UWORLD 12
What is a normal BNP?
less than 100
The nurse admits an elderly client with a history of stroke and left-sided weakness due to change in level of consciousness, dehydration, and diarrhea secondary to recurrent clostridium difficile. What is the nurse's priority action to keep the client free of injury? 1. Place a bedside commode on the client's right side 2. Place the client in a room closest to the nursing station 3. Raise the bed rails upon leaving the room 4. Use alcohol-based hand cleaner after removing gloves
1
What are some strategies for dealing with a toddler during a stage of physiologic anorexia and pickiness?
- Set and enforce a schedule for all meals and snacks - Offer the child 2 or 3 choices of food items - Do not force the child to eat - Keep food portions small - Expose the child repeatedly to new foods on several separate occasions - Avoid TV and games during meals or snacks
A client with hypothermia has just arrived in the emergency department via ambulance. The client is being rewarmed with blankets, and the IV fluids are being changed over to warmed fluids. What additional intervention is a priority? 1. Attaching the cardiac monitor 2. Covering the client's head 3. Drawing blood for electrolytes and glucose 4. Placing an additional large-bore IV catheter
1 Hypothermia can lead to cardiac arrhythmias
Which of these are correct nursing actions related to client positioning? Select all that apply. 1. Position client in high Fowler's for a paracentesis related to end-stage cirrhosis 2. Position client on left side after liver biopsy 3. Position client on side with head, back, and knees flexed after lumbar puncture 4. Position client Trendelenburg on left side if air embolism is suspected 5. Position client with arm raised above head for chest tube placement
1,4,5
The nurse working in an intensive care unit receives a prescription from the primary health care provider to discontinue a triple-lumen subclavian central venous catheter. Which interventions will help prevent air embolism on removal? Select all that apply. 1. Applying an air-occlusive dressing 2. Instructing the client to bear down 3. Instructing the client to lie in a supine position 4. Pulling the line harder if there is resistance 5. Pulling the line out when the client is inhaling
1,2,3
A client is admitted with an exacerbation of asthma following a respiratory viral illness. Which clinical manifestations characteristic of a severe asthma attack does the nurse expect to assess? Select all that apply. 1. Accessory muscle use 2. Chest tightness 3. Diminished breath sounds bilaterally 4. High-pitched wheezing on expiration 5. Prolonged inspiratory phase 6. Tachypnea
1,2,3,4,6 Also, cough and hypersecretion of mucus.
What nursing care related to peripherally inserted IV catheters can reduce the incidence of catheter-related infections? Select all that apply. 1. Clean ports with 70% alcohol prior to accessing the catheter system 2. Prior to insertion, apply chlorhexidine in a back and forth motion with friction 3. Prior to insertion, use povidone-iodine to paint a circle and wipe excess with a sterile gauze 4. Replace or remove the catheter every 3 days 5. Shave excess hair over insertion site
1,2,4
The clinic nurse prepares to teach the parent of a child who has been diagnosed with scabies. Which instructions should the nurse include in the teaching plan? Select all that apply. 1. All persons in contact with the child need treatment 2. Apply permethrin to all body areas below the head 3. Discard the child's stuffed animals 4. Fumigate all the living areas 5. Wash the child's bedding in hot water
1,2,5
A nurse is caring for a client who is breastfeeding and has been diagnosed with mastitis of the right breast. Which instructions should be included in the teaching? Select all that apply. 1. Increase oral fluid intake 2. Cease breastfeeding from right breast 3. Reduce frequency of feeds to every 8 hours in right breast 4. Take ibuprofen as needed for pain 5. Use underwire bra 24 hours a day for support
1,4
A 28-year-old client is admitted to the labor and delivery unit for severe preeclampsia. She is started on IV magnesium sulfate infusion. Which signs indicate that the client has developed magnesium sulfate toxicity? Select all that apply. 1. 0/4 patellar reflex 2. Blood pressure is 156/84 mm Hg 3. Client voided 600 mL in 8 hours 4. Respirations are 10/min 5. Serum magnesium level is 6 mg/dL
1,4 Although the normal blood level of magnesium is 1.5-2.5 mEq/L, a therapeutic magnesium level of 5-8 mg/dL is necessary to prevent seizures in a preeclamptic client (Option 5). Magnesium that exceeds the therapeutic level causes toxicity by acting as a central nervous system depressant and by blocking neuromuscular transmission. Loss of deep-tendon reflexes (DTRs) is the earliest sign of magnesium sulfate toxicity (9.6-12 mg/dL). If not recognized at this level, clients progress to respiratory depression(12-18 mg/dL), followed by cardiac arrest (24-30 mg/dL). Urine output is also reduced. The treatment for magnesium sulfate toxicity is immediate discontinuation of the infusion. Administration of calcium gluconate (antidote) is recommended only for cardiorespiratory compromise (not for loss of DTRs). (Option 1) DTRs are scored on a scale of 0-4; normal findings are 2+. DTRs should be assessed every 2 hours during magnesium administration. Decreased reflexes could be a sign of pending respiratory depression. (Option 2) Hypertension is a sign of preeclampsia. Hydralazine (Apresoline), methyldopa (Aldomet), or labetalol (beta blockers) is used to lower blood pressure if needed (usually considered when >160/110 mm Hg). (Option 3) Urine output below the obligatory amount of 30 mL/hr is a sign of magnesium toxicity. The client can always void more and would be expected to do so with additional fluid administration. (Option 4) Respiratory depression (rate <12/min) is an assessment finding indicating magnesium toxicity. Assessments (including vital signs) should initially be performed every 5-15 minutes during the loading dose and then every 30-60 minutes until the client stabilizes.
What clinical symptoms might the nurse expect to find in a client with a central venous pressure (CVP) of 24 mm Hg? Select all that apply. 1. Crackles in lungs 2. Dry mucous membranes 3. Hypotension 4. Jugular venous distension 5. Pedal edema
1,4,5
A client with left lobar pneumonia is transferred to the intensive care unit due to increasing respiratory distress. While providing care for the client, the nurse notes a significant drop in saturation when the client is placed in which position? 1. High Fowler's 2. Left side 3. Right side 4. Semi-Fowler's
2
The nurse is caring for a child who had a tonsillectomy and adenoidectomy. Which are appropriate nursing actions? Select all that apply. 1. Apply an ice collar to the child's neck 2. Encourage the child to drink cold liquids through a straw 3. Notify the health care provider (HCP) if the child's throat is white or has an odor 4. Teach the parents to administer acetaminophen for analgesia 5. Teach the parents to be aware of frequent, increased swallowing
1,4,5 For number 3 this is an expected finding post tonsillectomy and adenoidectomy. Also Do not perform routine suctioning. Until they awaken fully, children should be placed on their abdomen or in a side-lying position to facilitate secretion drainage. Parents/caregivers should also be taught that: • A low-grade fever is expected (call the HCP if it is >102 F [38.9 C]). • The child may also report ear pain when swallowing for 5-10 days afterward; this is just referred pain. • Chewing gum can reduce spasms in the muscles around the throat. • Observe for signs of postoperative bleeding such as restlessness, frequent swallowing, or clearing of throat (Option 5).
The nurse provides discharge instructions to a 67-year-old client with chronic bronchitis who was hospitalized for community-acquired pneumonia. Which instructions should be included in the discharge teaching plan? Select all that apply. 1. "Avoid the use of over-the-counter cough suppressant medicines." 2. "Oral antibiotics are not needed at home as you had intravenous (IV) therapy in the hospital." 3. "Pneumonia vaccination is not needed as you now have lifelong immunity." 4. "Schedule a follow-up with the health care provider (HCP) and chest x-ray." 5. "Use a cool mist humidifier in your bedroom at night." 6. "Use the incentive spirometer at home."
1,4,5,6
An unresponsive client is brought to the emergency department after a party. Friends report that the client drank beer, may have taken some kind of pills, and then passed out. Blood pressure is 90/62 mm Hg, pulse is 64/min, and respirations are 8/min. Which priority action is expected to be taken following the initial assessment? 1. Administer IV naloxone 2. Administer Ringer's lactate at 125 mL/hr 3. Collect a urine sample for a urine drug screen 4. Draw blood for a blood alcohol content test
1. Administer IV naloxone Explanation: The characteristic clinical features of opioid intoxication include the following: • Depressed mental status • Decreased respiratory rate (<12/min) (most notable) • Constricted (miotic) pupils (may not be present in every client) • Decreased/absent bowel sounds
The nurse is administering a pink pill to a hospitalized medical-surgical client. The alert, oriented client says, "This is a pill I haven't seen before." What follow-up action should the nurse take next? 1. Check the health care provider's prescription in the medical record 2. Explain that the health care provider has prescribed the medication 3. Look up the medication in the pharmacology reference 4. Teach the client about the purpose of the medication
1. Check the health care provider's prescription in the medical record When a mentally competent client questions a drug administration, it's the safest practice to check the prescription
A previously healthy client is hospitalized with left lower lobe (LLL) bacterial pneumonia. The nurse assesses chest pain with inspiration, productive cough of thick rusty sputum, and LLL fine inspiratory crackles and low-pitched expiratory wheezing. Which of the medications that the health care provider prescribes should the nurse question? 1. Furosemide 20 mg intravenous (IV) push every day 2. Guaifenesin ER 600 mg PO every 12 hours 3. Ibuprofen 600 mg PO every 6 hours PRN 4. Levofloxacin 500 mg IV every day
1. Furosemide 20 mg intravenous (IV) push every day Furosemide (Lasix) is a diuretic and is not appropriate for treating the fine crackles associated with pneumonia. The crackles result from alveolar filling and atelectasis, not from heart failure or pulmonary edema.
A homeless man known to have chronic alcoholism and who has not eaten for 8 days is undergoing nutritional rehabilitation via oral and enteral feedings. Which of the following findings would indicate that the client is developing refeeding syndrome? 1. Phosphorus 2.0 mg/dL, potassium 2.9 mEq/L, magnesium 1.0 mg/dL 2. Phosphorus 5.0 mg/dL, potassium 3.5 mEq/L, magnesium 2.0 mg/dL 3. Random blood glucose 60 mg/dL, sodium 120 mEq/dL, calcium 7.0 mg/dL 4. Random blood glucose 100 mg/dL, sodium 140 mEq/dL, calcium 10.0 mg/dL
1. Phosphorus 2.0 mg/dL, potassium 2.9 mEq/L, magnesium 1.0 mg/dL Refeeding syndrome is a potentially lethal complication of nutritional replenishment in significantly malnourished clients and can occur with oral, enteral, or parenteral feedings. The key signs of refeeding syndrome are rapid declines in phosphorous, potassium, and/or magnesium. Other findings may include fluid overload, sodium retention, hyperglycemia, and thiamine deficiency.
If a transfusion reaction (eg, chills, fever, low back pain, flushing, itching) occurs, what are the steps that should be taken?
1. Stop transfusion immediately and disconnect tubing at the catheter hub 2. Maintain IV access with normal saline, using new tubing 3. Monitor vital signs 4. Notify health care provider (HCP) and blood bank 5. Recheck tags, numbers, and client's blood type 6. Treat client's symptoms according to HCP's prescription 7. Return bag of blood and tubing set to the blood bank so additional testing can be done 8. Collect blood and urine specimens to evaluate for hemolysis 9. Complete necessary facility paperwork to document the reaction
The charge nurse must assign a semi-private room to a client with diabetes mellitus admitted for IV antibiotic therapy to treat leg cellulitis. Which of the 4 room assignments is the best option for this client? 1. Room 1: Client 1 day postoperative laparoscopic cholecystectomy who is awaiting discharge 2. Room 2: Client with dementia and urinary incontinence wearing an external urine collection device 3. Room 3: Client with history of splenectomy 15 years ago, now admitted for pulmonary embolism 4. Room 4: Client with lupus nephritis who is prescribed treatment with azathioprine
2
The nurse is gathering data on a client with obstructive sleep apnea. Which findings are consistent with this client's diagnosis? Select all that apply. 1. Difficulty arousing from sleep 2. Excessive daytime sleepiness 3. Morning headaches 4. Postural collapse and falling 5. Snoring during sleep 6. Witnessed episodes of apnea
2,3,5,6
• A client started a 24-hour urine collection test at 6:00 AM. The unlicensed assistive personnel (UAP) reports discarding a urine specimen of 250 mL at 10:00 AM by mistake but adding all specimens to the collection container before and after that time. What action should the nurse take? 1. Add 250 mL to the total output after the 24-hour urine collection is complete tomorrow morning 2. Discard urine and container, and restart the 24-hour urine collection tomorrow morning 3. Discard urine and container, have client void, add urine to new container, and then restart test 4. Relabel the same collection container, and change the start time from 6:00 AM to 10:00 AM
2. Discard urine and container, and restart the 24-hour urine collection tomorrow morning
The nurse assesses a client during the dwell time of a peritoneal dialysis cycle. Which assessment would require immediate intervention? 1. Blood pressure of 168/88 mm Hg and pulse of 72/min 2. Client experiencing intermittent nausea 3. Crackles present in the left and right lung bases 4. Presence of 1+ pitting edema in ankles and feet bilaterally
3
The nurse is caring for a client who has undergone a colonoscopy. Which client assessment finding should most concern the nurse? 1. Abdominal cramping 2. Frequent, watery stools 3. Positive rebound tenderness 4. Recurring flatus
3 Explanation: A risk of a colonoscopy (or any procedure in which a firm scope is inserted into a "hollow tube" organ) is perforation. Signs of perforation include abdominal pain (with shoulder tip pain), positive rebound tenderness, guarding, abdominal distension, tenesmus, and/or boardlike (rigid) abdomen. Another potential complication is rectal bleeding.
When caring for a client immediately after a laparoscopic cholecystectomy, which nursing intervention has the highest priority? 1. Apply anti-thromboembolism stockings 2. Assist with ambulation 3. Place client in the Sims' position 4. Teach about the importance of a low-fat diet
3 Explanation: Postoperative nursing care after laparoscopic cholecystectomy focuses on prevention of respiratory complications. The client is placed in the Sims' position to facilitate movement of carbon dioxide (CO2) utilized during surgery to fill the abdominal cavity. CO2 can irritate the phrenic nerve and diaphragm, potentially causing breathing difficulty. Other nursing interventions are essential but are not as important as promoting adequate ventilation.
During a routine assessment of a developmentally normal 18-month-old, the parent expresses concern about the small amount of food the child consumes. What is the nurse's priority intervention? 1. Check the child for parasitic infections 2. Consult a pediatric nutritionist for suspected eating disorder 3. Educate the parent about physiologic anorexia 4. Notify the primary health care provider
3 Physiologic anorexia occurs when the very high metabolic demands of infancy slow down to keep pace with the moderate growth of toddlerhood. During this phase, toddlers are increasingly picky about their food choices and schedules. Although to the parents it may appear that the child is not consuming enough calories, intake over several days actually meets nutritional and energy needs. Parents should be educated concerning what constitutes a healthy diet for toddlers and which foods they are more likely to consume.
When assessing a client with cholelithiasis and acute cholecystitis, which findings might the nurse note during the health history and physical examination? Select all that apply. 1. Flank pain radiating to the groin 2. High-protein food ingestion before the onset of pain 3. Low-grade fever with chills 4. Pain at the umbilicus 5. Right upper-quadrant (RUQ) pain radiating to the right shoulder
3,5
The nurse is caring for a client who performs frequent self-urinary catheterizations. Which client assessments would indicate a potential for a latex allergy? Select all that apply. 1. History of angioedema with lisinopril 2. History of epilepsy 3. Known allergy to avocados and bananas 4. Known allergy to shellfish 5. Lip swelling when blowing up balloons
3,5 Allergy to shellfish has to do with iodine not latex.
A client with end-stage renal disease, oxygen-dependent chronic obstructive pulmonary disease (COPD), and a Do Not Resuscitate (DNR) code status is admitted to the medical floor for COPD exacerbation. The nurse walks into the room and finds that the client is not breathing. What should the nurse do first? 1. Activate the code system 2. Call the health care provider (HCP) stat 3. Check the apical pulse 4. Check the blood pressure
3. Check the apical pulse The nurse has a medical order stating that the client should not be resuscitated. Therefore, the appropriate first action is to assess the apical pulse. Then the nurse should call the HCP. If the client's family members are present, the nurse should explain what is happening and make sure that they have support.
The nurse on the neurosurgery step-down unit is assigned to a stable client with a closed-head injury who is 1 day postoperative craniotomy. The nurse prepares to administer the 7:00 AM medications and reviews the client's medication administration record. Which prescription prompts the nurse to contact the prescribing health care provider (HCP) for prescription clarification? Click on the exhibit button for additional information. 1. Acetaminophen 1000 mg IV every 6 hours 2. Gabapentin 300 mg orally every 8 hours 3. Hydrocodone/acetaminophen (5 mg/325 mg) orally, every 4 hours PRN 4. Phenytoin 100 mg orally, every 12 hours
3. Hydrocodone/acetaminophen (5 mg/325 mg) orally, every 4 hours PRN • The recommended dose for acetaminophen should not exceed 4 g in 24 hours, as it can lead to liver injury. The nurse should contact the HCP to question the prescription for the PRN opioid analgesichydrocodone/acetaminophen (5 mg/325 mg) (Vicodin).
A newborn client is seen in the emergency department for vomiting. Which assessment finding indicates a possible emergency? 1. Frequent vomiting since birth 2. Tiny blood streaks in the vomit 3. Vomit that is green 4. Vomiting through the nose
3. Vomit that is green Bile made by the liver is green and is released into the duodenum on eating to aid digestion. When there is an obstruction in the intestines and stool cannot pass, it may come back up as green vomit. A bowel obstruction is an emergency that can lead to bowel rupture, peritonitis, and sepsis.
The client has just returned from having a cast placed on the right forearm and is found putting a lead pencil in the cast to "reach the itch." What is the nurse's priority action? 1. Offer the client a straw to reach the itch instead of a lead pencil 2. Perform a peripheral neurovascular check of the casted extremity 3. Pour a generous amount of baby powder or corn starch in the cast to reach the itch 4. Review appropriate itch relief technique using the cool setting of a hair dryer
4
A client who was suddenly overwhelmed with an intense fear that something terrible was going to happen is brought to the emergency department by the spouse after they were out at dinner. The client is now shaking and has shortness of breath and heart palpitations. What is the priority nursing action? 1. Encourage the client to perform deep breathing exercises 2. Explore possible reasons for the episode 3. Place the client in a private room and tell the client to relax 4. Stay with the client
4 Client is experiencing a panic attack and should not be left alone.
For which client is it most important for the nurse to provide teaching on ways to prevent the spread of the condition? 1. Client with eczema on upper torso 2. Client with oral candidiasis 3. Client with psoriasis on hands 4. Client with tinea corporis
4 Tinea corporis (ringworm) is a fungal infection of the skin often transmitted from one person to another or from an infected animal to a human. It appears as a scaly, pruritic patch that is often circular or oval in shape. It is highly contagious and can be spread via items such as grooming tools, hats, towels, and bedding. Tinea corporis often spreads via shared athletic equipment or in athletic locker rooms due to the proximity of infected gear.
The nurse should call the primary health care provider (PHCP) to obtain a new prescription prior to administering which medication to a client with type I diabetes mellitus? 1. 10 units regular insulin intravenous (IV) push for blood glucose >250 mg/dL 2. 14 units glargine insulin subcutaneous injection every night at 8:00 PM 3. 18 units aspart insulin subcutaneous injection 15 minutes before breakfast 4. 20 units NPH insulin IV push administered every morning at 7:00 AM
4. 20 units NPH insulin IV push administered every morning at 7:00 AM Subcutaneous injection is the indicated route for NPH insulin administration; it should never be administered via IV push. Regular insulin is the only insulin that can be administered via IV push; this is typically performed only in an acute care facility under close observation by the nurse.
The nurse has received report on 4 pediatric clients. Which client should the nurse assess first? 1. Client with coarctation of the aorta and diminished femoral pulses 2. Client with patent ductus arteriosus and a loud machinery-like murmur 3. Client with tetralogy of Fallot and oxygen saturation of 80% on room air 4. Client with ventricular septal defect; tachypnea and diaphoresis during feedings
4. Client with ventricular septal defect; tachypnea and diaphoresis during feedings Explanation: Ventricular septal defect is an acyanotic congenital heart defect causing blood to shunt from the left side of the heart to the right (left-sided heart has higher pressure than right-sided). An increase in pulmonary blood flow causes an increase in workload of the right heart and pulmonary arteries, resulting in pulmonary hypertension. Eventually, blood does not go to the lungs, but instead the pressure on the right side of the heart increases, resulting in shunt reversal. This causes more blood to be shunted to the left ventricle, followed by the left atrium, and then back into the lungs (heart failure). Tachypnea is due to pulmonary volume overload. Diaphoresis is an indication that an infant is expending too much energy during feeding. This client should be assessed first and evaluated for other signs of congestive heart failure (CHF).
The nurse prepares to care for a client being admitted with a confirmed diagnosis of Middle East respiratory syndrome. Which personal protective equipment will the nurse use when providing care to the client? 1. Gloves and gown 2. Gloves and mask 3. Gown and N95 respirator 4. Gown, gloves, N95 respirator, and eye protection
4. Gown, gloves, N95 respirator, and eye protection Middle East respiratory syndrome (MERS) is a viral respiratory illness caused by the coronavirus (MERS-CoV). Symptoms include fever, cough, and shortness of breath that often worsen and cause death in many of those afflicted. The incubation period is 5-6 days but can range from 2-14 days. How the virus spreads is not fully understood, but it is thought to spread via respiratory secretions. Because it has easily spread to those who care for infected persons, the Centers for Disease Control and Prevention recommends the use of standard, contact, and airborne precautions with eye protection when caring for clients with MERS.
What type of diet should a client with hepatitis eat?
A diet high in calories and carbohydrates while decreasing fat and protein consumption, which cause build up of ammonia and other toxic substances which a damaged liver will have trouble with.
Clients should report what immediately with use of Fluoroquinalone antibiotics (Ciproflaxin, levoflaxin)?
Achilles tendon pain. Can cause tenditis and tendon rupture
Diagnostic criteria for SIRS include 2 or more of what manifestations?
Hyperthermia (temperature >100.4 F [38 C]) or hypothermia (temperature <97 F [36.1]) • Heart rate >90/min • Respiratory rate >20 breaths/min or alkalosis (PaCO2 <32 mm Hg) • Leukocytosis (white blood cells >12,000 µL or 10% immature neutrophils [bands])
A client with acute decompensated heart failure would have a high?
BNP
What should not be done with a client with chronic venous insufficiency?
Cutting the client's fingernails and toenails
What are signs and symptoms of hyperemesis gravidurum?
Excessive vomiting (hyperemesis gravidarum) leads to fluid and electrolyte imbalances (hypokalemia, metabolic alkalosis), weight loss, nutritional deficiencies, and ketonuria. The signs and symptoms of dehydration include poor skin turgor, decreased urine output, tachycardia, low blood pressure, and dry mucous membranes.
Clients often report pain 1-3 hours after ingesting what foods?
Fatty foods. NOT protein or anything else. Associated symptoms are low-grade fever, chills, nausea, vomiting, and anorexia.
The nurse is beginning intravenous (IV) resuscitation therapy for a client weighing 85 kg (187 lb) with visible second- and third-degree burns covering 40% of his body. Using the Parkland Formula, enter the amount of fluid in liters needed during the first 8 hours of IV fluid resuscitation. Record your answer using 1 decimal place. Give answer in Liters.
First 24 hours of fluid = 4 mL * (weight in kg) * (percentage of body surface area burned) = 4 mL * 85 kg * 40 = 13,600 mL Fluid requirements in first 8 hours = Fluid requirements in first 24 hours = 13,600 mL = 6,800 mL = 6.8 L 2 2 The Parkland formula calculates IV fluid resuscitation therapy necessary for the first 24 hours to stabilize a burn victim as normal fluid regulation is lost in burned tissue. The key to answering this question is knowing that half of the calculated fluid must be administered in the first 8 hours; the initial answer will be divided by 2. The other half of the fluid is administered over the next 16 hours. Crystalloid solutions (eg, Ringer's lactate) are commonly used. Educational objective: The Parkland formula (4 mL * weight in kg * percentage of body burned) calculates the 24-hour fluid resuscitation requirements in a burn client; half is given during the first 8 hours.
A normal CVP is 2-8. An elevated CVP would indicate what?
Fluid volume overload
What are clinical signs of fluid volume overload?
Peripheral edema Increased urine output that is dilute Acute rapid weight gain Jugular venous distention S3 heart sounds in adults Tachypnea, dyspnea, crackles in lungs Bounding peripheral pulses
Flank pain radiating to the groin is seen with what?
Renal colic (uretal stones)
What is the most common bacteria for mastitis?
Staphylococcus aureus
What is the treatment for tinea corporis?
This condition is treated with topical antifungals (eg, tolnaftate, haloprogin, miconazole, clotrimazole).
What is the treatment for mastitis?
Treatment of lactational mastitis includes antibiotic therapy, breast support, adequate hydration, analgesics, and frequent continued breastfeeding (every 2-3 hours).
What is the priority intervention for 3rd degree AV block?
third-degree atrioventricular (AV) block, or complete heart block, which involves complete inhibition of impulse conduction from the atria to the ventricles, usually at the AV node or bundle of His. The atrial and ventricular rhythms are regular but unrelated to each other. A complete heart block results in bradycardia, decreased cardiac output, syncope, and possibly heart failure/shock. The client is typically symptomatic and requires immediate treatment with transcutaneous pacing until a permanent pacemaker can be inserted. Atropine, dopamine, and epinephrine can be used to increase heart rate and blood pressure until temporary pacing is available.
What are actions to prevent refeeding syndrome?
• Obtaining baseline electrolytes • Initiating nutrition support cautiously with hypocaloric feedings • Closely monitoring electrolytes • Increasing caloric intake gradually
What are dietary recommendations to avoid dumping syndrome?
• Small, frequent meals - reduces the amount of food in the stomach at any one time • Foods high in protein and fat - these take longer to digest and will remain in the stomach longer than carbohydrates • Drink fluids between meals (at least 30-45 min before or after meals) - fluids with meals would promote passage of stomach contents into the jejunum easily and worsen symptoms • Avoid meals high in carbohydrates - may trigger dumping syndrome as the carbohydrates are broken down into simple sugars (Option 2) • Diets high in fiber - delay the emptying of the stomach and prevent rapid absorption of simple sugars • Eat slowly in a relaxed environment • Avoid sitting up after a meal. Gravity increases gastric emptying. Lying down after meals would slow down gastric emptying and is preferred (Option 4).
