Chronic Illness Final
What are the tests for TB?
- Tuberculin skin test (TST) - Interferon-gamma release assays (IGRAs) - Chest X-Ray - Sputum smear and culture - Physical examination and medical history
What is the nursing care for a patient with TB?
-Adm heated & humidified oxygen therapy as prescribed -prevent infection transmission (N95, negative pressure room, isolation)
What should be expected in a burn patient?
-Expect hyperkalemia & hypovolemia b/c Potassium is high because of lost fluid volume -Increased risk for infection -Electrolyte shift due to loss of skin
sign of hypoxia
-Mental status changes ex. Agitation -cyanosis -labored breathing
What are the liver function tests?
i. AST ii. ALT iii. ALK Phos
What is the nursing teaching about fractures?
i. Elevation ii. Rest iii. ice
What is ejection fraction?
precent of blood pushed out each contraction 50-70% is normal
Antiplatelet Use
prevention of acute MI
antidote for heparin
protamine sulfate
What's the different between peripheral IV and PICC line?
- PICC i. Need large blood supply ii. Large amount to be transfused iii. Very Costic & irritated substances iv. Hard to assess v. Long-term treatment vi. Multiple lumens
What is part of the IV assessment?
- Redness - Swelling - Heat - Assess at least every 4hr and before use
What is some stuff to know about central lines?
- Subclavian - Most direct assess - Concern- infection - Multiple lumens - Want to be shortest amount of time possible
A nurse is caring for a client who has a new diagnosis of TB and has been placed on a multi medication regimen. Which of following instructions should the nurse give the client related to ethambutol?
"Watch for any changes in your vision"
A nurse is preparing to adm. a new prescription of isoniazid (INH) to a light-skinned client who has TB. The nurse should instruct the client to report which of the following findings as an reverse effect of the medication?
"You might experience tingling of your hands"
A nurse is teaching a client who has TB. Which of the following statements should the nurse include?
"You will need to provide sputum sample every 4 weeks to monitor the effectiveness of the medication."
Where should the IV go?
- Most distal - Cannot go below current site
Concern for the older adult client
-decreased hepatic & renal functions that alters the clearance of anesthetic agents and opiods -Co-morbidities -greater risk of adverse reactions to pre-op medications -less physiologic reserve than younger clients-> decreased immune system response & wound healing - reduction of muscle mass & amount of body water, which places older adult clients at risk for dehydration -sensory decline (decreased eyesight, hearing loss) - oral alterations (dentures, bridges, loose teeth) that pose problems during intubation -perspire less, which leads to dry itchy skin that becomes fragile and easily abraded -decreased subcutaneous fat, which makes them more susceptible to temperature changes
What is involve in the pre-operative assessment?
-detailed history -allergies -anxiety level -baseline data -venous thromboembolism risk -informed consent
Medications for asthma
1. Bronchodilators: Beta adrenergic agonists, Antichollinergics, Corticosteroids 2. Inhalers-metered dose inhalers 3. Nebulizers- hand held propels medicine into the airways and lungs via microscopic particles in a mist 3. Oral
Sodium range
135-145
Potassium range
3.5-5.0 mEq/L
What is the normal CD4-T cell range?
500-1,500
calcium range
8.5-10.5 mg/dL
A nurse is caring for a client who is receiving total parenteral nutrition via a peripherally inserted central catheter (PICC). When assessing the client, the nurse notes swelling of the client's arm above the PICC insertion site. Which of the following actions should the nurse take first? A. Measure the circumference of both upper arms B. Notify the provider who interred the PICC line C. Remove the PICC line D. Apply a cold pack to the client's upper arm
A
Embolism question related to fracture: A nurse is caring for a client who experienced a femur fracture 8 hr ago and now reports sudden onset dyspnea and severe chest pain. Which of the following actions should the nurse take first? A. Provide high flow oxygen B. Check the for positive Chvostek's sign C. IV vasopressor medication D. Monitor patient for headache
A
A nurse is caring for a client who experienced a femur fracture 8 hr ago and now reports sudden onset dyspnea and severe chest pain. Which of the following actions should the nurse take first? A. Provide high flow oxygen B. Check the client for a positive Chvostek's sign C. Adm. an IV vasopressor medication D. Montior the patient for headache
A Rationale: Fat embolism
A nurse is assessing a client who has a fracture of the femur. The nurse obtains vital signs on admission and again in 2 hours. Which of the following changes in assessment should indicate to the nurse that the client could be developing a serious complication? A. Increased respiratory rate from 18-44/min B. Increased oral temperature from 97.8-98.6 C. Increased BP from 112/68 to 120/72 D. Increased heart rate from 68-72
A Rationale: The respiratory rate is significant change and outside the normal, it was normal then increased
The nurse asks a client who is about to have a cardiac catheterization about any allergies. The client states, "I always get a rash when I eat shellfish." Which of the following is the priority nursing action? A. notify the provider of the client's allergy B. Attach a wrist band indicating the client's allergy C. Ask the client if any other foods cause such a reaction D. Notify the dietary department of the client's allergy
A Rationale: notify the provider- this is the greatest risk to the client at this movement, the client will be getting dye, which is a derivative of shellfish/iodine, the patient may need a steroid or antihistamine to prevent a reaction.
A nurse is reviewing the laboratory results of an adolescent female client and notes a WBC count of 16,000/mm³ with increased immature neutrophils (bands) and normal monocytes. Which of the following is the appropriate analysis of the results? A. An acute infectious process B. Allergic reaction C. Neutropenia D. A resolving inflammatory process
A Rationale: wbc is elevated, but the neutrophil count is elevated, remember that these are the mature cells to fight infection If its allergic it would be an increase in eosinophils, these will increase during hyper sensitivity reactions to help neutralize the release of histimine
A nurse is providing information about TB to a group of clients at a local community center. Which of the following manifestations should the nurse include? A. Persistent cough B. Weight gain C. Fatigue D. Night sweats E. Purulent sputum
A, C, D, & E Persistent cough, fatigue, night sweats, purulent sputum
What tests are we concerned about with a shellfish allergy?
Anything with contrast (CT, MRI), cardiac catheterization, dyes
ABG chart
Acid Alkanoic Ph 7.35--------7.45 Acid Alkanoic PaCO2 35----------45 Alkanoic Acid HCo3 22-------------26
Antiplatelet drugs
Aspirin, Clopidogrel
A nurse is caring for a female client in the emergency department who reports shortness of breath and pain in the lung area. She states that she started taking birth control pills 3 weeks ago and that she smokes. Her heart rate is 110/min, respiratory rate 40/min, and blood pressure 140/80 mm Hg. Her arterial blood gases are pH 7.50, PaCO2 29 mm Hg, PaO2 60 mm Hg, HCO3 20 mEq/L, and SaO2 86%. Which of the following is the priority nursing intervention? A. Prepare for mechanical ventilation B. Adm. oxygen via facemask C. Prepare to adm. a sedative D. Assess for indications of pulmonary embolism
B
A nurse is reviewing the laboratory values of a client who has respiratory acidosis. Which of the following findings should the nurse expect? A hco3 - 30meq/L B. Paco2 50mmhg C. pH 7.45 D. potassium 3.3 meq/L
B
A nurse in a community health clinic is administering seasonal inactive influenza vaccine. Before administering it, the nurse must confirm that the client is not allergic to which of the following? A. Shellfish B. Eggs C. Gelatin D. Yeast
B Rationale: Flu vaccine contains a small amount of egg protein and this can induce allergic reactions
A nurse in a clinic is collecting a history from a client who reports that a member of his family just received a diagnosis of pulmonary tuberculosis. The nurse should expect that the provider will prescribe which of the following diagnostic test first? A. Sputum culture for acid-fast bacillus (AFB) B. Nucleic acid amplification test (NAAT) C. CT scan D. Chest X-Ray
B Rationale: Nucleic acid amp. Test, cdc recommends tht the naat test replace other diagnostic tests, used on patient sputum
A nurse is teaching a client who has chronic obstructive pulmonary disease about ways to facilitate eating. Which of the following statements indicates a need for further teaching? A. I will rest for at least 30 minutes B. I will take my bronchodilators after meals C. I will eat five or six small meals throughout the day D. I will choose foods that are not gas forming
B Rationale: bronchodilators should be taken before meals this will help reduce shortness of breath
A nurse is caring for a client who has HIV. Which of the following laboratory values is the nurse's priority? A. Positive western blot test B. CD4-T cell count at 180 C. Platelets at 150,000 D. WBC 5,000
B Rationale: cd4 tc ell count of elss than 180 indicates that the client is severely immunocompromised and at high risk for infection
A nurse is assessing a client for a suspected anaphylactic reaction following a CT scan with contrast media. For which of the following client findings should the nurse intervene first? A. Urticaria B. Stridor C. Vomiting D. Hypotension
B Rationale: remember stridor indicates narrowing or occluded airway so the patient needs to be at alates a 45 but high fowlers would be better and this is an emergency
A nurse is assessing a client who has developed atelectasis postoperatively. Which of the following findings should the nurse expect? A. Facial flushing B. Increasing dyspnea C. Decreasing RR D. Friction Rub
B Rationale: remember this is something we try to prevent, but the post op patient is more at risk for developing due to the blunt cough reflex, an shallow breathing due to anesthesia, opioids or pain medications.
A home health nurse is teaching a client who has active tuberculosis and is following a medication regimen that includes a combination of isoniazid, rifampin, pyrazinamide and ethambutol. Which of the following client statements indicate understanding? A. "I can substitute one medication for another if I run out b/c they all fight infection" B. "I'll wash my hands each time I cough" C. "I will wear a mask when I am in a public area" D. "I am glad I don't have to have any more sputum specimens." E. "I don't need to worry where I go once I start taking my medications"
B & C Rationale: The client should wash their hands and wear a mask to prevent spreading the infection
Which inhaler gets used first with COPD & Emphysema patients?
Bronchodilators
A nurse is caring for a client who has just developed a pulmonary embolism. Which of the following medications should the nurse anticipate administering? A. Furosemide B. Dexamethasone C. Heparin D. Atropine
C
•A client who has a history of myocardial infarction (MI) is prescribed aspirin 325 mg. The nurse recognizes that the aspirin is given due to which of the following actions of the medication? A. analgesic B. anti-inflammatory C. anti-platelet D. antipyretic
C
A nurse is instructing a client who is newly diagnosed with pulmonary tuberculosis (TB) about the use of anti tubercular medications. Which of the following information should the nurse include in the teaching? A. Medications will need to be taken for the rest of the client's life, even if the client feels better B. Medications will need to be taken until the Mantoux test is negative C. A typical course of treatment involves 6-9 months of consistent medication use D. The client's family will also need to take medications to prevent infection
C Rationale: TB is contagous, active TB is treated with a combo of meds, therapy can ake a longer time Remember no drinking ETOH with these meds. Active TB is treated with a combination of meds usually 6-9 months and up to 2 yrs. Once diagnosed, Mantoux test will remin positive forever, not a good indicator Patient is treated with meds, but because of the effects of meds and possible resistance, TB not given prophylactically - talk about types of antibiotics
A nurse is assessing a client for hypoxemia during an asthma attack. Which of the following manifestations should the nurse expect? A. Nausea B. Dysphagia C. Agitation D. Hypotension
C Rationale: agitation- this can be due to decreased o2 and may cause neurological changes.
A nurse in an emergency department is reviewing the medical record of a client who has an extensive burn injury. Which of the following laboratory results should the nurse expect? A. Metabolic alkalosis B. Hypervolemia C. Hyperkalemia D. Low hemoglobin
C Rationale: this is due to the release of potassium form the damaged cells
A nurse is planning nutritional teaching for a client who is experiencing fatigue due to iron deficiency anemia. Which of the following foods should the nurse recommend to the client? A. Raisins B. Black tea C. Canned black beans D. Whole milk
C rationale: has the greatest amount of iron from the foods listed
What are the kidney function tests?
CR, BUN, GFR
What is the first sign of infection in the elderly?
Confusion
A nurse is developing a plan of care for a client who has COPD. The nurse should include which of the following interventions in the plan? A. Restrict the client's fluid intake to less than 2L/day B. Provide the client with low-protein diet C. Have the client use the early-morning hours for exercise and activity D. Instruct the client to use pursed-lip breathing
D
A nurse is preparing a client who is to receive chemotherapy for treatment of ovarian cancer. Which of the following actions should the nurse plan to take? A. Tell the client to expect dark stools following chemotherapy B. Have the client floss 4x day C. Have the client swish with commercial mouthwash before therapy D. Adm. an antiemetic prior to the procedure
D Rationale: administer the antiemetic prior to the procedure, this can help with the prevention.
A nurse in a clinic sees a client who has an acute asthma exacerbation. Which of the following medications should reduce the symptoms? A. Cromolyn via metered-dose inhaler B. Montelukast orally C. Budesonide via dry-powder inhaler D. Albuterol via jet nebulizer
D Rationale: albuterol due to bronchodilator to stop the spasm
What is the key finding of compartment syndrome?
significant increased pain due to constriction and loss of sensation and movement.
S&S of atelectasis
Dyspnea, chest pain or cough
What does lung crackles mean?
Fluid in the lungs, sign of HF
Potassium
HEART-prolonged PR intervals, wide QRS complex, orthostatic hypertension
Who is at risk for immunosuppression?
I. Cancer/chemotherapy patients ii. HIV/AIDS iii. Burn patients
What are the treatments for TB?
Isoniazid, Rifampin, Pyrazinamide, Ethambutol, Streptomycin sulfate,
What is the normal range for WBC?
Normal range 4,000-6,000
What are medication side effects for TB?
Orange secretions, monitor liver
Assessment of chest pain
P Position Q Quality/quantity R Radiation/relief S Severity T Symptoms
Anticoagulant uses
Prevent & treat DVTs & PE
What is Chvostek's sign?
Push the cheek and it spasms
What are the symptoms of compartment syndrome?
The 5 P's -pain, -pallor -paresthesia -pulselessness -paralysis
What are the concerns with a patient that has a gelatin allergy or preference to avoid?
This could be an issue if we have someone who is Vegan, many gelatins are from animal proteins
antidote for warfarin
Vitamin K
S/S of anaphylaxis
a. Stridor -constrictive/blockage b. Hypertension c. Anxious d. Urticaria -Aka hives
Risk factors for osteoporosis
age, skinny, smoking, alcoholics, steroids, menopause, malnutrition, family hx, Asians/whites
How is TB transmitted?
airborne
Which should you use first, albuterol (beta 2 adrenergic agonist) or glucocorticoid?
albuterol (beta 2 adrenergic agonist)
Medication to prevent osteoporosis
biphosphonates, calcium and vitamin D supplements
What does it mean to have a right shift?
body is winning
Foods to increase calcium
broccoli, kale, yogurt, cheese, milk
What is montelukast used for?
bronchodilator taken for chronic asthma but not for acute attacks
What is atelectasis?
collapsed lung/alveoli
What does the Chvostek's sign indicate?
hypocalcemia, we should initiate seizure precautions, monitor for signs of pathologic fractures we should give calcium gluconate 10%
How do you know if someone is dehydrated?
dark-colored urine, decreased urination, headaches, fatigue, dry skin, decreased skin turgor, and poor concentration
What is preload?
end diastolic volume
What is the reaction to an allergy (CBC related)?
eosinophil elevation
Treatment of compartment syndrome
fasciotomy and/or cast removal
What is after load?
force or pressure blood needs to over come
Formula for cardiac output
heart rate x stroke volume
Anticoagulant drugs
heparin, warfarin
What you find in a COPD or emphysema patient?
i. High-flowers ii. Tripoding iii. Breathing 1. Pursed lip breathing 2. Oxygen delivering devices - Masks i. High flow ii. Low flow iii. Humidification iv. Tracheostomy v. CPaps vi. BiPaps vii. Intubation viii. Oxygen safety ix. Patho-drive to breath 1. O2 & CO2 sensors
What can be done to decrease the risk of immunosuppression?
i. Own room ii. Limit/screen visitors iii. PPE iv. No fresh stuff (flowers) v. Cooked foods only (Processed) vi. No sushi (no raw food) vii. Home environment 1. No sharing 2. Use dishwasher
What does it mean to have a left shift?
i. Poor response ii. on-going infection iii. increased bands
Foods for iron deficiency anemia
i. Spinach ii. Black beans iii. Kidney beans
What are bands?
immature neutrophils
What is going on when there is an increase in neutrophils?
infection
Why do you want to avoid black tea with iron deficiency anemia?
it contains tannin which inhibits absorption of iron
What is neutropenia?
low neutrophil count Normal range 4,000-6,000
What is thrombocytopenia?
low platelet count Normal: Platelet range-150,000 to 500,000
Why do you want to avoid milk with iron deficiency anemia?
the calcium in the milk limits absorption of the iron
What is the western blot test used for?
to detect HIV
Fibraoinolytics aka Thrombolytic use
treat acute MI
Thrombolytic medication- Altepase use
treat massive PE, acute ischemic stroke, DVT and restore latency to central IV catheters
Budesonide Use
used for prevention but is for long term treatment
Potassium foods
yogurt, avocados, raisins, bananas
