HESI Fundamentals/ Final Semester 2

Malignant Hyperthermia Treatment

Dantrolene: counteract anesthesia, 2-3mg/kg Sodium bicarbonate: ABGs 50% dextrose w/ reg insulin: 10 units in 50ml D50 Terminate surgery/diff anesthesia, O2, foley, ABGs, IV fluids, active cooling (ice, cooling blankets, etc)

Bi-level positive airway pressure (BiPAP)

Delivers a set inspiratory positive airway pressure each time the pt begins to inspire, delivers a lower set end-expiratory pressure when pt begins to exhale

Volume limited or flow limited

Delivers a set tidal volume with the pt's inspiratory effort

Kubler-Ross's stages of grief

Denial Anger Bargaining Depression Acceptance

Nonmaleficence

Directs us to act in ways that avoid harm to others, including even the risk of harm. Duty to do no harm

Peripheral Arterial Disease (PAD)

Do NOT elevate the legs of a pt with PAD. Assessment findings: cool or cold feet, decreased or absent pulses, atrophy of skin, rubor

Manifestations of COPD

Dyspnea, decreased O2 sat levels, tachycardia, murmurs and gallops, orthostatic hypotension, pallor, cool to touch, intolerance of cold temps, nails are brittle and concave, increased somnolence and fatigue, headache

Peripheral Venous Disease (PVD)

Elevate pts legs.

Assessment of pt in restraints

*Perfusion *Pepsi (nutrition) *Potty *Pain *Positioning *Pulse *Psychosocial

Sympathetic pain experience

*Elevate respiratory rate- increase oxygen rate *Increased heart rate- provide increase oxygen to heart *Peripheral vasoconstriction -high bp with shift of blood supply *Increase blood glucose level - provide energy *Increase cortisol level- increase memory function *Diaphoresis- control body temp *Increase muscle tension-prepares muscle for action *Dilation of pupils-afford better vision *Lower gastrointestinal -free energy for immediate activity

Fluticasone

Corticosteroid, prevent asthma attack 50mcg MDI BID, 100-250mcg DPI daily Teach pt to use drug daily, even when no symptoms are present, use good oral care Side Effects: throat irritation, hoarseness, dry mouth, cough, temporary wheezing

3 phases of wound healing

*Inflammatory phase begins immediately 3 days Hemostasis, vasodilation, phagocytosis appearance is red and swollen has exudate *Proliferation Phase-3-24 days surface is shiny red bleeds easily increase in collagen, granulation (filling in of wound), epithelialization, contraction partial thickness, don't require filling in *Maturation Phase 24 days -1yr scar formation, remolding,

Moral Distress

unable to act upon what you believe is the morally appropriate action or when you act in a manner contrary to your personal and professional value

Respiratory Drugs

*Antihistamines *Intranasal glucocorticoids *Mucolytics *Expectorants *Antitussives *Bronchodialators

Developing Cultural Competence

*Awareness of personal culture value beliefs *Knowledge, of and respect for different cultures *Skills in interacting and responding to individuals from other cultures *Acknowledge about importance of culture and incorporated at all levels *Assess of cross culture relations *Vigilance toward the dynamic that result from cultural differences *Expansion of cult knowledge *Adaptation of services

Parasympathetic pain experience

*Pallor *Nausea vagus nerve send impulse *Low HR low BP result from vagal stimulation *Rapid irregular Heartbeat cause bodily defense *Behavior response untreated or unrelieved pain significantly alters quality of life

Pressure Ulcer Stages

*Stage I non blanchable redness- red warm edema pain High risk for pressure ulcer NEEDs Most Attention *Stage 2 partial thickness loss of dermis shallow *Stage 3 full visible fat, slough, tunneling *Stage 4 full thickness tissue loss, expose bone or tendon *Unstageable full thickness skin tissue loss depth of ulcer unknown eschar present (needs to be removed before staging)

Newborn heat loss

-evaporation: drying the newborn prevents heat loss via evaporation (liquid converts to vapor) -convection: maintain an ambient room temp of 75.2 degree (flow of heat from the body surface to a cooler ambient air) -conduction: using a protective cover prevents contact with the scale -radiation: place the newborn's bassinet away from the outside windows (loss of heat from the body surface to a cooler, solid surface not in direct contact with newborn but in relative proximity)

Bilirubin

0.3-1.0

INR

0.8-1.1 Therapeutic range is 2.5-3.0 or 3.0-4.5 for recurrent PE

Nursing response to nonreassuring FHR patterns

1. ID cause of nonreassuring pattern: examine strip and look for suggestions to causes of nonreassuring FHR patterns, Evaluate maternal VS (hypo/hypertension? Fever?) Perform vaginal examination to ID prolapsed umbilical cord IF INDICATED 2. Stop Oxytocin or other uterine stimulants, a tocolytic may be ordered 3. Reposition, avoid supine position 4. Increase rate of fluids to expand blood volume & improve placental perfusion 5. Administer O2 8-10L simple face mask (increase maternal O2 sat. = more O2 available to fetus) 6. Start continuous EFM monitoring w/ internal devices if not contraindicated 7. Notify physician ASAP and report... pattern that was ID, Nursing interventions taken in response, fetal response to interventions, response of the physician (orders) 8. If non-reassuring pattern is severe, other staff members should be alerted to possibility of immediate delivery (C-Section)

5 Step - Nursing Process (ADPIE)

1.Assessment 2.Diagnosis 3.Planning 4.Implementation 5.Evaluation

Therapeutic levels of warfarin

10-15mg orally once daily for 3 days initially. Subtherapeutic (too low INR) = pt not receiving enough warfarin. Prolonged Times (too high INR) = pt is at risk for bleeding. Antidote: Vitamin K

BUN

10-20

Ulcerative Colitis

10-20 liquid, blood stools per day Need for surgery is infrequent Same as Crohn's

PT

11-12.5 Therapeutic range is 1.5-2.5 times the normal

Sodium

135-145

Platelets

150,000-400,000

Digoxin Toxixity

2

aPTT

20-30, 30-40 Therapeutic range is 1.5-2.5 times the normal

Potassium

3.5-5.0

The nurse is assigned to care for an infant in the newborn nursery who is 24 hours old. During assessment the nurse becomes concerned that the baby is jaundiced. The nurse knows that jaundice first becomes visible in a newborn when serum bilirubin reaches what level?

5 to 7 mg/dL

WBC

5,000-10,000

Therapeutic levels of heparin

5,000-10,000 units as bolus IV push initially. Subtherapeutic (too low aPTT) = pt is not receiving enough heparin. Prolonged Times (too high aPTT) = pt is at risk for serious sponanteous bleeding. Antidote: protamine sulfate

Crohn's disease

5-6 soft loose stools per day Fistulas are common Need for surgery is frequent Eat well balanced, healthy diet, avoid alcohol, caffeine, and gas producing foods. Small, frequent meals. Stay hydrated. Too much fiber makes symptoms worse.

Factors that increase pt's risk for complications during and after surgery

65 or older, medications (anti-hypertensives, anticoagulants, NSAIDs, tricyclic antidepressants), decreased immunity, diabetes, pulmonary disease, cardiac disease, infection, illicit substance abuse, bleeding disorders, Latex and Shellfish Allergies (and ALL allergies), Malignant Hyperthermia!!! Pt must be NPO 6-8h before surgery b/c aspiration!!

Risk factors for cancer

7 warning signs: CAUTION C- Changes in bowel/bladder habits A- A sore throat that does not heal U- Unusual bleeding or discharge T- Thickening or lump in breast or elsewhere I- Indigestion or difficulty swallowing O- Obvious change in wart or mole N- Nagging cough or hoarseness

Fasting blood glucose test

<100 100-126 indicated impaired fasting glucose >126 on 2 tests, diagnosis of diabetes

Glucose tolerance test

<140 140-200 indicate impaired glucose tolerance >200 indicate provisional diagnosis of diabetes

Glycosylated hemoglobin (A1C) test

<5.7 5.7-6.4 indicate increased risk for development of diabetes >6.5 indicate diabetes >8 indicate poor diabetes control and need for adherence to regimen or changes in therapy

Hospital Acquired Pneumonia

>48 hrs after admission to hospital Pulmonary hygiene, ambulation, hydration Assess risk for aspiration, monitor for early s/s of sepsis Hand hygiene is critical

Breast cancer risk factors

>65, Family hx (genetic factors), oral contraceptives, nulliparity, hx of previous breast cancer, female, breast density

Nonreassuring FHR patterns

A baseline FHR of less than 110 bpm or more than 160 bpm Absent or persistently minimal variability Recurrent late or variable decelerations Bradycardia Fetal hypoxemia, deficiency of oxygen in arterial blood Inadequate supply of oxygen at cellular level

Ethics of Consequence: Utilitarianism

A moral action that results in the greatest good for the greatest number, greatest good with the least harm

Function of kidneys

A, W, E, T, B, E, D- Acid Balance, water removal, erythropoiesis, toxin removal, blood pressure regulation, electrolyte balance, vitamin d production

ABDCE guide for melanoma

A-Asymmetry or shape B-Border irregularity C-Color variation within one lesion D-Diameter greater than 6mm E-Evolving or changing in any feature

Methylergonovine Maleate (Methergine)

ACTION: Prevention and treatment of PP hemorrhage, subinvolution, and postabortion hemorrhage. SIDE EFFECTS: Nausea, vomiting, stomach pain or mild headache or dizziness. NURSING IMPLICATIONS: closely monitor BP, HR, RR, uterine contractions and bleeding. Monitor patient for adverse effects.

Oxytocin: (Pitocin)

ACTION: Used to induce labor, control PP hemorrhage, and to prevent uterine atony post delivery. SIDE EFFECTS: maternal effects with undiluted IV use include HTN, dysrhythmias, uterine hyperstimulation, and tachysystole. NURSING IMPLICATIONS: Monitor BP, HR, RR, FHR, intrauterine pressure, contractions (duration, strength, frequency) every 15 mins. Maintain careful I&O. Check for blood loss.

Carbopost Tromethamine (Hemabate)

ACTION: treatment of PP hemorrhage secondary to uterine atony. Contraindicated before delivery of placenta. SIDE EFFECTS: mild nausea, vomiting, diarrhea. Mild fever, chills. Cough, hiccups, headache. NURSING IMPLICATIONS: Monitor uterine contractions. Observe and report excessive vaginal bleeding and cramping pain. Save all clots and tissue for physician and lab analysis. Check vital signs at regular intervals.

Diverticulosis

Abnormal pouch-like herniations No symptoms Diagnosed during colonoscopy

Risk factors for DVT

Active cancer, paralysis, cast, bedridden for more than 3 days, major surgery with general anesthesia, previous DVT

General Adaptation Syndrome (GAS)

Alarm - elevated hormone levels, blood volume, glucose, heart rate, mental alertness, and oxygen intake Resistance - Body stabilizes, responds in opposite manner of alarm Exhaustion - when the body is no longer able to resist the effects of the stressor

Complications/Consequences of Hyperglycemia

Angiopathy-damage to blood cells, peripheral neuropathy, fluid/electrolyte/acid-base imbalances, diabetic ketoacidosis, HHS, retinopathy, nephropathy, neuropathy, cardiovascular, cerebrovascular disease, and ED in men

ACE inhibitors

Anti-hypertensive drugs -Drugs affecting the renin-angiotensin system by blocking the conversion of angiotensin I to angiotensin II and inhibiting breakdown of bradykinin (vasodilator) -Increased sodium and water excretion; vasodilation -Results in decreased BP and afterload on heart -Captorpil, Enalpril, Lisinopril

Buproprion

Antidepressant, smoking cessation

Metformin

Antidiabetic PO Max dose 2550mg/day

Pioglitazone

Antidiabetic PO Max dose 45mg

Glipizide

Antidiabetic PO 2.5-5mg Max dose 40mg/day

Exenatide

Antidiabetic SQ 5mcg per dose given BID

APGAR

Appearance (all pink, pink and blue, blue (pale)) Pulse (>100, <100, absent) Grimace (cough, grimace, no response) Activity (flexed, flaccid, limp) Respirations (strong cry, weak cry, absent)

BPH (benign prostatic hyperplasia)

Assess urgency, frequency, nocturia, hesitancy, "weak stream", incomplete bladder emptying, straining to begin urination Interventions: Drug therapy such as 5-ARI and alpha 1 selective blocking agents Teach side effects of medications Avoid alcohol, diuretics, and caffeine Nonsurgical procedures include trans-urethral needle ablation (TUNA), trans-urethral microwave therapy (TUMT), interstital laser coagulation (ILC), electrovaporization of the prostate (EVAP), and prostatic stents Surgical procedures include trans-urethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP)

4th stage of labor: recovery

BEGINS at delivery of placenta and ENDS 1-4 hours after birth Firmly contracted uterus can be palpated directly after birth, firm, midline, slightly below or @ umbilicus Vaginal drainage is Lochia Rubra; consists mostly of blood, some small clots may be present (Large clots NOT normal) Many women have a chill after birth for approx. 20 min. Discomfort results from birth trauma or after pains, Ice pack on perineum to limit hematoma formation Ideal time for bonding and best time to start breastfeeding

3rd stage of labor

BEGINS w/ birth of baby and ENDS w/ the expulsion of the placenta 4 signs suggest placenta separation: 1. Uterus has spherical shape. 2. Uterus rises upward in abdomen. 3. Cord descends further from the vagina 4. Gush of blood appears as blood trapped behind placenta is released. Pain during this phase is from uterine contractions and brief stretching of the cervix to pass placenta Inadequate uterine contraction after birth = greater risk for hemorrhage (Uterine Atony)

2nd stage of labor

BEGINS w/ complete (10cm) dilation and 100% effacement and ENDS w/ birth of child As baby descends and puts pressure on pelvic floor and rectum mom may say "The babys coming" "I have to poop" etc. Voluntary pushing efforts augment contractions (this may make her feel more in control than first stage) B/t contractions may be delirious or appear asleep Feels tremendous relief and excitement when 2nd stage ends with birth of baby

1st stage of labor

BEGINS with onset of true labor contractions, ENDS with complete dilation (10cm) and 100% effacement of cervix Longest stage of labor LATENT PHASE: beginning of labor until 3-5 cm dilation, woman is usually sociable & excited ACTIVE PHASE: Cervix dilates more rapidly, 4-6 cm. dilation. Internal rotation occurs as fetus descends in the pelvis. Discomfort increases TRANSITION PHASE: Intense contractions of fetal descent, final cervical dilation 7 or 8 cm - complete, bloody show increase, short but intense phase, woman may be anxious and irritable

Bronchitis S/S

BLUE BLOATER: cyanotic (blue), volume overload (bloater), cough, copious sputum production, wheezy on auscultation, rhonchi

Insomnia medications

Barbiturates- seconal, Nembutal, many side effects Benzodiazepines- short term side effects Non-Benzos- short term use more favorable side effect Sedatives- Antidepressants Trazodone

Reassuring FHR patterns

Baseline FHR in normal range of 110 to 160 beats/min, with no periodic changes and a moderate baseline variability Presence of accelerations and absence of decelerations

COPD Drug Therapy

Beta-adrenergic agents Cholinergic antagonists Xanthines Corticosteroids Cromones

Central obesity

Better indicator than BMI <35 inches for women, <40 inches for men

Sequence of growth and development (motor, sensory/cognitive)

Birth to 1 month: motor: palmar grasp, immediately drops object placed in hand sensory/cognitive: vision 20/100, reflexes dominate behavior 2-4 months: motor: holds object momentarily at 2 mos, brings object to midline at 4 mos, can get hand to mouth, can lift head off bed, can play with feet, puts foot in mouth, begins reaching and grasping with palm sensory/cognitive: begins to play with objects, follows objects with eyes, plays with fingers, turns head to locate sounds 4-6 months: motor: sits, leaning forward on both hands, turns from back to abdomen, transfers objects from one hand to another sensory/cognitive: can fixate on small objects, adjusts posture to see, responds to name, memory span is 5-7 mins 6-8 months: motor: sits steadily unsupported, can crawl and pull up sensory/cognitive: recognizes parent in other clothes/places, exhibits beginning sense of object permanence, is alert for 1.5 - 2 hrs 8-10 months: motor: pincer grasp develops, reaches for toys, rakes for objects and releases objects sensory/cognitive: beginning of development of depth perception, object permanence begins to develop, uses hands to learn concepts of in and out 10-12 months: motor: can stand alone, can walk with one hand held but crawls to get to places quickly, finger feeds self at 10 mos, feeds self with spoon and pincer grasp is complete at 12 mos sensory/cognitive: vision 20/40, searches for hidden toy, explores boxes, inserts objects into container 15-18 months: motor: builds tower with increasing number of blocks, scribbles, able to put a block in a cup, walks well forward and backward, stoops and recovers sensory/cognitive: can point to several body parts, says 3-10 single words 2 years: motor: holds pencil and scribbles, builds tower of 4-6 blocks, climbs stairs holding railing, runs, jump, kicks ball sensory/cognitive: has approx. 300 word vocabulary, follows two step directions, understands cause and effect 3 years: motor: can build tower of at least 8 blocks, feeds self well, jumps with both feet up and down and over a short distance sensory/cognitive: increasing vocabulary with intelligible speech, begins color identification, constantly asks "how" and "why" questions 4-5 years: motor: proficient holding crayon or pencil, draws purposefully, can tie shoelaces, hops on one foot or alternate feet, throws and catches a ball sensory/cognitive: vocabulary of 1500 words, understands opposites, follows several directions consecutively 6-8 years: motor: buttons and zips clothes, dresses and undresses without help, visual acuity is fully developed sensory/cognitive: vocabulary expands, understands different properties of language such as puns, joks, mnemonics 9-11 years: motor: hand-eye coordination fully developed, may begin to be more awkwards as growth spurt begins sensory/cognitive: reads more and enjoys comics and newspapers, interested in how things work, understands fractions, conversions of volume and weight Adolscence: motor: adult fine motor control, early growth related awkwardness develops into coordinated muscle control sensory/cognitive: becomes future oriented, views world in broad perspective, develops moral reasoning

newborn weight

Birth weight minus current weight = weight lost Weight lost divided by birth weight times 100%

Vaccine Schedule

Birth: 1st dose Hep B and Vitamin K 2 months: 2nd dose Hep B, 1st dose Rotavirus, DTaP, Hib, pneumococcal (PCV13), inactivated poliovirus (IPV) 4 months: 2nd dose Rotavirus, DTaP, Hib, PCV13, IPV 6 months: 3rd dose Hep B, DTaP, PCV13, IPV, annual flu 12 months: 4th dose Hib, PCV13, 1st dose MMR, Hep A 2 dose series, annual flu 15 months: 4th dose DTaP and annual flu 4-6 years: 5th dose DTaP, 4th dose IPV, 2nd dose MMR, Varicella 11-12 years: 1st dose meningococcal, Tdap, HPV 16 years: 2nd dose meningococcal

Process of attachment and bonding

Bonding describes the initial attraction felt by parents for their infants. It is unidirectional, from parent to child, and is enhanced when parent and infant are permitted to touch and interact the first 30 to 60 minutes after birth. Attachment is the process by which an enduring bond between a parent and child is developed through pleasurable, satisfying interaction.

Hypovolemic shock

Bone is vascular, so bleeding is a risk w/ bone injury; trauma can cut arteries causing hemorrhage, resulting in HS

Complications/Consequences of Hypoglycemia

Brain damage, coma, hypoxia, seizures, injury by falls, increased risk for dementia, aggression, violence, speech slurring, combative

Albuterol

Bronchodilator, rescue drug 1-2 inhalations q4-6h Teach to take at least 5 mins before other inhaled drugs and rinse mouth with water immediately Side Effects: headache, restlessness, nervousness, tremors, nausea, dizziness, throat dryness, irritation

Findings to report to Anesthesiologist and Surgeon

Cardiac disease, pulmonary disease, previous VTE/PE, previous MI/stroke, renal/liver disease, Malignant hyperthermia!!!

Maternal responses to labor

Cardiovascular: blood flow to the placenta gradually decreases maternal BP increases pulse decreases Respiratory: depth and rate increase Hematopoietic: elevated level of clotting factors

Varenicline

Chantix Smoking cessation

Nursing Interventions used to promote oxygenation/gas exchange

Chest percussion Postural drainage Ambulation Incentive spirometer Positioning 1 st thing you can do, semi fowlers Spirometer 10x/hr Turn cough deep breath

Ipratropium bromide

Cholinergic Antagonist, relieve and prevent asthma 2-4 inhalations 4-6 times daily Teach pt to shake well before using, increase daily fluid intake, do not take more than 2 inhalations at one time. Side Effects: cough, dry mouth, headache, nausea, headache, tremors, inability to sleep

Risk factors for COPD

Cigarette smoking, occupation hazards, air pollution, infection, heredity- antitrypsin factor (produced in liver, found in lung), aging

Normal sleep cycle

Circadian Rhythm *Circadian synchronization-Influenced by light and dark* regulated by individual biological clock 1) Nrem I transitional relaxed still aware lightest lever 2) NremII sound sleep relax progressed 10-20min body functions continue slow 3) NremIII less easily aroused, vs decline stays regular 15-30 4) Nrem IV deepest stage of sleep hard to arouse vs sign lower, sleepwalker enuresis (bedwetting) 5) REM vivid dreams 20min rapid eye movement, fluctuating vs, difficult to arouse

Fat Embolism Syndrome (FES)

Fat globules released from yellow bone marrow into blood stream 24-48 hrs after injury, usually from fractures, fracture repair, and sometimes total joint replacement Early S/S: hypoxemia, dyspnea, tachypnea, headache, lethargy, agitation, confusion, decreased LOC, seizures, and vision changes

While listening to the fetal heart, the nurse hears a heartbeat at the rate of 136 in the right upper quadrant and also at the midline below the umbilicus. What are the sources of these two sounds?

Funic souffle and fetal heart rate

Malignant hyperthermia

Genetic (1st degree relative- 50% chance as well) Life threatening condition Occurs when skeletal muscle is exposed to certain anesthetics

Risk factors for melanoma

Genetic predisposition, excessive exposure to UV light, presence of one or more precursor lesions that resemble unusual moles *Highly metastatic, a person's survival depends on early diagnosis and treatment

secondary prevention

Goal is to identify individuals in an early state of a disease process so that prompt treatment can be initiated. Usually screening tests

Risk factors for cervical cancer

HPV, early age first intercourse, early child bearing, multiple sex partners, high risk sex partners, hx of STD, low socioeconomic status, African american and smoking

Risk factors for vascular problems

Hypertension, Hyperlipidemia, Atherosclerosis

magnesium administration

IV 4-5g Pre-eclampsia decreased respiratory rate, drowsiness, hypotension, bradycardia, arrhythmia

Altered bowel elimination (ostomies)

Ileostomy- distal part of small intestine Colostomy- party of the large intestine Ostomies- Red or pink, clean with soap and water, dry thoroughly, regularly inspect Appliance must fit well, good skin care, & empty @1/3 -1/2 full

Risk factors for Endometrial (Uterine) Cancer

In reproductive years, family hx, DM, HTN, Obesity, Uterine polyps, late menopause, Nulliparity, Smoking

Pneumonia S/S

Increased RR/dypnea, hypoxemia, cough, fever, pleuritic chest discomfort, purulent/blood-tinged/ or rust colored sputum

Clinical signs of impending and imminent death

Increased periods of sleeping Coolness and color changes (mottling, cyanosis, pallor) Bowel incontinence Decreased urine Restless confusing Decrease intake Congestion Altered breathing

Acute compartment syndrome

Increased pressure within one or more compartments reduces circulation to the area Early signs (6 P's): Pain, Pressure, Paralysis, Paresthesia, Pallor, Pulselessness

Erikson's Theory of Development

Infancy: Trust vs Mistrust Toddler: Autonomy vs Shame & Doubt Preschool Age: Initiative vs Guilt School Age: Industry vs Inferiority Adolescence: Identify vs Role Confusion Young Adult: Intimacy vs Isolation Middle Adult: Generativity vs Stagnation Older Adult: Integrity vs Despair

Chronic Bronchitis (COPD)

Inflammation of the bronchi and bronchioles caused by chronic exposure to irritants, especially tobacco smoke. Only affects airways, not alveoli. Increases number and size of mucus glands. Mucus is a breeding ground for organisms and leads to chronic infection. PaO2 level decreases (hypoxemia), PaCO2 level increases (Respiratory acidosis)

Diverticulitis

Inflammation of the diverticula N/V, increased temp, decreased H&H Have pouches for life Do NOT put off BMs Add more fiber to a healthy, well balanced diet

Physiologic changes that occur in the newborn's respiratory and cardiovascular systems during the transition from fetal to newborn life

Initiation of extrauterine respirations Character of normal respirations Peripheral circulation Blood pressure Pulse Hematocrit concentration

Prevention strategies for DVT

Leg exercises Early ambulation Adequate hydration Compression stockings Anticoagulant therapy Pt education on DVT

Montelukast

Leukotriene modifier, prevent asthma attack Teach pt to use drug daily, even when no symptoms are present, and do not decrease the dose or stop taking any other asthma drugs unless instructed by HCP. Side Effects: headache

Vaccines

Live: weakened microorganisms, immunocompromised should avoid these Killed: inactivated microorganisms Toxoid: inactivated toxins; formation of antitoxins which produces active immunity Immune Globulin: contains antibodies from purified blood of people Anti-toxin: affective in neutralizing toxins and can kill bacteria and other microorganisms

Localized/systemic infection

Localized - pain tenderness @ wound site, standard precautions local to the affected area. Systemic - effects the entire body, can be fatal

Salmeterol

Long-acting Beta Agonist, preventative 2 inhalations q 12h Teach pt to shake inhaler and wait 1 min before 2nd inhalation Side Effects: headache, cough, tremor, dizziness, vertigo

Ventilator Associated Pneumonia

Lower respiratory tract infection that develops more than 48 to 72 hours after endotracheal intubation Elevate HOB at least 30 degrees, oral care regimen, suctioning either PRN or continuous Hand hygiene is critical

Hemoglobin, Hematocrit

Male - 13-16 / 41-50 Female - 12-15 / 36-44

DVT Manifestations and S/S

Manifestations: VIRCHOW'S TRIAD- stasis of blood flow, endothelial injury, and/or hypercoagulability Signs: Sudden onset of unilateral swelling of the leg, calf or groin tenderness/pain, warmth/redness

Small Bowel Obstruction (SBO)

Manifestations: abdominal discomfort/pain, N/V, upper/epigastric abdominal distention, obstipation, fluid/electrolyte imbalances, metabolic alkalosis

Large Bowel Obstruction

Manifestations: lower abdominal cramping and distention, obstipation or ribbon like stools, metabolic acidosis (not always present)

PE Manifestations and S/S

Manifestations: sudden onset dyspnea, sharp and stabbing chest pain, apprehension, restlessness, feeling of impending doom, cough, hemoptysis Signs: tachypnea, crackles, pleural friction rub, tachycardia, S3 or S4 heart sounds, diaphoresis, low grade fever, decreased SaO2

HoLEP

Minimally invasive laser removes obstructive tissue very little blood loss safe for pts taking anticoagulants

Tertiary prevention

Minimizing the effects of disease and disability; restorative through collaborative disease management; optimize the management of a condition and minimize complications so that individual can achieve highest level of health possible

Modifiable and Non-modifiable risk factors for vascular problems

Modifiable: Low HDL/High LDL, Increased triglycerides, Diabetes, Obesity, Smoking, Stress, Sedentary lifestyle Non-modifiable: genetic predisposition, African American or Hispanic ethnicity, older adult

Ethics of Consequence: Teleological

Moral actions are defined entirely on the basis of outcomes or consequences of an action. Often weigh disadvantages and advantages or harms and benefits of different actions.

VTE

Most common complication of lower extremity surgery or trauma and most often fatal complication Risk factors: cancer or chemo, surgery longer than 30 mins, hx of smoking, obesity, heart disease, prolonged immobility, oral contraceptives/hormones, hx of VTE complications, older adults (especially hip fractures)

Sleep requirements for age groups

Neonates-16hrs Infant-15 hrs Toddlers-12 hrs Preschool-12 hrs School age- 9-10 hrs Adolescent get 7.5 average Young adults get 6-8 hr Middle and older adults' total number of sleeps they get declines

Fight or Flight

Neurophysiological due to the release of epinephrine and norepinephrine, specifically these hormones increase HR, blood pressure, cardiac output, dilatation of bronchial airways, pupil dilation, increase blood flow, increase glucose, decrease blood flow to nonessential organs

Physical assessment for age groups

Newborn-6 months: involve parents, auscultate heart, lungs, and abdomen, assess head-to-toe 6 months-1 year: examine on parent's lap, provide warm room, smile and talk soothingly, begin assessment with feet and hands, listen to heart and lungs Toddlers: examine on parents lap, demonstrate exam on parents or doll before exam, give toddler choices about exam, observe play Preschoolers: may prefer to be examined on parents lap or on exam table, offer options, give simple explanations, allow child to play with equipment, use distraction School Age: willingly cooperate, offer gown for modesty, allow child to determine if parents or sibilings stay for exam for older school-age, use head-to-toe sequence, explain what you are doing and why, teach child how the body works Adolescent: protect modesty by offering privacy and covering up body parts not being assessed, use head to toe sequence, examine without parent present (unless requested by the pt), have a stand-by the same gender as pt

Stages of growth and development

Newborn: birth to 1 month Infancy: 1 month to 1 year Toddlerhood: 1 to 3 years Preschool Age: 3-6 years School Age: 6-11/12 years Adolescence: 11-21 years

Macular degeneration

No cure more common and progresses faster among smokers risk factors: hypertension, female, short stature, family hx, long time diet poor in carotene and vitamin E

Modifiable and Non-modifiable risk factors for CAD

Non-modifiable: age, gender, family hx, ethnic background Modifiable: elevated serum lipid levels, smoking/tobacco use, limited physical activity, Hypertension, DM, Obesity, Excessive alcohol intake and stress

BMI scale

Normal: 18.5-24.9 Overweight: 25-29.9 Obese: 30-39.9 Morbid Obese: >40

Beneficence

Obligation to do good by acting in ways that promote the welfare and best interest of other

Health Care Associated Pneumonia

Occurs <48 hrs after admission, >48 hrs in the past 90 days (living in a facility, IV therapy, wound care, chemotherapy in last 30 days) Hand hygiene is critical

Risk factors for Ovarian Cancer

Older than 40, family hx, DM, Nulliparity, breast cancer, colorectal cancer, Infertility, BRCA 1 or 2 gene mutations, endometriosis, Obesity, older than 30 at first pregnancy

Organic vs Functional ED

Organic: gradual deterioration diminishing firmness decrease in frequency Functional: psychological cause normal nighttime and morning erections sudden onset and follows high stress Treatments: phosphodieterase-5 inhibitors vacuum constrictive device injecting penis with vasodilation drugs penile implants

Emphysema S/S

PINK PUFFER: severe constant dyspnea/tachypnea (puffer), non-cyanotic (pink), mild cough, thin cachexic, diminished breath sounds on auscultation

newborn signs of hypoglycemia

Pallor, irritability, ineffective sucking, hypotonia

Hyperglycemia S/S

Polydipsia, polyuria, polyphagia, dehydration, fatigue, fruity odor to breath, kussmaul breathing, hunger, blurred vision, weakness, weight loss, numb/tingling extremities

Risk factors for impaired glucose metabolism

Pregnancy, LGA, SGA, Preterm infant, older adults, genetics, lifestyle (poor diet, lack of physical activity, etc), chronic conditions (Vitamin D deficiency, physiologic stress, celiac disease, adrenal insufficiency, autoimmune thyroid disorders), medications, genetics, obesity, acanthosis, PVD

Abnormalities that may result in dysfunctional labor

Problems of the Powers: Ineffective contractions, ineffective maternal pushing. Problems with the Passenger: fetal size, abnormal fetal presentation or position, multi-fetal pregnancy, fetal anomalies. Problems with the Passage: pelvis, maternal soft-tissue obstructions. Problems of the Psyche: a perceived threat caused by pain, fear, nonsupport, or personal circumstance can result in great maternal stress and interfere with normal labor progress.

Risk factors for PE

Prolonged immobility, surgery, obesity, advancing age, hx of thromboembolism, smoking, pregnancy, heart failure, stroke, cancer, trauma, central venous catheters

Lispro

Rapid acting SQ 0.5-1 unit/kg/day in divided doses

Actions/Side Effects of Statins

Reduce cholesterol synthesis in the liver and increase of LDL-C from the blood. Contraindicated in pts with active liver disease. Discontinue if pt has muscle cramping or elevated liver enzyme levels. Side effects: abdominal bloating, flatulence, diarrhea, and/or constipation. Teaching: avoid grapefruit and grapefruit juice.

Hypoglycemia S/S

Reduced cognition, tremors, diaphoresis, weakness, hunger, headache, irritability, seizure, memory issues

Ethics of Character - Virtue Ethics

Relies on the character of the indiviual. Moral virtues: respect, honesty, sympathy, charity, kindness, loyalty, and fairness. Practical virtues: intelligence, patience, prudence, and shrewdness. "What is the wise action to take?" Professional, professionalism, and professional identity. Leads to ethical inconsistency, choices may change over time with additional experience and character development.

Fidelity

Requires us to act in ways that are loyal, includes keeping promises, doing what is expected of you, performing your duties, and being trustworthy

Rho(D) immune globulin (RhoGAM) is prescribed for an Rh-negative client who has just given birth. Before giving the medication, the nurse verifies the newborn's Rh factor and reaction to the Coombs test. Which combination of newborn Rh factor and Coombs test result confirms the need to give Rho(D) immune globulin?

Rh positive with a negative Coombs result

Peptic Ulcer Disease (PUD)

Risk factors: NSAIDs, H. pylori infection Diagnosis: urea breath test, stool antigen test, EGD, chest/abdomen xray

Cholecystitis

Risk factors: aging, women, Native American/Mexican/Caucasian, obesity, rapid weight loss, increased serum cholesterol, hormone replacement therapy, family hx, pregnancy (4 F's: Female, Fat, Forty, Fertile) Diet: high in fiber/low in fat, gas producing foods should be avoided, small frequent meals Laproscopic cholecystectomy: recovery is quick, pain less severe Diagnosis: ultrasound of URQ

GERD (gastroesophageal reflux disease)

Risk factors: caffeine, chocolate, citrus fruits, tomatoes and products, smoking, calcium channel blockers, nitrates, peppermint/spearmint, alcohol Lifestyle changes: 4-6 small meals /day, do not snack in the evenings, do not eat for 2-3h before bed, remain upright for 1-2h after meals, maybe lose weight, avoid heavy lifting, straining, or bent over positions Key features: indigestion, regurgitation, coughing/hoarseness/wheezing, water brash (hypersalivation), dysphagia, painful swallowing, epigastric pain, abdominal pain, belching/flatulence, N/V, heartburn Diagnosis: pH monitoring

Renal Calculi

S/S: severe pain (renal colic), flank pain begins suddenly "unbearable" N/V, pallor, diaphoresis frequency and dysuria oliguria or anuria suggests obstruction VS may be increased due to pain Hematuria, color: smoky/rusty, increased turbidity, foul odor

Regular Insulin

Short acting SQ, IV 0.5-1.2

TURP

Small piece of gland is removed may require more TURPs invasive

Prevention strategies for PE

Start passive and active ROM exercises. Ambulate pts soon after surgery. Use anti-embolism and pneumatic compression stockings and devices after surgery. Evaluate the need for anticoagulant therapy. Assess peripheral circulation. Refrain from massaging leg muscles. Encourage smoking cessation. Change pt position q2h or ambulate as tolerated. Instruct pt not to cross legs. Teach pt to avoid activities that result in the Valsalva maneuver.

Retinal detachment

Sudden and painless Pt may see bright flashes of light or floating dark spots and have the sensation of a curtain being pulled over part of the visual field

Angle-closure glaucoma

Sudden onset Is an EMERGENCY severe pain around eye that radiates around face headache, brow pain, n/v halos around lights, blurred vision, decreased light perception, sclera may appear reddened and cornea foggy

Prostate Cancer

Surgery is most common Radial prostatecotomy Bilateral orchiectomy Laparoscopic radial prostatectomy (most common, PSA must be <10ng/mL) Radiation Chemotherapy

Malignant Hyperthermia S/S

Tachycardia, high temp (111.2 degrees), hyperkalemia, muscle rigidity, decreased O2 sats. Watch for all signs

Purpose of SCIP

To reduce safety issues through reduced post-op complications

True vs. False Labor

True Labor: progressive dilatation and effacement regular contractions increasing in frequency, duration, and intensity pain usually starts in the back and radiates to the abdomen pain is not relieved by ambulation or by resting False Labor: lack of cervical effacement and dilatation irregular contractions do not increase in frequency, duration, and intensity (Braxton-Hicks) contractions occur mainly in the lower abdomen and groin pain may be relieved by ambulation, changes of position, resting, or a hot bath or shower

Complications associated with obesity

Type 2 DM, Hypertension, Coronary Artery Disease, Stroke, Peripheral Artery Disease, Metabolic syndrome, Chronic back pain, decreased wound healing, urinary incontinence

Justice

Underlying principle that prohibits a nurse from treating pts differently. Fair treatment for all. Every pt is entitled to same level of care & consideration

Sildenafil

Viagra Erectile dysfunction

Infection

Wound infections are the most common type. Bone infection, osteomyelitis, is most common with open fractures

Continuous positive airway pressure (CPAP)

a set positive airway pressure throughout each cycle of inhalation and exhalation

Community Acquired Pneumonia

a type of pneumonia that results from contagious infection outside of a hospital or clinic Antibiotic treatment, minimum of 5 days.

Chain of Infection

agent →reservoir (people, equip) → portal of exit (droplets, excretions) → transmission route (airborne, direct, ingestion→ portal of entry (broken skin, GI tract, resp tract, mucous membranes) → susceptible host (burns, CVD, DM, sx, immunosuppression)

Primary prevention

aimed at health promotion includes health education programs, immunizations, and physical and nutritional fitness activities

Thiazide diuretics

anti-hypertensives, diuretics

Misoprostol

antiulcer agent

Proton Pump Inhibitors

antiulcer agents

Atherosclerosis

build up of fatty and/or fibrous material in walls of arteries

Kussmaul respirations

can cause metabolic acidosis

Ethics of Relationship

focused on the nature and obligations inherent in human relationships and community. "What is the caring response?"

Respect for Persons

human beings have an unconditional moral worth that requires us to treat each individual person with great value, dignity, and respect

Complications of COPD

hypoxemia, respiratory acidosis, respiratory infections, cardiac failure, cardiac dysrhythmias, respiratory failure

Statin Medications

lipid-lowering agents AVOID GRAPEFRUIT AND GRAPEFRUIT JUICE!!

Emphysema (COPD)

loss of lung elasticity and hyperinflation of the lung, results in dyspnea and the need for increased RR. Needs to use accessory muscles, increased need for oxygen creates an "air hunger". ABGs may not show gas exchange problem until the pt has advanced disease, but will have a low PaO2.

Ethics of Duty: Deontology

moral duties are seen as self-evident, needing no further justification, based on acting according to a specific duty simply because it is the right thing to do. Consequences are important, but secondary to duty

Open-angle glaucoma

most common usually effects both eyes no s/s in early stages sometimes, vision is foggy, mild eye aching or headaches Late s/s: seeing halos around lights, losing peripheral vision, decreased visual sensory perception (occurs after irreversible damage to optic nerve)

ABGs

pH 7.35-7.45 PaCO2 35-45 PaO2 80-100 HCO3 21-28

Cataracts

s/s: blurred vision and decreased color perception double vision may occur no pain or eye redness w/o surgery, progresses to blindness

Arteriosclerosis

the thickening and hardening of the walls of the arteries, occurring typically in old age.