Nursing 301 - Exam 4 Content
These are CONTRAINDICATED in CF patient's treatment because of their DRYING EFFECT.
Antihistamines
What is the drug therapy used for Cushing's syndrome?
"Medical adrenalectomy" - Mitotane (lysodren) suppresses cortisol production - Ketoconazole (Nizoral) and Cytadran inhibit cortisol synthesis - Administer these medications with food to reduce GI distress
What are the differences between the adult and pediatric asthma action plan?
*Refer to handouts* Pediatric: - Traffic light system - Easier to understand - Symptoms are dumbed down - Medications are identified in larger font - Emergency contact information takes up large portion of sheet Adult: - More in depth symptom list - Red, green, yellow "zone" system - List of triggers on back of sheet - Peek flow percentages written out
What are the diagnostic studies for Cushing's syndrome?
- 24 hour urine collection for free cortisol - Plasma cortisol levels - CT, MRI of pituitary and adrenal glands - Plasma ACTH levels
What is the symptomatology of asthma in the 0-6 age range?
- 80% of cases occur in first 6 years of life - Symptoms are varied - Primary symptoms include: Dry or productive cough, wheezing, SOB, and work of breathing - Symptoms are a result of airway inflammation, bronchospasm, airway edema, and airway mucous gland hypertrophy
What are the diagnostic studies for Addison's disease?
- ACTH stimulation test; failure of cortisol levels to rise in response to ACTH stimulation - Corticotropin-releasing hormone (CRH) stimulation test; will increase ACTH but no cortisol - Urine cortisol levels - CT, MRI to identify calcifications of enlargement
What are the nursing interventions for acute care of cystic fibrosis?
- Aggressive chest physiotherapy - Teach effective coughing - Chest physiotherapy every 2-4 hours - Increase fluid intake - Semi-fowlers - Antibiotics - Mouth care every 2-4 hours - Teach that exercise helps loosen thick mucus - Daily weights - O2 therapy - Good nutrition - Reduce child's anxiety - Encourage immunizations - Report any changes in bowel movements - Provide family support
What are the possible methods of treating CF?
- Airway clearance - CRFT modulators - Lung transplantation - O2 therapy - Nutritional therapy - Implanted devices - Antibiotics
These are secondary nursing diagnosis for CF
- Airway: Impaired gas exchange - Ineffective air clearance/breathing patterns
What is the symptomatology of asthma in the adult age range?
- Although asthma is considered a childhood disease, approximately 50% of patients have had onset in adulthood rather than adolescence - Adult-onset asthma increases with age - Asthma remission is uncommon and disease is often more severe and progressive
Name 2 neurocognitive diseases that are diagnosis of exclusion?
- Alzheimer's - Lewy body Dementia
What are the causes of Dementia?
- Alzheimer's disease (60-80%) - Vascular dementia (20%) - Lewy body (10%) - Parkinsons, Creutzfeldt-Jakob, etc (remainder)
What is the treatment of Lewy Body Dementia?
- Anticholinesterase inhibitors - Levodopa/Carbidopa - Antidepressants - Antipsychotics - Melatonin, Ambien - Management of dementia and problems related to dysphagia and immobility - Nutritional management
What are additional treatments for hyperthyroidism?
- Beta blockers - Iodine (Lugol's solution) - Radioactive iodine therapy (I131; damages thyroid tissue)
What are the clinical manifestations of Addison's disease?
- Bronze skin - Changes in body hair distribution - GI disturbances - Weakness - Hypoglycemia - Postural hypotension - Weight loss
List 2 diagnostic test that can aid in MS diagnosis
- CT and MRI - Evoked response
Name 3 symptoms associated with dementia (any type)
- Confusion - Agitation - Loss of: memory, orientation, attention, language, judgement, and/or reasoning
List 2 types of medications used to relieve symptoms of Huntington's disease?
- Dopamine antagonists - Anti-psychotics - Antidepressants
What are the clinical manifestations of hyperthyroidism?
- Exophthalmos (buggy eyes) - Finger clubbing - Temors - Diarrhea - Menstrual changes - Fine, straight hair - Intolerance to heat - Tachycardia - Increased BP - Weight loss - Breast enlargement - Muscle wasting - Localized edema - Enlarged thyroid
What are complications of cystic fibrosis?
- GFRD (cystic fibrosis related diabetes) - Bone disease - Sinus disease - Liver disease - Pneumothorax - Hemoptysis - Respiratory failure - Cor pulmonale
What are the causes of hyperthyroidism?
- Graves disease (autoimmune, most common) - Thyroid nodule (over-secretion by tumor) - Thyroiditis (infection) - Overdose of thyroid hormone medication
Name 4 things that can cause hypothyroidism?
- Hashimoto's - Removal of thyroid (thyroidectomy) - Iodine deficiency - Untreated Grave's disease (long term)
What is the post-op care of an adrenalectomy?
- High risk of hemorrhage - High doses of corticosteroids IV given (can lead to delayed wound healing) - Morning urine cortisol level obtained - Patient should wear medical alert bracelets when discharged - Should be taught how to adjust hormone replacement for stressful situations to prevent adrenal insufficiency symptoms - May take months to achieve normal levels - May need lifelong replacement
What mobility diseases discussed in lecture have a risk associated with family history?
- Huntingtons - MS - Parkinsons - ALS
Name 3 potential complications of a thyroidectomy?
- Hypothyroidism - Destructive airway - Hypocalcemia (accidental removal of parathyroid) - Hemorrhage - Infection - Damage to vocal cords/paralysis of vocal cords
Name 2 symptoms associated with severe stage of Alzheimers
- Long and short term memory loss - Immobility/complete assistance with ADLs - Difficulty eating and swallowing
What is the pathophysiology of cystic fibrosis?
- Low CFTR causes Na and Cl channels to be blocked - Linings of lungs are then low in NaCl and hence, low in water - Decreased water = abnormally chick mucous in lungs - Progresses from from airways (chronic bronchitis), to large airways, to destruction of lung tissue
What is the treatment for Addison's disease?
- Manage underlying cause - Replacement therapy with Hydrocortisone, Fludrocortisone (Florinef) - Administered daily - doses may need to be increased during stressful situations
What are the early warning signs of Alzheimer's? (STUDY THIS)
- Memory loss that affects job skills - Difficulty performing familiar tasks - Problems with language - Disorientation to time and place - Poor or decreased judgement - Problems with abstract thinking - Misplacing things - Changes in mood or behavior - Changes in personality - Loss of initiative
What are the symptoms of life-threatening hypothyroidism?
- Mental deterioration such as apathy, confusion, unresponsiveness and psychosis - Extremely low body temperature (hypothermia) - Extremely slow heartbeat (<60 bpm) - Heart failure - Respiratory failure - Death Emergency treatment may include thyroid replacement given in a vein and steroid therapy
What are the clinical manifestations of cushings syndrome?
- Moon face - Buffalo humps - Abdominal striae - Emotional disturbances - Osteoporosis - Obesity - Adrenal tumor or hyperplasia - Amenorrhea - Muscle weakness - Purpura - Skin ulcers
Name 4 clinical signs of Cushing's disease
- Moon face - Buffalo humps - Osteoporosis - Personality changes - Hyperglycemia - Sodium and fluid retention - Fat deposits on face and back of shoulders - Gynecomastia - Bruises - Purple striae
List 4 types of medications that treat specific symptoms of MS
- Muscle relaxants - Immunosuppressants - Immunomodulators - Corticosteroids - Antidepressants
What are the education parameters for Levothyroxine (Synthroid) administration
- Must be taken daily on a empty stomach- lifelong replacement - Frequent monitoring of TSH levels and dosage changes (every 3-6 months) - Important to educate about interactions with other medications - IV dose is ½ of oral dose - Be aware that some clients may prefer Synthroid, not generic equivalent - Brand name is more effective than generic - Missed doses can have cumulative effects that occur several days or weeks after
What do you need to teach patients with Addison's disease?
- Must wear medical alert bracelet - Must be knowledgable about medications - Understand when to increase medication dose - Lifelong replacement therapy - Carry an emergency kit of IM hydrocortisone and understand how to self administer - Take mineralocorticoids in the morning
What are the diagnostic studies for cystic fibrosis?
- Noninvasive CFTR analysis - Restriction fragment length polymorphism (RFLP) analysis - Newborn screening - Sweat chloride test (GOLD STANDARD FOR DIAGNOSIS; >60 mmol/L indicated CF) - Radiography - Genotyping
What pharmacological medications are used to treat cystic fibrosis?
- Pancreatic enzymes - Vitamins (A, D, E, K) - Bronchodilators - Mucolytics (dornase) - Cystic fibrosis transmembrane conductance regulator (CFTR) - Antibiotics (when FEV1 is decreased)
What is the symptomatology of asthma in the 12-18 age range?
- Prior to puberty, asthma risk is higher among males - At time of puberty, risk is equal - After puberty, asthma risk if higher among females - Symptoms are predominantly SOB with exertion, wheezing in response to triggers, chest pain, chest tightness, and cough - Symptoms can significantly impact sleep, school, sports, and social engagement - Children are often embarrassed about stigma of inhaler use - Remission is common (16-60%) - Smoking increases risk of developing lower lung function and COPD
What are the nursing goals of cystic fibrosis treatment in children?
- Relieving immediate respiratory distress - Maintaining adequate oxygenation - Remaining free from infection - Improving nutritional status - Relieving anxiety
List 2 nursing diagnosis for persons with advanced Lewy body Dementia/Disease
- Risk for falls - Risk of aspiration - Risk of malnutrition - Risk of skin intolerance/breakdown - Risk for memory loss
What are the considerations with corticosteroid therapy?
- Risk of peptic ulcer disease - Decreased wound healing - Take with food to prevent GI upset - Can increase glucose levels - Can lead to cataracts - Should not be abruptly discontinued - Immunosuppression
What is the role of the adrenal glands?
- Sit on top of kidneys, each one made of the adrenal cortex (outer part) and adrenal medulla (inner region) - Releases corticosteroids from the adrenal cortex
What is the symptomatology of asthma in the 7-11 age range?
- Spirometry becomes the main tool for management of symptoms - Symptoms tend to be more severe, leading to allergic triggered exacerbations - Exercise-induced symptoms manifest more clearly - Virally triggered asthma exacerbations occur in this age group
What are the post-op considerations for a thyroidectomy?
- Support head while turning due to location of incision - Must have O2, suction and trash equipment available at bedside - Access for tracheal compression, neck swelling, hemorrhage, and inability to speak - Monitor for signs of tetany if parathyroids are removed (Give Ca gluconate IV) - Monitor for Trousseaus signs (hypocalcemia; BP cuff on, wrist spasms) - Monitor for Chvostek's sign (hypocalcemia; Facial muscles twitch when tapping cheek) - Hoarseness is expected for 3-4 days - Control pain - Need for replacement of thyroid hormones if remaining tissue does not stimulate TRH - Levels must be monitored frequently
What is the treatment for hyperthyroidism?
- Supportive therapy - Drug therapy: does not provide cure, only manages symptoms - Anti-thyroid drugs: inhibits synthesis of hormones 1. Propylthiouracil (PTU) 2. Methimazole (Tapazole)
What are the diagnostic labs for thyroid dysfunction?
- TSH, T4, T3 - Palpation of thyroid gland - Ultrasound - CT, MRI, needle aspiration - Radioactive iodine uptake
How do you perform percussion therapy on a CF patient?
- Use a cupped hand - Do prior to meals - Change positions every 5-10 minutes - Do for 20 minutes
What are the clinical manifestations of Lewy body Dementia?
- Visual hallucinations - Short-term memory loss - Confusion - Unpredictable cognitive shifts - Sleep disturbances - Periods of drowsiness, staring into space, long naps - Depression - Poor BP, pulse, and sweating regulation
What type of musculoskeletal symptoms are associated with MS?
- Weakness - Spasms - Ataxia
What are the clinical manifestations of hypothyroidism?
- Weight gain - Decreased heat production - Low BMR - Cold intolerance - Lethargy - Fatigue - Constipation - Slightly lowered body temp - Altered thought process (similar symptoms to depression)**
A nurse is caring for a 17 year old female client with cystic fibrosis who has been admitted to the hospital to receive I.V. antibiotics and respiratory treatment for exacerbation of a lung infection. The client questions her future and the consequences of the disease. Which statements about the course of cystic fibrosis are true? (Select all that apply) 1 - Breast development is commonly delayed 2 - The client is at risk for developing diabetes 3 - Pregnancy and child bearing aren't affected 4 - Normal sexual relationships can be expected 5 - only males carry the gene for the disease 6 - By age 20, the client can probably decrease the frequency of respiratory treatment.
1 - Breast development is commonly delayed 2 - The client is at risk for developing diabetes 4 - Normal sexual relationships can be expected
How does Alzheimer's affect the brain?
1. Amyloid plaques 2. Neurofibrillary tangles 3. Loss of connection between cells and cell death Results in shrinking hippocampus and cortical, enlarged ventricles
The nurse is caring for a patient with hyperthyroidism who had a partial thyroidectomy yesterday. Which change in assessment would the nurse report to the health care provider immediately? 1. Temperature elevation to 100.2°F (37.9°C) 2. Heart rate increase from 64 to 76 beats/min 3. Respiratory rate decrease from 26 to 16 breaths/min 4. Pulse oximetry reading of 92%
1. Temperature elevation to 100.2°F (37.9°C) (indicative of an impending thyroid crisis)
Which actions should the nurse assign to the experienced LP/LVN for the care of a patient with hypothyroidism? Select all that apply. 1. Assessing and recording the rate and depth of respirations 2. Auscultating lung sounds every 4 hours 3. Creating an individualized nursing care plan for the patient 4. Administering sedation medications every 6 hours 5. Checking blood pressure, heart rate, and respirations every 4 hours 6. Reminding the patient to report any episodes of chest pain or discomfort
1. Assessing and recording the rate and depth of respirations 2. Auscultating lung sounds every 4 hours 5. Checking blood pressure, heart rate, and respirations every 4 hours 6. Reminding the patient to report any episodes of chest pain or discomfort
The nurse is providing care for a patient who underwent a thyroidectomy 2 days ago. Which laboratory value requires close monitoring by the nurse? 1. Calcium level 2. Sodium level 3. Potassium level 4. White blood cell count
1. Calcium level (parathyroid glands may have been accidentally removed with the thyroid)
The nurse is in charge of developing a standard plan of care for an Alzheimer disease care facility and is responsible for assigning and supervising resident care given by LPs/LVNs and delegating and supervising care given by assistive personnel (AP). Which activity is best to assign to the LPN/LVN team leaders? 1. Checking for improvement in resident memory after medication therapy is initiated 2. Using the Mini-Mental State Examination to assess residents every 6 months 3. Assisting residents in using the toilet every 2 hours to decrease risk for urinary incontinence 4. Developing individualized activity plans after consulting with residents and family
1. Checking for improvement in resident memory after medication therapy is initiated
All of the following nursing care activities are included in the care plan for a 78-year-old man with Parkinson disease who has been referred to the home health agency. Which activities will the nurse delegate to the assistive personnel (AP)? Select all that apply. 1. Checking for orthostatic changes in pulse and blood pressure 2. Assessing for improvement in tremor after levodopa is given 3. Reminding the patient to allow adequate time for meals 4. Monitoring for signs of toxic reactions to anti-Parkinson medications 5. Assisting the patient with prescribed strengthening exercises 6. Adapting the patient's preferred activities to his level of function
1. Checking for orthostatic changes in pulse and blood pressure 3. Reminding the patient to allow adequate time for meals 5. Assisting the patient with prescribed strengthening exercises
When providing care for a patient with Addison disease, the nurse should be alert for which laboratory value change? 1. Decreased hematocrit 2. Increased sodium level 3. Decreased potassium level 4. Decreased calcium level
1. Decreased hematocrit (person with Addison's is at risk for anemia; nurse should expect Na to decrease, and K and Ca to increase)
A patient with adrenal insufficiency is to be discharged and will take prednisone 10 mg orally each day. Which instruction would the nurse be sure to teach the patient? 1. Excessive weight gain or swelling should be reported to the health care provider. 2. Changing positions rapidly may cause hypotension and dizziness. 3. A diet with foods low in sodium may be beneficial to prevent side effects. 4. Signs of hypoglycemia may occur while taking this drug.
1. Excessive weight gain or swelling should be reported to the health care provider. (Signs of excessive drug therapy; dose needs to be adjusted)
A patient with multiple sclerosis tells the assistive personnel after physical therapy that she is too tired to take a bath. What is the priority nursing concern at this time? 1. Fatigue 2. Impaired safety 3. Decreased mobility 4. Muscular weakness
1. Fatigue
The nurse is orienting a newly graduated RN who is providing care for a postoperative patient after a thyroidectomy. The new RN assesses the patient and notes laryngeal stridor with a pulse oximetry measure of 89%. What is the priority action for the nurse and new RN? 1. Immediately notify the rapid response team (RR) 2. Apply oxygen by face mask. 3. Prepare to suction the patient. 4. Assess for numbness and tingling around the mouth.
1. Immediately notify the rapid response team (RR) (Immediately notify the RR if any signs of stridor, dyspnea, falling O2, inability to swallow, or drooling are noted)
Which change in vital signs for a patient with hyperthyroidism would the nurse instruct the assistive personnel (AP) to report immediately? 1. Rapid heart rate 2. Decreased systolic blood pressure 3. Increased respiratory rate 4. Decreased oral temperature
1. Rapid heart rate
A patient is hospitalized with adrenocortical insufficiency. Which nursing activity should the nurse delegate to assistive personnel (AP)? 1. Reminding the patient to change positions slowly 2. Assessing the patient for muscle weakness 3. Teaching the patient how to collect a 24-hour urine sample 4. Revising the patient's nursing plan of care
1. Reminding the patient to change positions slowly (postural hypotension)
The nurse is providing care for a patient newly diagnosed with early Alzheimer disease (AD). On assessment, which finding would the nurse expect to discover? 1. Short-term memory impairment 2. Rapid mood swings 3. Physical aggressiveness 4. Increased confusion at night
1. Short-term memory impairment
What is the pediatric asthma action plan?
Written plan for children to manage their asthma Green: Preventative anti-inflammatory medications Yellow: Preventative medications + doctor prescribed Red: Rescue medications
This is a non-invasive test used in assessment of CF, where there is placement of electrodes on the forearms and thighs of the patient, which will generate sweat. It is the primary test used to rule out CF. - ANYTHING 60meq/L or HIGHER indicates CF - If the range is 45-50, repeat the test in ONE WEEK.
Gibson Cook Qualification Test
The patient with hyperparathyroidism who is not a candidate for surgery asks the nurse why she is receiving IV normal saline and IV furosemide. What is the nurse's best response? 1. "This therapy is to protect your kidney function." 2. "You are receiving these therapies to prevent edema formation. 3. "Diuretic and hydration therapies are used to reduce your serum calcium 4. "These therapies may help to improve your candidacy for surgery."
3. "Diuretic and hydration therapies are used to reduce your serum calcium
A patient is admitted to the medical unit with possible Graves disease (hyperthyroidism). Which assessment finding by the nurse supports this diagnosis? 1. Periorbital edema 2. Bradvcardia 3. Exophthalmos 4. Hoarse voice
3. Exophthalmos
The LP/LVN who is assigned to care for a patient with Cushing disease asks the RN why the patient has bruising and petechiae across her abdomen. What is the RN's best response? 1. "Patients with Cushing disease often have bleeding disorders.' 2. "Patients with Cushing disease have very fragile capillaries 3. "Please ask the patient if she slipped or fell during the night." 4. "Thin and delicate skin can result in development of bruising."
2. "Patients with Cushing disease have very fragile capillaries
A patient who has Alzheimer disease is hospitalized with new-onset angina. Her spouse tells the nurse that he does not sleep well because he needs to be sure the patient does not wander during the night. He insists on checking each of the medications the nurse gives the patient to be sure they are "the same pills she takes at home. Based on this information, which nursing problem is most appropriate for this patient? 1. Acute patient confusion 2. Care provider role stress 3. Increased risk for falls 4. Noncompliance with therapeutic plan
2. Care provider role stress
A patient with Parkinson disease has a problem with decreased mobility related to neuromuscular impairment. The nurse observes the assistive personnel (AP) performing all of these actions. For which action must the nurse intervene? 1. Helping the patient ambulate to the bathroom and back to bed 2. Reminding the patient not to look at his feet when he is walking 3. Performing the patient's complete bathing and oral care 4. Setting up the patient's tray and encouraging the patient to feed himself
3. Performing the patient's complete bathing and oral care
What are the 3 corticosteroids secreted from the adrenal cortex?
Glucocorticoids: - regulates metabolism, glucose levels, and stress response Mineralocorticoids: - Aldosterone, regulate sodium and potassium balance Androgens: - Regulate growth and development, and sexual activity
The nurse is supervising a senior nursing student who will provide nursing care for a 63-year-old man diagnosed with amyotrophic lateral sclerosis (ALS). Which statements by the student indicate accurate understanding of the disease process, assessment findings, and nursing care needed for this patient? Select All That Apply 1. Patients usually die within 10 to 15 years of diagnosis. 2. Early symptoms include tripping, dropping things, and fatigue of extremities 3. ALS always leads to changes in consciousness and confusion. 4. Nursing care for a patient with ALS includes decreasing risk for aspiration and falls 5. There are no drugs and there is no cure for ALS. 6. The patient is likely to exhibit signs of depression. 7. The most common cause of death is respiratory tract infection. 8. Riluzole is a drug that can slow the progression of ALS.
2. Early symptoms include tripping, dropping things, and fatigue of extremities 4. Nursing care for a patient with ALS includes decreasing risk for aspiration and falls 6. The patient is likely to exhibit signs of depression. 7. The most common cause of death is respiratory tract infection.
Two assistive personnel (AP) are assisting a patient with Cushing disease to move up in bed. Which action by the APs requires the nurse's immediate intervention? 1. Positioning themselves on opposite sides of the patient's bed 2. Grasping under the patient's arms to pull him up in bed 3. Lowering the side rails of the patient's bed before moving him 4. Removing the pillow before moving the patient up in bed
2. Grasping under the patient's arms to pull him up in bed (patient's with Cushings disease usually have paper thin skin)
The nurse is preparing a care plan for a patient with Cushing disease. Which abnormal laboratory values would the nurse expect? Select all that apply. 1. Increased serum calcium level 2. Increased salivary cortisol level 3. Increased urinary cortisol level 4. Decreased serum glucose level 5. Decreased sodium level 6. Increased serum cortisol level
2. Increased salivary cortisol level 3. Increased urinary cortisol level 6. Increased serum cortisol level (high cortisol levels indicated in Cushing's disease; experience increased sodium, decreased Ca, and increased glucose)
The RN notes that a patient with myasthenia gravis has an elevated temperature (102.2°F 39°CI), an increased heart rate (120 beats/min, and a rise in blood pressure (158/94 mm Hg) and is incontinent of urine and stool. What is the nurse's best action at this time? 1. Administer an acetaminophen suppository. 2. Notify the health care provider (HCP) immediately. 3. Recheck vital signs in 1 hour. 4. Reschedule the patient's physical therapy.
2. Notify the health care provider (HCP) immediately.
What is the treatment of Cushing's syndrome?
Goal is to normalize hormone secretion - Depends on underlying cause - Surgical removal of pituitary tumor - Adrenalectomy (one or both) - Surgical removal of primary tumor - Discontinue exogenous corticosteroid therapy
Here: - Minimize respiratory complications - Provide adequate nutrients for growth - No cure, just management (Lung transplant a possible option) - Educate the family - Chest Pt Jacket, Postural Drainage & Nebulizer - Exercise, Diet & Pancreatic Enzymes - Protection from infections
Goals of cystic fibrosis
What happens if you have too much or not enough iodine?
Goiter
Social effects of a chronic neurologic disease include (select all that apply) a. divorce b. job loss. c. depression. d. role changes. e. loss of self-esteem.
a. divorce b. job loss. c. depression. d. role changes. e. loss of self-esteem.
Which test result is a key finding in the child with Cystic Fibrosis? 1 - Chest X-Ray 2 - Neck X-Ray showing areas of upper airway narrowing 3 - Lateral neck X-Ray revealing an enlarged epiglottis 4 - Positive pilocarpine iontophoresis sweat test
4 - Positive pilocarpine iontophoresis sweat test
Assessment findings for a patient with Cushing disease include all of the following. For which finding would the nurse notify the health care provider immediately? 1. Purple striae present on the abdomen and thighs 2. Weight gain of 1 lb (0.5 kg) since the previous day 3. Dependent edema rated as + 1 in the ankles and calves 4. Crackles bilaterally in the lower lobes of the lungs
4. Crackles bilaterally in the lower lobes of the lungs (Crackles caused by excessive water and sodium absorption)
To control the side effects of corticosteroid therapy, the nurse teaches the patient who is taking corticosteroids to a. increase calcium intake to 1500mg/ day. b. perform glucose monitoring for hypoglycemia. c. obtain immunizations due to high risk of infections. d. avoid abrupt position changes because of orthostatic hypotension.
a. increase calcium intake to 1500mg/ day.
What is delirium?
A state of temporary, acute mental confusion - Preventable and reversible - Caused by impaired cerebral oxygenation, aggravation of underlying dementia or other comorbidities, and infection - Symptoms range from hypoactive, hyperactive, or both
These vitamins are important to be replaced in CF patients.
A, D, E, K
A nurse assesses that a client diagnosed with Cushing's syndrome has an irregular heartbeat, right arm ecchymosis, 4+ pitting edema in the legs, and a blood glucose of 140 mg/dL. What finding is the first priority for intervention? A. Heartbeat B. Ecchymosis C. Edema D. Blood glucose level
A. Heartbeat
A priority goal of treatment for the patient with AD is to a. maintain patient safety. b. maintain or increase body weight. c. return to a higher level of self-care. d. enhance functional ability over time.
a. maintain patient safety
Which of the following diseases will not reduce a person's life expectancy on average? A. Parkinson's disease B. Progressive multiple sclerosis C. Amyotrophic lateral sclerosis D. Huntington's disease E. Myasthenia gravis
A. Parkinson's disease E. Myasthenia gravis
Vascular dementia is associated with a. transient ischemic attacks. b. bacterial or viral infection of neuronal tissue. c. cognitive changes secondary to cerebral ischemia. d. abrupt changes in cognitive unction that are irreversible
c. cognitive changes secondary to cerebral ischemia.
What are the clinical manifestations of Alzheimer's?
In addition to symptoms seen in the "stages of Alzheimers": Dysphasia: Difficulty comprehending language and oral communication Apraxia: Inability to manipulate objects or perform purposeful acts Visual agnosia: Inability to recognize objects by sight Dysgraphia: Difficulty communicating via writing Eventual loss of long-term memory Sundowning: Increasing agitation and resistance in late afternoon and evening
What age group and what gender are at higher risk for delirium?
>65 years old Male
The nurse teaches the patient that the best time to take corticosteroids for replacement purposes is a. once a day at bedtime. b. every other day on awakening. c. on arising and in the late afternoon. d. at consistent intervals every 6 to 8 hours.
c. on arising and in the late afternoon.
A 16-year old patient with cystic fibrosis is admitted with increased shortness of breath and possible pneumonia. Which nursing activity is most important to include in the patient's care? A. Perform postural drainage and chest physiotherapy every 4 hours. B. Allow the patient to decide whether she needs aerosolized medications. C. Place the patient in a private room to decrease the risk of further infection. D. Plan activities to allow at least 8 hours of uninterrupted sleep.
A. Perform postural drainage and chest physiotherapy every 4 hours. A: Airway clearance techniques are critical for patients with cystic fibrosis and should take priority over the other activities. B: Although allowing more independent decision making is important for adolescents, the physiologic need for improved respiratory function takes precedence at this time. C: A private room may be desirable for the patient but is not necessary. D: With increased shortness of breath, it will be more important that the patient have frequent respiratory treatments than 8 hours of sleep.
Betty is a 9-year-old girl diagnosed with cystic fibrosis. Which of the following must Nurse Archie keep in mind when developing a care plan for the child? A. Pulmonary secretions are abnormally thick. B. Elevated levels of potassium are found in the sweat. C. CF is an autosomal dominant hereditary disorder. D. Obstruction of the endocrine glands occurs.
A. Pulmonary secretions are abnormally thick A: CF is identified by abnormally thick pulmonary secretions. B: Diagnosis of CF is based on elevated chloride levels detected in sweat. C: It is a chronic, inherited disorder, particularly an autosomal recessive hereditary disorder concerning the exocrine, not endocrine glands. D: The thick mucus blocks the exocrine glands.
The nurse is developing a plan of care for the client with Alzheimer's Disease. Which goals should the nurse include? (Select all that apply) A. The client will remain physically safe B. The client will receive emotional support C. The client will receive physical health care D. The client will show cognitive improvement E. The client will function at the highest level of independence F. The client will regain the ability to live independently
A. The client will remain physically safe B. The client will receive emotional support C. The client will receive physical health care E. The client will function at the highest level of independence
These are GI signs and symptoms of a patient with CF.
Abdominal distention, dehydration, and weight loss
These are prescribed for respiratory infection.
Antibiotics
This is the most consistent pathology in Cystic Fibrosis patients. It is considered a Gold Standard for definitive diagnosis of CF. A test is performed, which analyzes sodium and chloride levels in sweat. A chloride concentration of 60meq/L or greater is a diagnosis of CF.
Abnormal sweat test
Myasthenia gravis is characterized by antibodies block what type of neurotransmitters?
Acetylcholine
What is Addisonian crisis?
Acute adrenal insufficiency in the face of a stressor - Can be life-threatening - Shock management and supportive care are necessary - High-dose hydrocortisone replacement - Fluid and electrolyte replacement
What is thyroid storm?
Acute, life-threatening form of thyrotoxicosis - Triggered by stressors in an already hyperthyroid state - Results in severe tachycardia, shock, hyperthermia, seizures - Extreme manifestations of hyperthyroid symptoms
This is a failure to break down nitrogen compounds resulting in excessive nitrogenous gas in feces and urine. It is another GI symptom of CF
Azotorrhea
Which of the following statements is correct about Parkinson's disease? A. It results from immune system attacks on the myelin sheaths of neurons B. It is associated with the degeneration of dopamine-producing neurons in the substantia nigra of the mid-brain C. It involves the degeneration of motor neurons in the brainstem and spinal cord D. It is an autoimmune disease inhibiting acetylcholine transmission in the neuromuscular junction
B. It is associated with the degeneration of dopamine-producing neurons in the substantia nigra of the mid-brain
The mother of a child with cystic fibrosis tells the nurse that her child makes "snoring" sounds when breathing. The nurse is aware that many children with cystic fibrosis have: A. Choanal atresia. B. Nasal polyps. C. Septal deviations. D. Enlarged adenoids.
B. Nasal polyps. B: Children with cystic fibrosis are susceptible to chronic sinusitis and nasal polyps, which might require surgical removal. A: Answer A is incorrect because it is a congenital condition in which there is a bony obstruction between the nares and the pharynx. C & D: Answers C and D are not specific to the child with cystic fibrosis; therefore, they are incorrect.
This will check out the outline of the lower intestine, looking for the presence of meconium ileus and stool obstruction
Barium enema
These are done instead of an Incentive Spirometer. Patients may blow bubbles instead, blow in a bag, homemade devices can be used.
Breathing exercises
This is performed as frequently as possible. Along with drugs, this is the most important management for Respiratory Complications of CF. - There are JACKETS that vibrate the chest wall to help. DO this along with the Jacket.
Chest physiotherapy
This diagnostic test will show patches of lung disease and early signs of obstruction and atelectasis. - A Pulmonary Function Test is important.
Chest x-ray
Which of the following diseases is not associated with cognitive impairment? Select all that apply A. Parkinson's disease B. Multiple sclerosis C. Amyotrophic lateral sclerosis D. Huntington's disease E. Myasthenia gravis
C. Amyotrophic lateral sclerosis E. Myasthenia gravis
Which finding is the best indication that a client with ineffective airway clearance needs suctioning? A. Oxygen saturation. B. Respiratory rate. C. Breath sounds. D. Arterial blood gases.
C. Breath sounds. C: Changes in breath sounds are the best indication of the need for suctioning in the client with ineffective airway clearance. A,B,C: Answers A, B, and D are incorrect because they can be altered by other conditions.
A nurse is performing an assessment on a client with Addison's disease. Which of the following would be an unexpected finding? A. Bronze pigmentation of skin B. Muscle weakness C. Hyperglycemia D. Decreased serum sodium
C. Hyperglycemia
Which of the following statements is not true about dementia? A. It is a diagnosis of exclusion that can be made only after other causes of cognitive impairment have been ruled out B. The Mini-Mental State Exam (MMSE) and clock drawing test are two useful tools for the diagnosis of Alzheimer's and other dementia C. Vascular dementia is the leading cause of dementia in the United States D. Persons in the moderate stage of Alzheimer's Disease may need some assistance with ADLs and can show agitationE. Eventually, both short- and long-term memory can be eroded in Alzheimer's Disease
C. Vascular dementia is the leading cause of dementia in the United States
What is the cause of Alzheimer's disease? Risk factors?
Cause is unknown Many risk factors that are known to cause and advance the disease: Age: >65 years Family history: ApoE gene Cardiovascular: Diabetes, hypertension, obesity, hypercholesteremia, smoking Head trauma
What is cushings syndrome?
Caused by: - Chronic exposure to excess corticosteroids, particularly glucocorticoids - results from ACTH secreting pituitary tumor - Adrenal tumors - Ectopic ACTH producing tumors in lung or pancreas - Prolonged administration of high dose corticosteroids
These are PRIMARY nursing diagnosis for CF patients because the disease is lifelong.
Guilt, anxiety, fear and anticipatory grief
What is the role of iodine?
Essential mineral for thyroid production of T3 (active hormone) and T4 (inactive hormone) - Absorbed in the small intestine - Optimal intake is 150mcg/day - Sources of iodine include: iodized salt, sea food, dairy products, meat, eggs
This is a multi-system disorder of the exocrine glands, leading to an increased production of thick mucus in the bronchioles, small intestines, and pancreatic and bile ducts. It effects the lungs, sweat glands, and can also be found in reproductive tissue. - Increased viscosity of secretions obstructs small passage ways of these organs and interferes with normal pulmonary and digestive function. - This can cause a delay in puberty for females and sterility in males
Cystic fibrosis
A student nurse is providing education for a client newly diagnosed with Grave's disease. Which of the following statements would require an intervention by the nurse? A. "You must monitor for symptoms such as high heart rate, high temperatures, and seizures." B. "You will likely be prescribed methimazole (Tapazole) or Propylthiouracil (PTU) to block your excess production of T3 and T4." C. "Untreated Grave's disease can eventually lead to hypothyroidism." D. "Propylthiouracil (PTU) is the preferred medication for most people as it works faster and has fewer side effects than methimazole (Tapazole)."
D. "Propylthiouracil (PTU) is the preferred medication for most people as it works faster and has fewer side effects than methimazole (Tapazole)."
The nurse is teaching the mother of a child with cystic fibrosis how to do postural drainage. The nurse should tell the mother to: A. Use the heel of her hand during percussion. B. Change the child's position every 20 minutes. C. Do percussion after the child eats and at bedtime. D. Use cupped hands during percussion.
D. Use cupped hands during percussion. D: The nurse or parent should use a cupped hand when performing chest percussion. A: Answer A is incorrect because the hand should be cupped. B: Answer B is incorrect because the child's position should be changed every 5-10 minutes and the whole session should be limited to 20 minutes. C: Answer C is incorrect because chest percussion should be done before meals.
What is the treatment for delirium?
Depends on the cause - Need for calming, familiar environment - Reorient as much as possible - Avoid restraints if at all possible - Medications to focus on symptoms, but NEED to treat underlying cause
How is Alzheimer's diagnosed?
Diagnosis by exclusion (must rule out every other possible diagnosis first) - Early and close evaluation - MMSE - Clock test - Comprehensive evaluation 1. Complete health history 2. Physical exam 3. Neurologic and mental status assessment 4. Laboratory tests - CT and MRI once the diagnosis is expected
What is Lewy Body Dementia?
Early onset dementia characterized by presence of Lewy bodies - Can have clinical features of both Alzheimer's and Parkinson's
This is the recommended formula for infants with CF because of its high calorie and high protein content.
Enfamil (Pregestimil)
These are the dietary recommendations for CF patients
High calories, high protein, and high fat
What is hyperthyroidism?
Hyperactive thyroid gland (too much T3 and T4 being secreted)
What thyroid condition does a patient have with the lab values of: - Low TSH - High or normal T4 - High or normal T3
Hyperthyroidism
What is hypothyroidism?
Hypoactive thyroid gland (not enough T3 and T4 being released)
What thyroid condition does a patient have with the lab values of: - High TSH - Low T4 - Low or normal T3
Hypothyroidism
A person with Addison's disease should have to carry what medication with them at all times?
IM hydrocortisone
What are the clinical manifestations of cystic fibrosis?
In children: - Meconium ileus - Acute and persistent respiratory symptoms (wheezing, coughing, frequent pneumonia) - Lung infection - Salty-tasting skin - FTT or malnutrition - Steatorrhea (large, oily, frequent bowel movements) - Family history - Emaciated appearance of extremities - Delayed puberty In adults: - Frequent cough - Viscous, purulent, often yellow or greenish sputum - Bronchiolitis, bronchitis, and pneumonia - Exacerbations characterized by: cough, weight loss, increased sputum, and decreased pulmonary function - DIOS - Reproductive issues in men - Difficulty conceiving children - Irregular periods
What is cystic fibrosis?
It is a genetic disorder of the cell membranes which causes thick, sticky mucus to build up in air passages and pancreas - Causes an altered transport of sodium and chloride ions in and out of epithelial cells
What is the medical treatment for hypothyroidism?
Levothyroxine (Synthroid)
It is said that this organ also has exocrine glands that can be affected by CF. Enzyme studies from this organ are an important diagnostic assessment.
Liver
This organ affected by CF is the most serious threat to life. Thick, sticky secretions pool here and can cause atelectasis (collapse) and serve as a median for bacterial growth. - Thick mucus can lead to obstruction of the AIRWAY and cause INFECTION
Lung
This is a supplement high in calories that helps digest nutrients. It is drawn up in a syringe and added to formula. It is very thick and will most likely clog the syringe.
MCT oil
CF patients have a great appetite but appear this way. This is because the nutrients are LOST in the GI tract. There is marked tissue wasting. They appear to have Failure to Thrive. - Nasal Polyps: Unable to smell and eat effectively
Malnourished with decreased weight
This is the earliest sign of Cystic Fibrosis. It occurs when meconium does not pass and impacts the large intestines. 10% of newborns with CF have this.
Meconium ileus
What treatments can be used to help with sundowning?
Melatonin and Ambien to aid in sleep Antipsychotics to reduce agitation - Create a quiet, calm environment - Maximize exposure to sunlight - Elavulate medications to determine if any could cause sleep disturbance - Limit naps and caffeine
What thyroid condition does a patient have with the lab values of: - Low TSH - Normal T4 - Normal T3
Mild hyperthyroidism
What thyroid condition does a patient have with the lab values of: - High TSH - Normal T4 - Normal T3
Mild hypothyroidism
What are the stages of Alzheimer's? (STUDY THIS)
Mild: - Forgetfulness beyond normal - Short-term memory impairment - Loss of initiative Moderate: - May need incontinence - Need assistance with some ADLs - Trouble sleeping - Agitation Severe: - Little memory - Can have difficulty eating, swallowing - Need complete assistance with most ADLs
This is used in young infants to help liquefy secretions
Mist tent
Extreme hypothyroidism can cause what potential fatal illness?
Myxedema coma
What is the treatment for Alzheimers?
NO CURE Drug therapy - Antidepressants: Depressive symptoms - Antipsychotics: Behavioral problems - Melatonin and Ambien: Sleep disturbances - Cholinesterase inhibitors (Aricept and Exelon): Memory and cognition Behavior modifications - Redirect, distract, and reassure - DON'T REORIENT - Light exercise - Active activities Pain management Safety - Supervision required - Risk of wandering Pain management Eating and swallowing difficulties - Pureed or thickened liquids - NG or PEG Oral care Infection prevention Skin care Elimination problems Caregiver support
What is dementia?
Neurocognitive disorder characterized by loss of: - Memory - Orientation - Attention - Language - Judgement - Reasoning
These are replaced by giving them pharmacologically. They are sprinkled on the food, or if the child is old enough, they are given in capsule form, PO with Meals. - If the child is NPO, do NOT give the enzymes.
Pancreatic enzyme replacement: Pancrease and COTAZYM-s
The pancreatic ducts become clogged with thick secretions in CF patients, and prevents these enzymes from reaching the duodenum, impairing digestion and absorption. (Breaks down Fats and Proteins)
Pancreatic enzymes
This is a major respiratory complication in CF. S/S are: - Tachypnea - Spitting up Blood - Cyanosis - Pallor - Tachycardia (Indication of evolving) A sudden drop in O2 sat may indicate this Along with this, CHF is another respiratory complication. S/S are cyanosis and clubbing of the fingers and toes. > All of these can lead to respiratory failure.
Pneumothorax
What are the causes of hypothyroidism?
Primary cause: - Hashimoto's (antibodies develop against the thyroid) - Iodine deficiency - Surgical removal or iodine radiation - Untreated Grave's disease - Medication reaction Secondary cause: - Pituitary/hypothalamic neoplasm - Congenital hypopituitarism
What does the thyroid do?
Produces 2 thyroid hormones (T3 and T4) and releases them as needed in the body - Controlled by the hypothalamus and pituitary glands - Hypothalamus produces THR which stimulate the pituitary gland to release TSH ** Decreased T3 levels causes hypothalamus to release more TRH and the pituitary to release more TSH; the thyroid gland then releases T3 and T4 until the body is receiving the required amount
These include: - Moist Crackles, Wheezing - Distended BARREL Chest/ Atelectasis (Alveoli are over inflated) <--Worst case scenario when children get older - Decreased O2 Sat - Hypoxia - Hypercapnea (Too Much CO2) - Acidosis
Progressing respiratory signs of cystic fibrosis
These are the primary bronchodilators used in Respiratory management of CF. One is a Nebulizer treatment that helps decrease viscosity of mucus. The other can cause VOICE ALTERATIONS
Pulmozyme and Dornase
What are the long-term and quick-relief medications used for asthma?
Quick-relief: - Bronchodilators (Short-acting inhaled B2-agonist, anticholinergics) - Anti-inflammatory (Corticosteroids) Long-term: - Anti-inflammatory (corticosteroids, leukotriene modifiers, Anti-lgE) - Bronchodilators (Long-acting inhaled B2-agonist, Long-acting oral B2-agonist, methylxanthines)
What is a myxedema coma?
Rare condition requiring emergency care that can occur in a person who has untreated, severe hypothyroidism. It usually occurs in older adults who have other illnesses, such as a serious infection or heart attack, in addition to their hypothyroidism.
This is a GI situation to be concerned with in CF patients. Results from heavy like stools.
Rectal prolapse
What is a thyroidectomy?
Removal of all or part of the thyroid gland - Used to treat cancers and hyperthyroidism
These include: - Dry, nonproductive cough, initially - Frequent respiratory infections - Culture of secretions have pseudomonas
Respiratory signs of cystic fibrosis
The food given to CF patients, which has enzymes sprinkled on it, must be given at this temperature, otherwise the enzymes will be destroyed
Room temperature
Na escapes through pores. This will appear in patients with CF, often first noticed when the mother kisses the infant on the forehead.
Salty taste to skin
This area of the intestines, in the absence of pancreatic enzymes, is unable to absorb protein and fats; thus, growth and puberty are retarded. Malabsorption - This also results in excessive fat and protein in the stool.
Small intestines
These three nutrients will be low (hypo) in patients with CF.
Sodium, chloride, and protein (albumin)
Do NOT encourage this in terms of diet and nutrition of CF patients
Soy milk
A.K.A "The 4 F's" - This is stool that is Foul Smelling, Fatty, Frothy, and Floating. It describes the type of stool found in patients with CF.
Steatorrhea
What are the medication requirements based on the step approach for asthma?
Step 1: SABA as needed Step 2: Low-dose inhaled corticosteroid Step 3: Low-dose inhaled corticosteroid + Long-acting inhaled B2-agonist Step 4: Medium-dose inhaled corticosteroid + Long-acting inhaled B2-agonist Step 5: High-dose inhaled corticosteroid + Long-acting inhaled B2-agonist Step 6: High-dose inhaled corticosteroid + Long-acting inhaled B2-agonist + oral corticosteroid (used late in treatment) - Add an anti IgE (Xolair) for asthma and allergies
What are the laboratory test results for hypothyroidism?
TSH either HIGH or LOW Free T4 usually LOW
What are the laboratory test results for hyperthyroidism?
TSH usually LOW Free T4 usually HIGH
Extreme hyperthyroidism can cause what potential fatal illness:
Thyroid storm (Thyrotoxicosis)
What is the adult asthma action plan?
Written plan for adults to manage their asthma Green: Good control >80% personal best Take usual medications. Yellow: Caution 50-80% personal best Take short-acting inhaled β2-agonist right away. Talk to your provider. Red: Medical alert <50% personal best Take short-acting inhaled β2-agonist right away. Seek emergency care
What is Addison's disease?
Under secretion of the adrenal cortex caused by deficient amounts of corticosteroids (lack of ACTH secretion) Results from: - An autoimmune response - TB, fungal infection, AIDS, Cancer - Hemorrhage and nephrectomy may cause iatrogenic Addison's disease
What type of dementia is characterized by multiple small strokes in the brain over a small period of time?
Vascular dementia
What are the components of asthma control? and how are they determined?
Well controlled Not well controlled Very poorly controlled
Which statement(s) accurately describe(s) mild cognitive impairment (select all that apply)? a. Always progresses to AD b. Caused by variety of factors and may progress to AD c. Should be aggressively treated with acetylcholinesterase drugs d. Caused b vascular infarcts that, if treated, will delay progression to AD e. Patient is usually not aware that there is a problem with his or her memory
b. Caused by variety of factors and may progress to AD
A nursing student is educating a client's family about Lewy body Dementia. Which of the following statements required further education by the student? a. The symptoms of LBD can be a combination of Alzheimer's and Parkinson's b. Certain drugs may improve cognition for a certain period of time c. Our family member may be taking antidepressants to treat symptoms of the disease d. We may be at an increased risk of Lewy body Dementia since we have a family member with the disease
b. Certain drugs may improve cognition for a certain period of time
The early stage of AD is characterized by a. no noticeable change in behavior. b. memory problems and mild confusion. c. increased time spent sleeping or in bed. d. incontinence, agitation. and wandering behavior.
b. memory problems and mild confusion.
Important nursing intervention(s) when caring for a patient with Cushing syndrome include (select all that apply) a. restricting protein intake. b. monitoring blood glucose levels. c. observing for signs of hypotension. d. administering medication in equal doses. e. protecting patient from exposure to infection.
b. monitoring blood glucose levels. e. protecting patient from exposure to infection.
Dementia with Lewy bodies (DLB) is characterized by a. Remissions and exacerbations over many years. b. Memory impairment, muscle jerks, and blindness. c. Parkinsonian symptoms, including muscle rigidity. d. Increased intracranial pressure secondary to decreased CSE drainage.
c. Parkinsonian symptoms, including muscle rigidity.
A 65-yr-old woman was just diagnosed with Parkinson's disease. The priority nursing intervention is a. searching the Internet for educational videos. b. evaluating the home for environmental safety. c. promoting physical exercise and a well-balanced diet. d. designing an exercise program to strengthen and stretch specific muscles.
c. promoting physical exercise and a well-balanced diet.
The nurse is reinforcing teaching with a patient newly diagnosed with amyotrophic lateral sclerosis (ALS). Which statement would be appropriate to include in the teaching? a. "ALS results from an excess chemical in the brain, and the symptoms can be controlled with medication" b. "Even though the symptoms you are experiencing are severe, most people recover with treatment" c. "You need to consider advance directives now, because you will lose cognitive function as the disease progresses" d. "This is a progressing disease that eventually results in permanent paralysis, though you will not lose any cognitive function"
d. "This is a progressing disease that eventually results in permanent paralysis, though you will not lose any cognitive function"
Which patient is most at risk for developing delirium? a. A 50-yr-old woman with cholecystitis b. A 19-yr-old man with a fractured femur c. A 42-yr-old woman having an elective hysterectomy d. A 78-yr-old man admitted to the medical unit with complications related to heart failure
d. A 78-yr-old man admitted to the medical unit with complications related to heart failure
After thyroid surgery, the nurse suspects damage or removal of the parathyroid glands when the patient develops a. muscle weakness and weight loss. b. hyperthermia and severe tachycardia. c. hypertension and difficulty swallowing. d. laryngospasms and tingling in the hands and feet.
d. laryngospasms and tingling in the hands and feet.
The clinical diagnosis of dementia is based on a. CT or MRS b. brain biopsy. c. electroencephalogram. d. patient history and cognitive assessment.
d. patient history and cognitive assessment.
Dementia is defined as a a. syndrome that results only in memory loss. b. disease associated with abrupt changes in behavior. c. disease that is always due to reduced blood flow to the brain d. syndrome characterized by cognitive dysfunction and loss of memory.
d. syndrome characterized by cognitive dysfunction and loss of memory.
What does the parathyroid do?
produce PTH (parathyroid hormone) which raises blood Ca levels, excretes phosphate, and stimulates vitamin D
