Next Gen Practice and Understanding

Pediatric Asthma: Clinical tests

1. Clinical diagnosis -No specific test is definitive -Based on symptoms and history -Confirmed with Spirometry Can be used with kids >5-6 years Helps assess effectiveness of treatment Done at least every year Peak Flow Meter -Evaluates how much air they can blow out in 1 second -Always double check child's technique -Establish personal best when asthma is stable -Then use to assess severity of asthma exacerbation Green (80-100% of personal best) = no concerns Yellow (50-79% of personal best) = caution Red (<50% of personal best) = medical emergency Allergen Testing -Skin and inhaled Others -Exercise challenges -Radiograph

PPH: Nursing concepts

1. Clotting 2. Perfusion

PPH: Pt. Education

1. S/S to report to provider (bleeding) 2. Can occur up to 2 weeks postpartum

Pediatric Asthma: Patho

Abnormal, heightened airway reactivity --Exposure to trigger --→Inflammation + Mucus --Bronchospasm (decreases size of airway) --Airflow obstruction --Airway remodeling (long-term changes to lungs, scarring)

Pediatric Gastrointestinal Dysfunction-Diarrhea: Acute vs Chronic

Acute: -Infectious -Rotavirus Chronic: -Malabsorption or Inflammation -Inflammatory Bowel Disease -Food allergies

Fracture: Cast

Alignment Immobilization Monitor for: swelling pain circulation sensation

COPD: Assessment

Barrel chest - expanded rib cage due to ↑ work of breathing and air trapping. Finger Clubbing Accessory muscle use -Adventitious breath sounds -Diminished -Crackles -Wheezes Congestion on Chest X-ray ABG → ↓ pH, ↑ pCO2, ↓ PaO2

DM: Type II

Beta cells do not produce enough insulin for body's needs OR - Body becomes resistant to insulin Lifestyle-related May or may not require insulin, depending on severity

Fracture: Compartment syndrome

Emergent intervention required to prevent loss of limb Fasciotomy required to relieve pressure -Once pressure goes down, can be closed or covered with skin graft

AKI nursing concepts

Fluid and electrolyte balance: -daily weights -strict I&O -monitor electrolytes and replace as needed -fluid restriction in oliguric phase Elimination: - monitor urine output: normal >30 mL/hr -look for progression from oliguric to diuretic phase -monitor for STI -prepare pt for dialysis

Fracture: Traction

Force applied in opposite direction to immobilize fracture Ensure proper alignment of the body 1. Buck's Traction- force applied to splint 2. Skeletal Traction- pin inserted through bone to hold traction force --Meticulous pin care --Weights should hang freely from bed: 1. do not set them on floor 2. do not remove weights without provider order 3. support weight when sliding up in bed

Pediatric Gastrointestinal Dysfunction-Diarrhea: The nurse caring for a 15-year-old with Crohn's disease knows which of the following are clinical manifestations of this disease? Select all that apply.

Growth restriction Crohn's disease is a type of inflammatory bowel disease that can cause malnutrition which if left untreated can affect long term growth. Mouth sores The inflammation that occurs in Crohn's disease can affect any part of the GI tract, including the mouth. Perianal lesions The inflammation that occurs in Crohn's disease can affect any part of the GI tract, including the anus. Rectal bleeding This is seen more commonly in ulcerative colitis. Weight loss Crohn's disease is a type of inflammatory bowel disease that can affect a client's nutritional status and cause weight loss.

Fracture: Nursing Concepts

Mobility Perfusion Comfort

MI- patient has a chief complaint of heartburn: what is the nurses immediate priority?

call for an EKG: client will simultaneously have vital signs taken

M.O.N.A

morphine: reduces pain, reduce myocardial workload oxygen: improve oxygenation, reduce ischemia nitrates: vasodilation, decrease workload and O2 demand aspirin: decrease platelet aggression, decrease mortality - contraindicated in inferior MI

Nursing concepts for MI

perfusion oxygenation

MI- medication that prevents heart attacks?

propranolol: this is a beta blocker that is used to treat hypertension, angina, arrhythmias, and heart attacks

AKI causes

Prerenal:decreased blood flow to the kidneys, accounts for majority of cases- hypotension, hypovolemia, decreased cardiac output (heart failure/shock) Intrarenal: damage within the kidneys themself- tubular necrosis, infection, obstruction, contrast dye, nephortoxic medications Postrenal: damage between the kidney and urethral meatus backs up, causing damage to kidneys-infection, calculi, obstruction

Pediatric Gastrointestinal Dysfunction-Diarrhea: The nurse is assessing a client and knows that which of the following findings are common with cholera infection? Select all that apply.

Rice-watery stools This is a common signs of cholera, which causes severe dehydration due to the watery stools, and wrinkled hands due to the severity of the dehydration. Grey stools Grey stools are indicative of gall bladder issues. Wrinkled hands This occurs with cholera due to severe dehydration. Pitting edema There is no fluid excess to cause pitting edema due to the excessive dehydration in the client with cholera. Black tarry stools This is indicative of upper GI bleeding.

Anemia: A nurse is caring for a client in the emergency department. The nurse suspects that this client is experiencing pernicious anemia. What sign or symptom would suggest this?

Tonsilloliths This refers to stones that form on the tonsils from poor dental hygiene and smoking. Fruity breath Clients in DKA often have fruity odor on their breath. This does not occur with pernicious anemia. Red, beefy tongue A client with pernicious anemia is missing vitamin B12 due to a lack of intrinsic factor in the GI system. Symptoms can include diarrhea or constipation, nausea, fatigue, loss of appetite, and a swollen, red tongue or bleeding gums. Strawberry red tongue A clients with a strawberry red tongue may have Kawasaki disease.

Pediatric Gastrointestinal Dysfunction-Diarrhea: Assess for malnutrition

Weight loss Growth restriction Delayed puberty Decreased energy Pallor

MI NOTE:

women often present with atypical symptoms and will often describe a feeling of acid reflex that is actually a heart attack clients receiving heparin are at an increased risk for bleeding-- a fall can be very detrimental

COPD: causes

smoking ( 75% of all COPD causes) long-term exposure to lung irritants genetics asthma age >40 y/o

Acute Kidney Injury (AKI)

sudden loss of renal function usually reversible or resolves on its own (1-2 weeks) leads to permanent damage if not reversed quickly --(CKD)

CVA: The nurse is caring for a client who had a hemorrhagic stroke. The nurse should question which of the following orders?

55 heart rate This is a little low but not concerning. The hypertension is the biggest concern since hypertension increases the bleeding risk. 210/112 mmHg BP High BP with hemorrhagic strokes are concerning for causing increased amount of brain bleeding. Hypertension is the main cause of hemorrhagic stroke and this increases the risk of bleeding more. 130 heart rate This is tachycardia and expected with a bleed. This is not as concerning as the hypertension since hypertension increases the bleeding risk. 90/53 mmHg BP This is a normal blood pressure, even if slightly low, and not as much of a concern at this time.

Pediatric Asthma: Triggers

A- allergens (seasonal, animal, food) S- sport or smoking T-temperatures (change in season, cold air) H- hazards (chemicals) M- microbes (infection) A- anxiety

COPD: Nursing concepts

Oxygenation -Listen to lungs -Monitor SpO2 (88-92%) -Caution with supplemental O2 - Do not give excessive supplemental O2 - aim for SpO2 88-92% only Gas Exchange -Monitor ABG -Monitor for s/s CO2 toxicity↓ LOC↓ RR Comfort-Encourage position of comfort

Anemia: Nursing Concepts

Oxygenation -May require supplemental oxygen -Monitor s/s poor oxygenation -Assess for dyspnea Perfusion -Monitor vital signs -Assess for chest pain Nutrition -If caused by nutritional deficiencies - provide supplements as ordered -Educate patient on food choices

Nursing assessment for MI

Pt may present with: chest pain: bursing, squeezing, crushing, radiation of pain, shortness of breath irregular heart rate altered vital signs: hypertension, tachycardia, abnormal EKG, low O2 saturation altered labs: troponins, lipid profile, CBC/BMP

What is the R.I.C.E method used for in Strains and Sprains?

R-rest I-ice C-compression E-elevation

Pediatric Gastrointestinal Dysfunction-Diarrhea: Assessment- Identify cause

Recent travel Dietary changes

DM: Complications- Dawn Phenomenon

Reduced insulin sensitivity between 5-8am Evening insulin administration may help

Preeclampsia: Therapeutic Management

SAFETY 1. Delivery of the baby is the only cure - If it is safe to keep the baby in longer, and safe for the baby, they will keep the mom pregnant 2. Magnesium sulfate is given prophylactically -Lowers BP - Seizure prevention - If progressed, the pt. can become eclampsia meaning that she has a seizure 3. Some antihypertensive drugs might be given to manage BP ex: labetalol 4. Fetal Assessment -IUGR: Intrauterine Growth Restriction -will monitor measurements

Pediatric Gastrointestinal Dysfunction-Diarrhea

Defined asStool volume > 10 g/kg/day in younger children >200 g/day in older children 9% of hospitalization in the US for children under 5 years of age May lead to dehydration, hypokalemia, metabolic acidosis, and death

Anemia: Therapeutic Management

Depends of type: 1. Assess for occult blood 2. Monitory laboratory studies (Hgb, Hct) 3. Increase iron intake in diet -Green leafy vegetables -Organ meat 4. Provide Iron or B12 supplements -Administer IM via Z-track method -Take PO Iron on an empty stomach 5. Limit visitors to patients with aplastic anemia -Will also have ↓ WBCs

COPD: Emphysema and Chronic Bronchitis

Destruction of alveoli due to chronic inflammation Decreased surface area for gas exchange ---------------------------------- Chronic airway inflammation with productive cough Excessive sputum production

Diabetes Pathophysiology

Diabetes: Type 1 occurs when there is an autoimmune (the body attacks the pancreas) response. The beta cells are attacked and can no longer produce and secrete insulin. Insulin is necessary to take sugar from the blood to the cells for energy. Without insulin delivery sugar to the cells, hyperglycemia (high blood sugar) occurs. Type II DM usually occurs because of genetics and or environmental factors. In type II the pancreas either does not secrete enough insulin or has difficulty with insulin action and insulin resistance occurs in the cells. Hyperglycemia occurs because the cells are resistant to insulin or because there is not adequate insulin production/secretion. When the body can not sufficiently move sugar from the blood to the cells, blood sugars rise and hyperglycemia occurs.

COPD: Therapeutic Management

Do NOT give O2 > 2 lpm Stimulus to breathe = ↓ O2 Chest Physiotherapy (CPT) -Loosen secretions Increase fluid intake (3 L / day) -Thin secretions Medications -Bronchodilators -Corticosteroids -Steroids (decrease inflammation)

COPD: The nurse knows that this patient is experiencing the most common respiratory symptoms. Please select the assessment items that are most common and require rapid follow-up by the nurse. Select all that apply

Dyspnea Cough Sputum production fever Wheezing

PPH: Assessment

Early: first 24 hours Late: after the first 24 hours Loss of 500 ml of blood for vaginal delivery Loss of 1000 ml of blood for c-section Boggy uterus on assessment or puddle of blood or constant ooze or trickle Saturating pads within 15 minutes or puddle of blood in bed --Remember that chucks pad under the patient Signs of shock - decreased LOC, restless, pale, diaphoretic, hypotensive, tachycardic, weak --Restlessness and tachycardia are early signs --Hypotension is a late sign

Anemia: A 25-year-old client is being treated for chronic anemia with iron, but it is not bringing up the client's red blood cell count. Which of the following medications is most likely the next line of treatment for this client?

Enalapril This is an ACE inhibitor that helps to manage hypertension and CHF. Escitalopram This is an SSRI antidepressant. Enoxaparin This is an anticoagulant used to treat or prevent clots such as DVT. Epoetin This is a hormone that stimulates erythropoiesis in the bone marrow to help treat anemia

Pediatric Gastrointestinal Dysfunction-Diarrhea: The nurse caring for a dehydrated six-year-old with diarrhea knows which of the following viruses is a common cause of childhood diarrhea?

Adenovirus This is a virus that usually causes cold and respiratory symptoms. It is not a common cause of diarrhea in children Parvovirus Parvovirus is the viral cause of the illness often referred to as "slapped-cheek disease" because it causes a distinctive facial rash. It does not usually cause diarrhea. Cytomegalovirus Cytomegalovirus is a common virus that goes undetected in most people because they are asymptomatic. It is not a common cause of diarrhea in children. Rotavirus Rotavirus is one the most common causes of diarrhea in children.

CVA: The nurse knows that identifying early condition changes are critical to impacting hemorrhagic stroke survival rates. Which of the following interventions should the nurse anticipate in the acute hemorrhagic stroke phase? Select all that apply

Adjust oxygen based on O2 Saturations Provide a quiet environment with the head of the bed elevated. Monitor vital signs for increasing blood pressure Monitor for seizures Observe for neurological deficits Observe for mood changes Assess higher functions like speech, memory, and cognition

Pediatric Gastrointestinal Dysfunction-Diarrhea: The nursing is providing care to a five-year-old who is mildly dehydrated after 48 hours of acute diarrhea. The nurse knows which of the following to be true regarding therapeutic management?

Antimotility drugs should be started immediately Antimotility drugs are not recommended in children due to side effects. The child should be started on the B.R.A.T. diet as soon as possible The Bananas, Rice, Applesauce, Toast diet is not recommended for pediatric clients due to it's low fat and low nutritional content. The child needs to be NPO until the diarrhea resolves Children are encouraged to eat a regular diet as soon as they can tolerate it to help lessen the severity of the illness. Oral rehydration is the preferred method of rehydrating Oral rehydration is safer, more effective, and less painful for children.

AKI pt education

Avoid foods high in sodium or potassium - caution salt substances made with potassium chloride Educate on fluid restriction S/S to report to nurse or provider especially chest pain

Anemia: A client with hemolytic anemia has jaundice. What advice does the nurse give?

Avoid scratching Jaundice is a symptom of hemolytic anemia, caused by a build-up of bilirubin in the body. This causes severe itching, but the client should avoid scratching because this can worsen the condition and cause breaks in the skin. The client should not use soap when bathing and bathe in tepid water to avoid pruritis. Watch for left upper abdominal pain Pain from the liver, if present, would be in the right upper quadrant of the abdomen. Use bar soap when bathing Bar soap can be drying and should be avoided. Bathe in hot water for comfort Hot water also causes dry skin, so this should be avoided.

DM: The nurse is teaching foot and skin care to a client with diabetes. Which of the following education points is appropriate?

Encourage cutting the nails with rounded corners The nails should be cut straight across. Encourage daily inspection of the feet The nurse should encourage daily inspection of the feet, because a client with diabetes may develop reduced sensation. It is important to catch any irritation or wound early in order to prevent complications associated with poor circulation and difficulty healing in the client with this condition. Encourage the use of flip-flops whenever possible Instead, the client should wear a firm, supportive shoe to protect the feet. Encourage the use of a heating pad to the feet Due to reduced sensation, the client should not use heat. Heat carries the risk of inadvertent burns.

COPD: The nurse is caring for a client with COPD who is admitted with pneumonia. Which of the following nursing considerations is most appropriate for this client?

Encourage small, frequent meals Small frequent meals help prevent hypoxia, rather than large long meals. Provide supplemental oxygen at 5 L/ min via nasal cannula Supplemental oxygen at this level is not necessarily appropriate, because the client may not need this high of a level. The oxygen rate depends on how the client's oxygen level responds to supplemental oxygen. Bedrest to conserve energy Bedrest is unnecessarily restrictive. Fluid restriction of 2L A client with COPD should increase their fluid intake to keep secretions thin. A fluid restriction is not appropriate.

Preeclampsia: A 34 week pregnant client is seen for a routine prenatal visit. She is asked how she is feeling and tells the nurse "I've had a horrible headache for 2 days and my rings suddenly won't fit on my fingers". What is the priority nursing action? Select all that apply.

Explain that this is normal in pregnancy This might not be normal and requires further assessment and feelings should not be minimized towards the client. Administer Acetaminophen Acetaminophen can be suggested for a headache but is not the priority nursing action because we need to assess for preeclampsia with a urine sample and blood pressure. Obtain a urine sample A urine sample should be collected to check for proteinuria since this is a sign of preeclampsia. This is a priority. Administer an antidiuretic The edema is a possible sign of worsening preeclampsia. Further assessment should be performed prior to intervention. Assess blood pressure Blood pressure should be assessed to see if her blood pressure is elevated, causing the headache and increase in swelling. Another sign of preeclampsia. This is another priority assessment.

Fractures: Complications

Fat Embolism: -Risk with long-bone fractures -Piece of fat from bone marrow moves through bloodstream to lungs Compartment Syndrome: -Increased pressure within compartment in extremity after fracture or crush injury -Cuts off circulation to muscles and nerves

DM: Complications- Lipohypertrophy

Fatty mass at insulin injection site (rotate sites)

Fracture: Assessment

Fracture: -Assess distal circulation -Pulses -Skin temperature -Color Assess distal nerve function: -Numbness -Tingling -May see obvious deformity -May see ecchymosis over fractured area Fat Embolism: =Anxiety, restlessness -Tachypnea, dyspnea Compartment Syndrome: -Pale skin -Extreme swelling -Loss of pulses or sensation distal to injury

Pediatric Gastrointestinal Dysfunction-Diarrhea: Assessment- Assess bowel characteristics

Frequency Blood Mucous

CVA: The nurse knows there are underlying physiological changes that will need to be addressed in order to mitigate the effects of intracranial hemorrhage. Select 4 medications that the nurse might anticipate the client receiving to address the client's clinical condition and prevent potential complications.

Fresh Frozen plasma IV Labetalol Tissue Plasminogen Activator Vitamin K Nicardipine

PPH: A postpartum client reports a big gush of blood. What is the nurse's priority action?

Fundal assessment This is the priority to see if the uterus is firm and massage if it is not. Fundal massage promotes uterine contractions which helps the uterus clamp down and stop bleeding. If the fundus is left boggy or soft, the bleeding could continue to get worse. It is also important to check the fundal location to assess for subinvolution. Subinvolution could cause hemorrhage as well. Weigh the pads It is important to weigh pads to quantify blood loss but this is not the priority. First check and massage the fundus to prevent worsening of bleeding. Give oxytocin The first priority is to assess the fundus and if it is boggy it needs to be massaged. If massage doesn't work and the uterus needs to be contracted then oxytocin can be given. Never give a medication without assessing first. Change her pad and reassess This ignores the problem. First assess the fundus firmness and location.

Pediatric Gastrointestinal Dysfunction-Diarrhea: Nursing concepts

Gastrointestinal/Liver Metabolism Fluid & Electrolyte Balance Elimination

CVA: The nurse is caring for a client admitted for hemorrhagic stroke 12 hours ago. The nurse should make sure the bed is in which position?

HOB flat A client who had a hemorrhagic stroke should not be positioned to increase intracranial pressure. The head of the bed should be at least 30 degrees. HOB elevated 45 degrees The head of the bed should be at 30 degrees for the first 24 hours following a hemorrhagic stroke. HOB elevated 15 degrees A client who had a hemorrhagic stroke should not be positioned to increase intracranial pressure. The head of the bed should be at least 30 degrees. HOB elevated 30 degrees To maintain a steady intracranial pressure and improve venous return, the client with an acute hemorrhagic stroke (less than 24 hours) should have the head of the bed at 30 degrees.

Pediatric Gastrointestinal Dysfunction-Diarrhea: A client has diarrhea. What should the nurse expect when auscultating the abdomen?

Hyperactive bowel sounds In a case of diarrhea, bowel sounds will be hyperactive. This is due to increased activity of the bowels when this condition is present.

AKI: A client has acute renal failure. Which of the following is the most serious complication of acute renal failure?

Hyperkalemia Acute renal failure causes an increase in certain serum electrolytes, including potassium and sodium. The most serious complication of acute renal failure is hyperkalemia, because this affects the client's heart rhythm and is potentially fatal.

CVA: Risk factors

Hypertension Substance Abuse (cocaine) Anticoagulant Therapy Trauma

Preeclampsia

Hypertensive disorder Proteinuria-has to have protein in urine After 20 weeks gestation Delivery- the only cure

Pediatric Gastrointestinal Dysfunction-Diarrhea: Assessment- Assess dehydration and fluid and electrolyte imbalances

Hypokalemia is common

PPH: A nurse is caring for a postpartum client that had a blood loss of 1,200 mL after vaginal delivery. Which of the following are priorities to include in her plan of care? Select all that apply.

Hysterectomy This is not necessary if the patient is stable and bleeding has stopped. There is no indication that the client is unstable or continuing to bleed in the stem of the question. Frequent fundal assessments The fundus should be examined frequently to ensure it stays firm and no more bleeding occurs. This may initially be done every hour, then spread out to every 2-4 hours depending on the progression. CBC in 6 hours A CBC should be checked in no more than 6 hours to see what the H&H are after the hemorrhage. It takes time for the lab work to catch up with the blood loss, so there is no need to check one right away as it will likely not show the extent of the blood loss. Aspirin for pain With this much blood loss we don't want to give anything that could cause more bleeding. A better option would be acetaminophen or a low-dose opioid analgesic until the bleeding has definitely subsided. Encourage bottle feeding The patient can still breastfeed and it would be encouraged

COPD: A client with COPD is receiving care at the primary provider's clinic with worsening of symptoms of emphysema. The provider orders an outpatient chest x-ray to determine if there have been any changes in lung structure. Which best describes what would show on a chest x-ray in the later stages of emphysema?

Increased size of the heart Emphysema does not enlarge the heart. Flattened diaphragm Emphysema is a form of COPD that occurs when the walls of the lung alveoli are destroyed. The lungs are no longer flexible in their ability to expand and contract normally, so the lungs become large and hyperinflated. Their increased size presses on the diaphragm at the base of the lung field so that it appears low and flattened on a chest x-ray. A mediastinal shift to the right Mediastinal shift occurs when there is a pneumothorax, not from late-stage emphysema. Plaque formation scattered throughout the lung This is not indicative of emphysema.

COPD: Pathophysiology

COPD stands for chronic obstructive pulmonary disease and includes emphysema, chronic bronchitis, and asthma. In a healthy individual air sacs are elastic and expand as the person inhales. When the healthy individual exhales the air sacs will then deflate. In COPD the air sacs are not as stretchy and are damaged with inflammation and thickness. The airways become obstructed with mucus. These factors make breathing and gas exchange a challenge.

Preeclampsia: A nurse is caring for a client with preeclampsia that is suffering from some vision changes. What is the best explanation by the nurse that describes what caused this condition?

Central nervous system swelling Vision changes are a serious side effect of preeclampsia from central nervous system swelling due to poor protein metabolism and hypertension. Normal pregnancy vision changes Vision changes are a sign that preeclampsia is worsening from CNS swelling. Uncontrolled diabetes Vision changes are a sign that preeclampsia is worsening from CNS swelling, there is no mention of the client being diabetic. Retinopathy that will resolve with delivery of the infant This is not a true diagnosis. The client is experiencing CNS swelling.

CVA: Based on the EHR information, select the assessment items requiring immediate follow-up by the nurse. Select all that apply:

Changes in the level of consciousness Locate last chest Xray Identify transfer facility Control blood pressure Headache Nausea Airway/ventilation management

DM: Complications- Somogyi Phenomenon

Night time hypoglycemia results in rebound hyperglycemia in the morning hours Bedtime snack may help

COPD: Pt. Education

Smoking Cessation Small, frequent meals Identify and avoid triggers Pursed lip breathing - helps complete expiration Proper use of inhalers Follow up

Fracture: A pediatric nurse is caring for a 2-year-old child who suffered a femur fracture. The child has a cast on the leg and has been placed in Bryant's traction. Which of the following considerations must the nurse implement when working with a child who uses this traction?

The knee must be maintained at a 90-degree angle This type of traction requires the leg to be straight. Provide the child with a liquid or mechanical soft diet Diet type and traction of a broken bone are not related. Perform range-of-motion of the affected hip every 4 hours The affected limb must be immobilized. Maintain the buttocks at a level just above the mattress of the bed Bryant's traction is used for a fracture of the femur in some children. A child who uses Bryant's traction is typically less than 2 years old and weighs less than 30 pounds. While caring for this child, the nurse should ensure that the buttocks are at a level just above the mattress of the bed, as this form of traction pulls the legs and hips straight up off the bed.

PPH: Risk factors

a. Previous hemorrhage b. Multiples c. Large fetus d. Multiple pregnancies e. Preeclampsia f. Prolonged labor g. Precipitous labor h. Assisted delivery i. Placenta previa j. Placental abruption

PPH: Main causes

a. Uterine atony is the inability of the uterus to contract (most common). --Number 1 cause b. Injury to the birth canal during delivery c. Retention of tissue from the placenta or fetus d. Bleeding disorders (coagulopathies) - the most dangerous being DIC The most common causes of postpartum hemorrhage are known by the "4 T's" - Tone, Trauma, Tissue, Thrombin Disorders. Tone, or uterine atony, is suspected when the uterus is large and boggy, and clots are seen. Medical factors for uterine atony include large baby, high parity, rapid labor, fever, and fibroids. Tissue refers to retained or abnormal placenta, with a client presentation of a large uterus that does not respond to interventions and strings of tissue seen in the bleeding. Trauma is normally associated with lacerations or hematoma. Bleeding with trauma is usually a steady trickle of unclotted, bright red blood, or a hematoma may be noted in the perineal area. Thrombin disorders, such as disseminated intravascul

MI diagnosis

blood pressure assessment ECG Cardiac enzymes Cardiac CATH

AKI: A nurse is caring for a client who has an order for a CT scan with contrast. Which of the following medication orders would require further clarification from the provider?

When given near IV contrast administration, Glucophage (metformin), can significantly increase the risk for contrast-induced nephropathy and may need to be held and/or additional pre-procedure medications may need to be given. This would require the nurse to call the provider to clarify and get an order to hold the medication.

Patient education for MI

diet/exercise smoking cessation taking new medications as prescribed follow up

Preeclampsia: The nurse identifies which of the following as potential complications for this patient/baby? (Select all that apply.)

hemorrhagic stroke intrauterine growth restriction seizure preterm delivery myocardial infarction blood sepsis Hypertension results in reduced blood flow to vital organs. Decreased cerebral blood flow can lead to seizure/coma/death, stroke; decreased placental blood flow can lead to intrauterine growth restriction (IUGR). Preterm delivery is a common complication of preeclampsia because delivery of the placenta is the only way to eliminate the problem.

Preeclampsia: The nurse is caring for the patient in an obstetrics office. The patient has arrived for her 30 week check up. Her last visit was 2 weeks ago. Select the 5 assessment findings that require immediate follow-up:

leukocytes <5 nerve pain to the right hip radiating down the leg 3/10 2+ edema to hands and feet T 99.2F oral cancel BP 146/94 complaint of headache 5/10 on numbers pain scale epigastric pain, intermittent, worse after eating fatigue weight 214 lbs protein 30mg/dL Rationale: Hand and face edema, headache, proteinuria, BP >140/90, and sudden weight gain are signs of pre-eclampsia. These findings require immediate follow up to determine extent of disease process. The other assessment findings are either expected during pregnancy (sciatic nerve pain, reflux, fatigue) or normal findings (leukocytes <5, T99.2F oral).

Preeclampsia: The nurse calls the healthcare provider and is anticipating orders. For each potential order, click to specify whether the potential order is anticipated, nonessential, or contraindicated for the client:

magnesium sulfate: Anticipated Furosemide: non-essential ACE inhibitor: contraindicated Recheck BP: anticipated Obtain blood culture: non-essential Therapeutic management of preeclampsia includes delivery of the baby, magnesium sulfate, and possibly antihypertensives (labetalol and nifedipine). Furosemide is reserved for pulmonary edema. ACE inhibitors are contraindicated in pregnancy due to being category C. Preeclampsia is not diagnosed without 2 consecutive readings >140/90. Blood cultures are drawn when the patient is symptomatic for infection. This patient has no symptoms of infection.

Fractures:

occurs when sufficient force is applied to a bone, causing it to break.

MI NOTE: EKG

the EKG provides more detailed information on the type of MI - normal EKG: HR:60-100 bpm, regualr rhythem, P wave 0.12-0.20 sec, QRS 0.08-0.1 sec and absent ST segament elevation or depression -ST elevation on a EKG suggests that the client is experiencing an ST-elevated MI or STEMI - if troponin is increased but there is no ST elevation on the EKG, the client may be having a non-ST elevated MI or a NSTEMI *treatment for the two MI are different therefore correct diagnosis is important

PPH: Select 3 assessment findings that require follow-up by the nurse?

Laboratory results Pain 3/10 Vital signs Peri pad saturated Client complains of being "dizzy" Boggy uterus

Preeclampsia: Assessment (What does this look like in a patient?)

A sudden increase in edema -Hands and face--fluid retention Sudden weight gain -Excess fluid retention (backs up) Complaints of headache (high BP) Complaints of epigastric or RUQ pain (Inflammation)- liver is inflamed Vision changes: -Serious symptom of preeclampsia -From swelling and irritation of the brain and the CNS Proteinuria (high BP)- kidney is not working as well to filter Fetal assessment --Intrauterine growth restriction (IUGR) --Placental blood flow is not at its best

CVA: Pathophysiology

A vessel ruptures and bleeds into the brain. This puts pressure and blood on the brain as the blood accumulates. This can be caused by a weakened vessel such as in an aneurysm. Bleed in/around brain due to ruptured vessel Hypertension → weakened vessel i.e. aneurysm rupture No flow past point of bleed Visible immediately on CT scan Presents as "worst headache of my life" (especially Subarachnoid Hemorrhage)

Preeclampsia: Classifications

A woman may or may not be symptomatic but will have elevated blood pressures and proteinuria Blood pressures: 140/90 or more x 2, 4 hours apart Or a systolic 160 mmhg or more Or a diastolic of 90 mmhg or more -So remember 140/90 and 160/90

DM: Complications- Diabetic Ketoacidosis (DKA)

Acute exacerbation of Type I Diabetes Mellitus See DKA Lesson

DM: Complications- Hyperglycemic Hyperosmolar Nonketotic State (HHNS)

Acute exacerbation of Type II Diabetes Mellitus See HHNS Lesson

COPD: The nurse knows that several diagnostic studies will display important findings for a client with COPD. Identify which of the diagnostic tests below may be normal or abnormal with COPD

Chest ultrasound- abnormal Chest X-ray-abnormal D-Dimer-normal Doppler of lower extremities-normal EKG-normal C-Reactive Protein and+/or procalcitonin-abnormal Alpha-1 Antirtrypsin deficiency screening-abnormal Post Bronchial Dilator Spirometry-abnormal

Pediatric Gastrointestinal Dysfunction-Diarrhea: Therapeutic Management- Chronic Diarrhea

Identify and treat cause Monitor Weight Monitor Growth Monitor Nutritional Status

Fracture: A nurse is caring for a client who has suffered a fracture to the humerus after falling on their outstretched arm. The ends of the bone were driven into each other during the fall. This type of fracture is best described as which of the following?

Impacted Fracture An impacted fracture is one in which the ends of the bone in a fracture are driven into each other. This type of fracture is most likely the result of a fall, such as onto an outstretched arm. It may also occur when the bone breaks from collapse of the structure, which is known as a buckle fracture. Greenstick fracture This type of fracture has occurred when one side of a bone is broken and the other side is bent, most common in children. Oblique fracture This type of fracture happens when the fracture line runs at an angle across the bone axis. Comminuted fracture This type of fracture occurs when the bone is splintered or crushed.

A nurse is teaching a nursing student about risk factors for postpartum hemorrhage. Teaching has been understood if the student identifies the most common cause of postpartum hemorrhage as which of the following?

Laceration This could be a cause of bleeding if it is not stitched properly, but it is not the most common cause of PPH. Uterine atony This is the most common cause of postpartum hemorrhage (PPH). Uterine atony is when the uterus doesn't contract after delivery. This allows blood vessels to continue to bleed. The goal is to stimulate uterine contractions through fundal massage or the use of oxytocin to stop the bleeding. Retained placenta This is a possible cause, but it is relatively rare. Uterine atony is the most common cause. Multigravida This is a risk factor for postpartum hemorrhage, but not a cause. Multigravida clients may have a uterus that has been stretched out more and therefore struggles to contract, therefore causing uterine atony, which is the most common cause of PPH.

COPD: The nurse knows that the underlying physiological changes will need to be addressed in order to mitigate the effects of COPD. Which medications could the nurse anticipate the client receiving based on addressing the client's clinical condition? Select All That Apply.

Long acting beta agonists Methylxanthines Short acting beta agonists Inhaled corticosteroids Mucolytic agents Anticholinergics

Anemia: Pt Education

Overall goal: is to increase amount of oxygen-carrying cells Increased intake of iron or B12 containing foods (green leafy vegetables) Medication instructions for iron or B12 supplements Possible Neutropenic or Thrombocytopenic precautions in Aplastic Anemia Energy conservation techniques

Therapeutic Management for MI

antiplatelet and anticoagulant medications: prevent platelet aggression and reduce viscosity of blood (aspirin and IV heparin vasodilatory agents: nitroglycerin, morphine time is tissue: PCI (percutaneous coronary interventions) should be performed within 90 min - to CATH lab to attempt stenting to restore blood flow CABG (coronary artery bypass grafting): in both emergent or non-emergent situations if PCI is unsuccessful high-dose statin beta-blockers/ACE-inhibitors vital signs and lab monitoring

Sprain

excessive stretching of ligament

Strain

excessive stretching of muscle

Complications due to MI

heart failure postinfarction angina thrombophlebitis

DM: Coronary Artery Disease

increased morbidity and mortality

MI- four most appropriate and effective methods for treatment of an cardiac ischemia that a nurse should implement:

iv morphine supplemental oxygen sublingual nitroglycerin subcutaneous enoxaparin

Hemorragic stroke/CVA

lack of blood flow to brain tissue caused by bleeding in/around brain

DM: The nurse is caring for a client with poorly managed diabetes mellitus. The nurse is planning education for this client. Which statement by the client indicates a need for more education?

"If I skip a couple meals, my glucose may go up" This statement is true. When the body goes into starvation mode, it starts to break down lipids which can spike the glucose levels. "I should check my glucose about six to seven times a day to get my HbA1C down" This statement is true. When a client's glucose level is poorly controlled, they must check their blood glucose often to understand how to better control the level. "As long as I inspect my feet for cuts or wounds daily, I shouldn't have to worry about getting a foot infection" This statement is true. When the client practices frequent feet checks, they will catch any issues early enough to get treatment in a timely manner. "As long as I administer insulin and maintain a normal glucose, I can eat whatever I want" This statement is not true, and indicates a need for more education. The client needs to eat a balanced diet along with insulin use to achieve stable glucose control.

Anemia: A client with anemia is having blood drawn to assess her levels of blood cells. Which best describes a normal level of hematocrit for a female client?

36 to 44% The hematocrit is a measurement of the amount of red blood cells present in a sample of whole blood, which is expressed as a percentage. Some clients with anemia or other blood disorders may have altered hematocrit levels. The normal level of hematocrit for a female client is approximately 36 to 44 percent. cancel

myocardial infarction

"heart muscle death" and is the result of a complete loss of blood flow, or perfusion to the heart oxygen supply cannot meet oxygen demand often caused by plaque breaking off of the cessel wall and causing acute loss of blood flow through the coronaries

PPH: Therapeutic Management

1. Fundal massage/assessment --Every 15 minutes for first hour --Every 30 minutes x 2 --Every hour times 4 --Assessment of location and bleeding. 2. Estimated blood loss: make sure to turn patient and look under them to qualify all of bleeding --Can weigh pads - 1 g = 1 mL 3. Labs: H/H - 6 hours after to see effects --Meds --Oxytocin --Methylergonovine --Carpropost Theramine --Blood products may be indicated, depending on severity --D&C or hysterectomy

DM: Type I

1. Immune disorder 2. Body attacks beta cells in pancreas (responsible for insulin production) 3. Pancreas makes NO insulin 4. Patient is insulin-dependent 5. Ketosis due to gluconeogenesis (body making glucose from fat cells)

Anemia Types

1. Iron-Deficiency -Inadequate iron supply - 60% of anemias 2. Pernicious -Vitamin B12 deficiency -Lack of Intrinsic Factor 3. Aplastic -↓ Production of all blood cells in the bone marrow (autoimmune related) 4. Sickle Cell Anemia

Anemia: Assessment

1. Pallor 2. Fatigue 3. Weakness 4. Tachycardia 5. Hypotension 6. Angina 7. Dyspnea 8. ↓ Hgb, Hct, RBC levels 9. ↓ MCV, MCH, Iron, B12 levels --Schilling test (for Pernicious anemia) 10. Spoon-like nails 11. Pica - craving non-food substances like ice, dirt, clay, starch. 12. Jaundice of eyes/skin 13. Cold hands/feet

DM overview

1. Pancreatic disorder resulting in insufficient or lack of insulin production leading to elevated blood sugar 2.Insulin is the key to allow glucose to be used by the cells for energy

DM Assessment- Vascular and Nerve Damage

1. Related to inflammation and hyperosmolarity in vessels 2. Poor circulation (small vessels-hands and feet) 3. Poor wound healing 4. Retinopathy → blurry vision 5. Neuropathy → decreased sensation, especially in feet/toes (numbness) 6. Nephropathy → may result in Chronic Kidney Disease

Preeclampsia: Nursing concepts

1. Reproduction: 2. Perfusion: worried about perfusion to all organs and to fetus through placenta

Postpartum Hemorrhage (PPH)

1. Severe bleeding post delivery 2. Can be up to 2 weeks after delivery 3. A major cause of maternal mortality

Preeclampsia: Pt. Education

1. WHEN TO CALL: Call MD if nausea, vision changes, headaches, epigastric pain or increased swelling occur 2. Perform daily kick counts @ home - Less than 10 kicks in 2 hours= call Dr 3. Home BP checks - 140/90 or Systolic over 160 or Diastolic over 90

Preeclampsia: The nurse is evaluating the effectiveness of treatment. For each finding, click to specify whether the finding is expected, unexpected, or unrelated:

2+ edema in hands and feet-expected nerve pain to the right upper hip radiating down the leg 3/10- unrelated blurry vision-unexpected fundal height 30cm-expected BP 140/88-expected Edema resolution will take more than 30 minutes following treatment. Nerve pain is likely related to sciatic nerve pain associated with pressure from baby/organs on nerve. Blurry vision is a symptom of worsening preeclampsia and should be reported to the healthcare provider immediately. Fundal height of 30cm is aligned to the patient being 30 weeks gestation. Blood pressure will not change significantly, therefore a slight lowering is expected.

Pediatric Asthma: Assessment

Acute Exacerbation -Shortness of breath -Unable to speak in complete sentences -Cough -Retractions -Chest tightness -Wheeze -Prolonged expiration -Silent chest - complete obstruction of airflow -Obtain blood for ABG Status asthmaticus -Acute asthma attack that is resistant to treatment -May result in respiratory failure or death Associated with "silent chest" on auscultation -Chronic- poorly controlled asthma -Frequent exacerbations -Nighttime cough -Barrel chest -Elevated shoulders -Use of accessory muscles -Growth delay -Puberty delay

Anemia: Pathophysiology

Anemia is when there is low red blood cells (RBC) count. This is caused by blood loss. a decrease in red blood cell production or increased RBC destruction. - Overall loss of RBC ↓ Amount of RBCs or hemoglobin in blood ↓ Capacity of blood to carry oxygen

AKI: For each laboratory test, indicate whether the result will be increased or decreased in Acute Kidney Injury that is caused by volume depletion.

Blood Urea Nitrogen- increased Urine Specific Gravity- increased Calcium- decreased Creatinine- increased Arterial pH- decreased Potassium- increased Blood creatinine results from protein and muscle breakdown and gradually increases 1 to 2 mg/dL every 24 to 48 hr, or 1 to 6 mg/dL in 1 week or less. Blood urea nitrogen (BUN) results from the breakdown of protein in the liver, creating the byproduct urea nitrogen excreted by the kidneys can increase to 80 to 100 mg/dL within 1 week. Urine specific gravity can be elevated up to 1.030 in cases of volume depletion as the kidneys release antidiuretic hormone to retain fluid. Electrolytes; hyperkalemia and hypocalcemia due to the cellular electrolyte shift. ABG: metabolic acidosis from the deficiency of bicarbonate and the excess of nitrogen.

CVA: Complications

Blood= irritant to tissues Seizures Vasospasm-vessels clamp down -cause more ischemia

Fracture: A nurse is caring for a client who has suffered an arm fracture and has a fiberglass cast applied. Which information should the nurse give to the client to help him reduce swelling in the extremity?

Check peripheral circulation by assessing capillary refill Assessing capillary refill is an important nursing assessment for a client with a fracture, but this assessment does not help reduce swelling. Elevate the cast and extremity The client with a cast in place may develop swelling in the affected extremity. Part of cast care is to teach the client how to prevent complications such as swelling and muscle atrophy. The nurse should encourage the client to keep the arm elevated and apply ice packs as needed. The client may check capillary refill, but this will not necessarily reduce swelling. Gentle exercise, such as range of motion activities, can also improve circulation and reduce swelling. Keep the fingers at rest to prevent increased circulation Range of motion and circulation should be preserved in the fingers by gentle exercise on a regular basis. Apply heat to the fingertips, such as with a heating pad Heat is not advised in the beginning stages of a fracture, because it can

CVA: The nurse is caring for a client who had an intracerebral hemorrhagic stroke. The family members are concerned about how this could happen. Without knowing the cause of this client's stroke, the nurse correctly informs the family that which of the following is the number one reason for intracerebral hemorrhagic stroke?

Chronic hypertension The most common cause of intracerebral hemorrhagic stroke is hypertension. The constant pressure from hypertension eventually leads to blood vessel rupture and subsequent brain bleed. Tachycardia Certain types of tachycardia, such as atrial tachycardia that occurs in atrial fibrillation can cause a clot to form, which can travel to the brain and cause an ischemic stroke. However, tachycardia does not cause hemorrhagic stroke. Heparin use This is a cause of hemorrhagic stroke, but hypertension is the most common cause. Fall This is a cause of hemorrhagic stroke, but hypertension is the most common cause.

Pediatric Asthma

Chronic inflammatory disease of the airways (bronchi and bronchioles)

chronic obstructive pulmonary disease (COPD)

Chronic obstruction of airflow due to emphysema and chronic bronchitis (is like a tourniquet for the lungs)

Fractures: Types of fractures (8)

Closed - skin intact Open/Compound - bone pierces skin Transverse - broken straight across Spiral - fracture from twisting force Comminuted - multiple pieces of bone Impacted - from vertical force on long bone Greenstick - incomplete fracture, common in children Oblique - diagonal fracture Displaced - bones no longer aligned

Preeclampsia: A nurse is caring for a newly admitted 32-week pregnant client with a blood pressure of 150/92, proteinuria, and severe right upper quadrant pain. The nurse knows that which of the following is a possible reason for this?

Constipation Constipation pain most often occurs in the LLQ. Liver inflammation RUQ pain in pregnant clients with signs of preeclampsia is most often caused by liver inflammation. Gallstones RUQ pain in clients with signs of preeclampsia is most often caused by liver inflammation, not gallstones. Fetal position Fetal positioning could cause discomfort in any quadrant, but RUQ pain in clients with signs of preeclampsia is most often caused by liver inflammation.

DM: The nurse providing education to a client who is newly diagnosed with diabetes mellitus. Which of the following should the nurse emphasize? Select all that apply.

Cut toenails with rounded corners cancel Toenails should be cut straight across to avoid inadvertently cutting into the corners of the toes. Use a heating pad to keep feet warm Heating pads can be dangerous due to the decreased sensation in the feet of a client with diabetes. The client could be burning him or herself without knowing it, leading to another slow and poorly healing wound. Don't walk barefoot There is a risk of injury when walking barefoot, so the client should be taught to always wear shoes. Wear proper fitting shoes Wearing properly fitting shoes helps reduce the risk of injuries and blisters to the feet. Inspect feet daily Diabetes Mellitus can cause poor circulation and decreased feeling in the feet. Foot care is important to prevent sores and ulcers, as these wounds heal slowly and poorly in the client with uncontrolled glucose levels.

CVA: The nurse knows that several diagnostic studies will display important findings for a client with intracranial hemorrhage. Identify which of the diagnostic tests below may be normal or abnormal with intracranial hemorrhage.

INR: Normal CT: Abnormal MRI: Abnormal EEG: Abnormal Spinal Tap: Abnormal The CT of a client with intracranial hemorrhage may be abnormal because there will be blood in the skull. freshly extravasated whole blood will be visible on CT as an increased density on non-enhanced CT scans of the brain due primarily to the protein in the blood (primarily hemoglobin). Hemorrhagic stroke is detected 8#% of the time versus MRI detecting hemorrhagic stroke 26% of the time. The MRI of a client with intracranial hemorrhage may be abnormal but takes longer to perform than a CT scan. The MRI takes multiple images of the inside of the head and reveals blockages of blood flow. THE MRI detects acute brain hemorrhages earlier than CT by detecting small amounts of unclotted blood. because of deoxyhemoglobin's susceptibility effect. The indication of a hemorrhagic stroke on MRI is dependent on the age of the blood, the type of hemoglobin present, and how intact the red blood cell walls are versus be

DM: Complications- Lipoatrophy

Loss of SubQ fat at insulin injection site (rotate sites)

M.O.N.A.T.A.S

M- morphine O-oxygen N-nitrates A-aspirin T-thrombolytics A-anticoagulants S-stool softeners

Preeclampsia: A nurse is caring for a 30 week pregnant client that has proteinuria and blood pressures of 142/92. What order should the nurse expect to receive?

Magnesium sulfate This is a prophylactic treatment for clients with preeclampsia to prevent seizures. Strict bed rest This is not necessary. We want to treat the blood pressure and prevent seizures. Diuretic This client is preeclamptic and this is not expected management. Immediate delivery At this gestation, they would try to control the BP and monitor further. Magnesium sulfate is our prophylactic treatment.

COPD: The nurse is assessing a client with COPD at the healthcare clinic. Which of the following would most likely increase this client's risk of suicide?

Malnutrition This is not correlated with a risk of suicide in clients with COPD. A condition that requires close dietary monitoring, like diabetes This is not correlated with a risk of suicide in clients with COPD. Recent weight loss of 5 percent of body weight or more This is not correlated with a risk of suicide in clients with COPD. A concomitant diagnosis of mental illness A chronic condition such as COPD is often associated with mental health issues, including diagnoses of depression and anxiety. A client with depression may be at increased risk of suicide, which the nurse should assess for when visiting with the client. A client who has attempted suicide in the past, a person with another mental health diagnosis, and someone with a history of substance abuse are all at higher risk of suicide.

AKI: The nurse is caring for a client who has suffered an acute kidney injury. Which of the following nursing interventions are appropriate? Select all that apply.

Monitor I&O-right A client with an acute kidney injury should be monitored for I&O to see how much fluid is being retained, and how much urine is being made by the kidneys. 1 gm NaCl tabs q6hrs-wrong Administering salt tablets will cause further fluid to be retained. Salt tabs are contraindicated. Head CT with contrast-wrong The contrast dye given with CT scans is contraindicated, because it is hard on the kidneys. Additionally, there is no reason for a head CT for the client in kidney failure. Fluid restriction-right With a fluid restriction, the client will retain less fluid and fluid overload will be less of a risk. With fluid overload, the client will begin to demonstrate adventitious heart sounds and crackles in the lungs, which indicates the need for diuresis and/or dialysis. Daily weights-right Injury to the kidneys can result in fluid retention, and tracking the client's daily weights is a way to monitor how well the kidneys are working.

COPD: The nurse knows that identifying early condition changes is critical to impacting COPD exacerbation. Which of the following interventions should the nurse anticipate in the acute COPD exacerbation phase? Select All That Apply

Monitor fluid balance Head of bed elevation The use of spacers or nebulizers Antibiotics as a standard of care Administration of long-acting bronchodilators Oral corticosteroids Monitor mental status changes

AKI therapeutic management

Oliguric phase: restrict fluid intake, identify and treat cause, diuretics Diuretic phase: replace fluids and electrolytes- especially watch K+ and Na+ levels If not recovering, pt may need dialysis

AKI phases

Onset: note a decrease in baseline urine output Oliguric: decreased urine output <400 mL/day, sickest phase, increased BUN/creatinine, decreased glomerular filtration rate (GFR) Diuretic: beginning to recover-gradual urine output increase followed by diuretics Recovery: decreased edema, electrolytes normalize, GFR increases

MI NOTE: Troponin

Troponin 1: is a cardiac-specific biomarker that identifies cardiac muscle damage - an elevated troponin can suggest a myocardial infarction, usually rising within 3 hours of an MI and peaking within 15-20 hours

Preeclampsia: The nurse is caring for a client who is 36 weeks pregnant with severe preeclampsia who was started on magnesium sulfate. The client seized, and the nurse addressed the seizure appropriately and notified the provider. The client is no longer exhibiting seizure activity and is stable. What is the next priority?

Preparing for delivery A client who has progressed from preeclampsia to eclampsia requires delivery as soon as possible. Turn mother on right side The mother should have been turned to the left side as part of seizure management. The mother does not need to be turned to the right side at this time. Prepare for emergent delivery and hysterectomy Eclampsia does not require a hysterectomy in addition to the delivery. Prepare for plasmapheresis Plasmapheresis is not indicated in this situation.

Pediatric Gastrointestinal Dysfunction-Diarrhea: Therapeutic Management- Acute Diarrhea

Rehydrate -Oral Rehydration --- Solution ---IV Fluids Treat electrolyte imbalances Diet --BRAT diet no longer recommended --Slowly resume usual diet Instruct on hand hygiene Antimotility drugs --Are not recommended

Pediatric Gastrointestinal Dysfunction-Diarrhea: Pt. Education

Rehydrate and promote return to regular diet as tolerated Notify provider if any signs of severe dehydration Notify provider if any bleeding in diarrhea Notify provider if any signs of metabolic acidosis

A nurse notes trickling of blood with every postpartum exam since a vaginal delivery, but on assessment, the client's fundus is firm. Based on these findings, the nurse knows that which of the following is the most likely cause?

Repaired episiotomy If it is repaired it shouldn't trickle blood. If an episiotomy or laceration goes unrepaired it can bleed. Retained placenta A retained placenta will cause trickling of blood as the body is trying to rid the retained piece. Hypotension This would not cause bleeding, though it could be a symptom of prolonged bleeding due to the loss of blood volume. Uterine atony If uterine atony was present, the fundus would be boggy, not firm, and there would likely be more than a trickle of blood.

Fracture: Pt Education

Report cold, purple, or numb fingers when in a cast Proper body alignment and movement restrictions when in traction Purpose of Fasciotomy / Wound care Medication instructions for analgesics

Fracture: The primary healthcare provider examines the 19-year-old patient and orders radiographs. Based on the results of the imaging study and given the patient's activity level, the health care provider has determined that a short arm cast will be applied. Which care needs would the nurse prioritize for this patient? Select all that apply.

Restoring function to injured area Immobilization Teaching the family cast care Pain management Monitoring neurovascular function Preventing further injury

Fracture: Fat Embolism

Risk with long bone fractures -fat moves from bone marrow into bloodstream and can go to the lungs, heart or brain. No specific treatment Support hemodynamics Corticosteroids Monitor in ICU

Fracture: The nurse is caring for a client with a broken femur. The client is at higher risk for which of the following due to this specific bone fracture? Select all that apply.

Stroke Long bone fractures such as the femur, tibia, and pelvis, put the client at risk for a fat embolism. This embolism can travel to the heart, lungs, or brain and cause obstructed blood flow to these areas. Heart Attack A fat embolism is possible following a long bone fracture. If this particle of fat becomes lodged in the vessels of the heart, it can cause the client a heart attack. Pulmonary embolism The femur is a long bone. Fractures to long bones increase the risk of a fat embolism, which can travel to the lungs and cause a pulmonary embolism. Deep vein thrombosis A deep vein thrombosis occurs when a clot develops in a deep vein. A fat embolism is different, because it originates in the long bone, and travels into the pulmonary circulation. Long bone fractures do not increase the risk for a DVT more than any other fracture. Pneumonia A fat embolism does not cause pneumonia.

DM: A nurse is caring for a client who has diabetes and has developed hypoglycemia. Which vital signs would be most consistent with this condition?

Tachycardia A client who is experiencing hypoglycemia may demonstrate changes in vital signs. The nurse should look for adrenergic symptoms such as tachycardia, hypertension, hypothermia, and tachypnea. Hyperthermia This is not a symptom of hypoglycemia. Hypotension This is not a symptom of hypoglycemia. cancelLow oxygen saturation This is not a symptom of hypoglycemia.

Pediatric Gastrointestinal Dysfunction-Diarrhea: Assess for signs of metabolic acidosis (↓pH ↓HCO3)

Tachypnea Lethargy Seizures Poor perfusion

PPH: Click to indicate which interventions the nurse would anticipate for initial management of a stage 1 postpartum hemorrhage caused by uterine atony, thrombin disorders, trauma, or retained tissue. Each intervention has at least one, but may have more than one, response item selected.

Uterine Atony -Administer IV Fluids -Fundal Massage -Oxytocin Thrombin Disorders -Administer IV Fluids -Infuse platelets Trauma -Administer IV Fluids -Prepare for procedure Retained Tissue -Administer IV Fluids -Prepare for procedure

COPD: A 60-year-old client is going through pulmonary rehabilitation for COPD. The nurse understands that an expected outcome of pulmonary rehabilitation is which of the following?

The client's pain from surgery has resolved This type of program is not going to eliminate pain. Rather, it can improve overall health-related quality of life and functioning. The client experiences improvement in the damage from his lung disease Unfortunately, the progression of COPD causes lung damage that cannot be improved. However, pulmonary rehab can improve different aspects of life which have been affected by COPD. The client has an easier time performing activities of daily living Pulmonary rehabilitation is designed to help a client with lung disease to improve their ability to perform activities of daily living and overall quality of life. The program may provide education about oxygen therapy and medications, offer tips for the client to exercise more, and often provides social support. The client no longer needs oxygen therapy Pulmonary rehab will not eliminate the need for oxygen therapy. Reset Test

Fracture: A nurse is caring for a client and is preparing to administer an intramuscular injection of pain medication in the deltoid. Which of the following would be a contraindication to administering medication with this route? Select all that apply.

The dose of the drug is 1 mL. It is safe to give an IM injection of 1 mL in the deltoid. Larger volume injections should go in a bigger muscle. The client says, "I think that medicine made me really sick before." This is a contraindication because the nurse should investigate this statement further to see if the client is referring to a side effect or an allergy. The client is obese. Clients who are obese can receive IM injections, the needle length and gauge should be selected appropriately. The client is on thrombolytic therapy. If the patient has received thrombolytic therapy, an IM injection is contraindicated because of the increased bleeding potential. There is an open wound around the injection site. Other situations in which the nurse should not give an IM injection include if there is redness, inflammation, bleeding, or a birthmark over the injection site.

PPH: The nurse is providing education to the client about the plan of care following the postpartum hemorrhage event. For each of the following client education topics, click to specify whether the education is appropriate or not appropriate to include.

The risk of postpartum hemorrhage is over at 24 hours after delivery. Oxytocin may be continued for the next few hours. Report to the nurse or provider if the peri pad is saturated in 1 hour or less. The client will be transferred to the ICU for observation. Do not breastfeed for at least 24 hours.

PPH: Which of the following conditions would most likely contribute to postpartum hemorrhage?

Uterine atony Uterine atony is a state during the postpartum period in which the uterus does not contract, leaving large placental blood vessels open which can cause hemorrhage. Normally, the uterus contracts to prevent excessive bleeding. When uterine atony is present, the uterus is boggy and soft, and the nurse performs fundal massage to assist the uterus to contract. Involution of the uterus Involution refers to the organ returning to its normal size, which is desired after delivery. This normal occurrence helps to prevent hemorrhage rather than cause it. Hemorrhoids Postpartum hemorrhage refers to hemorrhage from inside the reproductive system, while hemorrhoids are swollen rectal vessels. Hemorrhoids are not a risk factor for postpartum hemorrhage. Endometritis Endometritis is an infection inside the uterus, and can be present in a nonpregnant or postpartum woman. Endometritis does not lead to hemorrhage.

AKI assessment

s/s result from kidney inability to regulate fluid and electrolytes azotemia (retention of nitrogen wastes in blood-increased BUN/creatinine decreased GFR decreased urine output in oliguric phase (should see increased urine output with diuretic phase signs of volume overload (HTN, peripheral edema, pulmonary edema) s/s infection if that was the source metabolic acidosis-kidney is not holding HCO3 Electrolyte abnormalities: increased K+, decreased Na+, increased phosphate, decreased calcium