic, and hematologic complications that occur when nutritional replacement is given too rapidly (fluid-balance abnormalities, abnormal glucose metabolism, hypophosphatemia, hypomagnesemia,, hypokalemia, Thiamine deficiency) slow refeeding and the addition of phosphorus when total body phosphorus is depleted

True bradycardia occurs Bradycardia is often caused by

rarely and is not specifically related to fetal oxygenation. - fetal cardiac problem such as structural defects involving the pacemakers or conduction system or fetal heart failure. - viral infections (e.g., cytomegalovirus), - maternal hypoglycemia, - maternal hypothermia. Nursing interventions involve solving cause

Regarding Chronic Stable Angina drug therapy, Nitrates, such as isosorbide dinitrate (Isordil) and isosorbide mononitrate, are longer acting and are used to

reduce the frequency of anginal attacks.

Regarding Acute kidney injury (AKI), Prerenal azotemia results in a

reduction in the excretion of sodium (less than 20 mEq/L), increased sodium and water retention, and decreased urine output.

Regarding Acute kidney injury (AKI) phases and the Oliguric Phase, oliguria is a Nonoliguria AKI indicates a anuria

reduction in urine output to less than 400 mL/day and commonly seen with prerenal causes urine output greater than 400 mL/day and is seen with acute interstitial nephritis and ATN no urine output and is usually seen with urinary tract obstruction

The goal of management of hepatic encephalopathy is the What is used What if the patient doesnt respond? What should be prevented

reduction of ammonia formation reduced with lactulose Antibiotics such as rifaximin may also be given, particularly in patients who do not respond to lactulose. Constipation should be prevented, and regular and frequent bowel movements are necessary

Thrombocytopenia is a

reduction of platelets below 150,000/µL (150 × 109/L).

Late decelerations are caused by a

reflex fetal response to transient hypoxemia during a uterine contraction that reduces the delivery of oxygenated blood to the intervillous space of the placenta

Regarding Types of Dysrhythmias, Premature Ventricular Contractions (PVC) Treatment

relates to the cause of the PVCs (e.g., O2 therapy for hypoxia, electrolyte replacement). - Assessment of the patient's hemodynamic status is important to determine if treatment with drug therapy is needed. Drug therapy includes β-blockers, procainamide, or amiodarone.

Conservative therapy may be all that is necessary until kidney function improves. If conservative therapy is not effective in treating AKI, then

renal replacement therapy (RRT) is used. - Intermittent hemodialysis (HD) and continuous renal replacement therapy (CRRT) have both been used effectively also

the implications for nursing are that it is imperative that signs of trafficking are recognized so that appropriate care can be delivered. In fact, it is mandatory that nurses

report any suspected minor (younger than 18 years of age) human trafficking victims.

After the seizure the patient may require

repositioning (to open and maintain the airway), suctioning, and O2

Regarding Acute kidney injury (AKI), Intermittent hemodialysis (HD) and continuous renal replacement therapy (CRRT) have both been used effectively. HD is the method of choice when changes are It also requires Rapid fluid shifts during HD may cause

required emergently. anticoagulation therapy to prevent the patient's blood from clotting when the blood makes contact with the extracorporeal dialysis circuit. hypotension.

Regarding Bronchiolitis treatment, An infant who is tachypneic or apneic, has marked retractions, appears listless, has a history of poor fluid intake, or is dehydrated should be closely observed for

respiratory failure.

Safety Alert Because magnesium sulfate depresses the function of the central nervous system (CNS), it is essential that the nurse frequently assesses the woman's

respiratory status, deep tendon reflexes, and level of consciousness to identify signs that the serum level of magnesium sulfate is reaching toxic levels.

Respiratory imbalances result from the

retention or an excess of CO2 altering carbonic acid concentrations.

Regarding formalized groups or clubs, A prominent feature of these groups is the

rigid rules imposed on the members. - exclusiveness in the selection of people who have the privilege of joining. - Acceptance in the group is often determined on a pass-fail basis according to social or behavioral criteria. - Conformity is the core of the group structure. - often secret codes, shared interests, and special modes of dress, and special words that signify membership in the group.

Amnioinfusion is infusion of The purpose of amnioinfusion is to Amnioinfusion has no known effect on

room-temperature isotonic fluid (usually normal saline or lactated Ringer's solution) into the uterine cavity if the volume of amniotic fluid is low relieve intermittent umbilical cord compression that results in variable decelerations and transient fetal hypoxemia late decelerations and is no longer recommended as a means to dilute meconium-stained amniotic fluid

Phobic reactions tend to

run in families. - Having a first-degree relative with a specific phobia puts one at greater risk for having the same specific phobia.

Regarding Electronic Fetal Monitoring, The technique of continuous internal FHR or UA monitoring provides a more accurate appraisal of fetal well-being during labor than external monitoring. But For this type of monitoring, the membranes must be

ruptured, the cervix sufficiently dilated (at least 2 to 3 cm), and the presenting part low enough to allow placement of the spiral electrode or IUPC or both.

Since preterm infants remain at high risk for SIDS following discharge to the home environment, nurses should discuss Parents and other caregivers should be trained in

safe infant sleep practices with the parents and other potential caregivers, including guidelines for safe sleep for infants with special needs (gastroesophageal reflux, mechanical ventilation, oroesophageal malformations) infant CPR prior to taking a preterm infant home from the hospital.

You should counsel individuals experiencing intimate partner violence about developing a

safety plan, a plan for a rapid escape when abuse recurs. Ask patients to identify the signs of escalation of violence and to pick a particular sign that will tell them that "now is the time to leave." If children are present, they can all agree on a code word that, when spoken by the parent, means "It is time to go."

the interaction among peers leads to the formation of intimate friendships between

same-sex peers

Regarding Hyperthyroidism Nursing Implementation and post-op care, The appearance of the incision may be distressing to the patient. Reassure the patient that the

scar will fade in color and eventually look like a normal neck wrinkle. A scarf, jewelry, a high collar, or other covering can effectively camouflage the scar.

Regarding Neurologic Examination, Widely dilated and reactive pupils are often seen after Widely dilated and fixed pupils suggest

seizures and may involve only one side paralysis of cranial nerve III (oculomotor nerve) secondary to pressure from herniation of the brain through the tentorium

Once HCO3− levels are higher than 50 mEq/L, patients may develop

seizures, hypoventilation, and coma

Anorexia nervosa is characterized by

self-starvation, an intense fear of being fat, and disrupted self-image - they undertake strict and severe diets and rigorous extreme exercise

Regarding Electronic Fetal Monitoring, The external transducers are applied easily by the nurse but often must be readjusted as the woman or fetus changes position. The woman is asked to assume what position?

semi-Fowler's or lateral position. - Use of external transducers confines the woman to bed or chair.

Neutropenia is a Significant neutropenia will prompt Take every possible measure to prevent Monitor what? Precautions for the pt?

serious risk factor for life-threatening infection and sepsis. delay or modification (i.e., lower dosages). infections in these patients. Hand hygiene is the mainstay of patient protection. - Monitor temperature routinely. - Any sign of infection should be treated promptly, since fever in the setting of neutropenia is a medical emergency. - WBC growth factors (i.e., filgrastim [Neupogen], pegfilgrastim [Neulasta]) are routinely used to reduce the duration of chemotherapy-induced neutropenia (used as a prophylactic measure) - Neutropenic isolation (put mask and gown on pt to protect them) (reverse isolation) - For neutropenic - Fruits without skin - Bottle water only - No plants or flowers in room

Seizure disorders have many possible causes, most common causes of seizure disorder during the first 6 months of life are In people between 2 and 20 years of age, primary causes are In individuals between 20 and 30 years of age, seizure disorder usually occurs as the result of After 50 years of age, the primary causes of seizure disorders are

severe birth injury, congenital defects involving the central nervous system (CNS), infections, and inborn errors of metabolism birth injury, infection, trauma, and genetic factors structural lesions, such as trauma, brain tumors, or vascular disease. stroke and metastatic brain tumors

Regarding hemophilia, desmopressin acetate (also known as DDAVP) is not effective in the treatment of Because the effect of DDAVP is relatively short lived, the patient must be

severe hemophilia A, severe vWD, or any form of hemophilia B closely monitored and repeated doses may be necessary. It is an appropriate therapy for minor bleeding episodes and dental procedures.

Thiazide diuretics can cause

severe reductions in potassium levels.

Regarding Venous Thromboembolism Drug Therapy, Fondaparinux is contraindicated in patients with

severe renal disease.

Unlike those with anorexia, individuals with bulimia may feel

shame or disgust about their disorder and tend to seek help earlier. - The SCOFF screening assessment also can be used to assess patients with bulimia

Postoperative complications of adrenalectomy are related to the sudden withdrawal of cortisol. Observe for

shocklike symptoms (e.g., hypotension, hyperpyrexia).

Regarding Menopause Drug Therapy, Women may choose to use HRT for Risk include Benefits include

short-term symptom management and treatment for several years (4 to 5 years) of menopausal symptoms. - increased risk of breast and endometrial cancer, - risk for blood clots - minimizes bone loss, - hot flashes, - vaginal atrophic changes

Regarding breast cancer, When drug therapy is given before surgery, it is called neoadjuvant therapy. Neoadjuvant therapy is often used to Drug therapy after surgery is called adjuvant therapy. Drug therapy can decrease the

shrink the size of the tumor enough to make surgical removal possible, or to allow for breast-conserving surgery in women who would have been recommended to have a mastectomy rate of recurrence and increase the length of survival.

Regarding Clinical Manifestations of Myocardial Infarction, Patients with diabetes may experience

silent (asymptomatic) MIs because of cardiac neuropathy or may manifest atypical symptoms (e.g., dyspnea).

Green (2016) recommended asking __________________________ in order to screen for suspected trafficking

simple "yes" or "no" questions

The nurse should help in this area by providing parents with information about sexuality education that is geared to the child's developmental level. For example, adolescent girls need a

simple explanation of menstruation and instructions on personal hygiene during the menstrual cycle.

For couples who have prepared for labor by practicing relaxing and breathing techniques, a For those who have had no preparation,

simple review with occasional reminders may be all that is necessary to help them along. instruction and practice in simple breathing and relaxation techniques can be given early in labor and often are surprisingly successful. - Nurses can also model breathing techniques and breathe in synchrony with the woman and her partner. - readiness to learn is enhanced by the reality of labor

For children who develop recurrent seizures or epilepsy, treatment is begun with a

single drug known to be effective and have the lowest toxicity (i.e., the safest side-effect profile for the child's particular type of seizure). - The dosage is gradually increased until the seizures are controlled or the maximum recommended dose has been reached and seizures are still not controlled. - If a child develops intolerable side effects, the medication is stopped and another one is tried. - If the drug reduces but does stop all the seizures, a second drug is added in gradually increasing doses.

For a thoracentesis, the patient may

sit on the edge of a bed and lean forward over a bedside table.

For spinal anesthesia (block), the woman is in what position? The nurse should do what during this? To obtain the higher level of anesthesia desired for cesarean birth, she will To prevent supine hypotensive syndrome, the The anesthetic effect will last

sits or lies on her side (e.g., modified Sims' position) with back curved to widen the intervertebral space The nurse supports the woman and encourages her to use breathing and relaxation techniques because she must remain still during the placement of the spinal needle. be positioned supine with head and shoulders slightly elevated. uterus is displaced laterally by tilting the operating table or placing a wedge under one of her hips. 1 to 3 hours

If IV phenytoin is used, it should be administered via What can be used instead? How

slow IV push at a rate that does not exceed 50 mg/min. Because phenytoin precipitates when mixed with glucose, only normal saline is used to flush the tubing or catheter. Intravenous (IV) fosphenytoin is often used to treat seizures instead Fosphenytoin may be given in saline or glucose solutions at a rate of up to 150 mg phenytoin equivalent (PE)/min, and it may be given intramuscularly if necessary.

If complete seizure control is maintained on an anticonvulsant drug for 2 years, it may be safe to How?

slowly discontinue the drug for patients with no risk factors. When seizure medications are discontinued, the dosage is decreased gradually over weeks or months. Sudden withdrawal of a drug is not recommended because it can cause seizures

During the early school years, groups are usually In general, girls'; groups are less

small and loosely organized, with changing membership and no formal structure. The clubs and groups usually do not display elements of cooperation and order that are seen in groups of older children. formalized than boys' groups, and although there may be a mixture of both sexes in the early school years, the groups of later school years are composed predominantly of children of the same sex. Common interests are the basis around which the group is structured.

Regarding Cirrhosis Clinical Manifestations, Spider angiomas (telangiectasia or spider nevi) are Palmar erythema gynecomastia

small, dilated blood vessels with a bright red center point and spiderlike branches. - They occur on the nose, cheeks, upper trunk, neck, and shoulders. (a red area that blanches with pressure) is located on the palms of the hands (benign growth of the glandular tissue of the male breast)

People with tobacco use disorder (TUD) are dependent on the drug nicotine due to using tobacco products. A number of products contain nicotine, including

smoked tobacco (cigarettes, cigars, pipes), smokeless tobacco (chew, snuff, dip), and some electronic cigarettes. - Cigarette smoking is the main form of tobacco use

Drug therapy for bleeding esophageal and/or gastric varices may include the

somatostatin analog octreotide (Sandostatin) or vasopressin. - The main goal of drug therapy is first to stop the bleeding and identify the source and apply interventions to prevent further bleeding

Regarding epilepsy and seizures, A ketogenic diet is a Meals must be Patients on this diet who use anticoagulants need

special high-fat, low-carbohydrate diet that has been used to control seizures in some people with epilepsy carefully planned because the amount of protein and carbohydrate in the diet must be restricted. close monitoring for bleeding.

Thrombocytopenia can result in Avoid Risk of serious bleeding is generally not apparent until the platelet count Platelet transfusions may be necessary and are usually administered when platelet counts

spontaneous bleeding or major hemorrhage. invasive procedures and advise patients to avoid activities that place them at risk for injury or bleeding (including excessive straining). falls below 50,000/µL. fall below 20,000/µL.

Premature rupture of membranes (PROM) is the Preterm premature rupture of membranes (preterm PROM or pPROM) is

spontaneous rupture of the amniotic sac and leakage of amniotic fluid before the onset of labor at any gestational age membrane rupture before 37 0/7 weeks of gestation and is associated with approximately 10% of all preterm births in the United States.

Regarding Nonpharmacologic Strategies to Encourage Relaxation and Relieve Pain, Counterpressure is

steady pressure applied by a support person to the sacral area with a firm object (e.g., tennis ball) or the fist or heel of the hand. Pressure can also be applied to both hips (double hip squeeze) or to the knees - helps woman cope with the sensations of internal pressure and pain in the lower back

In diastolic failure, the LV is generally

stiff and noncompliant.

Premature Ventricular Contractions (PVC) are associated with

stimulants such as caffeine, alcohol, nicotine, aminophylline, epinephrine, isoproterenol, and digoxin.

Regarding Chronic Stable Angina drug therapy, β-Blockers should not be

stopped abruptly without medical supervision, as this may result in an increase in the number and intensity of angina attacks.

Regarding Chronic HF drug therapy, It is critical that the exact cause of cough and other side effects be confirmed before

stopping ACE inhibitor therapy

Regarding Types of Dysrhythmias, Atrial Flutter... Warfarin (Coumadin) is given to prevent

stroke in patients who have atrial flutter

Regarding the second stage of labor two phases, During the active pushing phase, the woman has This stimulation causes the release of

strong urges to bear down as the Ferguson reflex is activated when the presenting part presses on the stretch receptors of the pelvic floor. oxytocin which provokes stronger expulsive uterine contractions.

Regarding social anxiety disorder, The trait of shyness is also

strongly heritable. - Having parents who are shy carries a double risk of genetic transmission and parental modeling.

Regarding Clinical Manifestations of Myocardial Infarction, Persistent and unlike any other pain, it is usually described as heavy, pressure, tight, burning, constricted, or crushing feeling. Common locations are

substernal or epigastric areas. The pain may radiate to the neck, lower jaw, and arms or to the back

Peer groups and clubs allow children to

substitute conformity to a peer group for conformity to a family at a time when children are still too insecure to function independently.

Regarding Primary Generalized Seizures, A tonic seizure involves a Tonic seizures most often occur in How long does it last?

sudden onset of increased tone in the extensor muscles, contributing to sudden stiff movements. sleep and affect both sides of the body. Patients will fall if they are standing when the seizure occurs. usually last less than 20 seconds. The patient usually remains conscious.

Regarding Primary Generalized Seizures, A myoclonic seizure is characterized by a How long does it last?

sudden, excessive jerk or twitch of the body or extremities. The jerk represents a muscle contraction and may be forceful enough to hurl the person to the ground. These seizures last no more than a few seconds, but they may occur in clusters.

The most difficult time to maintain control during contractions comes during the latter part of the active phase of the first stage of labor, when the cervix dilates from 8 cm to 10 cm. Even for the woman who has prepared for labor, concentration on breathing techniques is difficult to maintain. Patterned-paced (pant-blow) breathing is

suggested during this time. - It is performed at the same rate as modified-paced breathing and consists of panting breaths combined with soft blowing breaths at regular intervals.

Patients diagnosed with major depressive disorder should always be evaluated for

suicidal ideation

Venous thrombosis is classified as either

superficial vein thrombosis or deep vein thrombosis.

Regarding Hyperthyroidism Drug Therapy, β-Adrenergic blockers (propranolol (Inderal), atenolol (Tenormin) or metoprolol (Toprol)) are used for These drugs block the

symptomatic relief of thyrotoxicosis the effects of sympathetic nervous stimulation, thereby decreasing tachycardia, nervousness, irritability, and tremors

Regarding Sudden cardiac death (SCD), what should a nurse teach?

symptoms of impending cardiac arrest and the actions to take can save lives (Many of these patients develop a "time bomb" mentality.)

During breathing techniques, The woman and her support person must be aware of and watch for How to help this?

symptoms of the resultant respiratory alkalosis: lightheadedness, dizziness, tingling of the fingers, or circumoral numbness. Having the woman breathe into a paper bag

RSV Diagnostic Evaluation

tests done on nasopharyngeal secretions, using either: - rapid immunofluorescent antibody-direct fluorescent antibody (DFA) staining - an enzyme-linked immunosorbent assay (ELISA) for RSV antigen detection Hyperinflation of the lungs is generally seen on the chest radiograph.

Regarding infants and children with Hypoxemia, Hypercyanotic spells, also referred to as blue spells or tet spells because they are often seen in infants with When does it occur?

tetralogy of Fallot, may occur in any child whose heart defect includes obstruction to pulmonary blood flow and communication between the ventricles. occur more often in the morning and may be preceded by feeding, crying, defecation, or stressful procedures.

An echocardiogram is a common diagnostic tool used in patients with HF. It provides information on

the EF. This helps to differentiate between HFpEF and HFrEF.

Regarding chemotherapy, The nurse should encourage parents to relax any eating pressures because severe mucosal ulceration indicates a need for

the anorexia accompanying stomatitis is well justified and usually temporary. decreased chemotherapy until complete healing takes place.

Regarding a infant in the NICU, At the bedside, the nurse should explain Involving the parent in some type of caregiving activity, no matter how minor it may seem to the nurse, enables the parent to

the function of each piece of equipment and the role it plays in facilitating recovery. - Explanations may often need to be patiently repeated because parents' anxiety over the infant's condition and the surroundings may prevent them from really "hearing" what is being said. "take on" a more active role.

The second stage of labor is the stage in which This stage begins with and ends with what?

the infant is born. full cervical dilation (10 cm) and complete effacement (100%) and ends with the baby's birth

Regarding Nonpharmacologic Strategies to Encourage Relaxation and Relieve Pain, An intradermal water block involves Side effect?

the injection of small amounts of sterile water (e.g., 0.05 to 0.1 mL) using a fine-gauge (e.g., 25-gauge) needle into four locations on the lower back to relieve lower back pain Intense stinging will occur for about 20 to 30 seconds after injection, but relief of back pain for up to 2 hours has been reported

separation anxiety disorder is accompanied by a significant level of discomfort and disability that impairs social and occupational functioning and does not respond well to

the most popular type of psychotherapy, cognitive-behavioral therapy.

Mild anxiety occurs in

the normal experience of everyday living and allows an individual to perceive reality in sharp focus - sees, hears, and grasps more information, and problem solving becomes more effective.

Regarding the first stage of labor two phases, The latent phase extends from

the onset of labor, characterized by regular, painful uterine contractions that cause cervical change, to the beginning of the active phase

Postpartum posttraumatic stress disorder (PTSD) is the result of exposure to trauma, either during Risk factors for postpartum PTSD include

the prenatal or intrapartum period, or it may be related to previous life experiences and events such as childhood sexual abuse or intimate partner violence - history of pregnancy loss, - high-risk pregnancy, - preterm birth, - infant in the NICU, - painful and/or difficult vaginal birth, - instrument-assisted vaginal birth, - emergency cesarean

Women who receive an epidural have a higher rate of fever (i.e., intrapartum temperature of 38° C [100.4° F] or higher), especially when labor lasts longer than 12 hours; the temperature elevation most likely is related to

thermoregulatory changes, although infection cannot be ruled out. - The elevation in temperature can result in fetal tachycardia and neonatal workup for sepsis, whether or not signs of infection are present

Regarding Alcohol Withdrawal, Wernicke-Korsakoff Syndrome is caused by

thiamine deficiency

Obsessions are defined as Compulsions are

thoughts, impulses, or images that persist and recur so that they cannot be dismissed from the mind even though the individual attempts to do so ritualistic behaviors an individual feels driven to perform in an attempt to reduce anxiety or prevent an imagined calamity - Performing the compulsive act temporarily reduces anxiety

Regarding Types of Dysrhythmias, Ventricular Tachycardia is a run of

three or more PVCs

Regarding Hyperthyroidism, Tell the patient that radiation How to relieve this? When should it subside?

thyroiditis and parotiditis are possible and may cause dryness and irritation of the mouth and throat. Relief may be obtained with: - frequent sips of water, ice chips, - a salt and soda gargle three or four times per day. This gargle is made by dissolving 1 tsp of salt and 1 tsp of baking soda in 2 cups of warm water. - A mixture of antacid (Mylanta or Maalox), diphenhydramine, and viscous lidocaine can be used to swish and spit, increasing patient comfort when eating. The discomfort should subside in 3 to 4 days.

Regarding Types of Dysrhythmias, Atrial Fibrillation often develops acutely with

thyrotoxicosis, alcohol intoxication, caffeine use, electrolyte disturbances, stress, and heart surgery.

Regarding the second stage of labor two phases, The latent phase, sometimes referred to as delayed pushing, laboring down, or passive descent, is the During this phase, the fetus The woman is

time from complete cervical dilation until the woman begins actively pushing continues to descend passively through the birth canal and rotate to an anterior position as a result of ongoing uterine contractions. quiet and often relaxes with her eyes closed between contractions. - urge to bear down is not strong, and some women do not experience it at all or only during the acme (peak) of a contraction.

Chronic stable angina is controlled with drugs on an outpatient basis. Because chronic stable angina is often predictable, drugs are

timed to provide peak effects during the time of day when angina is likely to occur.

Regarding Chronic Stable Angina drug therapy, NTG (Nitroglycerin) should cause a What symptoms does it cause?

tingling sensation when taken; otherwise it may be outdated. headache, dizziness, or flushing may occur

Gavage feeding is a safe means of meeting the nutritional requirements of infants who are unable to feed orally. These infants are usually Gavage feedings may be provided by The stomach is aspirated, the contents measured, and the aspirate

too weak to suck effectively, are unable to coordinate swallowing, and lack a gag reflex. continuous drip regulated via infusion pump or by intermittent bolus feedings. returned as part of the feeding.

Regarding Types of Dysrhythmias, Asystole represents the

total absence of ventricular electrical activity. Occasionally, P waves are seen. - Patients are unresponsive, pulseless, and apneic. - VF may masquerade as asystole. - Always assess the rhythm in more than one lead.

Regarding Preterm infants, After handling another infant or equipment, no one should ever What precautions are used

touch an infant without first performing hand hygiene Standard Precautions (no gowning)

Decreased estrogen causes thinning of the vaginal mucosa and disappearance of rugae, which results in a decrease in vaginal secretions and causes the vaginal secretions to become more alkaline. As a result of these changes, the vagina is easily

traumatized, the woman can experience more dyspareunia (Painful intercourse), and she can be more susceptible to infection.

Regarding Anxiety Pharmacological Interventions, Monoamine oxidase inhibitors (MAOIs) are reserved for Contraindicated for patients with

treatment-resistant conditions because of the risk of life-threatening hypertensive crisis if the patient does not follow dietary restrictions (patients cannot eat foods containing tyramine and must be given specific dietary instructions). contraindicated in patients with comorbid substance use disorders

A patient whose breast cancer tests negative for all three receptors (estrogen, progesterone, and HER-2) has

triple-negative breast cancer

Regarding Staging of Breast Cancer: TNM system stands for The stages range from 0 to IV, with stage 0 being Stage IV indicates

tumor size (T), nodal involvement (N), presence of metastasis (M) in situ cancer with no lymph node involvement and no metastasis metastatic spread, regardless of tumor size or lymph node involvement.

The usual course of Electroconvulsive Therapy for a patient with depression is

two or three treatments per week to a total of 6 to 12 treatments.

Regarding Types of Dysrhythmias, Premature Ventricular Contractions (PVC) that have the same shape are called

unifocal PVCs.

Regarding Bronchiolitis, specify that testing for specific viruses is

unnecessary because bronchiolitis may be caused by multiple viruses, although some institutions continue to test to detect RSV.

Regarding Types of Dysrhythmias, Ventricular Fibrillation (VF) results in an

unresponsive, pulseless, and apneic state. If it is not rapidly treated, the patient will not recover.

Regarding acute coronary syndrome (ACS), For patients with chest pain who do not show ST segement elevation or ST-T wave changes on the ECG, it is difficult to distinguish between

unstable angina (UA) and non-ST-segment-elevation myocardial infarction (NSTEMI) until serum cardiac biomarkers are measured

acute coronary syndrome (ACS) includes the spectrum of

unstable angina (UA), non-ST-segment-elevation myocardial infarction (NSTEMI), ST-segment-elevation myocardial infarction (STEMI)

Regarding chronic stable angina, Pain at rest is

unusual and often a symptom of UA.

All patients with cirrhosis should have an

upper endoscopy (esophagogastroduodenoscopy [EGD]) to screen for varices.

Regarding depression, Safety becomes the most important issue facing a team that cares for people with depression who may be at high risk for suicide. Suicide precautions are

usually instituted and include the removal of all harmful objects such as "sharps" (e.g., razors, scissors, and nail files), strangulation risks (e.g., belts), and medication that can be used to overdose. - Some patients with severe depression may need to have someone check on them frequently, perhaps every 15 minutes, or even have 1:1 observation

Because opioid (narcotic) agonist analgesics can inhibit

uterine contractions, they should not be administered until labor is well established unless they are being used to enhance therapeutic rest during a prolonged early phase of labor

Regarding Right-sided HF, When the RV fails, fluid backs up into the What does this cause?

venous system. This causes movement of fluid into the tissues and organs (e.g., peripheral edema, abdominal ascites, hepatomegaly, jugular venous distention).

Regarding Types of Dysrhythmias, When every other beat is a Premature Ventricular Contractions (PVC), the rhythm is called When every third beat is a PVC, it is called

ventricular bigeminy ventricular trigeminy

Regarding Myocardial Infarction healing, ACE inhibitors are given to limit

ventricular remodeling.

Synchronized cardioversion is the therapy of choice for the patient with

ventricular tachydysrhythmias (e.g., VT with a pulse) or supraventricular tachydysrhythmias (e.g., atrial flutter with a rapid ventricular response).

Regarding infants with HF, What may cause oral feedings to be withheld and gavage fed using a nasogastric tube be used

very stressed and fatigued, experiencing signs of respiratory distress, tachypneic to 80 to 100 breaths/min Some infants with severe HF, neurologic deficits, or significant gastroesophageal reflux may need placement of a gastrostomy tube to allow adequate nutrition.

Variable deceleration of the FHR is defined as a

visually abrupt (onset to lowest point <30 seconds) and apparent decrease in FHR below the baseline. - The decrease is at least 15 beats/min or more below the baseline, lasts at least 15 seconds, and returns to baseline in less than 2 minutes

A prolonged deceleration is a

visually apparent decrease (may be either gradual or abrupt) in FHR of at least 15 beats/min below the baseline and lasting more than 2 minutes but less than 10 minutes.

Acceleration of the FHR is defined as a Before 32 weeks of gestation, the definition of an acceleration is

visually apparent, abrupt (onset to peak <30 seconds) increase in FHR above the baseline rate - The peak is at least 15 beats/min above the baseline, and the acceleration lasts 15 seconds or more, with the return to baseline less than 2 minutes from the beginning of the acceleration. a peak of 10 beats/min or more above the baseline and a duration of at least 10 seconds.

Late deceleration of the FHR is a

visually apparent, gradual (onset to lowest point ≥30 seconds) decrease in and return to baseline FHR associated with UCs

Regarding Hyperthyroidism Nursing Implementation for Postoperative Care, Recurrent laryngeal nerve damage leads to What will need to be done?

vocal cord paralysis. If both cords are paralyzed, spastic airway obstruction will occur, requiring an immediate tracheostomy.

Cultural influences may impose certain behavioral expectations regarding acceptable and unacceptable behavior when experiencing pain. African-American and Puerto Rican women usually express their pain Native Americans are

vocally often stoic

Regarding Thrombocytopenia Clinical Manifestations, Because the bleeding may be internal, be aware of manifestations that reflect this type of blood loss, including

weakness, fainting, dizziness, tachycardia, abdominal pain, and hypotension.

Regarding chemotherapy, To lessen the trauma of seeing large amounts of hair on bed linen or clothing, the child can Families should also be aware that wigs are Encouraging children to choose a wig

wear a disposable surgical cap to collect the shed hair during the period of greatest hair loss, or the hair can be cut short or shaved. tax deductible and that hair typically regrows in 3 to 6 months. The hair is often a different color and texture than before cancer treatment. similar to their own hairstyle and color before the hair falls out is helpful in fostering later adjustment to hair loss.

To monitor fluid status (like during sever HF), tell patients to Tell patients to call the HCP if they see

weigh themselves at the same time each day. Ideally this should be before breakfast, using the same scale, and wearing the same type of clothing. a weight gain of 3 lb (1.4 kg) over 2 days or a 3- to 5-lb (2.3-kg) gain over a week.

Those with bulimia nervosa may have normal

weight for height or their weight may fluctuate with bingeing and purging.

Digoxin toxicity treatment

withholding the drug until the symptoms subside. In the case of life-threatening toxicity, IV digoxin immune Fab (ovine) (DigiFab) is an antidote.

Regarding chemotherapy, Viscous lidocaine is not recommended for

young children. - If applied to the pharynx, it may depress the gag reflex, increasing the risk for aspiration. - Seizures have also been associated with the use of oral viscous lidocaine

For Folliculitis (pimple), furuncle (boil), carbuncle (multiple boils): Staphylococcus aureus, methicillin-resistant S. aureus (MRSA) what rules should the pt follow?

• 5-inch soak of cup bleach diluted in a standard 50-gallon tub one-fourth filled with water once or twice weekly • No sharing of towels or clothing • Disposal of razors after one use • Application of mupirocin to nares bid for 5 days

Drug Alert Antiseizure Drugs

• Abrupt withdrawal after long-term use may precipitate seizures. • If weaning is to occur, the patient must be seizure free for a prolonged period (e.g., 2 to 5 yr) and have a normal neurologic examination and EEG.

Factors to Assess During a Home Visit for Older Adults

• Absence of or lack of access to basic necessities (food, water, medications) • Unsafe housing • Lack of or inadequate utilities, ventilation, space • Poor physical hygiene • Lack of assistive devices, such as hearing aids, eyeglasses, wheelchair • Medication mismanagement (outdated prescriptions, unmarked bottles)

Indications for Permanent Pacemakers

• Acquired AV block • Second-degree AV block • Third-degree AV block • Atrial fibrillation with a slow ventricular response • Bundle branch block • Cardiomyopathy Dilated Hypertrophic • Heart failure • SA node dysfunction • Tachydysrhythmias (e.g., ventricular tachycardia)

Criteria for Anti-D Antibody Therapy

• Age between 1 and 19 years of age; Rh(D)-positive blood type • Normal WBC count and hemoglobin level for age; platelet count of 20,000/mm3 • No active mucosal bleeding • No history of reaction to plasma products • No known immunoglobulin A deficiency • No concurrent infection • Absence of Evans syndrome (characterized by the combination of ITP and autoimmune hemolytic anemia) • No suspicion of lupus erythematosus or other collagen vascular disorder • No splenectomy

erectile disorder Risk Factors

• Aging • Misinformation or ignorance regarding sexual and social interaction • Unconscious guilt and anxiety regarding sex • Anxiety related to performance, especially with erectile and orgasmic dysfunction • Poor communication between partners about feelings and what they desire sexually • people who have more education have fewer sexual problems and are less anxious about issues pertaining to sex

NIC Interventions for Eating Disorders Management for Promote Increasing Independence

• Allow opportunity to make limited choices about eating and exercise as weight gain progresses in desirable manner. • Initiate maintenance phase of treatment when patient has achieved target weight and has consistently shown desired eating behaviors for designated period of time. • Place responsibility for choices about eating and physical activity with patient, as appropriate. • Institute a treatment program and follow-up care (medical, counseling) for home management.

Safety Alert for hyperthyroidism Airway Obstruction

• Although not common, airway obstruction after thyroid surgery is an emergency situation. • O2, suction equipment, and a tracheostomy tray should be readily available in the patient's room.

Additional Nursing Care for Women Undergoing Mastectomy With Reconstruction

• Apply no tight compression of the reconstructed breasts until approved by the plastic surgeon. • Wear loosely fitting garments for first 3 to 4 weeks. • Know that surgery is still a work in progress and that final cosmetic result of reconstruction takes many weeks. • Assess skin for potential of poor peripheral circulation that may cause skin necrosis, and report any skin changes immediately. • See drain care instructions under axillary dissection section.

Sodium Nitroprusside (Nitropress) Drug Alert

• Arterial BP monitoring is recommended during drug infusion. • Record baseline BP and continuously monitor during administration. • Too rapid rate of IV infusion can reduce BP too quickly and cause hypotension. • Headache, dizziness, nausea, agitation, and restlessness can occur. • Monitor thiocyanate (drug by-product) levels if infusion is greater than 3 mcg/kg/min, as toxicity can occur. • does not need titration after the initial IV bolus.

Inpatient Tobacco Cessation Interventions Take the following steps for every hospitalized patient.

• Ask each patient on admission if he or she uses tobacco and document tobacco use status. • For current tobacco users, list tobacco use status on the admission problem list and as a discharge diagnosis. • Use counseling and medication to help all tobacco users maintain abstinence and to treat withdrawal symptoms. • Provide advice and assistance on how to quit during hospitalization and remain abstinent after discharge. • Arrange for follow-up regarding smoking status. Supportive contact should be provided for at least a month after discharge.

Nursing Interventions for the Woman Receiving Neuraxial Anesthesia While the Block Is Wearing Off After Birth

• Assess regularly for the return of sensory and motor function. • Continue to monitor maternal vital signs as ordered. • Monitor for bladder distention: - Assist with spontaneous voiding on bedpan or toilet. - Insert a urinary catheter if necessary. • Promote safety: - Keep the side rails up on the bed. - Place the telephone and call light within easy reach. - Instruct the woman not to get out of bed without help. - Make sure there is no prolonged pressure on anesthetized body parts. • Keep the epidural catheter insertion site clean and dry. • Continue to monitor for anesthetic side effects

Regarding Hyperthyroidism Nursing Implementation, Important nursing interventions after a thyroidectomy include the following:

• Assess the patient every 2 hours for 24 hours for signs of hemorrhage or tracheal compression, such as irregular breathing, neck swelling, frequent swallowing, choking, blood on the dressings, and sensations of fullness at the incision site. Expect some hoarseness for 3 or 4 days after surgery because of edema. • Place the patient in a semi-Fowler's position and support the patient's head with pillows. Avoid flexion of the neck and any tension on the suture lines. • Monitor vital signs and calcium levels. Assess for signs of tetany secondary to hypoparathyroidism (e.g., tingling in toes, fingers, around the mouth; muscular twitching; apprehension) and any difficulty in speaking and hoarseness. Monitor Trousseau's sign and Chvostek's sign • Control postoperative pain by giving medication.

Nursing Interventions for the Woman Receiving Neuraxial Anesthesia Prior to the Block

• Assist obstetric care provider and/or anesthesia care provider with explaining the procedure and obtaining the woman's informed consent. • Assess maternal vital signs, level of hydration, labor progress, and fetal heart rate (FHR) and pattern. • Start an intravenous (IV) line, and infuse a bolus of fluid (lactated Ringer's solution or normal saline) if ordered (e.g., 500 to 1000 mL 15 to 30 minutes before induction of the anesthesia). • Obtain laboratory results (hematocrit or hemoglobin level, other tests as ordered). • Assess the woman's level of pain using a pain scale (from 0 [no pain] to 10 [pain as bad as it could possibly be]). • Assist the woman to void.

Nursing Interventions for the Woman Receiving Neuraxial Anesthesia During Initiation of the Block

• Assist the woman to assume and maintain the proper position. • Verbally guide the woman through the procedure, explaining sounds and sensations as she experiences them. • Assist the anesthesia care provider with documentation of vital signs, time and amount of medications given, etc. • Monitor maternal vital signs (especially blood pressure) and FHR as ordered. • Have oxygen and suction readily available. • Monitor for signs of local anesthetic toxicity as the test dose of medication is administered.

orlistat (Xenical, Allī [low-dose form available over the counter]) Nursing Considerations

• Associated with leakage of stool, flatulence, diarrhea, and abdominal bloating, especially if a high-fat diet is consumed • Severe liver injury may occur. • Fat-soluble vitamin levels may have to be supplemented.

The diagnosis of sexual dysfunction may be paired with NOC outcomes listed under the category of sexual functioning. Each is ranked on a 5-point scale where 1 is "never demonstrated" and 5 is "consistently demonstrated." Examples of outcomes include:

• Attains sexual arousal • Uses hormone replacement therapy as needed • Expresses ability to be intimate The diagnosis of ineffective sexuality pattern is linked by NOC with the outcome category sexual identity. Useful indicators (ranked the same way as the previous entry) include: • Exhibits clear sense of sexual orientation • Reports healthy intimate relationships • Uses precautions to minimize risks associated with sexual activity

Regarding Nursing Interventions for Patients Taking Anticoagulants, Injections

• Avoid IM injections. • Minimize venipunctures. • Use small-gauge needles for venipunctures unless therapy requires a larger gauge. • Apply manual pressure for at least 10 min (or longer if needed) on venipuncture sites

Drug Alert Anticoagulant Therapy

• Avoid IM injections. • Observe closely for any signs of bleeding: hypotension, tachycardia, hematuria, melena, hematemesis, petechiae, ecchymosis, oozing or visible bleeding from trauma site or surgical incision. • Tell patients to report any signs of bleeding: black or bloody stools, bleeding gums, bloody urine or sputum, coffee-ground or bloody vomit, excessive bruising, nosebleeds, excessive menstrual bleeding. • Assess for mental status changes, especially in the older patient, since this may indicate cerebral bleeding. • Tell patients to avoid taking aspirin, NSAIDs, fish oil supplements, garlic supplements, ginkgo biloba, and certain antibiotics (e.g., sulfamethoxazole and trimethoprim [Bactrim]).

Regarding Nursing Interventions for Patients Taking Anticoagulants, Patient Care

• Avoid restrictive clothing. • Apply moisturizing lotion to skin. • Use electric razors, not straight razors. • Perform physical care in a gentle manner. • Tell patient not to forcefully blow nose. • Avoid removing or disrupting established clots. • Humidify O2 source if supplemental O2 is ordered. • Use soft toothbrushes or foam swabs for oral care. • Reposition the patient carefully at regular intervals. • Limit tape application. Use paper tape as appropriate. • Give stool softeners to avoid hard stools and straining. • Lubricate tubes (e.g., suction catheter) adequately before insertion. • Avoid restraints if possible. Use only soft, padded restraints if needed. • Use support pads, mattresses, bed cradles, and therapeutic beds as indicated. • Apply graduated compression stockings or intermittent pneumatic compression devices (if ordered) and with attention to proper size, application, and use. • Perform risk for fall and skin breakdown assessments per agency policy and implement safety and preventive measures as needed.

Surgical Procedures for Breast Cancer

• Breast-Conserving Surgery (Lumpectomy) With Radiation Therapy • Mastectomy - Simple or Total Mastectomy (removes the entire breast) - Modified Radical Mastectomy (preserves the pectoralis major muscle, takes away everything else, port is placed in it) - Breast Implants and Tissue Expansion • Breast Reconstruction Tissue Flap Procedures - Transverse Rectus Abdominis Musculocutaneous (TRAM) Flap - Deep Inferior Epigastric Artery Perforator (DIEP) FlapSentinel node

Breast Cancer Surgical Therapy

• Breast-conserving surgery (lumpectomy) with SLNB and/or axillary lymph node dissection • Simple (total) mastectomy with SLNB and/or axillary lymph node dissection • Modified radical mastectomy (preserves the pectoralis major muscle, takes away everything else, port is placed in it) • Reconstructive surgery

Epilepsy and Seizure Disorders Diagnostic Studies

• CBC, urinalysis, electrolytes, creatinine, fasting blood glucose should be done to rule out metabolic disorders. • Lumbar puncture for CSF analysis • CT or MRI should be done in any new-onset seizure to rule out a structural lesion • MRA, MRS, PET scan may be used in selected clinical situations. • Electroencephalography (EEG) should be done within 24 hours of a suspected seizure. (only a small percentage of patients with seizure disorders have abnormal EEG findings the first time) - repeated EEGs or continuous EEG monitoring may be needed to detect abnormalities. - An EEG is not a definitive test because some patients without seizure disorders have abnormal patterns • Magnetoencephalography may be done in conjunction with the EEG. - This test has greater sensitivity in detecting small magnetic fields generated by neuronal activity.

Safety Alert Defibrillation and Cardioversion

• Check that the synchronizer switch is OFF when defibrillation is planned. • Turn the synchronizer switch ON when cardioversion is planned. • Never apply the defibrillator pads over a pacemaker or implantable cardioverter-defibrillator. • Be certain that personnel are "all clear" before discharging the device.

Breast Cancer Drug Therapy

• Chemotherapy • Hormone therapy • Immunotherapy • Targeted therapy

Pulmonary Embolism Diagnostic Studies

• Chest x-ray: not diagnostic for PE. • Continuous ECG monitoring • ABGs: ABG analysis is important but not diagnostic. • Troponin level, BNP level • Pulmonary angiography: most sensitive and specific test for PE. • D-dimer level: measures amount of cross-linked fibrin fragments. These fragments are the result of clot degradation and rarely found in healthy individuals. The disadvantage of D-dimer testing is that it is neither specific nor sensitive, up to 50% of patients with small pulmonary emboli have normal results • Spiral (helical) CT scan: used test to diagnose PE, IV injection of contrast media is required to view the pulmonary blood vessels. Allows visualization of all anatomic regions of the lungs • Ventilation-perfusion (V/Q) lung scan: If a patient cannot have contrast media, a ventilation-perfusion (V/Q) scan is done. Scan has two components and is most accurate when both are performed (Perfusion scanning and Ventilation scanning)

Call EMS after seizure if:

• Child stops breathing. • There is evidence of injury, or child has diabetes or is pregnant. • Seizure lasts for more than 5 minutes (unless duration of seizure is typically longer than 5 minutes), and written medical order is present. • Seizures continue for more than 10 minutes after administration of rescue medication. • Status epilepticus occurs. • Pupils are not equal after seizure. • Child vomits continuously 30 minutes after seizure has ended (sign of possible acute problem). • Child cannot be awakened and is unresponsive to pain after seizure has ended. • Seizure occurs in water. • This is child's first seizure.

Regarding Nonpharmacologic Strategies to Encourage Relaxation and Relieve Pain, Cognitive Strategies

• Childbirth education • Hypnosis • Biofeedback

The following examples demonstrate how women of different cultural backgrounds may react to pain. Because they are generalizations, the nurse must assess each woman experiencing pain related to childbirth. • Chinese women • Arab or Middle Eastern women. • Japanese women • Southeast Asian women • Hispanic women • Native American women • African-American women

• Chinese women may not exhibit reactions to pain, although exhibiting pain during childbirth is acceptable. They consider accepting something when it is first offered as impolite; therefore pain interventions must be offered more than once. Acupuncture may be used for pain relief. • Arab or Middle Eastern women may be vocal in response to labor pain. They may prefer medication for pain relief. • Japanese women may be stoic in response to labor pain, but they may request medication when pain becomes severe. • Southeast Asian women may endure severe pain before requesting relief. • Hispanic women may be stoic until late in labor, when they may become vocal and request pain relief. • Native American women may use medications or remedies made from indigenous plants. They are often stoic in response to labor pain. • African-American women may express pain openly. Use of medication for pain relief varies.

Regarding Hyperthyroidism in Children, The earliest indication of hypoparathyroidism may be anxiety and mental depression followed by paresthesia and evidence of heightened neuromuscular excitability, such as the following:

• Chvostek sign: Facial muscle spasm elicited by tapping the facial nerve in the region of the parotid gland • Trousseau sign: Carpal spasm elicited by pressure applied to nerves of the upper arm • Tetany: Carpopedal spasm (sharp flexion of wrist and ankle joints), muscle twitching, cramps, seizures, and stridor

Breast Cancer Staging Test

• Complete blood count, platelet count • Alkaline phosphatase • Liver function tests • Chest x-ray (if indicated) • Bone scan (if indicated, to see if spread to bone) • CT scan of chest, abdomen, pelvis (if indicated) • MRI (if indicated) • PET/CT scan (if indicated, see if it spread to body)

Nursing Interventions for the Woman Receiving Neuraxial Anesthesia While the Block Is in Effect

• Continue to monitor maternal vital signs and FHR as ordered • Continue to assess the woman's level of pain with every check of vital signs using a pain scale • Monitor for bladder distention: - Assist with spontaneous voiding on bedpan or toilet. - Insert a urinary catheter if necessary. • Encourage or assist the woman to change positions from side to side every hour. • Promote safety: - Keep the side rails up on the bed. - Place the telephone and call light within easy reach. - Instruct the woman not to get out of bed without help. - Make sure there is no prolonged pressure on anesthetized body parts. • Keep the epidural catheter insertion site clean and dry. • Continue to monitor for anesthetic side effects

Regarding Nonpharmacologic Strategies to Encourage Relaxation and Relieve Pain, Cutaneous Stimulation Strategies

• Counterpressure • Effleurage (light massage) • Therapeutic touch and massage • Walking • Rocking • Changing positions • Application of heat or cold • Transcutaneous electrical nerve stimulation (TENS) • Acupressure • Water therapy (showers, baths, whirlpool baths) • Intradermal water block

Heart Failure Patient & Caregiver Teaching, Activity Program

• Increase walking and other activities gradually, provided they do not cause fatigue or dyspnea. • Consider a cardiac rehabilitation program. • Avoid extremes of heat and cold.

Diagnostic Assessment for Both ADHF and Chronic HF

• Determination of underlying cause • Serum chemistries, cardiac biomarkers, BNP or NT-proBNP level , liver function tests, thyroid function tests, CBC, lipid profile, kidney function tests, urinalysis • Chest x-ray • 12-lead ECG • 2-dimensional echocardiogram • Nuclear imaging studies • Cardiac catheterization • BNP (diagnostic for heart failure) >100 pg/mL (28.8 pmol/L)

Metabolic Acidosis causes

• Diabetic ketoacidosis • Lactic acidosis • Starvation • Diarrhea • Renal tubular acidosis • Renal failure • Gastrointestinal fistulas • Shock

Thrombocytopenia Nursing Implementation

• Discourage excessive use of over-the-counter (OTC) medications (aspirin) • Observe for early signs of thrombocytopenia in the patient receiving cancer chemotherapy drugs. • Emphasize that a seemingly minor nosebleed or new petechiae may indicate potential hemorrhage and the HCP should be notified. • Bleeding from the posterior nasopharynx may be difficult to detect because the blood may be swallowed. • If a subcutaneous injection is unavoidable, the use of a small-gauge needle and application of direct pressure for at least 5 to 10 minutes after injection or apply ice pack • Avoid IM injections • Monitor all blood cell and coagulation studies. • Counting sanitary napkins used during menses. Blood loss of 50 mL will completely soak a sanitary napkin • Closely monitor the platelet count, coagulation studies, hemoglobin, and hematocrit • proper administration of platelet transfusions is an important nursing responsibility • Teach the person with acquired thrombocytopenia to avoid causative agents when possible. • If the causative agents cannot be avoided (e.g., chemotherapy), teach the patient to avoid injury or trauma during these periods and to be aware of the clinical signs and symptoms • Patients with either ITP or acquired thrombocytopenia should have planned periodic medical evaluations to assess their status.

Patient & Caregiver Teaching Systemic Lupus Erythematosus

• Disease process • Names of drugs, actions, side effects, dosage, administration • Pain management strategies • Energy conservation and pacing techniques • Therapeutic exercise, use of heat therapy (for arthralgia) • Relaxation therapy • Avoidance of physical and emotional stress • Avoidance of exposure to individuals with infection • Avoidance of drying soaps, powders, household chemicals • Use of sunscreen protection (at least SPF 15) and protective clothing, with minimal sun exposure from 11:00 AM to 3:00 PM • Regular medical and laboratory follow-up • Marital and pregnancy counseling as needed • Community resources and health care agencies

Regarding Nonpharmacologic Strategies to Encourage Relaxation and Relieve Pain, During the second stage of labor, the woman has somatic pain, which is often described as intense, sharp, burning, and well localized. This pain results from the following:

• Distention and traction on the peritoneum and uterocervical supports during contractions • Pressure against the bladder and rectum • Stretching and distention of perineal tissues and the pelvic floor to allow passage of the fetus • Lacerations of soft tissue (e.g., cervix, vagina, and perineum)

Drug Alert Carbamazepine (Tegretol)

• Do not take with grapefruit juice. • Instruct patient to report visual abnormalities. • Abrupt withdrawal after long-term use may precipitate seizures

Regarding Neurologic Examination for the eyes, Special tests, usually performed by qualified persons, include the following:

• Doll's head maneuver: Absence of this response suggests dysfunction of the brainstem or oculomotor nerve (cranial nerve III). • Caloric test, or oculovestibular response (RS): This response is lost when the pontine centers are impaired, thus providing important information in assessment of the comatose patient. • Funduscopic examination: The presence of preretinal (subhyaloid) hemorrhages in children is almost invariably a result of acute trauma with intracranial bleeding, usually subarachnoid or subdural hemorrhage.

Regarding Characteristics of Feeding Problems, For PICA

• Eating nonfood items after maturing past toddlerhood • Not culturally sanctioned • Not part of any other mental illness

Patient Teaching After a Mastectomy Without and With Reconstruction

• Empty surgical drains twice a day and as needed, recording the date, time, drain sites (if more than one drain is present), and amount of drainage in milliliters in the diary that you will take to each surgical checkup until your drains are removed. (Before discharge you may receive a graduated container for emptying drains and measuring drainage.) • Avoid driving, lifting more than 10 pounds, or reaching above your head until given permission by the surgeon. • Take medications for pain as soon as pain begins. • Perform arm exercises as directed. • Call health care provider if inflammation of incision or swelling of the incision or the arm occurs. • Avoid tight clothing, tight jewelry, and other causes of decreased circulation in the affected arm. • Until drains are removed, wear loose-fitting underwear (camisole or half-slip) and clothes, pinning surgical drains inside of clothing. (You will be taught how to do this safely.) • After drains are removed and surgical sites are healing and still tender, wear a mastectomy bra or camisole with a cotton-filled, muslin temporary prosthesis. Temporary prostheses of this type are often available from Reach to Recovery. • Avoid depilatory creams; strong deodorants; and shaving of affected chest area, axilla, and arm. • Sponge bathe for the first 48 hours; then you may shower. Thoroughly dry yourself afterward and reapply fresh dressings. • Return to the surgeon's office for incision check, drain inspection, and possible drain removal as directed. • Contact Reach to Recovery or a breast center nursing staff member for assistance in obtaining external prosthesis and lingerie when dressings, drains, and staples are removed and wound is healing and nontender. • Contact insurance company for information about coverage of prosthesis and wig if needed. Obtain prescriptions for prosthesis and wig to submit with receipts of purchase for these items to the insurance company. If insurance does not pay for these items, contact hospital or agency social worker or local American Cancer Society for assistance. • Practice breast self-exam (BSE) of unaffected side and affected surgical site and axilla. • Keep follow-up visits for professional examination, mammography, and testing to detect recurrent breast cancer. • Expect decreased sensation and tingling at incision sites and in the affected arm for weeks to months after surgery. • Resume sexual activities as desired. • Participate in breast cancer survivor support group if desired. • Encourage mother, sisters, and daughters (if applicable) to learn and practice BSE and have annual professional breast examinations and mammography (if appropriate).

Heart Failure Patient & Caregiver Teaching, Dietary Therapy

• Examine labels to determine sodium content. Also examine the labels of over-the-counter drugs such as laxatives, cough medicines, and antacids for sodium content. • Avoid using salt when preparing foods or adding salt to foods. • Weigh yourself at the same time each day, preferably in the morning, using the same scale and wearing similar clothes. • Eat small, frequent meals.

Regarding Chronic HF drug therapy, Captopril Drug Alert

• Excessive hypotension and hyperkalemia may occur. • Monitor patient for first-dose hypotension (first-dose syncope). • Skipping doses or discontinuing the drug can result in rebound hypertension. • Angioedema, a rare adverse effect, can develop suddenly and can be life-threatening. ACE inhibitor

Nursing Care for the Woman Receiving Tocolytic Therapy

• Explain the purpose and side effects of the tocolytic medication(s) to the woman and her family. • Position the woman on her side to enhance placental perfusion and reduce pressure on the cervix. • Monitor maternal vital signs including lung sounds and respiratory effort, fetal heart rate and pattern, and labor status according to hospital protocol and professional standards. • Assess mother and fetus for signs of adverse reactions related to the tocolytic medication(s) being administered • Determine maternal fluid balance by measuring daily weight and intake and output. • Limit fluid intake to 2500 to 3000 mL/day, especially if a beta-adrenergic agonist or magnesium sulfate is being administered. • Provide psychosocial support and opportunities for the woman and family to express feelings and concerns. • Offer comfort measures as needed. • Encourage diversional activities and relaxation techniques.

Breast Cancer Radiation Therapy

• External radiation • Brachytherapy • Palliative radiation therapy

Clinical Manifestations of Bacterial Meningitis in Infants and Young Children

• Fever • Poor feeding • Vomiting • Marked irritability • Frequent seizures (often accompanied by a high-pitched cry) • Bulging fontanel • Nuchal rigidity possible • Brudzinski and Kernig signs not helpful in diagnosis • Difficult to elicit and evaluate in this age-group • Subdural empyema (H. influenzae infection)

Glomerulonephritis Signs & Symptoms

• Fever • Azotemia: Anorexia, N/V, Malaise • HTN • Volume Overload • Uptake/excretion of dye with renal scan

The diagnosis of preterm labor is based on three major diagnostic criteria If the presence of fFN is used as another diagnostic criterion, a sample of

• Gestational age between 20 0/7 and 36 6/7 weeks • Regular uterine activity, accompanied by a change in cervical effacement, dilation, or both • Initial presentation with regular contractions and cervical dilation of at least 2 cm. cervical fluid should be obtained by sterile speculum exam. (Vaginal swab collection is no longer recommended) - presence of vaginal bleeding or ruptured membranes or a history of intercourse or digital cervical examination within the past 24 hours can reduce the accuracy

Heparin-induced thrombocytopenia treatment/drug therapy

• Heparin must be discontinued when HIT is first recognized • Direct thrombin inhibitor (lepirudin [Refludan], argatroban [Acova]) to maintain anticoagulation • Indirect thrombin inhibitor (fondaparinux [Arixtra]) • Warfarin (Coumadin) only when the platelet count has reached 150,000/µL • If the clotting is severe, Plasmapheresis (plasma exchange) • Thrombolytic agents • Platelet transfusions are not effective • never be given heparin or low-molecular-weight heparin (LMWH)

ED Diagnostic Studies

• History and physical examination • Sexual history • Serum glucose and lipid profile • Testosterone, prolactin, and thyroid hormone levels • Nocturnal penile tumescence and rigidity testing • Vascular studies 1. Self-administered assessment and treatment-related questionnaires have been developed and may prove useful as primary screening tools (International Index of Erectile Function (IIEF)) 2. physical examination should focus on secondary sexual characteristics, noting if secondary sexual characteristics reflect the individual's chronologic age (Tanner stage). A DRE should be done to assess prostate size, consistency, and presence of nodules. Assessment of BP with palpation and auscultation of the femoral arteries and peripheral pulses should also be included. 3. A serum glucose and lipid profile is recommended to rule out diabetes mellitus. Hormonal levels for testosterone, prolactin, LH, and thyroid hormones may help identify endocrine-related problems. PSA level and a complete blood count may help to identify other diseases. 4. Nocturnal penile tumescence and rigidity testing is a noninvasive method 5. Vascular studies, including penile arteriography, penile blood flow study, and duplex Doppler ultrasound studies, are used to assess penile blood inflow and outflow

Risk Factors for Spontaneous Preterm Labor

• History of genital tract colonization, infection, or instrumentation • African-American race • Bleeding of uncertain origin in pregnancy • History of a previous spontaneous preterm birth between 16 and 36 weeks of gestation* (in the family also) • Uterine anomaly • Use of assisted reproductive technology • Multifetal gestation • Cigarette smoking, substance abuse • Prepregnancy underweight (BMI <19.6) and prepregnancy obesity (BMI >30) • Periodontal disease • Limited education and low socioeconomic status • Late entry into prenatal care • High levels of personal stress in one or more domains of life • living in a disadvantaged neighborhood, state, or region and lack of access to prenatal care

Respiratory Alkalosis causes

• Hyperventilation (e.g., hypoxia, anxiety, fear, pain, exercise, fever) • Hypoxemia from acute pulmonary disorders (e.g., pneumonia, pulmonary embolus) • Stimulated respiratory center (e.g., septicemia, stroke, meningitis, encephalitis, brain injury, salicylate poisoning) • Liver failure • Mechanical hyperventilation

Bacterial Meningitis Drug Therapy

• IV antibiotics (ampicillin, penicillin and cephalosporin (e.g., cefotaxime [Claforan], ceftriaxone [Rocephin])) • codeine for headache • dexamethasone (a corticosteroid) • acetaminophen or aspirin for temperature >100.4° F (38° C) • phenytoin IV • mannitol (Osmitrol) IV for diuresis

Thrombotic Thrombocytopenic Purpura Drug therapy

• Identification and treatment of cause (like infection) • Plasmapheresis (plasma exchange) • Corticosteroids • Rituximab (Rituxan) • Immunosuppressives (e.g., cyclosporine, cyclophosphamide) • Chemotherapy (vincristine, vinblastine) • Splenectomy for pt who are refractory to plasma exchange or immunosuppression

Regarding Patient Teaching Smoking and Tobacco Use Cessation Dealing With Urges to Use Tobacco

• Identify situations that may cause you to want to smoke or use other tobacco, such as being around other smokers, being under time pressure, feeling sad or frustrated, and drinking alcohol. • Avoid difficult situations while you are trying to quit. Try to lower your stress level. • Exercise can help, such as walking, jogging, or bicycling. • Distract yourself from thoughts of smoking and the urge to use tobacco by talking to someone, going to a movie, getting busy with a task, or having a game night with friends. • Drink a lot of water. • Keep your hands busy with a pen or toothpick.

Pulmonary Embolism Drug Therapy

• Immediate anticoagulation is required for patients with PE: contraindicated if the patient has complicating factors such as blood dyscrasias, hepatic dysfunction causing alterations in the clotting, overt bleeding, a history of hemorrhagic stroke, or heparin-induced thrombocytopenia (HIT) - Subcutaneous administration of low-molecular-weight heparin (monitoring the aPTT is not necessary for LMWH) (e.g., enoxaparin [Lovenox]) or fondaparinux is safer than Unfractionated heparin IV - administered once daily • Fibrinolytic agent: such as tissue plasminogen activator (tPA) or alteplase (Activase), help dissolve the pulmonary embolus and the source of the thrombus in the pelvis or deep leg veins, decreasing the likelihood of recurrent emboli. • Warfarin (Coumadin) for long-term therapy: administered for at least 3 months and then reevaluated (alternatives apixaban (Eliquis), dabigitran (Pradaxa), and edoxaban (Savaysa)) • Opioids for pain relief

Causes of Acquired Thrombocytopenia

• Immune thrombocytopenic purpura (ITP) • Thrombotic thrombocytopenic purpura (TTP) • Heparin-induced thrombocytopenia (HIT) • Disseminated intravascular coagulation (DIC) • Drugs - Chemotherapy drugs - Aspirin • Quinine • Infections - Viral infection (hepatitis C virus, HIV, cytomegalovirus) - Bacterial infection • Hematologic malignancy (leukemia, lymphoma, myeloma)

Regarding Nursing Care in Second-Stage Labor, Signs That Suggest the Onset of the Second Stage

• Increase in frequency and intensity of uterine contractions • Urge to push or feeling need to have a bowel movement • An episode of vomiting • Increased bloody show • Uncontrolled shivering • Verbalizations of feeling out of control or unable to cope • Involuntary bearing-down efforts

Drug Alert Adenosine (Adenocard)

• Injection site should be as close to the heart as possible (e.g., antecubital area). • Give IV dose rapidly (over 1 to 2 sec) and follow with a rapid 20 mL normal saline flush. • Monitor patient's ECG continuously. Brief period of asystole is common. • Observe patient for flushing, dizziness, chest pain, or palpitations.

Intellectual disability is characterized by deficits in three areas:

• Intellectual functioning • Social functioning • Daily functioning

Drug Alert Tamoxifen

• Irregular vaginal bleeding or spotting may occur. • Decreased visual acuity, corneal opacity, and retinopathy can occur in women receiving high doses (240-320 mg/day for >17 mo). These problems may be irreversible. • Instruct patient to immediately report decreased visual acuity. • Monitor for signs of deep vein thrombosis, pulmonary embolism, and stroke, including shortness of breath, leg cramps, and weakness

Heart Failure Patient & Caregiver Teaching, Ongoing Monitoring

• Know the signs and symptoms of worsening heart failure (Think FACES: Fatigue, limitation of Activities, chest Congestion/cough, Edema, and Shortness of breath). • Recall the symptoms experienced when illness began. Reappearance of previous symptoms may indicate a recurrence. • Follow up with HCP on regular basis. • Consider joining a local support group with your family members and/or caregiver(s). • Report immediately any of the following to the HCP: • Weight gain of 3 lb (1.4 kg) in 2 days, or 3-5 lb (2.3 kg) in a wk • Difficulty breathing, especially with activity or when lying flat • Waking up breathless at night • Frequent dry, hacking cough, especially when lying down • Fatigue, weakness • Swelling of ankles, feet, or abdomen. Swelling of face or difficulty breathing (if taking ACE inhibitors) • Nausea with abdominal swelling, pain, and tenderness • Dizziness or fainting

Safety Alert Balloon Tamponade

• Label each lumen to avoid confusion. • Secure the tube to prevent movement of the tube that could result in occlusion of the airway. • Deflate balloons for 5 min every 8-12 hr per institutional policy to prevent tissue necrosis.

Safety Alert During a seizure, you should do the following:

• Maintain a patent airway for the patient. • Protect the patient's head, turn the patient to the side, loosen constrictive clothing, ease patient to the floor (if seated). • Do not restrain the patient. • Do not place any objects in the patient's mouth.

Diagnostic Criteria for Systemic Lupus Erythematosus

• Malar rash: fixed erythema, flat or raised (butterfly rash) • Discoid rash: raised patches with scaling follicular plugging; scarring in older lesions • Photosensitivity: skin rash as unusual reaction to light • Oral ulcers: usually painless • Nonerosive arthritis: two or more peripheral joints with tenderness, swelling, effusion • Pleuritis or pericarditis • Renal disorder: persistent proteinuria or cellular casts in urine • Neurologic disorder: seizures or psychosis (in the absence of causative drugs or known metabolic disorders) • Hematologic disorder: hemolytic anemia, leukopenia, lymphopenia, or thrombocytopenia • Immunologic disorder: anti-DNA antibody or antibody to Sm nuclear antigen or positive antiphospholipid antibodies • Antinuclear antibody: abnormal titer (present)

ADHD Nursing Interventions

• Management begins with an explanation to the parents and the child about the diagnosis • If decreased appetite is a concern, parents can give the psychostimulants with or after meals rather than before, encourage consumption of nutritious snacks in the evening when the effects of the medication are decreasing, and serve frequent small meals with healthy "on-the-go" snacks. • Sleeplessness is reduced by administering the medication early in the day. • Play therapy for younger children • Children taking tricyclic antidepressants display a dramatic increase in the incidence of dental caries. (increases saliva viscosity and produces a dry mouth) • Emphasis on rigorous dental hygiene, conscientious home fluoride treatments, regular visits to the dentist, limited intake of refined carbohydrates, and use of artificial saliva is an important nursing function. • The child should drink plenty of fluids and be well hydrated. • drugs have the potential for abuse, and all children taking these drugs should be monitored closely for psychologic dependence, tolerance, depression, and other adverse behavior changes or idiosyncratic effects. • Most children with ADHD are not interested in abusing their drugs because the effect of the drugs • caution parents to keep these drugs safely stored away • therapy is not necessarily a panacea and that it will extend over a long period

Management of Abnormal Fetal Heart Rate Patterns Interventions for Specific Problems Maternal hypotension Uterine tachysystole Abnormal fetal heart rate pattern during second stage of labor

• Maternal hypotension - Increase rate of primary IV infusion. - Change to lateral or Trendelenburg positioning. - Administer ephedrine or phenylephrine if other measures are unsuccessful in increasing blood pressure. • Uterine tachysystole - Reduce or discontinue dose of any uterine stimulants in use (e.g., oxytocin [Pitocin]). - Administer uterine relaxant (tocolytic) (e.g., terbutaline [Brethine]). • Abnormal fetal heart rate pattern during second stage of labor - Use open-glottis pushing. - Use fewer pushing efforts during each contraction. - Make individual pushing efforts shorter. - Push only with every other or every third contraction. - Push only with perceived urge to push (in women with regional anesthesia).

Nursing Alert for down syndrome Immediately report any child with the following signs of spinal cord compression:

• Persistent neck pain • Loss of established motor skills and bladder or bowel control • Changes in sensation

Patient and Family Teaching: Selective Serotonin Reuptake Inhibitors (SSRIs)

• May cause sexual dysfunction or lack of sex drive. Inform nurse or primary care provider if this occurs. • May cause insomnia, anxiety, and nervousness. Inform nurse or primary care provider if this occurs. • May interact with other medications. Tell primary care provider about other medications patient is taking (e.g., digoxin, warfarin). SSRIs should not be taken within 14 days of the last dose of a monoamine oxidase inhibitor. • No over-the-counter drug should be taken without first notifying primary care provider. • Common side effects include fatigue, nausea, diarrhea, dry mouth, dizziness, tremor, and sexual dysfunction or lack of sex drive. • Because of the potential for drowsiness and dizziness, patient should not drive or operate machinery until these side effects are ruled out. • Alcohol should be avoided. • Liver and renal function tests should be performed and blood counts checked periodically. • Medication should not be discontinued abruptly. If side effects become bothersome, patient should ask primary care provider about changing to a different drug. Abrupt cessation can lead to serotonin withdrawal. • Any of the following symptoms should be reported to the primary care provider immediately: - Increase in depression or suicidal thoughts - Rash or hives - Rapid heartbeat - Sore throat - Difficulty urinating - Fever, malaise - Anorexia and weight loss - Unusual bleeding - Initiation of hyperactive behavior - Severe headache

Digoxin Drug Alert

• Monitor for signs of hypokalemia and hyperkalemia, since these can increase or decrease the effects of digoxin, respectively. • Monitor for early signs of toxicity: anorexia, nausea and vomiting, fatigue, headache, depression, visual changes. • Monitor for late signs of toxicity, such as dysrhythmias (e.g., bradycardia, atrioventricular block). • Monitor serum potassium levels of all patients taking digitalis preparations and potassium-depleting and potassium-sparing diuretics.

Anemia Nursing intervention

• Monitor hemoglobin and hematocrit levels. • Administer iron supplements and erythropoietin. • Encourage intake of foods that promote RBC production

NIC Interventions for Eating Disorders Management for Monitoring

• Monitor physiological parameters (vital signs, electrolyte levels) as needed. • Weigh on a routine basis (e.g., at same time of day and after voiding). • Monitor daily caloric intake and intake and output of fluids, as appropriate. • Restrict food availability to scheduled, pre-served meals and snacks. • Encourage self-monitoring of daily food intake and weight gain/maintenance as appropriate. • Observe patient during and after meals/snacks to ensure that adequate intake is achieved and maintained. • Accompany patient to bathroom during designated observation times following meals/snacks. • Limit time spent in bathroom during periods when not under direct supervision. • Limit physical activity as needed to promote weight gain.

Regarding Chronic HF drug therapy, Spironolactone (Aldactone) Drug Alert

• Monitor potassium levels during treatment. • Use with caution in patients taking digoxin, since hyperkalemia may reduce the effects of digoxin. • Instruct patient to avoid foods high in potassium (e.g., bananas, oranges, dried apricots). • Assess male patients for gynecomastia, a common side effect of long-term use of spironolactone.

Drug Alert Nitrates

• NTG tablets must be kept in a dark, airtight container to maintain potency. • SL NTG must be placed under the tongue. • Translingual NTG should be sprayed on the tongue, not under the tongue. • Tell patient not to combine with drugs used for erectile dysfunction (e.g., sildenafil [Viagra]) as severe hypotension can occur. • Monitor for orthostatic hypotension because it may occur after administration. • Headaches are common after taking any NTG preparation. • Use gloves to apply and remove NTG ointment or transdermal patches to avoid contact with drug. • Never discharge a cardioverter-defibrillator over NTG ointment or transdermal patch. • When using long-acting nitrates, provide a 10- to 14-hour nitrate-free period.

Regarding Pharmacologic Control of Discomfort by Stage of Labor and Method of Birth, second stage of labor methods

• Nerve block analgesia and anesthesia • Local infiltration anesthesia • Pudendal block • Spinal (block) anesthesia • Epidural (block) analgesia • CSE analgesia • Nitrous oxide

Regarding Hemodialysis, Safety Alert Arteriovenous Fistulas and Grafts

• Never perform BP measurements, insertion of IV lines, and venipuncture in the extremity with the vascular access. • These special precautions are taken to prevent infection and clotting of the vascular access. • When a patient is hospitalized, hang signs in patient's room or label the arm with a band that says "No BP, blood draws, or IV in this arm."

Management for ONLY Chronic HF

• O2 therapy by nasal cannula if indicated • Drug therapy • Cardiac resynchronization therapy with biventricular pacing and internal cardioverter-defibrillator • LVAD • Heart transplantation • Rest-activity periods • Dietitian consult • Physical/occupational therapy consult • Cardiac rehabilitation • Home health nursing care (e.g., telehealth monitoring) • Palliative and end-of-life care

A closely related set of disorders anxiety results in abnormal selective overattention or obsessions. These obsessive-compulsive and related disorders include the following:

• Obsessive-compulsive disorder • Body dysmorphic disorder • Hoarding disorder • Trichotrillomania (hair pulling) disorder • Excoriation (skin picking) disorder

Warning Signs of Abuse

• Physical evidence of abuse or neglect, including previous injuries • Conflicting stories about the "accident" or injury from the parents or others • Cause of injury blamed on sibling or other party • An injury inconsistent with the history such as a concussion and broken arm from falling off a bed • History inconsistent with child's developmental level such as a 6-month-old turning on the hot water • A complaint other than the one associated with signs of abuse (e.g., a chief complaint of a cold when there is evidence of first- and second-degree burns) • Inappropriate response of caregiver such as an exaggerated or absent emotional response, refusal to sign for additional tests or agree to necessary treatment, excessive delay in seeking treatment, or absence of parents for questioning • Inappropriate response of child such as little or no response to pain, fear of being touched, excessive or lack of separation anxiety, indiscriminate friendliness to strangers • Child's report of physical or sexual abuse • Previous reports of abuse in the family • Repeated visits to emergency facilities with injuries • Parent or caregiver report of being gone and finding the child unresponsive, indicating absence during the supposed event that resulted in harm

Clinical Manifestations of Hemophilia

• Prolonged bleeding anywhere from or in the body • Hemorrhage from any trauma: Loss of deciduous teeth, circumcision, cuts, epistaxis, injections • Excessive bruising, even from a slight injury, such as a fall • Subcutaneous and intramuscular (IM) hemorrhages • Hemarthrosis (bleeding into the joint cavities), especially the knees, ankles, and elbows • Hematomas: Pain, swelling, and limited motion • Spontaneous hematuria

Regarding Nursing Care in Second-Stage Labor, Interventions for Active Pushing Phase

• Provide 1 : 1 nursing care (1 labor nurse to 1 laboring woman). Do not leave the woman alone. • Help the woman to change position, and encourage spontaneous bearing-down efforts. • Help the woman to relax and conserve energy between contractions. • Provide comfort and pain-relief measures as needed. • Cleanse the perineum promptly if fecal material is expelled. • Coach the woman to pant during contractions and to gently push between contractions when head is emerging. • Provide emotional support, encouragement, and positive reinforcement of efforts. • Keep the woman informed regarding progress. • Create a calm and supportive environment. • Offer a mirror to watch birth. • Encourage the woman to touch the fetal head when it is visible at the perineum.

Talking With Children Who Reveal Abuse

• Provide a private time and place to talk. • Do not promise not to tell; tell them that you are required by law to report the abuse. • Do not express shock or criticize their family. • Use their vocabulary to discuss body parts. • Avoid using any leading statements that can distort their report. • Reassure them that they have done the right thing by telling. • Tell them that the abuse is not their fault, that they are not bad or to blame. • Determine their immediate need for safety. • Let the child know what will happen when you report.

Suggested Measures for Supporting a Woman in Labor

• Provide companionship and reassurance. • Offer positive reinforcement and praise for her efforts. • Encourage participation in distracting activities and nonpharmacologic measures for comfort. • Give nourishment (if allowed by obstetric health care provider). • Assist with personal hygiene. • Offer information and advice. • Involve the woman in decision making regarding her care. • Interpret the woman's wishes to other health care providers and to her support group. • Create a relaxing environment. • Use a calm and confident approach. • Support and encourage the woman's support people by role-modeling labor support measures and providing time for breaks.

Regarding Characteristics of Feeding Problems, for Rumination

• Regurgitation with rechewing, reswallowing, or spitting • No GI or medical reason • Not part of other mental illness or eating disorder • Intellectual development disorder is association with rumination.

Bacterial Meningitis Therapeutic Management

• Respiratory Isolation (Droplet) precautions • Initiation of antimicrobial therapy • Maintenance of hydration • Maintenance of ventilation • Reduction of increased ICP • Management of systemic shock • Control of seizures • Control of temperature • Treatment of complications

Infertility Diagnostic Assessment

• Review of menstrual and gynecologic history • Assessment of possible sexually transmitted infections • Hormone levels - Serum hormone levels (e.g., FSH, LH, prolactin) - Urinary LH • Ultrasonography • Endometrial Biopsy • Tubal patency study - Hysterosalpingogram • Laparoscopy Other Test: • Pap test • Ovulatory study • Postcoital test - Cervical mucus - Sperm penetration assay - Semen analysis • Pelvic ultrasound • Genetic screening • Thyroid Function Test • Glucose Tolerance Test • Serum Prolactin Levels

Patient Teaching Activities for Children of Women on Activity Restriction for preventing preterm labor

• Schedule brief play periods throughout the day. • Keep a few favorite toys in a box or basket close to the bed or couch. • Read to the children. • Assemble puzzles together. • Watch videos or play video games (remote control for television is ideal). • Play card or board games. • Color in coloring books. • Cut out pictures from magazines, and paste on cardboard. • Play bed basketball with a soft (sponge) ball or rolled up sock and a trash can or empty laundry basket.

Substance abuse test

• Screening, Brief Intervention, and Referral to Treatment (SBIRT) • Alcohol Use Disorders Identification Test (AUDIT) • Drug Abuse Screening Test (DAST-10) • CAGE (Questions: Have you felt you needed to cut down on your drinking? Are people annoyed by your drinking? Have you felt guilty about your drinking? Have you ever had a drink in the morning (eye-opener)? Score of 2 or more is significant, although a score of 1 requires further assessment. • CAGE-AID (Questions are the same as CAGE but refers to Adapted to Include Drugs.) • T-ACE (Tolerance, Annoyance, Cut down, Eye-opener)

Metabolic Alkalosis causes

• Vomiting • Nasogastric suctioning • Ingestion of baking soda • Diuretic therapy • Hypokalemia • Excess NaHCO3 intake • Mineralocorticoid use

Male erectile disorder Advanced Practice Interventions

• Sensate focus: A therapeutic treatment in which patients progress from general touching and cuddling without intercourse to more intimate forms of expression. • Behavioral therapy: Useful for men with premature ejaculation when psychogenic or relationship factors are present and is often best combined with medication in an integrated treatment program. • Systematic desensitization: Involves combining relaxation exercises with sexually anxiety-producing stimuli. • Masturbation training: Especially helpful in women who have never had an orgasm. This approach helps women learn about their bodies and their responses to understand their sexual

the term anxiety disorder refers to a number of disorders including:

• Separation anxiety disorder • Specific phobia • Social anxiety disorder (social phobia) • Panic disorder • Agoraphobia • Generalized anxiety disorder

Regarding Patient Teaching Smoking and Tobacco Use Cessation Develop a Quit Plan

• Set a quit date, ideally within 2 weeks. • Talk to your HCP about getting help to quit. • Tell family, friends, and co-workers about quitting and request understanding and support. • Anticipate withdrawal symptoms and challenges when quitting. • Before quitting, avoid smoking in places where you spend a lot of time (work, car, home). • Throw away all tobacco products from your home, car, and work. • Have support options in place by your quit date.

Seizure Precautions

• Side rails raised when child is sleeping or resting • Side rails and other hard objects padded • Waterproof mattress or pad on bed or crib Appropriate precautions during potentially hazardous activities may include the following: • Swimming with a companion • Showers preferred; bathing only with close supervision • Use of protective helmet and padding during bicycle riding, skateboarding, and in-line skating • Supervision during use of hazardous machinery or equipment

Patient Teaching What to Do if Symptoms of Preterm Labor Occur

• Stop what you are doing. • Lie down on your side. • Drink two to three glasses of water or juice. • Lie down on your side. • Wait 1 hour. • If symptoms get worse, call your health care provider. • If symptoms go away, tell your health care provider what happened at your next prenatal visit. • If symptoms come back, call your health care provider.

Alopecia Nursing intervention

• Suggest ways to cope with hair loss (e.g., hair pieces, scarves, wigs). • Cut long hair before therapy. • Avoid excessive shampooing, brushing, and combing of hair. • Avoid use of electric hair dryers, curlers, and curling rods. • Discuss impact of hair loss on self-image.

Pulmonary Embolism Management

• Supplemental O2, intubation if necessary • Monitor aPTT and INR levels • Balance activity and rest • Inferior vena cava filter • Pulmonary embolectomy in life-threatening situation

Caring for the Patient With a Seizure Disorder Role of Nursing Personnel Registered Nurse (RN)

• Teach patient about factors that increase risk for seizures, such as alcohol use, fatigue, inadequate sleep, and stress. • Teach patient about prescribed antiseizure medications, including drug regimen, side effects, and required monitoring of drug levels. • Assess and document details of seizure events, including events preceding the seizure; length of each phase of the seizure; course and nature of seizure activity; and level of consciousness, vital signs, and activity during the postictal period. • Assess airway patency, and position patient to maintain airway during and after any seizures. • Administer IV antiseizure medications to the patient experiencing status epilepticus. • Make appropriate referrals to the Epilepsy Foundation and community agencies to assist patient with financial impact of the disorder, work training, employment, and living arrangements. • Teach family members and caregivers about management of seizures and status epilepticus. • In the ambulatory and home care setting, evaluate patient self-management of medications and lifestyle.

Patient and Family Teaching: Monoamine Oxidase Inhibitors (MAOIs)

• Tell the patient and family to avoid certain foods (especially those that are aged, cured, or ripened) and all medications (especially cold remedies) unless prescribed by and discussed with the patient's primary care provider. • Give the patient a wallet card describing the MAOI regimen. • Instruct the patient to avoid Asian restaurants (sherry, brewer's yeast, and other contraindicated products may be used). • Tell the patient to go to the emergency department immediately if he or she has a severe headache. • Ideally, blood pressure should be monitored during the first 6 weeks of treatment (for both hypotensive and hypertensive effects). • After the MAOI is stopped, instruct the patient that dietary and drug restrictions should be maintained for 14 days

Methods Used to Pressure Children Into Sexual Activity

• The child is offered gifts or privileges. • The adult misrepresents moral standards by telling the child that it is "okay to do." • Isolated and emotionally and socially impoverished children are enticed by adults who meet their needs for warmth and human contact. • The offender asks the child for help in finding a favorite pet or object with which the child can easily identify. • The successful sex offender pressures the victim into secrecy regarding the activity by describing it as a "secret between us" that other people may take away if they find out. • The offender plays on the child's fears, including fear of punishment by the offender, fear of repercussions if the child tells, and fear of abandonment or rejection by the family.

Patient and Family Teaching: Tricyclic Antidepressants (TCAs)

• The patient and family should be told that mood elevation may take from 7 to 28 days. Up to 6 to 8 weeks may be required for the full effect to be reached and for major depressive symptoms to subside. • The family should reinforce this frequently to the depressed family member because depressed people have trouble remembering and respond to ongoing reassurance. • The patient should be reassured that drowsiness, dizziness, and hypotension usually subside after the first few weeks. • When the patient starts taking TCAs, the patient should be cautioned to be careful working around machines, driving cars, and crossing streets because of possible altered reflexes, drowsiness, or dizziness. • Alcohol can block the effects of antidepressants. The patient should be told to refrain from drinking. • If possible, the patient should take the full dose at bedtime to reduce the experience of side effects during the day. • If the patient forgets the bedtime dose (or the once-a-day dose), the patient should take the dose within 3 hours; otherwise, the patient should wait until the usual medication time the next day. The patient should not double the dose. • Suddenly stopping TCAs can cause nausea, altered heartbeat, nightmares, and cold sweats in 2 to 4 days. The patient should call the primary care provider or take one dose of TCA until the primary care provider can be contacted.

Always assess the potential for lethality. Certain factors place a vulnerable person at greater risk for homicide including the following:

• The presence of a gun in the home • Alcohol and drug misuse • History of violence on the part of the perpetrator in other situations • Extreme jealousy and obsessiveness on the part of the perpetrator • ask individuals victimized by violence if they have ever felt like killing the perpetrator

Regarding Early Recognition and Diagnosis of Preterm, These interventions include the following:

• Transferring the mother before birth to a hospital equipped to care for her preterm infant • Administering antibiotics during labor to prevent neonatal group B streptococci infection • Administering antenatal glucocorticoids (e.g., betamethasone, dexamethasone) to women at risk for preterm birth to prevent or reduce neonatal and infant morbidity and mortality from health problems including respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, and other causes • Administering magnesium sulfate to women giving birth before 32 weeks of gestation to reduce the incidence of cerebral palsy in their infants

Respiratory Alkalosis Treatment

• Treat underlying condition • Respiratory support to raise CO2 levels (breath into a paper bag) • Treatment of psychological stress causing anxiety/panic • Encourage the anxious patient to verbalize fears

Respiratory acidosis Treatment

• Treat underlying condition (bronchodilator medicines and corticosteroids to reverse some types of airway obstruction) • Respiratory support such as mechanical ventilation, noninvasive positive-pressure ventilation, or noninvasive external negative- pressure ventilation • Smoking cessation • CPAP or BiPAP

Metabolic Acidosis Treatment

• Treating underlying condition (excreting excess acids) • Treat uncontrolled diabetes (insulin, fluids, electrolytes) • IV sodium bicarbonate to counter high acids • Dialysis for those with high levels of acid • Detoxification if caused by alcohol or drug poisoning

Metabolic Alkalosis Treatment

• Treating underlying condition (stop vomiting or discontinue gastric suctioning) • Patients on diuretics should have their dose reduced • Fluid and electrolyte support • Increase renal bicarbonate excretion

Management for BOTH ADHF and Chronic HF

• Treatment of underlying cause • Circulatory assist devices (e.g., ventricular assist device) • Daily weights • Sodium- and possibly fluid-restricted diet

NIC Interventions for Eating Disorders Management for Support

• Use behavioral contracting with patient to elicit desired weight gain or maintenance behaviors. • Use behavior modification techniques to promote behaviors that contribute to weight gain and limit weight-loss behaviors, as appropriate. • Provide reinforcement for weight gain and behaviors that promote weight gain. • Provide support (e.g., relaxation therapy, desensitization exercises, opportunities to talk about feelings) as patient integrates new eating behaviors, changing body image, and lifestyle changes. • Encourage patient use of daily logs to record feelings and circumstances surrounding urge to purge, vomit, or overexercise. • Assist patient (and significant others, as appropriate) to examine and resolve personal issues that may contribute to the eating disorder. • Assist patient to develop a self-esteem that is compatible with a healthy body weight.

Drug Alert Trastuzumab (Herceptin) (hormonal therapy for breast cancer)

• Use with caution in women with preexisting heart disease. • Monitor for signs of ventricular dysfunction and heart failure.

Clinical Manifestations of Bacterial Meningitis in Children and Adolescents

• Usually abrupt onset • Fever • Chills • Headache • Vomiting • Alterations in sensorium • Seizures (often the initial sign) • Irritability • Positive Kernig and Brudzinski signs • Hyperactivity but variable reflex responses • Petechial or purpuric rashes (meningococcal infection), especially when associated with a shocklike state • Joint involvement (meningococcal and Haemophilus influenzae infection) • Chronically draining ear (pneumococcal meningitis) May develop: • Photophobia • Delirium • Hallucinations • Aggressive behavior • Drowsiness • Stupor • Coma

Screening guidelines for the early detection of breast cancer vary depending on a woman's age and risk. For women at average risk for breast cancer, the following is recommended by the American Cancer Society:

• Women should undergo regular screening mammography starting at age 45 years. • Women aged 45 to 54 years should be screened annually. • Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually. • Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer. • The ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age.

Signs of Potential Complications: Maternal Opioid Abstinence Syndrome (Opioid/Narcotic Withdrawal)

• Yawning, rhinorrhea (runny nose), sweating, lacrimation (tearing), mydriasis (dilation of pupils) • Anorexia • Irritability, restlessness, generalized anxiety • Tremors • Chills and hot flashes • Piloerection ("gooseflesh" or "chill bumps") • Violent sneezing • Weakness, fatigue, and drowsiness • Nausea and vomiting • Diarrhea, abdominal cramps • Bone and muscle pain, muscle spasms, kicking movements

Glomerulonephritis Lab Values

• decreased GFR • increased BUN/Creatinine • Hematuria • Proteinuria • Hypoalbuminemia • Metabolic Acidosis

Patient Teaching Discharge Teaching for the Woman After Early Miscarriage

• emphasizes the need for rest. • Cleanse the perineum after each voiding or bowel movement, and change perineal pads often. • Shower (avoid tub baths) for 2 weeks. • Avoid tampon use, douching, and vaginal intercourse for 2 weeks. • Notify your health care provider if an elevated temperature or a foul-smelling vaginal discharge develops. • Eat foods high in iron and protein to promote tissue repair and red blood cell replacement. • Seek assistance from support groups, clergy, or professional counseling as needed. • Allow yourself (and your partner) to grieve the loss before becoming pregnant again.