Cardiology/respiratory/endocrine
what interventions would be appropriate for an adolescent diagnosed with a BMI of 30, type 2 diabetes, frequent urination, fatigue, and complaints of tingling on the feet?
an adolescent with type 2 diabetes should engage in regular physical activity to reduce his or her weight and glucose levels. dietary counseling helps improve nutritional intake and decrease saturated fats and sugars. behavioral modification weight programs help adolescents identify and eliminate inappropriate eating behavior habits. bariatric surgery is recommended for clients with morbid obesity (BMI greater than 40) . dietary restriction should not be recommended as this action may result in nutritional loss.
what dietary choices would the nurse teach for the client with peripheral arterial disease?
because peripheral arterial disease is caused by atherosclerosis, the nurse would teach the client heart-healthy diet principles such as limiting salt, eating more whole grains, using liquid rather than solid oils in cooking, and avoiding processed meats. high calcium intake dose not prevent atherosclerosis. intake of fresh fruits and vegetables would be increased because these will help lower atherosclerosis risk.
a client is admitted to the hospital with chronic asthma, what complications would the nurse monitor for in this client?
as a result of narrowed airways, adequate ventilation of lung tissue is compromised, and alveoli may collapse. pneumothorax is not a common complication of asthma. pulmonary edema is not a common complication of asthma, which is a result of left-sided heath failure. respiratory alkalosis is not a common complication of asthma, with narrowed air passages, the client with asthma is at risk for hypoxia and respiratory acidosis
what assessment findings would indicate a possible asthma exacerbation?
bronchial constriction with mucous production causes wheezing. with the decrease in arterial oxygenations associated with asthma, the heart rate will increase . and increases temperature is characteristic of infection, not asthma. stridor is usually caused by foreign body obstruction and/or upper airway obstruction, not asthma. hypertension, not hypotension, may occur with asthma
after a thoracentesis performed in an outpatient setting, what client statements indicate the nurse's teaching about possible postprocedural complications has been effective?
complications of thoracentesis include pneumothorax and fluid shifts into the pleural space, causing hypotension and tachycardia. the client statements about going to the hospital for increased shortness of breath or palpitations indicate a good understanding if the discharge teaching. acetaminophen and ibuprofen are safe to use for pain felt at the thoracentesis site. bruising at the site may occur, but is not emergent. thoracentesis is done using sterile technique and infection is not a common complication, therefore temperature is not much of a concern.
when a client is diagnoses with microvascular angina, which topics would the nurse include in client teaching?
microvascular angina is caused by atherosclerosis or spasm in very distal microvascular branches of the coronary artery system. daily aspirin use, tobacco cessation, and use of nitroglycerin would be included in client teaching. microvascular angina tents to cause symptoms during usually daily activities and the nurse would teach symptom management through activity modification or the use of nitroglycerin. because the coronary artery disease is in small and distal vessels, coronary artery bypass surgery is not an option for treatment.
when caring for a client with a diagnosis of right ventricular heart failure, the nurse expects which assessment finding?
with right sided heart failure, signs of systemic congestion occur as the right ventricle fails; key features include dependent edema and swollen hands and fingers. upper right quadrant discomfort is expected with right ventricular failure because venous congestion in the systemic circulation results in hepatomegaly. jugular venous collapse and oliguria are key features of left-sided heart failure. left-sided heart failure is associated with decreased cardiac output.
which action would the occupational health nurse take after a tuberculin skin test (TST) on a nurse working in the emergency department revealed an 11-mm induration?
Induration of 10mm or greater is a positive test result in employees of high-risk settings such as hospitals. the next step would be to determine whether the nurse has active tuberculosis by doing a chest Xray. no further TST would be done after a positive TST, because the test will remain positive. sputum specimens are tested for acid-fast bacillus if the chest Xray indicates possible tuberculosis. the nurse with a positive skin test, but no evidence of active tuberculosis, would be treated for latent tuberculosis with a single drug such as isoniazid.
what is the peak time for NPh insulin?
NPH insulin peaks in 4-12 hours
Which assessment findings are consistent with a client diagnosis of right-sided heart failure?
Right sided heart failure is associated with increased systemic venous pressures and venous congestion, as manifested by an enlarged liver with possible ascites (distended abdomen), dependent edema, and anorexia (decreased appetite). Distended neck veins occur in right sided heart failure. cool extremities are common in left-sided heart failure because of decreased cardiac output.
which physiological changes would the nurse expect to find in a client with a 20 year history of type 2 diabetes
blurry, spotty, or hazy vision; floaters or cobwebs in the visual field; and cataracts or complete blindness can occur as a result of diabetes. diabetic retinopathy is characterized by abnormal growth of new blood vessels in the retina (neovascularization). more than 60% of clients with type 2 diabetes have some degree of retinopathy after 20 years. arthritic changes of the hands and feet are not a usually complication associated with diabetes mellitus. clients who are diabetic have peripheral neuropathy, which is characterized by hypoactive, not hyperactive, reflexes. peripheral vascular disease is indicated by dependent rubor with pallor on elevation, not dependent pallor.
which topics would be included when teaching a client with heart failure who will be discharged with a new prescription for digoxin?
clients taking digoxin should be taught how to take a radial pulse and to document pulse rate and bring results to all medical appointments. hypokalemia may increase the risk for digoxin toxicity, and clients are advised to ear high potassium foods such as bananas and potatoes. vision changes may indicate digoxin toxicity and should be reported to the health care provider. pulse irregularity or a rate less than 60 beats a minute may indicate digoxin toxicity, and clients should report these changes to the health care provider. green leafy vegetables contain large quantities of vitamin k, but does not affect digoxin at all.
when determining the main difference between type 1 and type 2 diabetes, the nurse recognizes what clinical presentation about type 1?
clinical presentation of type 1 diabetes is characterized by acute onset, and there is not time to develop the long term complications that are common with long standing disease. 20% of newly diagnosed clients with type 2 diabetes demonstrate complications because the diabetes has gone undetected for an extended period of time. clinical presentation of type 1 diabetes is rapid, not slow, because pancreatic beta cells are destroyed by and autoimmune process; in type 2 diabetes, the body is still producing some insulin, and the onset of signs and symptoms is slow. in type one diabetes clients are generally lean or have and ideal weight, while type 23 diabetics 80% to 90^ overweight. type 1 diabetes requires diet control, exercise, and subcutaneous administration of insulin, not oral medications.
the nurse is caring for a client with type 1 diabetes, what signs or symptoms may indicate that the client has insulin-induced hypoglycemia?
hypo glycemia affects the central nervous system, causing weakness. hypoglycemia affects the sympathetic nervous system, causing diaphoresis. excessive hunger is associated with hypoglycemia because the body needs glucose for cellular metabolism. excessive thirst is associated with hyperglycemia because fluid shifts, along with the excess glucose being excreted by the kidneys, result in polyuria. deep respirations (kussmaul) are associated with hyperglycemia because the body is attempting to blow off carbon dioxide to compensate for the metabolic acidosis.
what would the nurse do to help alleviate the distress of a client with heart failure and pulmonary edema?
the orthopneic, or tripod position, allow maximum lung expansion because gravity reduces the pressured of the abdominal viscera on the diaphragm and lungs. coughing is useful for clients who have excessive mucus in the airways, such as clients with pneumonia, but is not useful for clearing pulmonary edema. elevation of the extremities should be prevented because it increases venous return, placing an increased workload on the heart. positioning for postural drainage does not relieve acute dyspnea; furthermore, it increases venous return to the heart.
when a client is diagnosed with left-sided congestive heart failure, which assessment findings would the nurse expect?
with left ventricular failure, increases in left ventricular volume and pressure lead to pulmonary congestion, causing dyspnea, lung crackles and cough. peripheral edema occurs when right-sided heart failure causes increases in systemic venous pressure. jugular vein distention also occurs with right-sided failure and increased systemic venous pressure.
what eye problem is the leading cause of blindness in clients with diabetes?
diabetic retinopathy is a leading cause of blindness in diabetics. glaucoma and cataracts also are associated with diabetes, but retinopathy is the most common eye problem. astigmatism is not associated with diabetes
after noting 12 mm of induration at the site of a tuberculosis skin test (TST) in a client with no tuberculosis risk factors, what information would the nurse give the client.
in a client with no risk factors for tuberculosis, an induration of 15mm or more is a positive result indicative of being infected with mycobacterium tuberculosis organism. because this client is not at high risk, no further testing is indicated. there is not active or latent tuberculosis and no medication is needed. a chest Xray would only be indicated for a positive TST. no further tuberculosis testing is needed.
what interventions would the nurse implement to relieve the symptoms associated with a hypoglycemic reaction?
liquids containing simple carbohydrates are most readily absorbed and this increase the blood glucose level quickly. although a solution of 50 %dextrose may be given if the client is comatose, 5% dextrose dose not supply sufficient carbohydrates. withholding a subsequent dose of insulin will not alter the current situation. complex carbohydrates and protein take longer to increase blood glucose level, so they should be administered AFTER a simple carbohydrate.
what rationale would the nurse use when teaching a client with chronic obstructive pulmonary disease (COPD) to used pursed lip breathing
pursed lip breathing prolongs the expiratory phase and increases airway positive pressure, leading to more complete expiration and reduced air trapping. bronchi and bronchioles stay open longer and are expanded during pursed lip breathing. pursed lip breathing does not strengthen the intercostal muscles or reduce diagrammatic excursion
the nurse is teaching pursed-lip breathing to a client with chronic obstructive pulmonary disease (COPD). the client asks about the benefit of the execises. which explanation would the nurse give?
pursed-lip breathing keep the airway open longer to decrease the work that goes into breathing. clients with COPD are taught to breathe out through pursed lips to help keep the air passages open until exhalation is complete. pursed-lip breathing does not prevent COPD complications, however it may relieve shortness of breath by decreasing the breath rate . pursed lip breathing does not increase the amount of air taken in during inspiration.
when a client is newly diagnosed with chronic obstructive pulmonary disease (COPD), what actions by the nurse have the highest priority?
smoking cessation slows the progression of COPD and is the most important action that the client can take to help maintain lung function. although many clients may not be ready to stop smoking, the nurse will asses the clients interest in smoking cessation at every encounter. teaching correct inhaler usage is important, but inhaled mediations treat the symptoms of COPD and do not slow disease progression. the client will be educated on the progression of COPD, but education alone dose not change the progression of the disease. pulmonary rehab programs are helpful in improving ability to do activities of daily living and also will assist teg client with tobacco cessation, but assessment of readiness to quit smoking is done before developing a plan quit
what type of acid-base imbalance would the nurse expect in a child admitted with a severe asthma exacerbation?
the restricted ventilation accompanying an asthma attack limits the body's ability to blow off carbon dioxide. as carbon dioxide accumulates in the body fluids, it reacts with water to produce carbonic acid, the result is respiratory acidosis. the problem basic to asthma is respiratory, not metabolic. respiratory alkalosis is caused by the exhalation of large amounts of carbon dioxide