3710 Final ALL 4 EXAMS COMBINED

varicella

-rash, tiredness, headache, fever -infected blisters, bleeding disorders, pneumonia -spread by air and direct contact

Acute phase of schizophrenia

-second Florid positive and negative symptoms; cognitive symptoms Actually exhibit pos and neg symptoms, sometimes cognitive

traction

-stabilizes and immobilizes fractures until surgery -Skin: (buck's) muscle spasms, alignment -Skeletal: realignment, more complex frx, heavier weights, trapeze bar

coumadin teaching

-started while on heparin bc takes 3 days to become therapeutic -Avoid foods that interfere with therapeutic levels (Chart 36-8) -Be consistent with typical diet, No drastic increases -Fresh frozen plasma -Platelets included -INR to manage coumadin (2-3= therapeutic for a pt on this) Get blood drawn regularly

stabilization phase of schizophrenia

-third Placed in hospital or treatment program, start therapy, stabilizing

rotavirus

-through the mouth -diarrhea, fever, vomiting -severe diarrhea, dehydration

characteristics of sexual abusers of children

often a parent, family member, someone they know If a child knows someone, they trust them. Not easy to tell on the abuser

Transphenoid hypophysectomy

removal of tumor/mass, etc Incision is made in the inner aspect of the upper lip & gingiva A muscle graft is taken from thigh to support area and prevent leakage of CSF-->Bc pituitary is very close to hypothalamus in brain

urolithiasis

renal calculi--> flank pain residual of: calcium salts (phosphate, oxalate), uric acid, struvite (magnesium ammonium phosphate), cystine assessment: renal colic (flank pain), vomiting, obstruction, hematuria

lab values for triglycerides, cholesterol, LDL, HDL (ones munson gave in ppt- do not use book)

tri- <150 chol- <200 LDL- below 100 in healthy person, below 70 in chronic illness HDL- >40

T or F A history of attempts increases the risk of a completed suicide

true

T or F Sexual minority youths are more likely to report suicide ideation

true

T or F children as young as 3yrs have and can be diagnosed with major depressive disorder

true

t or f by 1 month, an infant should be able to lift their head up

true

t or f chronic illness is often associated with major depressive disorder in older adults

true

t or f drug therapy for addison's is lifelong

true

t or f eating disorders are culturally influenced

true

t or f vyvanse can help with binge eating disorders

true

t or f people with OCD rarely need hospitalization

true

t or f panic disorder symptoms can mimic those of a heart attack

true

t or f anxiety is the most basic emotion

true- felt when faced with uncertainty

gross motor 4-6mos

turns from abd to back at 5mos, then back to abd at 6mos, can support much of own weight when pulled to standing, no head lag when pulled to sit

hypothyroidism labs

TSH increased, t3/t4 decreased

highly lethal suicide methods

Guns, hanging, carbon monoxide, staging a car crash

what are some overt statements a pt could make that would indicate suicidal ideation

"I can't take it anymore." "Life isn't worth living anymore." "I wish I were dead." "Everyone would be better off if I died." "Living is useless."

total joint replacement implications

(Table 18-2) & (Chart 18-2) Chart 18-3 dislocation: --do not cross legs --use abductor pillow btwn legs --do not bend hip beyond 90 degrees --avoid sitting in low chairs infection: --drains after surgery venous thromboembolism: --anticoag therapy --SCD's

Herpes interventions (74-2)

*Antivirals* --Acyclovir, famoiclovir, valacyclovir --Course of treatment: primary: 7-10 Recurring 1-5 days, best if started on FIRST day of symptoms *Self-management education* --Education about infection, transmission, recurrence, antivirals, sexual activity --IT DOESN'T GO AWAY! --What causes virus to come back: stressors-Sick, fever, menstruation --Viral shedding- virus sheds and during that time the pt can spread the infection --Abstain from sex while lesions are present- Use condoms if they HAVE herpes at all: you can't see viral shedding --Only report in NEONATES (chart 74-4 and 74-2)

s/s of celiac disease

*Impaired Fat Absorption* -Steatorrhea (excessively large, pale, oily, frothy stools) -Exceedingly foul-smelling stools *Impaired Nutrient Absorption* -Malnutrition/Anorexia -Muscle wasting (especially prominent in legs and buttocks) -Anemia -Abdominal distention *Gluten Crisis* -Diarrhea

nursing management of asthma (iggy chart 30-5)

*Improve airway clearance and gas exchange* *Prevent infections* - Pneumonia vaccine (every 5-10 years) - Seasonal influenza, every year, keep up with new strains, etc *Avoidance of triggers* - Encourage exercise though! *Deep breathing exercises, sitting up* - Tell children to use pin wheels, bubbles, etc. - Let them stay with their parents- reduced anxiety - Dx tests at the bedside are much better for them *Teaching regarding Asthma Action Plan* *Use a spacer when taking meds, especially long acting* *Biggest thing-->HAVE AN ACTION PLAN. KNOW WHAT TO DO DURING AN EXACERBATION* - Don't exercise/play sports during red zone/exacerbation

nutritional therapy for diabetes: carb recommendations

*Include carbohydrates from fruit, vegetables, whole grains, legumes, and low-fat milk is encouraged for good health *Low-carbohydrate diets < 130 g/day are not recommended *Monitoring carbohydrate, whether by carbohydrate counting, exchanges, or experienced-based estimation Meal plans are individualized

risks of cataract surgery

*Infection:* Keep the eye clean and wash hands before touching the eye. Monitor for yellowish to green drainage. Some creamy, crusty drainage expected post op *Bleeding:* The surgeon may ask the patient to stop certain medicines (Coumadin, Aspirin, Plavix, etc.) before surgery. TEST QUESTION???? *Intraocular Pressure:* post operative pain, esp with N/V call MD--> EMERGENT

stages of chronic PAD

*Stage I: Asymptomatic- not aware there is an issue* • No claudication is present. • Bruit or aneurysm may be present. • Pedal pulses are decreased or absent. *Stage II: Claudication* • Muscle pain, cramping, or burning occurs with exercise and is relieved with rest. • Symptoms are reproducible with exercise *Stage III: Rest Pain* Pain while resting commonly awakens the patient at night. • Pain is described as numbness, burning, toothache-type pain. • Pain usually occurs in the distal portion of the extremity (toes, arch, forefoot, or heel), rarely in the calf or the ankle. • Pain is relieved by placing the extremity in a dependent position. Usually when they look for medical attn *Stage IV: Necrosis/Gangrene* • Ulcers and blackened tissue occur on the toes, the forefoot, and the heel. • Distinctive gangrenous odor is present. - Leads to amputations in LE, uppers too nut rare

gonorrhea interventions

*TREATMENT: CEPHTRIAXONE (ROCEPHIN) 180mg IM + AZITHROMYCIN (ZITHROMAX) 1gm PO SINGLE DOSE* --or doxycycline --Give combo bc at risk for co-infection with chlamydia: treat both --Expedited partner therapy no longer recommended (can't have a prescription for IM injection) *education* --Possibility of re-infection --Risk for PID in women --Stop sexual activity until antibiotic therapy is done --Reportable --Notify partners!! --Abstinence until asymptomatic; should be okay after antibiotic therapy --Proper use of condoms --Chlamydia risk

clinical manifestations of TIA's (chart 45-1)

*Visual Deficits* • Blurred vision • Diplopia (double vision) • Blindness in one eye • Tunnel vision *Mobility (Motor) Deficits* • Weakness (facial droop, arm or leg drift, hand grasp) • Ataxia (gait disturbance) *Sensory Perception Deficits* • Numbness (face, hand, arm, or leg) • Vertigo *Speech Deficits* • Aphasia • Dysarthria (slurred speech)

normal LDL

- < 70 - 100mg/dl

examples of carbohydrates

- Grains, such as breads and cereals. • Dried beans (but not red beans??) and soy products. • Starchy vegetables, such as potatoes, peas, carrots, and corn. • Fruit and fruit juices. • Milk and yogurt. • Sweets and snack foods, such as cake, cookies, candy, chips, soft drinks, and fruit drinks. (these are simple carbs!!) -simple carbs: raw sugar, high fructose corn syrup, fruit juice, milk -complex carbs: whole wheat bread, cereal, corn, oats, rice

Tx of UTI (cystitis)

- Septra, Bactrim, Macrodantin, Cipro, Levaquin, Amoxillin -bladder analgesics (pyridium- turns urine orange/red) -antispasmotics for bladder spasms -cranberry juice/tablets at least 4 wks, must take daily -increased water

chronic bronchitis

- part of COPD - Inflammation of bronchi and bronchioles caused by chronic exposure to irritants affects only airways, - Production of large amounts of thick mucus

pre op care for total or subtotal thyroidectomy

-Achieve euthyroid state -Decrease thyroid size & vascularity -Control symptoms Patient teaching: --Head support- incision protection --Exercises- nurse performs manual ROM --Quality of voice- pt will have some hoarseness after surgery. If quality diminishes, notify HCP

post surgical care for cataracts

--Antibiotics: ocular abx (eyedrops) --Eye patch --Dark glasses --Steroid eye drops Normal symptoms? --Mild itching --Creamy colored drainage --Should NOT have pain What indicates complications? --PAIN --Intraocular pressure --Infection --Bleeding

syphilis interventions

--Benzathine penicillin G (monitor for allergic reaction). IM single dose- for ALL stages --ASK ABOUT ALLERGIES- Jarisch-Herxheimer reaction: Pain at injection site, fever, hypotension, body aches. SEEK CARE!! --Follow-up evaluation at 6, 12, 24 months for blood tests, Determining if syphilis has been eradicated --Partner notification and treatment UP TO 3 MONTHS BACK --Reporting to local health authority --May need psychosocial support --Abstinence until asymptomatic --May be passed on to infants

Urolithiasis tx

-Allow to pass spontaneously, strain urine to send to lab -Hydration -Ambulation: May sound painful but helps with movement of stone -Opioid analgesics -Antispasmodics -Antibiotics lithotripsy--> waves that break the stone up --no sedation, maybe just mild to tolerate vibrations --may cause bruising to skin, tell pts this is normal --may cause hematuria stent placement in ureter nephrolithotomy--> when a stone obstructs the kidney --nephrostomy tube --record o/p in bag --ok to have small amt of blood in bag 24-48hrs after insertion medications

Radioactive Iodine Therapy (RAI) for hyperthyroidism

-Given on outpatient basis -PT'S SECTRETIONS ARE RADIOACTIVE -Patient teaching: takes 6-8wks for effect -Oral care for thyroiditis/parotiditis -Radiation precautions for 2-3wks = *Chart 63-4* ---Separate toilet ---Put spills and wipes in plastic bag ---Males should sit to prevent splashing ---Laxative to quickly expel radioactive stool ---Plastic utensils and cups, disposable items ---Use Kleenex, DISPOSABLE ITEMS ---Symptoms of hypothyroidism = big risk!!

foot care for diabetics (chart 64-4)

-Inspect feet daily -Wash the feet in warm water; not hot, using mild soap; do not soak feet -Dry feet after washing, esp. between toes -Do not put lotion or cream in between toes -Cut the nails straight across; see podiatrist -Wear properly fitting shoes (see text) -Never walk barefoot -Don't use heating pads -Elevate feet when possible to increase circulation -Report non-healing breaks in the skin to healthcare provider

myxedema coma- complication of hypothyroidism

-Precipitated by infection, drugs, cold, trauma -must be admitted to ICU COMA: protect airway, neuro status, skin integrity (turn q2), DVT prophylaxis RESPIRATORY FAILURE: may require intubation, aspiration precautions HYPOTENSION: IV NS 0.9% HYPONATREMIA: 3% hypertonic NaCl HYPOTHERMIA: warming blankets HYPOGLYCEMIA: IV glucose

interventions for anaphylaxis

-RESPIRATORY FUNCTION, abc's -establish or stabilize airway -stop causing agent -stay w/ pt -give antihistamines, EPI, oxygen (if pt is hypotensive w/o respiratory probs, put in trendelenburgs -beta adrenergic agonists, corticosteroids, oral steroids

Hib

-air and direct contact -may not be any a/e unless bacteria enter the blood -meningitis, intellectual disability, epiglottis, pneumonia

Diphtheria

-air and direct contact -sore throat, mild fever, weakness, swollen neck glands -swelling of heart muscle, heart failure, coma, paralysis, death

influenza

-air, direct contact -fever, muscle pain, sore throat, cough, extreme fatigue -pneumonia

pneumococcal

-air, direct contact -may be no symptoms, pneumonia -bacteremia, meningitis, death

measles

-air, direct contact -rash, fever, cough, runny nose, pinkeye -encephalitis, pneumonia

rubella

-air, direct contact -rash, fever, swollen lymph nodes -v serious in pregnant women, can lead to miscarriage, still birth, premature delivery, birth defects

pertussis

-air, direct contact -severe cough, runny nose, apnea -pneumonia

mumps

-air, direct contact -swollen salivary glands, fever, headache, tiredness, muscle pain -meningitis, encephalitis, inflammation of testicles or ovaries, deafness

polio

-air, direct contact, through the mouth -may be no symptoms, sore throat, fever, nausea, headache -paralysis, death

drug therapy for hypoparathyroidism

-calcium chloride/calcium gluconate--> cute therapy for tetany, etc --Calcium PO--> long term therapy --calcitriol (Rocaltrol)--> acute vitamin D --Ergocalciferol PO--> long term vitamin D --Magnesium sulfate

hep B

-contact with blood or body fluids -may be no symptoms, fever, headache, weakness, vomiting, jaundice, joint pain -chronic liver infection, liver failure/cancer

DI clinical manifestations

-dehydration--> skin turgor, MM, increased urine output -polyuria -polydipsia -tachycardia -hypotension -tachypnea -restless, irritable -seizures, coma -low specific gravity, urine osmolarity -high PLASMA osmolarity -hemoconcentration -hypernatremia

hep A

-direct contact, contaminated food or water -may be no symptoms, fever, stomach pain, loss of appetite, vomiting, fatigue, jaundice, dark urine -liver failure, arthralgia, kidney, pancreatic and blood disorders

status asthmaticus- medical emergency

-exacerbation symptoms are not under control after a treatment *Hypoventilation leads to:* - Increased CO2 - Decreased ph - Resulting in respiratory acidosis - Can lead to pneumothorax-sudden chest pain and SOB-chest xray-chest tube - Sudden chest PAIN- not tightness- especially to one side...Chest xray to dx - Can be fatal - give O2 to keep sats greater than 90% - inhaled nebulizers and short acting b2 agonists can be given back to back - systemic corticosteroids - epi aerosolized injection may be more beneficial than a neb tx - IV access for fluids and medications - frequent ABGs and electrolyte labs

tetanus

-exposure through cuts in skin -stiffness in neck an abd muscles, difficulty swallowing, muscle spasms, fever -broken bones, breathing difficulty, death

maintenance lithium blood levels

0.4-1.3mEq/L

therapeutic lithium levels

0.6-1.2 mEq/L

examples of foods that equal one serving of carbs

1 slice of bread (1 oz) or 1 six-inch tortilla. 1 cup fresh fruit or one small piece of fruit. 1 cup milk. 1 cup plain fat-free yogurt or yogurt sweetened with artificial sweeteners 1 small fresh fruit ½ of a hamburger bun or English muffin. ½ cup dry cereal, grits. ½ cup hot cereal. ½ cup mashed potatoes ½ cup canned or frozen fruit or fruit juice. ½ cup cooked dried beans or starchy vegetable, such as peas, corn, or potatoes. ½ cup rice or pasta.

five rights of delegation

1) right task- tasks the nurse believes the other health care worker has the knowledge and skill to perform, taking into consideration training, cultural competence, experience and facility/agency policies and procedures. 2) right circumstance- consider the setting, resources, staffing, pt health status, complexity of care 3) right person- competent individual, in their job description 4) right communication- clear, concise, correct, complete, verify AP's comprehension of task 5) right supervision- nurse must still monitor, evaluate, intervene, provide feedback

alcohol recommendations for diabetes

1-2 drinks per day avoiding mixed drinks with carbs One alcoholic drink = 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of distilled spirits *Main danger: Hypoglycemia (especially if taking insulin) because alcohol may decrease the normal physiologic reactions in the body that produce glucose (gluconeogenesis). *Excessive intake may impair the ability to recognize and treat hypoglycemia

malignant htn

>200/150 (medical emergency) Leads to renal failure, stroke, heart failure At risk for target organs (heart and brain) to be impacted major problems Medical emergency lower asap Usually younger males, unaware they have htn Can lead to renal failure, cva!!

normal urine specific gravity

1.005-1.030

toxic lithium blood levels

1.5mEq/L and above

four cardinal features of delirium

1.Acute onset and fluctuating course 2. Reduced ability to direct, focus, shift, and sustain attention 3. Disorganized thinking 4. Disturbance of consciousness

BP for 6 year old

105/65

BP for 10-13 years old

110/65

BP for 14-17 year old

119/75

normal wbc ranges

5000-10,000

infant HR

120-160

1 serving of carbs equals??

15g=4oz=1/2cup

RR adolescents

16-20

opioid withdrawal symptoms

6-8hrs after, profound state of unease, restless, agitated, NVD, **pinpoint pupils**

prevention of pneumonia

>65 years and chronic health problems to receive pneumococcal vaccine every 5 to 10 years & Influenza vaccine seasonally

bipolar spectrum disorder is characterized by..?

2 opposite poles- mania and depression

duration of tonic clonic seizures

2-5mins

RR for children

20-30

what are some characteristics of an inpatient mental health unit setting

24-hour nursing care Locked units (for safety) Crisis care- Suicidal thoughts/attempts Residential treatment programs State acute care systems General hospital psychiatric units Private psychiatric hospital acute care

RR for toddlers

25-32

RR for infants

30-50

RR for newborns

35-40 breaths per min

how long are restraint orders good for?

4 hours for adults

young healthy bone takes how long to heal

4-6wks

BP for newborn

40(mean)

normal ejection fraction

50-70%

what needle length is recommended for giving infants IM vaccines

5/8 in

adolescent HR

60-90

when should solid foods be introduced?

6mos.. iron fortified cereals - one new food per week - veggies first, then fruits and sweets 12 mos- may introduce cows milk

a diabetic pts meal tray contains the following: ½ cup of gumbo with ½ cup of rice 1 cup of sweet tea 1 small roll 1tsp. Margarine 1 bowl of lettuce and cucumber salad 2 tablespoon of Paul Newman's -Balsamic vinaigrette Salad dressing (label reads Total Carb: 33 g; 1 serving= 2 tbsp) how many servings of carbohydrates are in the meal, and how many units of insulin would you administer

7 total servings, 7 units of insulin ½ cup of gumbo with ½ cup of rice- 2 1 cup of sweet tea- 2 1 small roll- 1 1tsp. Margarine 1 bowl of lettuce and cucumber salad 2 tablespoon of Paul Newman's -Balsamic vinaigrette Salad dressing-2

normal HDL

> 40mg/dl

school-age child HR

75-100

preschooler HR

80-110

BP for 1 month old

85/54

toddler HR

90-140

BP for 1 year old

95/65

normal triglycerides

<150 mg/dL

total cholesterol

<200 mg/dL

The unlicensed assistive personnel (UAP) reports to a staff nurse that a client who had surgery 4 hours ago has had a decrease in blood pressure (BP), from 150/80 to 110/70, in the past hour The nurse advises the UAP to check the client's dressing for excess drainage and report the findings to the nurse. Which factor is most important to consider when assessing the legal ramifications of this situation? A. The parameters of the state's or province's nurse practice act. B. The need to complete an adverse occurrence report. C. Hospital protocols regarding the frequency of vital sign assessment every hour postoperatively. D. The healthcare provider's prescription for changing the postoperative dressing.

A

give an example of fidelity

A client asks a nurse to be present when he talks to his mother for the first time in a year. The nurse remains with the client during this interaction.

give an example of veracity

A client states, "You and that other staff member were talking about me, weren't you?" The nurse truthfully replies, "We were discussing ways to help you relate to the other clients in a more positive way."

what is the fundamental goal of psychiatric care?

A fundamental goal of psychiatric care is to strike a balance between the rights of the individual patient and the rights of society at large.

sickle cell anemia

A hereditary trait occurring most commonly in African Americans The production of abnormal hemoglobin S that causes the red blood cells to stiffen and elongate, taking a sickle shape during times of hypoxia.

give an example of beneficence

A nurse helps a newly admitted client who has a psychotic disorder to feel safe in the environment of the mental health facility.

Which patient is appropriate to assign a new RN graduate who just completed orientation? An anxious patient with acute pain who frequently uses the call button A patient on the second postoperative day who needs pain medication before dressing changes A patient with HIV infection who reports headache, abdominal, and chest pain A patient with chronic pain who needs discharge instruction with a new surgically implanted catheter A patient complaining of pain at the site of a peripheral IV line A patient with a kidney stone who needs frequent PRN pain medication

A patient on the second postoperative day who needs pain medication before dressing changes A patient complaining of pain at the site of a peripheral IV line A patient with a kidney stone who needs frequent PRN pain medication

what procedure is done for atherosclerosis/plaques if the plaque is extensive

Arterial Revasculatization (Femoral Popliteal Bypass) (fem pop bypass) -post op care is same as PVI, PLUS infection

status epilepticus

A state of constant seizure or condition when seizures recur in rapid succession without return to consciousness between seizures Time, observe Over 5mins= concern

hyperthyroidism patho

A sustained increase in synthesis and release of thyroid hormones by thyroid gland (T3 and T4) Occurs more often in women Highest frequency between ages 20 to 40 years most common form: grave's disease other: toxic goiter, thyroid hormones

bipolar II

At least 1 hypomanic episode At least 1 major depressive episode More common in females

lab assessment for COPD

ABG values for abnormal oxygenation, ventilation, acid-base status Sputum samples- positive CBC- elevated w/ infection/pneumonia Hemoglobin and hematocrit- elevated in polycythemia Serum electrolytes Chest x-ray Pulmonary function test Forced expiratory volume (FEV) Residual volume (RV) Total lung capacity (TLC) COPD normal PaO2= 80-100 SaO2= 92-100

what are 3 potentially life threatening a/e of all antipsychotic drugs (schizophrenia)

ACh toxicity- Mental status changes; cardiovascular, and GI symptoms Neuroleptic malignant syndrome (NMS)- Reduced consciousness; muscular rigidity; autonomic dysfunction Agranulocytosis- Low WBC; neutropenia

type 1 diabetes mellitus

Absence of insulin secretion from beta cells of pancreas due to destruction of beta cells from pancreas

What is mental health?

According to World Health Organization (WHO) "state of well being in which each individual is able to realize his/her own potential, cope with the normal stresses of life, work productively and make a contribution to the community."

genital herpes

Acute, recurring, incurable viral disease HSV-1, HSV-2 Incubation—2 to 20 days Primary outbreak may be asymptomatic but patient is still infectious Before sores: tingling- prodromal! Dx test: viral culture, PCR Complications: systemic--> encephalitis Neonatal transmission Higher risk for HIV Ask about partners in last 5 weeks Have partners been diagnosed or treated? For what??

neurohormonal HF compensation

Activation of SNS and RAAS Sympathetic nervous system and renin-angiotension Leads to an adverse condition called cardiac remodeling

Unlicensed Assistive Personnel (UAP) can perform which tasks

Activities of daily living (bathing, grooming, dressing, toileting, feeding (without swallowing precautions), positioning bed making intake and output vital signs for stable clients Transfer stable patient

health teaching after cataract surgery

Activities to avoid? Increase IOP: sneezing, coughing, bending over, vomiting, straining, sex, blowing nose, tight collars 47-2 Procedure for eyedrops 47-1

initial assessment of a pt with delirium would include:

Acute onset Sudden reduced clarity of environmental awareness Impaired ability to focus, sustain, or shift attention and fluctuating course Inattention; questions need to be repeated Looking around while you're trying to interview them, cannot focus Distracted by irrelevant stimuli Fluctuating, unpredictable levels of consciousness May be lucid and alert one hour, drowsy and confused the next Sundowning: Disorientation worse at night and early morning

what should we remember when giving new drugs to the elderly

Age alters the metabolism, absorption, and elimination of many medications, and older adults are more sensitive to these effects. In older patients, remember to "start low and go slow."

tricyclic antidepressants for MDD

Amitriptyline

cataracts

An opacity or clouding of the eye's naturally clear lens that affects vision. Loss of peripheral vision Related to aging and common in older adults.

Affective symptoms of schizophrenia

Assessment for depression is crucial May herald impending relapse Increases substance abuse Increases suicide risk Further impairs functioning

dx for PAD

Assessment of posterior tibial pulse - best one, also dorsalis pedis - Pink color, Hair loss, skin atrophy, Cap refill, Skin temp, Ulcers, gangrene on BIG TOE (arterial problem) Doppler studies - checking blood flow to extremities, Not the kind we use to find pulses!!! Different!! Angiogram - Insert dye to see where blood goes- more definitive

Peripheral arterial disease

Atherosclerosis causes blockage that decreases perfusion to the extremities. - ARTERIAL: blood cannot get to the extremities Intermittent claudication(goes away with rest) most common symptom Pain that occurs even while at rest; numbness and burning Pallor, changing color, pulses not palpable

drug therapy for hyperlipidemia: HMG-CoA reductase inhibitors -> Statins

Atorvastatin (Lipitor) Simvastatin (Zocor) Rosuvastatin (Crestor) Pravastatin (Pravachol)

lifestyle changes for GERD

Avoid alcohol, peppermint, licorice, caffeine, high fat foods etc. 4-6 small meals/day, bland Weight loss Avoid tight fitting garments- Waist trainers, skinny jeans Elevate head of bed- Blocks under mattress, fancy new beds, pillows, etc Stop smoking, alcohol Avoid food and drink before bed time: 2-3hrs Infants—thickened feedings, upright position--> *1tsp-1tbsp. of rice cereal for every 1 ounce of formula* Pts must discover what triggers their GERD, all individualized

tx of celiac disease

Avoid foods with gluten High in calories and proteins with simple carbohydrates such as fruits and vegetables but low in fats. Include corn and rice

prevention for recurrences of VTE

Avoid prolonged sitting, crossing legs Elevate legs, active movement, wear hose, and drinking fluids liberally Long term anticoagulant therapy

explain the multi-axial system of the DSMV

Axis 1- top diagnosis, mental disorder, all mental pt have this.. What brought them to the mental health unit 2- any personality or intellectual disorders.. Some pt may have a combination (not every pt will have this) 3- medical conditions, anything that may exacerbate that particular mental disorder (ex: hyperthyroidism and anxiety disorder) 4- any psychosocial stressors (job loss, divorce, death in the family, etc.. Anything out of the ordinary that occurs in the pt's life)`

The role of a psych nurse on an inpatient unit would include which one of the following A) Prescribing meds B) Maintaining a therapeutic milieu C) Analyzing pt behavior D) Providing psychotherapy

B

normal BUN and creatinine

BUN: 10-20 cre: 0.6-1.2

what are some implementations for a child with ADHD

Behavior modification therapy, parent training, and school accommodations Encourage the parents and the school to be patient Pharmacologic agents that address inattention and hyperactive and impulsive behaviors methylphenidate (Ritalin) amphetamine salts (Adderall) atomoxetine (Strattera) Big side effect is insomnia!! Do not let child take after 4pm, take with food Educate parents on all of this!!

dependent PD

Belief in inability to survive if left alone Excess need to be taken care of Solicit caretaking through clinging and submission Perversely, excessively submissive Intense fear of separation and being alone Tolerant of poor, even abusive relationships If relationship does end, the individual has an urgent need to get into another Inability to make decisions without excessive reassurance EXTREME dependence on s/o Will not really see in hospital

upper GI bleeds

Black stools almost always indicate the presence of digested blood Unless the bleeding profuse, maroon or bright red blood may be noted in the stools

diagnostics for dka

Blood glucose usually > 250 mg/dl Positive ketones in serum and urine Sodium and potassium may be low, normal, or high- Depends on the amount of dehydration Abnormal ABG's

PVI (PVD)

Blood pools in the lower extremity a valvular damage has occurred Fluid leaves the blood vessel Causing edema and the skin to become shiny and hard Color- reddish/brown to mottled/purple to very dark Deoxygenated cells die causing release of inflammatory chemicals - Skin appears reddish brown, discoloration to lower legs and ankles - Stasis ulcers - Edema

infection--> complication of frx

Bone pain worsens with movement Fever Erythema Warmth Edema Purulent drainage *Non-healing wound* wound culture WBC, ESR *osteomyelitis*- infection of bone --first indication= failure to heal in a specific are --confirmed by MRI, CT, xray, bone biopsy, scan

asthma

Chronic inflammatory disorder of the airways- REVERSIBLE - Caused by a medication, disease process, other triggers, etc - Asprins, nsaids = allergic asthma - Children w/ gerd - Exercise induced- don't tell them to stop, just tell them to use a SABA right before - Smoking/fires *CHART 30-5* *Limited air flow or obstruction that reverses spontaneously or with treatment*

Which individual may need involuntary hospitalization A) A person with alcoholism who has been sober but began drinking 6 mos ago B) A person with schizophrenia who stops taking antipsychotics C) A person with bipolar disorder, manic phase, who has not eaten in 4 days D) Person who repeatedly phones a national tv service with news tips

C

nursing assessment of pt w/ osteoarthritis

Chronic joint pain and stiffness Pain will increase with use and be relieved with rest as disease progresses. Pain after inactivity Enlarged joint May get nodules or nodes* and have crepitus with movement Patient may limp and restrict walking distances Elevated ESR and C-reactive protein MRI

give an example of justice

During a treatment team meeting, a nurse leads a discussion regarding whether or not two clients who broke the same facility rule were treated equally.

emergency care of pts w/ extremity fracture

CHART 51-4 you know what to do but in a much more real sense you have no idea what to do just assess every 1hr for 24hrs they be ok

diagnostics for stroke

CT scan without contrast MRI EKG Prothrombin time (PT) International normalized ratio (INR) Partial thromboplastin time (PTT) CBC (Complete Blood Count - include Platelet Count) Fasting Blood Glucose and Lipid Panel

diagnostics for TIA

CT of the Head- 1st dx MRI of the Brain Carotid Ultrasonography for occlusions, definitive Echocardiogram Auscultation of Bruit Find the source!!

VTE assessment

Calf or groin tenderness or pain Sudden onset of unilateral swelling of leg Checking Homans' sign not advised Localized edema Redness and hot, not warm Venous duplex ultrasonography

what does the orientation phase of peplau's model of the nurse-pt relationship consist of

Establishing rapport Parameters of the relationship Formal or informal contract Confidentiality Terms of termination

the psychosocial assessment helps obtain what information

Central or chief complaint (in patient's own words) History of violent, suicidal, and self-mutilating behaviors Alcohol and/or substance abuse Family psychiatric history Personal psychiatric treatment, including medications and complementary therapies Stressors and coping methods Quality of activities of daily living (ADLs) Personal background- work? School? Social background, including a support system-Family? Friends? Weaknesses, strengths, and goals for treatment Racial, ethnic, and cultural beliefs and practices Spiritual beliefs or religious practices

croup syndrome is characterized by...?

Characterized by hoarseness, barking cough, inspiratory stridor, and varying degrees of respiratory distress from swelling or obstruction the larynx, trachea, and bronchi

clinical manifestations of bradycardia

Chest pain Weakness Cyanosis Dizziness, confusion, syncope Shortness of breath Pale cool skin, diaphoresis Hypotension can indicate decreased perfusion and oxygenation

common, NORMAL a/e of vaccines

Chills, fever, muscle aches and pains, rash- NORMAL (if mild) Drowsiness, prolonged or unusual crying, not feeding/eating- NORMAL Pain & tenderness at the injection site- NORMAL Palpable lump with tetanus injection (resolves in days to months)

reportable STIs

Chlamydia Gonorrhea Syphilis Herpes simplex virus - neonates only HIV

SSRIs used for MDD

Citalopram (Celexa) Escitalopram (Lexapro) Fluoxetine (Prozac) Paroxetine (Paxil) Sertraline (Zoloft)

what kind of things will you look at when assessing speech during the MSE

Clear, mumbling, understandable, volume, emphasis on words, rate, fluency and rhythm

antianxiety drugs for bipolar disorder

Clonazepam (Klonopin) Lorazepam (Ativan) Atypical antipsychotics Olanzapine (Zyprexa) Risperidone (Risperdal)

LPN's can perform which tasks

Complete an ongoing assessment Reinforcement of client teaching from a standard care plan Administer tube feeding Maintain a NG tube for patency Inserting a urinary catheter Administer medication except IV push medications and chemotherapy Cannot maintain central lines or implanted devices (i.e. mediports, Hickman etc) Perform wound care

cognitive symptoms of schizophrenia

Concrete thinking Impaired memory Impaired information processing Impaired executive functioning

what is epilepsy

Condition in which a person has spontaneously recurring seizures caused by underlying chronic condition Metabolic, idiopathic

macrovascular changes in diabetes

Coronary heart disease Cerebrovascular disease Peripheral vascular disease

potassium iodine (SSKI) and lugol's solution hyperthyroidism

DECREASES t3&4, but also vascularity of thyroid gland--Good before surgery bc decreased bleeding risk Administration: Short term, PTU in addition to this Toxic effects

diabetic ketoacidosis (DKA)

Deficiency of insulin that leads to hyperglycemia, ketosis, acidosis, dehydration and electrolyte imbalances Risk factors: stress, illness, infection, inadequate insulin dosage, poor management, undiagnosed

four defense behaviors of alzheimers

Denial (cover up) Confabulation (making up answers in unconscious attempt to maintain self-esteem) Perseveration (repetition of phrases or behavior) Avoidance of questions

Alcohol intoxication criteria/blood level

Depends on body weight/height, amount- the more drinks, the higher the BAC, intoxicated= 0.08-0.1, 4 drinks

volkmann's contracture

Develops from increased pressure causing shortening of the ischemic muscle and from nerve involvement--> permanent

management of gout

Diet - Limit purine foods (organ meats, shellfish, sardines; red meats) Avoid aspirin and diuretics Weight loss High fluid intake to help w/ excretion Alcohol may precipitate an attack Medications --Allopurinol - continues removes uric acid (chronic gout). Take everyday --NSAIDS (Acute gout), inflammation, GI symptoms--Ketorlac? --Colchicine—pain attack (acute gout)

Tx of pernicious anemia

Diet of animal protein, milk, eggs, dairy products Oral supplements Vitamin B12 IM if intrinsic factor problem Vegans can use fortified soy milk

teachings for iron supplements

Dilute liquid preparations of iron and drink with straw Take between meals/ 30 minutes before or 2 hours after Avoid antacid with iron Drink orange juice or other vitamin C Expect stool to dark green or black Call MD for constipation or diarrhea teeth staining

what should you avoid when dealing w/ pts with personality disorders

Discussing yourself or other staff members with patient Promising to keep a secret Accepting gifts from patient Doing special favors for patient

teaching points for pts w/ a cast

Do not scratch or stick anything under the cast Cushion rough edges Report the following signs and symptoms: persistent pain or swelling; changes in sensation, movement, skin color, or temperature; and signs of infection or pressure areas Required follow-up care Cast removal

pt teaching for sickle cell

Drink liberal amounts of fluids Dress warmly in cold temperatures Avoid vigorous physical exercise Avoid clothes that cause vasoconstriction Stop smoking or other use of nicotine Obtain flu and pneumonia vaccines Seek MD with first sign of infection Seek genetic counseling for getting pregnant

nursing implementations for substance abuse

Drug-free environment Atmosphere- calm, decrease stimuli. Make sure treatment team maintains consistency, all on same page Focus on feelings- all abt the patient, unless theyre psychotic, then talk them down Dealing with manipulative behavior- let pt know what is acceptable and what is not acceptable, and the consequences Acceptance- don't judge a pt, but control their behavior Nutritional support- important, restore electrolytes, vitamins, protein, etc. banana bag IV

SNRIs used for MDD

Duloxetine (Cymbalta) Venlafaxine (Effexor)

causes of sinus arrhythmia

During inspiration negative intrathoracic pressure causes more blood to enter the right atrium. The heart rate increases slightly to compensate. During expiration intrathoracic pressure is positive. Flow of blood through the heart is normal and the heart rate slows down. In sinus arrhythmia heart rate increases and decreases slightly with respiration in a cyclic pattern.

s/s of peptic ulcer disease

Dyspesia Fullness or hunger Nausea/vomiting Bleeding

main dx test for seizures

EEG, CT, MRI

nonpharmacologic treatments for MDD

Electroconvulsive therapy (ECT) Transcranial magnetic stimulation Vagus nerve stimulation Deep brain stimulation Light therapy St. John's wort Exercise

Non-pharmacologic treatments for bipolar disorder

Electroconvulsive therapy (ECT)- specifically the depression Teamwork and safety Support groups Health teaching and health promotion

interventions for a pt in hypovolemic shock

Ensure a patent airway. • Insert an IV catheter or maintain an established catheter. • Administer oxygen. • Elevate the patient's feet, keeping his or her head flat or elevated to no more than a 30-degree angle. • Examine the patient for overt bleeding. • If overt bleeding is present, apply direct pressure to the site. • Administer drugs as prescribed. • Increase the rate of IV fluid delivery. • Do not leave the patient.

how often should you assess your pt with restraints

Every 15 minute documentation of provision for hydration, nutrition, elimination, skin care, and mental status Patient must be released when threat of danger no longer present

general pt teaching for TB

Everyone in the home has been exposed will need a TB skin test completed Use tissue to cover mouth and nose when sneezing or coughing, dispose of in plastic bags Wear mask when in contact with others Sputum specimens will be needed every 2-4 weeks Hospitalized patient is in airborne isolation N95 mask

thyroid storm

Excessive amounts hormones released Thyroidectomy patients at risk Increased risk for shock, cardiac arrest S/S: tachycardia (IV propranolol), increased systolic BP, fever TX: AIRWAY--> IV PTU, Sodium iodide Glucocorticoids IV Cooling blanket for fever Monitor vitals q30min

compulsive hoarding

Excessive collection of items considered worthless Cant get into their house

sprains (TABLE 51-3)

Excessive stretching of the ligaments usually from sudden twisting motion.

active TB

Exposed developed disease immediately or latent TB disease became active because of weakened immune disease can spread to others Symptoms Showing actual signs

latent TB

Exposed, but no symptoms, not active disease No symptoms No transmission Treatment, must be compliant to adhere to month long prescriptions Can become active later on when your body is weak if not treated

what kind of things will you look at when assessing behavior during the MSE

Eye contact, excessive body movements, agitation, restlessness

warning signs of stroke

F- face: facial drooping, uneven smile A-arms: weakness, unable to lift S- speech: difficulty, slurred, understandable T- time: go to hospital immediately others: Sudden-> Numbness or Weakness. Confusion or trouble speaking or understanding. Trouble seeing in one or both eyes. difficulty walking, dizziness, loss of balance or coordination. Severe headache with no known cause and vomiting

T or F oxygen is always your first line treatment for pts with an asthma exacerbation

FALSE- drug therpy 1st, o2 wont help them if the airway is closed

crucial factors for adequate development in children/infants

Factors: nutrition, talking to the child, reading to them, letting them listen to music-very impacted by the environment If there is something wrong with relationship btwn mom and baby, can effect development Tummy time!! When they are awake, let them play and explore environment-CRUCIAL to development Prenatal education!!

avoidant PD

Feelings of low self-worth Hypersensitive to criticism or rejection Avoid situations requiring socialization; withdrawal Fearful of disappointment or ridicule Inhibited, reluctant to express irritation or anger, even when justified Social phobia Wont really see in hospital unless they become depressed

systemic signs of cystitis (UROSEPSIS)

Fever Chills Nausea or vomiting Malaise Flank pain

Acute Epiglottitis

Fever up to 104 Stridor, Rapid breathing, Accessory muscle involvement Sitting forward; Not wanting to lie down; tripod position Tongue protruding, Drooling, Sore throat -painful -poor feeding- problems swallowing Bacterial infection Acute medical emergency!! Nurse- Do not be aggressive, will usually intubate just in case, then get labs, etc.

what are some methods to help prioritize tasks

First Level is airway, breathing, cardiac status/circulation, vital signs (including acute pain) Second level is concerns of mental status changes, untreated medical issues, elimination, abnormal labs, risk factors Third level is long term issues, rest, coping, and health education

to be diagnosed with MDD, you must experience...?

Five (or more) of the following in 2-week period PLUS—at least one symptom is also either Depressed mood or Loss of interest or pleasure (anhedonia) Lost ability to concentrate Cant focus at school or work bc so overwhelmed

Schizoid Personality Disorder

Flat affect, appearing indifferent to both praise and criticism Unable to establish relationships Restricted range of interpersonal emotions Invest little energy in human relationships; conversely, may invest enormous energy in nonhuman interests (e.g., mathematics, astronomy, etc.); often connect more with animals Often creative, original thinkers Do everything they can to NOT interact w/ individuals Guidelines for Nursing Care: Avoid being too "nice" or "friendly" Do not try to increase socialization Assess for symptoms the patient is reluctant to discuss Protect against group's ridicule Treatment: Psychotherapy Group therapy- but do not force them Antidepressants

interventions for a child with PTSD

Focuses on improving relationships and connections to others- Happens initially with nurse. First step is establishing trust and safety The nurse-patient relationship provides a foundation of connection and caring- The nurse can help the child express their feelings through play, art, drawing, sometimes very vividly

s/s of benign prostatic hyperplasia

Frequency Urgency Nocturia: getting up multiple times at night to void Hesitancy in starting urination, also dribbling Decrease in force and volume--Some men find it easier to sit down than stand up Urinary retention

broad spectrum drugs for seizures

Gabapentin (Neurontin) Lamotrigine (Lamictal) Topiramate (Topamax) Levetiracetam (Keppra)-newer

Dx of H. pylori

Gastroscopy--> best test --Biopsy --More risk bc sedative, bleeding Urea breath test--> best test --Pt will exhale into container w/ carbon --If breath breaks down carbon= positive for h. pylori Blood test Stool May not treat bacteria bc a/e may not be worth it, especially in elderly

what sudden behavioral changes could indicate a pt is contemplating suicide

Giving away prized possessions Writing farewell notes Making out a will Putting personal affairs in order Failing to sleep or fall asleep for more than one night in a row (global insomnia) Exhibiting sudden or unexpected improvement in mood after being depressed and withdrawn Neglecting personal hygiene

diabetic nephropathy

Glomerular deterioration Early sign= albumin excretion Medical Management -Control blood glucose levels, hypertension- ACE inhibitor --If pt has a rxn that causes angioedema, with give ARBs instead -Read abt nephrotoxic drugs in textbook -Drug therapy; avoid nephrotoxic drugs, contrast dye, low protein (know foods high in protein and sodium) and sodium reduction; smoking cessation

Narcissistic Personality Disorder

Grandiose sense of personal achievement Haughty sense of entitlement Lack of empathy; exploiting others to meet own needs Increasing attention seeking over time Envious of others Use of splitting, tantrums Can be sadistic, with paranoid tendencies Guidelines for Nursing Care: Remain neutral. Avoid power struggles or becoming defensive. Role model empathy. Treatment: Difficult to treat: patients not likely to seek help or confront shortcomings Cognitive-behavioral therapy (CBT) to deconstruct faulty thinking Group therapy; lithium for mood swings

what kind of things will you look at while assessing appearance during the MSE

Grooming, hair, clothing, hygiene, odor, posture, gait, matching clothes, makeup, just look and describe what you see

Growth vs. Development

Growth encompasses the physical changes across a person's life span. Development: A progressive and continuous process of change from a simple to a higher or more complex level

drug therapy for atherosclerosis

HMG CoA reductase inhibitors Atorvastatin (Lipitor) Simvastatin (Zocor) Rosuvastation (Crestor) Pravastation (Pravachol) --get baseline liver fx before starting-- d/c if muscle cramps or increase AST/ALT no grapefruit

plaster of paris cast material

Heavy, not water resistant, up to 24-48 hours to dry Feels hot immediately at application then cool and damp Cheaper More disadvantages than advantages Do not use fingertips to mold, use palm of had Set on pillow, not a hard surface

physical assessment for PAD

Hair loss and dry, scaly, pale or mottled skin, thickened toenails Severe arterial disease Extremity is cold and gray-blue or darkened Pallor may occur with extremity elevation Dependent rubor Muscle atrophy

Trichotillomania disorder

Hair pulling- gives the person a sense of relief

what 4 questions should you ask before delegating a task

Has the LPN/UNP received training and has the validation of competency in performing task been documented? Does the agency or nursing employer have written policies and procedures in place for this task? Is the task within the RN's scope of practice? Does the delegation of this task meet the requirements of the administrative rules on delegation?

pt goals for diabetes

HbA1c levels are maintained at 6.5% or below. The majority of premeal (preprandial) blood glucose levels are 70 to 130 mg/dL Peak after-meal (postprandial) blood glucose levels are less than 180 mg/dL

seasonal influenza

Headache, muscle aches, high fever, chills, fatigue and weakness Swab to dx Vaccination Rapid Test Tamiflu- antiviral, just slows down progression, does not actually treat fluid intake, rest, droplet precautions Daycare, hospitals, etc. COPD, asthma, weakened immune system

diabetes diagnostic studies

Hemoglobin A1C level: 6.5% or higher Fasting plasma glucose level: higher than 126 mg/dL Glucose tolerance test-pregnancy 24-28 weeks Classic symptoms of hyperglycemia with random plasma glucose level of 200 mg/dL or higher

TURP complications

Hemorrhage Clots Bladder spasms Infection Urinary incontinence

recommended vaccines

Hepatitis A and hepatitis B Diphtheria, tetanus, pertussis (DTP) Polio (IPV) Rotovirus Measles, mumps, rubella (MMR) Varicella Haemophilus influenzae type B (HIB) Pneumococcal (PCV7) Influenza (annually)

prevention of croup syndrome requires which vaccine

Hib

gastric ulcers (PUD)

High left epigastric/upper abdominal burning/gnawing pain increased 30-mins-1 hour pc meals

EKG paper

Horizontal blocks - Each small block is counted as 0.04 seconds of time. Each 5 small blocks is bordered by a bold line creating a large square. How many seconds is every large square?_________. Vertical blocks - Each small block on the vertical equals 0.1 mv in amplitude. Used to measure ST segment for elevation and depression

personality

How we perceive and interact with the world. Personality traits: Stylistic peculiarities that all people bring to social relationships

neonatal effects of gestational diabetes

Hypoglycemia Hypocalcemia Hyperbilirubinemia Respiratory distress syndrome

surgical management of hypercortisolism

Hypophysectomy Adrenalectomy

Types of Hemorrhagic Stroke

ICH - (Intracerebral hemorrhage) and SAH -(Subarachnoid hemorrhage) (Ex. Aneurysm and AVM - Arteriovenous malformation)

heparin induced thrombocytopenia

If platelets drop 50% or more- sign of HIT!! Notify dr and stop drip Get baseline platelets before starting May see bleeding, bruising

Live vaccines are contraindicated in

Immunosuppressed Pregnant Children younger than 6 months Long term steroid use Asthma (nasal spray avoided)

addison's patho/causes

Impaired secretion of aldosterone & cortisol Causes- atrophy of adrenal glands; surgical removal; infection; tuberculosis; Sudden cessation of corticosteroids Body stops making after a while-->takes over adrenal function Sudden cessation-->no more adrenal gland secretion

empathy vs sympathy

In empathy, we understand the feelings of others- Acknowledging their feelings In sympathy, we feel the feelings of others; objectivity is lost. "I'm sharing in those feelings"

failure to thrive

Inadequate growth resulting from the inability to obtain or use calories required for growth. -Infant in 5th percentile or below or with persistent weight loss -Whether its from a disease process, lack of education, abuse, lack of access, etc, anything

most severe symptoms of OCD include

Include frequent thoughts of sexuality (leading to rape), violence, illness, and death

how to treat normal a/e of vaccines

Increase fluid intake, rest Acetaminophen administer 45 minutes prior to vaccines and age appropriate dosages and intervals thereafter Warm or cool compress on site Should not have symptoms longer than 24hrs

hyperparathyroidism patho/causes

Increased levels of parathyroid hormone (PTH)= Hypercalcemia, Hypophosphatemia Causes --Parathyroid tumor --Neck trauma/radiation --Vitamin D deficiency --Chronic kidney disease

glaucoma

Increased ocular pressure Cupping and atrophy of optic disc Symptoms? Types: Primary open-angle glaucoma and Angle-closure glaucoma

hypersensitivity rxn type 1

Increased/excessive response to presence of antigen exposure Body overreacts to a foreign substance-->mast cells react-->release histamine-->allergic manifestations

nursing DX for pt with MDD

Individuals with depression are always evaluated for the risk of suicide. Risk for suicide—safety is always the highest priority Hopelessness Ineffective coping Social isolation Spiritual distress Self-care deficit

signs of dehydration and how to monitor

Infant- depressed fontanels No tears when crying Observe frequency of voiding Counting the number of wet diapers - 6 diapers/24 hours-make sure you weight them in the hospital! Compare dry diaper with weight of wet Output amount= 1 ml/kg/hr for weight of 30 kg 30 ml per hour for >30kg Weigh at hospital

characteristics of the physically abused abused child

Infants and young children at a higher risk- they cant defend themselves Children with disabilities, special needs

STI

Infectious diseases spread through sexual contact with the penis, vagina, anus, mouth, sexual fluids of an infected person Mucosal tissues in genitals, rectum, and mouth are especially susceptible Can also be spread through --Skin-to-skin (HPV) --Via blood or blood products (HIV or mother to baby) --Autoinoculation (spread through touch of infection)-From one part of body to another

iron deficiency anemia

Insufficient iron to produce hemoglobin blood loss- menstrual cycle, gastrointestinal Insufficient Dietary intake malabsorption of iron (small intestines) Chronic alcoholism Pregnancy

type 2 diabetes

Insulin receptor sites are resistant Decreased beta-cell secretion

nursing interventions for DI

Intake & output: Take accurate I/O- DELEGATION OK Fluid status: Adequate hydration, fluid intake (PO, IV if severe). Intake should match output, will differ for each pt. Patient teaching: Understand HOW to take drug, intranasal at home, a/e of drug--> MAY NOT skip it, stop taking it Be consistent- lifelong therapy

androgens

Involved in growth and development, sexual activity

binge eating disorder

Is a variant of compulsive overeating. Is an eating pattern that resembles that of obesity. Recurrent episodes of thinking about and eating large amount of food occur in a short period. Feelings of disgust, depression, and guilt are expressed after bingeing. -symptom of depression outcomes- table 18.6

agoraphobia

Is an intense and excessive level of anxiety and a fear of being in places and situations from which escape is impossible.

social anxiety disorder

Is severe anxiety provoked by exposure to a social or performance situation. Fear of saying something foolish Fear of public speaking is the most common.

MAOIs for MDD

Isocarboxazid (Marplan)

Physician Emergency Certificate (PEC)

Issued after initial exam by any physician, psychologist or mental health nurse practitioner. Detained for 72 hours until second exam by the Coroner

contraindications for vaccine administration

Known severe allergic reaction, such as anaphylaxis- Find out exactly what the rxn was Moderate or severe febrile illness Immunocompromised child or household member should NOT receive live vaccinations- HIV/AIDS, meds that are immunosuppressant. DO NOT GIVE A LIVE VACCINE Recently acquired passive immunity (blood transfusion, immunoglobulin, or maternal) Known allergic response such as eggs, yeast Certain vaccines with pregnancy (i.e. MMR) Long term history of asthma, etc

what lab values should be checked when assessing a pt for a stroke/after a stroke

LDL HDL triglycerides cholesterol glucose levels CBC cardiac enzymes PT, INR, PTT

duration of atonic (drop attack) seizures

LOC for 15 seconds

hypoparathyroidism

Lack of PTH secretion or effectiveness of PTH on target tissue--> hypocalcemia, Hypomagnesemia, hyperphospatemia Iatrogenic - removal of parathyroid tissue Idiopathic - occurs spontaneously; autoimmune

nursing actions after infant death from SIDS

Let them hold the baby, give them time with the baby--do not investigate abuse, etc quite yet Read book about grieving portion of this

Acute Adrenal Insufficiency/Addisonian Crisis

Life-threatening event; need for cortisol and aldosterone is greater than available supply Usually occurs in response to stressful event Emergency Care (Chart 62-6) How do you know it's working/ not working?? idc if u think u know it already go look at the damn chart

anaphylaxis

Life-threatening type I hypersensitivity reaction Rapid, systemic medical emergency Blood vessel dilation Decreased cardiac output Bronchoconstriction Blood pressure drops-->shock oxygen- HYPOXIA can be fatal

fiberglass cast material

Light, can be water resistant, dries in minutes Easy care Preferred

Contact Dermatitis

Localized inflammation on the skin from an irritant or allergen- Cosmetic, perfume, Hair products, Nickel Avoid irritant if known, stop itching. Children may need socks on hands, etc to prevent scratching and irritation Steriod therapy to reduce inflammation-no cure Antihistamines Comfort measures

bundle of his

Located in the upper portion of the interventricular septum. Intrinsic rate of 40 to 60 beats per minute. Conducts electrical impulse to the right and left bundle branches. Right bundle branch: Sends impulse down to the right ventricular myocardium. Left bundle branch: Separates into the right and left fascicles which transmit the impulse to the endocardium.

emergency management for status epilepticus

Lorazepam (Ativan); diazepam (Valium)- priority drugs!! Administer first!! Stops motor activity, As often as every 2mins, up to 4mg Phenytoin (Dilantin) or fosphenytoin (Cerebyx) IV Make sure this is ordered PRN!! Should be given IV, loading dose Phenytoin= pt should be on heart monitor Fosphenytoin is safer

heart failure

Loss or dysfunction of cardiac muscle Inability of ventricle to fill or eject blood Heart muscle is unable to pump adequately Blood supply not enough to meet metabolic needs Left sided- Systolic ventricular or Diastolic heart failure Right sided

Acute Laryngotracheobronchitis

Low grade fever Stridor- in severe cases from narrowing of airways- scares parents Brassy cough, hoarseness- scares parents Nasal flaring, intercostal retractions, tachypnea After upper respiratory rhinitis Viral, can be treated at home

communication guidelines for schizophrenia focus on

Lowering the patient's anxiety Decreasing defensive patterns Encouraging participation in therapeutic and social events Raising feelings of self-worth Increasing medication compliance

perforation- complication of PUD

Main concern--> PERITONITIS (erosion into peritoneal cavity) --sudden, severe abd pain --rigid, board like abd --tender to palpation --fetal position --absent/decreased bowel sounds pt will need emergency surgery, NG tube post op give fluids, antibiotics, NPO status

nursing management of acute stroke

Maintain airway and adequate ventilation- ABC's Monitor vitals, neuro checks, and observe for signs of ↑ ICP Maintain fluid & electrolyte balance and ensure adequate nutrition Tissue perfusion Assess hypoglycemia and hyperglycemia Establish a means of communication Administer medications as ordered Protect the skin

what does the working phase of peplau's model of the nurse-pt relationship consist of

Maintain relationship Gather further data Promote patient's problem-solving skills, self-esteem, use of language Facilitate behavioral change Overcome resistant behaviors Evaluate problems and goals (redefine them as necessary) Promote practice and expression of alternative adaptive behaviors

info/pt teaching for phenytoin (dilantin)

Maintain therapeutic level 10-20mcg/mL Lab draws regularly! Stress importance to pt Takes a few weeks to see effect Do not abruptly withdraw Take everyday, be consistent If a dose is missing, CONTACT provider Good dental hygiene- Gingival hyperplasia

implementation for abuse

Mandatory reporting- older adult and child abuse Interview in private area Assure safety- do not include perpetrator, inform pt that there are safe places, shelters, etc, even the hospital Encourage to discuss event Allow patient to make own decisions Provide resource information

dx assessment of TB

Manifestation of signs/symptoms Sputum smear for acid-fast bacillus Sputum culture of M. tuberculosis Tuberculin (Mantoux) test—PPD given intradermally in forearm - Induration of 10 mm or greater diameter = positive for exposure 48-72 hours after - Elderly and immunocompromised is 5 mm - Screening - If already exposed and known, do blood work instead QuantiFERON-TB Chest X-ray- shows lesions

lower GI bleeds

Maroon or bright red usually from lower tract or if the bleeding from the upper GI tract is profuse

implementation for stabilization and maintenance phases of schizophrenia

Medication administration/adherence Relationships with trusted care providers Community-based therapeutic services Teamwork and safety Activities and groups

gonorrhea

Men - urethra Women - cervix Can also get infection in rectum and oropharynx YELLOW-GREEN DRAINAGE, MALODOROUS Complications: *MEN:* epididymitis, urethra stricture, prostatitis, sterility, may become systemic - may have symptoms in mouth - EARLY ID IS KEYYYYYYYYYYY *WOMEN:* PID, ectopic pregnancy, infertile *report to LDH*

post op care for total or subtotal thyroidectomy

Monitor for complications -Airway closure form swelling, trachea compression -Assess swelling -Trach kit in room!! -Hemorrhaging during 1st 24hrs -HYPOCALCEMIA bc of parathyroid--Calcium IV -Proper positioning

pin site care

Monitor for signs of inflammation or infection Clear fluid drainage or weeping is common up to 72 hours Concern when drainage changes Follow agency policy NS, betadine, q-tips

tx of sinus tachycardia

Monitor heart rate and blood pressure Monitor oxygen saturation Monitor for cardiac dysrhythmias Maintain calm environment Maintain bed rest Avoid caffeine, alcohol, nicotine Medications beta blockers, digitalis can cause slowing of the heart rate... remember a/e

COPD interventions

Monitor respiratory status Q2 hours and prn Oxygen to keep O2 sats 88% or higher BIPAP (Non-invasive ventilation) - Helps reduce amount of CO2 that pt is retaining/has - Some pts may have to sleep with this every night Breathing techniques (Chart 30-10) - AND coughing techniques!! Flutter valve - Replaces chest physiotherapy, helps shake up mucus, get it moving Positioning- make sure they have enough lung expansion - Sitting up in a chair, high fowlers Coughing Nutrition

characteristics of the sexually abused child

Most common: oldest daughter, then moves to next sibling May become attached to abuser Starts slow, perp attempts to gain child's trust Kids are fearful of telling, feel like its their fault

bipolar I

Most severe form Highest mortality rate of the three At least 1 manic episode More common in males

what are some things that put a child at risk for failure to thrive

Nonorganic (Disturbed parent-child interactions, poverty) Organic (preterm birth, GERD, down syndrome) ASK: what are they eating? How much? Are they interested? How are you diluting the formula? What age was the baby born? Preterm?

teaching family how to monitor for respiratory depression

Tachycardia Tachypnea that decreases Substernal and intercostal retractions Flaring Nares Increased restlessness—hypoxia Cyanosis Severe stridor Symptoms increase at night No antibiotics for tx bc viral origin

opioid use disorder treatment

Narcan (IV, IM, SQ, nasal) (3-5mins to work)- stops opioid from binding to receptors in brain, reverses effects. OD=emergency If not working: give another dose (some pt may develop withdrawal symptoms) If working: improved respirations, regain consciousness, dilated/reactive pupils

Treatment for Severe Stridor for both LTB or epiglottitis is:

Nebulizer treatment with racemic epinephrine- very short lived, causes vasoconstriction= decrease in swelling Can usually go home after couple hours observation and EPI Epi/nebulizers can be given abt every hour, ordered by dr - Remember to only to dx studies AFTER pt is intubated/airway is stabilized

fetal effects of gestational diabetes

Neural tube defects Cardiac defects Caudal regression syndrome Macrosomia Preterm delivery

risks for STI

New or multiple sexual partners More than one sexual partner Sexual partners who have had multiple partners Sharing needles to inject drugs Alcohol or drug dependence or abuse Inconsistent or incorrect use of condoms or other barrier methods Not being vaccinated for STIs that have vaccines Having one STI is a risk factor for getting another Women are more easily infected, and have more asymptomatic infections Young women sexually active with men have greatest risk for STI Younger adults may have more unprotected sex Postmenopausal women may not use barrier protection

describe an unconditional release

No other signs of exacerbation, released without referral to outpt facility Doesn't happen very often

sick day rules for diabetes

Notify healthcare provider that you are ill Monitor glucose at least every 4 hours Test urine for ketones when blood sugar is >240 mg/dl Continue to take insulin or oral anti-diabetic agents To prevent dehydration, drink 8 to 12 ounces of sugar free liquids every hour (While awake) Continue to eat at regular times if able If unable to tolerate solid foods - liquids with carbohydrate content of meal Get plenty of rest Call MD for any of the following: persistent nausea and vomiting, moderate or Large amount of ketones, blood glucose elevation after two supplemental doses of insulin, high fever (101.5 or greater) or fever > 24 hours **chart 64-8**

simple focal seizures: symptoms

One sided jerking movement, pt is fully aware and awake entire time, uncontrollable movement of one side

obstruction- complication of PUD

Occurs from scarring, swelling from edema and inflammation Usually blocks the pyloric sphincter area Pt presents with nausea, vomiting, constipation, epigastric fullness, abd distension -complete obstruction: hyperactive sounds above, hypoactive/absent below METABOLIC ALKALOSIS AND HYPOKALEMIA TREATMENT: -NG tube to decompress stomach -IV fluids w/ electrolyte replacement -maybe surgery -NPO -antiemetics will not help!!

gestational diabetes

Onset during pregnancy Due to hormones secreted by placenta, which inhibit the action of insulin

clinical manifestations of DKA

Onset sudden Polyuria, polydipsia, dehydration, electrolyte imbalance Blurred vision Weakness Headache May have orthostatic hypotension Weak,rapid pulse Anorexia, nausea, vomiting, and abdominal pain Acetone breath (a fruity odor) Kussmaul respirations Mental status: varies from alert, lethargic or comatose

s/s of fracture

Pain Deformity Impaired sensation (numbness) distal to site of frx Loss of function- cant do hand grips, etc Crepitus- grating sound Edema Ecchymosis More s/s depending on location Ribs: respiratory s/s

six p's of ischemia

Pain Pallor Pulselessness Paralysis Paresthesia Poikilothermy (coolness)

Neurovascular assessment

Pain Pulses Movement Pallor Temperature Sensations Capillary Refills

assessment for pts with htn

Patient history - Activities? Lifestyle? Stress? - Make sure they record their numbers at home too!! Physical assessment - No symptoms with essential and secondary - Malignant -morning headaches, blurred vision, and dyspnea- May not recognize that these are a result of malignant htn Psychological assessment - New baby? New job? Whats causing the stress? Coping strategies? Diagnostic assessment - 2-3 consecutive readings above 140/90

Indications for ECT for MDD

Patient is suicidal or homicidal. Agitation or stupor is extreme. Life-threatening illness is a result of the refusal of foods or fluids. History includes a poor drug response or a good ECT response. Standard medical treatment has no effect.

what is a seizure

Paroxysmal, uncontrolled electrical discharge of neurons in brain, interrupting normal function Abnormal movements, LOC, amnesia From brain tumor, stroke, swelling- seizures go away once these are treated

what are some outcomes for pt with delirium

Patient will return to premorbid level of functioning. Patient will remain safe and free from injury while in the hospital. Patient will be oriented to time, place, and person. Patient will be free from falls and injury. Patient's tubes will remain in place- constant monitoring

what should you look for when assessing a patient with anorexia nervosa

Perception of the problem Eating habits History of dieting Methods used to achieve weight control Value attached to a specific shape and weight Interpersonal and social functioning Mental status and physiological parameters

what behaviors are affected by anxiety

Perceptual field Ability to learn Physical or other characteristics

Paranoid Personality Disorder (PPD)

Pervasive, persistent, inappropriate suspiciousness and distrust of others (unjustified) Present as hostile, irritable, injustice collectors; jealous, lacking warmth May appear businesslike and efficient, but generate fear and conflict in others Find malice in benign comments and behaviors (ideas of reference) Guidelines for Nursing Care: Strictly adhere to schedule Provide clear and straightforward explanations Use simple language and neutral affect Set limits Treatment: Psychotherapy Group therapy Antianxiety, antipsychotic medications

nursing interventions for hemorrhagic stroke

Perform neurologic assessments and Monitor blood pressure If photosensitive - decrease lighting Avoid Valsalva maneuver Implement Seizure precautions Pain relief regimen Ensure self care & nutritional needs met

Transurethral Resection of the Prostate (TURP)

Performed with scope Overgrown tissue chipped away Postoperative care: foley cath (3 way, 30ml balloon) --continuous irrigation to decrease clot formation --3000mL bag, keep open and flowing. if clot suspected--> use irrigation tray w/ sterile water until gone... may hurt pt *the CNA may empty foley bags and record o/p. nurse must change bags* *bag total - volume infused by EOS = urine o/p --monitor for bleeding: dark red urine for 24h, then pink tinged. should be clear yellow after 48hrs --if still bloody, watch vitals and H&H

occurrence of violence/abuse requires

Perpetrator + Vulnerable person = Crisis situation Can occur anywhere, in any family, in any race, in any social make-up

Antisocial Personality Disorder

Persistent disregard for others Persistent violation of others' rights Absence of remorse for hurting others (callousness) Sense of entitlement Deceitfulness Impulsiveness; risky behaviors to "feel alive" May be at risk for self harm

clinical manifestations of hyperglycemia

Polyuria Polydipsia Polyphagia Weight loss Weakness and fatigue Recurrent infections Dehydration Hemoconcentration-->hypovolemia--> hyperviscosity-->hypoperfusion-->hypoxia Metabolic Acidosis, Kussmaul respiration, Ketone bodies Hypokalemia initially, hyperkalemia during acidosis, or normal serum potassium levels

what is refeeding syndrome

Potentially life-threatening metabolic complication - protein catabolism leads to muscle and cell loss, often in major organs (heart, liver, and lungs). The body cells lose valuable electrolytes (potassium and phosphate) Can cause cardio, respiratory and neuro, problems observe for shallow respirations, weakness, acute confusion, seizures, and increased bleeding tendency - reintroduce nutrients slowly

body dysmorphic disorder

Preoccupation with an imagined "defective body part" Compulsive plastic surgeries

Risks for SIDS

Preterm birth Smoking in home Co-sleeping w/ baby

anticoagulants

Prevents the formation of a blood clot Does not dissolve the existing clot but can keep from getting larger. Body will dissolve over time --Heparin induced thrombocytopenia!!

what are some characteristics of an outpatient mental health setting

Primary care providers Patient-centered medical homes Primary care medical homes Community mental health centers Psychiatric home care Intensive outpatient programs

interventions for addison's

Promoting fluid balance: Elevated K+--> CARDIAC FUNCTION= priority, Assess q1-4hrs Monitoring for fluid deficit: Weight, I/O, promote intake. Caffeine promotes diuresis- avoid Preventing hypoglycemia

when should we NOT give alteplase for strokes

Pt that just had surgery, past 3 months Pt w/ hemorrhagic stroke, aneurysm, bleed Head trauma Problems w/ GI bleeding, actively

heparin antidote

Protamine sulfate-have on unit

nursing care during a seizure

Protect from injury Turn pt on side, loosen restrictive clothing Do not put ANYTHING in their mouth, except if an airway is needed No tongue blade, spoon, etc DO NOT restrain pt Prevent aspiration Suction but not in between teeth Documentation Length of seizure Over 5 mins= status epilepticus

lab values before initiating heparin

Prothrombin time (PT) International normalized ratio (INR): 2-3 therapeutic range (book says 1 &1/2 -2??) Activated partial thromboplastin time (aPTT) CBC- Platelets below 100 notify MD

what is the diagnostic and statistical manual V (DSM-V)?

Provides guidelines for identifying and categorizing mental illness All psychiatric illnesses are listed with diagnostic criteria Multi-axial system for categorizing mental disorders Used to categorize mental illness Ex= Depression- DSM V will list certain criteria needed for the pt to be diagnosed with depression

characteristics of PAD

Pulses- Weak or absent , requires doppler Skin- Cool to cold, Dry scaly, Pallor (when elevated), rubor (redness when dependent) Edema- absent Ulceration- On great toe, between and on top Necrosis/Gangrene- Likely Pain- Intermittent claudication Nails/Hair- Thick brittle; hair loss

characteristics of PVD (PVI)

Pulses- strong Skin- Mottling with brown pigmentation, bluish, warm Edema- Present Ulceration- Venous stasis ulcers, At bone, lower legs Necrosis/Gangrene- unlikely Pain- Aching, cramping Nails/Hair- Normal

assessment of pt w/ gout

Red, swollen, painful, warm joint May be able to palpate uric crystals in joint Periods of attacks with remission Serum uric acid 24 hour urine uric acid

local infection

Redness Hot/warmth Swelling Exudate pus (purulent)

S/S of iron deficiency anemia

Reduced energy Feel cold all the time Fatigue Dyspnea with minor physical exertion Tachycardia RBC, hemoglobin and hematocrit low

signs of PTSD in children

Reduced play, don't want to participate in games, recess, isolated from peers. Child may act out trauma in play or on others Child may blame themselves, say its their fault, they deserve it May show signs of depression Look at how they interact with other children

interventions to increase comfort in pts w/ fractures

Relieve pain Elevate to reduce edema --If this goes down, normally pain does too --Elevate above heart Apply ice or cold intermittently Implement position changes Administer analgesics

Schizotypal Personality Disorder

Resembles schizophrenia but with no psychosis Odd, eccentric behavior and speech Cognitive perceptual distortions without psychosis May display magical thinking and rituals Give-and-take conversations difficult Genuinely unhappy about lack of relationships Social anxiety and unhappiness may increase over time Guides for nurses: Avoid being too "nice" or "friendly" Do not try to increase socialization Assess for symptoms the patient is reluctant to discuss Protect against group's ridicule Treatment: Psychotherapy Group therapy Antidepressants

nursing implementation for hypothyroidism

Respiratory status Cardiovascular status Cognitive status-AAOx4

Bronchiolitis and RSV

Respiratory syncytial virus (RSV) causes mucus and exudate to fill the lining of bronchi and bronchioles Very common in infants and elderly Premature infants at high risk (before 35 weeks) Very common in day cares, very contagious Detected by a swab of the nasal passage Bronchiolitis normally is caused by RSV Inflammatory process--> excessive exudate-->viral infection risk

management of pts w/ osteoarthritis

Rest the joint with non-stressful exercise, but give them rest periods --Swimming! Apply heat- cold: Whatever pt finds comfort in weight loss Splints, canes or crutches Arthroscopic surgery to remove loose cartilage or bone spurs Medication-1st choice Tylenol; Lidoderm patch; NSAIDS; Tramadol (Ultram)--Watch Tylenol levels!! Total joint replacement May try steroid injections (4/year)--> watch insulin levels (may have to increase dose)

nursing implications for cellulitis

Resting the area, elevating extremity Elevate and immobilize the affected extremity Warm moist soaks every 4 hours Medications to control fever and pain as ordered--> acetaminophen Intravenous, intramuscular, or oral antibiotics as ordered Frequent handwashing-->contact isolation if r/t MRSA

treatment for respiratory alkalosis

Results from hyperventilation Assessment: tachypnea, inability to concentrate Correcting the underlying cause - Fear, anxiety—anxiety reduction, antidepressants - Excessive mechanical ventilation—check settings Oxygen therapy, rebreathing techniques

manifestations of hypersensitivity rxns

Rhinorrhea, stuffy nose, itchy, watery eyes Clear mucus- NOT AN INFECTION Postnasal drip, dry, scratchy throat and pharyngitis Pain/headache to cheeks and gums -increased WBC w/ increased eosinphils, igE

Pharmacological interventions for Panic disorder (PD), generalized anxiety disorder (GAD), and social affective disorder (SAD)

SNRIs venlafaxine (Effexor) duloxetine (Cymbalta)

first line drugs for anxiety disorders, OCD, and BDD

SSRIs paroxetine (Paxil) fluoxetine (Prozac) escitalopram (Lexapro) sertraline (Zoloft)

which drug schedules have the highest abuse potential

Schedule I: Not for medical use; high potential for abuse Ex. Heroin, marijuana, ectasy Schedule II: Prescription only; high potential for addiction Ex. Hydrocodone, oxycodone, fentanyl, cocaine Becoming more of a problem

which drug schedules have the lowest abuse potential

Schedule III: Prescription only; moderate potential for misuse Ex. Acetaminophen/codeine Schedule IV: Prescription only; low risk Ex. Alprazolam, lorazepam, zoldipem Schedule V Limited quantities; low risk Ex. Atropine/dyphenoxylate (Lomotil), guafensin and codeine (Robitussin AC),

when should seclusion be used for a pt with bipolar disorder

Seclusion is warranted when documented data (collected by the nursing and medical staff) reflect the following: Risk of harm to others or self is substantial. Patient is unable to control actions. Problematic behavior has been sustained. Other measures (e.g., setting limits beginning with verbal de-escalation or using chemical restraints) have failed.

alcohol use disorder treatment

Seizures: diazepam (valium) Can also give IV lorazepam (Ativan) for tremors

nonsuicidal self-injury

Self-injury directed to the surface of the body to induce relief from a negative feeling/cognitive state or to achieve a positive mood state

what do you do if 2 alzheimer's pts get in an argument

Separate them for abt 5 mins, then come back and explain to them WHY you had to intervene "when you calm down you may go back into the community room"

specific phobias

Specific objects or situations include dogs, spiders, heights, storms, water, blood, and closed spaces, among others. Are common, but do not usually cause much difficulty.

interdisciplinary interventions for a child experiencing failure to thrive

Speech therapist- Issues w/ tongue r/t bottle feeding may be neurological. Want to assess hearing also Occupational therapist-Fine motor skills, unable to grasp rattle, pick up block, etc. Adults- ADLs, button clothing, etc. adaptive equipment Counselors- Traumatic events, regression, or to figure out things that are going on CLS. Also for adults/parents!! Post partum depression!! Teens and children in schools, etc. Physical therapist- Gross motor skills Dietician - Nutrition, calories, breastfeeding coaches

stages of treatment for PTSD in children

Stage 1: Safety & Stabilization Getting them away from cause of PTSD, ensuring they are safe and they feel safe. Stabilize symptoms, predictable environment. Stop self-destructive behaviours Stage 2: Symptom Reduction Stage 3: Coping/Problem-solving skills Usually from an advanced practice practitioner

what is an appropriate intervention for an alzheimers pt who is verbally aggressive

Stay calm, ACKNOWLEDGE their feelings. "you appear to be upset" or "I know this is upsetting"

co-morbidities of schizophrenia

Substance abuse disorders- very common, pt tries to use them to control symptoms, but only exacerbates them Anxiety disorders Depression OCD Panic disorders Obesity (probably due to antipsychotic medications-2ndG); leads to comorbid diabetes and risk of cardiovascular disease

symptoms of atonic (drop attack) seizures

Suddenly falls to ground, at high risk for head injury

what are some red flags for suicide risk?

Suddenly going from sad and depressed to happy and peaceful Patient gives away treasured possessions. If patient is to be managed on an outpatient basis, assess: Social supports, Significant other's knowledge of signs of potential suicidal ideation and community crisis resources

symptoms of tonic clonic/grand mal seizures

Suddenly loses consciousness, body stiffens (tonic phase, only a few secs), then subsequent jerking of extremities (clonic phase), may see cyanosis, sputum, incontinence, bite tongue, cheek, etc.

clinical manifestations of hypothyroidism

Systemic effects characterized by slowing of body processes Cold intolerance Decreased appetite increased weight Lots of sleep Manifestations variable Slow onset

hypertension

Systolic blood pressure ≥150 and/or diastolic blood pressure ≥90 in 60 or older who does not have diabetes mellitus or other chronic disease process that has hypertension as risk factor 140/90 for those younger than 60 Patients with DM should have BP < 130/85

activities that increase intraocular pressure

TABLE 74-2

common causes of glaucoma

TABLE 74-3

transient ischemic attack

Temporary interruption of cerebral blood flow Considered a warning sign of the ischemic stroke- Almost inevitable that they will have a stroke in the future Sudden onset of neurologic deficits - Some pts may not notice these s/s Neurologic deficits resolve in 30-60 minutes Etiology-> Atherosclerosis - build up of fatty plaque in cerebral blood vessels. common in carotid arteries

cycle of violence in intimate partner violence

Tension-building stage- person may just shove, push, verbally abusive--> RED FLAG Acute battering stage- severely injured, death. Pt may or may not disclose reason for injuries Look for black eyes, strangulation marks on neck, cigarette burns Honeymoon stage- perpetrator expresses remorse, buys gifts, woman is drawn in again bc she only wants to see the good Eventually becomes shorter, abuse becomes more severe Woman may "wake up" and press charges, leave

croup syndrome

Term that is given to a complication from a resp tract infection Usually follows a common cold. Will see runny nose, low grade temp, swelling, fussy at night bc very uncomfortable, will cry, don't want to eat! Caused by a virus during the fall and winter months rarely bacteria Comparison of Croup Syndromes Table 21-2 - only focus on 2

purkinje fibers

The left and right Bundles of His end in the Purkinje fibers. Cause rapid conduction of impulses throughout the ventricles leading to organized ventricular contraction. Intrinsic rate of 20 to 40 bpm.

signs of a hip frx

leg deformity, rotation, length difference, bruising to skin (may see 24hrs later), pain, no weight/lifting, immobility hematoma long term

hemorrhagic stroke

There is bleeding into brain tissue by a leaking or ruptured arterial blood vessel. Ruptured aneurysm - Shows up on CT

schizophrenia affects

Thinking Language Emotions Social behavior Ability to perceive reality accurately

pt teaching for anticoag therapy chart 36-7

educate ur pt or they gonna die

incubation

Time from initial infection to time symptoms 1st appear or screening tests turn positive First contact to first sign of symptoms or positive screen Sometimes DOESN'T INVOLVE SYMPTOMS INCREASED chance of SPREAD

teaching for hypoglycemia prevention

To carry some form of simple sugar with them all the time *Wear an ID bracelet stating that they have diabetes *Refrain from eating high-calorie, high-fat dessert foods (eg cookies, cake, doughnuts, ice cream) to treat hypoglycemia fat can slow absorption of the glucose Do not use as an excuse to reward themselves with desserts Better plan an occasional dessert, than treat hypoglycemic episodes with them

fractures--> causes

Traumatic- Trauma directly to bone Compression- pts w/ osteoporosis, bone collapses into itself Stress- More common in athletes, repetitive movement that causes strain to the bone Pathological- Secondary to a disease process. cancer, etc, osteoporosis

management for gastritis

Treat underlying cause Fluid replacement Blood transfusion for low H&H: 7 & 25 = time for transfusion Surgery- typically not needed Medications: H2 receptor antagonists (IV push), PPIs (IV push) Diet

DSM-V Criteria for Schizophrenia

Two or more of the following for a significant portion of time in 1 month: Delusions Hallucinations Disorganized speech Gross disorganization or catatonia Negative symptoms (diminished emotional expression or avolition) Functional impairment of some kind -Continuous disturbance for at least 6 months

latex allergy

Type I hypersensitivity reaction Protein found in natural latex rubber products is specific allergen Allergen causes interaction with IgE Incidence of latex allergy is increasing Health care workers especially susceptible

red flags of caregiver-child interaction for cases of suspected abuse

Uninterested, irritated, unconcerned parent Blaming child for injury, "clumsy" "stupid" Hostile, uncooperative towards nurse

borderline personality disorder

Unstable, intense relationships Instability of affect; unstable, frequent mood changes Emotional lability (shifting from anxiety, to irritability, etc.) Poor impulse control; self-destructive; suicide-prone Chronic depression Projected identification Emotional dysregulation Splitting Implementation: Provide clear and consistent boundaries Use clear, straightforward communication Calmly review therapeutic goals Teamwork and safety Respond matter-of-factly to superficial self-injuries

what are compulsions in OCD

Unwanted, ritualistic behavior the individual feels driven to perform to reduce anxiety

local signs of cystitis

Urgency Frequency Low back pain Dysuria Hematuria Cloudy urine Foul smelling

anticonvulsant drugs for bipolar disorder

Valproate (Depakote) Carbamazepine (Tegretol) Lamotrigine (Lamictal)-Approved for long term use, common in maintenance phase -all have negative effects on liver (watch for dark urine, bruising)

typical absence seizures (petit mal)

Usually occurs only in children and rarely beyond adolescence Child will just blankly stare into space, unable to get their attention Can occur up to 100 times per day, but can go away as child matures or develop into other seizure types May cease as the child matures or develop into another type Can be precipitated by flashing lights and hyperventilation

Causes of bradycardia

Vagal stimulation (vomiting, carotid massage, valsalvar maneuvers). Hypothyroidism Medications that slow heart rate digitalis, beta blockers, calcium channel blockers. Defective conduction system

diabetic retinopathy-microvascular

Vascular changes in retina Assessment Findings: -Diminished visual acuity-leads to blindness -Annual Ophthalmic examination -Blood pressure medication Self care deficit esp. in elderly: -Problems drawing up insulin -Cooking

postictal manifestations of tonic clonic seizures

Very exhausted, wants to sleep, doesn't remember seizure. Involves both hemispheres so amnesia

risk factors for PTSD in children

Victims of abuse- physical or sexual Poverty Non-nurturing environment- Not necessarily abuse, but more neglect

pandemic influenza

Virus from animals and birds- H1N1 Strict isolation Tamiflu Check any recent travels Supportive treatment Tx is symptom based

nursing care after a seizure

Vital signs Neurologic checks Pupils, orientation, LOC Prevent aspiration Suction at bedside, keep pt on side during recovery bc still at risk Rest Documentation Pt LOC, precautions taken, vitals, neuro checks, cyanosis, excess salivation, incontinence, length of time pt took to return to pre-seizure state

coumadin antidote

Vitamin K

s/s of bleeding (complication of PUD)

Weakness and feeling faint Mental confusion Restlessness Bright red blood in emesis or stool Hematemesis - blood in emesis Melena- tarry stools Decreased blood pressure, rapid pulse (signs of hypovolemic shock)

clinical manifestations of sinus tachycardia

Weakness, fatigue Dyspnea Hypoxia Hypotension Restlessness, confusion, anxiety Palpitations Chest pain

closed angle glaucoma

With closed-angle glaucoma, eye pressure builds up rapidly when the drainage area of the eye suddenly becomes blocked. Blurry vision, rainbow halos around lights, headaches or severe pain may occur with closed-angle glaucoma. This type of glaucoma is less common than open-angle and may cause blindness if it is not treated immediately

how does magnesium affect ECGs

low- almost identical to hypokalemia high- Prolonged PR interval, prolonged QRS, and prolonged QT interval.

You are working on a medical-surgical unit, and the unit secretary pages you to see all four of these patients immediately: a 52-year-old male with Type II diabetes, needs to have his glucometer reading done "right now" a 90-year-old female who needs to be turned in bed a 34-year-old female who was admitted after seizures, whose roommate says, "she has not been out of the bathroom for 25 minutes" a 45-year-old male, admitted with hypertension, who says, "I want to talk to my doctor about my tests! I think I got the wrong test this morning!" Who will you see first? Next? Last? WHY?

a 34-year-old female who was admitted after seizures, whose roommate says, "she has not been out of the bathroom for 25 minutes"= 1 (possible seizure while in BR) a 52-year-old male with Type II diabetes, needs to have his glucometer reading done "right now"= 2 (may be experiencing signs of hypo/hyperglycemia) a 90-year-old female who needs to be turned in bed= 3 (risk for bed sores) a 45-year-old male, admitted with hypertension, who says, "I want to talk to my doctor about my tests! I think I got the wrong test this morning!"= 4 (too late now, wont be life-threatening)

sepsis

a life-threatening organ dysfunction resulting from a host response to infection Risks- immunocompromised, infections, wounds, diabetes, cancers, elderly Bacterial/fungal infection progresses to dangerous condition within days SYNDROME- not a disease process Can lead to shock-->death, Notify pcp immediately Systemic inflammatory response (SIRS) - a syndrome resulting from a severe clinical insult that initiates an overwhelming inflammatory response by the body

how does calcium affect the heart

low- shortens QT interval high- lengthens QT interval

what major complication can systemic infections lead to

acute kidney injury!! -elevated BUN and cre -also r/t dehydration -will return to normal if underlying issue is treated quickly

an RN may NOT delegate what tasks

administration of investigational drugs; administration of cancer therapeutic drugs; administration of medications by IV push, other than those defined by health agency protocol for emergency situations; administration of blood and blood products; administration of total parenteral nutrition solutions; accessing the implanted device Initial assessment of patient; and every 24 hours Initiate the care plan, revise or change Teaching of complex or initial teaching

complications of GERD

aspiration--> immobile pts and elderly, aspiration pneumonia scar tissue--> may cause difficulty swallowing, may need dilation barrett's epithelium--> tissues of esophagus start to change, become like stomach tissues to be able to handle acid. Creates lesions, which can put pt at higher risk for esophageal cancer

what types of mental health pts are admitted into an inpatient unit

admission is reserved for pt who are harmful to themselves or others -suicidal -homicidal (may go to jail first) -extremely disabled and in need or short term acute care (ex- so depressed to a catatonic point, vegetative state)

the CAGE questionnaire is used to assess?

alcohol abuse

who should set the pace of the clinical interview?

always the patient

ischemic stroke

an obstruction or blockage of a cerebral artery by thrombus or embolus

table 66-3 risk factors for UTI

anal intercourse. all u need to know. go look at the chart still tho

Addie, age 15, is brought to the school nurse after fainting during gym class. She is grossly underweight, wears baggy clothes, and has dry skin. She complains of feeling cold despite wearing two sweaters. As the nurse examines her routinely, she notices that Addie's skin seems slightly yellow, and a gentle scrape of her skin shows signs of dehydration. what do you suspect addie is experiencing

anorexia nervosa, malnutrition, starvation

cannabis use disorder treatment

antianxiety and antidepressive meds

what other drugs can be given to pt with schizophrenia other than antipsychotics

antidepressants and mood stabilizers

a childs growth/weight below which percentile ranking is concerning

anything below 5th percentile--> failure to thrive

whats the one third gen antipsychotic for treating schizophrenia

aripiprazole (Abilify) Improves positive and negative symptoms and cognitive function Little risk of EPS or tardive dyskinesia very new drug

fine motor 6-8 mos

bang objects together, pulls string to obtain obj, transfers obj from hand to hand

how should you document things as a mental health nurse?

be VERY specific and objective. document every reaction and response as soon as it happens, how you responded, what actions were taken and when, etc

gross motor skills 2-4mos

bears weight on forearms, sits erect with support, turns from side to back, begins to smile at people, coos, gurgling, plays with people

tx of fat embolus

bedrest oxygen hydration (IV)--> dissolves fat steroid therapy--> inflammatory response in lungs intubation and placement on mechanical ventilation if necessary

when is a baby considered preterm

born before 37 weeks

what does diathesis mean in regards to mental illness

biological predisposition

when should iron supplements be taken

btwn meals- 30 mins before or 2hrs after

fine motor 10-12 mos

can place obj in containers, able to hold pencil or crayon and mark paper

postictal manifestations of atonic (drop attack) seizures

can resume normal activity

A patient comes to the emergency department immediately after experiencing numbness of the face and an inability to speak, but while the patient awaits examination, the symptoms disappear and the patient requests discharge. Why should the nurse emphasize that it is important for the patient to be treated before leaving? a. The patient has probably experienced an asymptomatic lacunar stroke. b. The symptoms are likely to return and progress to worsening neurologic deficit in the next 24 hours. c. Neurologic deficits that are transient occur most often as a result of small hemorrhages that clot off. d. The patient has probably experienced a transient ischemic attack (TIA), which is a sign of progressive cerebrovascular disease.

d

what are some drugs used for treatment of alzheimers disease

cholinesterase inhibitors: donepezil (Aricept) rivastigmine (Exelon) galantamine (Razadyne)

Hypoparathyroidism assessment

chvostek's sign trousseau's sign

atopic allergy

coming in contact w/ something, on the skin, inhaled, etc Rxn-->capillaries more permeable-->leak-->swelling most common type

fat embolus s/s

complication of frx -tachypnea -air hunger -hypoxia -fever -tachycardia -restlessness -decreased mental status -petechiae rash around head/neck--> later on can get lodged in lungs!! to differentiate btwn pulmonary embolus or fat, look at labs, coag, etc. Tx is different

compartment syndrome

complication of frx--> unrelieved pain may indicate. SEVERE PAIN Inadequate or obstructed blood flow to muscle, nerves, or tissue. Compression of the muscle compartment from bulky dressing or internal bleeding Medical emergency Pale tissue, weak pulses, pain with movement may require cast change bc of discomfort from pressure

causes of dysrhythmias

coronary artery disease, electrolyte imbalance, hypoxia, and drug toxicity

gross motor 8-10 mos

crawls or pulls entire body along floor w/ arms, pulls self to sitting or standing, creeps on hands and knees

promoting mobility in frx pts

crutches, cane, walker

hypoparathyroidism labs

decreased calcium increased phosphorus decreased magnesium decreased cAMP

DI patho

decreased water reabsorption, just pee it out, become v dehydrated, hemoconcentration, increased osmolarity Leads to excessive thirst, dehydration

p wave

depolarization of atria rounded shape should not exceed 3mm in height

DI drug therapy

desmopressin acetate (DDAVP)- synthetic vasopressin - nephrogenic: Diabenese- oral antidiabetic, monitor glucose hypoglycemia *Goals of drug therapy* -Providing more ADH to normalize functions -TO REPLACE ADH only way to stop excess fluid loss -PO, IM, IV, intranasal (most common) *Therapeutic* -Less urine, less thirst -Normal vitals increased BP, decreased HR -Specific gravity return to normal, increased *NONTHERAPEUTIC* -Too high- Fluid overload, increased weight -Too low- o/p still high, etc *DAILY WEIGHT* -Same time, same scale, same clothes

medical management of vascular ulcers

diet- protein intake (albumin is lost through ulcers), vitamin A and C, zinc debridement of necrotic tissue- enzyme ointments, surgical unna paste boot (zince oxide)- not a daily dressing change occlusive dressings- oxygen permeable or impermeable (duoderm) left for min of 3-5 days

describe a conditional release

discharge with conditions, pt must participate in outpatient therapy upon release for example

secondary htn

disease process that causes the htn (kidney failure from fluid retention)

tolerance

dont experience same effects from the dose as they used to, takes a higher dose sometimes

when does anorexia nervosa appear

early to middle adolescence

clinical manifestations of cataracts

early: blurred vision, inability to distinguish colors late: double vision, blindness

What therapies does the nurse anticipate the provider will order for a pt with anaphylaxis and angioedema (Select all that apply.) Epinephrine (Adrenalin) Diphenhydramine (Benadryl) Acetaminophen (Tylenol) IV fluids Oxygen

epi, benadryl, fluids, o2`

thought stopping in behavior modification therapy

examples include snapping a rubber band on one's wrist to stop an obsession or negative thought

flooding in behavior modification therapy

exposing the patient to a large amount of an undesirable stimulus in an effort to extinguish the anxiety response.

LOC with complex partial seizures

eyes open, but pt is unconscious

T or F insulin therapy for type 1 diabetes may or may not be necessary

false

T or F insulin therapy for type 2 diabetes is required for life

false

T or F its ok to give info about a pt after they die

false

T or F nurses cannot initiate restraints

false

T or F pts with asthma should be regularly taking SABAs

false

t or f seizures are easily curable

false

t or f it is normal to have small amounts of protein in the urine

false- should not have any

How is H. pylori transmitted?

fecal-oral route, contaminated food, utensils -clean and prepare food properly, wash hands -acid wont kill it

management of strains and sprains

first 24-48hrs: RICE & NSAIDs rest, ice (for pain/swelling), compression, elevation after 48hrs: heat (muscle spasms). exercise depending on severity (PT) may need surgical intervention

pacemakers

for sinus bradycardia Electrical impulse applied to the heart to cause depolarization. Can be applied to right atrium or ventricles or both atrium and ventricles. --Temporary pacing - Used in emergency situations --Synchronous - (demand) pacing where the pacemaker only fires if the patient heart rate drops below a preset heart rate. --Asynchronous - a pacemaker that is set on a fixed rate.

fine motor 4-6 mos

grasps obj at will and can drop things to pick up others, pulls feet to mouth to explore, holds baby bottle, knows familiar faces, responds to own name

what kind of perceptual disturbances will you be looking for during the MSE

hallucinations, auditory or visual

PR interval

from the point where the P wave leaves the isoelectric line to the beginning of the QRS atrial depolarization normal range= 0.12 - 0.2 sec count tiny boxes, multiply by 0.04

chart 36-4!! comparison of LE ulcers

go look at it right now or the rotting feet will follow you for the rest of your life

chart 66-7 and 66-8: preventing UTIs

go look over it or you'll get the worst UTI of ur life

surgical therapy for hyperthyroidism

good candidates: Large goiter causing tracheal compression, Unresponsive to antithyroid therapy, Thyroid cancer, Not a candidate for RAI -more rapid reduction in t3/t4 -not a first line treatment *total or subtotal thyroidectomy*

systematic desensitization in behavior modification therapy

gradually exposing a person to the feared object or situation until the person is free of incapacitating anxiety

allergic rhinitis

hay fever- runny nose, clear triggered by rxn to airborne allergens

what s/s could a pt with htn also experience

headache, lightheaded, tired, overwhelmed

cannabis use disorder intoxication symptoms

heightened sensations, brighter colors, more details, time moves slow out of body experience with higher doses= depersonalization, or derealization- dejavu

hyperparathyroidism assessment

hypercalcemia, kidney stones, GI pain

medical management of delirium is directed towards..?

identifying and treating the underlying cause

surgical management of cataracts

if reduced vision does not interfere with normal activities, surgery is not needed. Surgery is preformed on an outpatient basis with local anesthesia. Surgery usually takes less than 1 hour and patients are discharged soon afterward. Complications are rare but may be significant.

Coroner Emergency Certificate (CEC)

if still not stable after PEC Detained for up to 15 days or until no longer showing any symptoms

what kind of things will you look for while assessing the pts thoughts during the MSE

if what they're saying makes sense, delusions

three defining characteristics of ADHD

inattention impulsiveness hyperactivity

labs for hyperthyroidism

increased t3, t4 decreased TSH

SIADH patho

increased water reabsorption, fluid overload, hemodilution, decreased osmolarity, Na+ dilution HYPONATREMIA

gout

inflammation of the joint caused by accumulation of uric acid in the blood associated w/ ineffective metabolism of purines uric acid crystals accumulate in joint

long term complications after a stroke (chart 45-4)

left: right sided paralysis, communication problems, aphasia, agraphia, alexia, slow & cautious behavior, memory deficits right: left-sided paralysis, spatial perceptual deficits, quick/impulsive behavior, disorientation, inability to recognize faces □ Hemiplegia- flaccid extremities, no control over them- pt/ot collab!! □ Swallowing and Slurred Speech (Dysarthria)- ST collab, maybe pureed/liquid diet □ Gag reflex □ Self care deficits Communication- Exercises with speech therapy, communication boards,etc □ Aphasia ○ Expressive- they cant tell you anything - Receptive- they cant understand anything - Mixed- both emotional lability impaired judgement, impulsive elimination issues

pernicious anemia

lack of intrinsic factor Unable to absorb vitamin B12 diet intake (vegan diet, lack of diary products) GI tract absorption (small bowel resection, gastrectomy) alcohol absorption

drug therapy for chf

lasix, bumex, ACE inhibitors, nitrates, vasodilatiors

when are MAOIs prescribed for anxiety

last attempt treatment, for resistant conditions due to risk of life threatening hypertensive crisis. also social anxiety disorder and rejection sensitivity -Isocarboxazid (Marplan)

when does bulimia nervosa appear

late adolescence

what would you expect to find in a child with failure to thrive

less than 5th percentile, malnourished appearance, no fear of strangers, minimal smiling, decreased activity level, stiff or flaccid body (lack of movement), feeding disorder, wide-eyed gaze, and developmental delays-->learning deficits

first line pharmacological agent for bipolar disorder

lithium carbonate

HMG-CoA Reductase Inhibitors are contraindicated in...?

liver failure and pregnancy

treatment for osteomyelitis

long term abx (4-6wks) --Pt can go home or o/p infusion center, PICC line. depends on insurance. May even go to LTCF pain management hyperbarics (HBO) --lots of O2 --may cause problems w/ ears, hearing surgical debridement--> wound vac --surgical removal of bone, amputation

when a pt with schizophrenia is being treated with first gen antipsychotics and is experiencing EPS, how can we fix it?

lower dose, add antiparkinson's drugs to med list: trihexyphenidyl (Artane) benztropine mesylate (Cogentin) diphenhydramine hydrochloride (Benadryl) biperiden (Akineton) amantadine hydrochloride (Symmetrel)

peak expiratory flow meters

measure the maximum flow velocity during forced exhalation Do it 3 times, record highest number= good day, baseline level Find out what baseline number is!! Very small, should be on them always Green- good, Yellow- could be better, Red Zone- get to the ER Chart 30-4 Incentive spirometer=intervention to help PFM= diagnostic tool

what is the main potentially life threatening condition that may be caused by treatment of schizophrenia with second gen antipsychotics

metabolic syndrome Weight gain, dyslipidemia, altered glucose Risk of diabetes, hypertension, atherosclerosis, and increase in heart disease

what is modeling in behavior modification therapy

mimicking appropriate behaviors in situations

persistent MDD

minimum 2wks to 6mos

what is the difference between mood and affect

mood- inquired, a sustained state of inner feeling affect- observed expression of inner feeling, facial expressions

open fractures

more significant, requires more tx Tear in soft tissue, bone exposed to outside Potential for contamination Higher morbidity and mortality

chronic MDD

more than 2 years

you should d/c or change HMG coA reductast inhibitors if...?

muscle cramping or elevated liver enzymes (AST, ALT)

hallucinogen withdrawal symptoms

no official dx, but can continue to have flashbacks/hallucinations Possibly restrain patient, give benzos

adrenalectomy preop care

no surgery if pt has ANY imbalances High protein diet before surgery Optimize physical condition Control hypertension and hyperglycemia Correct hypokalemia What to expect after adrenalectomy: --NG tube- decompression --Urinary catheter- accurate i/o --IV therapy- fluid balance --Central venous pressure monitoring- fluid status --Leg sequential compression devices- clots

a major cause of relapse in bipolar disorder is..?

nonadherence to medication

compartment syndrome tx

notify dr position extremity at heart level release constriction--> cut cast or dressing surgery incision to relieve constriction (if not fixed from cutting cast) --fasciotomy: cut into tissue to relieve pressure --pack w/ damp gauze, sterile dressings w/ normal saline --surgeon will come back and attempt to close it

describe counter transference in the nurse-pt relationship

nurse displaces feelings related to people in nurse's past onto patient -Patient's transference to nurse often results in countertransference in nurse -Common sign of countertransference in nurse is overidentification with the patient

what actions should be taken/things to assess for a child with failure to thrive

nutritional history, observe parent-child interactions- watch them feed the child, feeding patterns and feeding environment, allergies, PMH, activity level

cannabis withdrawal symptoms

occur within a week Irritable, aggressive, cant sleep- smoke to relieve symptoms, creates a cycle

partial seizures involve how many/which hemispheres

one

what kind of things will you be asking/looking for when assessing cognition during the MSE

orientation, level of consciousness

signs of sickle cell crises

pain in joints fever over 101 chest pain jaundice pallor in mucus membranes hard to breath fatigue abd swelling (splenomegaly) headache sudden weakness or loss of feeling sudden change in vision

s/s of folic acid and pernicious anemia

pallor, jaundice, glossitis paresthesia and poor balance (B12 deficiency)

describe transference in the nurse-pt relationship

patient unconsciously and inappropriately displaces onto nurse feelings and behaviors related to significant figures in patient's past ex: nurse reminds the pt of her mother, tells the nurse she's being judgemental

who is in charge of obtaining the informed consent?

physician or advanced practice provider

fine motor 8-10 mos

picks up small obj, uses pincer grasp, shows hand preference

in schizophrenia, first gen antipsychotics are best for treating...?

positive symptoms -haloperidol (haldol) -less expensive than second gen, BUT: Minimal impact on negative symptoms Extrapyramidal side effects (EPS)- life threatening Anticholinergic side effects- life threatening Tardive dyskinesia Weight gain, sexual dysfunction, endocrine disturbances (chart 12.4)

Vesicoureteral Reflux

primary: Children born with a defect in the valve that prevents urine to flow backwards secondary: recurrent UTIs TREATMENT: Allow to mature Antibiotics prophylactics to decrease UTI risk Surgery repair if does not mature on its own as child gets older

calcitonin

produced by the thyroid gland and decreases the serum calcium concentration if it is increased above its normal level inhibits bone resorption

prevention of RSV

prophylaxis vaccine; hand washing, droplet and contact isolation Take them out of day care for awhile, let them stay home, less contact Wipe surfaces down Teach them to sneeze/cough on tissue--make it fun/game! They'll mimic what you do No vaccines, but drug available for very high risk children (don't need to know it)- May give this to premie babies upfront -always assess for respiratory distress -will have poor feedings from mucus

what drug is given as supportive therapy for HR in hyperthyroidism

propranolol (inderal)

A pt complains of frustration with his impulse to use tissues to touch or grab anything and everything around him. He feels clean and safe doing it that way, but sometimes w/o it he can barely stand to open a door

pt has OCD

withdrawal

pt stops taking substance, resulting in physiological symptoms

postictal manifestations of myoclonic seizures

pt will be awake and able to think clearly

potential complications of thrombophlebitis

pulmonary embolus --maintain bed rest --give ordered anticoag --ted hose bleeding --monitor lab values (PTT, PT, INR)- increase is thera peutic but higher risk for bleeding --keep antidotes for OD of anticoags --monitor for signs of bleeding (skin, gums, stools, urine o/p) --apply direct pressure if bleeding occurs --electric razors instead of disposable

Sinus Tachycardia

rate greater than 100 regular rhythym p wave present, consistent, upright and rounded PR interval 0.12-0.2 normal after activity dangerous after acute MI

sinus arrhythmia

rate regular rhythm regular p wave present before qrs pr interval 0.12-0.2 sec normal in children and young adults abnormal in older adults

sinus bradycardia

rate- less than 60bpm regular rhythm P wave present, upright and rounded normal PR interval normal in athletes

interventions for cardio and cerebrovascular disease as a macrovascular complication of diabetes

reduce modifiable risk factors smoking cessation Diet exercise blood pressure control below 140/80 mm Hg maintaining prescribed aspirin use maintaining prescribed lipid-lowering drug therapy low-density lipoprotein (LDL) cholesterol remains below 100 mg/dL in healthy and below 70 mg/dL for patients with manifestations of CVD Eliminating saturated fat, trans fat, and cholesterol intake; increasing intake of omega-3 fatty acids, and fiber

describe therapeutic milieu

refers to surroundings and physical environment. In a therapeutic context, it refers to the overall environment and interactions within that environment. an all-inclusive term that recognizes the people (patients and staff), the setting, the structure, and the emotional climate as important to healing -well managed milieu offers patients a sense of security and promotes healing

the nurse-pt relationship should be...

safe, confidential, reliable, consistent, with clear boundaries

define informal admission

sought by the patient

angioedema

severe type I hypersensitivity reaction that involves the blood vessels and all layers of the skin, mucous membranes, and subcutaneous tissues in the affected area -swelling around lips, mouth, facial area -can lead to airway obstruction!! -anxiety, impending sense of doom **high risk in clients on ACE inhibitors!!**

thought content for a pt with bipolar disorder

similar to schizophrenia Grandiose delusions Persecutory delusions

2 types of partial seizures

simple and complex focal

Excoriation Disorder

skin picking

U wave

small wave that in some people follows the T wave. Can indicate hypokalemia, hypocalcemia, and hypomagnesemia. Rounded and symmetrical, less than 2 mm in height and smaller than the T wave.

voluntary admission

sought by patient or guardian (pt cannot leave unless deemed appropriate)

gross motor 10-12mos

stands alone, walks holding onto furniture, sits from a standing position

response prevention in behavior modification therapy

starts with the therapist preventing the compulsion, such as hand washing, and gradually helping the patient limit the time between rituals until the urge dissipates

intoxication

taking an excess of a substance, manifests as physical symptoms, etc.

afterload

the peripheral resistance against which the left ventricle must pump to eject blood through the aorta into peripheral circulation.

preload

the volume of blood in the ventricles at the end of diastole, before the next contraction. Preload determines the amount of stretch placed on the fibers.

Left sided diastolic HF

thick, stiff muscle in L ventricle. Cannot relax, smaller chambers, decreased CO

left sided systolic heart failure

thin, weak, heart muscle. More blood pooling into chambers, heart cannot pump against afterload. Lower EF

opioid intoxication symptoms

thoughts and movements slow down, drowsy, slurred speech, cant really act, just existing --> coma if lots

types of ischemic stroke

thrombus; embolus

addiction

to be dependent on a substance, sometimes only takes one exposure

denver scale

to identify children with special needs or who may be at risk for developmental delays or school difficulty for children 0-6yrs

constant blood flow to brain is necessary because....?

to provide oxygen and glucose, as well as to rid the brain of metabolic waste(such as carbon dioxide and lactic acid).

SIADH drug therapy

tolvaptan (Samsca) PO conivaptan (Vaprisol) IV Diuretics- Lasix 3% sodium chloride-->For Na+ that is SEVERELY low less than 115, Watch w/ cardiac pts!! *Goals of drug therapy* -WATER EXCRETION -These are ONLY given in hospital bc monitoring of Na+ must be done v closely -Do not give diuretic if Na+ is below 125!! *Therapeutic* -Increased urine o/p know pts baseline when they are admitted -WEIGHT!! More definitive -Decreased BP, increased HR normalized vitals *non-therapeutic responses* -Too high: Dehydration (MM, skin turgor, pulse low, etc) sodium loss-Give fluids again!! -Weight gain, no change in weight (should see in 24hrs/less than) -No change in vitals -Too low: PULMONARY EDEMA

pre-gestational diabetes

type 1 or 2 diabetes that existed prior to pregnancy

dx tests for UTI

urinalysis--> color, clarity, pH, specific gravity, sediment, RBC, WBC, pus, bacteria --leukoesterase and nitrate levels= definitive culture and sensitivity 24hr urine collection may need to do in/out cath to get proper specimen

pyelonephritis

usually after an untreated UTI, e. coli s/s: flank pain/tenderness, chills, fever, weakness dx: UA (pyuria), ultrasound, CT, KUB (xray of kidneys, ureter, bladder) tx: Relieving fever Relieving pain Antimicrobial therapy Prevention of kidney damage 8-8oz water daily IV fluids

sickle cell crisis

vascular occlusions for sickling of cells form low o2 Pain occurs when sickle cells plug blood vessels and stop the flow of blood Pain often causes severe, painful in arms, legs, back, chest, or abdomen Infections High altitude Emotional stress Surgery Blood loss Dehydration Acidosis Low body temperature

qrs complex

ventricular depolarization width should not exceed 0.12 (3 tiny boxes) Q wave should not be wider than 0.04 sec

t wave

ventricular repolarization rounded and positive If the T wave becomes inverted, peaked or flattened one might suspect electrolyte imbalance, hyperventilation, CNS disease, ischemia or myocardial infarction.

simple focal seizures LOC

very awake -aura before it happens

Nursing Management of hypoparathyroidism

wear med alert bracelet lifelong drug therapy high calcium, low phosphorus diet --avoid milk, yogurt, cheese --go for leafy greens

SIADH clinical manifestations

weight gain--> cannot palpate edema bc generalized -anorexia, nausea, decreased appetite, vomiting -hypertension -bounding pulse -pulmonary edema!! (assess lungs frequently for SOB, crackles, tightness, etc) -tired, decreased LOC--> hyponatremia -high specific gravity and urine osmolarity -low PLASMA osmolarity

BMI calculation

weight in lbs X 703 / height in inches, squared

what LGBT population is most likely to be bullied

white and hispanic females

how long before the MD has to come see the pt with restraints?

within 1 hour of initiation

involuntary commitment admission

without patient's consent, if they are mentally ill and a danger to themselves or others, unable to acquire basic needs

what age group is most commonly diagnosed with schizophrenia

young people in their teens and early 20s, at the beginning of their productive lives

characteristics of physically abusive parents

younger, teens, not mature enough to handle responsibility and become easily frustrated Single parents or step parent Socially isolated parents, will keep child away from others Substance abusers -stress, divorce, poverty, poor housing

factors that contribute to decreased LES pressure (table 54-1)

• Caffeinated beverages, such as coffee, tea, and cola • Chocolate • Citrus fruits: oranges, lemons, etc • Tomatoes and tomato products • Smoking and use of other tobacco products • Calcium channel blockers • Nitrates • Peppermint, spearmint • Alcohol • Anticholinergic drugs • High levels of estrogen and progesterone • Nasogastric tube placement Pregnancy, obesity

adrenalectomy post op care

↑ Risk of hemorrhage bc adrenal gland is very vascular--Monitor for hemorrhage!! Q15min until stable, then every hour. CVP, I/O, vitals Large release of hormones into circulation → instabilities in BP, fluid balance, and electrolyte levels. Will require hormone therapy for life if both removed. If one is removed, the other will be sufficient eventually, up to 2yrs... pt will be on hormone therapy until then Monitor for acute insufficiency, infection

initial neuro assessment for stroke- done in ER (table 45-2)

● Level of Conscious - questions and commands ● Motor - Legs ● Limb Ataxia ● Gaze ● Sensory ● Visual ● Best Language (aphasia) ● Facial Palsy ● Extinction and Neglect ● Motor - Arms Scale from 0-40 Higher = more deficits = bad Can also do GCS: higher the # the better

hemorrhagic stroke signs and symptoms

● Severe headache (thunderclap) ● Declining LOC ● Photophobia ● Seizures ● Vomiting ● Nuchal rigidity ● AMS (altered mental status) ● Pupil Changes ● Increased Intracranial Pressure(ICP)- ↑ ICP Chart 45-6 ● Motor dysfunction

strains (TABLE 51-3)

*Pulling or tearing of either muscle or tendon or both* First degree (mild)-inflammation Tenderness, swelling, ecchymosis Second degree (moderate)-tearing of muscle or tendon Third degree (severe) - rupture of muscle or tendon complete separation; severe pain and disability

what are some covert statements a pt could make that would indicate suicidal ideation

"It's okay now. Everything will be fine." "I won't be a problem much longer." "Nothing feels good and never will again." "I want to give my body to medical science."

osteoarthritis (degenerative joint disease)

"Wear and tear " disease - very common due to playing sports and obesity Cartilage wears away and bone rubs together, particles of cartilage break and float leading to crepitus Joint becomes deformed, may have overgrowth of bone, painful, with limited ROM Risk factors: aging, obesity, trauma, heavy manual occupations, professional athletes (football, runners and gymnastics)

drug therapy for hyperparathyroidism

(1) furosemide (Lasix)-->first line tx (2) cinacalcet (Sensipar)-->for more severe s/s (3) Oral phosphates-->no response from others

depolarization

(Contraction) - The movement of charged particles across a cell membrane causing the inside of the cell to become positive.

repolarization

(Relaxation) - The movement of charged particles across a cell membrane in which the inside of the cell is restored to its negative charge.

PID interventions

*Antibiotic therapy:* Doxycycline [CEPHALOSPORIN} PO 14 DAYS Possible hospitalization depending on severity-->IV ABX *Care coordination and transition management*--> Transfer to PO abx *Home care management Self-management education* --Follow up with HCP after dc --Continue oral abx, complete course, etc, you know the deal at this point --Watch for recurrence: know symptoms!1 (abd pain, etc, see last slide) --Contact sexual partners- usually caused by STI --Condom use Health care resources

management of otitis media

*Antibiotic* - Drug of choice = Oral amoxicillin (80-90mg/kg/day, divided into 2 doses)- KNOW THIS - Will typically take for 10-14 days - Tell parents to complete ENTIRE prescription!! Day cares can give these to children so not an excuse *Manage other symptoms such as fever and pain* - Pain in ear= child will pull at ear *Recurrent infections* - Tympanostomy tube placement and adenoidectomy (avoid water in ear) - Usually go home same day - CAN fall out!!! Will fall out in about 6mos-year, normal. Just let dr know when they fall out. - Make sure fam knows that drainage post-op is normal - Clean ears are a must!! Only use a q-tip for things in EXTERNAL ear... do not try to dig inside - No water in ears!! Wear ear plugs *Chronic complication—hearing loss* - Multiple/reoccurring episodes/issues *Speech pathologist can also be consulted for hearing*

what are some things to avoid when conducting the clinical interview

*Arguing - "The CIA is monitoring us through the fluorescent lights in this room. Be careful what you say. Wrong - "That is impossible. The CIA is prohibited from operating in health care facilities." Right - "It sounds like you're concerned about your privacy." *False reassurance - The nurse says to a patient having suicidal ideations - "Don't worry everything will be all right *Interpreting - instead listen attentively, use silence and try to clarify the patient's problem Patient: I always take this towel wherever I go. Nurse: That towel must always be with you. *Probing *Sell the patient *Attacks *Criticizing

prevention of aspiration pneumonia

*At risk: tube feeding, unconscious, poor swallowing, neurologic injury* *Prevention:* - Elevate HOB - Turn patient to side when vomiting - Prevention of stimulation of gag reflex with suctioning or other procedures - Assessment, proper administration of tube feeding - Rehabilitation for speech therapy for swallowing - Avoid thin liquids with swallowing problems - Tuck chin to chest

dx tests for GERD

*Barium swallow*-->series of xrays to see delayed gastric emptying --Tell pt ok to have white/clay color stools, want this to happen --Drink lots of water post op --Laxatives may be ordered *Esophagogastroduodenoscopy* --Sedative and lidocaine spray on throat --Monitor vitals, O2, return of gag reflex --May give sips of water/ice chips to test --Throat soreness ok *pH monitoring*-->catheter thru nose for 48hrs to monitor pH level in esophagus --Pt keeps diary of s/s and foods eaten while tube is in --Most effective w/ GERD

complications of PUD

*Bleeding* --Check vitals, watch for hypovolemic shock (tachycardia, hypotension, tachypnea) --H&H, RBC, bleeding times, electrolytes (K+ and Na+) --EGD cauterizing --Make sure pt is on bedrest *Perforation* *Obstruction*

drug therapy for pneumonia

*Broad spectrum ab:* - Rocephin, Levaquin, and Zyvox - 72 hours after initiation should be switching to oral therapy if symptoms subsiding. - Avoid use in viral pneumonia- very easy for them to grow in this environment - Can only treat symptoms if viral - If pt is showing signs of improvement, will switch to oral AB and discharge - If temp, give antipyretic - Do not get them to perform any aggressive exercises in first few days, but make sure to get them out of the bed, even to chair

addison's labs

*CHART 62-8* Sodium levels (135-145)- low Potassium levels (3.5-5)- high Blood glucose levels- low Cortisol- low WBC- Eosinophils high

Transphenoid hypophysectomy Post operative care

*Chart 62-3* Sedated, drowsy, disoriented: Reorient to room, Assess neuro status frequently Diabetes insipidus could result!! --Monitor fluid status Positioning: Elevated HOB, relieve pressure Clear drainage--> CSF leakage. Halo sign: clear drainage w/ dark spot in center. RBC separate from CSF... Collect drainage, send to lab to confirm (has glucose in it). Must remain on bedrest to allow body to seal itself Constant drip in back of throat: LOOK w/ pen light. If blood, notify HCP. Assess vitals Headache, fever, stiff neck--> meningitis!! Recommend antibiotics

tx for PUD

*Combination drug therapy* --Proton pump inhibitors: 2 Antibiotics for 10-14 days -Flagyl and tetracycline OR Biaxin and amoxicillin --Bismuth (Pepto-Bismol)- may be added as a 4th drug to take throughout the day, PRN --Carafate, Antacids, H2 receptor antagonist --Bland diet; avoid bedtime snacks --Avoid irritants: Smoking, caffeine, alcohol

HPV interventions

*Drug therapy* *Cryotherapy, TCA or BCA, podophyllin* --Topical self-application: ---Podofiyox @ 2x daily for 3 days ---Aldara @ bedtime 3x week ---Sinecatechin 15%- 3x day for 16 wks or until gone *Self-management education* --Teach about transmission, incubation, treatment, complications, partner education --Recurrence is likely! Most vulnerable: 1st 3 months after --Make sure to test for other STIs + partner --Avoid sex until lesions are gone --Gardasil: Usually given as young as 9, BEFORE sexual activity begins --Paps starting @ 21, yearly; low risk- q3 years

pneumonia

*Excess fluid in lungs resulting from inflammatory process* *Inflammation triggered by infectious organisms, inhalation of irritants* - Community-acquired pneumonia - Hospital-acquired pneumonia - Aspiration pneumonia - - Pt with swallowing problems from dementia, immobility, stroke, etc - - Avoid straws, sit up, chin to chest, double swallow - - Aspiration precautions = interventions/teachings - - Checking GRVs in PEGs - - Coughing/choking w/ feedings? *Risk factors and Prevention* - Table 31-1 and Chart 31-1

pulmonary tuberculosis

*Highly communicable;* caused by Mycobacterium tuberculosis *Transmitted via airborne transmission* through talking, sneezing, laughing or singing small particles from droplets become airborne- NOT through kissing, utensils, etc - Know airborne isolation precautions - isolate pt immediately- don't wait - Incidence increase related to onset of HIV - Risks: HIV, homeless - Testing annually to make sure for HCW!! - Reportable to CDC!

hypothyroidism drug therapy

*Levothyroxine (Synthroid)= hormone replacement* Dosages start w/ lowest and gradually increased based on s/s Therapeutic response--> Labs should decrease Patient & family teaching: --Lifelong --Teach pt how to take pulse bc will initially cause bradycardia--> want it to return to normal, don't want tachycardia --Takes 4-6wks to work, sometimes 8

Epiglottitis: medical emergency what to do upon arrival in ER

*Nurses should avoid assessing the throat if suspected swelling* - child will be very irritated already, will make it worse, occlude airway even more Have emergency equipment available during throat inspection this is a bacterial infection= antibiotics!! -high fever, tripod, stridor, drooling and tongue protruding= key signs (compared to LTB) Oxygen with mask or flow by (not a mask, extra irritation= worsening of symptoms) Antibiotics, Steroids, IV fluids NPO, quickest onset Potential for respiratory obstruction if anxious Make sure someone the child knows is holding them/with them to decrease anxiety during treatment. Nurse just works with this

Open angle vs closed angle glaucoma

*OPEN* --most common --drainage canals become clogged gradually over months or years --eye pressure rises slowly --fluid is produced at a normal rate but drains slowly --painless, no early signs --blind spots or patches of vision loss --peripheral vision is usually lost first *CLOSED* --far less common --drainage canals suddenly become blocked or covered --medical emergency bc vision loss occurs in 2-3hrs --eye pressure rises rapidly bc fluid abruptly blocked while production continues (IOP 30mg of gr8r) --abrupt onset of severe eye pain and headache --rainbow colored halos around lights, sudden vision loss, n/v

patho and causes of GERD

*Pathophysiology* Gastric secretions reflux into esophagus-->can lead to esophagitis Esophagus damaged Sometimes goes undiagnosed, pt says they can treat themselves at home pH is higher in esophagus than stomach (more acidic in stomach) Causes: Lower esophageal sphincter does not close tightly; hiatal hernia

dx examinations for asthma

*Pulmonary function tests- initially* - Peak expiratory flow rates (PEFR)- Teach pts with asthma to keep up w/ this. Use it daily. Wil tell them when exacerbation is expected - Forced vital capacity (FVC) - Forced expiratory volume (FEV1) *ABGs* - Initially decrease in CO2 and later increase in CO2- Goes back and forth. Can be either acidosis or alkalosis *Sputum collection* - if you can, sometimes r/t infection *Skin testing (for allergy)* - find out what specifically to avoid that trigger

nursing assessment for asthma

*Respiratory* - Feeling of chest tightness - Shortness of breath - Prolonged expiration - Retractions - Tachypnea - Dry cough- mucus - Wheezing, rhonchi--If pt has been wheezing for a while, but suddenly silent= medical emergency!!! - Nasal flaring - Hypoxia *Cardiovascular* - tachycardia *neurologic* - symptoms of hypoxia - restlessness - anxiety - difficulty sleeping - unable to speak a few words, very short of breath *Integumentary* - pallor - cyanosis *Musculoskeletal* - exercise intolerance

Lifestyle modifications for HTN

*Sodium restriction* -2400mg/daily; 1500mg is preferred -Foods high in sodium—canned foods, processed, etc. -More fluid volume= higher BP -KNOW WHAT FOODS ARE HIGH IN NA+ *Weight reduction* - Lowers bp and glucose level *Reduced alcohol intake to 1-2 drinks/day Exercise- 30mins, 5 days out of the week Decrease stress levels Avoid Smoking and caffeine - vasoconstrictors*

treatment for hemorrhagic stroke

*avoid anything that would cause more bleeding!!* Avoid anticoagulants and platelet inhibitors Blood Pressure Control Craniotomy (if surgical) □ Clamp □ Coil □ Remove Complete Bedrest - Avoid any unnecessary activity, pay attention to how you turn the pt- Log roll with draw sheet Meds for cough reduction Elevate HOB Want to stop extra bleeding in brain/pooling Lighting in the Room- dim lighting bc pts are v sensitive Avoid Valsalva maneuver- give a stool softener

drug therapy teaching for TB (chart 31-3)

*Watch for signs of liver damage* - Less appetite, or no appetite for food - An upset stomach or stomach cramps - Nausea or vomiting - Cola-colored urine or light stools - Rash or itching - Yellowing skin or eyes - Increased bleeding time (PT, PTT) Tingling or numbness in your hands or feet Secretions and urine will turn orange and stain clothing STRESS must follow and adhere to drug schedule to avoid TB resistant

COPD nutritional therapy

*Weight loss and malnutrition are common.* - Pressure on diaphragm from a full stomach causes dyspnea. - Difficulty breathing while eating leads to inadequate consumption. *To decrease dyspnea and conserve energy* - Rest at least 30 minutes before eating. - Use bronchodilator- prior to eating *Take in high calorie, high protein foods!!* - Avoid drinking at same time, get full too fast *Avoid* - Foods that require a great deal of chewing - Exercises and treatments 1 hour before and after eating - Gas-forming foods *High-calorie, high-protein diet is recommended.* *Fluids (intake of 3 L/day) should be taken between meals.* *Soft mechanical diets can help!* *Avoid foods that will make them feel bloated* *Smaller meals? 6 small meals/day, decreases bloating* *Educate family members abt foods at home*

drug therapy for osteoporosis

*biphosphonates*--> slow bone destruction --Alendronate: Fosamax --Risendronate: Actonel --Ibandronate: Boniva --Take on an empty stomach first thing in the AM w/ a full glass of water. Remain upright standing or sitting for 30mins after. --CAN CAUSE ESOPHAGITIS - also osteonecrosis of jaw *estrogen agonists/antagonists* -evista: prevents bone loss and increases bone density -monitor for signs of DVT and monitor LFT's

pt education for propylthiouracil (PTU) hyperthyroidism

*blocks iodine binding but may be stored hormones* -Delayed response -Patient teaching ---Prevention of infection: stay away from sick and crowds, hand washing, etc -DO NOT ABRUPTLY D/C ---However, can eventually stop taking and go into remission, not necessarily therapy for life -Therapeutic versus nontherapeutic response ---Pulse return to normal, no more hot flashes, etc. mainly treated outpt in community ---Not enough= continuation of symptoms ---Too much= hypothyroidism. Teach them these signs so they know!! -Adverse effects: Yellow skin, Dark urine, LIVER TOXICITY

s/s of GERD

*general* Heartburn- #1 Dyspepsia Regurgitation Dysphagia Bleeding: if esophagus has been exposed for a long period of time to acid, mucosal lining starts to break down *INFANTS* Spitting up, regurgitation, vomiting (may be forceful) Excessive crying, irritability, arching of the back with neck extension, stiffening Weight loss, growth failure (failure to thrive) Respiratory problems, fluid in back of throat. (cough, wheeze, stridor, gagging, choking with feedings) Aspiration!!

risk factors for atherosclerosis (table 36-4)

*modifiable* Physical inactivity- teach exercise Diet- teach high fatty foods to avoid Tobacco smoking Hypertension Diabetes- A1C 6.5 or below Obesity Low HDL-C- should be high High LDL-C- should be low Increased Trigylcerides *non-modifiable* Family history Increasing age Gender Ethnicity

risk factors for TIA and brain attack

*modifiable* Smoking Substance Use (Cocaine) Obesity Sedentary Lifestyle Heavy alcohol use Oral contraceptive use *nonmodifiable* Race Age Women *modifiable w/ treatment* hypertension diabetes high cholesterol

diabetes insipidus- types

*not enough ADH* Primary neurogenic- problem w/ hypothalamus and pituitary gland, directly affected Secondary neurogenic- something else has cause the problem, tumor, head injury, surgery, etc Nephrogenic- unique; not a problem with ADH secretion, but interferes w/ kidneys RESPONSE to ADH, inherited Drug-related: LITHIUM

prevention and treatment of TIA

*prevention* Lifestyle changes Smoking cessation Diet changes-> low fat Exercise Decrease alcohol consumption (mild to moderate) Omega 3 -> helps reduce plaque growth and inflammation, which reduces clot formation- Lowers triglyceride levels *treatment* -antihypertensives -antiplatelets -antidiabetics

causes of SIADH

*too much ADH* Malignancies Pulmonary disorders- lung disease is very often the cause, lungs begin to make ADH, causes an increase in production CNS disorders- tumor, trauma, etc Drugs- antiepileptics (carbamazepine), opioids, tricyclic antidepressants

TB interventions

- Combination drug therapy with strict adherence: Isoniazid, Rifampin, Pyrazinamide, Ethambutol *Chart 31-1* - 3 Negative sputum culture = no longer infectious - May have to be kept/monitored in a facility to make sure they take meds and do not spread to others - Go back to work 2-3wks after symptoms resolve. Dr will determine when - Everyone in the TB person's home should be tested for exposure - Should wear mask, cover sneezing, coughing, etc, good cleaning, hand hygiene - Not everyone with active TB is hospitalized!! Can be treated at home!!

complications of COPD

- Hypoxemia - Acidosis- monitor ABGs--Trouble getting rid of CO2- Get rid of it w/ ventilator, BIPAP, etc - Respiratory infections (pneumonia)--Pneumonia vaccine!! Prone to bc of mucus in airway - Cardiac failure, especially cor pulmonale, Right sided heart failure -- More work for heart bc of pressure from lungs= enlargement of RS= HF --Peripheral edema!! Ascities Diuretics!! Lasix!! - Cardiac dysrhythmias- Atrial fibrillation - Polycythemia= more blood cells and iron produced as compensation by body. - Pulmonary embolus= use coumadin, eloquis, long term at home Treat underlying cause

treatment for ischemic stroke

- IV Fluids of isotonic (don't want ICP, edema) non-dextrose (don't want to elevate glucose) solution - HOB low to maximize cerebral flow, but higher or at 30º if need to prevent aspiration or improve oxygenation- 10-15 degrees - Thrombolytic Therapy IV >Given at onset up to 4.5 hours from beginning symptoms >Contraindicated for hemorrhagic CVA Control of hypertension systolic > 180 and diastolic > 105 - Want to make sure its on the higher end!! To help with perfusion. But control it, keep under 180/150 Anticoagulants- will be ordered after tPA is over Antiplatelets - 24 hours after tPA Surgery- Endovascular Interventions, Carotid artery angioplasty with stent placement ○ A catheter is placed through the groin ○ See Nursing Safety Priority p. 939

emphysema

- part of COPD - Loss of lung elasticity and hyperinflation of lung - Air trapping and overstretching and enlargement of alveoli, collapse of small airways (bronchioles) - Prolonged expiration

cast care

--Elevate to reduce edema --Ice packs 24-48 hours for swelling and pain: Make sure isn't watery and dripping on cast --Position air dry circulates around and under the cast; do not cover cast --Handle wet cast with palms not fingers --Neurovascular checks!!! Can fit 1 finger under cast --Circle any drainage & write date & time. explain this process to pt --Analgesics for pain

osteoporosis prevention

--Follow a balanced diet high in calcium and vitamin D throughout life --Use calcium supplements to ensure adequate calcium intake: take in divided doses with vitamin D --Calcium carbonate, OsCal (take with food, 6-8 ounces of water) --Regular weight bearing exercises: walking best --Prevention of falls to avoid fractures (compression fx) --Dual x-ray absorptiometry (DXA)- bone density test

HPV

--Skin-to-skin contact: vaginal, anal, oral sex, Also: non-penetrative sex --Incubation period ranges from weeks to months to years --Infection with 1 type of HPV does not prevent infection with another type --Previously named genital or venereal warts --Incubation: "several weeks" --More frequent in pregnant women --Recurrence is likely --Single, small white or flesh-colored papillary growths that may grow into large, cauliflower-like masses. Painless --Warts may disappear and resolve, or recur. Internal and external --chronic vaginal discharge and spotting --Pap and HPV DNA testing; other STI tests may be done as well --Wart biopsy

tx of pulmonary embolus

-associated w/ DVT -s/s of fat embolus except petechiae -lovenox by weight

Prodromal (prepsychotic) phase of schizophrenia

-first Mild symptoms, difficulty sleeping, irritable, subtle signs that something is wrong

maintenance phase of schizophrenia

-fourth Symptoms in remission, with possible presence of milder, persistent residual symptoms Sometimes pt will never go into complete remission, but will be a significant decrease. Normal for them, not us

risk factors for hyperglycemia/diabetes

-genetics -aging process -unhealthy lifestyle choices -ethnicity -recurrent infections -longer healing time -pancreatitis -glucocorticoids (prednisone/solu-medrol) -thiazides and dilantin -pregnancy -stress -prediabetes -gestational diabetes (large babies) -metabolic syndrome (Abdominal obesity, Hyperglycemia, Abnormal A1C, Hypertension, Hyperlipidemia)

A patient has severe pain and bladder distention related to urinary retention and possible obstruction. An experienced nursing assistant states that she received training in Foley catheter insertion at a previous job. What task can be delegated to this nursing assistant? 1. Assess the bladder distention and the pain associated with urinary retention 2. insert the Foley catheter, once you ascertain that she knows sterile technique 3. evaluate the relief of pain and bladder distention after the catheter is inserted 4. measure the urine output after the catheter is inserted and obtain a urine specimen

4. measure the urine output after the catheter is inserted and obtain a urine specimen

clinical manifestations of hyperthyroidism

INCREASED BMR Heat intolerance, even in cold weather Weight loss Increased appetite Hr increased w/o excess activity Diarrhea Bulging eyes

assessment of suicide potential in MDD areas to assess

Affect- flat Thought processes Mood- sad, lethargic Feelings- guilt hopelessness Physical behavior- lack of energy Communication- may become mute Religious beliefs and spirituality- may have abandoned them/stopped participating

Labs and dx for pneumonia

All are treated relatively the same Will go ahead and start broad spectrum antibiotics Gram stain, culture and sensitivity of sputum CBC ABGs Blood cultures Chest x-ray- confirmation Pulse oximetry

give an example of an appropriate nursing dx for a pt that has a DSM dx of major depression

Alteration in sleep pattern related to biochemical imbalance as evidenced by patient reports sleep of 2-3 hrs. per night for the past 2 weeks.

positive symptoms of schizophrenia

Alterations in reality testing --Delusions − False, fixed beliefs. Most common are: Persecutory; grandiose, or religious ideas (Table 12-1) --Concrete thinking − Inability to think abstractly Alterations in perception Alterations in behavior alterations in speech ( associative looseness, clang association, neologisms, echolalia)

cyclothymic disorder

Alternate with symptoms of mile to moderate depression for at least 2 years (adults) Rapid cycling possible Begins in early adolescence/early adulthood usually

communication guidelines for alzheimers

Always identify yourself. Call the person by his or her name at each meeting. Speak slowly. Use short, simple words and phrases. Maintain face-to-face contact. Be near the patient when talking, one or two arm lengths' away. Focus on one piece of information at a time. Talk with the patient about familiar things. Encourage reminiscing about happy times. Bc eventually they wont remember When the patient is delusional, acknowledge the patient's feelings and reinforce reality. Do not argue or refute delusions Have the patient wear eyeglasses or a hearing aid. Keep the patient's room well lit. Have clocks, calendars, and personal items (e.g., family pictures, Bible) in clear view. Reinforce the patient's pictures, nonverbal gestures, X's on calendars, and other methods to present reality.

cluster C PD

Anxious types: Avoidant Dependent Obsessive-compulsive

what are the criteria for a diagnosis of suicide behavior disorder according to the DSMV model?

Attempt within last 24 months Attempt was not initiated in delirium or confusion Attempt was not undertaken for a religious or political objective

hallucinogen intoxication symptoms

General: alters thought processes, paranoid, psychotic symptoms, hallucinations (visual), lose concept of time, out of body experience/dejavu PCP: medical emergency, become violent and aggressive, belligerent

health promotion and maintenance for gastritis

Balanced diet Regular exercise Stress-reduction techniques Limit foods and spices that cause gastric distress. Avoid tobacco, alcohol. Avoid excessive use of aspirin, NSAIDs. PPI Combination therapy if h pylori

VTE treatment

Bed rest Elevation Anticoagulant therapy ---Heparin drip: starting to see a decrease in tx w/ this bc risks are extremely high ---Low molecular weight heparin ---LOVENOX: 1mg/kg of body weight not to exceed 90mg Warm moist packs ---Helps with comfort in this situation ---Cellulitis- causes more vasodilation, promotes healing Do not massage

assessment and tx of bleeding as a complication of PUD

Blood pressure and pulse should be monitored every 15-30 minutes w/ evidence of GI bleeding Hematocrit and hemoglobin levels (H&H)- Can take up to 4-6 hours to notice any abnormalities. re-draw q6hrs H&H Goals are to stop bleeding and replace blood loss--> Blood transfusion IV fluids replacement isotonic solution, 0.9% NS or LR Stabilized patient; look for source--> Endoscopic examinations -EGD, Colonoscopy, Electrocauterization NG tube placed to evacuate blood--> *Normal saline* lavage for severe bleeding Antacids- May administer q4h thru tube

osetoporosis

Bones become brittle, fragile due to a reduction in bone mass (osteoclast) activity is greater than the rate of bone formation (osteoblast) activity. Affects the spine, wrist, & hips most times more frequent in women.

cellulitis

Can be caused by Streptococcus, Staphylococcus aureus, or Haemophilus influenza Can be related to puncture, wound, etc Local manifestations- Edema, Erythema, Pain, Skin hot to touch, Can be treated outpatient if not bad Systemic manifestations- Fever, Malaise

syphilis

Can become systemic and cause serious complications, including death --Chancre is first sign of primary syphilis- Goes away after around 6 weeks, Comes back: considered systemic (6 wks-6mos) --Primary, secondary, tertiary stages --Secondary= systemic: Flu like symptoms, rash has spread. penile lesion disappears then comes back, rash is spread to other places (hands, feet, mouth) Incubation period: 10-90 days COMPLICATIONS: Neurosyphilis, cardiovascular syphilis Chancre specimen--> WEAR GLOVES VDRL and RPR tests

dx tools and therapeutic management for cellulitis

Complete blood count Blood cultures Culture of affected area Initially intramuscular or intravenous does of antibiotics, then 10 days of oral antibiotics More systemic-- >IV dose

PID assessment

Complete history Menstrual, obstetric, sexual, and family histories History of previous PID and/or STI diagnosis Contraceptive use Reproductive surgery Other risk factors Sexual abuse Lower abdominal or pelvic pain is most frequent symptom May have vaginal bleeding, dysuria vaginal discharge, malaise, fever, chills Pelvic examination may show discharge, "friable" cervix Patient may be anxious and fearful Laboratory assessment: ESR, CRP, WBC INCREASED: INFECTION AND INFLAMMATION Other diagnostic assessment: Abd or transvaginal ultrasound to identify absesses

management of hypoglycemia

Conscious patient -15g of quick-acting carbohydrate -4-6 ounces of juice or soft drink -8 ounces skim milk -Two or three glucose tablets or 15 g of glucose gel Unconscious patient or unable to swallow -Injectable glucagon 1mg -IV 50% dextrose per order Check again in 15mins

characteristics of abuse perpetrators

Consider their own needs more important than the needs of others- don't care abt the other person's needs. Satisfaction out of being "power holder", in control Poor social skills- keep the victim from doing so as well Extreme pathological jealousy May control family finances- sense of control

htn drug therapy (chart 36-1)

Diuretics- na and k, daily weight Calcium channel blockers Angiotensin-converting enzyme (ACE) inhibitors- Monitor K Angiotensin II receptor Blockers (ARB) Beta-adrenergic blockers Renin inhibitors Know a/e of these- ortho hypo, etc Low BP-- give fluids, Trendelenburg's (elevate feet and lower head)

oral anticoagulants

Dabigatran Rivaroxaban Apixaban Warfarin

what should you chart after administering a vaccine

Date Vaccine name (dose #) Manufacturer, Lot number, and expiration date- keep your vial to know these Site and route (left vastus lateralis, IM) In infants, deltoid is not enough tissue yet Toddlers, just depends, but VL to be safe Edition date of VIS given to family Name of the person giving the vaccine Your signed name

Dawn phenomenon in diabetes

Dawn phenomenon (normal process) -Morning hyperglycemia present on awakening -Due to release of counterregulatory hormones in predawn hours If the 2:00 to 4:00 AM blood glucose level is high, the insulin dosage should be increased. In addition, counsel the patient on appropriate bedtime snacks

risk factors for otitis media

Day care settings!! Smoking environments!! Allergic rhinitis/allergies= higher risk Cleft palate Propping of bottles (mom doesn't actually hold it up, propped up somewhere)

drug therapy for allergic rxns

Decongestants- Causes vasoconstriction-->stops leaking, Not for pt with hypertension Antihistamines- Dry mouth, drowsiness Corticosteroids Mast cell stabilizers Leukotriene antagonists

hypothyroidism patho

Deficiency of thyroid hormone Slow metabolic rate More common in women than in men

what are some typical characteristics of autism spectrum disorder

Deficits in social relatedness and relationships Stereotypical repetitive speech Obsessive focus on specific objects Over adherence to routines or rituals Hyper- or hypo-reactivity to sensory input Extreme resistance to change Appears in early childhood-First 3 yrs of life Deficits in social interaction, child is not affectionate

communication strategies for pts with bipolar disorder

Display a firm, calm approach. Express short, concise explanations or statements.- pt is not able to focus well on what you're saying Remain neutral. Maintain consistency. Conduct frequent staff meetings to agree on approach and limit setting. Hear and act upon legitimate complaints. Firmly redirect energy.

types of depressive disorders

Disruptive mood dysregulation disorder Persistent depressive disorder (previously dysthymia) Premenstrual dysphoric disorder Substance/medication-induced depressive disorder Depressive disorder due to another medical condition MDD is most common

nursing implications for delirium

Distraction-reduced environment Communication Reality-orientation aids Maintain consistency-Have a schedule Encourage family members box 23.2

medications for treatment of alcohol disorder

Disulfiram (Antabuse)- most common, for the actual abuse tx If they drink alcohol, will have very intense symptoms- NV, headache, breathing difficulty Hopefully, bc of the symptoms, the pt wont drink anymore. Also includes substances WITH alcohol Table 22.6 Benzodiazepines for withdrawal symptoms

interventions to reduce preload and enhance contractility in HF

Diuretics Nitrates Diet Low dose beta blockers (Coreg) (Chronic HF) Digoxin

postictal manifestations of complex partial seizures

Don't remember anything, may not be able to return to normal activity. May need a recovery period, feel tired

S/S of pulmonary embolism

Dyspnea Hemoptysis Tachypnea Tachycardia Chest pain Feeling of impending doom Cyanosis Coughing Altered mental status

S/S of left sided heart failure

Dyspnea Orthopnea Pulmonary crackles Cough Frothy sputum

cluster A PD

Eccentric types: Paranoid Schizoid Schizotypal

dx tools for CHF

Echocardiogram Ejection fraction B-type Natriuretic Peptide (BNP) --Cardiac hormone released when there is decreased cardiac output --normal <100 --The higher the level, the more severe the failure

S/S of right sided heart failure

Edema: Legs Thighs Genitalia Lower trunk Liver Abdomen (ascites) Jugular veins distention

gastritis assessment (chart 55-2)

Epigastric alterations in comfort Nausea, vomiting, upper abdominal or epigastric pain Gastric hemorrhage- emergency. --Hematemesis, melena --Bright red= lower bleed --Dark = upper bleed NPO until source is figured out Diagnostic assessment- EGD, Cytologic examination, Rapid urease testing

cluster B PD

Erratic types: Borderline Narcissistic Histrionic Antisocial

Symptoms of myoclonic seizures

Excessive jerk or twitch of an extremity. Pt may be hurled to ground, dangerous

cushing's patho/causes

Excessive secretion of cortisol Causes- adrenal gland hyperplasia; pituitary tumor; adrenal gland tumor; corticosteroid therapy Interfering w/ body's feedback loop-->too much

difference between anxiety and fear

FEAR = a reaction to a specific danger. ANXIETY = a feeling of apprehension, uneasiness, uncertainty, or dread resulting from a real or perceived threat whose actual source is unknown or unrecognized.

systemic infection

Fever-->increased temp is attempting to kill the bacteria, etc Elevated HR, RR Malaise Chills Enlarged lymph nodes Diarrhea Vomiting Confusion (elderly first sign of inf)- *encephalopathy*. Even pt with dementia!! Change in their baseline

celiac disease

Genetic autoimmune disorder when ingestion of gluten damages the small intestines villi that are responsible for nutrient absorption Gluten is a protein found in wheat, rye, barley

what are some nursing Dx for children with autism

Impaired Social Interaction- top dx - Short-term - Client will demonstrate trust in one caregiver (as evidenced by facial responsiveness and eye contact) - Long-term - Client will initiate social interactions (physical, verbal, and nonverbal) Impaired Verbal Communication Short-term - Client will establish a means of communicating needs and desires to others

gastritis

Inflammation in the lining of the stomach Acute--> Erosive- caused by NSAIDs, alcohol use, or radiation treatment Arthritis, typical chronic pain Chronic--> Nonerosive- caused by Helicobacter pylori infection H. pylori likes the stomach environment, can live in the lining for a while Start to see changes in characteristics of stomach

otitis media

Inflammation of the middle ear- just focus on acute process of it Eustachian tubes are for drainage in ears Tympanic membrane for sounds/vibrations - normal color is pearly/grey - when infected, red and bulging, start to get symptoms Usually follows a respiratory infection caused by RSV and influenza

allergens that cause a hypersensitivity rxn are contracted by..

Inhalation (pollens, spores, animal dander, dust, grass, ragweed)Environment-->more risk w/ southern states, etc Ingestion (foods, food additives, drugs) Injection (bee venom, drugs, biologic substances) Contraction (latex, pollens, foods, environmental proteins)

assessing for abuse/indications of

Interview process- know history, family situation, home life, what happened. Victim must disclose abuse--> establish trust, rapport, talk in private -How do you and your partner resolve disagreements? Violence indicators -Bruises on face, abdomen, back, buttocks Level of anxiety and coping responses -Very fearful, quiet, around perpetrator. Will look at them before answering a question, hesitant to answer. No eye contact Family coping patterns- really a community nurse's job, go into pts home, observing conditions, patterns Support systems-Did someone close to you cause the injuries? Suicide and/or homicide potential- high risk- Perpetrator is now commonly the one committing suicide Drug and alcohol use Documentation- objectively, open ended questions, use of body map, maybe take pictures if pt says ok, ask them to return in a few days to assess progress

diabetes prevention- dietary fat

Limiting total fat intake to 20% to 35% of daily calorie intake • Choosing monounsaturated and polyunsaturated fats over saturated fats and trans fats • Limiting dietary cholesterol to less than 200 mg/day • Having two or more servings of fatty fish per week (with the exception of commercially fried fish) to provide n-3 polyunsaturated fatty acids Fiber minimum of 25 g of fiber daily for women and 38 g daily for men

Histrionic Personality Disorder

Manipulative, insensitive Dramatic, rapidly shifting, charming, flamboyant, and sexually seductive behaviors Need to become and remain the center of attention, love, and admiration Constant, sudden emotional shifts and lability Superficial, shallow, short-lived relationships Lack insight into cause of relationship failures Guidelines for nursing care: Know that seductive behavior is a response to distress. Keep interactions professional; ignore flirtations. Model concrete language. Help patient clarify inner feelings Teach and role-model assertiveness. Treatment: psychotherapy

AV node

May be called the AV junction if it includes the Bundle of His. Its function is to delay impulse to the Bundle of His, allowing time for the atria to empty their contents into the ventricles before the onset of ventricular contraction. This is known as the atrial kick, contributing as much as 30% of the cardiac output. Passage of the electrical impulse from the SA node through the AV node and Bundle of His is reflected on the EKG as the PR interval. Intrinsic rate of 40-60 beats per minute.

considerations for hypoglycemia in gestational diabetes

May not recognize the symptoms of hypoglycemia Decreased renal function Takes longer for oral hypoglycemia agents to be excreted by the kidneys Decreased appetite, financial limitations Skipping meals may occur

prevention of hypoglycemia

Meal is served within 15-30 minutes of rapid acting insulin Eats the prescribed diet and between meal snacks, bedtime snacks If nausea, vomiting, diarrhea, or if client is NPO MD should be aware Administering the correct medication and types of insulin at the right times Check insulin with another nurse

symptoms of complex partial seizures

Similar to petit mal, pt is in a dream like state Automatisms- smack lips, appear to be chewing something, repetitive tapping. Lasts 30sec-2mins

primary drugs for controlling seizures

Phenytoin (Dilantin)- very common Carbamazepine (Tegretol)-No grapefruit Phenobarbital (Luminal) Divalproex (Depakote)

characteristics of vulnerable older adults to abuse

Poor mental or physical health Dependent on perpetrator (caregiver rolestrain) Female, older than 75 years, white, living with a relative Elderly father cared for by a daughter he abused as a child Elderly woman cared for by a husband who has abused her in the past

characteristics of women vulnerable to abuse

Pregnancy may trigger or increase violence- becomes v dangerous bc baby is in danger too Violence may escalate when wife makes move toward independence, tries to escape Greatest risk for violence when the woman attempts to leave the relationship

SA node

Primary pacemaker of the heart. Firing of the SA node creates the P wave which indicates atrial depolarization. Intrinsic rate of 60-100 beats per minute - richly supplied by sympathetic and parasympathetic nerve fibers so the heart rate varies with activity. Impulse leaves the SA node and travels to AV node by means of three internodal pathways.

post procedural care for percutaneous vascular intervention

Priority for nursing care following a PTCA is to observe for bleeding at the arterial puncture site. -->Made an incision= risk for bleeding Some drs will say to cont lovenox and some will say to hold it. make sure you clarify! Monitor for manifestations of impending hypovolemic shock, including a decrease in blood pressure, increased pulse rate, and decreased urinary output. Monitor vitals--> may be an internal issue Perform frequent checks of the distal pulses in both legs to ensure adequate perfusion and oxygenation. Anticoagulant or antiplatelet therapy will be continued before and after procedure to avoid clotting. So RISK FOR BLEEDING

definition of delegation

Process of transferring to a competent person the authority to perform a selected nursing task or activity in a selected patient care situation. -nurse is still ultimately responsible

Alzheimer's characteristics

Progressive deterioration of cognitive functioning and global impairment of intellect No change in consciousness Difficulty with memory, problem solving, and complex attention At least two of these cognitive functions must be impaired for a diagnosis of dementia: -Memory -Communication/language -Attention span or ability to focus or concentrate -Reasoning and judgment -Visual perception

clinical manifestations of TB

Progressive fatigue Lethargy Nausea Anorexia Weight loss Irregular menses Low-grade fever, night sweats Cough, mucopurulent (mucus and pus) sputum, blood streaks (hemoptysis)

prevention of VTE for bedridden pts

Promote activity and exercise Ankle-pumping exercises TED hose (elastic stocking) venous compression devices

nursing management for abused children

Protect the child from further abuse- Taking care of injuries Support the child- making sure they play together Support the family- Nurses must not become substitute parent!! Encourage attachment to non-abusive parent/caregiver Plan for discharge- Where is the child going? Foster care? Another relative? Child should not be released until court has reached a decision

right ventricular failure

Right ventricle is unable to pump effectively against increased pressure in the pulmonary circulation. Blood cannot move forward into the lungs results in peripheral congestion. Right ventricle unable to empty and cannot accommodate all the venous blood. Forcing fluid out of the vascular into the interstitial space Peripheral edema

give an example of autonomy

Rather than giving advice to a client who has difficulty making decisions, a nurse helps the client explore all alternatives and arrive at a choice.

PTSD in adults

Re-experiencing of the trauma - Military combat, car accident, school shootings, environmental traumas (the flood) Avoidance of stimuli associated with trauma- too many bottled up emotions. Must be dealt with Persistent symptoms of increased arousal- Increased anxiety, alterations in mood.

somogyi effect in diabetes

Rebound effect in which an overdose of insulin causes hypoglycemia Release of counterregulatory hormones causes rebound hyperglycemia If a patient is experiencing morning hyperglycemia, checking blood glucose levels between 2:00 AM and 4:00 AM A bedtime snack, a reduction in the dose of insulin, or both can help to prevent the Somogyi effect

foods high in iron

Red Meat Organ meat (liver) Egg yolks Kidney beans Leafy green veg Raisins

peptic ulcer disease

Referred to as a gastric, duodenal, or stress ulcer Erosion of GI lining Primary cause: Bacterium H. pylori Curable Influenced by smoking

patient outcomes for bulimia nervosa

Refrain from binge-purge behaviors. Demonstrate two new skills for managing anxiety. Obtain and maintain normal electrolyte balance. Be free of self-directed harm. Express feelings in a nonfood-related way. Name two personal strengths.

patient outcomes for anorexia nervosa

Refrain from self-harm. Normalize eating patterns, as evidenced by eating 75% of three meals per day plus two snacks. Achieve 85% to 90% of ideal body weight. Be free of physical complications. Demonstrate two new, healthy eating habits. Demonstrate improved self-acceptance, AEB verbal and behavioral data. Address maladaptive beliefs, thoughts, and activities related to the ED. Participate in the treatment of associated psychiatric symptoms (e.g., defects in mood, self-esteem). Participate in long-term treatment to prevent relapse.

how to determine regularity on ECGs

Regularity means that each R wave is the same distance from every other R wave.

cortisol function

Regulate metabolism, ↑ blood glucose Critical in physiologic stress response Cannot live w/o!!!

aldosterone function

Regulate sodium and potassium balance Holds Na+, secretes K+

treatment for metabolic alkalosis

Results from ingesting to much bases (antacids, bicarbonate), blood transfusion, nasogastric suctioning, vomiting, diuretics, laxatives Assessment: Symptoms of hypocalcemia and hypokalemia Treatment is aimed at the cause -GI losses: antiemetic -Fluid and electrolyte are replaced PO or IV-->Monitor serum electrolyte levels closely Respiratory alkalosis teach stress relieving techniques and identify causes of anxiety

duodenal ulcers (PUD)

Right of or below midepigastric/ burning/cramping pain increased 1.5-3 hours after meal/middle of night (empty stomach). Relieved with food or antacids

nursing dx for alzheimers

Risk for injury Impaired verbal communication Impaired environmental interpretation syndrome Impaired memory Confusion Caregiver role strain

how to determine rate in ECGs

Rule of 10 - An approximate rate can be calculated by counting how many R waves occur in a 6 second strip and multiplying that number by 10. Rule of 1500 - Locate two consecutive R waves. Count the number of small blocks between the two R waves and divide that number into 1500. Can use for irregular HR Rule of 300 - If two consecutive R waves fall on a bold line, count the number of large squares and divide that number into 300.

What is the SAD PERSONS scale?

S: Male sex → 1 A: Age If <19 or >45 years → 1 D: Depression or hopelessness → 2 P: Previous suicidal attempts or psychiatric care → 1 E: Excessive ethanol or drug use → 1 R: Rational thinking loss (psychotic or organic illness) → 2 S: Separated, widowed, or divorced → 1 O: Organized plan or serious attempt → 2 N: No social support → 1 S: Stated future intent (determined to repeat or ambivalent) → 1 *Guidelines for Clinical Action* 0-5: May be safe to discharge (depending upon circumstances) 6-8: Probably requires psychiatric consultation > 8: Probably requires hospital admission (voluntary or involuntary)

diabetic neuropathy-microvascular

Sensory: -Decreasing sensations; numbness; tingling usually in feet and hands -Pain-burning, cramping, crushing feeling/Sensitive to touch -Foot injury and ulcerations develop -Drug therapy (Neurontin and Lyrica) for pain relief Autonomic: -digestive- gastroparesis (delayed gastric empyting) -Urinary retention -sexual dysfunction

COPD exacerbation treatment

Short-acting bronchodilators- mild situations Corticosteroids- inflammation Antibiotics- pneumonia, chronic bronchitis Mucolytics- remove secretions, tell them to cough, encourage fluids Supplemental oxygen therapy- don't be aggressive, 2-3L so avoid decreasing hypoxic drive BIPAP machines are gr8

lower risk suicide methods

Slashing wrists, inhaling natural gas, ingesting pills

what are some deficits experienced in autism

Social and emotional reciprocity Verbal and nonverbal communicative behaviors used for social interaction Developing and maintaining relationships appropriate to the developmental level

alcohol withdrawal symptoms

Starts with mild tremors/jitters, can progress to seizures- for those w/ heavy alcohol use. They'll drink again to get rid of symptoms. Librium drug can help-sedative/hypnotic Pt may develop psychosis w/o tx= medical emergency, bc can quickly progress to seizures, coma, delirium. Treat with Librium and benzos Autonomic symptoms: increased HR, RR

to be diagnosed with autism spectrum disorder, a child must demonstrate what types of behaviors

Stereotyped or repetitive speech, motor movements, and echolalia, and the repetitive use of objects Excessive adherence to routines, rituals, or excessive resistance to change Fixated interests that are abnormal in intensity Hyporeactive or hyperreactive to the sense of joy or unusual interest in sensory aspects of the environment (e.g., indifference to pain, heat, cold)

what does the termination phase of peplau's model of the nurse-pt relationship consist of

Summarize goals and objectives achieved Discuss ways for patient to incorporate new coping strategies learned Review situations of relationship Exchange memories

Common causes of delirium

Surgery Drugs Infection, hypoglycemia, fever, other homeostatic disruptions Pain, emotional stress Pneumonia, cerebrovascular disease Congestive heart failure (CHF)

acute treatment of ischemic stroke

Thrombolytic Agents - tPA(tissue plasminogen activator)/Altepase/Activase- CLOT BUSTER □ Dose - 0.9 mg/kg (Max dose of 90 mg) □ Nursing Responsibilities ○ Neuro assessment frequently - SEE Chart 45-5 ○ Monitor BP - look for ICP!! ○ Avoid invasive tubes ○ Discontinue if bleeding occurs ○ Repeat CT scan after treatment

Folic acid deficiency anemia

Unable to absorb vitamin B12 diet intake (vegan diet, lack of diary products) GI tract absorption (small bowel resection, gastrectomy) alcohol absorption

what are obsessions in OCD

Unwanted, intrusive, persistent ideas, thoughts, impulses, or images that cause significant anxiety or distress Same underlying result=anxiety They feel like they have to perform these rituals to reduce anxieties

live vaccines

Varicella MMR (measles, mumps, rubella) LAIV (live attenuated influenza virus)(nasal spray) Going back to injections bc not good results w/ nasal spray Rotovirus Herpes Zoster (Shingles)

transphenoid hypophysectomy pre-op care

What can the patient expect after the procedure? Wake up in ICU, surrounded by tubes and machines Feel something in their nose--> nasal packing (gauze) to collect drainage, mustache dressing Explain that nasal packing will be present for 2-3 days. Instruct not to brush teeth, cough, sneeze, blow nose, or bend forward afterwards. May increase pressure on incision, muscle graft Can give antihistamine, etc Culture nasal and oral mucus membranes No infection before surgery!! Can go to brain

5 lead ECG electrode placement

White-right arm Black left arm Green right leg Red left leg Brown chest White snow tops over trees Smoke over fire Brown in center

what do to for severe sepsis (table 37-5)

Within the first 3 hours of suspecting severe sepsis: 1. Measure serum lactate levels. 2. Obtain blood cultures before administering antibiotics. 3. Administer broad-spectrum antibiotics. 4. Administer 30 mL/kg crystalloids intravenously for hypotension or lactate ≥4 mmol/L. Within 6 hours of initial indications of suspected septic shock: 5. Administer prescribed vasopressors for hypotension that does not respond to initial fluid resuscitation measures to maintain MAP ≥65 mm Hg. 6. If arterial hypotension persists despite initial fluid volume resuscitation or lactate remains ≥4 mmol/L (36 mg/dL), reassess volume status and tissue perfusion and document findings (reassessment of volume status and tissue perfusion as outlined below). 7. Remeasure lactate level if initial value was elevated. Document reassessment of volume status and tissue perfusion with EITHER: • Repeat focused examination (after initial fluid resuscitation), including vital signs, cardiopulmonary, capillary refill, pulse, and skin findings OR TWO OF THE THREE FOLLOWING: • Measure of central venous pressure • Measure of central venous oxygen saturation • Bedside cardiovascular ultrasound • Dynamic assessment of fluid responsiveness with passive leg raise or fluid challenge

You are working on a medical-surgical unit, and the unit secretary pages you to see all four of these patients immediately: a 51-year-old male with a fracture of the right lower leg, complaining of 4 on a 10 scale pain a 45-year-old female with lung cancer, complaining of severe shortness of breath a 31-year-old male with gastroenteritis, who states he has "just vomited a large amount" an 88-year-old female, admitted with a history of left-sided stroke (cerebral vascular accident) who states, "I have a terrible headache" Who will you see first? Next? Last? WHY?

a 45-year-old female with lung cancer, complaining of severe shortness of breath= 1 (ABC's) an 88-year-old female, admitted with a history of left-sided stroke (cerebral vascular accident, or CVA) who states, "I have a terrible headache" =2 (stroke risk) a 51-year-old male with a fracture of the right lower leg, complaining of 4 on a 10 scale pain =3 (have pain w fracture - expected; meds) a 31-year-old male with gastroenteritis, who states he has "just vomited a large amount" =4 (expecting vomiting; meds)

thrombophlebitis

blood clot (thrombus) --Obstruction of blood flow --More common in calves *Contributing factors* Immobility-blood pooling Sitting long periods Trauma Hip/knee surgery Oral contraceptives Cancer

fracture reduction

closed- realigning the bone from the outside through manipulation ---cast, splint, traction open- realigning the bone by opening up the limb in surgery ---internal fixation: stabilizing w/ plates, screws, etc ---external fixation: stabilizing w/ pins, screws from outside or just casts/splints

A patient's wife asks the nurse why her husband did not receive the clot buster medication (tPA-tissue plasminogen activator) that she has been reading about. Her husband is diagnosed with a hemorrhagic stroke. What is the best response by the nurse to the patient's wife? a. "He didn't arrive within the timeframe for that therapy." b. "Not everyone is eligible for this drug. Has he had surgery lately?" c. "You should discuss the treatment of your husband with his doctor." d. "The medication you are talking about dissolves clots and could cause more bleeding in your husband's brain."

d

ESR

erythrocyte sedimentation rate, will be increased w/ infection/inflammation response

hypoglycemia etiology and manifestations

etiology- too much insulin, not eating enough or too late, exercise CM-blood glucose <70 mg/dl, Shakiness/Nervousness /Irritability, Lightheadness, Tingling or numbness, Diaphoresis, Loss of consciousness, Coma "I'm sweaty, cold and clammy-please give me some candy"

general symptoms of major depressive disorder

extreme feelings of sadness, emptiness, irritability, somatic (body) concerns, and impairment of thinking -impact pts ability to function

T or F if you feed your baby solid foods for the first time and they stick their tongue out and try to get the food out of their mouth, it means they dont like it and you should not feed that food to your child anymore

false- just new to them, new texture, taste, etc. dont give up

t or f benzos are prescribed for long term treatment of anxiety

false- short term bc very addictive (pams and lams) -buspirone (BuSpar) is good for long term treatment

t or f as anxiety decreases, dysfunctional behavior will increase

false- will decrease bc dysfunctional behavior is a defense, coping mechanism

T or F you should always try the most restrictive means first to calm a pt down

false-least

Risk factors for osteoporosis

female, Caucasian, asian family hx small frame post menopause, advanced age low testosterone in men decreased calcitonin low calcium intake, low VitD intake high phosphate intake (carbonated drinks) sedentary lifestyles low sunlight exposure lack of weight bearing exercises low weight/BMI excessive caffeine, alcohol, smoking corticosteroids, antiseizure meds, heparin, thyroid hormone meds anorexia, hyperthyroidism, renal failure, malabsorption

duration of myoclonic seizures

few seconds, but happens in clusters

where should the clinical interview be performed

in a private area, but still easily seen by the public, easy to escape, both ppl should feel safe

gross and fine motor skills birth to one month

inborn reflexes, recognizes caregivers voice, turns head towards breast or bottle, communicates through body language, starts to smile, may raise head while on tummy later on -reflexive grasp

hyperparathyroidism labs

increased calcium decreased phosphorus increased magnesium increased cAMP

vitamin D

increased calcium absorption from the intestines

how does potassium affect ECGs

low- Isoelectric T wave or small T wave Ventricular arrhythmia high- Peaked T wave; p wave begins to disappear Wide QRS, bradycardia

normal ABG values

pH= 7.35-7.45 PaO2 (oxygen)=80-100 mmHg PCO2 (carbon dioxide)=35-45 mmHg HCO3 (bicarb)=22-26 meQ/L SaO2 (O2 sat)=95-100%

speech patterns for a pt with bipolar disorder

similar to schizophrenia Pressured speech Circumstantial speech Tangential speech Loose associations Flight of ideas Clang associations

gross motor 6-8mos

sits alone without support, bears full weight on feet, can hold onto furniture, can move from sitting to kneeling

T or F a positive reaction does not mean that active disease is present, but does indicate exposure to TB or dormant disease.

true

T or F risk for suicide should be put above all other nursing dx

true

T or F the diathesis-stress model is the most accepted explanation for mental illness

true

T or F nurses can only delegate tasks if the pt is stable

true

t or f a 1 degree increase in temperature could indicate crisis state

true

t or f anxiety can be caused by or exacerbated by medical conditions

true

parathyroid hormone

when serum calcium levels are lowered secretion increases and stimulates bone to release calcium to the blood.

tx of sickle cell crisis

• Administer oxygen. • Administer prescribed pain medication. • Hydrate the patient with normal saline IV and with beverages of choice (without caffeine) orally. • Remove any constrictive clothing. • Encourage the patient to keep extremities extended to promote venous return. • Do not raise the knee position of the bed. • Elevate the head of the bed no more than 30 degrees. • Keep room temperature at or above 72° F (22.2° C). • Avoid taking blood pressure with external cuff. • Check circulation in extremities every hour: • Pulse oximetry of fingers and toes • Capillary refill • Peripheral pulses • Toe temperature

interventions for glaucoma

*Drug Types (Chart 47-6)* --Systemic drugs such as mannitol (Osmitrol) may be given for angle closure glaucoma --Osmotic diuretic- potent diuretic, will pull fluid from eye to directly decrease pressure *Goal: slow the process, reduce IOP, prevent from getting worse. Won't restore vision* *Teaching* --How eyedrops work --How to administer- punctal occlusion ~3 min. Prevent systemic absorption --Monitor for side effects: Eyes may be red or burn after admin, blurred vision --Compliance, timely dosing --Consistently and on time --Wait at least 5 MINUTES BETWEEN DIFFERENT DROPS

interventions for PAD

*Exercise and positioning* Collateral circulation Elevate feet to prevent swelling not above heart - combination problem Dangling feet for comfort and blood flow- main thing we want to do Don't stop altogether unless unbearable pain *Vasodilation* Warmth and avoid cold by wearing socks and keeping home environment warm Never use direct heat Avoid vasoconstrictors - caffeine, stress, smoking, cold, clothing- waist trainers n shit, skinny jeans *Drug therapy*—Plavix, Aspirin, Trental Chart 36-6 Foot Care with PVD

GERD medications

*Antacids (Maalox and Mylanta)- neutralize stomach acids* --1 hour before meals or 2-3 hours after meals --Do not take every day, 2-3times per day. Just for when s/s flare up *H2 receptor antagonists (Pepcid and Zantac)* --Can be OTC --Infants may take these if having severe problems and thickened formulas don't work --Should not be on these and PPI at same time- one or the other *Proton pump inhibitors (Prilosec Protonix)*

drug therapy for asthma

*CHART 30-6* *Bronchodilators* - relaxes smooth muscles aiding in bronchospasms - Short acting beta2 agonist -rapid relieve rescue inhaler (Albuterol) & prophylactic for exercising - Long acting beta2 agonist-preventive (Serevent) daily use- green zone med *Cholinergic antagonists* - bronchodilation and decreased pulmonary secretions (Atrovent—short acting) (Spiriva -long acting daily) - Steroids can also help - Review meds!! Short and long acting

cushing's assessment

*CHART 62-10* General Appearance- Truncal obesity, striae, bruising, hirsutism Cardiovascular-Increased BP, RR, HR Musculoskeletal Skin-Moon face, acne, Immune System-Suppressed, more prone to infection, but no overt signs of infection??

addison's assessment

*CHART 62-7* Neuromuscular-Muscle weakness, fatigue Gastrointestinal-Hyperactive bowel sounds, Hyperkalemia, Decreased appetite, nausea, weight loss Skin- Bronzing, Poor skin turgor Cardiovascular- Distant heart sounds Androgen- Decreased libido, Irregular menstruation

cushing's labs

*CHART 62-8* Sodium levels- high Potassium levels-low Blood glucose levels-high Cortisol- high WBC- Decreased lymphocytes from decreased immunity

addison's drug therapy

*CHART 62-9* Cortisone hydrocortisone (Cortef, Hycort) Prednisone (Winpred)- most common fludrocortisone (Florinef)- main drug r/t fluid volume --Synthetic form of aldosterone --Take w/ food --Cant take a dose if missed, notify dr bc can go into Addisonian crisis --Elevated BP--> a/e --Dose may be adjusted according to stress level

home therapy for croup w/ mild stridor or no stridor at rest (LTB)

*Cool air mist to soothes inflamed mucosal lining and reduce respiratory discomfort* - Cool night air - Showers/humidifiers- SAFETY RISK FOR TODLERS! Make sure they are out of reach (burns, drowning, etc) - Taking child outside at night, putting windows down and driving through neighborhood - Some drs say use warm, but evidence now shows cool air is better- Warm, steamy air works too though! Munson is all for it *Nasal saline drops* - otc, provides moisture, use before suctioning *Suctioning nasal passages with bulb syringe* - before bed and feedings -DO NOT SUCTION AFTER FEEDING- may cause reflux, throw up, etc *Treat fever and pain* - ibuprofen and tylenol - follow recommendations according to child's weight (kg) *Encourage fluid intake to prevent dehydration* - use fun foods like popsicles - Develops from increased breathing and lack of interest in food/liquids due to pain - Dehydration may be the reason they are hospitalized *Oral Steroids* - for inflammation, oral prescription at home *Activity should be limited to quiet activities - get them to rest, heal* - Video games - Puzzles - Hand held toys - When they want to be more active, usually a clue that they are feeling better/healing - Don't restrain them, let them set the pace

interventions for SIADH

*Fluid restriction* -240ml in 1 cup.. May even have restriction of 500ml!!! -No water pitchers in room! -Check food trays!! -Oral swabs, COMFORT the pt, Suck on hard candy -Watch NG tubes!! Boluses!! *Fluid status* -Daily weight -Gain of 2.2lbs= 1L- SIGNIFICANT -Notify physician -1st listen to lungs!!! ASSESS ---Pulmonary edema: Crackles, SOB, pink frothy sputum, orthopnea, chest pain, JVD= Give O2, sit up, morphine- for SOB *Safe environment* -May be irritable, disoriented -Reduce stimuli -Do not let walk around alone -Side rails up, bed low -Seizure precautions!!! ---O2, IV access, suction, intubation *Neurological assessment* -Maybe q1-2 assess neuro status

drug therapy for BPH

*alpha adrenergic blockers (relaxes smooth muscles)* --doxazosin (Cardura) and terazosin (Hytrin) --Flomax: alpha adrenergic blocker (not tx for HTN)--> Helps with relaxing.. WILL NOT HELP WITH COMPLETE RETENTION. May cause hypotension, syncope *5 alpha reducatase inhibitor* --Proscar - hormone inhibitor Side effects erectile dysfunction, decreased sexual desire, orthostatic hypotension Do not stop taking medication Viagra can worsen side effects of hypotension Meds will not work if complete retention--> must do bladder scan, then do cath insertion

chlamydia

--most common --ask how many partners in the last month *Incubation period: 1-3 weeks* --Women: lower abd pain, vaginal discharge, dysuria, frequent urination --Men: discharge in morning --Complications: ectopic pregnancy, infertility --may be asymptomatic for mos *Treatments:* azithromycin, single dose (preferred) --Doxycycline- 7 days --Sexual partners should be treated as well (EPT) --Expedited partner therapy- treat partners; HCP will write prescription for partner as well—reduces recurrence *abstinence until tx is completed* --screen 3-12mos after tx *report to LDH w/in 5days*

fine motor skills 2-4 mos

-holds rattle, looks at fingers, plays with them, are able to bring objects from hand to mouth, follows things with eyes

what should we teach diabetic pts about self monitoring

-how to use, calibrate the machine When to test: Before meals Two hours after meals When hypoglycemia is suspected During illness Before, during, and after exercise

general tx for fractures

-immobilize the body part before moving -splinting: must include joint above and below fractured long bone. immediately post injury -clothing removed from unaffected side then affected side -cover any wounds w/ dressing

COPD

-irreversible - emphysema and chronic bronchitis

Stretta tx pt teaching for GERD

-last resort, when nothing else is working -clear liquids 24hrs post opp -soft diet after that chart 54-3

what is a mental illness?

-must have a definable diagnosis -must cause significant dysfunction related to developmental (birth, childhood), biological (brain dysfunction), or psychological disturbances in mental functioning

safety guidelines for a pt with delirium

-never leave a pt in acute delirium alone -visiting family or friends must not be held responsible for sitting or watching a confused pt -use trained sitters

in schizophrenia, second gen antipsychotics are best for treating..? what are the advantages and disadvantages?

-pos and neg symptoms -minimal a/e, EPS -significant weight gain risperidone (Risperdal) olanzapine (Zyprexa) Quetiapine (Seroquel)

t or f psychosis is a diagnosis

false- a symptom -total inability to recognize reality (e.g., delusions and hallucinations). Psychosis is usually given to pts as a DX with unconfirmed schizophrenia

t or f babies should not be breastfed after 6mos

false- can still be breastfed at 1yr, just make sure they are getting real foods too, other nutrients

prostate-specific antigen (PSA)

>10 could mean cancer, positive malignancy >4, get more definitive dx (biopsy)

hypertensive crisis

>180/120 (Chart 36-2) Issue, but lower than malignant htn

Which of these patients would be appropriate to assign to a licensed practical nurse under your supervision as a registered nurse? A patient who needs preoperative teaching for the use of a PCA pump A patient with a leg cast who needs neurologic and circulatory checks and prn pain medication A patient who underwent a toe amputation and has diabetic nerve pain A patient with terminal cancer and severe pain who gets IVP pain medications A patient who complains of abdominal pain after being kicked, punched, and beaten A patient with chronic arthritis who needs scheduled pain medications and heat applications

A patient with a leg cast who needs neurologic and circulatory checks and prn pain medication LPN - if its not initial A patient who underwent a toe amputation and has diabetic nerve pain LPN - nerve pain is chronic (stable) after initial assessment A patient with chronic arthritis who needs scheduled pain medications and heat applications LPN - chronic condition

T or F mental health patients have the same rights as patients in other units

true- can still have visitors, telephone, complaints about care, **right to refuse meds** (gets tricky)

Nursing Dx and outcomes for OCD

Anxiety-Self-monitors intensity; uses reduction techniques; maintains role performance Ineffective coping-Identifies ineffective and effective patterns; asks for assistance and information; modifies as needed Chronic low self-esteem- Verbalizes self-acceptance and increased confidence Self-mutilation- Identifies predictive feelings; practices self-restraint

T or F increases in HR increase oxygen demand

true--- why tachycardia is dangerous for pts with acute MI

negative symptoms of schizophrenia

Apathy Anhedonia Poor social functioning Poverty of thought Flat, blunted, inappropriate, or bizarre affect Develop insidiously over long period of time. Difficult to assess during an acute psychotic episode

tx for symptomatic bradycardia

Apply oxygen Administer IV fluids if hypovolemic Atropine Sulfate - 0.5 mg IV bolus every 3-5 minutes for a maximum of 3mg. --Monitor for tachycardia. --Monitor for chest pain and dysrhythmia --Be aware Atropine Sulfate is also an anticholinergic - causes dry mouth. --Avoid in acute closed angle glaucoma

cardinal symptoms of alzheimers

Amnesia or memory impairment Aphasia- difficulty with articulation of speech -Expressive aphasia- they can understand but they cant EXPRESS it, get it out -receptive aphasia- they cant understand Apraxia- difficulty moving Agnosia-difficulty recognizing objects Disturbances in executive functioning

home care assessment for the pt at risk for sepsis

Assess the patient for any signs and symptoms of infection, including: • Temperature, pulse, respiration, and blood pressure • Color of skin and mucous membranes • The mouth and perianal area for fissures or lesions • Any nonintact skin area for the presence of exudates, redness, increased warmth, swelling • Any pain, tenderness, or other discomfort anywhere • Cough or any other symptoms of a cold or the flu • Urine; or ask patient whether urine is dark or cloudy, has an odor, or causes pain or burning during urination Assess patient's and caregiver's adherence to and understanding of infection prevention techniques. Assess home environment, including: • General cleanliness • Kitchen and bathroom facilities, including refrigeration • Availability and type of soap for handwashing • Presence of pets, especially cats, rodents, or reptiles

low Na+ diet

Buy fresh, plain frozen, or canned "no salt added" vegetables Read the labels for sodium amounts Fresh poultry, fish, and lean meat No canned or processed types Herbs, spices, and salt-free seasoning blends in cooking Cut back on frozen dinners, pizza, packaged mixes, canned soups or broths, and salad dressings Rinse canned foods Low or reduced sodium or no salt-added Pickles, ketchup, no shaker salt

interventions for venous insufficiency (36-9)

Decrease edema and promote venous return to the heart Compression devices (SCDs) --Correct size --Don't roll down Exercising Elevation of legs above heart- 20 minutes 4-5 times a day

CBC for a pt with anemia

Decreased RBC Decreased hemoglobin and hematocrit Total iron-binding capacity Iron level Ferritin level

what kind of personal information should you gather during the MSE?

Demographics, age, gender, family history, birthday, marital status, race, etc.

tx of folic acid deficiency anemia

Diet of leafy green vegetables, liver, citrus fruits, Folic acid 1mg supplement daily Folic acid IM for absorption problems

common agents to cause anaphylaxis

Drugs- Antibiotics (penicillin, vancomycin, etc.), Angiotensin-converting enzyme (ACE) inhibitors, Chemotherapy, Whole blood, opiates, radiocontrast Foods- shellfish, peanuts, berries, bananas Other- latex, fire ants, molds

open angle glaucoma

Open-angle glaucoma occurs slowly as the drainage area in the eye becomes clogged. Pressure builds up when the fluid inside the eye is unable to drain. Side (peripheral) vision is damaged gradually. Open-angle glaucoma is the most common kind of glaucoma.

obsessive compulsive PD

Orderliness, stubbornness, attention to detail Indecisiveness Emotional constriction Pervasive pattern of perfection and inflexibility Perseveration (persistent pursuit of an action even in the face of repeated failures) High achievers Superficial, rigidly controlled intimacy Stinginess Different from OCD.. This is just perfectionism, OCD can be anything, fears, etc Not frequently hospitalized Guidelines for nursing care: Guard against power struggles Remember that the patient has difficulty dealing with unexpected changes Treatment: Patients tend to seek help Also seek help for anxiety or depression Group and behavioral therapy Clomipramine or fluoxetine for obsessions, anxiety, and depression

PID

Organisms from lower genital tract migrate from endocervix upward through uterine cavity into fallopian tubes (most common) *Resultant infections:* --Endometritis --Salpingitis --Oophoritis --Parametritis --Peritonitis --Tubal or tubo-ovarian abscess

interventions for pneumonia

Oxygen Therapy- to keep sats over 92% Incentive spirometer Turn, cough, deep breath Bronchodilators nebulizers- may not hear any sounds if true consolidation, will help open up airways, get productive cough going IV steroids- similar to COPD Expectorants

treatment of bronchiolitis and RSV

Oxygen to maintain above 90% Fluid intake (oral or IV) Suctioning to remove secretions- avoid deep suction--> respiratory depression Bronchodilators= mobilizing secretions Chest physiotherapy not recommended anymore Admission for respiratory distress or dehydration

seizure precautions

Oxygen- apply if pt becomes cyanotic Suction equipment for sputum, aspiration Airway- intubation equipment - Breathing is temporarily stopped. Brain will not get enough o2--> respiratory arrest IV access- rapid med admin Will not be able to take meds by mouth Side rails up and padded Place pt close to nurses station- to act quickly

nursing care for stroke rehab phase

Patient/Family Teaching Prevent Deformities and Maintain Function Emphasize Medication Compliance to Prevent More Strokes Collaborate with PT/OT for ambulation/transfer and ADL skills Assess for signs of Depression Refer to Social Services for support (including respite care) and counseling Refer to local Stroke support groups

communication guidelines for pt with MDD

Person with depression may speak and comprehend very slowly. Extreme depression—Person may be mute. Nurses—Are uncomfortable with silence. Sitting with a patient in silence is a valuable intervention.

types of abuse

Physical abuse Sexual abuse Emotional abuse Neglect Economic abuse

interviewing the abused child

Physical abuse Sexual abuse Know the child's language, vocabulary about body parts Must be careful as the nurse not to become too attached or coerce the child Who takes care of you? What happens when you do something wrong?

what is observed during the mental status exam

Physical behavior, nonverbal communication, appearance, speech patterns, mood and affect, thought content, perceptions, cognitive ability, and insight and judgment

phases of seizures

Preictal phase- sees an aura, smell something, become confused, they kind of know something is abt to happen Ictal phase- actual seizure activity Postictal phase- recovery period, after the seizure. Lasts between 5-30 mins, sometimes longer if very large seizures. May be drowsy, just want to sleep. Perform assessment, talk vitals, let them sleep

prevention of abuse

Primary prevention- Measures taken to prevent the occurrence of abuse, support groups, education Secondary prevention- Early intervention in abusive situations to minimize their disabling or long-term effects Tertiary prevention-Facilitating the healing and rehabilitative process, Providing support, Assisting survivors of violence to achieve their optimal level of safety, health, and well-being

Abnormal PR interval

Prolonged PR interval greater than 0.2 seconds indicates a delay in conduction. Seen in first degree AV block, hypothyroidism, digitalis toxicity. A shortened PR interval could indicate an ectopic focus originating close to the AV node and traveling to the AV node through an abnormal pathway.

COPD clinical manifestations

Prolonged expiratory phase Wheezes Decreased breath sounds ↑ Anterior-posterior diameter (barrel chest) Tripod position Pursed lip breathing Clubbing Pts can lose their o2 drive after time!!! O2 levels will be low, put them on o2 so they don't lose hypoxic drive (up to 6L) Dyspnea Cough Sputum production Chronic fatigue- from lack of o2 Weight loss- difficulty eating, thinner around lower extremities May experience chest tightness with activity Bluish-red color of skin DO NOT TAKE PULSE OX FOR FACE VALUE - ALWAYS LOOK FOR SIGNS OF HYPOXIA

preventative interventions for pts w/ traction devices

Promptly report any alteration in sensation or circulation Provide frequent back care and skin care Regularly shift position Special mattresses or other pressure-reduction devices Perform active foot and leg exercises every hour Pt probably on anticoags and to decrease DVT, SCDs -dont move the weights -do ur NV assessment -monitor for skin breakdown, nerve pressure, circulatory impairment

implementations for acute phase pf schizophrenia

Psychiatric, medical, and neurological evaluation Psychopharmacological treatment Supportive/directive communications Supervision and limit setting in the milieu Monitor fluid intake Working with aggression Regularly assess for risk and take safety measures

who are the members of the multidisciplinary mental health treatment team

Psychiatrist, psychologist, social workers/counselors, nurses, techs/sitters (mental health techs), pharmacists, therapists (rec/occ) Nurses are often the first to see the pt, will gather data through assessment, dr takes that data to evaluate before even seeing the pt... your assessment is V important Techs gather data from observation Therapists gather data through pt response from activities, etc

pt teaching to avoid SIDS

Put baby on back to sleep, not too many blankets Put on a onesie for pjs Nothing that will cover their face, bumpers, etc Firm mattress, no pillow No stuffed animals in bed Pacifier recommended, breast feeding, up to date on immunizations Should not be in same crib with twin/other children

interventions for cushings

Restoring fluid balance: At risk for fluid overload--> PULMONARY EDEMA. Fluid and Na+ restriction. I/O, weight, vitals Preventing injury: Osteoporosis!! Pathologic fractures . Do not grab pt to pull up in the bed. Watch glucose--> seizures. Skin tears, friction, pressure sores--> turn q2!! Inspect skin!! Preventing infection: Increased glucose, compromised immune system= more risk. Hand washing!! Stay away from sick ppl, crowds. Respiratory infection!! Assess lungs (cough). INCENTIVE SPIROMETER. UTI--> frequency, burning, odor, color. Wounds may not show typical s/s of infection!! EVEN 1 DEGREE INCREASE IN TEMP SHOULD BE CLOSELY MONITORED. H2 INHIBITORS, ppis, for GI protection

treatment for metabolic acidosis

Results from: DKA, starvation, kidney failure, excessive intake of acids, diarrhea Assessment: Kussmaul respirations, warm, flushed dry skin, confusion Correcting the underlying cause: -DKA—give insulin drip, IV fluids, oxygen, K+ if low -Diarrhea- antidiarrheal medications and hydration -Sepsis- antibiotics and rehydration-->IV hydration with isotonic or hypotonic solution *Bicarbonate is only given if the levels from body producing are low*

treatment for respiratory acidosis

Results from: hypoventilation Assessment: confusion, coma, tachycardia, variable respirations, pale to cyanotic and dry skin Improving ventilation and oxygenation - Oxygen therapy, ventilator, positioning, breathing techniques - Bronchodilators (breathing treatments) Assessing breathing and respiration status hourly Abnormal signs—wheezing, use of accessory muscles, cyanosis

what should you tell a pt during a suicidal crisis

The crisis is temporary. This unbearable pain can be survived. Help is available. You are not alone.

elderly and UTIs

The only manifestation may be something as vague as increasing mental confusion or frequent, unexplained falls. A sudden onset of incontinence or a worsening of incontinence may be the only manifestation of an early urinary tract infection (UTI). Fever, tachycardia, tachypnea, and hypotension, even without any urinary manifestations, may be signs of urosepsis. Loss of appetite, nocturia, and dysuria are common manifestations.

generalized seizures involve how many/which hemispheres

both

antihistamines are helpful for treating anxiety in which population?

elderly