thermoregulation/cellular regulation
what is therapeutic hypothermia?
it is intentionally induced to reduce metabolism and preserve tissue by preventing tissue ischemia.
What is brachytherapy?
internal radiation that delivers high dose of radiation to limited areas to local areas. because it is affected a limited area, less healthy tissue is subjected.
what does the BRCA 2 genetic marker indicate?
likelihood of breast cancer; 40-60% will get
what are the most common types of cancer among men and women?
men: prostate lung colon women: breast lung colon
what structures are created through slower proliferation?
muscles cartilage bone
Temperature hyperthermia
over 37.6
what is clotting?
process that involved platelets (thrombocytes) that circulate in the blood until they are needed. when injury occurs, platelets are activated to become sticky so they become aggravated and clot. This is also known as clotting cascade.
What is apoptois?
programmed cell death
While at a soccer match, a player drops to the ground with heat exhaustion and a diminished level of consciousness. After ensuring the ABC's are intact, what does the team nurse do first?
put them in the shade
what are common treatments of cancer?
radiation surgery hormonal therapy ionization chemotherapy targeted therapy- biologic therapy can also be considered targeted therapy/ biologic therapy stem cell transplant
what is the ESR?
rate at which RBC fall into blood plasma It is elevated with chronic infections and inflammation such as arthritis.
A postoperative client is receiving epidural analgesia and reports itching. What does the nurse do next?
reduce the dose
the nurse identifies which priority nursing intervention for a patient with hyperthermia?
removing clothing
What is meisosis?
reproduction
what is cell proliferation?
reproduction of new cells through division
what is an example of secondary prevention?
screening for malignant hyperthermia. (MH is a genetic autosomal dominant disorder that affects skeletal muscle and results in dangerously high temperature)
what is a field block?
series of injections around the operative field (dental surgery, chest procedures, hernia repair)
what are some drugs that require frequent monitoring?
sodium heparin wafarin newer anticoagulants (direct thrombin inhibitors) Educate the importance of getting levels drawn.
a homeless person is brought to the ED after prolonged exposure to cold weather. the nurse would assess the patient for which manifestations?
stupor as a result of decreased CNS activty
A high school athlete recently suffered heat exhaustion. The school nurse is instructing the student on how to prevent a recurrence of this situation. Which student statement demonstrates that the nurse's teaching has been effective?
take rest periods
what does the benign and malignant grading scale measure?
the measure of a celll anaplasia "how much it differs from other cells"
what is targeted therapy?
they prevent growth signaling and interefere with tumor formation by stimulating the immune system to avoid cancer cells.
radiation therapy
treatment of cancer with a radioactive substance, x-ray, or radiation; they also penetrate healthy cells and kill them. ex: linear accelerator
s/s of increased clotting:
- symptoms of venous thrombosis
what is acetazolamide?
A sulfa drug.
what are abnormal findings of a neoplasm?
visible lesions physical asymmetry palpable masses abnormal sounds or presence of blood during a pelvic exam, or guauic test for occult blood.
what is the most common cause of hypothermia?
weather; wind chill
Regional Anesthesia:
Epidural; knee surgery
what are some common carcinogens?
asbestos, dioxins, tetrachloroethylene, arsenic
what is the most common type of breast cancer?
ductal carcinoma
A client diagnosed with acute leukemia tells the nurse that his brother cannot donate stem cells for a transplant because the brother has type O blood and he has type A blood. How will the nurse respond?
"Blood type and tissue type are not connected. If your brother's tissue type matches yours, you can receive his stem cells." Tissue type and blood type are controlled by different genes and are not related.
Which of the following statements is essential when teaching a patient who has received an injection of iodine-131?
"Do not share a toilet with anyone else for 3 days." The radiation source is an unsealed isotope that is eliminated from the body mainly through urine and feces. This material is radioactive for about 48 hours after instillation. The patient should not share a toilet with others for 3 days to ensure the isotope has been completely eliminated and is no longer radioactive.
what are characterisitics of HYPERTHERMIA?
- dehydration - hypotension - tachycardia - decrease perfusion and cardiac output resulting in cerebral edema, renal necrosis, and CNS effects. - cardiac collapse what it looks like: - flushed appearance -vasodilation - warm skin -sweating - decreased urinary output - dry skin -hypercoagulation - electrolyte imbalance - cognitive and CNS status can lead to seizures.
What are common risk factors for increased clotting?
- immobility - polycethemia (excessive prodcution of RBC which increases risk for clots) -smoking - Diabetes (associated with decreased blood flow and more at risk for VTE - atrial fib (causes pooling of blood in the atria) and often leads to embolus. - age and smoking makes platelets more sticky and aggravate more - as a result of age, venous statis is increased when venous valves that normally prevent backflow , become weak.
what is primary prevention for promoting cellular regulation?
- minimize exposure to sun -stop smoking - consume diet low in fat and high in fiber to prevent breast and colon cancer - increase exercise - avoid environmental hazards
s/s of decreased clotting:
- purpural leasions (ecchymosis) - petechiae (pinpoint purpura) -frank bleeding from gums or nose - presence of blood on urine or stool
how to treat altitude related illness?
- slow ascend - recognize s/s - adequate hydration and nutrition - avoid alcohol and sleeping pills - adminster Diamax -protect skin and eyes
What are some age considerations for ELDER adults?
- slower circulation - decreased vasoconstriction response - decreased sweating - reduced heat production as a result of slower metabolism -decreased shivering response - reduced perception of temperature change
what are risk factors for breast cancer?
- women -pregnancy - age - family hx - menstrual -hormone replacements -obesity
Assessing RR depression properly:
- you always watch the rise and fall of the patients chest and count respirations for a full 60 seconds. - count respirations before wakening the patient to get accurate result. - if the patient is difficult to arouse, always stop the administration and stay with the patient and call for help. - is snoring is heard, immediately reposition the patient (sitting position) and depending on severity, consult RT to determine the next step. one risk factor for RR depression is adults older than 55. Always assess the patients to the first opioid dose before and obtain peak time if giving through a bolus.
what are the most common lab values to measure clotting factor levels and bleeding time?
-PT (prothrombin time) - aPtt (activated partial thromboplasm time - INR (measures warfarin)
what are the roles of cells?
-creating fuel for the body - manufacturing proteins - transporting materials - disposing of waste
What are common risk factors for decreased clotting?
-heamophillia A and B - thrombocytopenia (inadequate number of platelets) - chemo drugs bc they cause bone marrow suppression and decreased production of RBC -steroid drugs bc they cause bone marrow suppression and decreased production of RBC - liver cirrhosis (bc they have dc clotting factors) complications: for patients whose blood can not clot enough, they are at risk for internal bleeding.
elder adults and fever:
-infection can be present without infection - elder adult temperature may be 1-2 degrees lower than younger adults. - may have a fever at 99 F (37.2)
what are risk factors for prostate cancer?
-older age -family hx - men older than 50
Rapid Cultures:
-strep A - TB -Flu
what are the risk factors for impaired cellular regulation?
1) 55 y/o and older' more significantly for 70 and older 2) smoking 3) poor nutriton 4) exposure to environmental hazards 5) radiation 6) no exercise; sedentary 7) chemotherapy 8) genetic predisposition
What are ways that heat is maintained by the body?
1) By metabolism via the release of epinephrine 2) by the muscle and through metabolic activity of the liver. 3) conservation of heat through peripheral vasoconstriction
what are some vancomycin considerations?
1) check serum trough ( lowest serum concentration) and peak levels (highest levels). 2) the trough level is drawn 30 minutes before the next dose. 3) A specimen for peal levels is drawn 30-60 minutes after medication administration.
interventions for increased clotting:
1) drink adequate fluids 2) avoid crossing legs 3) ambulate frequently and avoid prolonged sitting 4) refer patients to smoking cessation 5) cell HCP is redness, warmth, or edema occurs. 6) provide anticoags
Considerations for bringing a patient out of sedation:
1) during recovery, rigidity, shivering, and cyanosis may show.
complications of inadequate clotting:
1) internal bleeding in brain (hemorrhagic stroke) 2) GI bleeds (AEB blood in stool) 3) bleeding in urinary tract (hematuria) 4) bleeding under the skin-purpura 5) external bleeding- epistaxis
what are common concepts associated with cancer?
1) nutrition- patients with cancer are malnourished, patients also become anorexic as a result of chemo, gi complaints of chemo are also a factor. 2) immunity- have lowered immunity 3) infection-have increased infection likelihood 4) pain 5) fatigue 6) elimination- diarrhea 7)n F&E disturbances- early in tx pt are at risk for tumor lysis syndrome (eleveted uric acid, elevated phosphate and potassium levels, dehydration, hypercalemia, third spacing of fluids. 8) anxiety
What are ways in which the body loses heat?
1) radiation 2) conduction ( transfer of heat from one surface to another) 3) convection- loss of heat through air currents 4) heat loss also occurs through vasodilaltion * wet skin accelerates heat loss
What are considerations for INFANTS and heat maintenance?
1) they have a larger surface area so they lose heat faster (this is why they maintain the fetal position to reduce surface area). 2) They have brown fat to help produce heat. 3) They generally do not shiver so a process called (nonshivering thermogenesis) occurs. It involves increasing metabolism and oxygenm consumption to offset heat loss. 4) they have a thin layer of SQ fat so are less insulated. 5) blood vessels are closer to the skin and they lose heat faster.
What are some education points for thermoregulation management?
1) wear synthetic clothing because it dries fast and moves moisture away from the body. Cotton is not recommended bc it holds moisture. 2) wearing too many pairs of socks can reduce circulation 3) wet socks or gloves promote frostbite
interventions for decreased clotting:
1)looks for s/s of bleeding, bruising
FROSTBITE:
1st degree: -hyperemia (increased blood flow to area) - edema 2nd degree: - milky blisters - partial thickness necrosis 3rd degree: - small blisters that contain dark fluid - the affected body part does not blanch and is red or cool; full thickness; requires debridement 4th degree: - gangrene tx: for all partial and full thickness forms of frostbite, rapid rewarming in a water bath ( 104-108 F) (40-42C) is indicated. Administer IV fluids and opiates to decrease this painful experience. Also, give Ibuprofen as it decreases thromboxane production in the inflammatory cascade that can prevent secondary tissue injury. When the rewarming is complete, keep the body part above the level of the heart to decrease tissue edema. Assess hourly for compartment syndrome. early manifestations of CS are pain even after tx, paresthesia or numbness and tingling, decrease pulses, muscle weakness, and pallor. For frostbite, the patient should recieve a tetanus shot, recieve antibiotics, nonadherent dressings, avoid compression of injuries, and dont let the thawed part unfreeze.
Normal body temperature
36.2 - 37.6 (97-100) with average being 98.6 (37C)
what is the recommend axilla temperature for a newborn?
36.5 (97.8)
how much fluid does perspiration account for?
600 ml per day; in extreme situations a person can lose 4L per hour.
Clients who have been admitted to the emergency department (ED) are assessed by the ED triage nurse for an oncoming shift. Which client is most appropriate to assign to an LPN/LVN
A client with heat exhaustion, receiving an IV of normal saline, with normal chemistry laboratory results and a temperature of 98.6° C (37° C) It is appropriate to assign an LPN/LVN to care for the stable, heat exhaustion client who is already receiving appropriate treatment.
Which of the following findings during a female breast examination should the nurse report as suspicious for breast cancer?
A poorly defined, firm lump that is nontender and nonmovable A poorly defined, firm lump that is nontender, nonmovable, and fixed to the skin is characteristic of breast cancer.
how is perfusion related to thermoregulation?
If there is not adequate perfusion, the body cannot constrict blood vessels to retain heat and cannot dilate blood vessels to get rid of it.
A hiker begins to feel ill within 48 hours after arriving at a resort in Colorado. Symptoms include poor activity tolerance, tachycardia, tachypnea, and a dry cough. Which treatment provides the most effective relief for this hiker?
Acetazolamide sodium (Diamox) Dexamethasone (Decadron) oxygen therapy Lower altitude - CORRECT
A client with cancer is receiving low-dose oral morphine but is reporting both "sharp, tingly" pain and constipation. What intervention does the nurse implement first?
Administers ordered docusate sodium (Colace) and gabapentin (Neurontin) As a first intervention, docusate (Colace) and gabapentin (Neurontin) take priority. Docusate is a stool softener and gabapentin is an adjuvant for neuropathic pain.Constipation is a side effect of morphine, but decreasing the morphine dose will cause this client's pain to become even worse. Giving an enema is not the first intervention that should be tried by the nurse. Recording bowel movements is helpful for assessment, but does nothing to relieve the client's constipation. you wouldnt want to decrease the dose bc this would increase their pain.
what is an antibiotic sensitivity test?
After obtaining a culture, you isolate the microorganism and test the effects of various antibiotics on that particular organism. Test results are available in 24-72 hours. Antimicrobial therapy should not be started until the microorganism is identified.
The nurse is directing the care of a newly admitted client who is severely hypothermic. What does the nurse advise the rapid response team (RRT) to do first?
Apply electrocardiographic (ECG) monitor leads to monitor cardiac activit
what are the most useful laboratory tests for diagnosing ?
CBC and chemistry panel
what is mitosis? (for growth and tissue production)
Cell division that generates new cells for growth and repair. The division of one cell into two genetically identical daughter cells.
what are the components of cellular regulation?
Cellular growth Cellular replication Cellular differenetiation (specializing a cell due to responses from ECC)
On a hot summer day, an older adult is found by a neighbor lying on the floor, agitated and confused. After calling 911, the neighbor places ice bags on the client's groin area and armpits. Upon arrival at the hospital, which action does the emergency department (ED) nurse perform first?
Check the client's airway and administer high-flow oxygen therapy. The first action made by the ED nurse is to check the client's airway and give high-flow oxygen therapy. Once in a clinical setting, the nurse monitors and supports the client's airway, breathing, and circulatory status. High-concentration oxygen therapy and IV lines with 0.9% saline solution are also indicated.
Moderate sedation:
Conscious sedation that reduces sensory perception but allows a patent airway. It may be the injection of a hypnotic, sedative, or opioid. Amnesia is short and return to normal function and vital is quick. ex: Versed (midazolam), propofol (Diprivan), and morphine. ex: cardiac cath, closed fracture reduction, endoscopy, and wisdom tooth extraction. Patient cannot eat until 30 minutes after last dose of sedation.
Nursing interventions to treat opioid side effects:
Constipation: - Lubiprostone, Amitizal N/V: - zofran dexamethasone - reduce opioid dose - consider switching to another opioid Sedation: - reduce dose to reduce RR depression - stimulants such as caffiene can counterinteract sedation RR depression: - Recognize that snoring is RR obstruction - Proper assessment is not just checking the RR rate but also watching the chest rise and fall. - stop administration if RR depression for significant depression, stay with the patient, continue attempts to arouse the patient, support respirations, and call for code. blue, consider giving naloxone.
what is the drug used to treat malignant hyperthermia?
Dantrolene It can be given prior to or during surgery to prevent its occurrence.
The nurse is caring for a client who had a fractured ankle repaired. Twenty minutes after receiving 1.5 mg of hydromorphone (Dilaudid) IV push, the client is slow to respond and has constricted pupils and a respiratory rate of 6 breaths/min. What action does the nurse take initially?
Gives the client a dose of naloxone (Narcan) 0.4 mg IV Initially, the nurse would give the client a dose of naxalone 0.4 mg IV. For an unresponsive client, the nurse would administer naloxone (Narcan) 0.4 mg (diluted in 10 mL) over a 2-minute time period to reverse the action of the opioid analgesic.T
what are other cancer specific scales?
Gleason score- prostate cancer Bloom-Richardson- breast cancer Fuhrman-kidney cancer
what bacteria can cause cancer?
Hepatitis B and C HPV (oropharyngeal, cervical, and anal) Helio pylori (gastric cancer)
A priority problem of hyperthermia is identified by the long-term-care RN who is caring for a client with a urinary tract infection. Which intervention is most appropriate to delegate to a nursing assistant?
Increase fluid intake by assisting the client to choose approved and preferred beverages.
The nurse is planning care for a patient with hypercalcemia secondary to bone metastasis. Which of the following interventions will be included in the plan of care?
Increasing oral fluids Observation for muscle weakness Serious complications of hypercalcemia include severe muscle weakness, dehydration, loss of deep tendon reflexes, paralytic ileus, and electrocardiographic changes. Early manifestations of hypercalcemia include fatigue, loss of appetite, nausea, vomiting, constipation, and polyuria (increased urine output).
what occurs with malignant hyperthermia?
It affects skeletal muscles. When skeletal muscle are exposed to drugs, there is an increase in calcium in the muscle cells. so, calcium and potassium are increased > leading to acidosis, high temperature, and arrhythmias s/s: tachycardia dysrhytmmias muscle rigidity of jaw and upper chest hypotension tachypnea skin mottling cyanosis myoglobinuria (muscle proteins in urine) The most sensitive indication: -rise in end tidal carbon dioxide -decreased in oxygen saturation -tachycardia. . temperature above 111 is a late sign. It is most common in males because they have more muscle mass.
Upon entering the room, the nurse finds the patient, who has just had a mastectomy, crying. When the nurse asks about her crying, the patient states, "I know I shouldn't cry because this surgery may well save my life." What is the nurse's best response?
It is okay to cry; mourning the loss of your breast is important for getting past this."
Local Anesthesia:
Local anesthesia is delivered topically to the skin or mucous membranes or injected directly into the tissues.
what is the difference between a benign cell and malignant cell?
Malignant cells- have no comparison to original cells benign cells- they mirror the original cell
Both local and regional anesthesia:
Motor function remains intact, patient is conscious and can follow directions. Risk for aspiration is low, and gag reflex is intact. Complications from both: overdose, incorrect route or delivery of medication. Complications of local anesthesia are inflammation and edema. Abscesses may occur in the site of administration and cause rissue necrosis. Systemic toxicity of local agent may induce heart and CNS effects. tx: fast acting barbituate, open airway, adminster oxygen, call HCP
A young black woman who has sickle cell disease (SCD) comes to the emergency department with severe joint and back pain, a cough, a temperature of 102.2F (39C), and shortness of breath. She appears anxious and states "I have never felt this way before." The health care provider prescribes 3 mg of morphine IV and a stat chest X-ray. What additional assessment data are most important to obtain? Provide a rationale for your selection.
Perform a complete respiratory assessment, including rate and depth, pulse oximetry, auscultation of all lung fields, and capnography. This patient has symptoms of acute chest syndrome and, until the problem has been ruled out, must be managed as such. Acute chest syndrome is life-threatening and a common cause of death for patients with SCD.
A patient with breast cancer asks the nurse why 6 weeks of daily radiation treatments is necessary. What is the nurse's best response
Research has shown more cancer cells are killed if the radiation is given in smaller doses over a longer period of time." Because of the varying responses of all the cancer cells within a given tumor, smaller doses of radiation given on a daily basis for a set period of time provides multiple opportunities for the destruction of cancer cells while minimizing damage to normal tissues
how is skin integrity related to thermoregulation?
Skin helps regulate body temperature so when there is impaired skin integrity, thermoregulation is also impaired.
The nurse is teaching a health and wellness class. What will the nurse include in the discussion of common risk factor for impaired cellular regulation?
Smoking Poor nutrition Physical inactivity Over the age of 70 alcohol- NO Risk factors that increase the probability of impaired cellular regulation include smoking, poor nutrition, lack of physical activity, and an age greater than 50. Also, those clients greater than 70 years of age have a significant potential for abnormal cell development.Alcohol intake is not associated with impaired cellular regulation.
what are the stages of induction of anesthesia?
Stage 1: Sedation and relaxation ( ends with LOC) Hearing is exaggerated. Stage 2: Excitement, Delirium (begins with LOC) and end with regular breathing pattern. Before the end of this stage, irregular breathing, laryngospams, and vomiting may occur. Patient is susceptible to external stimuli. May have increased muscle tone and involuntary muscle twitching as well. Stage 3: (operative anesthesia)- begins with generalized mu. relaxation and ends with depressed vitals and loss of reflexes. The patient cannot hear and ability to sense pain is lost. Stage 4: Danger: begins with depression of vitals and ends with RR depression, cardia arrest, and death. Pupils are fixed and dilated and apnea occurs.
What are benign tumors?
cells that are capable of replication but not mestastasis (so they cannot invade adjacent cells).
What is neoadjuvant therapy?
Treatment given before the standard therapy for a particular disease.
what is biologic therapy?
colony stimulating factors gene therapy monoclonal therapy vaccines immmuno agents.
The nurse cares for a client diagnosed with polycythemia. What should the nurse include in the client teaching
The nurse needs to teach the client that pain, redness, and swelling in the calves are symptoms of deep vein thrombosis (DVT). Clients with polycythemia have an excessive amount of red blood cells leading to blood clots and a corresponding increased risk of developing DVTs.Excessive bruising is associated with disorders of decreased clotting or thrombocytopenia. Avoiding crowds or people who are ill is important for those who are immunocompromised but there is no evidence that this client is immunocompromised. Clients with polycythemia can, and may even be advised to, take NSAIDs to diminish the chance of blood clot formation.
how is intracranial regulation related to thermoregulation?
compression of brain structures from cerebral edema can reduce the ability of the brain to respond and control temperature.
What priority intervention will the nurse employ to prevent injury to the patient with bone cancer?
Using a lift sheet when repositioning the patient The resultant bone destruction from bone cancer can cause pathological fractures by grasping or pulling on a patient by the extremities or trunk of the body during re-positioning. Use of a lift sheet evenly distributes the patient's weight, lessening the chance of fractures occurring. While safety risks exist, the priority for bone cancer is reducing risk of fractures.
drug alert for monitoring for after sedation:
assess patients getting epidural local anesthesia for ability to bend knees and lift their butt off of the mattress. ask them to point any areas of numbness or tingling. mild transient lower extremity motor weakness and hypotension may be present. they will need help with ambulation. Promptlyreport inability to bear weight, areas of numbness outside of the surgical site, and severe hypotension to the anethesia provider.
The family of a client who had a successful stem cell transplant for leukemia 3 months ago asks the nurse whether they should obtain influenza vaccinations now. How will the nurse respond?
Yes, obtain the vaccination now to protect your family member from influenza."
what is an example of primary prevention?
dressing in appropriate layers (ex: dress infants warm to prevent hypothermia)
what are example of benign neoplasms?
endometreosis nevi hypertrophic scars
1. The community nurse is educating a client about frostbite prevention. Which factors will the nurse teach that are risk factors for developing frostbite? (Select all that apply.)
a. Dehydration ** b. Smoking history ** c. Previous frostbite ** d. Excessive fatigue ** e. Smoking ** f. Wearing wool socks g. History of diabetes **
2. Which signs and symptoms does the nurse expect to find in clients with any type of anemia? (Select all that apply.)
a. Exercise intolerance b. Fatigue c. Glossitis d. Jaundice e. Leukopenia f. Microcytic red blood cells g. Paresthesias of the hands and feet h. Tachycardia A, B. H exercise intolerance, fatigue, and tahcycardia
Which change in laboratory test results of a client with sickle cell disease who was started on therapy with hydroxyurea 4 weeks ago indicates to the nurse that the therapy is effective?
a. Increased HgbF from 2% to 10% Hydroxyurea stimulate fetal hemoglobin (HgbF) production, which dilutes the amount of HgbS available. Because HgbF does not sickle under low oxygen conditions and because HgbS is reduced, there is less sickling of red blood cells in patients with sickle cell disease. The changes in the levels of HgbA, platelets, and white blood cells are not really significant. The hydroxyurea may lower the white blood cell count, but this can occur even if the drug does not effectively increase the HgbF levels.
1. Which emergency care does the nurse recognize that will be implemented for a client with malignant hyperthermia? Select all that apply.
a. Removal of endotracheal tuben (no) b. Cessation (stopping) of surgery, when possible ** c. Insertion of Foley catheter to monitor urine output ** d. Transfer of client to intensive care unit when stabilized ** e. Assess arterial blood gases (ABGs) for respiratory alkalosis (no) f. Use active cooling techniques, such as a cooling blanket, and ice packs around the axillae and groin ** ANS: B, C, D, F
what are malignant neoplasms?
abnormal cells that multiple and migrate to other areas. Malignant (cancer cells) are able to recruit normal cells to perform their needed functions. neoplastic drugs target these recruited normal cells but not the actual cancer cells themselves.
A child is about to be admitted to the pediatric intensive care unit (PICU) after surgery for removal of a tumor in the hypothalamic region of the brain. The nurse manager should intervene immediately when the child's nurse: A. Places a hypothermia blanket at the bedside. B. Adjusts the bed to the Trendelenburg position. C. Obtains electronic equipment for monitoring the vital signs. D. Secures a pump to administer the ordered intravenous fluids.
adjusts the bed to tredelenbergs bc raising the feet increasing ICP in the brain.
General Anesthesia and balanced anesthesia:
administered by IV and inhalaiton. Uses balanced anesthesia that is easy to control, has minimal physiological disturbance, and is used for high risk patients such as in elders. drug interactions can occur. Complications: sore throat, Malignant hyperthermia, overdose, unrecognized hypoventilation which is an anesthesia induced coma, and intubation complications such as broken teeth, vocal cord trauma.
A nursing technician reports that a client who is receiving IV PCA morphine is very drowsy, unable to complete a sentence without falling asleep, and has a respiratory rate of 10 breaths per minute. What is the nurse's priority action at this time?
arouse the client and place the bed in a 90 position. The client's respiratory rate requires intervention to promote breathing. Elevating the head of the bed helps to expand the chest cavity and allow the lungs more room for expansion. Taking vital signs will not improve breathing. Naloxone is usually given when the respiratory rate is less than 8 breaths per minute.
what structures are created through rapid proliferation?
epithelial cells bone marrow GI tract
why is ionizing radiation bad for you?
because exposure to radon gas increases rick for lung cancer
Temperature for hypothermia
below 36.2
what is fibrinolytic?
breakdown of clots
what is the treatment of choice for severe hypothermia?
extracorpeal rewarming methods such as hemodialysis or cardiopulmonary bypasss.
what clinical indicator will the nurse most likely identify when assessing a patient with pyrexia?
increased pulse
what is a key sign of HACE?
development of ataxia ( defective muscle coordination).
what part of the brain is temperature controlled by?
diencephalon
what are characterisitics of HYPOTHERMIA?
what does it look like: -vasconstriction > eventually leads to vasodilation and gives false sense of warmth. -cyanotic - slow capillary refill - muscle rigidity and shivering (stops at 30C) - poor coordination and sluggishness at 34 C - cognitive effects - dysrhythmmias-coma- and cardiovascular collapse -increased viscosity of blood - metabolism slows and causes reduced perfusion - diminished urinary function Interventions: Mild hypothermia- passive and active rewarming. Passive (internal) rewarming includes warm clothing, dryness, exercise,and warm drinks. Active (external) rewarming is using a heated environment, warm water baths, heated blankets, and heating pads. Monitor heating applications every 15-30 minutes to reduce risk of burn injury. Mild (uncomplicated) hypothermia: drinking warm high carb liquids that do not contain alcohol or caffiene. alcohol causes vasodilation which will increased heat loss and caffiene cause diuresis which will cause dehydration. Severe hypothermia- active rewarming with core warming measures. Core warming should be done slowly to prevent dysrhythmmias and must be monitored. Active warming includes inhaling warm oxygen, gastric lavage with warm fluid. warm IV solutions. When providing core warming, the trunk should be actively warmed before the extremeties to prevent "after drop" which is the continued decrease in core body temperature (caused by the return of cold blood from the periphery to the core). Treatment of choice is cardiopulmonary bypass rewarming (this is the fastest rewarming method). General Hospital care of both moderate and severe hypothermia include: -positioning the patient supine prevents OH caused by cardiovascular instability - maintain ABCS -give drugs slowly and at longer intervals because metabolism can be unpredictable with hypothermia - drugs can accumulate without any signs so monitor for toxicity - consider witholding IV drugs unless it is a vasopressor until core temperature is above 86 - defibrilation attempt is allowed one time and defibrilaiton may not be effective until the core body temperature is 86.
embolus
when a clot becomes dislodged