Medsurg 1 test 2

Hypokalemia nursing management

-ALWAYS DILUTED IV KCl, -never give KCl IV push or bolus -Pump should not exceed 10 mEq/hr via pump except for severe deficiencies with urine output at least 0.5 ml/kg

Sinusitis -Cm -tx -caution

-pain in sinuses, drainage, decongestion, obstruction, fever, ,malaise -treat symptoms, antibiotics if longer than 10 days -CAUTION USE OF TOPICAL DECONGESTANT D/T REBOUND

upper urinary tract infection

-pyleonephritis (kidney infection) -systemic sm -fever, chills, flank pain

Allergic rhinitis -Cause -CM -TX

-reaction of nasal mucosa to allergen -sneezing, itchy eyes and nose, clear nasal drainage -avoid allergens

TB diagnostic studies -Sputum -cultures

-•Sputum samples obtained (usually) on 2-3 consecutive days -can take up to 8 wks

Nursing management of fluid alterations

daily weights: most accurate ewas to measure change in volume status. increase in a pound is increase of 1 l of water I&O Urine specific gravity

Asthma goals

decrease amount of exacerbations, adequate knowledge

Uncomplicated UTI

-occurs in normal urinary tract, usually only involves the bladder

The nurse receives a change-of-shift report on the following four clients. Which client should the nurse assess first?

immobile client with a sudden onset of shortness of breath

Oxygen therapy for COPD

improves prognosis, hct, pulmonary hypertension

Smoking effect on resp tract

increased mucus, decreased cilia activity, inflammation, decreased oxygen capacity

D5W

isotonic, but dextrose quickly metabolized causeing administration of free water (hypotonic) free water wo electrolytes prevents ketosis and treats water losses/hypernatremia

LR

isotonic, contains sodium, potassium, chloride, calcium and lactate CONTRAINDICATED W HYPERKALEMIA AND LACTIC ACIDOSIS

Use of VQ scan

look for pulmonary embolism

CO2 narcosis

loss of sensitivity to high levels of CO2, causes decrease in act of breathing

Hypernatremia Nursing management

treat primary water defecit ( only isotonic or hypotonic fluids) Dilute sodium free IV fluids and promote excretion w diuretics dont decrease sodium levels too quickly: no more than 8-15 mEq per 8 hr period

Latent tb infection

treated with INH for 6-9 mos

Active Tb

treatment is agressive, four drug regimen. liver function monitored

UTI CM:

urinary frequency, urgency, incontinence, weak stream, nocturia, intermittency, postvoid, foul-smelling urine

A client with chronic obstructive pulmonary disease (COPD) and cor pulmonale is being prepared for discharge. The nurse should provide which instruction?

"Weigh yourself daily and report a gain of 2 lb (0.91 kg) in 1 day."

Which statement indicates a client understands teaching about the purified protein derivative (PPD) test for tuberculosis?

"Because I had a previous reaction to the test, this time I need to get a chest X-ray."

The nurse is collecting data on a client with a urinary tract infection (UTI). Which statements should the nurse expect the client to make? Select all that apply.

"I need to urinate frequently." "It burns when I urinate." "I need to urinate urgently."

A nurse is planning a group teaching session on the topic of urinary tract infection (UTI) prevention. Which statement, if made by a group member, would indicate understanding of the teaching?

"I should notify the physician if urinary urgency, burning, frequency, or difficulty urinating occurs."

Hypomagnesemia -causes -cm -tx

-ALCOHOLISM, fluid loss in GI, diuretics, fasting, starvation -CORRESPONDING W HYPOCALCEMIA AND HYPOKALEMIA CAUSES SYMPTOMS -treat underlying cause, oral supplements, increase dietary intake, too quick of increase can cause hypotension or cardiac/resp arrest

Lower urinary tract infection

-no systematic cm -cystitis -urethritis

Acute Viral Rhinitis -Cause -CM -TX -complciations

- Causse URTI -CM runny nose, watery eyes, nasal congestion, sneezing, cough, sore throat, fever, headache, fatigue - TX may be treated with antibiotcs, relieve symptoms ( decongestions, rinses, nose sprays, suppressants) MOBILIZE SECRETIONS -Complications: secondary bacterial infection, pharyngitis, sinusitis, otitis media, tosillitis, ling infections

Hypokalemia Causes CM

- causes: increased loss of k+ via kidneys of GI, diabetic ketoacidosis, deficiency, if alkalosis is bad it can cause shift as well -CM: cardiac, muscle weakness, weak resp muscles, hyperglycemia, decreased GI

Hyponatremia - causes -complications

- loss of sodium containing fluids or water excess -altered sensory and decreased level of conciousness, irreversible neuro damage

Phosphate -maintained by -essential to what function

- maintained by kidneys, must be adequately working -RBC, muscle, nervous system, acid base, atp, uptake of glucose, metabolism

actue pharyngitis

-CM: sore throat, red, edema pharynx, fever, node enlargemtn, yellow to green exudate, irregular candida albicans patches -rapid strep test if three or more symptoms present -tx: relieve symptoms, treat fungal infection if present, prevention

Potassium -maintenence of? -sources -regulated by

-Cardiac rhythms -salt sustitutes -kidneys clear potassium

Hypercalcemia -Causes -CM

-Causes: Hyperparathyroidism, malignancy, -CM:SEDAtIVE LIKE CM, fatigue, lethargy, weak, confused, bone pain, fracture, hallucinations

Diagnostic study for UTI

-Determine bacteria susceptibility to antibiotics - SENSITIVE OR RESISTANT

When if pt infectous of Tb after starting tx

-Infectious for first 2 weeks after starting treatment if sputum +

Hypocalcemia -biggest risks -causes -CM

-Laryngospasm, respiratory distress -causes: decreased PTH, multiple blood transfusions (citrate binds to calcium), alkalosis, removal or damage to parathyroid -CM: TETANY, pos trousseaus or Chvostecks signs, Laryngeal stridor, dysphagia, tingling, cardiac dyrhythmias

bronchoscopy Nursing management

-NPO 6-12 hr before -concent-admin sedative -keep NPO until gag returns -Monitor bloody sputum

UTI patho

-Organisms introduced via the ascending route from urethra and originate in the perineum -Hospital-acquired UTI accounts for 31% of all nosocomial infections

Complications of pneumonia

-Pleurisy -Pleural effusion -Atelectasis -Bacteremia -Lung abscess -Empyema -Pericarditis -Meningitis -Sepsis -Acute respiratory failure -Pneumothorax

Drug therapy for UTI

-Selected on empiric therapy or results of sensitivity testing

Nasal fracture -cause -complication -tx

-blunt trauma -csf clear liquid from nose or ear -maintain airway, upright, icem analgesics, surgery

Calcium -functions -where we get it -what vitamin do we need to absorb it -what organ regulates calcium

-bone, teeth, clotting, muscle contractions, -we get it from digested foods, need vit d absporb -balanced by parathyroid hormone, calcintonin (decreases calcium)

Hypernatremia -causes -complications it caues

-caused by inadequate fluid intake, excess water loss, or sodium gain causes cellular dehydration

Hypermagnesemia -cause -cm -tx

-caused by increased products with agnesium when renal insufficiency or failure is present, excess IV admin, pregnant women for preeclampsia tx -CM:RESP or Cardiac arrest, lethargy, n/v, impaired reflexes, muscle paralysis -IV Cacl or calcium gluconate, diuretic/fluids to enhance excretion

Fluid volume excess -CAUSES -CM -TX

-causes: heart failure, renal failure, colloids -cm: headache, confusion, lethargy, peripheral edema, JVD, bounding pulses, hypertension, dyspnea, crackles, pulmonary edema, muscle spasms, seizures, coma --tx: underlying cause, remove fluid without changing electrolyte composition or osmolarity

Hypophosphatemia -causes -CM -tx

-causes: malnourishment, diarrhea, antacids, inadequate PTN -CM: impaired cellular energy and oxygenation, cns depression, muscle weakness and pain, resp/heart failure -tx:oral supplements, iv admin of sodium or phosphate

Influenza -manifestations -complications -tx

-cm: abrupt fever, chills, anorexia, myalgia -complications: dyspnea, crackles, pneumonia -antivirals, prevention vaccine

Thoracentesis Nursing management

-concent -position upright -instruct pt to not talk or cough -verify breathe sounds -encourage deep breathing to expand lungs

Magnesium -imporrtant for -excreted by

-important for cardiac function, metabolis, dna, glucose control, BP, ATP -Kidneys

Effects of aging on urinary system

-in 70's, loss of 30-50% glomerular function, athersclerosis decreases renal size -decreased renal blood flow implications for med admin

Hyperphosphatemia -causes -CM -tx

-kidney injury or disease, chemo, excessive intake, hypoparathyroidism HYPOCALCEMIA -Neuromuscular irritability, tetany (like hypocalcemia) , calcified depositions -tx: treat underlying cause, restrict dairy, oral phosphate binding agents, correct hypocalcemia

Accidental dislodgement

-minor dyspnea can be alleviated with semi fowlers postition -cover stoma with sterile dressing -ventilate with bag mask

Hypotonic fluid (0.45% NaCl)

-more water than electrolytes, maintence fluids, can cause celluar swelling and edema

Cleaning inner cannula of trach

1. gather equiptment 2. don sterile gloves 3. unclock cannula and clean with sterile saline, reinsert

COPD and smoking

15% smoker 80-90% copd deaths were smokers

1st space 2nd space 3rd space

1st- normal distribution 2nd- abnormal (edema)n 3rd- difficult for fluid to be reabsorped

How long does it take pulmonary TB to develop

2-3 wk

How much does 1L of water weigh

2.2lb (1kg)

Sulfamethoxazole has been prescribed to treat a client's urinary tract infection. The initial dosage is 2 g orally. The nurse has 500-mg tablets available. How many tablets should the nurse give? Record your answer using a whole number.

4

Structural remodeling asthma

4-6 hr after initial attack, more severe than early phase, last longer,

TB skin test

A waning immune response can cause false negative results, repeating may improve reaction. Two step mostly required

Hyperkalemia -causes

ACIDOSIS, RENAL FAILURE, massive k+ intake

Drug therapy for pneumonia

Empiric therapy -improves in 3-5 days start with iV then switch to oral once pt is stable. Min 5 days antibiotic therapy

A client with chronic obstructive pulmonary disease (COPD) has developed tachypnea, dyspnea, and oxygen saturation (SaO2) of 90%. Which action by the nurse is most appropriate?

Assist the client to sit in a chair and lean slightly forward with hands on the knees

Vesicoureteral reflux

Backward movement of urine from lower to upper urinary tract

Hyperkalemia CM TX:

CM: CARDIA DYSRHYTHMIAS, cramping, weak muscles TX: eliminate potassium intake, diuretics to promote loss, if urgent: ADMIN INSULIN AND D50 IV or calcium, or bicarbonate. zuse of albuterol and calcium gluconate

Opportunistic pneumonia

Caused by microorganisms that do not normally cause diseas, pts at risk (immune deficient, chemo, radiation, steroid)

Decannulation

Close stoma with dressing, splint with coughin wallowing and speaking, should close within 4-5 days

complicated UTI

Coexists with presence of -Obstruction -Stones -Catheters -Diabetes/neurologic disease -Pregnancy-induced changes -Recurrent infection

A nurse is planning care for a client after a tracheostomy. One of the client's goals is to overcome verbal communication impairment. Which intervention should the nurse include in the care plan?

Encourage the client's communication, allowing time to select or write words

Hypercalcemia Nursing Management

Excretion via loop diuretic, hydration w isotonic, low calcium diet, calcitonin, dialysis in life threatening situtaiton

Peak airflow intervals

Green: 80-100 yellow: 50-80 red: 50 or less

medical care-associated pneumonia (MCAP)

HAP: pneumonia occurring 48 hours or longer after hospital admission and not incubating at the time of hospitalization. VAP: occuring more than 48 hr after endotracheal intubation

D10W

Hypertonic highest dextrose that can be admin peripheral IV

COPD Cor Pulmonale

Hypertrophy of right side of heart Result of pulmonary hypertension Late manifestation of COPD Eventually causes right-sided heart failure -dyspnea, JVD, hepatomegaly, periph edema, weight gain

Normal saline

ISOTONIC, preferred immediate resonse, compatible with most meds and only solution used with blood

A client is admitted to a healthcare facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this client?

Impaired gas exchange related to airflow obstruction

Asthma Triad

Nasal polyps, asthma, and sensitivity to aspirin and NSAIDs

A client with a history of asthma is brought to the emergency department in respiratory distress. Which is the priority action by the nurse?

Position in Fowler's position, initiate oxygen, and administer bronchodilators as ordered

UTI analgesic

Pyridium stains urine reddish orange and can be mistaked for stain clothing,

Hyponatremia CM

Result of cellular swelling and manifested in CNS headache, irritable, difficulty concentrating

The nurse is offering further education to a client about the management of COPD. Which outcomes would indicate the teaching has been effective? Select all that apply.

The client demonstrates pursed-lip breathing and coughing exercises., The client maintains smoking cessation. The client schedules follow-up physician appointments.

Oxygen at the rate of 2 liters per minute through nasal cannula is prescribed for a client with chronic obstructive pulmonary disease (COPD). Which of the following statements best describes why the oxygen therapy is maintained at a relatively low concentration?

The client's respiratory center is so used to high carbon dioxide and low oxygen levels that changing these levels may eliminate his stimulus for breathing.

Hypocalcemia nursing management

Treat cause, calcium replacement, rebreathe into paper bag, treat hyperventilation anxiety

urinary reflux

abnormal backward or return flow of urine from the bladder into the ureters, can cause uti

TB skin test positive criteria

above or equal to 15 mm in low risk above or equal 5 in immunecompromised

TB precaution

airborne precaution, requires close, long, frequent exposure

A nurse is reviewing orders for a client having an acute asthma attack. Which medication should the nurse administer?

albuterol 2.5 mg per nebulizer

Pneumonia tx

antibiotics, xray, supportive care for hypoxemia, chestpain, fever, activity, antiviral fro influenza pneumonia

Nursing assessment for pneumonia

assess risk of immune compromise: antibiotic, corticosterois, immunospuppresant P&H recent surgery, intubation, tube feedings

Empiric therpay

based on severity of illness, where it was acquired, and probable causative organism

Anions

bicarbonate, chloride, phosphate

COPD drug therapy

broncho dilators, corticosteroids, antibitics

Which medication should be available to provide emergency treatment if a client develops tetany after a subtotal thyroidectomy?

calcium gluconate

Important to assess when admin oral fluid therapy

can pt swallow

A client with chronic kidney disease (CKD) has a blood urea nitrogen (BUN) of 100 mg/dL, serum creatinine of 6.5 mg/dL, potassium of 6.1 mEq/L, and lethargy. What is the priority nursing assessment?

cardiac rhythm

ECF volume deficiency (hypovolemia - causes -cm -tx

causes: diarrhea, vomiting, hemorrhage, polyuria cm:restless, drowsy, lethargic, confused, postural hypotension, tachycardia, tachypnea, weak, dizzy, weightloss, seizure, coma tx: correct underlying cause and replace water and electrolytes

A client with emphysema is at a greater risk for developing what acid-base imbalance?

chronic respiratory acidosis

A client admitted with tuberculosis reports concerns about paying for needed medications. The nurse should:

collaborate with the social worker to investigate possible availability of funds

Nursing assessment Tb

color of sputum, weight loss, pleuritic chest pain, crackles over apices of lungs

clinical manfestations of pneumonia

cough, fever, shakin, dyspnea, tachypnea, pleuritic chest pain, green, yellow, rust colored sputum, CHANGE IN MENTATION FOR OLDER PT

COPD CM

cough, sputum, exposure to risk factors, dyspnea on exertion, chest breathing, iunderweight, fatigue, prolonged expiratory, wheeze, tripod, barrel chest, pursed lip, bluish red skin

A client has undergone a left hemicolectomy for bowel cancer. Which combination of activities is most effective in preventing the occurrence of postoperative pneumonia in this client?

coughing, breathing deeply, frequent repositioning, and using an incentive spirometer

Trach cuff deflation

deflate only if pt is not at risk for aspiration, allows taking and swallowing

After suctioning a client's tracheostomy tube, the nurse waits a few minutes before suctioning again. The nurse should use intermittent suction primarily to help prevent:

depriving the client of sufficient oxygen supply

TB Ghon focus

develops into granuloma Infection walled off and further spread stopped

Pt at risk for uti

diabetic, immunecompromised, catheter placed, incontinent

Nursing management asthma

identify known triggers, fluid intake, avoid cold air, avoid NSAIDS, aspirin nonselective beta blockers

Pt education TB

drug side effects, wear mask if out of neg pressure room, screen close contacts

Cystitis and pyelonephritis

early treatment of cystitis to prevent pyelonephritis

Hyponatremia Nursing Management

if cause is SIADH and water excess: restrict fluids w loop diuretic replacement fluid with sodium severe symptoms to icu only

A client with chronic renal failure is admitted with a heart rate of 122 beats/minute, a respiratory rate of 32 breaths/minute, a blood pressure of 190/110 mm Hg, jugular vein distention, and bibasilar crackles. Which nursing diagnosis takes highest priority for this client?

excess fluid volume

Isotonic (0.9 NS/LR)

expands ECF only, filling up the tank, dont affect ICF or electrolytes, ideal for ECF volume defecit

65 yr old plus in regard to pneumonia

health promotion

Cytomegalovirus (CMV) pneumonia

herpes virus, lifethreatening to immune suppressed, asyptomatic to severe, treated with IGG and antiviral

nurse consulting with a nutrition specialist knows it's important to consider a special diet for a client with chronic obstructive pulmonary disease (COPD). Which diet is appropriate for this client?

high protein

COPD dietary

high protein/calorie, 3 L fluid a day

Diffusion

high to low concentration

What air should trach pt initially recieve

humidified air

D1/2 NS

hypertonic common maintence for fluid loss KCl added for maintence or replacement

On the third day after a partial thyroidectomy, a client exhibits muscle twitching and hyperirritability of the nervous system. When questioned, the client reports numbness and tingling of the mouth and fingertips. Suspecting a life-threatening electrolyte disturbance, the nurse notifies the surgeon immediately. Which electrolyte disturbance most commonly follows thyroid surgery?

hypocalcemia

A client is admitted with fever and flank pain and is diagnosed with pyelonephritis. What is a priority nursing intervention in a client with this disorder?

monitoring laboratory values, especially WBCs

how often should trach tube be changed

monthly, pt can use clean technique at home

Advantages of trach tube

more secure, less mobility, less risk of airway damage, easier to breathe, increased comfort, pt can speak and eat

Potential for traach dislodgement prevention

most dangerous 5-7 days to prevent: 1. replace at bedside, dont change ties for 24 hours, physician performs first dressing change

A client who has been taking furosemide has a serum potassium level of 3.2 mEq/L. Which assessment findings by the nurse would confirm an electrolyte imbalance?

muscle weakness and a weak, irregular pulse

rhinoplasty nursing considderations

nasal packing, observe adquate oxygenation, swelling and head elevation

A physician orders albuterol for a client with newly diagnosed asthma. When teaching the client about this drug, the nurse should explain that it may cause

nervousness

Directly observed treatment for tb

noncompliance is major factor in tx failure

A client must receive a blood transfusion of packed red blood cells (RBCs) for severe anemia. What I.V. fluid should the nurse use to prime the tubing before hanging this blood product?

normal saline solution as this is considered an isotonic solution

emphysema and aging

physiologic changes in aging

Epistaxis tx

pinch entire lower portion of nose for 10-15 min, risk of respiratory impairment

Hypernatremia CM

postural hypotension, tachycardia, weakness, alterations in mental status raging from agitation, restless ness, confusion, lethargy, coma THINK NEURO

Asthma and exercise

premedicate before exercising

Pt education uti

prevent to spread to upper tract infection, wipe front to back, Avoid unnecessary catheterization and early removal of indwelling catheters, chg wipes, avoid incontinent episodes, one of the ps, Emphasize taking full course of antibiotics despite disappearance of symptoms, void after intercourse,

Goals of COPD

prevention, ability to perform adls. knowledge, quality of life

Renal regulation of water balance

primary organ for fluid and electrolyte balance

The graduate registered nurse (RN) is assigned the care of a client with acute renal failure and hypernatremia. Which actions can the graduate RN delegate to the unlicensed assistive personnel (UAP)? Select all that apply.

provide oral care

Hypertonic fluids

provides calories as a part of PTN, expands ECF, must observe for fluid overload

Community aquired pneumonia

pt who hasnt been hospitalized or resided in long term care facility within 14 days of onset

A client who has been hospitalized for treatment of a pneumothorax is ready for discharge. Which outcomes indicate that the client has adequate respiratory function? Select all that apply.

respiratory rate of 12 to 20 breaths per minute, breath sounds present and equal in all lobes,oxygen saturation on room air is 95%.

What is the tube with the inflated cuff on a trach used for

risk of aspiration or in mechanical ventilation q

acute pyelonephritis can lead to

sepsis, can lead to death

Urinary Tract Calculi CM

severe pain, flank pain, kidney stone dance, uti symptoms

Cations

sodium, potassium, calcium, magnesium

A client with bacterial pneumonia is to be started on IV antibiotics. The nurse should verify that which diagnostic test has been completed before administering the antibiotic?

sputum culture

What makes TB active again

stress, illnes

What is a tracheostomy

surgically created stoma to bypass obstruction, facilitate secretion removal, long term mechanical ventilation

Life threatening asthma

sweating, cant talk, drowsy, confused

UTI symptoms in older adult

symptoms often absent, cog impairment, nonlocalized absominal discomfort, fever less likely

Corticosteroids for asthma

taken on a fixed schedule, systemic to form control exacerbations and manage persistent asthma, can cause candidiasis, wash moth after use

CVA assessment urinary

tenderness, bruits

A client with a history of type 1 diabetes is admitted to the hospital with community-acquired pneumonia. The client's blood glucose level in the emergency care unit was 576 mg/dl (31.97 mmol/L). The physician orders an I.V. containing normal saline solution, an insulin infusion, and I.V. levofloxacin. The nurse piggybacks the insulin infusion into the normal saline solution. The nurse questions whether piggybacking the levofloxacin into the same I.V. line is appropriate. Which health team member should the nurse collaborate with to check the compatibility of these solutions?

the pharmacist covering the floor

Acute attack urinary tract calculi

treat infection, obstruction, and pain STRAIN ALL URINE

COPD PATHO

vascular changes causes pulmonary hypertension, blood vessels thicken

A client with an indwelling urinary catheter is suspected of having a urinary tract infection. The nurse should collect a urine specimen for culture and sensitivity by

wiping the self-sealing aspiration port with antiseptic solution and aspirating urine with a sterile needle

CM of pyelonephritis

§Mild fatigue §Chills §Fever §Vomiting §Malaise §Flank pain CVA) tenderness

COPD

•Chronic bronchitis •Emphysema progressive

symptoms of TB, early and late

•High fever •Chills, generalized flulike symptoms •Pleuritic pain •Productive cough •Adventitious breath soundsnitial dry cough that becomes productive •Constitutional symptoms (fatigue, malaise, anorexia, weight loss, low-grade fever, night sweats) •Dyspnea and hemoptysis late symptoms

GERD and Asthma

•Reflux may trigger bronchoconstriction as well as cause aspiration.

Asthma CM

•Restlessness, anxiety, inappropriate behavior, increase HR and BP, •Severe attacks may have no audible wheezing.