3810 Exam 3
a pt with a stroke has right sided stroke has a nursing dx of unilateral neglect r/t sensory perceptual deficits. During the pt's rehab, what nursing interventions is important for the nurse to do?
teach pt to care consciously for the affected side
A week following a SCI at T2, a pt experiences movement in his leg and tells the nurse that he is recovering some function. what is the nurse's best response?
that could be a really positive finding. Can you show me the movement?
Carotid endarterectomy
the atheromatous lesion is removed from the carotid artery to improve blood flow and prevent impending cerebral infarction
what primarily determines the neuro function that are affected by a stroke?
the brain area perfused by the affected artery
Transluminal angioplasty
the insertion of a balloon to open a stenosed artery in the brain and improve blood flow. The balloon is threaded up to the carotid artery via a catheter inserted in the femoral artery.
What components are able to change to adapt to small increases in ICP?
-blood -brain tissue -CSF
What are chracteristics of a stroke caused by an intracerebral hemorrhage?
-carries a poor prognosis -caused by a rupture of a vessel -creates a mass that compresses the brain
The rehab nurse assesses the pt, caregiver, and family before planning the rehab program for this pt. What needs to be included in this assessment?
-cognitive status of family -body strength remaining -physical status of the body systems affected by the stroke -pt and caregiver expectations of the rehab
Stroke Manifestations of involvement of the Vertebral Artery
-cranial nerve deficit -diplopia -dizziness -nausea -vomiting -dysarthria -dysphagia -coma
The pt with CKD is receiving dialysis and the nurse observes excoriations on the patient's skin. What pathophysiologic changes in CKD can contribute to this finding?
-dry skin -sensory neuropathy -calcium-phosphate skin deposits
The nurse is monitoring a pt for increased ICP following a head injury. What are manifestations of increased ICP
-fever -oriented to name only -right pupil dilated greater than left -decorticate posturing to painful stimulus
During the secondary assessment of the pt with a stroke what should be included?
-gaze -sensation -facial palsy -proprioception -distal motor function
the pt being treated with diuretics for ascites from cirrhosis must be monitored for
-hypokalemia -renal function
what are causes of vasogenic cerebral edema?
-ingested toxins -fluid flowing from intravascular to extravascular space
The pt with CKD is considering whether to sue peritoneal dialysis or hemodialysis (HD). What are the advantages of PD when compared to HD
-less CV stress -requires fewer dietary restrictions
What are intrarenal causes of AKI
-nephrotoxic drugs -acute glomerulonephritis -tubular obstruction by myoglobin
S/S of TIA involving the carotid system
-temporary loss of vision in one eye (amaurosis fugax) -transient hemiparesis -numbness or sudden loss of sensation -sudden inability to speak
S/S of TIA involving the vertebrobasiliar system
-tinnitus -vertigo -darkened or blurred vision -diplopia -ptosis -dysarthria -dysphagia -ataxia -unilateral or bilateral numbness or weakness
Acalculous cholecystitis
(occurs in absence of obstruction kind of gall bladder disease) Older adults and critically ill Prolonged immobility, fasting, parenteral nutrition, diabetes Bacteria or chemical irritants Adhesions, neoplasms, anesthesia, opioids
Stroke Manifestations of involvement of the Posterior Cerebral Artery
-Hemianopsia -Visual hallucination -spontaneous pain -motor deficit
Stroke Manifestations Related to Involvement of the Anterior Cerebral Artery
-Motor and/or sensory deficit (contralateral), -sucking or rooting reflex, -rigidity, gait problems, -loss of priprioception -fine touch
The nurse is instructing a pt with chronic pancreatitis on measures to prevent further attacks. What information should be provided?
-avoid nicotine -eat bland foods -observe stools for statorrhea
Phases of PD
1. Inflow 2. Dwell 3. Drain
what lab findings are expected in ulcerative colitis as a result of diarrhea and vomiting
decreased Na, K, Mg, Cl, and HCO3
Which urine specific gravity value would indicate to the nurse that the pt is receiving excessive IV fluid therapy?
1.002
Fibrolytic Therapy Candidate
185/110, maintain at or below 180/105 mmHg for 24 hours post tx (good number for these pts)
The pt is being monitored long-term with a brain tissue oxygenation cath. What range for the pressure of o2 in brain tissue will maintain cerebral o2 supply and demand?
20-40 mm HG
the nurse recognizes the presence of Cushing's Triad in the pt with which vital sign changes
decreased pulse, irregular respirations, and widened pulse pressure
a pt with an intracranial problem doesn't open his eyes to any stimulus, has no verbal response except moaning and muttering when stimulated, and flexes his arm in response to painful stimuli. What should the nurse record as the patient's GCS score?
7
an early sign of increased ICP that the nurse should assess for is
decreasing LOC
a patient receives atropine, an anticholinergic drug, in prep for surgery. the nurse expects this drug to affect the GI tract by doing
decreasing secretions and peristaltic action
Which patient is most appropriate for the intensive care unit (ICU) charge nurse to assign to a registered nurse (RN) who has floated from the medical unit? a. A 45-year-old receiving IV antibiotics for meningococcal meningitis b. A 25-year-old admitted with a skull fracture and craniotomy the previous day c. A 55-year-old who has increased intracranial pressure (ICP) and is receiving hyperventilation therapy d. A 35-year-old with ICP monitoring after a head injury last week
ANS: A An RN who works on a medical unit will be familiar with administration of IV antibiotics and with meningitis. The postcraniotomy patient, patient with an ICP monitor, and the patient on a ventilator should be assigned to an RN familiar with the care of critically ill patients.
A college athlete is seen in the clinic 6 weeks after a concussion. Which assessment information will the nurse collect to determine whether a patient is developing postconcussion syndrome? a. Short-term memory b. Muscle coordination c. Glasgow Coma Scale d. Pupil reaction to light
ANS: A Decreased short-term memory is one indication of postconcussion syndrome. The other data may be assessed but are not indications of postconcussion syndrome.
A 42-year-old patient who has bacterial meningitis is disoriented and anxious. Which nursing action will be included in the plan of care? a. Encourage family members to remain at the bedside. b. Apply soft restraints to protect the patient from injury. c. Keep the room well-lighted to improve patient orientation. d. Minimize contact with the patient to decrease sensory input.
ANS: A Patients with meningitis and disorientation will be calmed by the presence of someone familiar at the bedside. Restraints should be avoided because they increase agitation and anxiety. The patient requires frequent assessment for complications. The use of touch and a soothing voice will decrease anxiety for most patients. The patient will have photophobia, so the light should be dim.
Admission vital signs for a brain-injured patient are blood pressure 128/68, pulse 110, and respirations 26. Which set of vital signs, if taken 1 hour after admission, will be of most concern to the nurse? a. Blood pressure 154/68, pulse 56, respirations 12 b. Blood pressure 134/72, pulse 90, respirations 32 c. Blood pressure 148/78, pulse 112, respirations 28 d. Blood pressure 110/70, pulse 120, respirations 30
ANS: A Systolic hypertension with widening pulse pressure, bradycardia, and respiratory changes represent Cushing's triad. These findings indicate that the intracranial pressure (ICP) has increased, and brain herniation may be imminent unless immediate action is taken to reduce ICP. The other vital signs may indicate the need for changes in treatment, but they are not indicative of an immediately life-threatening process.
A male patient who has possible cerebral edema has a serum sodium level of 116 mEq/L (116 mmol/L) and a decreasing level of consciousness (LOC). He is now complaining of a headache. Which prescribed interventions should the nurse implement first? a. Administer IV 5% hypertonic saline. b. Draw blood for arterial blood gases (ABGs). c. Send patient for computed tomography (CT). d. Administer acetaminophen (Tylenol) 650 mg orally.
ANS: A The patient's low sodium indicates that hyponatremia may be causing the cerebral edema. The nurse's first action should be to correct the low sodium level. Acetaminophen (Tylenol) will have minimal effect on the headache because it is caused by cerebral edema and increased intracranial pressure (ICP). Drawing ABGs and obtaining a CT scan may provide some useful information, but the low sodium level may lead to seizures unless it is addressed quickly.
Which action will the emergency department nurse anticipate for a patient diagnosed with a concussion who did not lose consciousness? a. Coordinate the transfer of the patient to the operating room. b. Provide discharge instructions about monitoring neurologic status. c. Transport the patient to radiology for magnetic resonance imaging (MRI). d. Arrange to admit the patient to the neurologic unit for 24 hours of observation.
ANS: B A patient with a minor head trauma is usually discharged with instructions about neurologic monitoring and the need to return if neurologic status deteriorates. MRI, hospital admission, or surgery are not usually indicated in a patient with a concussion.
Which manifestation may be seen in pt with cirrhosis r/t esophageal varices
development of collateral channels of circulation in inelastic fragile esophageal veins as a result of portal HTN
After endotracheal suctioning, the nurse notes that the intracranial pressure for a patient with a traumatic head injury has increased from 14 to 17 mm Hg. Which action should the nurse take first? a. Document the increase in intracranial pressure. b. Ensure that the patient's neck is in neutral position. c. Notify the health care provider about the change in pressure. d. Increase the rate of the prescribed propofol (Diprivan) infusion.
ANS: B Because suctioning will cause a transient increase in intracranial pressure, the nurse should initially check for other factors that might be contributing to the increase and observe the patient for a few minutes. Documentation is needed, but this is not the first action. There is no need to notify the health care provider about this expected reaction to suctioning. Propofol is used to control patient anxiety or agitation. There is no indication that anxiety has contributed to the increase in intracranial pressure.
a pt with a stroke has a right sided hemiplegia. what does the nurse teach the fam to prepare them to cope with the behavior changes seen with this type of stroke
distract the pt from inappropriate emotional distractions
A patient admitted with a diffuse axonal injury has a systemic blood pressure (BP) of 106/52 mm Hg and an intracranial pressure (ICP) of 14 mm Hg. Which action should the nurse take first? a. Document the BP and ICP in the patient's record. b. Report the BP and ICP to the health care provider. c. Elevate the head of the patient's bed to 60 degrees. d. Continue to monitor the patient's vital signs and ICP.
ANS: B Calculate the cerebral perfusion pressure (CPP): (CPP = mean arterial pressure [MAP] - ICP). MAP = DBP + 1/3 (systolic blood pressure [SBP] - diastolic blood pressure [DBP]). Therefore the (MAP) is 70 and the CPP is 56 mm Hg, which is below the normal of 60 to 100 mm Hg and approaching the level of ischemia and neuronal death. Immediate changes in the patient's therapy such as fluid infusion or vasopressor administration are needed to improve the cerebral perfusion pressure. Adjustments in the head elevation should only be done after consulting with the health care provider. Continued monitoring and documentation will also be done, but they are not the first actions that the nurse should take.
A 20-year-old male patient is admitted with a head injury after a collision while playing football. After noting that the patient has developed clear nasal drainage, which action should the nurse take? a. Have the patient gently blow the nose. b. Check the drainage for glucose content. c. Teach the patient that rhinorrhea is expected after a head injury. d. Obtain a specimen of the fluid to send for culture and sensitivity.
ANS: B Clear nasal drainage in a patient with a head injury suggests a dural tear and cerebrospinal fluid (CSF) leakage. If the drainage is CSF, it will test positive for glucose. Fluid leaking from the nose will have normal nasal flora, so culture and sensitivity will not be useful. Blowing the nose is avoided to prevent CSF leakage.
Which statement by a 40-year-old patient who is being discharged from the emergency department (ED) after a concussion indicates a need for intervention by the nurse? a. "I will return if I feel dizzy or nauseated." b. "I am going to drive home and go to bed." c. "I do not even remember being in an accident." d. "I can take acetaminophen (Tylenol) for my headache."
ANS: B Following a head injury, the patient should avoid driving and operating heavy machinery. Retrograde amnesia is common after a concussion. The patient can take acetaminophen for headache and should return if symptoms of increased intracranial pressure such as dizziness or nausea occur.
After evacuation of an epidural hematoma, a patient's intracranial pressure (ICP) is being monitored with an intraventricular catheter. Which information obtained by the nurse is most important to communicate to the health care provider? a. Pulse 102 beats/min b. Temperature 101.6° F c. Intracranial pressure 15 mm Hg d. Mean arterial pressure 90 mm Hg
ANS: B Infection is a serious consideration with ICP monitoring, especially with intraventricular catheters. The temperature indicates the need for antibiotics or removal of the monitor. The ICP, arterial pressure, and apical pulse are all borderline high but require only ongoing monitoring at this time.
The nurse is admitting a patient with a basal skull fracture. The nurse notes ecchymoses around both eyes and clear drainage from the patient's nose. Which admission order should the nurse question? a. Keep the head of bed elevated. b. Insert nasogastric tube to low suction. c. Turn patient side to side every 2 hours d. Apply cold packs intermittently to face.
ANS: B Rhinorrhea may indicate a dural tear with cerebrospinal fluid (CSF) leakage. Insertion of a nasogastric tube will increase the risk for infections such as meningitis. Turning the patient, elevating the head, and applying cold packs are appropriate orders.
Family members of a patient who has a traumatic brain injury ask the nurse about the purpose of the ventriculostomy system being used for intracranial pressure monitoring. Which response by the nurse is best? a. "This type of monitoring system is complex and it is managed by skilled staff." b. "The monitoring system helps show whether blood flow to the brain is adequate." c. "The ventriculostomy monitoring system helps check for alterations in cerebral perfusion pressure." d. "This monitoring system has multiple benefits including facilitation of cerebrospinal fluid drainage."
ANS: B Short and simple explanations should be given initially to patients and family members. The other explanations are either too complicated to be easily understood or may increase the family members' anxiety.
what is a clinical manifestation of age related changes in the GI system that the nurse may bind in an older patient
reflux of gastric contents into the esophagus
The nurse admitting a patient who has a right frontal lobe tumor would expect the patient may have a. expressive aphasia. b. impaired judgment. c. right-sided weakness. d. difficulty swallowing.
ANS: B The frontal lobe controls intellectual activities such as judgment. Speech is controlled in the parietal lobe. Weakness and hemiplegia occur on the contralateral side from the tumor. Swallowing is controlled by the brainstem.
n unconscious 39-year-old male patient is admitted to the emergency department (ED) with a head injury. The patient's spouse and teenage children stay at the patient's side and ask many questions about the treatment being given. What action is best for the nurse to take? a. Ask the family to stay in the waiting room until the initial assessment is completed. b. Allow the family to stay with the patient and briefly explain all procedures to them. c. Refer the family members to the hospital counseling service to deal with their anxiety. d. Call the family's pastor or spiritual advisor to take them to the chapel while care is given.
ANS: B The need for information about the diagnosis and care is very high in family members of acutely ill patients. The nurse should allow the family to observe care and explain the procedures unless they interfere with emergent care needs. A pastor or counseling service can offer some support, but research supports information as being more effective. Asking the family to stay in the waiting room will increase their anxiety.
A 46-year-old patient with a head injury opens the eyes to verbal stimulation, curses when stimulated, and does not respond to a verbal command to move but attempts to push away a painful stimulus. The nurse records the patient's Glasgow Coma Scale score as a. 9. b. 11. c. 13. d. 15.
ANS: B The patient has a score of 3 for eye opening, 3 for best verbal response, and 5 for best motor response.
A 23-year-old patient who is suspected of having an epidural hematoma is admitted to the emergency department. Which action will the nurse plan to take? a. Administer IV furosemide (Lasix). b. Prepare the patient for craniotomy. c. Initiate high-dose barbiturate therapy. d. Type and crossmatch for blood transfusion.
ANS: B The principal treatment for epidural hematoma is rapid surgery to remove the hematoma and prevent herniation. If intracranial pressure (ICP) is elevated after surgery, furosemide or high-dose barbiturate therapy may be needed, but these will not be of benefit unless the hematoma is removed. Minimal blood loss occurs with head injuries, and transfusion is usually not necessary.
older patients may have cardiac or renal insufficiency and may be more susceptible to problems from vomiting and antiemetic drug S.E. what nursing intervention is most important
do hourly visual checks or use a sitter to keep them safe
When a brain-injured patient responds to nail bed pressure with internal rotation, adduction, and flexion of the arms, the nurse reports the response as a. flexion withdrawal. b. localization of pain. c. decorticate posturing. d. decerebrate posturing.
ANS: C Internal rotation, adduction, and flexion of the arms in an unconscious patient is documented as decorticate posturing. Extension of the arms and legs is decerebrate posturing. Because the flexion is generalized, it does not indicate localization of pain or flexion withdrawal.
The nurse has administered prescribed IV mannitol (Osmitrol) to an unconscious patient. Which parameter should the nurse monitor to determine the medication's effectiveness? a. Blood pressure b. Oxygen saturation c. Intracranial pressure d. Hemoglobin and hematocrit
ANS: C Mannitol is an osmotic diuretic and will reduce cerebral edema and intracranial pressure. It may initially reduce hematocrit and increase blood pressure, but these are not the best parameters for evaluation of the effectiveness of the drug. Oxygen saturation will not directly improve as a result of mannitol administration.
The public health nurse is planning a program to decrease the incidence of meningitis in adolescents and young adults. Which action is most important? a. Encourage adolescents and young adults to avoid crowds in the winter. b. Vaccinate 11- and 12-year-old children against Haemophilus influenzae. c. Immunize adolescents and college freshman against Neisseria meningitides. d. Emphasize the importance of hand washing to prevent the spread of infection.
ANS: C The Neisseria meningitides vaccination is recommended for children ages 11 and 12, unvaccinated teens entering high school, and college freshmen. Hand washing may help decrease the spread of bacteria, but it is not as effective as immunization. Vaccination with Haemophilus influenzae is for infants and toddlers. Because adolescents and young adults are in school or the workplace, avoiding crowds is not realistic.
A patient has been admitted with meningococcal meningitis. Which observation by the nurse requires action? a. The bedrails at the head and foot of the bed are both elevated. b. The patient receives a regular diet from the dietary department. c. The lights in the patient's room are turned off and the blinds are shut. d. Unlicensed assistive personnel enter the patient's room without a mask.
ANS: D Meningococcal meningitis is spread by respiratory secretions, so it is important to maintain respiratory isolation as well as standard precautions. Because the patient may be confused and weak, bedrails should be elevated at both the foot and head of the bed. Low light levels in the room decrease pain caused by photophobia. Nutrition is an important aspect of care in a patient with meningitis.
Stroke Manifestations related to involvement of the middle cerebral artery
dominant side: aphasia, motor and sensory deficit, and hemianopsia non-dominant side: neglect, motor and sensory deficit, hemianopsia
The nurse is caring for a patient who was admitted the previous day with a basilar skull fracture after a motor vehicle crash. Which assessment finding is most important to report to the health care provider? a. Complaint of severe headache b. Large contusion behind left ear c. Bilateral periorbital ecchymosis d. Temperature of 101.4° F (38.6° C)
ANS: D Patients who have basilar skull fractures are at risk for meningitis, so the elevated temperature should be reported to the health care provider. The other findings are typical of a patient with a basilar skull fracture.
After having a craniectomy and left anterior fossae incision, a 64-year-old patient has a nursing diagnosis of impaired physical mobility related to decreased level of consciousness and weakness. An appropriate nursing intervention is to a. cluster nursing activities to allow longer rest periods. b. turn and reposition the patient side to side every 2 hours. c. position the bed flat and log roll to reposition the patient. d. perform range-of-motion (ROM) exercises every 4 hours.
ANS: D ROM exercises will help prevent the complications of immobility. Patients with anterior craniotomies are positioned with the head elevated. The patient with a craniectomy should not be turned to the operative side. When the patient is weak, clustering nursing activities may lead to more fatigue and weakness.
Acute Kidney Injury
Abrupt deterioration of kidney function resulting in decreased GFR
a patient with oral cancer has a history of heavy smoking, excessive alcohol intake, and personal neglect. during he patients early postop course, what does the nurse anticipate that the patient may need
drug therapy to prevent substance withdrawal symptoms
which type of stroke is r/t endocardial disorders, has a rapid onset, and is unrelated to activities
embolic stroke
secondary TBI's
epidural, subdural, subarachnoid hematoma or cerebral aneurysms (2 days to 3 months for swelling in the brain)
what extra intestinal manifestations are seen in both ulcerative colitis and crowns disease
erythema nodosum and osteoporosis
what is one indication for early surgical therapy of the pt with a SCI?
evidence of continued compression of the cord is apparent
hypercapnia
excessive carbon dioxide in the bloodstream, typically caused by inadequate respiration.
a pt with a SCI has spinal shock. the nurse plans care for the pt based on what knowledge?
resolution of spinal shock is manifested by spasticity, hyperreflexia, and reflex emptying of bladder
A patient is just admitted to the hospital following a spinal cord injury at the level of T4. A priority of nursing care for the patient is monitoring for return of reflexes. bradycardia with hypoxemia. effects of sensory deprivation. fluctuations in body temperature.
Answer: B Rationale: Neurogenic shock is due to loss of vasomotor tone caused by injury and is characterized by hypotension and bradycardia, which are important clinical clues. Loss of sympathetic nervous system innervation causes peripheral vasodilation, venous pooling, and decreased cardiac output. These effects are generally associated with a cervical or high thoracic injury (T6 or higher). Injury or fracture below the level of C4 results in diaphragmatic breathing if the phrenic nerve is functioning. Even if the injury is below C4, spinal cord edema and hemorrhage can affect the function of the phrenic nerve and cause respiratory insufficiency. Hypoventilation almost always occurs with diaphragmatic respirations because of the decrease in vital capacity and tidal volume, which occurs as a result of impairment of the intercostal muscles. Cervical and thoracic injuries cause paralysis of abdominal muscles and often intercostal muscles. Therefore the patient cannot cough effectively enough to remove secretions, leading to atelectasis and pneumonia. An artificial airway provides direct access for pathogens, making bronchial hygiene and chest physiotherapy extremely important to reduce infection. Neurogenic pulmonary edema may occur secondary to a dramatic increase in sympathetic nervous system activity at the time of injury, which shunts blood to the lungs. In addition, pulmonary edema may occur in response to fluid overload.
During assessment of a patient with a spinal cord injury at the level of T2 at the rehabilitation center, which finding would concern the nurse the most? A heart rate of 92 A reddened area over the patient's coccyx Marked perspiration on the patient's face and arms A light inspiratory wheeze on auscultation of the lungs
Answer: C Rationale: Autonomic dysreflexia is a massive uncompensated cardiovascular reaction mediated by the sympathetic nervous system. It occurs in response to visceral stimulation once spinal shock is resolved in patients with spinal cord lesions. The condition is a life-threatening situation that requires immediate resolution. If resolution does not occur, this condition can lead to status epilepticus, stroke, myocardial infarction, and even death. Manifestations include hypertension (up to 300 mm Hg systolic), throbbing headache, marked diaphoresis above the level of the lesion, bradycardia (30 to 40 beats/min), piloerection (erection of body hair) as a result of pilomotor spasm, flushing of the skin above the level of the lesion, blurred vision or spots in the visual fields, nasal congestion, anxiety, and nausea
The nurse is caring for a patient after a head injury. How should the nurse position the patient in bed? A. Prone with the head turned to the right side B. High-Fowlers position with the legs elevated C. Supine position with the head on two pillows D. Side-lying with the head elevated 30 degrees
Answer: D Rationale: To prevent increased intracranial pressure, the nurse should maintain the patient in the head-up position (no more than 30 degrees). Head elevation over 30 degrees may decrease cerebral perfusion pressure. Extreme neck flexion (head on two pillows) and hip flexion (high-Fowlers position) should be avoided. Head should remain midline.
Patient has ulcerative colitis. After teaching D.B. about dietary modifications, you determine that teaching was effective when he chooses which menu? Baked cod, baked sweet potato, and canned pears Barbecued brisket, coleslaw, baked beans, and angel food cake Fried shrimp with cocktail sauce, corn on the cob, and a fruit roll-up Turkey burger with cheese on a whole wheat bun, french fries, and an orange
Answer: a Rationale: Patients with inflammatory bowel disease require a high-calorie, high-vitamin, high-protein, low-residue, lactose-free (if lactase deficiency) diet. High-fat foods may trigger diarrhea. Cold foods and high-fiber foods may increase gastrointestinal transit.
A patient with advanced cirrhosis who has ascites is short of breath and has an increased respiratory rate. The nurse should: Initiate oxygen therapy at 2 L/min to increase gas exchange. Notify the health care provider so that a paracentesis can be performed. Ask the patient to cough and breathe deeply to clear respiratory secretions. Place the patient in Fowler's position to relieve pressure on the diaphragm.
Answer: d Rationale: Dyspnea is a frequent problem for the patient with ascites, and a semi-Fowler's or Fowler's position allows for maximal respiratory efficiency. Oxygen administration is not indicated; SpO2 level less than 90% would be an indication for oxygen. The respiratory distress is caused by ascites (not by respiratory secretions); coughing and deep breathing will not alleviate the respiratory distress. A paracentesis may be performed to remove ascitic fluid; however, this procedure provides only temporary relief and is reserved for severe respiratory distress or abdominal pain.
a pt rapidly progressing toward end-stage kidney disease asks about the possibility of a kidney transplant. In responding to the pt, the nurse knows that what is a contraindication to kidney transplantation
extensive vascular disese
A pt has ICP monitoring with an intraventricular catheter. What is a priority nursing intervention for this pt?
Aseptic technique to prevent infection
During assessment of a pt. with a SCI, the nurse determines that the pt has poor cough with diaphragmatic breathing. Based on this finding, what should the nurse's first action be?
Assess lung sounds and RR and depth
What is the primary way that a nurse will evaluate the patency of an AVF
Auscultate for the presence of a bruit at the site
a patient has a nursing dx of risk for ineffective cerebral tissue perfusion r/t cerebral edema. What is an appropriate nursing intervention for the patient?
Avoid positioning the pt with neck and hip flexion
What metabolic demands can increase ICP?
fever (greater than 38°C), agitation/shivering, pain, and seizures
A patient with AKI is a candidate for continuous renal replacement therapy (CRRT). What is the most common indication for the use of CRRT?
fluid overload
on physical examination of a pt with headache and fever, the nurse should expect a brain abscess when the pt has
focal symptoms
what are characteristics of gingivitis
formation of abscesses with loosening of teeth
when caring for a patient following a glossectomy with dissection of the floor of the mouth and a radical neck dissection for cancer of the tongue, what is the nurses primary concern
patent airway
What is the outcome of AKI determined by?
patient's overall health, the severity of kidney failure, and the number and type of complications.
P.D. is diagnosed with a thrombotic stroke. Over the next 72 hours, you plan care A) will show gradual improvement of the initial neurologic deficits. B) may show signs of deteriorating neurologic function as cerebral edema increases. C) should not be turned or exercised to prevent extension of the thrombus and increased neurologic deficits. D) with the knowledge that he is ready for aggressive rehabilitation.
B) may show signs of deteriorating neurologic function as cerebral edema increases.
The HCP has ordered IV dopamine for a pt in the ED with a SCI. The nurse determines that the drug is having a desired effect when what is observed in the pt assessment?
BP of 106/82
In promoting health maintenance for prevention of strokes, the nurse understands that the highest risk for the most common type of stroke is present in which people
people with HTN and DM
which digestive substances are active or activated in the stomach
pepsin gastrin
A 41-year-old patient who is unconscious has a nursing diagnosis of ineffective cerebral tissue perfusion related to cerebral tissue swelling. Which nursing intervention will be included in the plan of care? a. Encourage coughing and deep breathing. b. Position the patient with knees and hips flexed. c. Keep the head of the bed elevated to 30 degrees. d. Cluster nursing interventions to provide rest periods.
C The patient with increased intracranial pressure (ICP) should be maintained in the head-up position to help reduce ICP. Extreme flexion of the hips and knees increases abdominal pressure, which increases ICP. Because the stimulation associated with nursing interventions increases ICP, clustering interventions will progressively elevate ICP. Coughing increases intrathoracic pressure and ICP.
the pt was in a traffic collision and is experiencing loss of function below C4. Which effect must the nurse be aware of to provide priority care for the pt?
respiratory diaphragmatic breathing
when using intraventricular ICP monitoring, what should the nurse be aware of to prevent inaccurate readings?
CSF is leaking around the monitoring device
While performing ROM on unconscious pt with increased ICP, the pt experiences severe decerebrate posturing reflexes. What should the nurse do first?
perform the exercises less frequently because posturing can increase ICP
A newly admitted pt diagnosed with right sided brain stroke has a nusing dx of disturbed visual sensory perception r/t homonymous hemianopsia. Early in the care of the pt, what should the nurse do?
place objects on the right side of the pt's field of vision
Four days post stroke, a patient is to start oral fluids and feedings. Before, what should the nurse do?
Check pt's gag reflex
P.D. also has dysphagia. Before allowing him to eat, which action should you take first? Check the patient's gag reflex. Request a soft diet with no liquids. Place the patient in high-Fowler's position. Test the patient's ability to swallow with a small amount of water.
Check the patient's gag reflex
As one of your clinical assignments, you are assisting an RN with health screening at a health fair. Which individual is at greatest risk for experiencing a stroke? A)A 46-year-old white female with hypertension and oral contraceptive use for 10 years B)A 58-year-old white male salesman who has a total cholesterol level of 285 mg/dl C)A 42-year-old African American female with diabetes mellitus who has smoked for 30 years D)A 62-year-old African American male with hypertension who is 35 pounds overweight
D
a pt with acute pancreatitis has a nursing dx of pain r/t distention of the pancreas and peritoneal irritation. In addition to the effective use of analgesics, what should the nurse include in the plan of care
position the pt on the side with the HOB elevated 45 degrees for pain relief
What indicates to the nurse that a pt with oliguria has prerenal oligura?
reversal of oliguria occurs with fluid replacement
after eating, a patient with a inflamed gallbladder experiences pain caused by contraction of the gallbladder. what is the mechanism responsible for this action
production of cholecystokinin by the duodenum
Why is hemodynamic instability a complication of stroke?
protective mechanism to maintain cerebral perfusion
the incidence of stroke in pts with TIAs and other risk factors is reduced with the administration of which med?
Daily low dose aspirin
Cerebral auto-regulation
Delivers constant rate of blood flow from 50-100 MAP
What does the dialysate for PD routinely contain?
Dextrose in a higher concentration than in the blood
What are the different types of classifications of head injuries?
Diffuse (generalized) Focal (localized) Minor (GCS 13-15) Moderate (GCS 9-12) Severe (GCS 3-8)
what is one of the most challenging nursing interventions to promote healing in the patient with viral hepatitis
providing adequate nutritional inake
What is the BP range for stroke patients that can get BP medications?
Drugs to decrease BP recommended only if systolic is greater than 220 or diastolic greater than 120
checking for the return of the gag reflex and monitoring for LUQ pain, N/V ware necessary nursing actions after which diagnostic procedure
ERCP
In replying to a pt's question about the seriousness of her CKD, the nurse knows that the stage of CKD is based on what?
GFR
primary TBI's
scalp lacerations, skull fractures, concussions, contact sports or blast from military
what test will be done before prescribing treatment for the patient with positive testing for HCV
HCV genotyping
which type of hepatitis is a dan virus, can be transmitted via exposure to infection blood or body fluids, is required for HDV to replicate, and increases the risk of the chronic carrier for hepatocellular cancer
HEp B
During the nursing assessment of the pt with renal insufficiency, the nurse asks the patient specifically about a history of
HTN
the pt with CKD asks why she is receiving nifedipine (Procardia) and furosemide (Lasix). The nurse understands that the these meds are being used to treat the pt's
HTN
what is a nursing intervention indicated for the pt with hemiplegia?
Having the patient perform passive ROM of the affected limb with the unaffected limb
During the patient's process of grieving for the losses resulting from spinal cord injury, which should the nurse do?
Help the pt to understand that working through the grief will be a lifelong process.
Complications of Stroke
Hemodynamic instability (BP wide range) Infections Sensory impairments Contractures Immobility complications (DVT, PE) Fluid imbalance Inappropriate ADH Malnutrition (gag reflex) aspiration
A pt. with paraplegia has developed an irritable bladder with reflex emptying. What will be most helpful for the nurse to teach the pt?
How to perform intermittent self cath
The nurse determines that further discharge instruction is needed when the pt with acute pancreatitis makes which statement
I shouldn't eat any salty foods or foods with high amounts of sodium
A dehydrated pt is in the injury stage of the RIFLE staging of AKI. What would the nurse first anticipate in the treatment of this pt
IV insulin and sodium bicarb
a patient who has been vomiting for several days from an unknown cause is admitted to the hospital. what should the nurse anticipate will be included in the collaborative care
IV replacement of fluid and electrolytes
What happens to the pupil if CN III is compressed?
If the oculomotor nerve [CN III] is compressed, the pupil on the affected side (ipsilateral) becomes larger until it fully dilates. If ICP continues to increase, both pupils dilate.
What causes an initial incomplete SCI to result in complete cord damage?
Infartion and necrosis of the cord caused by edema, hemorrhage, and metabolites
Ulcerative colitis
Inflammation and ulceration of the colon and rectum
Crohn's Disease
Inflammation of any segment of the GI tract from mouth to anus
When assessing a pt with acute pancreatitis the nurse would expect to find
severe midepigastric or LUQ pain
a pt is admitted with a left hemiplegia. to determine size and location and to ascertain whether a stroke is ischemic or hemorrhagic, the nurse anticipates the HCP will request a
MRI
what drug tx helps to decrease ICP by expanding plasma and the osmotic effect to move fluid?
Mannitol (Osmitrol) (25%)
vigorous control of fever in the patient with meningitis is required to prevent complications of increased cerebral edema, seizure frequency, neuro damage, and fluid loss. What nursing care should be included?
Monitor LOC r/t increased brain metabolism
A pt. with a metastatic tumor of the spinal cord is scheduled for removal of the tumor by a laminectomy. In planning postop care for pt. what should the nurse recognize?
Metastatic tumors are commonly extradural that are treated pallatively
what tx measure is used in the management of the pt with acute pancreatitis
NG suction to prevent gastric contents from entering the duodenum
Following a T2 SCI, the pt develops paralytic ileus. While this condition is present, what should the nurse anticipate that the patient will need?
NG suctioning
for the patient hospitalized with IBD, which treatments would be used to rest the bowel
NPO iv fluids nasogastric suction parenteral nutrition
In caring for a pt with with AKI, what should the nurse be aware of?
One of the most important nursing measure in managing fluid balance in the pt with AKI is taking accurate daily weights
An unconscious pt with increased iCP is on vent support. the nurse notifies the HCP when arterial blood gas measurement results reveal what?
PaO2 of 70 mm Hg
Gerontologic Considerations for Acute Kidney Injury because they are more susceptible if they have these
Polypharmacy Hypotension Diuretic therapy Aminoglycoside therapy Obstructive disorders Surgery Infection
during the immediate post op care of a recipient of a kidney transplant, what should the nurse expect to do?
Regulate fluid intake based on urine output
68 yod man with hx of HF resulting from HTN has AKI as a result of the effects of nephrotoxic diuretics. Currently his potassium is 6.2 with cardiac changes, BUN of 108, and creatinine of 4.1, and his bicarb is 14. He is somnolent and disoriented. Which tx should the nurse expect to be used?
Renal replacement therapy
What is an appropriate food for a pt with a stroke who has mild dysphagia?
Scrambled eggs
If there is a primary TBI, what should you assess for?
Secondary TBI
Autonomic dysreflexia (AD) signs and symptoms
Severe HTN Bradycardia Severe headache Nasal stuffiness Flushing/sweating Goose bumps above SCI, pallor below Most common cause is bowel or bladder distention Additional cause: labor, bowel impaction, temp changes, ingrown toenails, tight clothing, UTI, pain, decubiti
a pt's wife asks the nurse why her husband didnt receive the clot busting medication (TPA) she has been reading about. Her husband had an hemorrhagic stroke. What is the best response?
The meds you are talking about dissolves clots and could cause more bleeding in your husbands brain
Skull x-rays and a CT scan provide evidence of a depressed parietal fracture with a subdural hematoma in a pt admitted to ED following a car crash. In planning care for the pt, what should the nurse anticipate?
The pt will be taken to surgery for a craniotomy for evacuation of blood and decompression of the cranium.
w/o surgical stabilization what method of immobilization for the pt with a cervical SCI should the nurse expect to be used?
skeletal traction with skull tongs
Cerebral edema
Swelling in brain is medical emergency because this can result in brain herniation with can result in death
A 70 yod pt is admitted after falling from his roof. He has a SCI at C7. What findings during assessment identify the presence of spinal shock?
Tetraplegia with total sensory loss
What statement describes GFR
The GFR is primarily dependent on adequate blood flow and hydrostatic pressure
What is cerebral blood flow?
The amount of blood in milliliters passing through 100 g of brain tissue in 1 minute
Two days following a SCI, a pt asks continually about the extent of the impairment that will result from it. Best response by nurse?
The extent of your injury can't be determined until the secondary injury to the cord is resolved
What accurately describes the care of a pt with CKD?
The use of calcium-based phosphate binders in the pt with CKD is contraindicated when serum calcium levels are increased
The pt with CKD is brought to the ED with Kussmaul respirations. What does the nurse know about CKD that could cause this reaction?
They're caused by respiratory compensation for metabolic acidosis
If patient has cirrhosis, the risk for hepatitis is increased. True or False.
True
What maintains ICP?
Under normal conditions in which intracranial volume remains relatively constant, the balance among the three components (brain tissue, blood, CSF)
A pt with advanced cirrhosis has a nursing dx of imbalanced nutrition: less than body requirements r/t anorexia and inadequate food intake. What would be an appropriate midday snack for the pt?
a fresh tomato with salt free butter
a patient with ulcerative colitis undergoes the first phase of a total proctocolectomy with ileal pouch and anal anastomosis. on post op assessment of the patient, what should the nurse expect to find
a loop ileostomy with a plastic rod to hold in place
what is the normal finding during physical a assessment of the mouth
a thin, white coating of the dorsum of the tongue
In a pt with AKI, which lab urinalysis indicates tubular damage?
specific gravity fixed at 1.01
dysarthria
a disturbance in the muscular control of speech; impairment involves pronunciation, articulation, and phonation
which infection or inflammation is found related to systemic disease and cancer chemotherapy
stomatitis
successful achievement of pt outcomes for the pt with cranial surgery would be best indicated by what
absences of s/s of increased ICP
what causes the systemic effects of viral hepatitis
activation of the complement system by antigen antibody complexes
the nurse is planning to teach the patient with GERD about foods or beverages that decrease lower esophageal sphincter pressure. what should be included in this list
alcohol chocolate fatty foods cola sodas
Metabolic acidosis occurs in the oliguric phase of AKI as a result of impairment of
ammonia synthesis
How is urinary function maintained during the acute phase of SCI?
an indwelling catheter
Which complication of chronic kidney disease is treated with erythropoietin (EPO)?
anemia
During the incubation period of viral hepatitis what should the nurse expect the patient to report
anorexia and RUQ discomfort
although HAV antigens are not tested in the blood, the stimulate specific immunoglobulin M and immunoglobulin G antibodies. which antibody indicates there is acute HAV infection
anti HAV IgM
the patient is receiving the following meds. which one is prescribed to relieve symptoms rather than treat a disease
antidiarrheal agents
Pt. has hepatic encephaolpathy. What is priority nursing intervention to keep the patient safe?
assist pt to bathroom
a 68 yo patient is in the office for a physical. she notes that she no longer has regular BM. which suggestion by the nurse would be most helpful to the patient
attempt defecation after breakfast because gastrocolic reflexes increase colon peristalsis at that time
In which type of dialysis does the pt dialyze during sleep and leave the fluid in the abdomen during the day
automated peritoneal dialysis
the pt's SCI is at T4. what is the highest level goal of rehab that is realistic for this patient to have?
be independent in self-care and wheelchair use
hemianopsia
blindness of over half of the vision field
which conditions contribute to formation of abdominal ascites
blood flow through the portal system is obstructed, which causes portal HTN
Hydrocephalus
build up of fluid in the brain and is manifested by ventricular enlargement; can be caused by excess CSF production, obstruction of flow, or an inability to reabsorb the CSF; treatment usually consists of a ventriculostomy or ventricloperitoneal shunt
serologic findings in viral hepatitis include both the presence of viral antigens and antibodies produced in reps pose to the viruses. what lab result indicates that the nurse is immune to HBV after vaccination
surface antibody anti-HB
A dx of a ruptured cerebral aneurysm has been made in a pt with manifestations of a stroke. The nurse anticipates which tx option to be considered for this pt?
surgical clipping of the anerysm
what is an appropriate nursing intervention of promote communication during rehab of the pt with aphasia?
talk about activities of ADLs familiar to pt
Portal Hypertension
characterized by increased venous pressure in the portal circulation, splenomegaly, large collateral veins, ascites, and gastric and esophageal varices
a thrombus that develops in a cerebral artery does not always cause a loss of neurologic function because
circulation via the circle of Willis may provide blood supply to the affected area of the brain
when assessing the body functions of pt with increased ICP, what should the nurse assess first?
circulatory and respiratory status
what problem should the nurse assess the patient for if the patient was on prolonged antibiotic therapy
coagulation problems
the media prescribed for the patient with IBD include cobalamin and iron injections. what is the rationale for using these drugs
correct malnutrition
Which test is most specific for renal function other than GFR
creatinine clearance
In counseling pts with spinal cord lesions regarding sexual function., how should the nurse advise a male patient with complete lower motor neuron lesion? a. he's most likely to have reflexogenic erections and may experience orgasm is ejaculation occurs. b. he may have uncontrolled reflex erections but orgasm and ejaculation are usually not possible. c. he has a lesion with the greatest possibilty of successful psychogenic erection and no ejaculation or orgasm. d. He will probably be unable to have either psychogenic or reflexogenic erections and no ejaculation or orgasm.
d. He will probably be unable to have either psychogenic or reflexogenic erections and no ejaculation or orgasm.
Which factors decrease cerebral blood flow
decreased MAP PaCO2 of 30 mm Hg
The pt has been dx'ed with a cerebral concussion. WHat should the nurse expect to see in this pt?
headache, retrograde amnesia, and transient reduction in LOC
pt is admitted to ED with a SCI at T2. Which finding is of most concern to the nurse?
heart rate of 42 bpm
the nurse can assist the pt and fam in coping with the long term effects of a stroke by doing what?
helping the pt and fam to understand the significance of residual stroke damage to promote problem solving and planning
following a needle stick, what is used as prophylaxis against HBV
hepatitis B immune globulin (HBIG)
key manifestations of bacterial meningitis?
high fever, nuchal rigidity, and severe headache
What is the most serious electrolyte disorder associated with kidney disease?
hyperkalemia
during acute phase of stroke, the nurse assesses the pt's VS and neuro status q4. what is the CV sign that the nurse would see as the body attempts to increase cerebral blood flow
hypertension
An 83 yod female was found lying on the bathroom floor. She said she fell 2 days ago and has not been able to take her heart medication, eat or drink anything since. What conditions could be causing prerenal AKI in this patient
hypovolemia decreased CO
the nurse identifies a need for further teaching when the patient with hep B makes which statement
i must avoid all physical contact with my family until the jaundice is gone
what physiologically occurs with vomiting
immediately before the act of vomiting, activation of the parasympathetic nervous system causes increased salivation, increased gastric motility, and relaxation of the lower esophageal sphincter
a pt with cirrhosis that is refractory to other treatments for esophageal varices undergoes a portacaval shunt. As a result of this procedure, what should the nurse expect the pt to experience?
improved hemodynamic function and renal perfusion
When should ICP be monitored?
in patients admitted with a Glasgow Coma Scale (GCS) score of less than or equal to 8 and an abnormal CT scan or MRI (hematomas, contusion, edema)
What causes the GI manifestation of stomatitis in the pt with CKD
increased ammonia from bacterial breakdown of urea
which lab finding should the nurse expect in the patients with persistent vomiting
increased pH, decreased potassium, increase hematocrit
A pt with an obstruction of the renal artery causing renal ischemia exhibits HTN. What is one factor that may contribute to the HTN
increased renin release
Combined with clinical manifestations, what is the lab finding that is most commonly used to dx acute pancreatitis?
increased serum amylase
the patient asks why the serologic test of HBV DNA quantitation is being done. what is the best rationale for the nurse to explain the test to the patietn
indicated viral replication and effectiveness of therapy for chronic HBV
a patient diagnosed with chronic hepatitis B asks about drug therapy to treat the disease. what is the most appropriate response by the nurse?
interferon combined with lamivudine will decrease viral load and prevent complications
a 54 yod man is recovering from a skull fracture with a subacute subdural hematoma that caused unconsciousness. he has a return of motor control and orientation but appears apathetic and has reduced awareness of his environment. When planning discharge of the pt, what should the nurse explain to the pt and fam?
pt is likely to have long-term emotional and mental changes that may require professional help
Acute Tubular necrosis is the most common cause of intrarenal AKI. Which pt is most likely to develop ATN?
pt with major surgery who required a blood transfusion
the pt has lack of comprehension of both verbal and written language. Which type of communication difficulty does this patient have?
receptive aphasia
Extracranial-intracranial bypass
involves anastomosing (surgically connecting) a branch of an extracranial artery to an intracranial artery (most commonly, superficial temporal to middle cerebral artery) beyond an area of obstruction with the goal of increasing cerebral perfusion. This procedure is generally reserved for those patients who do not benefit from other forms of therapy.
what manifestation in the pt does the nurse recognize as an early sign of hepatic encephalopathy
irritable and lethargic
What is the global CBF?
is approximately 50 mL/min per 100 g of brain tissue
What is intracranial pressure?
is the hydrostatic force measured in the brain CSF compartment
when caring for a patient with autoimmune hepatitis, the nurse understand that what in this patient is different from the patient who ahas viral hepatitis
is treated with corticosteroids or other immunosuppressive agents
A carotid endarterectomy is being considered as tx for a pt who has several TIA's. What should the nurse explain to the pt about this surgery?
it involves removing an atherosclerotic plaque in the carotid artery to prevent an impending stroke
zofran is prescribed for a patient with cancer chemotherapy induced vomiting. what should the nurse understand about this drug
it relieve vomiting centrally by action in the vomiting center and peripherally by promoting gastric emptying
What BP medications are preferred for stroke patients?
labetalol and nicardipine
when caring for patient who has ad most of the stomach surgical removed, what is important for the nurse to teach the patient
lifelong supplementation fo cobalamin will be needed
following auscultation of the abdomen, what should the nurses next action be
lightly percuss over all four quadrants
A fever of a pt at risk for increased ICP should be controlled in order to...
maintain a temperature of 36° to 37°C by using antipyretics (e.g., acetaminophen), cool baths, cooling blankets, ice packs, or intravascular cooling devices as necessary without causing the patient to shiver or shake. Shivering should be avoided as this increases the metabolic workload on the brain, and sedatives may be needed or a different type of cooling method selected.
When a pt is admitted to the ED following a head injury, what should be the nurse's first priority in management of the patient once a patent airway is confirmed?
maintain cervical spine precautions
During the tx of pt with bleeding esophageal varices, what is the most important thing the nurse should do?
maintain the pt's airway and prevent aspiration of blood
pt is admitted to the ED with a possible cervical SCI after a car crash. During admission, what is the highest priority for the nurse?
maintaining a patent airway
What is the priority intervention of in the ED of the pt with a stroke>
maintenance of respiratory function with a patent airway and O2 administration
What is the pt with chronic pancreatitis more likely to have than a pt with acute pancreatitis?
malabsorption and DM
a patient with ulcerative colitis has a total proctocolectomy with formation of a terminal ileum stoma. what is the most important nursing intervention for the is patient postoperatively
measure the ileostomy output to determine the status of the patients fluid balnce
which nursing coins are indicated for a liver biopsy
monitor for internal bleeding position to right side after test check coagulation status before test
what is a normal finding on physical exam of the abdomen
observation of visible pulsations
Thrombolitic Stroke
occurs from injury to a blood vessel wall and formation of a blood clot
a patient with IBD has a nursing diagnosis of imbalanced nutrition les than body requires related to decreased nutritional intake and decreased intestinal absorption. which assessment data support this diagnosis
pallor and hair loss
which complication of acute pancreatitis requires prompt surgical drainage to prevent sepsis
pancreatic abscess
a patient is admitted to the hospital with LUQ pain. what may be a possible source of the pain
pancreatitis
what characterizes auscultation of the abdomen
the presence of borborygmi indicated hyperperistalsis
While caring for the pt in the oliguric phase of AKI, the nurse monitors the pt for associated collaborative problems. When should the nurse notify the HCP?
the pt experiences increasing muscle weakness and abdominal cramping
the family members of a patient with hep A ask if there is anything that will prevent them from developing the disease. what is the best response by the nurse
those who have had household or close contact with the patient should receive immune globulin
a patients serum liver enzyme tests reveal an elevated AST. the nurse recognized what about the elevated AST
tissue damage in organs other than the liver may be identified
Why is it critical to maintain CBF?
to preserve tissue and thus minimize secondary injury
Why is the GCS used?
to quickly assess the LOC
what lab test would the nurse expect to find in a pt with cirrhosis
total bilirubin 3.2
the nurse suspects the presence of an arterial epidural hematoma in the pt who experiences
unconsciousness at the time of a head injury with a brief period of consciousness followed by a decrease in LOC
eyelid ptosis
upper eyelid droops over the eye
a pt is admitted with possible bacterial meningitis. During initial assessment, the nurse questions the patient about a hx of what?
upper resp infection
the occurrence of acute liver failure is most common in which situation
use of acetaminophen with alcohol
a patient is scheduled for biopsyy of a painful tongue ulcer. based on knowledge for risk factors of oral cancer, what should the nurse specifically ak the patient about during a history
use of any type of tobacco products
which events cause increased ICP
vasodilation edema from initial brain injury necrotic tissue edema
a patient treated for vomiting is to begin oral intake withe symptoms have subsided. to promote rehydration the nurse plans to administer which fluid first
water
a 20 yo patient with a history of crowns disease comes to the clinic with persistent diarrhea. what are characteristics of crowns disease
weight loss abdominal pain has segmented distribution involves the entire thickness of the bowel
