Module 1 (Inflammation, cholecystitis, IBD, PUD, HIV, lupus, fluid/electrolytes, infection, pneumonia, TB, acid/base, asthma, COPD, ABG, tissue integrity)

Respiratory alkalosis

A rise in blood pH due to hyperventilation (excessive breathing) and a resulting decrease in CO2.

Stimuli for acute inflammation

Infections Necrosis Trauma Foreign bodies Immune reactions

Chronic inflammation

A slow ongoing process. *Lymphocytes, monocytes, macrophages.* Severe and progressive tissue injury. Less prominent.

Pucker factor

Severity of situation. How much is your gluteal hole puckered? With immunocompromised patient with a fever, should be a, 8-9/10.

Electrolytes

Minerals that carry electrical charges that help maintain the body's fluid balance. Help with heart rhythm, brain function, and muscle contraction.

Acute inflammation

Minimal and short-lasting injury to tissue. Initiated by *neutrophils.* Mild, self limiting tissue injury. More prominent.

Psoriasis (1-3) (know teaching, care, meds and teaching.)

Skin disorder characterized by flare-ups in which red papules covered with silvery scales occur on the elbows, knees, scalp, back, or buttocks

COPD prevention

Smoking cessation *Vaccination: pneumococcal & influenza q fall* Pulmonary Rehab Surgery

Nasal cannula (1-3) (know oxygen therapy assessment, teaching, care)

1-6 L/m

Chron's disease

Anywhere between mouth and anus

PUD teaching

Avoid acid-producing food (spicy food, caffeine, milk products) Small, frequent meals

IBD S/S

Lower abdominal pain Fever Diarrhea High-pitched bowel sounds Steatorrhea Malnutrition (brittle hair and nails) Anemia (can't absorb vitamins) Swelling (decreased protein - decreased albumin - albumin maintains water in blood)

Who are considered to be the first responders to site of injury and begin to phagocytize the threat? Neutrophils Macrophages Lymphoctyes Monocytes

Neutrophils

Lymph nodes protect against

Bacteria Viruses Infectious microbes Cancer

Would you give an immunocompromised patient a live virus vaccine?

No

Phagocytosis

Cell eating

Who reacts differently to fever?

Elderly Infants Immunocompromised

Interventions for hypophosphatemia

Oral replacement of phosphorus with a vitamin D supplement I.V. only when extremely low Restrict calcium, antacids, diuretics Food sources: tuna, beef

Dermatitis medications

Steroids or antihistamines. Topical immunisuppressants - avoid occlusive dressings or if infection is present.

Gallbladder (2-4) (know s/s, nutrition)

Stores and concentrates bile

Foods that cause odor

fish, eggs, asparagus, garlic, beans, and dark leafy greens

How do we get infections?

Organism breeches bodys defenses Immune system activated Organism proliferates and multiplies (Incubation phase) Inflammatory response (prodromal stage) Illness stage Convalescence stage

Cellulitis nursing actions

Outline (physically with a pen) to track size, shape, and growth of area of redness.

Hypervolemia treatment

Semi Fowler's Loop, osmotic diuretics Limit sodium/fluid intake Reduce IV fluids Monitor skin Edema Repostion q2hr Support arms/legs- decrease dependent edema

Asthma S/S

Sudden dyspnea Wheezing Accessory muscles Nasal flaring Tightness in chest Coughing Produces thick sputum Tachypnea Rapid pulse Profuse perspirations Hyperresonant lung fields Diminished breath sounds

PUD medications

*Antibiotics* Metronidazole, amoxicillin, clarithromycin, and tetracycline for H. Pylori -combination of 2 or 3 *Ranitidine, Famotidine, Cimetidine, and Nizatidine* Suppress secretion of gastric acid -used with H. Pylori antibiotics -prevents stress ulcers for clients with --post op NPO --major burns --sepsis --increased ICP *Pantoprazole, esomeprazole, omeprazole, lansoprazole, and rabeprazole* Suppress gastric acid secretion Long term use can increase risk of fractures, pneumonia, acid rebound, and C. Diff. *Antacids* Aluminum hydroxide and magnesium hydroxide -neutralize acid in gut -provides symptomatic relief -does not accelerate healing -can be given 7x/day -flavored antacids delay emptying of stomach *Mucosal protectants* Sucralfate -coats and protects ulcer Bismuth subsalicylate -prevents H. Pylori from binding to mucosal wall

Pneumonia medications

*Antibiotics* Penicillins & cephalosporins -observe stool with cephalosporins -monitor kidney function with either IV then switched to oral Culture first, then antibiotic. Change antibiotic is results warrant *Bronchodilators* -reduce bronchospasm and irritation Albuterol -beta2 agonist -watch for tremors and tachycardia Ipratropium -cholinergic (decreases secretions) -assess for dry mouth and monitor heart rate -headache, blurred vision, and palpitations indicate toxicity Theophylline -methylxanthines -require close monitoring of medication levels (10-20) -tachycardia, nausea, diarrhea indicate toxicity *Anti-inflammatories* Fluticasone & Prednisone -glucocorticosteroids -monitor for immunosuppression, fluid retention, hyperglycemia, hypokalemia, & poor wound healing -assess for black, tarry stools

Cholecystitis therapeutic procedures

*Extracorporeal shock wave lithotripsy* -shock waves are used to break up stones for non-surgical candidates of normal weight with small, cholesterol-based stones. *Cholecystectomy* Laparoscopic -provide immediate post op care -instruct client to ambulate frequently to minimize free air pain -watch for bile leak (pain, vomiting, abdominal distention) Minimally invasive -through the mouth, vagina, or rectum -eliminates visible incisions -decreases risk of complications for client -instruct client to ambulate frequently to minimize free air pain -watch for bile leak (pain, vomiting, abdominal distention) Open approach -may place a Jackson-Pratt drain in gallbladder bed -- placed intraoperatively to prevent accumulation of fluid -may place a T-tube in common bile duct -- less common -- report obstruction (absence of drainage with nausea and pain) -- clamp tube 1hr before meals to provide bile for digestion --provider may prescribe placement above abdomen to maintain some bile -- monitor for bile peritonitis (pain, fever, jaundice) -- remove within 1-3 weeks -avoid heavy lifting for 4-6 weeks Avoid fatty and gas-producing foods, have small, frequent meals, take fat-soluble vitamins or bile salts to enhance absorption and aid with digestion.

TB Medications

*Isoniazid* Monitor for hepatotoxicity -jaundice, anorexia, malaise, fatigue, nausea -liver function testing prior to and monthly -advise client not to drink alcohol Monitor for neurotoxicity -tingling of hands and feet -prevent with vitamin B6 (pyridoxine) *Rifampin* Monitor for hepatotoxicity -liver function testing prior to and monthly Can interfere with efficacy of contraceptives Urine and other secretions will be orange *Pyrazinamide* Monitor for hepatotoxicity -liver function testing prior to and every two weeks -avoid alcohol Can cause nongouty polyarthralgias -assess for gout -increase fluids *Ethambutol* Can cause vision changes -baseline, then monthly, visual acuity test -determine color discrimination ability -stop immediately for ocular toxicity Do not give to children under 8 *Streptomycin Sulfate* Only for client's with multi-drug resistant TB -high level of toxicity Ototoxicity Monitor renal function -assess/report urine output -BUN/Creatinine

SLE Complications

*Lupus nephritis* When SLE cannot be managed with medications Need for kidney transplant -monitor for periorbital and lower extremity swelling and hypertension -monitor BUN, creatinine *Pericarditis & Myocarditis* Inflammation of heart, its vessels, and surrounding sac -monitor for chest pain, fatigue, arrhythmias, and fever.

Cholecystitis medications

*Morphine Sulfate or Hydromorphone* For acute biliary pain -monitor for GI bleed *Ketorolac* For mild to moderate pain -monitor for GI bleed *Chenodiol or Ursodiol* Bile acid -gradually dissolves cholesterol-based gall stones -caution in clients with liver disorders -clients should report abdominal pain, diarrhea, or vomiting -medication is limited to 2 years of administration -requires a gallbladder ultrasound every 6 months during the first year to determine effectiveness

Rheumatoid Arthritis Treatment

*NSAIDs* -request concurrent rx for GI-acid lowering agent (H2A, PPI) for GI distress *COX-2 enzyme blocker* -less GI distress -risk for cardiac disease *Steroids* -used for acute exacerbations -not used long term due to osteoporosis, hyperglycemia, immunosuppression, cataracts *DMARDs* Hydroxychloroquine (antimalarial) Minocycline (antibiotic) Sulfasalazine (sulfonamide) Etanercept, Infliximab, Adalimumab, Chelator penicillamine (biologic response modifiers) Methotrexate, leflunomide, cyclophosphamide, azathioprine (cytotoxic) can cause severe adverse effects. *Plasmapheresis* Removes circulating antibodies from plasma -decreases attacks on client's tissues *Total joint arthroplasty* Surgical repair and replacement of joint Moist heat Encourage physical activity

SLE medications

*NSAIDs* reduce inflammation and pain -contrindicated for clients with impaired kidney function -monitor for NSAID induced hepatitis *Prednisone* Corticosteroids -immunosuppression and reduce inflammation -monitor for fluid retention, hpt, and kidney function -taper dose *Methotrexate & Azathioprine* Immunosuppressant agents -monitor for toxicity (bone marrow suppression, increased liver enzymes) *Hydroxychloroquine* Antimalarial -suppression of synovitis, fever, fatigue -encourage frequent eye examinations

HIV complications

*Opportunistic infections* Bacterial diseases -TB, bacterial pneumonia, septicemia HIV-associated malignancies -Kaposi's sarcoma, lymphoma, and squamous cell carcinoma Viral diseases -cytomegalovirus -herpes simplex -herpes zoster Fungal diseases -pneumocystis jirevocii pneumonia (PCP), candidiasis, cryptococcosis, and penicilliosis Protozoal diseases -PCP, toxoplasmosis, microsporidiosis, cryptosporidiosis, isosporidiosis, and leishmaniasis *Wasting syndrome* Maintain nutrition *Fluid/electrolyte imbalance* Monitor *Seizures (HIV encephalopathy)* Implement seizure precautions

Severe PUD complications

*Perforation/hemorrhage* Surgical emergency -severe epigastric pain spreading across abdomen -rigid, board-like abdomen -rebound tenderness -client will display symptoms of shock, hypotension, and tachycardia Start 2 large-bore IV lines for replacement of blood and fluids *Pernicious anemia* Deficiency of IF secreted by gastric mucosa -pallor, glossitis, fatigue, paresthesias -lifelong monthly B12 injections *Dumping syndrome* Following gastrectomy surgery Rapid gastric emptying or high-carbohydrate ingestion causes a shift of fluid to the abdomen. -client may report a full sensation, weakness, diaphoresis, palpitations, dizziness, and diarrhea -lying down after a meal slows digestion -eliminate liquids with meals -avoid milk & sugars Vasomotor symptoms can occur 10-90m after a meal -pallor, perspiration, palpitations, headache, warmth, dizziness, drowsiness -advise client to lie down Late symptoms can be from rapid release of blood glucose, followed by an increase in insulin production, resulting in hypoglycemia *Octreotide* SubQ can be prescribed if manifestations are severe, not controlled with dietary measures. *Acarbose* slows absorption of carbohydrates *Pyloric obstruction* From scarring, edema, or spasm of the area distal to pyloric sphincter -prevents emptying of stomach -feeling of fullness, distention, nausea after eating, and emesis of undigested foods

IBD complications

*Peritonitis* Life threatening inflammation of peritoneum and lining of abdominal cavity -rigid, board-life abdomen -abdominal distention -n/v -rebound tenderness Place client in high-fowlers to drain fluid Use oxygen therapy, positioning, coughing If surgery is performed -monitor I&O every hour -monitor post op vitals -sterile technique for wound irrigation *Bleeding due to deterioration of the bowel* Observe for rectal bleeding Monitor vitals Check HCT, HGB, and coagulation *Fluid & electrolyte imbalance* From d/v and suctioning Monitor lab values -replacement therapy as needed Monitor weight Monitor fluid volume -skin turgor *Abscess & fistula formation From destruction of bowel wall Monitor fluid & electrolytes Monitor for evidence of infection -indicative of abdominal abscesses or sepsis *Toxic megacolon* From inactivity of the colon. Massive dilation -risk for perforation Prepare for surgery if client does not show improvement within 72 hours

SLE diagnostic tests

*Skin biopsy Immunologic tests* ANAs -SLE prep -dsDNA -ssDNA -Anti-DNP -SS-A Serum compliment (C3, C4) decreased ESR elevated *BUN & Creatinine* increased with kidney involvement *Urinalysis* positive for protein and RBCs with kidney involvement *CBC* pancytopenia

IBD medications

*Sulfasalazine* Sulfonamide -reduce inflammation -contraindicated with sulfa allergy -monitor CBC, kidney, hepatic function -adverse effects are nausea, fever, rash -monitor for agranulocytosis, hemolytic anemia, and macrocytic anemia. -can cause urine, skin, and contact lenses to have yellow/orange color *Mesalamine, Balsalazide, Olsalazine* Nonsulfonamides -can be contraindicated for clients with salicylate or sulfa allergy -monitor for kidney toxicity -report headache or GI problems Olsalazine rarely used -for clients intolerant to sulfasalazine *Prednisone, Prednisolone, Hydrocortisone, Budesonide* Corticosteroids -not for long-term use due to adverse effects -adrenal suppression, osteoporosis, risk of infection, & cushingoid syndrome Reduce pain, inflammation from prolonged use. -taper dose *Cyclosporine, Methotrexate, Azathioprine, Mercaptopurine* Immunosuppressants -monitor for pancreatitis and neutropenia -can take 6 months for therapeutic effect -reserved for refractory disease due to toxicity -monitor for bleeding, bruising, infection *Infliximab, Adalimumab, Natalizumab, Certolizumab* Immunomodulators -chills, fever, hypotension/hypertension, dysrhythmias, blood dyscrasias -monitor liver enzymes, coagulation, and CBC Adalimumab -self-administered SubQ Natalixumab -can cause *progressive multi-focal leukoencephalopathy* deadly brain infection *Diphenoxylate & atropine, Loperamide* Antidiarrheals -decrease risk of fluid volume deficit and electrolyte imbalance can lead to *toxic megacolon --can lead to peritonitis and gangrene --hypotension, fever, abdominal distention, decrease or absence of bowel sounds -observe for respiratory depression in older adults

Prostaglandin

Wanted in stomach, improves blood flow to kidneys.

CFS S/S

-6mo+w/4 or more of: short-term memory loss, muscle pain, tender lymph nodes, non-refreshing sleep, multi joint pain, post-exercise discomfort

Pneumonia Pathophysiology

-Acute lung infection triggered by inhalation of infectious organism, aspiration of irritant -Inflammation and alveolar damage -Alveoli filled with exudate and edema -Reduced surface area for gas exchange

Pneumonia risk factors

-Advanced age (due to fewer cilia, decreased lung elasticity, and thickening alveoli) or extremely young (weak immune system, shorter airway for microbe to travel through) -Recent exposure to viral, bacterial, or influenza infections -Exposure to plant pollen, molds, animal dander, and environmental contaminants -Presence of foreign body -Mechanical ventilation -Lung diease -Smoking -Immunosuppressed -Immobility or impaired mobility -Post op

TB risk factors

-Contact with untreated individual -Lower socioeconomic status/homelessness -Immunocompromised -Poorly ventilated, crowded environments (prison, long-term care facilities) -Advanced age -Substance use -Performing respiratory treatments, suctioning, coughing procedures -Frequent and close contact with untreated individuals -Travel to places where TB is endemic

Interventions for hyponatremia

-Drug therapy: decreasing DIURETICS, IV SALINE SOLUTIONS, antagonizing ADH -Nutrition therapy: collaboration w/ RD, increasing oral sodium, decreasing oral fluid intake

Ostomy care

-Hand hygiene; gloves; REMOVE pouch form stoma.* -Inspect stoma. It should appear MOIST, SHINY & PINK. The peristomal area should be INTACT, & skin should appear healthy. -Use mild SOAP & H20 to cleanse the skin, and then dry it gently & complete. Apply PASTE if used. *Measure & draw where to cut skin barrier, allowing only stoma to appear through opening.* -Cut opening in skin barrier; if necessary, apply barrier pastes to creases, apply skin barrier & pouch, fold bottom of pouch & place closure clam on pouch. -Dispose of used pouch. Remove the gloves & perform hand hygiene

TB nursing actions

-Heated and humidified oxygen therapy -Airborne precautions may not be needed for home treatment since family has already been exposed. -Client should continue with follow-up care for one full year. -Sputum samples needed every 2-4 weeks to monitor therapy for effectiveness.

Hypervolemia s/s

-Hypertension -Bounding pulse -JVD -Peripheral edema -↑ urine output that is dilute -Acute, rapid weight gain -S3 heart sound in adults -Bulging fontanels in infants -Crackles on auscultation -Dyspnea, cough and increased RR -Mental status changes (headache, confusion, lethargy; seizures possible)

TB pathophysiology

-Inhalation of Mycobacterium Tuberculosis in lung -Immune system activated -Microorganism multiplies and proliferates -Body encases TB bacillus with collagen and other cells (appears as Ghon tubercle on x-ray) but can't destroy because of capsule -Can't spread since it's encased, but are still multiplying

IBD nursing actions

-Monitor procedure for manifestations of bowel perforations (rectal bleeding, firm abdomen, tachycardia, hypotension) -Monitor by colonoscopy due to increased risk of colon cancer -Dietary supplements that are high in protein and low in fiber

Lupus patho

-Small antigens bond with healthy tissues -Immune response produces antibodies to attack antigens and healthy tissue

Cholecystitis nursing actions

-analgesics as prescribed -dietary teaching

Cholecystitis risk factors

-females (hormone therapy and oral contraceptives) -obesity -genetics -elderly -type 2 diabetes mellitus or Chron's disease -rapid weight loss -Native American or Mexican

SLE nursing care

-increased risk for infection (pneumonia) which is a major cause of death; (due to decreased phagocytosis, antibodies, & immunosuppressive meds) -Check TEMP-consider fever serious Fatigue/activity intolerance: -energy conservation and protection of small joints -rest balanced with exercise, use assistive devices Acute pain (joints usually): -assess, medicate, heat & cold Impaired skin integrity: -protect from sun (it exacerbates symptoms), keep clean & dry Ineffective therapeutic regime management: -Need education on chronic illness, support groups, early report of fever, edema, decreased output, chest pain, dyspnea to ensure early intervention! Also, are pregnancy issues! Can abort! Observe for: Fever pattern Joint inflammation Limitation of motion Location and degree of discomfort Fatigability Monitor weight and I&O Collect 24-hour urine sample Assess neurological status Explain nature of disease Provide support Ambulatory and home care: Emphasize health teaching Reiterate that adherence to treatment does not necessarily halt progression Minimize exposure to precipitating factors Psychosocial issues Counsel patient and family that SLE has good prognosis Physical effects can lead to isolation & self-esteem and body image disturbances Assist patient in developing goals

PUD S/S

-pain -dyspepsia -cramping, burning -anorexia, nausea, vomiting -bleeding -low H&H -gastric or fecal occult blood may be found -weight loss -black tarry stools -coffee ground emesis

TB S/S

-persistent cough >3 weeks -purulent sputum -fatigue/lethargy -anorexia -hemoptysis (coughing up blood) -dyspnea -fever -night sweats Older adult clients present with atypical symptoms. -altered mentation -unusual behavior -fever -anorexia -weight loss

Interventions for hypocalcemia

1. Ca supplements PO or IV 2. Aluminum Hydroxide reduces Phosphorus levels, causing the countereffect of increasing Ca 3. Seizure precautions 4. Move pt. carefully, monitor for pathological fracture 5. Keep 10% calcium gluconate available for tx of acute calcium deficit 6. Consume food high in Ca.

5 R's of inflammatory response

1. Recognition of agent 2. Recruitment of leukocytes 3. Removal of agent 4. Regulation/control of response 5. Resolution/repair

Non-rebreather

10-15 L/m Bag must be inflated at all times. If not, turn O2 up.

Percent of water in fetus

100%

A patient weighing 133 points is prescribed to receive 50mL/kg IV fluid over the next 24 hours. How many mL per hour will the patient need to receive?

125mL/hr

What to watch for immediately post-op

Signs of bleeding

Positive intradermal TB test within

2-10 weeks of exposure

Normal HCO3

22-26 mEq/L acidosis < 22 - 26 > alkalosis

When to watch for signs of infection post-op

24 hours after procedure

Cellular component responsible for prostaglandin formation, pain, and fever.

Arachidonic acid

Normal PaCO2

35-45 mmHg alkalosis < 35 - 45 > acidosis CO2 is an acid. Decreased CO2 increases pH.

Pneumonia diagnostic testing

Sputum culture & sensitivity before starting antibiotic therapy CBC (WBC 4,100-11,200) ABGs (PaO2 < 80 mmHg) Blood culture (rule out organisms in blood) Serum electrolytes (dehydration) Chest x-ray Pulse ox

Venturi Mask

4-12 L/m Can deliver an exact concentration of oxygen.

Simple facemask

4-5 L/m

Normal WBC Count

4000-11000

A patient is being seen in the emergency department for vomiting and diarrhea that has lasted 4 days. The patients current weight is 154 pounds. The nurse has initiated IV fluid therapy. What hourly urine measurement, based on weight, would indicate to the nurse that efforts to rehydrate this client have been successful?

40mL/hr (0.5mL/kg/hr)

Percent of water in elderly

55%

Partial rebreather

6-10 L/m

Percent of water in adult

60%

Normal pH

7.35-7.45 acidosis < 7.35 - 7.35 > alkalosis

Percent of water in infant

80%

Normal PaO2

80-100 mmHg

HIV stages (1-3) (know s/s, care, meds and teaching, safety)

Stage 1 - asymptomatic. CD4+ >500 Stage 2 - asymptomatic. CD4+ 200-499 Stage 3 - symotomatic. CD4+ <200 Stage 4 - no information available.

Peptic Ulcer Disease (3-5) (know prevention, s/s, care, diagnostics, nutrition, teaching, meds and med education)

A break or ulceration in the protective mucosal lining of the lower esophagus, stomach, or duodenum. Hydrochloric acid in stomach can eat through layers once lining is broken. Ulcers form opposite of acid-forming cells.

Biliary stasis

A condition in which bile is stagnant and allowed to develop into sludge or stones. In elderly and pregnancy.

Chronic fatigue syndrome

A debilitating and complex disorder characterized by profound fatigue that is not improved by bed rest and may be made worse by physical or mental activity.

Respiratory acidosis

A drop in blood pH due to hypoventilation (too little breathing) and a resulting accumulation of Co2.

Inflammation

A localized response to an injury or to the destruction of tissues Inflammation in itself can also cause tissue damage. "redness and swelling with heat and pain."

A nurse is caring for a client who was in a MVA. The client reports chest pain and difficulty breathing. A chest x-ray reveals the client has a pneumothorax. Which of the following ABG findings should the nurse expect? A. pH 7.06 PaO2 86 PaCO2 52 HCO3- 24 B. pH 7.42 PaO2 100 PaCO2 38 HCO3- 23 C. pH 6.98 PaO2 100 PaCO2 30 HCO3- 18 D. pH 7.58 PaO2 96 PaCO2 38 HCO3- 29

A. pH 7.06 PaO2 86 PaCO2 52 HCO3- 24

nurse is providing information about a new prescription for corticosteroid cream to a client who has mild psoriasis. Which of the following instructions should the nurse include? (Select all that apply.) A. Apply an occlusive dressing after application. B. Apply 3-4 times a day. C. Wear gloves after application to lesions on the hands. D. Avoid applying to skin folds. E. Use medication continuously over a period of several months.

A. Apply an occlusive dressing after application. C. Wear gloves after application to lesions on the hands. D. Avoid applying to skin folds.

A nurse is reviewing nutrition teaching for a client who has cholecystitis. The nurse should identify that which of the following food choices can trigger cholecystitis? A. Brownie with nuts B. Bowl of mixed fruit C. Grilled turkey D. Baked potato

A. Brownie with nuts

A nurse is monitoring a group of clients for increased risk of pneumonia. Which of the following clients should the nurse expect to be at risk? (Select all that apply.) A. Client who has dysphagia B. Client who has AIDS C. Client who was vaccinated for pneumococcus and influenza 6 months ago D. Client who is postoperative and has received local anesthesia E. Client who has a closed head injury and is receiving ventilation F. Client who has myasthenia gravis

A. Client who has dysphagia B. Client who has AIDS E. Client who has a closed head injury and is receiving ventilation F. Client who has myasthenia gravis

A nurse is admitting a client who reports N/V and weakness. The client has dry oral mucous membranes. Which of the following findings should the nurse identify as manifestations of fluid volume deficit? (Select all that apply.) A. Decreased skin turgor B. Concentrated urine C. Bradycardia D. Low-grade fever E. Tachypnea

A. Decreased skin turgor B. Concentrated urine D. Low-grade fever E. Tachypnea

A nurse is assessing a client who has hyperkalemia. The nurse should identify which of the following conditions as being associated with this electrolyte imbalance? A. Diabetic ketoacidosis B. Heart failure C. Cushing's syndrome D. Thyroidectomy

A. Diabetic ketoacidosis

A nurse is admitting an older adult client who is experiencing dyspnea, weakness, weight gain of 2#, and 1+ bilateral edema of the lower extremities. The client has a temp of 99º F, pulse 96, respirations 26, O2S 94% on 3L O2 NC, BP 152/96. Which of the following manifestations of fluid volume excess should the nurse expect? (Select all that apply.) A. Dyspnea B. Edema C. Bradycardia D. Hypertension E. Weakness

A. Dyspnea B. Edema D. Hypertension E. Weakness

A nurse is caring for a client who has a serum potassium of 5.4 mEq/L. The nurse should assess for which of the following manifestations? A. ECG changes B. Constipation C. Polyuria D. Paresthesia

A. ECG changes

A nurse is preparing to administer a dose of a new prescription of prednisone to a client who has COPD. The nurse should monitor for which of the following adverse effects of this medication? (Select all that apply) A. Hypokalemia B. Tachycardia C. Fluid retention D. Nausea E. Black, tarry stools

A. Hypokalemia C. Fluid retention E. Black, tarry stools

A nurse in a clinic is teaching a client who has ulcerative colitis. Which of the following statements by the client indicates understanding of the teaching? A. I will plan to limit fiber in my diet B. I will restrict fluid intake during meals C. I will switch to black tea instead of drinking coffee D. I will try to eat three moderate to large meals a day

A. I will plan to limit fiber in my diet

A charge nurse is teaching a group of nurses about conditions related to metabolic acidosis. Which of the following statements by a unit nurse indicates the teaching has been effective? A. Metabolic acidosis can occur due to diabetic ketoacidosis B. Metabolic acidosis can occur in a client who has myasthenia gravis C. Metabolic acidosis can occur in a client who has asthma D. Metabolic acidosis can occur due to cancer

A. Metabolic acidosis can occur due to diabetic ketoacidosis

A nurse in a clinic is caring for a client whose parter states the client woke up this morning, did not recognize him, and did not know where she was. The client reports chills and chest pain that is worse upon inspiration. Which of the following actions is the nursing priority? A. Obtain baseline vitals and oxygen saturation B. Obtain a sputum culture C. Obtain a complete history from the client D. Provide a pneumococcal vaccine

A. Obtain baseline vitals and oxygen saturation

A nurse in an outpatient clinic is assessing a client who reports night sweats and fatigue. He states he has had a cough along with nausea and diarrhea. His temp is 100.6º F. The client is afraid he has HIV. Which of the following actions should the nurse take? (Select all that apply.) A. Perform a physical assessment B. Determine when manifestations began C. Teach the client about HIV transmission D. Draw blood for HIV testing E. Obtain a sexual history

A. Perform a physical assessment B. Determine when manifestations began E. Obtain a sexual history

A nurse is assessing a client for HIV. The nurse should identify that which of the following are risk factors associated with this virus? (Select all that apply.) A. Perinatal exposure B. Pregnancy C. Monogamous sex partner D. Older adult women E. Occupational exposure

A. Perinatal exposure -women who are pregnant should take precautionary measures to prevent exposure D. Older adult women -vaginal dryness, thinning of vaginal wall E. Occupational exposure -healthcare workers, etc.

A nurse is providing information about tuberculosis to a group of clients at a local community center. Which of the following manifestations should the nurse include in the teaching? (Select all that apply.) A. Persistent cough B. Weight gain C. Fatigue D. Night sweats E. Purulent sputum

A. Persistent cough C. Fatigue D. Night sweats E. Purulent sputum

A nurse is reviewing the plan of care for a client who has systemic lupus erythematous. The client reports fatigue, joint tenderness, swelling, and difficulty urinating. Which of the following lab findings should the nurse anticipate? (Select all that apply.) A. Positive ANA titer B. Increased HGB C. 2+ urine protein D. Increased serum C3 and C4 E. Elevated BUN

A. Positive ANA titer C. 2+ urine protein E. Elevated BUN

A nurse is working in an outpatient clinic is assessing a client who has RA. The client reports increased joint tenderness and swelling. Which of the following findings should the nurse expect? (Select all that apply.) A. Recent influenza B. Decreased range of motion C. Hypersalivation D. Increased blood pressure E. Pain at rest

A. Recent influenza B. Decreased range of motion E. Pain at rest

A nurse in the emergency department is completing an assessment of a client who has suspected stomach perforation due to a peptic ulcer. Which of the following findings should the nurse expect? (Select all that apply.) A. Rigid abdomen B. Tachycardia C. Elevated blood pressure D. Circumoral cyanosis E. Rebound tenderness

A. Rigid abdomen B. Tachycardia E. Rebound tenderness

A nurse is teaching a client who has a duodenal ulcer and a new prescription for esomeprazole. Which of the following information should the nurse include in the teaching? (Select all that apply) A. Take the medication 1hr before meals B. Limit NSAIDs when taking this medication C. Expect skin flushing when taking this medication D. Increase fiber intake when taking this medication E. Chew the medication thoroughly before swallowing

A. Take the medication 1hr before meals B. Limit NSAIDs when taking this medication

A nurse is discharging a client who has COPD. Upon discharge, the client is concerned that he will never be able to leave his house now that he is on continuous oxygen. Which of the following is an appropriate response by the nurse? A. There are portable oxygen delivery systems that you can take with you. B. When you go out, you can remove the oxygen and then reapply it when you get home. C. You probably will not be able to go out as much as you used to. D. Home health services will come to you so you will not need to get out.

A. There are portable oxygen delivery systems that you can take with you.

A nurse is caring for a client who has a serum sodium level of 133 and serum potassium of 3.4. The nurse should recognize that which of the following treatments can result in these laboratory findings? A. Three tap water enemas B. 0.9% sodium chloride solution IV at 50mL/hr C. 5% dextrose with 0.45% sodium chloride solution with 20 mEq of K+ IV at 80mL/hr. D. Antibiotic therapy

A. Three tap water enemas

A nurse is caring for a client who is suspected of having HIV. The nurse should identify that which of the following diagnostic tests and lab values are used to confirm an HIV infection? (Select all that apply.) A. Western blot B. Indirect immunofluorescence assay C. CD4+ T-lymphocyte count D. HIV RNA quantification test E. CSF analysis

A. Western blot B. Indirect immunofluorescence assay (CD4+ is to determine the stage, not whether or not the virus is present.)

A nurse is teaching a client who has a new diagnosis of RA. Which of the following statements should the nurse include in the teaching? A. You can experience morning stiffness when you get out of bed. B. You can experience abdominal pain C. You can experience weight gain D. You can experience low blood sugar.

A. You can experience morning stiffness when you get out of bed.

Asthma Diagnostic Tests

ABG Oxygen saturation H&H X-Ray Sputum samples Peak expiratory flow rate (PEFR)

Second spacing

Abnormal accumulation of interstitial fluid (edema)

Metabolic acidosis

Abnormal condition of high hydrogen ion concentration in the extracellular fluid caused by either a primary increase in hydrogen ions or a decrease in bicarbonate.

Causes of Hypokalemia

Actual total body potassium loss -Excessive use of meds such as diuretics and corticosteroids -Increased secretion of aldosterone (Cushing's Syndrome) -Vomiting, diarrhea -Wound drainage (gastrointestinal) -Prolonged nasogastric suction -Excessive diaphoresis -Renal disease impairing reabsorption of potassium Inadequate intake of potassium -Fasting -NPO Movement of potassium from the extracellular fluid to intracellular fluid -Alkalosis -Hyperinsulinism Dilution of serum potassium -Water intoxication -IV therapy with potassium poor solutions

Types of inflammation

Acute and chronic

Infection interventions

Administer antimicrobials Hand hygiene to prevent HAIs Patient Education Immunizations Refer to the CDC website about immunizations. It is important to know which vaccines are live or dead.

Interventions for hypercalcemia

Administer fluids Administer medications as ordered Furosemide (Lasix) Pamidronate (Aredia) Zoledronic Acid (Zometa) Calcitonin Hemodialysis

Risk of TB transmission decreases when?

After 2-3 weeks of anti tuberculin therapy.

Clients with TB are no longer considered infectious when?

After 3 consecutive negative sputum cultures. Client may return to work.

Tuberculosis precautions

Airborne -place client in negative pressure airflow room -wear gloves when assisting with oral hygiene -nurse should wear N95 respirator mask -use antimicrobial sanitizer for hands -client should wear surgical mask when transported -only dispose of sputum in provided plastic bags or no-touch receptacles.

What is the role of the inflammatory response? Neutralize the threat Remove necrotic tissue Prepare injured area for healing and repair All of the above

All of the above

Psoriatic arthritis

An inflammatory arthritis associated with psoriasis of the skin

Pneumonia complications

Atelectasis -Inflammation and edema lead to alveolar collapse --> increased risk of hypoxia -Diminished or absent breath sounds over affected area -Chest x-ray shows area of density Bacteremia (sepsis) -Pathogens enter blood stream Acute respiratory distress syndrome -Persistent hypoxemia despite oxygen therapy -Dyspnea worsens, bilateral pulmonary edema -Chest x-ray with area of density with ground-glass appearance -Hypercarbia combined with decreased O2 sat

SLE Client education

Avoid prolonged sun exposure Use mild protein shampoo, avoid harsh hair treatments Steroid creams for skin rash Report edema Report evidence of infection from immunosuppression Avoid crowds SLE medications X pregnancy

Ulcerative colitis

Chronic inflammation of the colon with presence of ulcers

If a patient is prescribed a corticosteroid (beclomethasone) and a bronchodilator (albuterol), which should be given first?

B before C. *B*ronchodilator first to open airway, then *c*orticosteroid. *A*lbuterol before *b*eclomethasone

COPD risk factors

Cigarette smoking Occupational chemicals & dust Air pollution Genetics Aging

A nurse is caring for a client who has pneumonia. Assessment findings include temperature 100º F, respirations 30/m, blood pressure 130/76, heart rate 100bpm, and SaO2 91% on room air. Prioritize the following nursing interventions. A. Administer antibiotics B. Administer oxygen therapy C. Perform sputum culture D. Administer an antipyretic medication to promote client comfort

B. Administer oxygen therapy C. Perform sputum culture A. Administer antibiotics D. Administer an antipyretic medication to promote client comfort

A nurse is teaching a client who has a history of psoriasis about photochemotherapy and ultraviolet light (PUVA) treatments. Which of the following instructions should the nurse include in the teaching? A. Apply vitamin A cream before each treatment. B. Administer psoriasis medication before treatment C. Use this treatment every evening. D. Remove the scales gently following each treatment

B. Administer psoriasis medication before treatment

A nurse is providing discharge teaching to a client who is postoperative following open cholecystectomy with T-tube placement. Which of the following instructions should the nurse include in the teaching? (Select all that apply.) A. Take baths rather than showers. B. Clamp tube for 1 hour before and after meals C. Keep the drainage system above the level of the abdomen D. Expect to have the tube removed 3 days postoperatively E. Report brown-green drainage to the provider

B. Clamp tube for 1 hour before and after meals C. Keep the drainage system above the level of the abdomen

A nurse is completing discharge teaching with a client who has Chron's disease. Which of the following instructions should the nurse include in the teaching? A. Decrease intake of calorie-dense food B. Drink canned protein supplements C. Increase intake of high fiber foods D. Take a bulk-forming laxative daily

B. Drink canned protein supplements

A nurse is reviewing the serum laboratory data of a client who has an acute exacerbation of Chron's disease. Which of the following tests should the nurse expect to be elevated? (Select all that apply.) A. HCT B. ESR C. WBC D. Folic acid E. Albumin

B. ESR C. WBC

A nurse is caring for a client who has RA. Which of the following lab tests are used to diagnose this disease? (Select all that apply) A. Urinalysis B. ESR C. BUN D. ANA titer E. WBC count

B. ESR D. ANA titer E. WBC count

A nurse is educating a female client on the use of calcipotriene topical medication for the treatment of psoriasis. Which of the following information should the nurse include? (Select all that apply.) A. Recommended or facial lesions B. Expect a stinging sensation upon application C. Apply to the scalp D. Obtain a pregnancy test E. Limit application to skin folds

B. Expect a stinging sensation upon application C. Apply to the scalp D. Obtain a pregnancy test E. Limit application to skin folds

A nurse is caring for a client who has a nasogastric tube attached to low intermittent suctioning. The nurse should monitor for which of the following electrolyte imbalances? A. Hypercalcemia B. Hyponatremia C. Hyperphosphatemia D. Hyperkalemia

B. Hyponatremia

A nurse is reinforcing teaching to a client on the purpose of taking a bronchodilator. Which of the following client statements indicates an understanding of the teaching? A. This medication can decrease my immune response B. I take this medication to prevent asthma attacks C. I need to take this medication with food. D. This medication has a slow onset to treat my symptoms

B. I take this medication to prevent asthma attacks

A home health nurse is teaching a client who has active tuberculosis. The provider has prescribed the following medication regimen: -Isoniazid 250mg PO daily -Rifampin 500mg PO daily -Pyrazinamide 750mg PO daily -Ethambutol 1mg PO daily Which of the following client statements indicate the client understands the teaching? (Select all that apply.) A. I can substitute one medication for another if I run out because they all fight infection. B. I will wash my hands each time I cough. C. I will wear a mask when I am in a public area. D. I am glad I don't have to have any more sputum specimens. E. I don't need to worry where I go once I start taking my medications.

B. I will wash my hands each time I cough. C. I will wear a mask when I am in a public area.

A nurse is caring for a client who is experiencing respiratory distress. Which of the following early manifestations of hypoxemia should the nurse recognize? (Select all that apply.) A. Confusion B. Pale skin C. Brazycardia D. Hypotension E. Elevated blood pressure

B. Pale skin E. Elevated blood pressure

A nurse is caring for a client who has SLE and is experiencing an episode of Raynaud's phenomenon. Which of the following findings should the nurse anticipate? A. Swelling of joints of the fingers. B. Pallor of toes with cold exposure C. Feet that become reddened with ambulation D. Client report of intense feeling of heat in the fingers.

B. Pallor of toes with cold exposure

A nurse is caring for a client who has contact dermatitis and a new prescription for diphenhydramine. For which of the following adverse effects should the nurse monitor? A. Elevated blood glue levels B. Urinary retention C. Hyperpigmentation of the skin D. Insomnia

B. Urinary retention

A nurse is caring for a client who has dyspnea and will receive oxygen continuously. Which of the following oxygen devices should the nurse use to deliver a precise amount of oxygen to the client? A. Nonrebreather B. Venturi mask C. Nasal cannula D. Simple face mask

B. Venturi mask

A nurse in the emergency department is caring for a client who is having an acute asthma attack. Which of the following assessments indicates that the respiratory status is declining? (select all that apply.) A. SaO2 95% B. Wheezing C. Retraction of sternal muscles D. Pink mucous membranes E. Premature ventricular complexes

B. Wheezing C. Retraction of sternal muscles E. Premature ventricular complexes

A nurse is completing preoperative teaching for a client who is scheduled for a laparoscopic cholecystectomy. Which of the following should be included in the teaching? A. The scope will be passed through your rectum B. You might have shoulder pain after surgery C. You will have a Jackson-Pratt drain in place after surgery D. You should limit how often you walk for 1-2 weeks

B. You might have shoulder pain after surgery

A nurse is teaching a client who has tuberculosis. Which of the following statements should the nurse include in the teaching? A. You will need to continue taking the medication regimen for 4 months. B. You will need to provide sputum samples every 4 weeks to monitor the effectiveness of the medication. C. You will need to remain hospitalized for treatment. D. You will need to wear a mask at all times.

B. You will need to provide sputum samples every 4 weeks to monitor the effectiveness of the medication.

A nurse is assessing a client who has a history of asthma. Which of the following factors should the nurse identify as a risk for asthma? A. gender B. environmental allergies C. alcohol use D. race

B. environmental allergies

A nurse is reviewing ABG lab results of a client who is in respiratory distress. The results are pH 7.47, PaCO2 32, HCO3 22. The nurse should recognize that the client is experiencing which of the following acid-base imbalances? A. respiratory acidosis B. respiratory alkalosis C. metabolic acidosis D. metabolic alkalosis

B. respiratory alkalosis

A home health nurse is seeing a patient with congestive heart failure. The patient is taking furosemide. The nurse notes the patient's most recent serum potassium is 3.4. Which food would the nurse encourage this patient to choose from the dinner menu?

Banana

A nurse is caring for a client admitted with confusion and lethargy. The client was found at home unresponsive with an empty bottle os aspirin lying next to her bed. Vital signs reveal BP 104/72, HR 116 with regular rhythm, respirations 42 and deep. Which of the following ABG findings should the nurse expect? A. pH 7.68 PaO2 96 PaCO2 38 HCO3- 28 B. pH 7.48 PaO2 100 PaCO2 28 HCO3- 23 C. pH 6.98 PaO2 100 PaCO2 30 HCO3- 18 D. pH 7.58 PaO2 96 PaCO2 38 HCO3- 29

C. pH 6.98 PaO2 100 PaCO2 30 HCO3- 18

A nurse is completing an assessment of a client who has a gastric ulcer. Which of the following findings should the nurse expect? (Select all that apply.) A. Client reports pain relieved by eating B. Client states that pain often occurs at night C. Client reports a sensation of bloating D. Client states that pain occurs 30m-1hr after a meal E. Client experiences pain upon palpation of the epigastric region

C. Client reports a sensation of bloating D. Client states that pain occurs 30m-1hr after a meal E. Client experiences pain upon palpation of the epigastric region

A nurse is assessing a client who has been taking prednisone following an exacerbation of IBD. The nurse should recognize which of the following findings as the priority? A. Client reports difficulty sleeping B. The client's urine is positive for glucose C. Client reports having an elevated body temperature D. Client reports gaining 4# in the last 6 months

C. Client reports having an elevated body temperature

A nurse in a clinic is reviewing the laboratory reports of a client who has suspected cholelithiasis. Which of the following is an expected finding? A. Serum amylase 80 units/L B. WBC 9,000/mm3 C. Direct bilirubin 2.1 mg/dL D. Alkaline phosphate 25 units/L

C. Direct bilirubin 2.1 mg/dL

A nurse is providing discharge teaching to a client who has COPD and a new prescription for albuterol. Which of the following statements made by the client indicates an understanding of the teaching? A. This medication can increase my blood sugar levels B. This medication can decrease my immune response C. I can have an increase in my heart rate while taking this medication D. I can have mouth sores while taking this medication

C. I can have an increase in my heart rate while taking this medication

A nurse is teaching a client who has SLE about self-care. Which fo the following statements by the client indicates an understanding of the teaching? A. I should limit my time to 10 minutes in the tanning bed. B. I will apply powder to any skin rash. C. I should use a mild hair shampoo D. I will inspect my skin once a month for rashes

C. I should use a mild hair shampoo

A nurse is completing discharge teaching for a client who has an infection due to H. Pylori. Which of the following statements by the client indicates an understanding of the teaching? A. I will continue my prescription for corticosteroids B. I will schedule a CT scan to monitor improvement C. I will take a combination of medications for treatment D. I will have my throat swabbed to recheck for this bacteria

C. I will take a combination of medications for treatment

A nurse is providing discharge teaching to a client who has a new prescription for prednisone for asthma. Which of the following client statements indicates an understanding of the teaching? A. I will decrease my fluid intake while taking this medication B. I will expect to have black, tarry stools C. I will take my medication with meals D. I will monitor for weight loss while on this medication

C. I will take my medication with meals

A nurse is teaching a client who has a new prescription for sulfasalazine. Which of the following instructions should the nurse include in the teaching? A. Take the medication 2hr after eating B. Discontinue this medication if your skin turns yellow-orange C. Notify the provider if you experience a sore throat D. Expect your stools to turn black

C. Notify the provider if you experience a sore throat

A nurse is providing teaching to the parent of a child who has contact dermatitis. Which of the following information should the nurse include? A. Use fabric softener dryer sheets when drying the child's clothing. B. Apply a warm, dry compress to the rash area. C. Place the child in a bath with colloidal oatmeal. D. Leave the child's hands uncovered during the night.

C. Place the child in a bath with colloidal oatmeal.

A nurse is planning to instruct a client on how to perform pursed-lip breathing. Which of the following should the nurse include in the plan of care? A. Take quick breaths upon inhalation B. Place your hand over your stomach C. Take a deep breath in through your nose D. Puff your cheeks upon exhalation

C. Take a deep breath in through your nose

A nurse is assessing a client for Chvostek's sign. Which of the following techniques should the nurse use to perform this test? A. Apply a blood pressure to the client's arm B. Place the stethoscope bell over the client's carotid artery C. Tap lightly on the client's cheek D. Ask the client to lower her chin to her chest

C. Tap lightly on the client's cheek

A nurse is caring for a client who has a new diagnosis of tuberculosis and has been placed on a multi medication regimen. Which of the following instructions should the nurse give the client related to ethambutol? A. Your urine can turn dark orange. B. Watch for changes in the sclera of your eyes. C. Watch for changes in vision. D. Take vitamin B6 daily.

C. Watch for changes in vision.

A nurse is preparing to administer a new prescription for Isoniazid to a client who has tuberculosis. The nurse should instruct the client to report which of the following findings as an adverse effect of the medication? A. You might notice yellowing of your skin. B. You might experience pain in your joints. C. You might notice tingling of your hands. D. You might experience a loss of appetite.

C. You might notice tingling of your hands.

Interventions for hypomagnesemia

CARDIAC monitor Magnesium sulfate IV may be prescribed in severe cases Seizure precautions Monitor Mg levels obviously. Monitor for diminished DTR's

HIV diagnostic tests

CBC (anemia, thrombocytopenia, leukopenia) Platelets ↓ PCR HIV blood testing - ELISA Western blot test Polymerase Chain Reaction

Porcelain gallbladder

Calcification of the gallbladder wall due to chronic inflammation. Becomes hard and blue. Typically have cholecystectomy, because cell damage and inflammation raises risk of gallbladder cancer.

Gall stones

Can be pigment/bilirubin (dark; usually seen on xray) or cholesterol (light; not visible with X-ray). Cholesterol are more irritating to the gallbladder and more inflammatory.

B Cells

Cells manufactured in the bone marrow and are released from the spleen. Produce antibodies. Become plasma and memory cells when stimulated.

COPD diagnostic studies

Chest x-rays History and physical exam Pulmonary function studies Spirometry ABG ECG can show signs of right ventricular failure BQ scan- scan of lungs if detect clots

Cellulitis (1-3) (know meds and education, care, teaching)

Infection of skin cells

COPD (4-6) (know s/s, care, meds and teaching, nutrition, complications)

Chronic Obstructive Pulmonary Disease Chronic bronchitis, emphysema. Not curable

Fibromyalgia (1-3) (know s/s, meds and teaching, syndrome teaching, and evaluation)

Chronic condition with widespread aching and pain in the muscles and fibrous soft tissue. Widespread pain above and below the waist, worst in the morning. Pain lasting longer than 3 months Pain not associated with any condition CFS symptoms IBS

Diagnose infection

Culture & Sensitivity CBC-D X-Ray/CT

A nurse is assessing a client who has a new diagnosis of SLE. Which of the following findings should the nurse expect? A. Weight gain B. Petechiae on thighs C. Systolic murmur D. Alopecia

D. Alopecia

A nurse is caring for a client 2 hr after admission. The client has an SaO2 of 91%, exhibits audible wheezes, and is using accessory muscles when breathing. Which of the following classes of medications should the nurse expect to administer? A. antibiotic B. Beta-blocker C. antiviral D. Beta2 agonist

D. Beta2 agonist

A nurse is providing teaching for a client who has stage 2 HIV disease and is having difficulty maintaining a normal weight. Which of the following statements made by the client should indicate to the nurse an understanding of the teaching? A. I will choose a diet high in fat to help gain weight B. I will be sure to eat three large meals daily C. I will drink up to 1 liter of liquid each day D. I will add high-protein foods to my diet

D. I will add high-protein foods to my diet

A nurse is providing teaching for a client who has stage 3 HIV disease. Which of the following statements by the client should indicate to the nurse an understanding of the teaching? A. I will wear gloves while changing the pet litter box B. I will rinse raw fruits with water before eating them C. I will wear a mask when around family members who are ill D. I will cook vegetables before eating them

D. I will cook vegetables before eating them

A nurse is instructing a client on the use of an incentive spirometer. Which of the following statements by the client indicates an understanding of the teaching? A. I will place the adapter on my finger to read my blood oxygen saturation level B. I will lie on my back with my knees bent C. I will rest my hand over my abdomen to create resistance D. I will take a need breath and hold it before exhaling

D. I will take a need breath and hold it before exhaling

A nurse is teaching a client who has a new diagnosis of dumping syndrome following gastric surgery. Which of the following should the nurse include in the teaching? A. Eat three moderate-sized meals a day B. Drink at least one glass of water with each meal C. Eat a bedtime snack that contains a milk product D. Increase protein in the diet

D. Increase protein in the diet

A nurse is caring for an older adult client in a long-term care facility. The client has become weak and confused. He ate 40% of his breakfast and lunch. The client's temp is 100.9º F, pulse 92, respirations 20, BP 108/60. He has lost 3/4# and reports dizziness when assisted to the bathroom. He also has a nonproductive cough with diminished breath sounds in the right lower lobe. Which of the following actions should the nurse take? A. Initiate fluid restrictions to limit intake. B. Observe for signs of peripheral edema. C. Encourage the client to ambulate to promote oxygenation. D. Monitor for ortho-hypo.

D. Monitor for ortho-hypo.

A nurse is assessing a client who is dehydrated for fluid volume deficit. Which of the following findings should the nurse expect in the client? A. Moist skin B. Distended neck veins C. Increased urinary output D. Tachycardia

D. Tachycardia

A nurse is reviewing a new prescription for Ursodiol with a client who has cholelithiasis. Which of the following information should the nurse include in the teaching? A. This medication is used to decrease acute biliary pain. B. This medication requires thyroid function monitoring every 6 months. C. This medication is nor recommended for clients who have diabetes mellitus. D. This medication dissolves gallstones gradually over a period of up to 2 years.

D. This medication dissolves gallstones gradually over a period of up to 2 years.

A nurse is obtaining ABGs for a client who has vomited for 24hr. The nurse should expect which of the following acid-base imbalances? A. respiratory acidosis B. respiratory alkalosis C. metabolic acidosis D. metabolic alkalosis

D. metabolic alkalosis

Pneumonia (4-6) (know s/s, prevention, care, teaching, meds and med education)

Infection of the lungs caused by microbes -Community-acquired pneumonia (CAP) is most common as a complication of influenza. -Healthcare-associated pneumonia (HAP) has higher mortality rate and more likely to be antibiotic-resistant. Usually takes 24-48 hours from time of exposure.

Causes of hyperphosphatemia

Decreased renal excretion -Renal insufficiency Tumor lysis syndrome Increased intake of phosphorous Hypoparathyroidism

Causes of hypernatremia

Decreased sodium excretion -Corticosteroids -Cushing's Syndrome -Renal failure -Hyperaldosterone Increased sodium intake -Excessive oral sodium ingestion -Administration of sodium containing IV fluids Decreased water intake -Fasting -NPO Increased water loss -Increased rate of metabolism -Fever -Hyperventilation -Infection -Excessive diaphoresis -Watery diarrhea -Diabetes insipidus

White blood cells

Destroys bacteria, viruses, and toxic proteins Assists the body in developing immune responses Defends the body against diseases

Dermatitis treatments

Do not use occlusive dressings. Discontinue when rash clears up, not lifelong.

Osmosis

Draws the solvent from a less concentrated solute across a semi-permeable membrane into a more concentrated solute. Equalizes the concentration of the solvent.

Pneumonia precautions

Droplet

COPD S/S

Dyspnea Chronic cough Sputum production Wheezing/chest tightness Tripod-ing Clubbed nails Prolongued expiration Barrel chest "Pursed lip" breathing Hypoxemia Hypercapnia Polycythemia

A nurse is assessing a client who has pancreatitis. The client's ABGs reveal metabolic acidosis. Which of the following are expected findings? (Select all that apply.) A. Tachycardia B. Hypertension C. Bounding pulses D. Hyperreflexia E. Dysrhythmia F. Tachypnea

E. Dysrhythmia F. Tachypnea

Asthma risk factor

Elderly Smoking Allergies Family history GERD Exposure

Bile

Emulsifies fat

Hypovolemia Medical Management

Encourage p.o fluids IV therapy

Atopic dermatitis

Excess inflammation; dry skin, redness, and itching from allergies and irritants.

Edema

Excessive fluid in interstitial space. From decreased oncotic pressure, increased or normal hydrostatic pressure

Causes of hyperkalemia

Excessive potassium intake -Overingestion of foods or meds -Rapid infusion of potassium-containing IV solutions Decreased potassium excretion -Potassium sparing diuretics -Renal failure -Adrenal insufficiency such as Addison's disease Movement of potassium from the intracellular fluid to extracellular fluid -Acidosis -Tissue damage -Hyperuricemia -Hypercatabolism

Contact dermatitis

Exposure to chemical or mechanical irritation (detergent, tight pants). Well demarcated rash. Distribution depends on contact.

Steatorrhea

Fat in the feces

Lupus S/S

Fatigue/malaise Alopecia Blurred vision Pleuritic pain Anorexia Depression Joint pain, swelling, tenderness Fever Anemia Lymphadenopathy Pericarditis Butterfly rash over nose and cheeks

RA risk factors

Female (3:1) 20-50 years genetics Epstein-Barr virus Stress Elderly

Pneumonia S/S

Fever Chills Anxiety Fatigue Chest discomfort from coughing SOB Diaphoresis (excessive sweating) Yellow-tinged sputum Crackles/wheezes Dull chest percussion over areas of consolidation Decreased O2 saturation Possible purulent, blood-tinged or rust-colored sputum

Systemic inflammation

Fever Leukocytosis Antibody production

Intravascular compartment

Fluid that is within blood vessels

Bilirubin

Formed by the breakdown of hemoglobin when red blood cells are destroyed, released by the liver in bile.

Acute cholecystitis

Gallstone gets lodged in the cystic duct or the common bile duct, causing acute inflammation, pain, and sometimes infection.

IBD risk factors

Genetics Caucasians (UC) Jewish Tobacco use (Chron's) Incidence peaks at adolescence to young adulthood for females Older adulthood for males

Interventions for hyperphosphatemia

Give calcium with vitamin D Restrict phosphorus Diuretics Restrict dark sodas (not clear)

Dressings for wet/purulent wounds

Goal is to absorb the moisture. Use alginate, hydro fiber, foam, or dry gauze.

Dressings for dry wounds

Goal is to add moisture. Use hydrogen, hydrocolloid, or moist or vaseline gauze.

Dressings for moist wounds

Goal is to maintain moistness. Use hydrocolloid, hydro fiber, foam, or moist gauze.

PUD diagnostic testing

H&H H. Pylori testing Stool sample for H. Pylori and blood Urea breath testing, BUN, Creatinine Esophagogastroduodenoscopy (EGD) -monitor vitals until sedation wears off -monitor for perforation (pain, bleeding, fever)

IBD diagnostic tests

HCT (35-52%) & HGB (11.5-17.3) ↓ ESR (0/0-15/20 F, 0/0-20/30 M) ↑ CRP (?) ↑ Albumin (3.5-5) ↓ Stool occult for blood (+) K+ (3.5-5.1), Mg (1.7-2.7), Ca (8.4-10.2) ↓ B12 (0.8-8) ↓ Magnetic resonance enterography Colonoscopy Barium enema CT or MRI Endoscopy

Infection prevention

Hand washing Break chain of infection Isolation precautions Asepsis

Prevent PUD

Handwashing to prevent H. Pylori infection Stop smoking Avoid NSAIDs Proton pump inhibitor Mucosal protectants Antacids Limit caffiene Prepare foods properly

Hypervolemia diagnostics

Hemoglobin, Hematocrit, BUN and urine specific gravity - will be decreased. Chest X-Ray - will show fuzziness or congestion. ABG Weigh Daily

Hypovolemia Diagnostics

Hemoglobin, Hematocrit, Sodium, BUN, Creatinine, Protein will all be elevated

Basophils release ______ which is responsible for vasodialation and increased capillary permeability. Serotonin Histamine Kinins Progtaglandin

Histamine

Interventions for hypernatremia

If cause is fluid loss, prepare to administer IV infusions If cause is inadequate renal secretion of sodium, prepare to administer diuretics that promote sodium loss Restrict sodium and fluid intake as prescribed

Patho of RA

Immune complexes deposited in the synovial membrane or articular cartilage in the joints Inflammatory response; neutrophils release enzymes that damage articular cartilage and thicken synovial lining Joint changes from chronic inflammation invades surrounding cartilage, ligaments, tendons, and joint capsule "Pannus" forms within the joint, resulting in contracture and joint laxity Fibrous adhesions may form, causing joint immobility and deformities

Lupus (2-4) (know s/s, diagnostics, teaching, care, meds and med education, evaluation for effectiveness)

Immune system attacks tissues causing redness, pain, swelling, and damage. Affects the connective tissues of multiple organ systems and can lead to major organ failure. Discoid or systemic. Temporary form can be medication-induced.

Vascular changes in acute inflammation

Increase in blood flow to bring cells and proteins to the site of the injury by vasodilation and increased vascular permeability.

Causes of hypercalcemia

Increased calcium absorption -Excessive oral intake of calcium -Excessive oral intake of Vitamin D Decreased calcium excretion -Renal failure -Use of thiazide diuretics Increased bone resorption of calcium -Hyperparathyroidism -Hyperthyroidism -Malignancy (bone destruction from metastatic tumors) -Immobility -Use of glucocorticoids Hemoconcentration -Dehydration -Use of lithium -Adrenal insufficiency

Causes of hypermagnesemia

Increased magnesium intake -Magnesium-containing antacids and laxatives -Excessive admin of magnesium by IV Decreased renal excretion of magnesium -Renal insufficiency

Causes of hyponatremia (1-3) (know s/s, interventions, management of care, and diagnostics FOR ALL SODIUM IMBALANCES)

Increased sodium excretion -Excessive diaphoresis -Diuretics -Vomiting and Diarrhea -Wound drainage -Renal disease -Decreased secretion of aldosterone Inadequate sodium intake -NPO -Low salt diet Dilution of serum sodium -Excessive ingestion of hypotonic fluids or irrigation with hypotonic fluids -Renal failure -Freshwater drowning -Syndrome of Inappropriate antidiuretic hormone secretion -Hyperglycemia -CHF

Hypovolemia s/s (2-4) (know s/s, meds and education, care, diagnostics, and evaluation)

Increased temp Rapid/weak pulse Increase respiration Hypotension Anxiety Urine specific gravity >1.030 High H&H

Dyspepsia

Indigestion

Tuberculosis (1-3) (know care, teaching, safety, meds & med teaching)

Infectious disease caused by Mycobacterium tuberculosis, transmitted through aerosolization. Can be active or latent. Only small percentage of people infected with TB actually develop active form. Can lie dormant for many years before producing the disease. Primarily affects the lungs, but can spread to any organ in the flood.

Inflammatory bowel disease (3-5) (know s/s, nutrition, surgical interventions, and diagnostic procedures)

Inflammation of the colon and small intestine Chron's & Ulcerative Colitis

Patho of IBD

Inflammation of the mucosa Chronic inflammation leads to scarring and atrophy of the colon

Causes of hypocalcemia

Inhibition of calcium absorption from the GI tract -inadequate intake of calcium -lactose intolerance -Malabsorption Syndrome (Celiac Sprue or Crohn's Disease) -Inadequate intake of Vitamin D -End-stage renal disease Increased Calcium excretion -Renal failure, polyuric phase -Diarrhea -Steatorrhea -Wound drainage, especially GI Conditions that decrease the ionized fraction of calcium -Hyperproteinemia -Alkalosis -Meds such as calcium chelators or binders -Acute pancreatitis -Hyperphosphatemia -Immobility -Removal or destruction of the parathyroid gland

Causes of hypomagnesemia (1-3) (know s/s, care, diagnostics, complications, meds and teaching FOR ALL POTASSIUM/MAGNESIUM IMBALANCES)

Insufficient magnesium intake -Malnutrition and starvation -Vomiting diarrhea -Malabsorption syndrome -Celiac disease -Crohn's disease Increased magnesium secretion -Meds such as diuretics -Chronic alcoholism Intracellular movement of magnesium -Hyperglycemia -Insulin administration -Sepsis

Causes of hypophosphatemia

Insufficient phosphorous intake -Malnutrition and starvation Increased phosphorous excretion -Hyperparathyroidism -Malignancy -Use of magnesium-based or aluminum hydroxide-based antacids Intracellular shift -Hyperglycemia -Respiratory alkalosis

TB diagnostic tests

Intradermal TB test QuantiFERON-TB Gold (active or latent) Mantoux test Chest x-ray Acid-fast bacilli smear and culture

Mantoux test

Intradermal injection of tubercle bacilli Read within 48-72 hours Induration (palpable, raised, hardened area) >10mm indicates positive - >5mm for immunocompromised clients A positive result indicates that the client has declined an immune response. It does not mean that active disease is present.

Rheumatoid arthritis (1-3) (know s/s, meds and teaching, care, diagnostics)

Joints and some organs of other body systems are attacked.

Asthma prevention

Lifestyle changes Smoking cessation Relaxation techniques Prophylactic Inhalors: Albuterol 10-15min before Exercise

Local inflammation

Limited to the area of injury

TB complications

Military TB Organism invades bloodstream. Can spread to multiple body organs. *-headaches, neck stiffness, drowsiness* life-threatening Pericarditis -dyspnea, swollen neck veins, pleuritic pain, and hypotension from accumulation of flood in pericardial sac. Inhibits heart's ability to pump effectively.

Interventions for hypokalemia

Monitor cardio, resp, neuro-mus, GI, and renal status Place on cardiac monitor Monitor electrolyte values Administer potassium supplements orally or IV as prescribed Institute safety measures for the client experiencing muscle weakness Potassium-losing diuretic will be replaced for potassium sparing diuretic Teach about foods high in potassium

Interventions for hypermagnesemia

Monitor cardio, resp, neuromus, and CNS status; place on cardiac monitor Diuretics are prescribed to increase renal excretion of magnesium IV administered calcium chloride or calcium gluconate may be prescribed to reverse the effects of magnesium on cardiac muscle Instruct to restrict dietary intake of magnesium Instruct to avoid laxatives and antacids containing magnesium

Filtration

Movement by hydrostatic pressure from an area of higher to lower concentration.

Diffusion

Moving from higher concentration to lower. Solute is dissolved

Risk factors for PUD

NSAIDs H. pylori Caffeine intake Smoking Socioeconomic status/dirty water Type O blood Pernicious anemia Stress

Inflammatory bowel disease S/S

Nausea/vomiting Abdominal cramps Fever Fatigue Anorexia Weight loss Steatorrhea Low grade fever

Cellulitis complications

Necrotizing skin infection

Cholecystitis S/S

Normal -Right upper quadrant pain radiating to right -scapula, usually after meals -Murphy's sign (pain with deep inspiration during right subcostal palpation) -Blumberg's sign (rebound tenderness) -Fat intolerance -Flatulence -Dyspepsia -Diaphoresis -Nausea, vomiting -Chills -Fever Increasing severity -Possible jaundice -Steatorrhea -Dark urine because of bilirubin Immediate attention -Rigid, board-like abdomen if gallbladder ruptures and stones enter abdominal cavity.

First spacing

Normal distribution of fluid in ICF and ECF

HIV medications

Nucleoside reverse transcriptase inhibitors (NRTIs) -Zidovudine Nonnucleoside reverse transcriptase inhibitors (NNRTIs) -Delavirdine -Efavirenz Protease inhibitors -Indinavir -Nelfinavir -Atazanavir -Saquinavir Fusion inhibitors -Enfuvirtide Entry inhibitors -Maraviroc Integrase inhibitors -Raltegravir Antineoplastic medication -Interleukin

Cholecystitis complications

Obstruction of the bile duct -ischemia, gangrene, and rupture -rupture can cause local abscess or peritonitis (rigid, board-like abdomen) *requires surgery and broad spectrum antibiotics* Bile peritonitis -when adequate amounts of bile are not drained from surgical site. *potentially fatal* -monitor for pain, fever, jaundice Postcholecystectomy syndrome -manifestations of gallbladder disease continue after surgery.

RA s/s

Pain with rest or movement morning stiffness pleuritic pain dry mouth anorexia parasthesias recent illness/stressor joint pain/swelling fever muscle weakness/atrophy reddened sclera, abnormal pupils lymph node enlargement

Risk for cellulitis

Patients with impaired circulation Trauma

Interventions for hyperkalemia

Place on CARDIAC MONITOR RESTRICT K Impaired renal function, give Sodium Polystyrene Sulfonate (Kayexalate) Dialysis if K is critically high IV calcium is hyperkalemia is severe to avert myocardial excitability. Hypertonic glucose w/ insulin to move excess potassium into the cells. Avoid salt substitutes

Acid-fast bacilli smear and culture

Positive shows active infection - obtain 3 early morning sputum samples in PPE and negative airflow room.

Cholelithiasis

Presence of stones in the gallbladder. Stones can obstruct the pancreatic duct and cause pancreatitis. Can cause gallbladder rupture, resulting in secondary peritonitis.

Pneumonia nursing actions

Promote deep breathing Position client to high-fowlers Oxygen therapy (monitor for skin breakdown with devices) Incentive spirometer Structure client-oriented activity Promote nutrition & fluid > 3L/d

Function of immune system

Provides protection against infection and disease

Asthma medications

Quick relief (rescue) -Short-acting β2 agonists, systemic corticosteroids Long term (preventer) -Corticosteroids, antiallergy agents, NSAIDS, long-acting β2 agonists, leukotriene modifiers (Singulair), long-acting bronchodilators, nebulizers Theophylline: monitor serum levels-ER settings Leukotriene modifiers-(Singulair) block inflammation & bronchospasm effects Chest physiotherapy Breathing exercises; physical training

Cellular events of acute inflammation

Recruitment of leukocytes, activation of leukocytes, destruction of invaders, production of mediators by phagocytosis.

Fibromyalgia treatment

Regular aerobic exercise (gradually increase to prevent crashes) Good sleep hygiene. Cognitive behavioral therapy Massage Relaxation therapy Medications reserved for those who fail above treatment. Duloxetine or milnacipran (SSRIs) Pregabalin helps treat pain, muscle stiffness,

A patient is seen in the emergency department for a sprain. What initial interventions should the nurse teach the patient for treatment of this soft tissue injury? Hyperbaric therapy and passive range of motion Antipyretic and antibiotic drug therapy Warm, moist heat and debridement Rest, ice, compression, and elevation

Rest, ice, compression, and elevation

Chronic cholecystitis

Results from the intermittent obstruction of the cystic duct by gallstones. Epithelial cells surrounding gallbladder begin to die from chronic inflammation.

Eczema dermatitis

Symmetrical

Cellulitis medications

Systemic antibiotic

T Cells

T cells are produced in the in the bone marrow and move to the thymus where they mature Helper cells and natural killer cells

Third spacing

The accumulation and sequestration of trapped extracellular fluid in an actual or potential body space as a result of disease or injury. Ascites, burn edema.

Osmolality

The concentration of solutes in body fluids

Intracellular compartment

The fluid part of the body contained within cells

Extracellular compartment

The fluid space of the body that exists outside the cells

Hydrostatic pressure

The force exerted by the weight of a solution.

A patient is having a heart attack and needs to go for an angiogram STAT. The cardiologist has written an order for the patient to receive 40mEq of potassium chloride in 250mL NS IV over an hour for severe hypokalemia of 2.9 mEq/L. At what rate should the nurse set the pump?

The infusion rate is too fast, the nurse should not give the KCl at that rate. 10 mEq/hr is the fastest you can infuse Potassium.

Rokitansky-Aschoff sinuses

Tiny pockets within the gallbladder wall caused by constant inflammation with chronic cholecystitis.

Why a combination or meds for TB?

To treat antibiotic resistant TB due to non-compliance. Treatment usually lasts 6-12 months.

Psoriasis treatment

Topical STEROIDS -warm, moist occlusive dressings after applying a cream for 8 hours a day. Do not apply to skin folds or scalp. Apply as prescribed, but may need medication vacation for overuse. TAR preparations (PSORALEN drug class). -can cause stinging and burning, staining of clothes, and has a strong odor. Usually worn at night so only pajamas are stained and odor can be showered off in the morning. Vitamin D (Calcitrol) -prevents cellular proliferation. Risk of hypercalcemia. Limit sun exposure due to risk of skin cancer. Vitamin A -slows cellular division and reproduction. Cannot be used in pregnancy, and avoid sun exposure. Methotrexate -cytotoxic. Can cause bone marrow suppression and thrombocytopenia. Contraindicated in pregnancy. Increased risk of infection. Biologics (-cept, -mab) -report signs of infection. Lifelong treatment. Increases risk of cancer. Cyclosporine -immunosuppressant if they do not respond to other therapies PUVA treatments -photochemotherapy and ultraviolet light. monitor for redness and tenderness. Extreme photosensitivity. Can lead to cataracts, skin cancer, and premature skin aging.

IBD surgical interventions

Ulcerative colitis -colectomy with or without ilestomy Chron's -laparoscopic stricturoplasty to increase diameter of bowel -surgical repair of fistulas

Brown gallstones

Usually sign of a biliary tract infection, stones have likely ventured into the bile duct. Caused by E. Coli, Ascaris Lumbricoides, or Clonorchis Sinensis (endemic to Asia - more common in Asian populations).

Diagnostic tests for cholecystitis

WBC (4,100-11,200) for infection bilirubin (0-1 critical 12) for bile duct obstruction amylase (60-160) and lipase (20-180) for pancreatic duct obstruction/pancreatitis AST (0-40), lactate (0.7-2.1), alk. Phos (35-129) for common bile duct obstruction Ultrasound Abdominal x-ray or CT scan Hepatobiliary scan (HIDA) -assesses potency of biliary duct with IV contrast Endoscopic retrograde cholangiopancreatography -direct visualization using an endoscope through esophagus into common bile duct via duodenum. -can perform a sphincterotomy with gallstone removal. Magnetic resonance cholangiopancreatography -oral & IV contrast with MRI to determine *cause* of cholelithiasis.

SLE risk factors

Women between 20-40 African American, Asian, or Native American Incidence declines in women following menopause, but remains steady in men.

Rheumatoid Arthritis Diagnostics

Xrays -determine degree of joint destruction and monitor progression Athrocentesis -synovial fluid aspiration by needle -shows increased WBCs and RF Anti CCP Rheumatoid factor Inflammation ESR ANA CRP

Asthma (2-4) (know s/s, care, diagnostics, teaching, evaluation)

a chronic inflammatory disorder of the airways that causes air passages to become narrow or blocked, making breathing difficult.

Organs of immune system

bone marrow, thymus gland, spleen, lymph nodes, tonsils, appendix

Foods that can cause gas

dark leafy green vegetables, beer, carbonated beverages, dairy products, and corn.

Metabolic alkalosis

elevation of HCO3- usually caused by an excessive loss of metabolic acids

HIV S/S

fatigue weight loss muscle or joint pain painful or swollen glands night sweats fever

Infection

invasion of the body by a pathogenic organism

Interventions for chronic pain

long-acting or controlled release opioids lister regularly monitor non-pharm pain relief self-care noise control educate resources

Dietary sources of protein

meats (poultry, pork, beef), fish, legumes (soybeans), tree nuts, vegetables, eggs, and some diary (cheese and milk)

Determining alkalosis/acidosis

pH determines alkalosis/acidosis PaCO2 - respiratory HCO3 - metabolic

Foods to decrease gas (p. 304)

yogurt, crackers, and toast.