Exam 3 NUR 231
Abdominal-
surgical approach
Vaginal-
surgical approach
Radical-
removal of the uterus as well as the surrounding tissue, including the upper third of the vagina and pelvic lymph nodes
nasal canula
-1-6 L/min -not super limiting
sodium
135-145
Perfusion-
transport of oxygen, the actual blood flow through the pulmonary vasculature; blood is pumped into the lungs by the right ventricle through the pulmonary artery
Expiration-
lungs recoil and force the air out through the bronchi and trachea
Ventilation-
movement of the walls of thoracic cage and diaphragm, Breathing, At the lung level
DKA
-typically type 1 1. Illness prevention - sick day rules (chart 51-9) a. Take insulin or oral antidiabetic agents as usual b. Test bs and ketones q 3-4 hrs c. Report elevated BS or ketones to HCP as specified d. If take insulin may need more q3-4 hrs e. If can't eat reg food substitute soft food 6-8 times daily f. If vomiting or diarrhea or fever persists take liquids ½ cup reg cola or orange juice, ½ cup broth, 1 cup sports drink every ½ to 1 to prevent dehydration and provide calories g. Report nausea, vomiting, diarrhea to HCP because extreme fluid loss = dangerous h. If unable to retain oral fluids may require hospitalization to avoid DKA and coma 2. clinical manifestations a. early symptoms: frequent urination, thirst or very dry mouth, high blood glucose, high level of ketones in the urine b. other symptoms: tired, nausea, vomiting, dry skin, heard time breathing, fruit odor on breath, confusion c. assessments/diagnostics: low bicarb, low pH, low PCO2, ketones in blood and urine 3. Management: IV drips a. 500-1000 ml/ hr of ns and insulin, consider restoring K+
creatinine
0.5-1.5
insulin to carb ratio
1 unit insulin to 15 g arbs
hip fracture
1. Assessment a. Age, female, hx of osteoporosis, one leg shorter than other, bucks traction, hydration, respiratory support. Circulation checks, pain control, prevention of immobility, hx of chronic conditions and medications 2. Post-op care a. How do ADLS? b. prevention 3. Complications a. Dislocation, blood clots, ulcers, infection, heel pressure ulcer 4. Prevention a. Abduction split, wedge pillow, don't flex 90 degress, fracture pain, lift self trapeze, high seat, semi reclining
hyperkalemia
1. Clinical Manifestations a. Cardiac changes and dysrhythmias, muscle weakness with potential respiratory impairment, paresthesias, anxiety, GI manifestations 2. Assessment a. usually treatment related, impaired renal function, hypoaldosteronism, tissue trauma, acidosis 3. Diagnostics a. Blood test greater than 5.0 4. Nursing Management a. Assessment of serum potassium levels, mix IVs containing K+ well, monitor medication affects, dietary potassium restriction/dietary teaching for patients at risk
hypokalemia
1. Clinical Manifestations a. Fatigue, anorexia, nausea, vomiting, dysrhythmias, muscle weakness and cramps, paresthesias, glucose intolerance, decreased muscle strength, DTRs 2. Assessment a. GI losses, medications, alterations of acid-base balance, hyperaldosteronism, poor dietary intake 3. Diagnostics a. Blood test below 3.5 4. Nursing Management a. Assessment, severe hypokalemia is life-threatening, monitor ECG and ABGs, dietary potassium, nursing care related to IV potassium administration
hypernatremia
1. Clinical Manifestations a. adrenal insufficiency, water intoxication, SIADH or losses by vomiting, diarrhea, sweating, diuretics 2. Assessment a. excess water loss, excess sodium administration, diabetes insipidus, heat stroke, hypertonic IV solutions 3. Diagnostics a. Blood test greater than 145 4. Nursing Management a. adrenal insufficiency, water intoxication, SIADH or losses by vomiting, diarrhea, sweating, diuretics
hyponatremia
1. Clinical Manifestations a. poor skin turgor, dry mucosa, headache, decreased salivation, decreased blood pressure, nausea, abdominal cramping, neurologic changes 2. Assessment a. Neuro check, adrenal insufficiency, water intoxication, SIADH or losses by vomiting, diarrhea, sweating, diuretics 3. Diagnostics a. Blood test show less than 135, signs and symptoms 4. Nursing Management a. assessment and prevention, dietary sodium and fluid intake, identify and monitor at-risk patients, effects of medications (diuretics, lithium)
HHS
1. Clinical manifestations a. Hypotension, profound dehydration (dry mucous membranes, poor skin turgor), tachycardia, variable neurologic signs 2. Assessment and Diagnostics a. BG, electrolytes, BUN, CBC, serum osmolality 3. Management a. Similar to DKA, monitor volume and electrolytes, insulin replacement therapy is less important but still admin 4. Nursing process a. Maintaining Fluid and Electrolyte Balance b. Increasing Knowledge about Diabetes Management c. Decreasing Anxiety d. Monitoring and Managing potential complications Educating patients about self-care
cervical cancer
1. Clinical manifestations (early & late) a. Early i. Rarely produces symptoms b. Late i. Discharge ii. Irregular bleeding iii. Pain or bleeding during sexual intercourse iv. Excruciating pain in the back and legs v. Fever vi. Anemia 2. Assessment & Diagnosis a. Abnormal Pap smear i. Diagnosis may be made on the basis of abnormal Pap smear results, followed by biopsy results identifying severe dysplasia b. HPV screenings i. Screening should begin w/in 3 years of intercourse or at 21 years of age. c. Carcinoma in situ - Preinvasive cancer i. Classified as severe dysplasia and is defined as cancer that has extended through the full thickness of the epithelium of the cervix, but not beyond. d. Pelvic exam - large, reddish growth or a deep, ulcerating lesion e. Spotting or bloody discharge f. Biopsies and colposcopies i. Colposcopy - is a medical diagnostic procedure to examine an illuminated, magnified view of the cervix and the tissues of the vagina and vulva. Many premalignant lesions and malignant lesions in these areas have discernible characteristics which can be detected through the examination. g. D & C, CT, & MRI i. Dilation and curettage - refers to the dilation (widening/opening) of the cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus by scraping and scooping (curettage). It is a therapeutic gynecological procedure as well
diabetes and exercise
1. FIT acronym a. Frequency i. Regular 3-4 times per week b. Intensity i. 60-80% of maximal heart rate c. Time i. Aerobic activity ii. 20-30 mins with 5-10 min warm up 2. Relationship of exercise, insulin, & BS a. Need both insulin and glucose for exercise b. Exercise makes BS drop 3. Patient education (Chart 51-4)
surgical menopause
1. Hysterectomy a. Indications for Hysterectomy: i. Fibroids (leiomyomas) ii. Pelvic pain iii. Uterine prolapse iv. Pelvic Prolapse v. Dysfunctional uterine bleeding vi. Malignancy vii. Endometriosis 2. Oophorectomy 3. Salpingectomy
uterine cancer
1. Medical management a. Surgical staging b. Total or radical hysterectomy c. Bilateral salpingo-oophorectomy i. Removal of both fallopian tubes and ovaries d. Lymph node sampling e. Monitoring of cancer antigen (CA-125)
control breathing
1. Resting respiration is the result of cyclic excitation of the respiratory muscles by the phrenic nerve 2. The rhythm of breathing is controlled by respiratory centers in the brain 3. The inspiratory and expiratory centers in the medulla oblongata and pons control the rate and depth of ventilation to meet the body's metabolic demands 4. The apneustic center in the lower pons stimulates the inspiratory medullary center to promote deep, prolonged inspirations. 5. Central chemoreceptors; peripheral chemoreceptors; mechanoreceptors; proprioceptors; baroreceptors
oxyhemoglobin dissociation curve
1. Shows the relationship between the partial pressure of oxygen (PaO2) and the percentage of saturation of oxygen (SaO2)
hypoglycemia
1. clinical manifestations a. Shaky, fast heartbeat, sweaty, dizzy or shaky, anxious, hungry, blurred vision, weak or tired, headache, nervous or upset 2. treatment at home and in hospital a. treat with carbs, want protein or another meal soon to keep bs even b. provide education
potassium
3.5-5.0
hematocrit
35-50
bun
5-25
A 31-year-old patient has returned to the post-surgical unit following a hysterectomy. The patient's care plan addresses the risk of hemorrhage. How should the nurse best monitor the patient's postoperative blood loss? a. Have the patient void and have bowel movements using a commode. b. Count and inspect each perineal pad that the patient uses. * c. Swab the patient's perineum for the presence of blood at least once per shift. d. Leave the patient's perineum open to air to facilitate inspection.
B
A patient is post-operative day 1 following a vaginal hysterectomy. The nurse notes an increase in the patient's abdominal girth and the patient complains of "bloating." What is the nurse's most appropriate action? a. Provide the patient with an unsweetened, carbonated beverage. b. Encourage the patient to ambulate and provide a warm compress. c. Provide an ice pack to apply to the perineum and suprapubic region. d. Assist the patient into a prone position.
B
A patient has returned to the post-surgical unit after a total vaginal hysterectomy. What intervention should the nurse prioritize during the initial postoperative period? a. Monitoring the incision sites for bleeding and hemorrhage. b. Administering sitz baths every 4 hours and opioids PRN. c. Monitoring and counting perineal pads and controlling pain. d. Avoiding analgesics unless the patient's pain is unbearable
C
A patient is being discharged home after a hysterectomy. When providing discharge education for this patient, the nurse has cautioned the patient against sitting for long periods. This advice addresses the patient's risk of what surgical complication? a. Pudendal nerve damage b. Fatigue c. Venous thromboembolism d. Hemorrhage
C
A nurse providing prenatal care to a pregnant woman is addressing measures to reduce her postpartum risk of cystocele, rectocele, and uterine prolapse. What action should the nurse recommend? a. Maintenance of good perineal hygiene b. Prevention of constipation c. Increased fluid intake for 2 weeks postpartum d. Performance of pelvic muscle exercises *
D
Airway resistance and compliance
Resistance is determined by the radius, or size of the airway through which the air is flowing, as well as by lung volumes and airflow velocity; Compliance is the elasticity and expandability of the lungs and thoracic structures. Compliance allows the lung volume to increase when the difference in pressure between the atmosphere and the thoracic cavity (pressure gradient) causes air to flow in
respiratory acidosis
Treatment aimed at improving ventilation
small cell
a. 10-15% b. Occur in major bronchi, spread by infiltration along bronchial wall Very aggressive, early mets to lymph and blood poor prognosis c. Associated with tumor production of hormones including ACTH
diabetic food classification system
a. 50-60% of calories should be from carbohydrates b. 20-30% from fats c. Animal fats do not need to be removed from the diet. d. 10-20% from protein e. Low fat does not mean low sugar or low glycemic index.
non small cell
a. 85-90% b. Squamous cell CA c. Adenocarcinoma- peripheral lung masses or nodules i. Likely to metastasize d. Large cell CA i. Fas growing, mets early
respiratory alkalosis
a. Correct cause of hyperventilation
metabolic alkalosis
a. Correct underlying disorder, supply chloride to allow excretion of excess bicarbonate, restore fluid volume with sodium chloride solutions
metabolic acidosis
a. Correct underlying problem, correct imbalance i. Bicarbonate may be administered
skin breakdown
a. Over bony prominences, do not itch b. Pad a lot before casting
comparment syndrome
a. Pain, pulselessness, paresthesia, poikilothermic, pallor, paralysis b. Lower the extremity to heart level, notify the physician, bivalve cast (split), leave parts as split, get client ready for OR & fasciotomy
diabetics and alcohol
a. Talk to MD b. Glucagon and hypoglycemia c. Medical Bracelet d. Alcoholic intake quantity Educate friends
fat embolism
a. Usually break of big bone such as arm or leg b. Petechial rash, respiratory insufficiency, tachycardia, fever, jaundice, renal impairment, thrombocytopenia, anemia, ESR> fat macroglobulinemia
infection
a. Warmth, drainage, odor, skin breakdown at edges of cast, edema greater than 24-48 hrs after casting b. Teaching: report to HCP pain/pressure, keep cast dry, don't scratch under cast, keep distal portion elevated higher than proximal part of cast
Bucks Traction-
boot with where weights must hang freely, hip back into joint, helps with circulation
Inspiration-
capacity of the chest is increased, air moves into the bronchi, bronchioles, and alveoli and inflates the lungs
The nurse is providing preoperative education for a patient diagnosed with endometriosis. A hysterectomy has been scheduled. What education topic should the nurse be sure to include for this patient? a. Menstrual periods will continue for several months, some of them heavy and painful. b. Normal activity will be permitted within 48 hours following surgery. c. After a hysterectomy, hormone levels remain largely unaffected. d. The bladder must be emptied prior to surgery and a catheter may be placed in surgery.
d. ThD
Hypoxemia-
decreased oxygen in the blood
Hypoxia-
decreased oxygen in the tissues
cystocele
i. A downward displacement of the bladder toward the vaginal orifice ii. Clinical manifestations 1. Sensation of pelvic pressure 2. Urinary problems (incontinence, frequency, and urgency) 3. Back and/or pelvic pain iii. Prevention/non-surgical management (chart 57-4) 1. Kegels a. How long do you hold for? 10 seconds, relax. Repeat 30 - 80 times a day 2. Pessary a. Latex item that is inserted into the cervix that keeps uterus up high b. Reason for insertion: don't want to have vaginal vault come out 3. Prenatal care iv. Nursing management 1. Preventative measures a. kegels 2. Post-operative care a. Immediate postoperative goals i. Preventing infection and pressure on any existing suture line b. Perineal care i. Void w/in a few hours after surgery for cystocele and complete tear ii. If no void and reports pain after 6 hours - catheterized (indwelling may be indicated for 2-4 days. iii. After each void or BM, perineum may be cleaned w/ warm, sterile saline solution and dried w/ sterile absorbent material if perineal incision has been made. iv. Ice pack applied locally to relieve discomfort (weight of ice bag must rest on the bed, not on the patient). 3. Patient education v. Self-care 1. Cleanliness 2. Prevention of constipation 3. Recommended exercises 4. Avoiding lifting heavy objects or standing for prolonged periods 5. Report any pelvic pain, unusual discharge, inability to carry out personal hygiene, and vaginal bleeding.
rectocele
i. An upward pouching of the rectum that pushes the posterior wall of the vagina forward ii. Clinical manifestations 1. Sensation of pelvic pressure 2. rectal problems (incontinence, frequency, and urgency) 3. Back and/or pelvic pain iii. Prevention/non-surgical management (chart 57-4) 1. kegels iv. Nursing management 1. Preventative measures a. kegels 2. Post-operative care a. Immediate postoperative goals i. Preventing infection and pressure on any existing suture line b. Perineal care i. Void w/in a few hours after surgery for cystocele and complete tear ii. If no void and reports pain after 6 hours - catheterized (indwelling may be indicated for 2-4 days. iii. After each void or BM, perineum may be cleaned w/ warm, sterile saline solution and dried w/ sterile absorbent material if perineal incision has been made. iv. Ice pack applied locally to relieve discomfort (weight of ice bag must rest on the bed, not on the patient). 3. Patient education v. Self-care 1. Cleanliness 2. Prevention of constipation 3. Recommended exercises 4. Avoiding lifting heavy objects or standing for prolonged periods 5. Report any pelvic pain, unusual discharge, inability to carry out personal hygiene, and vaginal bleeding.
atelectasis
i. Assessment findings 1. Low-grade fever 99-100 F cough, sputum production 2. Diminished or crackles 3. Dyspnea, cyanosis, anxiety, tachypnea, pleural pain 4. CXR - patchy, airless, or consolidated areas 5. Pulse ox often <90 ii. Nursing care (interventions) 1. Measures to lung expansion 2. IS 3. T, C, & DB 4. Early ambulation 5. Pain management 6. Avoid excessive sedation 7. á fluids 8. Respiratory tx (as ordered) iii. Diagnostics 1. Described in relation to x-ray confirmation 2. Decreased breath sounds
pneumonia
i. Assessment findings 1. VS: T, P, R (tachypnea) Shaking? Chills? Dyspnea? Cough? Secretions? 2. Egophony, Dullness on percussion, Crackles (rales) 3. Pleuritic pain?, Mental status / confusion?, Fatigue?, Dehydration? ii. Nursing care (interventions) 1. Bacterial- antibiotics 2. Viral- supportive, palliative 3. Fungal- antifungals 4. Supportive treatment, airway clearance, vaccinations as appropriate, rest (semi/high fowlers), nutrition 5. Turn cough, deep breath, incentive spirometer, chest physiotherapy iii. Diagnostics 1. H&P, CXR, blood culture, sputum sample, WBC, differential, C&S
hypovolemia
i. Clinical Manifestations 1. Decreased skin turgor, oliguria, concentrated urine, orthostatic hypotension, rapid weak pulse, cool clammy skin due to vasoconstriction, lassitude, thirst, nausea, muscle weakness & cramps ii. Nursing Management 1. Sodium, potassium, bun/creatine, hct, weight, fluids, I&Os, lungs, vitals
hypervolemia
i. Clinical Manifestations 1. Edema, distended neck veins, abnormal lung sounds (crackles), tachycardia, increased blood pressure, pulse pressure and CVP, increased weight, increased urine output, shortness of breath and wheezing ii. Medical Management 1. Bun, hematocrit, urine sodium, xray, restrict fluids, diuretics, dialysis iii. Nursing Management 1. Vitals, lung sounds, I&Os, restrict fluids and sodium, diuretics
uterine prolapse
i. Clinical manifestations 1. Uterus prolapses into vaginal vault 2. Coughs 3. Lifts a heavy object (> 10lbs) 4. Stands for a long time 5. Even normal activities (walking up stairs) may aggravate ii. Prevention/non-surgical management (chart 57-4) 1. Kegels 2. Pessary 3. Prenatal care iii. Nursing management 1. Preventative measures a. kegels 2. Post-operative care a. Immediate postoperative goals i. Preventing infection and pressure on any existing suture line b. Perineal care i. Void w/in a few hours after surgery for cystocele and complete tear ii. If no void and reports pain after 6 hours - catheterized (indwelling may be indicated for 2-4 days. iii. After each void or BM, perineum may be cleaned w/ warm, sterile saline solution and dried w/ sterile absorbent material if perineal incision has been made. iv. Ice pack applied locally to relieve discomfort (weight of ice bag must rest on the bed, not on the patient). 3. Patient education a. Self-care i. Cleanliness ii. Prevention of constipation iii. Recommended exercises iv. Avoiding lifting heavy objects or standing for prolonged periods v. Report any pelvic pain, unusual discharge, inability to carry out personal hygiene, and vaginal bleeding.
telemetry
i. Identify sinus rhythms ii. Count QRS waves in a 6 second strip multiply by 10 iii. Is the number between 60 and 100 ? iv. Are the QRS in a regular pattern? v. No skips of too early? vi. How fat are the QRS waves? Should be less than .12 seconds? vii. Look at P waves are they the same and before each QRS? viii. Are the P waves within .21 second of the QRS?
Diagnostic tests R/T resp. system
i. Know those discussed in class; focus on nursing care (pre-procedure care, teaching, post-procedure care) ii. Sputum C & S iii. ABG interpretation
respiratory assessment
i. Nursing assessment of respiratory system ii. Inspect, palpation, auscultation iii. Auscultation: 1. Normal breath sounds- sounds normal 2. Crackles- pops 3. Wheezes- high pitched
hysterectomy
i. Nursing management 1. pre, intra, post-operative care a. Preop i. Patient advised to discontinue anticoagulant medications, NSAIDs, and vitamin E ii. Pregnancy is ruled out on the day of surgery iii. Prophylactic antibiotic agents may be administered and discontinued next day iv. Prevention of DVT is critical b. Postop i. Major risks are infection and hemorrhage ii. Voiding problems may occur - edema or nerve trauma may cause temporary loss of bladder tone (bladder atony) and indwelling catheter may be inserted 2. nursing interventions a. Relieving Anxiety and body image disturbance i. Allow patient to express feelings ii. Explain physical preparations and procedures iii. Address sexual issues iv. Approach and evaluate each patient individually b. Relieving pain i. Postoperative pain and discomfort are common ii. Administer prescribed analgesics iii. When return of bowel sounds - may begin soft diet iv. Encourage early ambulation - promotion of peristalsis c. Hemorrhage i. For early detection, ii. RN counts perineal pads used or checks incision site iii. Assesses the extent of saturation with blood iv. Monitors vital signs d. Venous Thromboembolism Due to surgery positioning, postoperative edema, low activity i. Use anti-embolism stockings ii. Encouraged, frequent position changes iii. Avoidance of pressure behind the knees iv. Exercise legs and feet while in bed v. Early Ambulation e. Bladder dysfunction i. Occasional indwelling catheter placed ii. D/C with initiation of ambulation 3. Education a. Hemorrhage b. For early detection, c. RN counts perineal pads used or checks incision site d. Assesses the extent of saturation with blood e. Monitors vital signs f. Venous Thromboembolism Due to surgery positioning, postoperative edema, low activity g. Use anti-embolism stockings h. Encouraged, frequent position changes i. Avoidance of pressure behind the knees j. Exercise legs and feet while in bed k. Early Ambulation 4. discharge teaching a. She must know what limitations or restrictions, if any, to expect. b. She is instructed to check the surgical incision daily and to contract her primary provider if redness or purulent drainage or discharge occurs. c. She is informed that her periods are now over but that she may have a slightly blood discharge for a few days; if bleeding recur after this time, it should be reported immediately. d. Importance of an adequate oral intake and maintaining bowel and urinary tract function. e. Resume activities gradually. Don't sit for long periods because it may cause blood to pool in the pelvis, increasing the risk of VTE. f. Showers are preferable to tub baths g. Avoid straining, lifting having sexual inctercourse, or driving until permitted h. Vaginal discharge, foul odor, excessive bleeding, any leg redness or pain, or an elevated temperature should be reported ii. Complications 1. Signs and symptoms & Nursing interventions a. Hemorrhage i. For early detection, ii. RN counts perineal pads used or checks incision site iii. Assesses the extent of saturation with blood iv. Monitors vital signs b. Venous Thromboembolism Due to surgery positioning, postoperative edema, low activity i. Use anti-embolism stockings ii. Encouraged, frequent position changes iii. Avoidance of pressure behind the knees iv. Exercise legs and feet while in bed v. Early Ambulation i. Nursing interventions 1. Relieving Anxiety a. Allow patient to express feelings b. Explain physical preparations and procedures c. Provide emotional support 2. Improving Body image a. Listen and address concerns b. Provide appropriate reassurance c. Address sexual issues d. Approach and evaluate each patient individually 3. Relieving pain a. Postoperative pain and discomfort are common b. Administer prescribed analgesics c. When return of bowel sounds - may begin soft diet d. Encourage early ambulation - promotion of peristalsis ii. Patient education 1. Must know limitations/ restrictions 2. Check surgical incision daily and report redness, purulent drainage or discharge 3. Periods are over, but may have slightly bloody discharge for few days 4. Report any bleeding immediately 5. Adequate oral intake and maintenance of bowel and urinary function.
Traction
i. Patient Care 1. Can use manual traction before casting- use trapeze bar for movement 2. Check neurovascular status 3. Teach patient 4. Pin cleaning a. - Neurovascular checks q 2 hours - Pin care Pin Site Care -Avoid Infection and Osteomyelitis- Assess pin sites every 8 hours - Pin site care 1 to 2 times a day initially then weekly - Increase frequency if pins loose or early signs of infection - Chlorhexidine recommended - clean each pin separately - Notify MD if pins or clamps loosen
amputations
i. Patient Care 1. High protein, high nutrient diet 2. Phantom limb pain is real a. Treat like real pain 3. Rehab: prosthesis 4. BKA- below knee amputation a. Best saves joint 5. AKA- above knee amputation 6. Traumatic? a. Assess residual limb for function, condition, infection, lymph nodes, fever drainage (do a culture and sensitivity on any drainage) b. Nutritional status c. High protein and vitamin rich diet promotes healing d. Concurrent health problems? i. Diabetes, respiratory problems, steroid use, vasoconstrictors vasodilators psychological status, emotional reaction to body image 7. Goals a. Homeostasis immediately post op, assess hemorrhage prior to surgery (keep monitoring for bleeding post op) b. Infection potential (especially if traumatic, (wound was contaminated on scene) c. Pain Relief d. Wound Healing (consider gentle aseptic touch to residual limb, if cast or dressing comes off: i. 1 wrap with compression bandage asap(otherwise risk for edema, ii. 2 notify surgeon e. Body image/ grieving f. Self care g. Physical mobility Directly after surgery there may be elevation but not long term (do not place on a pillow, the muscles may contract... flexion contracture is an issue.) h. If hip, knee: i. no sitting for long periods, ii. ROM hip/knee to residual limb iii. get this person an overhead trapeze i. If upper extremity i. Pt to both shoulders j. IDENTIFY ENVIRONMENTAL BARRIERS i. RID OF RUGS, STEPS, THINKING ABOUT INCLUDES DOORS, WET SURFACES, WHAT DO YOU NEED FOR MOBILITY?
knee arthroplasty
i. Patient Care 1. Recovery degree depends largely on accurate fit, presence of health bone, patient condition prior to surgery, muscle mass, activity level prior to surgery, cardiac and lung function. 2. CPM (continuous passive motion) machine to restore mobility of the joint to 180 degrees 3. Commonly used to a. repair a torn meniscus b. Reconstruct a torn ligament (usually the anterior cruciate) c. Remove inflamed synovial tissue d. Trimming damaged articular cartilage e. treat patella problems
lungs cancer
i. Risk factors 1. Inhaling carcinogenic chemicals, Previous scarring, Genetics, Environmental carcinogens (radon, asbestos), Smoking ii. Pathophysiology 1. Malignant Δs in lung epithelial cell when carcinogen binds to cell DNA and causes damage 2. May differentiate into several CA lines 3. Pulmonary tissue changes to malignant tissue and has potential to metastasize rapidly to bone, adrenal, liver, intestine and brain iii. Classifications 1. ? iv. Staging 1. TNM i. Clinical manifestations 1. Often asymptomatic until late 2. Cough or Δ in chronic cough 3. Dyspnea 4. Chronic upper respiratory infection 5. Hemoptysis 6. Recurrent fever 7. Chest or shoulder pain 8. Hoarseness 9. Weakness, anorexia, weight loss ii. Assessment 1. Chest x-ray - shows tiss density, solid nodule (coin lesion), atelect.; good when compared to previous 2. CT scan - things not seen on xray; evaluate and localize tumors; do with needle bx 3. Other scans for mets - bone, liver, brain CT, MRI 4. Sputum cytology - sputum spec collected through deep cough in morning or bronch; neg sputum does not mean no cancer; bronch with bx more reliable 5. Labs 6. CBC for abnormal counts, liver function, lytes, alk phos, for mets 7. Thoracentesis or aspiration 8. Staging TNM system iii. Diagnostics 1. CT scan with contrast 2. Obtain cells for biopsy 3. Sputum cytology - bronchoscopy 4. Thoracentesis or aspiration 5. Nursing Care of patients with lung cancer
pulmonary embolism (PE)
i. Risk factors 1. Surgery, trauma, pregnancy, CHF, hypercoagulation, immobility/venous stasis, long bone fractures, DM, COPD, obesity, oral contraceptives, constrictive clothing, previous history ii. Prevention measures 1. anticoagulant therapy 2. intermittent pneumatic leg compression devices If high risk for repeated clot: Vena Cava Filter
menopause
i. Signs and symptoms 1. 7 menopausal dwarfs 2. Itchy 3. Bitchy 4. Sweaty 5. Bloaty 6. Sleepy 7. Forgetful 8. Psycho 9. Headaches and hot flashes 10. Teeth loosen and gums recede 11. Risk of cardiovascular disease 12. Backaches 13. Body and pubic hair becomes thicker and darker 14. Bones lose mass and become more fragile 15. Vaginal dryness, itching, and shrinking 16. Stress or urge incontinence 17. Abdomen loses some muscle tone 18. Skin and mucous membranes become drier, skin develops rougher texture 19. Nippels become smaller and flatten 20. Breasts droop and flatten 21. Hair becomes thinner and loses luster
diabetic nursing managment
i. Survival Skills Chart 51-5 ii. Continuing Education 1. be able to identify and differentiate examples of each of the above bolded areas 2. patho a. basic define (diabetes = higher bs) b. normal/target bs range c. effects of insulin and exercise (decrease) d. effects of food, stress, illness, infection (increase) e. basic treatment approaches 3. treatment a. admin insulin and oral antidiabetic medications b. meal planning (food groups, timing of meals) c. monitoring of blood glucose and urine ketones 4. recognition, treatment, and prevention of acute complication a. hypoglycemia vs hyperglycemia 5. pragmatic information a. where to buy/store insulin, syringes, and glucose monitoring supplies b. when and how to contact HCP
fractures
i. Types 1. Greenstick 2. Spiral 3. Comminuted 4. Transverse 5. Compound 6. Vertebral compression ii. Assessment 1. RICE a. Rest, apply ice as directed, consider compression, elevate above heart 2. Compound antibiotics, pain med, head injury? iii. Treatment 1. Closed- reduction with immobilization 2. Open-reduction with internal (ORIF) or external fixation; Correction and alignment of the fracture after surgical dissection and exposure of the fracture iv. Emergency and hospital care of people with fractures 1. Immobilization 2. Circulation 3. Nerve- strength, function, sensation, paresthesia v. Cast care/care of patient with a cast/complications 1. Elevate, aerate, keep dry, while hardening be careful to keep shape, peripheral neurovascular exam, apply ice in bag or cool dry compress 2. Complications a. Skin breakdown, Edema, Surgical complications, Disuse, Infection, Home maintenance: driving, getting dressed, etc b. Smell or drainage of cast = not normal = bad
ventri non rebreathing
i. most amount of oxygen
Hypercapnia-
increase in PaCO2 and respiratory acidosis, decrease in oxygen/carbon dioxide exchange; too much carbon dioxide in the blood; rising CO2 levels result in respiratory acidosis
Diffusion-
process by which oxygen and carbon dioxide are exchanged from areas of high concentration to areas of low concentration at the air-blood interface (alveolar-capillary membrane)
Respiration-
process of gas exchange, Between air and blood, This is at cell level
Skin Traction-
pull on skin and weight, used to pull on skin to reduce a fracture or decrease muscle spasms before surgery
Total-
removal of the uterus and the cervix
Skeletal Traction-
rod into bone pulls on bone and weight; clean from skin out
