med surg exam 1
What's the difference between conductive hearing loss and sensorineural hearing loss
- Conductive is the outer ear - Sensorineural is the inner ear
pt education for insulin
- Room temperature 28 days once in use - Refrigerate if not in use - do not freeze - rotate your sites
what should patients do post-op cataract surgery
- Sunglasses - avoid activities that increase intraocular pressure - antibiotics
what are some factors that contribute to metabolic syndrome
- abdominal obesity - hyperglycemia - hypertension - hyperlipidemia
Examples of ADLs
- bath - dress - eat - toilet - walk
what are some factors that affect learning
- motivation - readiness o physical/emotional conditon - timing - scheduling the session - active involvement - feedback o good job - repetition - learning environment o pull curtain, private, quiet - amount and complexity of content - communication o verbal/nonverbal - Developmental stage - cultural factors o old people/children - health literacy o med term is tricky to understand - promoting literacy o draw pics o simple words o no medical jargon o hospital-approved written and printed instructions
5 rights to good pt education
- time - context - goal - content - method
examples of IADLS
- use the phone - grocery shop - make food - housekeeping - pay bills
what are some common issues with the elderly
-deficiencies in calcium vitamin D vitamin C vitamin A -lose their teeth or have dentures they may not be eating as much -drink 2 liters of water and eat 35 to 50 grams of fiber daily to avoid Constipation and dehydration -walk 30 minutes three to five times a week -risk for presbyopia which is vision changes such as cataracts and glaucoma
how long does the maturation phase last
1 year
Long acting insulin onset
1-2 hours
What are the domains of learning?
1. Cognitive - thinking 2. Affective- feeling 3. Psychomotor- skills
Clinical Reasoning Cycle
1. Consider the patient situation 2. Collect cues/information 3. Process information 4. Identify problems/issues 5. Establish goals 6. Take action 7. Evaluate outcomes 8. Reflect on process and new learning
What are the 3 P's of Diabetes?
1. PolyUREA= Much urination 2. PolyDipsea= Much thirst 3. PolyPHAGIA= Much eating
Signs of wound infection
1. Purulent drainage 2. Edema 3. Erythema
NPH duration
10-16 hours
Rapid onset
15 min
NPH onset?
2-4 hours
regular peak
2-4 hours
long-acting insulin duration
24 hours
rapid duration
3-5 hours
Regular onset
30-60 min
rapid peak
30-90 minutes
NPH peak?
4-12 hours
at what age are annual eye exams recommended
40
regular duration
5-8 hours
What is metabolic syndrome?
A cluster of conditions that increase the risk of heart disease, stroke, and diabetes.
what is the criteria to be diagnosed with diabetes
A1C is greater than 6.5%
what scale is used to assess skin break down
Braden scale
Macrovascular complications
Cardiovascular disease Cerebrovascular disease reduced immunity
characteristics of melanoma
Irregular edges Black Most likey to mestasize
what is meniere's disease
It is called 'my ears disease'. An idiopathic chronic condition associated with water in the ear. - Episodic Vertigo - Tinnitus - hearing loss - causes lymph fluid buildup in the ear and results in a sudden drop attack
what is the inflammatory phase
Phase attempts to slow tissue damage in bleeding
what is mechanical debridement
Physical removal of debris by irrigation, hydrotherapy or wet-to-dry dressing application
what are some interventions used to prevent pressure ulcers from happening
Q2 hour turns Clean dry Barrier cream
what does STAND, stand for when assessing the skin
S- score using the braden scale T-turn the patient A-apply barrier cream N-nutrition D-discuss specialists
What is the appropriate nursing response when a 66 year old healthy client asks how often a visit to the eye care providers recommended a. annually b. every six months c. only if you have vision problems d. one to two years if you have no eye problems
a
Which communication method is appropriate when a nurse is interacting with the client who's deaf a. use pictures and writing b. speak with enunciated words c. ask the client to read the nurse's lips d. speak with the clients caregivers
a
a nurse is assessing a lesion on a client who has basal cell carcinoma. The nurse should expect which of the following findings? a. a pearly shiny nodule b. a pigmented nodule c. a rough scaly tumor d. a weeping vesicle
a
which class of drugs lowers blood glucose levels by lowering liver glucose production in intestinal absorption of glucose plus includes insulin sensitivity a. biguanides (metformin) b. insulin stimulators (glipizide, glyburide) c. insulin sensitizers d. alpha glucosidase inhibitors
a
which patient is at greatest risk for developing a pressure ulcer a. bilateral 3 plus pitting lower extremity edema a non blanching right heel wound and activity orders of bed rest b. mild confusion and a need for assistance to ambulate to the bathroom c. bowel and bladder incontinence in a normal pre albumin level
a
cardiovascular disease
a disease of the heart and blood vessels - blood vessels become thickened because poor glucose regulation which leads to chronic ischemia, poor tissue perfusion, and hypoxia
What is macular degeneration?
a disease that progressively destroys the macula, the central portion of the retina, impairing central vision
Cerebral vascular disease
a group of brain dysfunctions related to disease of the blood vessels supplying the brain
The nurse performs an initial health assessment of an older adult which assessment findings indicate that the client may be at risk for falls select all that apply a. has presbyopia b. has peripheral neuropathy c. uses a cane d. takes multiple medications e. has bilateral cataracts f. has papery thin skin
a,b,c,d,e
the nurse is caring for an older client who is experiencing acute confusion and agitation following a fractured hip repair this morning which risk factor may be contributing to the clients delirium a. anesthesia used during surgery b. surgical pain c. unfamiliar environment d. noisy hospital unit e. medications used to manage pain
a,b,c,d,e
when teaching a community group of older adults what information will the nurse include regarding normal hearing changes associated with aging select all that apply a. hair in the ear thins and falls out b. hearing acuity changes in older adults c. cerumen dries and becomes impacted more easily d. The ability to hear low frequency pitches diminished first e. the sounds F,s, Sh and PA may be more difficult to discern
a,b,d,e
Which physiological processes directly prevent severe hypoglycemia in a healthy adult without diabetes whose NPO for 12 hours a. Gluconeogenesis b. Glycogenesis c. Glycogenolysis d. Ketogenesis e. Lipogenesis f. Lipolysis
a,c
What teaching will the nurse provide to a client who continues to experience more frequent episodes associated with meniere's disease SATA A. reducing activity can reduce frequency of episodes B. episodes will eventually decrease in severity and number C. reduce sodium caffeine and alcohol intake can be beneficial D. the only treatment that is effective is to undergo labyrinthectomy E. when moving from sitting to standing be cautious and take your time
a,c,e
While assessing A functional ability which activities will the nurse document as instrumental activities of daily living select all that apply a. cooking a meal b. walking down the hallway c. getting dressed for the day d. answering the phone e. taking a shower before bed f. shopping at the local market
a,d,f
What is presbyopia?
age-related vision loss
A nurse is assessing a client who has basal cell carcinoma on her nose. The nurse should expect which of the following findings? a. a multi-colored lesion with irregular borders b. a small, translucent papule with rolled borders c. a crusted lesion with indurated margins d. a small macule with dry yellow scale
b
A nurse is caring for a client with recurrent ophthalmic stomatitis who asked for a food choice or healing which food will the nurse suggest a. an orange b. chocolate pudding c. chips with hummus d. tomato juice
b
An older adults furosemide dosage was increased 2 days ago to 40 milligrams daily. This morning the nurse observes that the client has become confused and very weak what is the nurse's best action a. encourage fluid intake b. withhold the mornings dose of furosemide c. Review the most recent serum electrolyte levels d. place the patient on strict intake and output
b
Which class of drugs lowers blood glucose levels by triggering the release of preformed insulin from beta cells a. biguanides (metformin) b. insulin stimulators (glipizide, glyburide) c. insulin sensitizers d. alpha glucosidase inhibitors
b
Which of the following is the most effective teaching strategy a. telling the patient everything they need to know in 10 minutes b. assessing the patient's baseline knowledge c. Assessing what other RN's taught patient d. Asking patient why don't you know this we discussed it yesterday
b
a client with diabetes who now has chronic albuminuria asked the nurse how this will affect his health how will the nurse answer this question a. you will need to limit your intake of dietary albumin and other proteins to reduce your albuminuria b. the change indicates beginning kidney problems and requires good blood glucose control to prevent more damage c. your risk for developing utis is greatly increased requiring the need to take daily antibiotics for prevention d. from now on you'll need to limit your fluid intake to just one liter daily and completely avoid caffeine to protect your kidneys
b
which class of drugs is patient at most risk for hypoglycemia a. biguanides (metformin) b. insulin stimulators (glipizide, glyburide) c. insulin sensitizers d. alpha glucosidase inhibitors
b
which health promotion activities will the nurse recommend to prevent harm in a client with type 2 diabetes select all that apply a. Avoid all dietary carbs and fat b. have your eyes envisioned assessed by an ophthalmologist every year c. reduce your intake of animal fat and increase your intake of plant sterols d. be sure to take your anti diabetes drug right before you engage in any type of exercise e. keep your feet warm and cold weather by using either a hot water bottle or a heating pad f. avoid foot damage from shoe rubbing by going barefoot or wearing foot flops when you're at home
b,c
Which client statement affirms the nurse teaching about installation of multiple different eye drops has been effective select all that apply a. it will be very easy for me to install b. A schedule will help me remember when to instill the eyedrops c. If I have trouble instilling the drops, there are devices that can be helpful d. I can label the eyedrops by color to help me easily distinguish which one is which e. I will not touch the droppers to my eyes as this can cause contamination and infection
b,c,d,e
The assistive personnel is preparing to transfer a client with limited weight bearing from the bed to the chair. which action by the AP would require intervention from the nurse a. places the bed at hip level b. applies a gate belt to the client c. extends arms to reach out to client d. creates a wide base with feet
c
The nurse is caring for a 25 year old client with a new spinal cord injury resulting in tetraplegia. The client states "I won't be able to do any activities that I enjoy now" what is the priority nursing intervention a. Encourage the client to explore new activities that they can do b. teach your client about reasonable goals for activities c. allow the client to discuss feelings of loss related injury d. consult pastoral care to provide encouragement to client
c
Which class of drugs lowers blood glucose levels by decreasing liver production and increasing receptors insulin sensitivity a. biguanides (metformin) b. insulin stimulators (glipizide, glyburide) c. insulin sensitizers d. alpha glucosidase inhibitors
c
Which of the following describes the most appropriate evaluation of a teaching plan a. evaluating how good you taught the patient b. Making sure the patient states back everything you taught perfectly c. evaluating what the patient states back and how accurately they teach back d. filling out the TCP rubric
c
which precaution is priority for a nurse to teach a client prescribed pramlintide to prevent harm a. only take this drug once weekly b. do not mix the stroke with alcohol c. do not mix in the same syringe with insulin d. report any genital itching to your Primary Health care provider
c
interpersonal communication
communication between two people
corrective insulin
covers hyperglycemia (sliding scale) usually rapid or short-acting insulins
A nurse at an outpatient surgery center is providing discharge teaching to a client and his spouse following surgical removal of a cataract. Which of the following should the nurse include in the teaching? a. take ibuprofen for eye discomfort b.creamy white drainage is an indication of infection c. notify the provider immediately if the operative eye itches d. the client should wear dark glasses while outside
d
The nurse is conducting an assessment of an older adult living in the community which assessment findings are considered usual physiologic changes of aging select all that apply a. Dementia b. relocation stress c. urinary incontinence d. presbyopia e. obesity
d
What teaching well the nurse provides to a client who has just been fitted for new hearing aids a. turn off the hearing aid when not using it b. immerse the ear mold in alcohol to fully clean it c. store the hearing aid in a warm humid bathroom when not in use d. avoid using Hairspray makeup and personal care products around the device
d
Which patient does the nurse identify at highest risk for development of dry age-related macular degeneration a. 55 year old client who has recently began wearing glasses b. 59 year old client who has controlled hypertension c. 62 year old client with hypothyroidism d. 65 year old client with diabetes
d
You are the patient where should you be discharged or referred to help meet your optimal state of Wellness a. the best SNF in the state b. your house c. in ltac for sure d. the facility that best meets your discharge needs based on the RN assessment of the physical condition and ability to manage ADL's
d
when caring for four clients which client does a nurse report to the health care provider who should not receive an otoscopic examination a. 25 year old with throat and ear pain b. a 39 year old experiencing dizziness c. a 46 year old who has type 2 diabetes d. the 60 year old experiencing delirium
d
which class of drugs lowers blood glucose levels by inhibiting intestinal tract enzymes from breaking down starches into glucose a. biguanides (metformin) b. insulin stimulators (glipizide, glyburide) c. insulin sensitizers d. alpha glucosidase inhibitors
d
What are the 3 D's often associated with the elderly
depression, dementia, delrium
what is medicare for
elderly
Cataracts Pathophysiology
increase in proteins in the lens of the eye
What is stomatitis?
inflammation of the oral mucosa (canker sores)
prandial insulin
mealtime insulin
basal insulin
mimics pancreatic function
group communication
more than 2 people
long acting insulin peak
no peak
is an elderly pt has yellow tinged sclera does it mean that they are jaundiced
no they have fatty deposits
diabetes-related nephropathy
o #1 cause of end stage renal disease and kidney failure o risk factors § DM 10 to 15 years § uncontrolled BS, HTN o albuminuria screening, low GFR, creatinine o what will you teach your patient to control § BP, BS, cholesterol o nephrotoxic drugs include NSAIDs and antibiotics
diabetes-related autonomic neuropathy
o Orthostatic hypotension and syncope o Gastroparesis o neurogenic bladder o anhidrosis o sexual dysfunction o defective balancing hormones
thrush is a
opportunistic infection, sceondary
what does PASS stand for
p- probable that the patient will have swallowing difficulty a-account for previous swallowing problems s-screen for signs and symptoms s-speech and language pathologists needed
whos is Medicaid for
poor
Diabetes-related retinopathy
process of microvascular damage to the retina because of chronic hyperglycemia, nephropathy, and hypertension in patients with diabetes
Diabetic peripheral neuropathy
progressive deterioration of nerve function that results in loss of sensory perception
characteristics of squamous cell carcinoma
red, scaly, crusty
cataracts s/s
report poor night vision, a yellowing or fading of colors, or loss of brightness of color
intrapersonal communication
self talk
characteristics of basal cell carcinoma
shiny, scaly, pearly, most common least likely to metastasize
what is important to do before a pt has cataract surgey
stop anticoagulants
What is surgical debridement?
surgical removal of dead, damaged, or infected tissue
what is chemical debridement
using enzymes to debride wound
what is the proliferative phase
what phase starts the regrowth of new tissue promoting buds and granulation
who are people with cataracts diagnosed
with an eye exam
what are some things about foot care that should be taught to someone newly diagnosed with diabetes
§ Inspect feet daily § Wash feet daily with warm water § Apply moisturizer to feet but never in between your toes § Clean socks cotton § Check shoes for foreign objects § Buy shoes later in the day to make sure your feet fit properly § Trim nails
