Uworld pt 3

Electroencephalogram (EEG)

- A diagnostic procedure used to evaluate the presence of abnormal electrical discharges in the brain, which may result in a seizure disorder -The eeg can be done in a vairety of ways, such as with the child asleep or awake with or without stimulation Teaching for the parent includes the following 1. HAIR should be WASHED to remove oils and hair care products, and accessories such as ribbons or barrettes should be removed. Hair may need to be washed after the procedure to remove electrode gel 2. AVOID CAFFEINE, STIMULANTS, AND CENTRAL NERVOUS SYSTEM DEPRESSANTS prior to the test 3. The Test is NOT PAINFUL, and no analgesia is required routine EEG is not performed under sedation, and so the child should remember the procedure

Hemophilia

- a bleeding disorder caused by a deficiency in coagulation proteins -client with classic hemophilia, or hemophila A, lack facot VIII -client with hemophila B (christmas disease) lack factor IX -when injured clients with hemophila should be monitored closely for external as well as internal bleeding -the most frequent sites of bleeding are the JOINTS (80%), especially the knee -HEMARTHOSIS can occur with minimal or no trauma, with episodes beginning during toddlerhood, when the child is active and ambulatory -Over time, chronic swelling and deformity can occur

Digoxin

- a cardiac glycoside used to treat HEART FAILURE AND ATRIAL FIBRILLATION -Cardiac glycosides have positive ionotropic effects (increased cardiac output) and negative chronotropic (decreased heart rate) -However, DRUG TOXICITY is common due to digoxin having narrow therapeutic-range levels (0.5-2.0 ng/mL) -CARDIAC ARRHYTHMIAS are the most dangerous symptoms -digoxin toxicity can result in BRADYCARDIA and HEART BLOCK, which can cause dizziness or lightheadedness -Clients are instructed to CHECK THEIR PULSE and if it is low (<60/min) or has skipped beats to hold the medication and notify the hcp Other manifestations of digoxin toxicity that clients should report include: -VISUAL SYMPTOMS (ALTERATIONS in color vision, scotomas, blindness) -GASTROINTESTINAL SYMPTOMS (anorexia, nausea, vomiting, abdominal pain) - frequently the EARLIEST SYMPTMS -NEUROLOGIC MANIFESTATIONS (lethargy, fatigue, weakness, confusion

Hypospadias

- a congenital defect in which the urethral opening is on the underside of the penis -except in very mild casesm the condition is typically corrected around 6-12 months by surgically redirecting the URETHRA to the penis tip -CIRCUMCISION IS DELAYED so the foreskin can be used recontstruct the urethra -if not corrected, clients may have toilet-training difficulties, more frequent urinary tract infections, and inability to achieve erections later in life Postoperatively, the client will have a catheter or STENT to maintain patency while the new meatus heals. -Urinary output is an important indication of urethral patency -fluids are encouraged and the hourly ouput is documented, absence of urinary output for over and hour inddicates that a kind or obstruction may have occurred and requires immediate follow up

Oxycodone (long term side effect of opioid use)

- a morphine-like opioid medication -opiod medication binds to opiod receptors in the intestine, which slows peristalsis and increases water absorption, leading to constipation -constipation is an almost univerally expected side effect from opioid medications -Clients will not develop tolerance to this side effect -although clients wit idiopathic chronic constipation are not commonly advised to take laxatives , opioid-induced constipation is treated with simultaneous use of SENNA (stimulant) and docusate (stool softener) -Constipation is an expected long-term effect of OPIOID USE

Colostomy

- a surgical procedure that creates an opening (stoma) in the abdominal wall for the passage of stool to bypass an obstructed or diseased portion of the colon -stool drains through the intestinal stoma into a pouch device secured to the skin -Clients with a descending or sigmoid colostomy drain stool that is more formed and similar to a normal bowel movement -Although less common, some clients choose to irrigate their colostomy in order to create a bowel regimen that allows them to wear a smaller pouch or a dressing over the stoma -When irrigated DAILY, the client gains increased control over the passage of stool

Immune thrombocytopenic purpura (ITP)

- an autoimmune condition in which antibodies bind to and cause destruction of platelets -clients with ITP have a platelet count <150,000 and are at increased risk of bleeding Key teaching to reduce the client's risk of bleeding includes: -use soft-bristle toothbrushes, gentle flossing, and nonalcoholic mouthwashes. These prevent peridontal disease and gingival bleeding -avoid activities that may cause trauma (high-intensity sports) . Appropriate exercise includes LOW-IMPACT ACTIVITY (walking) while wearing nonskid footwear to help prevent falls -Tke prescribed stool softeners and laxatives as needed. THese medications prevent hard stools and straining, which can cause anorectal fissuring, bleeding, and hemorrhoids -clients should use electric razors instead of safety or straight razors. Electric razors have a compelte guard, reducing risk of accidentaly nicking of skin -Clients with ITP should avoid NSAIDS (aspirin, ibuprofen, ketorlac) which further impair platelet function . Acetaminophen and opiates are better options for pain mangement

Right upper quadrant or epigastric pain (in pregnancy)

- can be an indicator of HELLP syndrome, a sever form of preeclampsia -HELLP syndrome (hemolysis, Elevated liver enzymes, and Low PLATELET COUNT) is often mistaken for viral gastroenteritis due to its variable and nonspecific presentation -Misdiagnosis may lead to severe complications (placental abruption, liver failure, stroke) and/or maternal/fetal death -clients may have RUQ pain, NAUSEAM VOMITING, AND MALAISE -Headache, visual changes, proteinura, and hypertension may or may not be present

Cystic fibrosis

- defective protein responsible for transporting sodium and chloride causes exocrine gland secretions to be thicker and sticker than normal -VISCOUS respiratory SECRETIONS accumulate, RESULTING in impaired airway clearance and a chronic cough -Clients eventually develop chronic lung disease, which predisposes them to recurrent respiratpr infections Pancreatic enzyme secretion, needed for digestion and absorption of nutrients, is also impaired because thick secretions block pancreatic ducts. Therfore the client needs supplemental enzymes iwth all meals and snack -the client requires multiple vitamins and a diet HIGH IN CARBOHYDRATES, PROTEIN, FAT to help meet nutritional requirement for grwoth Sweat gland abnormalities prevent sodium and chlorid reabsorption, causing increased salt loss, dehydration, and hyponatremia during times of significatnt perspiration -therefore, parents should increase the child's salt intake and fluids during hot weather, exercise, or fever

Bulimia nervosa

- eating disordr characterized by episodes of uncontrollable binge-eating (consuming very large amounts of food, often in secret) followed by inappropriate compensatory behaviors to prevent weight gain -compensatory behaviors may include laxative or diuretic use, self-induced vomiting, or excessive exercise 1-2 hours after binging Other sign of BN may include -Physical changes related to self-induced vomiting (scars or calluses on the hand, enlarged parotid glands, erosion of tooth enamel, dental caires) - preoccuaption with body image, weight, food, and dieting Characteristics -Weight within or above normal range -preoccupation with weight and shape -binge eating and compensatory behavior (purging,exercise, fasting, laxatives)

Hookworms

- parasytic bloodsucking roundworms that are contracted from larvae in contaminated soil -they can infect the intestines, causing interstinal bleeding and anemia

Prior to starting therapy with STATIN MEDICATIONS

- prior to starting therapy with statin medications, the client's LIVER FUNCTION TESTS SHOULD BE ASSESSED -the drug is metabolized by the hepatic enzyme system and could cause drug-induced hepatitis and INCREASED LIVER ENZYMES. -Liver fuction tests should be assessed prior to the start of therapy -Statins can also cause MUSCLE ACHES and severe muscle injury (rhabdomyolysis) -clients should be educated to report the development of muscle pains while on therapy. Assessment of muscle strength is not necessary prior to starting therapy

Cane length should equal

- the distance from the client's greater trochanter to the floor

Treatment of oropharyngeal candidiasis

--infection is treated with antifungals( nystatin) and proper oral hygiene

cystitis

-Burning on urination -frequency -urgency -suprapubic discomfort -hematuria

Burn injuries

-Caused by direct tissue damage from exposure to caustic (Thermal, chemical, electrical) sources -these injuries may be life-threatening, depending on the extent of tissue injury and organ damage -to prioritize the initial management of burn injuries, nurses should use the ABC's (airway, breathing, circulation) CIRCULATORY COMPROMISE is common after sustaining a burn, as extensive tissue injury combined with the systemic inflammatory response causes increased capillary permeability , fluid and electrolyte shifts, and decreased intravascular volume -These intravascular lossess begin rapidly after a burn and may lead to hypovolemic shock and death . -Therefore, the nurse should prioritize initiation of fluid resuscitation

Leukemia

-Characterized by unrestricted proliferation of abnormal white blood cells (lymphoblasts), resulting in depression of normla bone marrow activity -this disorder is the most common form of childhood cancer -INFECTION IS A MAJOR CONCERN due to NEUTROPENIA -in addition, anemia occurs due to decreased red blood cell production, and bleeding is common as a result of decreased platelet production -Leukemia is a cancer of the blood and organs involved in hematologic function. Due to myelosupppression, clients are at risk for problems related to INFECTION, ANEMIA, AND BLEEDING -It would be appropriate for this client with leukemia to share a room with a client with minimcal change nephrotiic syndrome (MCNS). MCNS is a non-infectious condition of the glomeruli and poses no risk to a client with leukeumia

Chest tubes in infants

-Chest tube and chamber should be assessed every hour for color and quanitity of drainage -Drainage >3mL/kg/hr for 3 consecutive hours OR >5-10 mL/kg in 1 hr shouldbe reported immediately to the hcp -this could indicate postoperative hemorrhage and requires immediate intervention -Cardiac tamponade can develop rapidly in children and can be life-threatening -This child weighs 4 kg and an output of 50mL in 1 hr is excessive

Postoperative cognitive dysfunction

-Client's who have undergone surgery (coronary artery bypass graft) may experience some POSTOPERATIVE COGNITIVE DYSFUNCTIOn (POCD) -this may include memory impairment and problems with concentration, language comprehension, and social integration -some clients may cry easily or become teary -the risk for POCD increases with advanced age and in clients with preexisting cognitive deficits, longer operative times, intraoperative complications, and postsurgical infections -POCD can occur days to weeks following surgery -most symptoms typically resolve after complete healing has occured -in some cases, this condition can beome a permanent disorder

Congenital heart defects (left to right shunt)

-Congenital heart defects that cause blood to shunt from the higher pressure left side of the heart to the lower pressure right side (patent ductus arteriosus, atrial septal defect, ventricular septal defect) increase pulmonary blood flow -Left-to-right shunting results in PULMONARY CONGESTION, causing increased work of breathing and decreased lung compliance -compensatory mechanisms (tachycardia, diaphoreis) result from SYMPATHETIC STIMULATION Clinical manifestations of acyanotic defects may include: -Tachypnea -tachycardia, even at rest -diaphoresis during feeding or exertion -heart murmur or extra heart sounds -signs of congestive failure -increased metabolic rate with poor weight gain

Chronic obstructive pulmonary disease (optimizing nutritional intake)

-Consuming adequate nutrition is difficult for clients with advanced chronic obstructive pulmonary disease (COPD), as chewing and swallowing increase work of breathing and a full stomach increases pressure on the diaphragm -As a result, clients often lose weight because their energy expenditure is greater than their nutritional intake To optimize nutritionakl intake, clients should: -DRINK fluid between meals, rather than before or during, to prevent STOMACH DISTENSION and decrease pressure on the diaphragm while eating -Eat small, frequent meals, snacks, and supplements that are HIGH IN CALORIES AND PROTEIN. SMALLER meals require less energy to chew and swallow, resulting in less fatigue and dyspnea -Perform ORAL HYGIENE BEFORE MEALS. Chronic mouth breathing leads to dry mouth; excessive sputum and medication side effects can alter the taste of food, decreasing the appetite -for clients with advanced COPD, exercise is discourgaged for 1 hr before and 1 hr after eating as it increases oxygen demand and fatigue -GAS-FORMING FOODS (broccoli, beans, cabbage) and carbonated beverages should be avoided as they cause intestinal bloating and increased pressure on the diaphragm

Unexpected findings in newborns include

-Decreased muscle tone (hypotonia), which may indicate a congenital neurological abnormality (down syndrome) or spinal injury. Newborns normally have increased muscle tone and should resist movement of the extremities -Sacral Dimples, with or without tufts of hair or skin tags, are associated with SPINA BIFIDA OCCULTA, which is an incomplete closure of vertebrae that cannot be seen externally -Presence of a single umbilical artery, which is sometimes associated with congenital defects particulary of the kidneys and heart. Normal umbilical cords contain 2 arteries and 1 vein

Newborns who are LARGE FOR GESTATIONAL AGE (LGA)

-Diagnosed after birth by plotting their birth weight and gestational age on a growth char; weight must be at least >90th percentile and is commonly >8lb 13 oz (4000g) -Risk factors include gestational diabetes; excessive gestational weight gain or elevated prepegnancy BMI; history of a prior newborn who was LGA; posterm gestation; and genetics (male sex, maternal birth weight, ethnicity) -The nurse should prioritize assessment of birth injuries and hypoglycemia When developing the plan of care for a newborn who is LGA, the nurse should include the following interventions -Document gestational age assessment, weight, length, and head circumference to identify newborns who are LGA -Assess the newborn for BIRTH-RELATED INJURIES (cephalohematoma, clavicular fracture, lacerations) and review the birth record to determine if an operative vaginal birth occurred (forceps) -Discuss the need for possible feeding supplementation (breastmilk, formula) if the newborn is hypoglycemic -assist the mother to feed the newborn soon after birth and every 2-3 hours thereafter to prevent hypoglycemia -Obtain a capillary blood glucose (bg) BEFORE feeding to assess fo hypoglycemia, and notify the hcp when a capillary reading is <40-45 mg/dL

The procedure for a bowel irrigation is as follows:

-Fill the irrigation container with 500-1000mL of lukewarm water, flush irrigation tubing, and reclamp; hang the container on a hook or iv pole -Instruct the client to sit on the toilet, place the irrigation sleeve over the stoma, extend the sleeve into the toilet , and place the irrigation container approximately 18-24 inches above the stoma -Lubricate CONE-TIPPED IRRIGATOR, insert cone and attached catheter gently into the stoma, and hold in place -slowly open the roller clamp, allowing irrigation solution to flow for 5-10 minutes -clamp the tubing if cramping occurs, until it subsides -Once the desired amount of solution is instilled, the cone is removed and feces is allowed to drain through the sleeve into the toilet

Arterial Blood Gases (ABGs)

-Indicate the acid-base balance in the body and how well oxygen is being carried to the tissues -It is common to measure ABGs after a ventilator change to assess how well the client has tolerated it -It is common to measure ABGs after a ventilator change to assess how well the client has tolerated it -factors such as CHANGES IN THE CLIENT'S ACTIVITY level or OXYGEN SETTINGS, or SUCTIONING WITHIN 20 minutes prior to tthe blood draw can cause inaccurate results -Unless the client's condition dictates otherwise, the nurse should avoid SUCTIONING AS IT WILL DEPLETE THE CLIENT'S OXGYEN LEVEL and cause inaccurate test results

Tumor necrosis factor (TNF) inhibitors

-Infliximab -adalimumab -etanercept -Suppress the inflammatory response in autoimmune diseases such as rheumatoid arthritis, crohn disease, and psoriasis -Due to the immunosuppressive action of TNF inhibitors, clients taking these drugs are at increased risk for infection - a client with current, recent, or chronic infection should not take a TNF inhibitor -the immunosuppressive action of TNF inhibitors can activate LATENT TUBERCULOSIS. Therefore a tst should be administered PRIOR to beginning TNF inhibitor therapy, and clients who test positively for LATENT TB must also undergo treatment for TB before starting therapy. Clients should have a TST every year while receiving the drug -Clients taking immunosuppressive TNF inhibitors should receive an annual iNACTIVATED (INJECTABLE) influenza vaccine to reduce the risk of contracting the flu virus (at risk for infection and should NOT receive live attenuated vaccines)

Monoamin oxidase inhibitors interaction

-Monamine oxidase inhibitors (MAOIs) (selegiline interact with many medications including many antidepressants) -CONCURRENT USE OF MAOIs with SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) (eg escitalopram ) may precipitate life-threatening adverse reactions (serotonin syndrome, neuroleptic malignant syndrome, hypertensive crisis) -if a client's prescribed medication regimen will to or from an MAOI, the existing medication should be tapered and discontinued, followed by a 2 week "washout" period without either medication. The client can then begin taking the new medication

Therepeutic hypothermia

-Neurologic injury is the most common cause of mortality in clients who have had cardiac arrest particulary ventricular fibrillation or pulseless ventricular tachycardia -INDUCING Therapeutic Hypothermia in these clients WITHIN 6 HOURS of arrest and maintaining it for 24 hours has been shown to decrease mortality rates and improve neurologic outcomes -It is indicated in all clients who are COMATOSE or DO NOT FOLLOW COMMANDS after resuscitation The client is cooled to 89.6-93.2 for 24 hours before rewarming -cooling is accomplished by cooling blankets; ice placed in the groin, axillae, and sides of the neck; and cold IV fluids -the nurse must closely assess the cardiac monitor (bradycardia is common), core body temperature, blood pressure (mean arterial pressure to be kept >80 mm Hg) , and skin for thermal injury -The nurse must also apply neuroprotective strategies such as keep the head of the bed elevated to 30 degrees -after 24 hours, the client is slowly rewarmed

Treatment of frostbite should include the following

-Remove clothing and jewelry to prevent constriction -Do not massage, rub, or squeeze the area involved. Injured tissue is easily damaged -Immerse the affected area in water heated to 98.6-102.2 F, preferably in a whirlpool. Higher temperatures do not significantly decrease warming time but can intensify pain -avoid heavy blankets or clothing to prevent tissue sloughing -provide analgesia as the rewarming procedure is extremely painful - as thawing occurs, the injured area will become edematous and may blister. Elevate the injured area after rewarming to reduce edema -Keep wounds open immediately after a water bath or whirlpool treatment and allow the to dry before applying LOOSE, NONADHERENT, STERILE DRESSINGS -Monitor for signs of compartment syndrome

The legal criteria for involuntary admission include:

-THe individual appears to be an imminent danger to self or others -the individual has a GRAVE DISABILITY (is unable to adequately care for basic needs [food, clothing, shelter, medical care, personal safety]) as a result of mental illness Clients also have the right to the least restrictive environment in which treatment can be provided in a safe manner -involuntary commitment is generally used as a last resort in dealing with a client whose illness is so severe that judgement and insight in deciding to refuse treatment are markedly impaired

Suctioning the artificial airway

-The process of suctioning a client's airway removes oxygen in addition to the secretions; therfore, the client should be preoxygenated with 100% O2, and suction should be applied NO MORE THAN 10 SECONDS during each pass to prevent hypoxia -the nurse must wait 1-2 minutes between passes for the client to ventilate to prevent hypoxia -In addition, deep breathing should be encouraged -the suction catheter should be NO MORE THAN half the width of the artifical airway and INSERTED WITHOUT SUCTION -the nurse should DON STERILE GLOVES if the client does not have a closed suction system in place. Suction should be set at MEDIUM PRESSURE (100-120 mm Hg for adults, 50-75 mm Hg for children) as excess pressure will traumatize the mucosa and can cause hypoxia -Clients usually cough as the catheter enters the trachea, and this helps loosen secretions. The catheter should be advanced until resistance is felt and then, to prevent mucosal damage, retracted 1 cm before applying suction

Lymphoma

-a form of cancer that begins in the body's lymphatic system (lymph nodes, spleen) and is characterized by abnormal growth of lymphocytes -it is usually classified within two major subtypes, HODGKIN LYMPHOMA and NON-HODGKIN LYMPHOMA and is further identified by numberous categories -furthermore, hodgkin lymphoma tends to follow a PREDICTABLE PATH OF METASTASIS whereas NHL tends to be more widely disseminated -THE MOST COMMON clinical manifestation of any form of lymphoma is the presence of at least ONE PAINLESS, ENLARGED LYMPH NODE, often in the neck, underarm, or groin -clients may also present with or develop FEVER; -SIGNIFCANT unexplainable WEIGHTLOSS (>10% of body weight); -and/or DRENCHING NIGHT SWEATS ("B SYMPTOMS"); which typically associate with a poor prognosis -Additional indications are NONSPECIFIC (ITCHING, FATIGUE) although some clients are asymptomatic at the time of diagnosis -it is critical that nurses are alert to potential symptoms of lymphoma because early identification and treatment improve the client's chance for complete remission

Benign prostatic hyperplasia

-an abnormla prostate enlargement that most commonly affects male clients age >50 -the prostate gradually enlarges and compresses the urethra, causing voiding problems -Symptoms include URINARY URGENCY, FREQUENCY, AND HESITANCY, dribbling urine after voiding, night time frequency (nocturia) , and urinary retention -Treatment includes lifestyle changes and medications that shrink or slow growth of the prostate, and symptom management interventions (voiding schedule, avoidance of caffeine and antihistamines) -Surgical prostate resection may be required clients with BPH have increased risk for UTI because of incomplete bladder emptying and urine retention -symptms of UTI are often similar to those of BPH; however Burning sensation with urination and cloudy/fooul smelling urine are specific UTI symtoms that require further assessment and treatment

Testicular torsion

-an emergency condition in which blood flow to the testis (scrotum) has stopped - the testicle rotates and twists the spermatic cord, initially causing venous drainage obstruction that leads to swelling and SEVERE PAIN -Arterial blood supply is subsequently interrupted, resulting in TESTICULAR ISCHEMIA AND NECROSIS, which require surgical removal of the testis -The condition can be diagnosed with ultrasound -there is a SHORT TIME FRAME in which testicular torsion can be treated (to untwist the rotation), generally 4-6 hours, making this condition a priority

Attention-deficit hyperactivity disorder intervention with hyperactivity

-an immediate intervention to help settle an pout of control child is deep breathing -taking slow, deep breaths relaxes the body, slows the heart rate, and distract the child from inappropriate behaviors -asking the child to blow up a balloon provides an easy mod of distraction and engages the child in a deep breathing exercise -after the child is calm the nurse can further discuss the disruptive behavior

Isotretinoin

-an oral acne medication derived from VITAMIN A -Due to teratogenic risk and severity of side effects (STEVENS-JOHNSON SYNDROME, SUICIDE RISK), isotretinoin is used to treat only severe and/or cystic acne not responding to other treatments -Exposure to any amount of this medication during preganncy can cause birth defects -Clients are REQUIRED TO ENTER A web-based RISK MANAGEMENT plan (iPLEDGE) and use 2 form of contraception -Taking VITAMIN A supplements along with isotretinoin can cause VITAMIN A TOXICITY, which can cause increased INTRACRANIAL PRESSURE, gastrointestinal upset, liver damage, and changes in skin and nails. Therefore clients should be instructed to avoid vitamin A supplements while taking this medication Blood donation is also prohibited during the duration of treatment and up to a month after treatment ends due to the possibility of inadvertant transfusion to a pregnant women isotretinoin should not be taken with tetracycline because the latter also increases the risk for intracranial hypertension

ACE inhibitors (lisinopril, Prinivil, zestril)

-angiotensin-converting enzyme inhibitor prescribed to treat hypertension and slow the progression of HEART FAILURE -Lisinopril has a low incidence of serious adverse effects except ANGIOEDEMA (RAPID SWELLING OF LIPS, TONGUE, THROAT, FACE, AND LARYNX) -ANGIOEDEMA can lead to airway obstruction and possible death -ACE inhbitors are the most frequent medications causing drug-induced angioedema -The risk is 5 times greater for AFRICAN AMERICANS than for caucasians -if clients experience symptoms of angioedema, they are INSTRUCTED TO DISCONTINUE THE DRUG AND NOTIFY THE HCP immediately -Persistent, DRY COUGH IS A COMMON, annoying adverse effect of ACE inhbiitors that is caused by a buildup of bradykinin in the lung -if the client cannot tolerate this side effect, the HCP can prescribe an ANGIOTENSIN-RECEPTOR BLOCKER INSTEAD, which has a similar actions -OTHER COMMON ADVERSE EFFECTS of ACE inhibitors include ORTHOSTATIC HYPOTENSION (DIZZINESS) and HYPERKALEMIA

Recommendation for client with MRSA or other drug-resistant organisms

-bathed with PRE-MOISTENED CLOTHS OR WARM WATER containing chlorhexidine solution -Bathing clients in this way can signifcantly reduce MRSA infection

Hyperkalemia (immediate ANTIDOTE)

-can be asymptomatic but may cause fatigue, generalized weakness, or in severe cases muscle paralysis and/or dysrhythmias -management includes preventing LIFE-THREATENING DYSRHYTHMIAS and correctins serum potassium levels -INTRAVENOUS CALCIUM GLUCONATE is administered to hyperkalemic clients with ECG changes (peaked T waves). Calcium gluconate itself does not decrease the serum potassium level but temporarily stabilizes the MYOCARDIUM by RAISING the threshold for dyssrhythmia occcurence -once the nurse stabilizes the client by administering calcium gluconate, other prescriptions may then be implemented to decrease serum potassium level (INTRAVENOUS REGULAR INSULIN WITH DEXTROSE, Sodium polystyrene sulfonate, hemodialysis) Intravenous regular insulin temporarily corrects hyperkalemia by shifting potassium into the cells. -Dextrose is administered concurrently to prevent hypoglycemia. ALthough intravenous regular insulin will effectively decrease serum potassium levels, calcium gluconate will provide immediate protection from dysrhythmias -Sodium polystyrene sulfonate causes excretion of potassium from the body via the gastrointestinal tract. Although this will effectively decrease serum potassium levels, calcium gluconate will provide immediate protection from dysrhythmias

in heart failure

-cardiac output is reduced because the heart is unable to pump blood adequately -this reduction in cardiac output reduces perfusion to the vital organs , including the kidneys -Decreased renal blood flow triggers the kidneys to activate the renin-angiotensin system as a compensatory mechanism, which increases blood volume by increasing water resorption in the kidneys -the COMPENSATORY MECHANISM RESULTS IN FLUID VOLUME EXCESS AND DILUTIONAL HYPONATREMIA (more free water than sodium) -Dilutional hyponatremia can be treated with fluid restriction, loop diuretics, and ACE INHIBITORS (lisinopril, captopril) -furosemide works to resolve hyponatremia by promoting free water excretion, allowing for hemoconcentration and increased sodium levels

Iron deficiency during infancy

-causes reduced hemoglobin production, resulting in anemia, decreased immune function, and delayed growth and development -during gestation , the fetus stores iron recevied from the mother, the amount of iron stored is dependent on the length of gestation -after birth, iron stores are progressively depleted and nutritional sources of iron are eventually required -Infants born at PRETERM GESTATION HAVE Less time in utero to accumulate iron -preterm infants typically deplete iron stors by age 2-3 months and require additonal IRON SUPPLEMENTATION (oral iron drops, iron-fortified formula) -therfore, a 3 month old infant born at preterm gestation who is excluseively receiving breastmilk is most at risk for anemia

Phenylketonuria (PKU)

-characterized by DEFICIENCY OR ABSENCE of an enzyme to metabolize phenylalanine , an amino acid found in protein foods -High levels of phenylalanine can cause intellectual disability by interfering with brain growth and development, which is particulalry concerning for the developing fetus and infant -clients with PKU should follow a low-phenylalanine diet before and during pregnancy to prevent potential teratogenic effects (microcephaly, mental disability, heart defects) -Avoiding high-protein foods (meat, dairy, dry beans, nuts, eggs)helps to maintain phylalanine levels in a safe range -if the newborn is also diagnosed with PKU , special formulas with low-phenylalanine will likely be required. Exclusive breastfeeding may pose harm to the newbron with PKU because phenylalanine is transfererred via breast milk -PKU is acquired genetically via autosomal recessive inheritance. Partners may not realize they are potential cariers of a recessive gene. prior to conceving, couples may benfeit from geneitc counseling to better understand their risk of having an affected child -Newborn screening tests are typically offered before hosptial discharge to detect inborn errors of metabolsim (PKU) and other serious condition -adequate newborn intake is important for obtaining accurate results

Hyperemesis gravidarum (HG)

-characterized by SEVERE, persistent NAUSEA AND VOMITING during pregnancy that usually leads to considerable weight loss (>/_5% of prepregnancy weight), fluid and electrolyte imbalances (hypokalemia) and nutritional deficiencies -clients with HG may require hospitalization for IV fluid replacement and antiemetic therapy -Routine laboratory assessment for HG includes urinalysis dipstick testing to monitor the client's health status. EXPECTED FINDINGS include: -ELEVATED URINE SPECIFIC GRAVITY -KETONURIA - Urine specific gravity increases when urine is concentrated due to dehydration, and ketones are a BY-PRODUCT of the FAT BREAKDOWN that occurs in starvation states

Paralytic ileus

-characterized by temporary paralysis of a portion of the bowel, which affects peristalsis and bowel motility -signs and symptoms include abdominal discomfort, distension, and nausea/vomitng -Risk factors for paralytic ileus include: --abdominal sugery --perioperative medictions (anestheisa, analgesics) -- immobility To prevent further abdominal distension and resulting nausea, the client shoild remain NPO -nasogastric tube to wall suction may be necessary to decompress the stomach -Iv fluid and electrolyte replacement (normal saline ) may be necessary to correct lossess that occur from nasogastric suction -nausea can be treated with prescribed antiemetics (odansetron, promethazine) -this client should not take medications by mouth (due to NPO STATUS), and opiod medications should be avpided as they PROLONG PARALYTIC ILEUS -Instead, NON-OPIOD IV anaglesics (KETOROLAC, IBURPOFEN, acetaminophne( should be administered as prescriobed if the client is in pain)

Chest tube removal

-chest tube is removed when drainage is minimal (<200 mL/24 hr) or absent, an air leak (if present) is resolved, and the lung has reexpanded THe geeneral steps for chest tube removal include: 1. Premedicate the client with analgesic (iv opioid, nonsteroidal anti-inflammatory drug [ketorolac]) 30-60 mins before the procedure to promot comfort as evidence indicates that most clients report significant pain during removal 2. Provide the hcp with STERILE SUTURE REMOVAL EQUIPMENT 3. Instruct the client to breathe in, hold it, and bear down (valsalva maneuver) while the tube is removed to decrease the risk for a pneumothorax. Most HCPs use this technique to increase intrathoracic pressure and prevent air from entering the pleural space 4. Apply a sterile airtight occlusive dressing to the chest tube site immediately; this will prevent air from entering the pleural space 5. Perform a chest x-ray with in 2-24 hours after chest tube removal as a post-procedure pneumothorax or fluid accumulation usually develops within this time fram Cclient should be place in semifowler's position or on the unaffected side to promote comfort and facilitate access for tube removal

SSRIs

-citalopram -escitalopram -sertaline -paroxetine -fluoxetine

Moderate to severe asthma exacerbations

-clincal manifestations characteristic of moderate to severe asthma exacerbations include tachycardia (>120/min), tachypnea (>30/min), saturation <90% on room air, use of accessory muscles to breath, and peak expiratory flow (PEF) <40% of predicted or best (<150L/min) Pharmacologic treatment modalities to correct hypoxemia, improve ventilation, and promote bronchodilation include 1. oxygen to maintain saturaion> 90% 2. High-dose inhlaed short-acting beta agonist (SABA) (albuterol) and anticholinergic agent (ipratropium) nebulizer treatments every 20 mins 3. Systemic corticosteroids (solu-medrol)

Oxygen

-colorless, odorless, gas that supports combustion and makes up about 21% of the atmosphere -oxygen is not combustile itself, but i can feed a fire if one occurs -wHen using home oxygen, safety precautions are imperative 1. vaseline is an oil-based, flammable product and should be avoided. A water-soluble lubricant may be used instead 2. Oxygen canisters should be kept at least 5-10 feet away from gas stoves, lighted fireplaces, wood stoves, candles, or other sources of open flames. clients should use precautions as cooking oils and grease are highly flammable 3. The prescribed concentration of O2, usually 24-28% for clients with COPD, should be maintained. Oxygen is prescribed to raise the PaO2 to 60-70 mm Hg and the saturations from 90-93%. a flow rate of 2L/min provides approximately 28% oxygen concentration, and 6L/min provides approximately 44% -HIGHER RATES USUALLY DO NOT HELP AND CAN EVEN BE DANGEROUS IN CLIENTS WITH COPD AS THEY CAN DECREASE THE DRIVE TO BREATHE. The clients should notify the care provider about excessive shortness of breath as additional treatment can be indicated

Lead poisoning

-common source of exposure is lead-based paints found in houses built before 1978 , when such paint was banned -Blood lead level (BLL) screenings are recommended at ages 1 and 2 , and up to age 6 if not previously tested -Because lead poisoning particularly affects the neurological system, elevated Blood lead levels (>/_5 mcg/dL) are dangerous in young children due to immature development of the brain and nervous system - a mild to moderate increase in BLL can manifest with hyperactivity and impulsiveness; prolonged low-level exposure can cause developmental delays, reading difficulties, and visual-motor issues -Extremely elevated BLLs lead to permanent cognitive impairment, seizures, blindness, or even death

Constipation in pregnancy

-constipation is a common discomfort of pregnancy and is due to an increase in the hormone progesterone, which causes decreased gastric motility -ferrous sulfate (iron) supplementation may also cause supplementation Interventions to preven or treat constipation include: 1. High-fiber diet: high amount of fruits , vegetables, breakfast cereals, whole-grain, prunes 2. HIgh fluid intake: 10-12 cups of fluid daily 3. Regular exercises: moderate-intensity exercise (walking, swimming, aerobics) 4. Bulk-forming fiber supplements: PSYLLIUM , METHLYCELLULOSE, WHEAT DEXTRIN

Radiation

-damages the DNA which causes cell destruction -radiation (and chemotherapy) usually affects tissues with rapidly proliferating cells (oral mucosa, gastrointerstinal tract, bone marrow) first, followed by tissues with slowly proliferating cells (cartilage, bone, kidney) -as a result, EARLY MANIFESTATIONS OF RADIATION DAMAGE INCLUDE ORAL MUCOSAL Ulcerations, vomiting/diarrhea, and low blood cell counts -the extent of radiation exposure can be monitored indirectly by measuring blood cell counts

Preterm Labor (PTL)

-defined as progressive cervical dilation and/or effacement from uterine contractions before term gestation The nurse should anticipate the following interventions for clients in PTL BEFORE 34 WEEKS gestation 1. Administering IM antenatal glucocorticoids (betamethasone, dexamethasone) to stimulate fetal lung maturation and promote surfactant development 2. Administering ANTIBIOTICS (penicillin) to prevent group B streptococcus infection in the newborn if preterm birth Occurs 3. Initiating an IV magnesium sulfate infusion for fetal neuroprotection if at <32 weeks gestation 4. giving tocolytic medications (nifidepine, indomethacin) to suprress uterine activity, which allows antenatal glucocorticoids time to have a therapeutic effect 5. Monitoring pertinent laboratory results, including cultures for vaginal or urinary tract infection and group b streptococcus, if obtained

patient-controlled analgesia (PCA_

-delivers a set amount of IV analgesic each time the client presses the administration button -with many PCA pumps, a continous IV soultion (normal saline) is required to KEEP THE VEIN OPEN and FLUSH THE PCA medication through the line so that the boluses reach the client -Many facilities have a policy regarding IV fluid for use with PCA; however, a prescription may be required -To ensure uninterupted delivery of this client's pCA, the nurse should contact the hcp to clarify the prescription to discontinue the normal saline

Opioid Nausea and vomitin

-expected side effects of opioid medications (morphine sulfate) when the treatment is initiated -however, tolerance develops quickly and persistent nausea is rare -it is recommended that the client take an anti-emetic with the pain medication -Nausea and vomiting are less likely to occur in a recumben client, and the risk increases up to 40% in clients who are up and walking -taking opioid medications on an empty stomach may increase the risk of nausea

Initial management of a near-drowning victim

-focuses on airway management due to potential aspiration (leading to acute respiratory distress syndrome), pulmonary edema, or bronchospasm (Leadin to airway obstruction) -Hypoxia is managed and prevented by ensuring a patent airway via intubation and mechanical ventilation as necessary -Careful handling of the hypothermic client is important because as the core temperature decreases, the cold myocardium becomes extremely irritable -Frequent turning could cause spontaneous ventricular fibrillation and should not be performed during the acute stage of hypothermia -Continous cardiac monitoring should be initiated There are passive, active external, and active internal rewarming methods. Passive rewarming methods include removing the client's wet clothing, providing dry clothing, and applying warm blankets -active external rewarming involves using heating devices or a warm water immersion -active internal rewarming is used for moderate to severe hypothermia and involes administering warmed IV fluids and warm humidified oxygen

Leopold maneuvers

-help determine fetal presentation and involve systematic paplation of the client's abdomen -these maneuvers assist the nurse in locating the fetal back for optimal placement fo the ultrasound transducer for external fetal heart monitoring

Mastectomy position post op

-immediately after mastectomy surgery, the client is placed in a semi-fowler's position with the affected side's arm and hand elevated on several pillows to promot drainage and prevent venous and lymphatic pooling -flexing and bending of the affected side's fingers is begun immediately with gradual increase in arm movement over the next few postoperative days -postoperative arm and shoulder exercises are intitiated slowly with the goal of full range of motion of the affected side within 4-6 weeks of the mastectomy

Risks associated with suctioning

-include hypoxemia, microatelectasis, and cardiac dysrhythmias -Suctioning removes secretions and oxyen -to minimize both the amount of oxygen removed and mucosal trauma, suction is applied when removing, not inserting, the catherter into the artifical airway -if secretions are thick and difficult to remove, INCREASING HYDRATION , not suctioning time is indicated -Aerosols of STERILE NORMAL SALINE or MUCOLYTICS such as ACETYLCYSTEINE (Mucomyst) administered by nebulizer can also be used to thin the thick secretionsm, but water should not be used -aerosol therapy may induce bronchospasm in certain individuals and can be relieved by use of a bronchodilator (albuterol) -morphine is administered to promote breathing synchrony with the mechanical ventilator, reduce anxiety, and promote comfort in clients receiving MV -Preoxygenation with 100% OXYGEN FOR 30 SECONDS BEFORE SUCTIONING, unless otherwise specified, is the recommended practice to reduce suctionin-associated risks for hypoxemia, microatelectasis, and cardiac dysrhtymias

pudendal nerve block

-infiltrates local anesthesia (lidocaine) into the areas surrounding the pudendal nerves that innervate the lower vagina, perineum, and vulva -when birth is imminent, a pudendal block provides the best pain releif with the LEAST MATERNAL/NEWBORN SIDE EFFECTS and could be administered Quickly by the hcp - it does not relieve contraction pain but it does RELIEVE PERINEAL PRESSURE when administered in the late second stage of labor -in clients without an epidural, pudendal blocks may be used in preparation for forceps-assisted birth or laceration repair

Tapeworm larvae

-ingested when a person eats food that is contaminated with feces or undercooked meat from an infected animal -poor appetite, inadequate absorption of nutrients from food, and weight loss are symotms

Nitrazine pH test strip

-inserted into the vagina can differentiate between amniotic fluid, which is alkaline, and vaginal fluid, which is acidic -A blue-green, blue-gray, or deep blue color indicates a positive result and probable rupture of membranes - a yellow, olive-yellow, or olive green color indicates a negative result and suggests that membranes are intact

Frostbite

-invovles tissue freezing, resulting in in ice cyrstal formation in intracellular spaces that causes peripheral vasoconstriction, reduced blood flow, vascular stasis, and cell damage -superficial frostbite can manifest as mottled, blue, or waxy yellow skin -Deeper frostbite may cause skin to appear white and hard and unable to sense touch. This can eventually progress to gangrene

Levetiracetam

-keppra -a medication often used to treat seizures in various settings -it has minimal drug-drug interactions compared to PHENYTOIN and is often the preferred antiepileptic medication

Acetylcysteine

-may be given via nebulizer to help LOOSEN and liquify respiratory secretions to more easily clear them from the airway -Inhaled acetylcystein may be used for clients with CYSTIC FIBROSIS or other respiratory conditions with thick bronchial mucus -Acetylcysteine has NO THERAPEUTIC EFFECT ON AIRWAY SMOOTH MUSCLE AS it works primarily on secretion and has been shown to cause and/or WORSEN BRONCHOSPASM -Nurses caring for clients with reactiv airway diseases (asthma) prescibed ACETYLCYSTEINE SHOULD CLARIFY the prescription with the hcp

Joint dislocations

-may become orthopedic emergencies because articular bone may compress surrounding vasculature, causing limb-threatening distal ischemia -when a joint is dislocated, the articular tissues, blood vessels, and nerves are often traumatized by stretching -signs of joint dislocation include pain, deformity, decreased range of motion, and extremity paresthesia -the nurse should frequently assess neurovascular status and provide analgesics until the dislocation can be reduced and immobilized

Umbilical cord prolapse

-may occur after rupture of membranes if the presenting fetal part is not firmly applied to the cervix -Cord compression caused by a prolapsed cord will produce abrupt fetal heart rate deceleration, FETAL BRADYCARDIA, and disruption of fetal oxygen supply -The priority action is to insepct the vaginal area and perform a STERILE VAGINAL EXAMINATION to assess for a prolapsed cord -if a prolapsed cord is visualized or palpated, the nurse should then manually elevate the presenting fetal pat off the umbilical cord, leave the hand in place, and call for help

Myopia

-nearsightedness -reduced visual acuity when viewing objects at a distance -myopia occurs when the eye structure causes images to focus before they arrive at the retina -Near vision is usually intact, and many clients with myopia report needing to hold objects near their face or sit near objects to see clearly -Myopia in pediatric clients may first be discovered by the school nurse during routine visual acuity testing -children often report HEADACHES, DIZZININESS, AND THE NEED TO SQUINT THE EYES TO SEE CLEARLY -School performance may be affected because of impaired ability to see class presentations

Cirrosis of the liver

-occurs when chronic liver disease (hepatitis C infection) causes scar tissue and nodules, which can decrease liver function and lead to LIVER FAILURE -clients with end-stage liver disease may experience exacerbations requireing hospitalization and acute intervention -numerous laboratory abnormalities occur in the setting of liver failure and correlate with assessement findings (high serum ammonia resulting in hepatic encephalopathy ) Lactulose, an osmotic laxative, decreases serum ammonia levels by causing ammonia to be excreted through stool. -the desired therapeutic effect is the production of 2 or 3 sft bowel movements each day; therefore, clients receiving lactulose should not exhibit constipation

Paraphimosis

-occurs when the uncircumcised male foreskin cannot be returned (reduced) to its original position, after being pulled back (retracted) behind the glans penis, resulting in pain, progressive swelling of the foreskin, and impaired lymph and blood flow -Paraphimosis can occur when a hcw accidentally leaves the foreskin in the RETRACTED position for an extended period of time (under a comdom catheter sheath) -it is critical for the precepting nurse to intervene when the student nurse retracts the foreskin before applying the condom catheter to avoid permanent damage to the glans resulting form impaired circulation

C. Difficile

-often associated with antibiotic therapy but can also be a nonsocomial hospital-acquired infection -antibiotics, especially broad-spectrum, reduce normal bacteria in the body -this allows other bacteria, such as C. difficile, to take over and cause a superinfection -it grows in the intestinal tract and causes antibiotic-associated diarrhea -METRONIDAZOLE (flagyl) is an ANTI-INFECTIVE DRUG commonly used to treat C. Difficile. -for severe C. difficile infection, ORAL VANCOMYCIN may be used; intravenous vancomycin may be used; IV vancomycin is ineffective

Vaginal Candidiasis

-often causes itching and painful urination due to urine stinging the inflamed areas of the vulva -assessment shows a thick, white, curd-like vaginal discharge and reddened vulvar lesions -Candida albicans (YEAST) can colonize and cause infections of the vulvovaginal region -Miconazole, an antifungal cream commonly prescribed to treat vaginal candidiasis, is inserted HIGH INTO THE VAGINA using an applicator -it is best applied at bedtime so that it will remain in the vagina for an extended period -Sexual intercourse is avoided until the inflammation is resolved, typically for the duration of treatment, approximately 3-7 days -however sexual activity is not a significant cause of infection or reinfection of candida, and partner evaluation is not needed -Trichomoniasis, syphilis, gonorrhea, and HIV are mainly sexually transmitted; therefore, partners should be evaluatd and treated Other teaching points for this client should include : -ensuring proper hygiene of the perineum-cleansing from anterior to posterior (front to back) to prevent accidental introduction of fecal organisms -wearing loosley fitted cotton underwear and avoiding synthetic undergarments to promote ventilation, decrease friction, and reduce moisture -refraining from douching, which can introduce organisms higher up into the vaginal canal and cervix

Thiazolidinediones

-pioglitazone -rosiglitazone -are use to treat type 2 diabetes mellitus -these agents improve insulin insensitivity but do not release excess insulin, leading to a low risk for hypoglycemia (similar to metformin) -These drugs can WORSEN HEART FAILURE by causing fluid retention and increase the risk of BLADDER CANCER -Heart failure or volume overload is a contraindication to thiazolidinedione use -these medications also increase the risk for cardiovascular events such as myocardial infarction and heart failure

Hyperopia

-reduced visual acuity when viewing objects up close with intact distance vision is associated with hyperopia -Clients with hyperopia may report having to hold materials far away to read or sit at a distance to have clear vision

Sundowning

-refers to the increased confusion experienced by an individual with dementia; it occurs at night, when lighting is inadequate, or when the client is excessively fatigued -Wandering is a common associated behavior - a client with mild-to-moderate dementia may need frequent REALITY REORIENTATION to promote appropriate behaviors -HOWEVER, with advanced dementia, reality orientation may not be effective and might cause the client to feel anxious, leading to inappropriate behaviors and aggression -in this situation, VALIDATION THERAPY is more appropriate and involves recognizing and exploring the client's feelings and concerns but not reinforcing or arguing with any incorrect perceptions

Perseveration

-repeating the same words or phrases in response to different questions

Meniere Disease

-results from excess fluid accumulation inside the inner ear -clients have episodic attacks of vertigo, tinnitus, hearing loss, and aural fullness -the vertigo can be severe and associated with nausea and vomitng. clients report feelings of being pulled to the ground (drop attacks) -During an attack, the client is treated with vestibular suppressants, includin SEDATIVES (benzodiazepiens such as diazepam), antihistamines (diphenhydramine, meclizine), anticholinergics (scopolamine) and antiemetics) -the nurse's priority is to plan for client safety with FALL PRECAUTIONS given the severe vertigo and use of sedating medications Clients diet should be SALT RESTRICTED to prevent build up in the ear

Anorexia nervosa

-significant low weight -intense fears of gaining weight/distorted body image subtypes: -Binge/purge -Restricting (dieting, fasting, excessive exercise)

Pinworm

-the most common worm infection in the us -easily spread by inhaling or swallogin microscopic pinworm eggs, which can be found on contaminated food, drink, toys, and linens -Once eggs are ingests, they hatch in the intestines -during the night, the female pinworm lays thousands of microscopic eggs in the skinfolds around the anus, resulting in anal itching and troubled sleep -when the infected person scratches, eggs are transferred from the fingers and fingernails to other surfaces -PINWORM infection is treated wit anti-parasitic medications

Metabolic alkalosis

-the most likely cause of this alkalosis is the loss of acidic gastric contents from prolonged gastric suctioning -Metabolic imbalances affect the BICARBONATE LEVEL -This client's ABG is high in pH (alkalosis) and bicarbonate -Bicarbonate (HCO3) is BASIC; therefore, an elevated bicarbonate level indicates a more basic (alkalotic) state due to a metabolic cause The nurse recognizes that this is uncompensated alkalosis -the lungs compensate for metabolic imbalance by either blowing off acidic CARBON DIOXIDE (HYPERVENTILATING) or retaining it (HYPOVENTILATING) -HYPOVENTILATING raises the carbon dioxide level, making the blood more acidic -Compensation is complete once the pH returns to normal limits

Additional ways to deal with hallucinations include the following

-the priority nursing action is to explore the content of the hallucinations -the client may be experiencing command auditory hallucinations that could lead to self-directed or other-directed injury and harm. After the content of the hallucinations has been explored, implementing an intervention may be necessary to reduce the potential for violence -Telling the client that you know they are real to the client but do not hear the voices (or see the vision, feel the sensation) -Not arguing with or challenging the client about the hallucination -Directing the client to a reality-oriented topic of conversation of acitivity

checking an unconscious client (head to toe assessment on admisison)

-the unconscious client requires a thoroguh head-to-toe assessment on admission to assess for foreign objects, devices, or belongings that have potential for harm This includes checking for: -Medical alert bracelets/necklaces: indicating allergy status, emergency contact, or code status -contact lenses: Remove to prevent corneal injury -Medication patches: TO PREVENT DRUG INTERACTIONS AND determine conditions currently being treated -Tampons (in female clients): Remove to prevent toxic shock syndrome or infection -Rings and jewelry: Remove to prevent constrictive injury or vascular damage if edema develops Medication patches should NOT be removed without first consulting the hcp. Clients are often prescribed transdermal patches for chronic conditions (clonidine for hypertension, nitroglycerin for angina). Removing and discarding a medication pathc without additinal info may harm the client

Jehovah witness acceptible products

-they bleieve that TRANSFUSION OF BLOOD AND BLOOD PRODUCTS IS NOT ACCEPTABLE -ACCEPTABLE blood product alternatives include non-blood volume expanders (saline, lactated ringer's dextran, hetastarch) and albumin-free erythopoietin -Unacceptable treatment are transufusions of whole blood, red cells, white cells, platelets, and plasma

The guaiac fecal occult blood test

-used to assess for microscopic blood in the stool as a screening tool for colorectal cancer. The steps for collecting a sample include: 1. Assess for recent ingestion (within last 3 days) of red meat or medications (vitamin C, aspirin, anticoagulants, iron, ibuprofen, corticosteroids) that may interfere and produce false test results 2. Obtain supplies (hemoccult test paper, wooden applicator, hemoccult developer), washhands, and apply nonsterile gloves 3. Open the slide's flap and use the wooden applicator to apply 2 separate stool samples to the boxes on the slide. Collect from 2 different areas of the specimen as some portions of the stool may not contain microscopic blood 4. Close the slide cover and allow the stool specimen to dry for 3-5 minutes 5 OPen the back of the slide and apply 2 drops of developing solution to the boxes on the slide 6. Assess the color of the hemoccult slide paper within 30-60 seconds. A POSITIVE guaiac result will turn the test paper blue, indicating presence of microscopic blood in the stool 7. Dispose of used gloves and the wooden applicator and perform hand hygiene 8. Documen the results

Urinary output for infant

1-2 ml/kg/hr

Clinical features of urinary tract infections: PYELONEPHRITIS

Acute pyelonephritis is an infection of the KIDNEY usually caused by an extension of infection from the lower urinary tract (bladder) -chills and fever, vomiting, flank pain, and costovertebral tenderness are characterisitic -Nausea and vomiting -fever and chills -flank pain -costovertebral tenderness

Hyperemesis Gravidarum

Clinical features -Weight loss -poor skin turgor -Dry mucous membranes -Hypotension -Tachycardia Laboratory abnormalities -Hypokalemia/hyponatremia -KETONURIA -Increased urine specific gravity -hemoconcentration -metabolic alkalosis

Age 5

Gross motor -skips -walks bacward -uses a jump rope Fine motor -draws a triangle -ties shoelaces -prints letters, number, or words Language -counts to 10 -speaks full sentences -names coins an days of the week Social/cognitive -Independently dresses and bathes -identifies real from pretend

age 4

Gross motor -walks down stairs with alternating feet -balances on 1 foot -catches a ball Fine motor -Draws a square -cuts with scissors -ties a simple knot Language -names>/_2 colors -likes telling stories Social/cognitive -begins imaginative/group play -recognizes analogies -often focus on self

3 years

Gross motor -walks up stairs with alternating feet -pedals tricycle -jumps forward Fine motor -Draws circle -feeds self without help -grips crayon with fingers instead of fist Language -can form sentences of 3-4 words - asks "why" questions -states own age Social cognitive -Begins associative play -is toilet trained, except wiping

2 years

Gross motor -walks up/down stairs alone, 1 step at a time -runs without falling -kicks ball Fine motor -Builds tower of 6-7 blocks -when looking at books, turns 1 page at a time -draws line Language -has vocabulary of 300+ words -can form phrases of 2-3 words -states own name Social/cognitive -begins parallel play -begins to gain independence from parents

18 months

Gross motor -walks up/down stairs with help -throws ball overhand -jumps in place Fine motor -builds tower of 3-4 blocks -when looking at books, turns 2-3 pages at a time -Scribbles -uses cup and spoon Language -has vocabulary of 10+ words -identifies common objects Social/cognitive -has temper tantrums -understands ownership (mine) -imititates others

AGE 12 MONTHS

Gross motor: -walks first steps independently -crawls up stairs Fine motor -uses 2-finger pincer grasp -hits 2 objects together Language -says 3-5 words -uses nonverbal gestures(eg, waving goodbye) Social /cognitive -May have separation anxiety -searches for hidden objects

Metabolic acid is due to an

INCREASE IN THE PRODUCTION OR RETENTION OF ACID OR THE DEPLETION OF BICARBONATE VIA THE KIDNEYS OR GASTROINTESTINAL (GI TRACT) -iN metabolic acidosis there is a decrease in pH (<7.35) and HCO3 (<22) Most common causes of metabolic acidosis include -GI bicarbonate losses (diarrhea) -Ketoacidosis (diabetes, alcoholism, starvation) -lactic acidosis (sepsis, hypoperfusion) -Renal failure (hemodialysis with inaccessible arteriovenous shunt) -salicylate toxicity)

intusspection perforation

If perforation occurs, the client could develop peritonitis in which the peritoneum in the abdomen becomes inflamed due to infection -this can quickly lead to sepsis and multiple organ failure -Peritonitis is characterized by FEVER, ABDOMINAL RIGIDITY, GUARDING, AND REBOUND TENDERNESS -This condition can be fatal if it is not treated quickly

Monoamine oxidase inhibitors

Isocarboxazid phenelzine selegiline Tranylcypromine

Laboratory abnormalites seen in liver dysfunction

Low serum albumin -fluid overload: edema, ascities, weight gain -normal levels 3.5-5.0 High serum ammonia -hepatic encephalopathy: confusion, lethargy, asterixis, coma -Normal range: 14-45 Elevated INR/ prolonged PT -Bruising, bleeding -INR 0.75-1.25 -PT: 11-16 Increased bilirubin -Jaundice, scleral icterus, itching -0.2-1.2 mg/dL Lowe platelets (thrombocytopenia) petechiae, spontaneous bleeding -150,000-400,000/mm3

Anaphlaxis

Triggers -foods -medications -insect stings Clinical manifestations Cardiovascular -vasodilation-->hypotension and tissue edema -tachycardia Respiratory -upper airway edema--> stridor and hoarseness - bronchospasm --> wheezing Cutaneous -urticarial rash, pruritus, flushing Gastrointestinal -nausea, vomiting, abdominal pain Treatment -Intramuscular epinephrine -airway management and volume resuscitation -adjunctive therapy (antihistamines, glucocorticoids) The nurse should instruct the parent to first assess for signs of swelling of the mouth, tongue, lips, and upper airway -the child will have wheezing and difficulty breathing next, followed soon by cardiovascular symptoms -these include lightheadedness due to hypotension, loss of consciousness and cardiovascular collapse -an anaphylactic reaction is life-threatening and requires rapid assessment and intervention (FEVER is NOT a symptoms of anaphylactic reaction that would be included in the rapid assessment_

Client teaching for heart failure

Weight monitoring - measure and record daily weights (same amount of clothing, before breakfast but after voiding, same scale) Diet -sodium restriction to decrease fluid overload -Examine over-the-counter drugs such as laxatives, cough medicines, and antacids for sodium content -Increase food rich in potassium if taking potassium-losing diuretics; restrict potassium if taking potassium-sparring diuretics Medication regimen -Take own pulse for 1 minute if taking digoxin or beta blockers. Notify health care provider if <50 or 60/min as instructed or if >120/min -Know signs and symptoms of orthostatic hypotension and ways to prevent it -take blood pressure and keep a record of it Activity -Increase walking or other activities gradually -Plan for rest periods -Consider a cardiac rehabilitation program -Avoid extremes of heat and cold Symptoms to report -Weight gain of 3lb in 2 days or 3-5 lb in week -Difficulty breathing, especially with exertion or when lying flat -waking up breathless at night -Frequent dry, hacking cough, especially when lying down -fatigue, dizziness, fainting -swelling of ankles, feet, abdomen, or face

Pregnancy is a

hypercoagulable state that provides protection from hemorrhage after birth , but also greatly augments risk of thrombus formation -women who give birth by cesarean section are at particulalry increased risk for deep venous thrombisos (DVT) -Additional risk facotrs for DVT include obesity, smoking, and genetic predisposition -if unrecognized, DVT may progress to pulmonary embolism (PE), often characterized by anxiety/restlessness, pleuritic chest pain/tightness, shortness of breath, tachycardia, hypoxemia, and hemoptysis -The nurse's priority is rapidly identifying symptoms, assessing respiratory status, administering supplemental oxygen, and notifying the hcp

INH interferes with

interferes with the action of VITAMIN B6 (pyridoxine), RESULTING peripheral neuropathy - it manifests as ataxia and paresthesia -individuals who are most predisposed to becoming neurotoxic from taking INH include older adults, those who are malnourished, diabetic clients, pregnant or breastfeeding clients, alcoholics, children, those with liver or renal disease, and HIV-positive individuals -to prevent these complications, a vitamin B6 supplement at a dose of 25-50 mg/day is recommended for those at high risk