RN 202 Med Surge Final Exam

What are the patient and caregiver teaching for peptic ulcer disease?

1. Avoiding foods that cause epigastric distress, such as acidic foods. 2. Avoid cigarettes. Smoking promoting ulcer development and delays ulcer healing. 3. Reduce or eliminate alcohol use. 4. Avoid OTC drugs unless approved by the HCP. Many preparations contain ingredients, such as aspirin, that should not be taken unless approved by the HCP. Check with the HCP about the use of NSAIDs. 5. Do not interchange brands of PPIs, antacids, or H2 receptor blockers that you can buy OTC without checking with the HCP. This can lead to harmful side effects. 6. Take all medications as prescribed. This includes both antisecretory and antibiotic drugs. Not taking medications as prescribed can cause a relapse. 7. It is important to report any of the following: • Increased nausea or vomiting • Increased epigastric pain • Bloody emesis or tarry stools 8. Stress can be related to signs and symptoms of PUD. Learn and use stress management strategies 9. Share concerns about lifestyle changes and living with a chronic illness.

What are the patient and caregiver teaching for skin reactions?

1. Gently cleanse the skin in the treatment field using a mild soap (Ivory, Dove), tepid water, a soft cloth, and a gentle patting motion. Rinse thoroughly and pat dry. 2. Apply nonmedicated, nonperfumed, moisturizing lotion or cream, such as calendula ointment, aloe gel, Aquaphor, or Biafine cream, to alleviate dry skin. Some substances must be gently cleansed from the treatment field before each treatment and reapplied. Over-the-counter hydrocortisone cream 1% may reduce itching. 3. Rinse the area with saline solution. Expose the area to air as often as possible. If copious drainage is present, use astringent compresses (such as Domeboro solution) and nonadhesive absorbent dressings. Change dressings as soon as they become wet. 4. Observe the area daily for signs of infection. 5. Avoid wearing tight-fitting clothing, including brassieres and belts, over the treatment field. 6. Avoid wearing harsh fabrics, such as wool and corduroy. A lightweight cotton garment is best. If possible, expose the treatment field to air. 7. Use gentle detergents (e.g., Dreft, Ivory Snow) to wash clothing that will come in contact with the treatment field. 8. Avoid direct exposure to the sun. If the treatment field is in an area that is exposed to the sun, wear protective clothing, such as a wide-brimmed hat, when out in the sun and apply sunscreen lotion. 9. Avoid all sources of excessive heat (hot water bottles, heating pads, sunlamps) on the treatment field. 10. Avoid exposing the treatment field to cold temperatures (ice bags or cold weather). 11. Avoid swimming in saltwater or in chlorinated pools during the time of treatment. 12. Avoid the use of potential irritants (e.g., perfumes, powders, or cosmetics) on the skin in the treatment field. Review the use of other topical medications or lotions with your HCP during treatment. Avoid tape, dressings, and adhesive bandages unless allowed by the radiation therapist. 13. Continue to protect sensitive skin after the treatment is completed. Do the following: • Avoid direct exposure to the sun. A sunscreen agent and protective clothing must be worn if the potential of exposure to the sun is present. • Use an electric razor if shaving is needed in the treatment field.

What are the patient and caregiver teaching for thrombocytopenia? ( select all that apply)

1. Notify your HCP of any symptoms of bleeding. These include: • Black, tarry, or bloody bowel movements • Black or bloody vomit, sputum, or urine • Bleeding from the mouth or anywhere in the body • Bruising or small red or purple spots on the skin • Difficulty talking, sudden weakness of an arm or leg, confusion • Headache or changes in how well you can see 2. Ask your HCP about restrictions in your normal activities, such as vigorous exercise or lifting weights. Generally, walking is safe. Wear sturdy shoes or slippers. If you are weak and at risk for falling, get help or supervision when getting out of bed or chair. 3. Do not blow your nose forcefully; gently pat it with a tissue if needed. For a nosebleed, keep your head up and apply firm pressure to the nostrils and bridge of your nose. If bleeding continues, place an ice bag over the bridge of your nose and the nape of your neck. If you are unable to stop a nosebleed after 10 minutes, call your HCP. 4. Do not bend down with your head lower than your waist. 5. Prevent constipation by drinking plenty of fluids. Do not strain when having a bowel movement. Your HCP may prescribe a stool softener. Do not use a suppository, an enema, or a rectal thermometer without the permission of your HCP. 6. Shave only with an electric razor. Do not use blades. 7. Do not tweeze your eyebrows or other body hair. 8. Do not puncture your skin, such as getting tattoos or body piercing. 9. Do not use any medication that can prolong bleeding, such as aspirin. Other medications and herbs can have similar effects. If you are unsure about any medication, ask your HCP or pharmacist about it in relation to your thrombocytopenia. 10. Use a soft-bristle toothbrush to prevent injuring the gums. Flossing is usually safe if done gently using the thin tape floss. Do not use alcohol-based mouthwashes since they can dry your gums and increase bleeding. 11. Women who are menstruating should keep track of the number of pads that are used per day. When you start using more pads per day than usual or bleed more days, notify your HCP. Do not use tampons; only use sanitary pads. 12. Ask your HCP before you have any invasive procedures done, such as a dental cleaning, manicure, or pedicure.

What are the exogenous insulin administration procedure

1.Wash hands thoroughly. 2.Inspect insulin bottle for proper type and concentration, and expiration date. a.For intermediate-acting insulins, gently roll the insulin bottle between the palms of hands to mix the insulin. Clear insulins do not need to be agitated. 3.Choose proper injection site. 4.Ensure that the site is clean and dry. 5.Push the needle straight into the skin (90-degree angle). If you are very thin, muscular, or using an 8- or 12-mm needle, you may need to pinch the skin and/or use a 45-degree angle. 6.Push the plunger all the way down, leave needle in place for 5 sec to ensure that all insulin has been injected, and then remove needle. 7.Destroy and dispose of single-use syringe safely. Key points for insulin injection -Rotate injection site. -Only the person using the syringe should recap the needle; never recap a needle used for a patient.

Arrange blood transfusion in order

Administration Procedure 1.Verify physician's order for blood transfusion. 2.Confirm consent is signed by patient and provider. 3.Ensure that patient has IV access (preferably 18- or 16-gauge) 4.Request or obtain blood from the blood bank 5.Assess the blood product's expiration data, observe for abnormal color, clumping, RBC clumping, gas bubbles, and extraneous materials 6.Verify blood compatibility, patient identify and vital signs with another licensed nurse 7.Hang the blood

What are the common documents for EOL care?

Advance directive General term used to describe documents that give instructions about future medical care and treatments and who should make the decisions in the event the person is unable to communicate • Should adhere to guidelines established by state of residence Allow natural death (AND) Written order acknowledging that comfort measures only are being provided to patient. Used in many palliative care and hospice settings to indicate that patient wants to die naturally with dignity and comfort • In many settings, may be used in conjunction with DNR terminology to ensure patient/family wishes for advance directives are followed (DNR/AND) Directive to physicians (DTP) Written document specifying the patient's wish to be allowed to die without heroic or extraordinary measures • Indicates specific measures to be used or withheld Do not resuscitate (DNR) Written physician's order instructing HCPs not to attempt CPR. DNR order often requested by family • Must indicate any specific measures to be used or withheld • Must be signed by a physician to be valid Living will Lay term used to describe any documents that give instructions about future medical care and treatments or the wish to be allowed to die without heroic or extraordinary measures should the patient be unable to communicate for self • Must identify specific treatments that a person wants or does not want at end of life Medical power of attorney (MPOA) Term used by some states to describe a document used for listing the person(s) to make health care decisions should a patient become unable to make informed decisions for self • May be the same as durable power of attorney for health care, health care proxy, or appointment of a health care agent or surrogate • Specifies measures to be used or withheld • Person appointed may be called a health care agent, surrogate, attorney-in-fact, or proxy Physician Order for Life-Sustaining Treatment (POLST) or Medical Order for Life-Sustaining Treatment (MOLST) A standardized physician order guided by the patient's medical condition and based upon personal preferences stated by patient or expressed in advance directive • Only for those whose illness may limit life to <12 mo • Guides current treatments. Differs from advance directive, which guides future treatments • Physician completes form based on discussion with patient or authorized representative, or in review of advance directive • Signed by physician, patient, or patient representative • Printed on bright pink paper Power of attorney for health care (POAH) Term used by some states to describe a document used for listing the person(s) to make health care decisions should a patient become unable to make informed decisions for self • May be the same as medical power of attorney • Indicates specific measures to be used or withheld

What are the risk factors for UTI?

Anatomic Factors • Congenital defects leading to obstruction or urinary stasis • Fistula exposing urinary stream to skin, vagina, or fecal stream • Obesity • Shorter female urethra and colonization from normal vaginal flora Factors Compromising Immune Response • Aging • Diabetes • HIV infection Factors Increasing Urinary Stasis • Extrinsic obstruction (tumor, fibrosis compressing urinary tract) • Intrinsic obstruction (stone, tumor of urinary tract, urethral stricture, BPH) • Renal impairment • Urinary retention (e.g., neurogenic bladder) Foreign Bodies • Catheters (indwelling, external condom catheter, ureteral stent, nephrostomy tube, intermittent catheterization) • Urinary tract instrumentation (cystoscopy) • Urinary tract stones Functional Disorders • Constipation • Voiding dysfunction with detrusor sphincter muscle incoordination Other Factors • Habitual delay of urination ("nurse's bladder," "teacher's bladder") • Pregnancy • Menopause • Multiple sex partners (women) • Poor personal hygiene • Use of spermicidal agents, contraceptive diaphragm (women), bubble baths, feminine sprays

What are the different types of griefs by family members or caregiver?

Anticipatory Grief •Grief experienced long before the actual death event Adaptive Grief •Grief that helps the person accept the reality of death -Healthy response -Ability to see good resulting from the death -Positive memories of the deceased person Prolonged grief disorder •Dysfunction reaction to grief -Recurring and severe distressing emotions and intrusive thoughts -Self-neglect -Denial of loss longer than 6 months

What is palliative care and its goals? ( Select all that apply)

Any form of care or treatment that focuses on reducing the severity of disease symptoms. • Regard dying as a normal process • Provide relief from symptoms, including pain • Affirm life and neither hasten nor postpone death • Support holistic patient care and enhance quality of life • Offer support to patients to live as actively as possible until death • Offer support to the family during the patient's illness and in their own bereavement

What are the normal and abnormal findings of lymph node assessment?

Assess lymph nodes symmetrically *Location, size (cm), degree of fixation (e.g., movable, fixed), tenderness, and texture. *Examine superficial lymph nodes with light palpation. We cannot palpate deep lymph nodes. They are evaluated by radiologic examination. Normal: *Not palpable in adults. *If a node is palpable, it should be small (0.5 to 1 cm), mobile, firm, and nontender to be considered a normal finding. Abnormal: *Tender, hard, fixed, or enlarged (regardless if it is tender or not) = requires investigation *Tender nodes are usually a result of inflammation. *Hard or fixed nodes suggest cancer.

How do we prevent CAUTIs?

Avoid unnecessary urinary catheterization!

What are the risk factors for cervical cancer? ( Select all that apply)

Cancer of the cervix. •Risk factors •Infection with high-risk strains of HPV 16 and 18 •Immunosuppression •Using OCPs for a long period of time •Being exposed to the drug diethylstilbestrol (DES) •Giving birth to many children •Smoking Diagnostic Tests •Pap and HPV testing •Pap at 21 years of age every 3 years •HPV cotesting starts at age 30

What is hospice and who decides which patients are eligible for hospice care?

Care that provides compassion, concern, and support for persons in the last phase of a terminal disease. Eligibility for hospice services Two physicians certify that the patient's prognosis is terminal, with less than 6 months to live.

What are the clinical manifestations for blood transfusion reaction? ( Select all that apply)

Clinical manifestations •Fever with or without chills •Chest, flank, abdominal or back pain •Infusion site pain •Tachycardia •Dyspnea •Tachypnea •Hypotension •Rigors •Headache •Pruritis •Urticaria

What are the clinical manifestations of C.Diff and causes?

Clinical manifestations •Watery diarrhea, fever, anorexia, nausea, abdominal pain Causes •Prolonged use of antibiotics followed by exposure to feces-contaminated surfaces •Spores on hands and environmental surfaces are extremely hard to kill Clostridium difficile infection •C. difficile spores can survive for up to 70 days on objects. •Strict infection control precautions can transmit C. difficile from patient to patient = Contact Precautions •Meticulous hand washing with soap and water •Lactobacillus probiotics may be used to prevent or as adjunct •Treated with oral vancomycin (125 mg 4 times a day) or fidaxomicin (200 mg twice daily) for 10 days. •Metronidazole is an option when patients are unable to be treated with vancomycin or fidaxomicin.

What are the clinical manifestations for sickle cell disease? ( select all that apply)

Clinical manifestations of vaso-occlusive crisis include: •Pain •Fever •Swelling •Tenderness •Tachypnea •Hypertension •Nausea and vomiting

What are the nursing interventions for bone marrow suppression?

Common side effect of chemotherapy and radiation therapy Can result in life-threatening conditions: *Neutropenia *Thrombocytopenia *Anemia Nursing Implementation Neutropenia *Monitor the patient's CBC panel: neutrophil, platelet, and RBC count *Monitor for signs and symptoms of infection: fever *Administer WBC growth factors Thrombocytopenia *Monitor for signs and symptoms of bleeding *Avoid invasive procedures *See next slide for patient and family education *Administer platelet transfusion if platelet levels fall below 20,000/uL Anemia *Administer RBC growth factors *Administer packed RBCs

What are the different therapies for menopause medical treatment?

Drug Therapy •Use of estrogen with or without progesterone •Risks associated with HRT •Increased risk for breast and endometrial cancer •Risk for blood clots Nonhormonal Therapy •SSRI antidepressants, clonidine (Catapres), an antihypertensive drug, and gabapentin (Neurontin), selective estrogen receptor modulators •Regular exercise several times per week •Herbal therapies to ease the symptoms they experience during menopause •Black cohosh •Soy Nutritional Therapy •Adequate intake of calcium and vitamin D helps maintain healthy bones and counteracts loss of bone density. •Daily calcium intake of at least 1500 mg. •Women taking estrogen replacement need at least 1000 mg/day.

what are the general manifestations for leukemia?

Fever, fatigue, weight loss, weakness, pallor, anemia Acute Myelogenous Leukemia (AML) *Accounts for 15%-20% of acute leukemia in children and 80% in adults. Increase in incidence with advancing age after 60 yr. *Fatigue and weakness, headache, mouth sores, anemia, bleeding, fever, infection, sternal tenderness, gingival hyperplasia, mild hepatosplenomegaly (one third of patients) *Low RBC count, Hgb, Hct, platelet count. Low to high WBC count with myeloblasts. High LDH. Hypercellular bone marrow with myeloblasts. Acute Lymphocytic Leukemia (ALL) *Median diagnosis is 15 yr with 57.2% diagnosed at younger than 20 yr. About 27% of cases are diagnosed at age 4 or older and only 11% at age 65 or older. *Fever, pallor, bleeding, anorexia, fatigue, and weakness. Bone, joint, and abdominal pain. Generalized lymphadenopathy, infections, weight loss, hepatosplenomegaly, headache, mouth sores, neurologic manifestations: CNS involvement, increased intracranial pressure (nausea, vomiting, lethargy, cranial nerve dysfunction) from meningeal infiltration. Men may have painless enlargement of the scrotum. *Low RBC, Hgb, Hct, platelet count. Low, normal, or high WBC count. High LDH. Hypercellular bone marrow with lymphoblasts. Lymphoblasts may be in cerebrospinal fluid. Presence of Philadelphia chromosome (up to 30% of patients). Up to 15% may have a mediastinal mass. Chronic Myelogenous Leukemia (CML) *Increase in incidence with advancing age, with median age at diagnosis of 67. Rare in children. *No symptoms early in disease. Fatigue and weakness, fever, sternal tenderness, weight loss, joint pain, bone pain, massive splenomegaly, increase in sweating. *Low RBC count, Hgb, Hct. High platelet count early, lower count later. ↑ Banded neutrophils and myeloblasts and often basophils, normal number of lymphocytes, and normal or low number of monocytes. Nucleated red cells are common. Low leukocyte alkaline phosphatase. Presence of Philadelphia chromosome in ≥90% of patients. Chronic Lymphocytic Leukemia (CLL) *Increase in incidence with advancing age after 65 yr, with predominance in men. * Frequently no symptoms. Detection of disease often during examination for unrelated condition, chronic fatigue, anorexia, splenomegaly and lymphadenopathy, hepatomegaly. May progress to fever, night sweats, weight loss, fatigue, and frequent infections. *Mild anemia and thrombocytopenia with disease progression. Total WBC count >100,000/μL. Increase in peripheral lymphocytes and lymphocytes in bone marrow. May have autoimmune hemolytic anemia, idiopathic thrombocytopenic purpura, and hypogammaglobulinemia.

What are the assessment abnormalities for GI?

Glossititis -Reddened, ulcerated, swollen tongue -Exposure to streptococci, irritation, injury, vitamin B deficiencies, anemia Dyspepsia -Burning or indigestion -Peptic ulcer disease, gallbladder disease Dysphagia -Difficulty swallowing, sensation of food sticking in esophagus -Esophageal problems, cancer of esophagus Eructation -Belching -Gallbladder disease Ascites -Accumulated fluid within abdominal cavity, eversion of umbilicus (usually) -Peritoneal inflammation, heart failure, metastatic cancer, cirrhosis Absent bowel sounds -No bowel sounds on auscultation -Peritonitis, paralytic ileus, obstruction Bruit -Humming or swishing sound heard through stethoscope over vessel -Partial arterial obstruction (narrowing of vessel), turbulent flow (aneurysm) Steatorrhea - Fatty, frothy, foul-smelling stool -Chronic pancreatitis, biliary obstruction, malabsorption problems

What are the clinical manifestations you would see for digitalis exam and what would you assess for?

Group of inflammatory and noninflammatory conditions affecting the prostate gland. Clinical manifestations •Acute prostatitis include fever, chills, back pain, and perineal pain. In addition, acute urinary symptoms such as dysuria, urinary frequency, urgency, and cloudy urine may occur. The patient may progress to acute urinary retention caused by prostatic swelling if he remains untreated. •With digital rectal exam, the prostate is extremely swollen, extremely tender, and boggy. •Chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome, manifestations are similar but generally milder than those of acute bacterial prostatitis. •These include irritative voiding symptoms (frequency, urgency, dysuria), backache, perineal and pelvic pain, and ejaculatory pain. Obstructive symptoms are rare unless there is coexisting BPH. •With DRE, the prostate feels enlarged and soft or boggy and can be slightly tender with palpation.

What are the different causes why women get induced for menopause?

Induced menopause occurs after surgical intervention to remove the ovaries or from side effects of chemotherapy, radiation therapy, or other drugs. Post-menopause is a term that refers to the time in a woman's life after menopause.

What is the interprofessional care for cervical cancer?

Interprofessional Care •Vaccination against HPV provides for primary prevention of cervical cancer. •Teach both parents and patients about the need to complete the HPV vaccination series prior to first sexual contact. •The CDC recommends that all children, males and females, be vaccinated at age 11 to 12, when the immune system has a better uptake of the vaccine. Vaccines can be given as early as age 9. •Currently 3 vaccines are available to protect against HPV. •These vaccines are given in 2 or 3 IM doses (depending upon the patient's age) over a 6-month period.

What order would you do for a patient with hypoglycemia?

Interprofessional treatment •Rule of 15 •Ingest 15 grams of carbohydrates •Recheck blood glucose in 15 minutes •If still low, repeat another 15 grams of carbohydrates •Worsening symptoms, •Subcutaneous or IM injections of 1 mg of glucagon or •IV administration of 20-50 mL of 50% dextrose or glucose Steps to take for a patient complaining of hypoglycemia 1.Check blood glucose 2.Give the client 15 gram of carbs 3.Take the client's vital signs 4.Recheck the blood glucose. 5.Give the client a small snack of carbohydrate and protein. 6.DocumenT

What are the manifestations of thrombocytopenia?

Low platelet levels (<150,000/uL) Clinical manifestations: •Mucosal or cutaneous bleeding •Nose bleeds, gingival bleeding •Petechiae •Purpura •Ecchymoses •pain and tenderness

What are the manifestations of anemia?

Mild (Hgb 10-12 g/dL [100-120 g/L]) Moderate (Hgb 6-10 g/dL [60-100 g/L]) Severe (Hgb <6 g/dL [<60 g/L]) Cardiovascular *Palpitations *Increased palpitations, "bounding pulse" *Tachycardia, increased pulse pressure, systolic murmurs, intermittent claudication, angina, HF, myocardial infarction Eyes *None *None *Icteric conjunctiva and sclera, retinal hemorrhage, blurred vision Gastrointestinal *None *None *Anorexia, hepatomegaly, splenomegaly, difficulty swallowing, sore mouth General *None or mild fatigue *Fatigue *Sensitivity to cold, weight loss, lethargy Integument *None *None *Pallor, jaundice, pruritus Mouth *None *None *Glossitis, smooth tongue Musculoskeletal *None *None *Bone pain Pulmonary *Exertional dyspnea *Dyspnea *Tachypnea, orthopnea, dyspnea at rest Neurologic *None *"Roaring in the ears" *Headache, vertigo, irritability, depression, impaired thought processes

What are the normal and abnormal findings of the abdomen?

Normal findings: •Relatively high pitched and gurgling. Abnormal findings: •Stomach growling or loud gurgles (borborygmi) = hyperperistalsis. •High pitched (rushes and tinkling) bowel sounds = intestinal obstruction. •A perfectly "silent abdomen" is uncommon. •A bruit is a swishing or buzzing sound and = turbulent blood flow.

What are the nursing implementations for blood transfusion reaction?

Nursing implementation of transfusion reaction 1.Stop the transfusion 2.Maintain a patent IV line with saline solution 3.Notify the blood bank and HCP immediately 4.Recheck identifying tags and numbers 5.Monitor vital signs and urine output 6.Treat symptoms per HCP order 7.Save the blood bag and tubing and send them to the blood bank for examination 8.Collect required blood and urine specimens at intervals based on the hospital policy to evaluate for hemolysis 9.Document

What is the patient education on DM?

Nutritional Therapy Total carbohydrate • Include carbohydrate from fruits, vegetables, grains, legumes, and low-fat milk • Monitor by carbohydrate counting, exchange lists, or use of appropriate proportions • Fiber intake at 25-30 g/day •Nonnutritive sweeteners are safe when consumed within FDA daily intake levels Protein • Individualize goals • High-protein diets are not recommended for weight loss Fat • Individualize goals • Minimize trans fat • Dietary cholesterol <200 mg/day • ≥2 servings of fish per week to provide polyunsaturated fatty acids Alcohol • Limit to moderate amount (maximum 1 drink per day for women, 2 drinks per day for men) • Consume alcohol with food to reduce risk for nocturnal hypoglycemia in those using insulin or drugs that promote insulin secretion • Moderate alcohol consumption has no acute effect on glucose and insulin concentrations • Carbohydrates taken with the alcohol (mixed drink) may raise blood glucose Personal hygiene •Daily brushing and flossing and regular dental visits •Regular bathing, with an emphasis on foot care •Advise patients to inspect their feet daily, avoid going barefoot, and wear shoes that are supportive and comfortable. •If cuts, scrapes, or burns occur, treat them promptly and monitor them carefully. Wash the area and apply a nonabrasive or nonirritating antiseptic ointment. •Cover the area with a dry, sterile pad. Teach patients to notify the HCP at once if the injury does not begin to heal within 24 hours or if signs of infection develop.

What are the clinical manifestations and management of spinal cord compression, hypercalcemia, and superior vena cava syndrome. ( Select all that apply)

Obstructive Emergencies Spinal Cord Compression • Neurologic emergency caused by cancer in epidural space of spinal cord. • Common causes are breast, lung, prostate, GI, renal cancers, melanoma. • Lymphomas can invade epidural space. Manifestations • Intense, localized, and persistent back pain with vertebral tenderness. • Motor weakness, sensory paresthesia and loss. • Autonomic dysfunction (e.g., change in bowel or bladder function). Management • Radiation therapy, corticosteroids. • Surgical decompressive laminectomy. • Activity limitations and pain management. Superior Vena Cava Syndrome (SVCS) • Results from obstruction of superior vena cava by tumor or thrombosis. • Common causes are lung cancer, non-Hodgkin's lymphoma, metastatic breast cancer. • Presence of central venous catheter and previous mediastinal radiation increase risk. Manifestations • Facial edema, periorbital edema. • Distention of veins of head, neck, and chest (Fig. 15.18). • Headache, seizures. • Mediastinal mass on chest x-ray. Mangament • Considered a serious medical problem. • Radiation therapy to site of obstruction. • Chemotherapy for tumors more sensitive to this therapy. Metabolic Emergencies Hypercalcemia • Occurs in metastatic disease of bone or multiple myeloma, or when a parathyroid hormone-like substance is secreted by cancer cells. • Immobility and dehydration can contribute to or worsen hypercalcemia. Manifestations • Serum calcium higher than 12 mg/dL (3 mmol/L) often produces symptoms. • Apathy, depression, fatigue, muscle weakness, ECG changes, polyuria and nocturia, anorexia, nausea, vomiting. • High calcium elevations can be life threatening. • Chronic hypercalcemia can result in nephrocalcinosis and irreversible renal failure. Management • Treat primary disease. • Hydration (3 L/day) and bisphosphonate therapy. • Diuretics (especially loop diuretics) used to prevent heart failure or edema. • Infusion of bisphosphonate zoledronate (Zometa) or pamidronate (Aredia).

What are the percussion sounds of urinary system?

Percussion •Tenderness in the flank area may be detected by fist percussion (kidney punch). This technique is performed by striking the fist of one hand against the dorsal surface of the other hand, which is placed flat along the posterior CVA margin. Normally this type of percussion should not elicit pain. •If CVA tenderness and pain are present, it may indicate a kidney infection or polycystic kidney disease. •A bladder does not percuss until it contains at least 150 mL of urine. If the bladder is full, dullness is heard above the symphysis pubis. •A distended bladder may be percussed as high as the umbilicus. Normal physical assessment of urinary system • No costovertebral angle tenderness • Nonpalpable kidney and bladder • No palpable masses

What are the urinalysis of proteins, ketones, WBC, and glucose?

Protein Normal Random protein (dipstick): 0-trace Abnormal Finding Persistent proteinuria Possible ET Characteristic of acute and chronic kidney disease, especially involving glomeruli. Heart failure. Normal 24-hr protein (quantitative): 50-80 mg/day. Possible ET In absence of disease: high-protein diet, strenuous exercise, dehydration, fever, emotional stress, contamination by vaginal secretions Ketones Normal None Abnormal Finding Present Possible ET Altered carbohydrate and fat metabolism in diabetes and starvation; dehydration, vomiting, severe diarrhea WBC Normal 0-5/hpf Abnormal >5/hpf Possible Et UTI or inflammation Glucose Normal None Abnormal Glycosuria Possible Et Diabetes, low renal threshold for glucose reabsorption (if blood glucose level is normal).Pituitary disorders

What are the structures associated with abdomen regions? ( select all that apply)

RUQ • Liver and gallbladder • Pylorus • Duodenum • Head of pancreas • Right adrenal gland • Portion of right kidney • Hepatic flexure of colon • Portion of ascending and transverse colon LUQ • Left lobe of liver • Spleen • Stomach • Body of pancreas • Left adrenal gland • Portion of left kidney • Splenic flexure of colon • Portion of transverse and descending colon RLQ • Lower pole of right kidney • Cecum and appendix • Portion of ascending colon • Bladder (if distended) • Right ovary and fallopian tube • Uterus (if enlarged) • Right spermatic cord • Right ureter LLQ • Lower pole of left kidney • Sigmoid flexure • Part of descending colon • Bladder (if distended) • Left ovary and fallopian tube • Uterus (if enlarged) • Left spermatic cord • Left ureter

How do you obtain a urinalysis from a client with urinary catheter in placed? ( Select all that apply)

The following measures can be used to manage patients with a urethral catheter and prevent a CAUTI. • Determine need for catheterization, but HCP must order. • Choose appropriate type and size of catheter. • Insert catheter in patient with urethral trauma, pain, or obstruction. • Develop plan of care to decrease risk for infection in patient with indwelling catheter. • Teach catheter care to the patient, particularly one who is ambulatory. • Use a sterile, closed drainage system in short-term catheterization. • Do not disconnect the distal urinary catheter and proximal drainage tube except for catheter irrigation (if ordered and indicated). • Use sterile technique whenever the collecting system is open. If frequent irrigations are necessary in short-term catheterization to maintain catheter patency, a triple-lumen catheter may be preferable, permitting continuous irrigations within a closed system. • A routine catheter change is not needed if the patient is catheterized for less than 2 weeks. For long-term use of an indwelling catheter, replace the catheter based on patient assessment and not on a routine changing schedule. • If ordered, aspirate small volumes of urine for culture from the catheter sampling port using a sterile syringe and needle. Prepare the puncture site with an antiseptic solution. • With long-term use of a catheter, a leg bag may be used. If the collection bag is reused, wash it in soap and water and rinse thoroughly. When it is not reused immediately, fill it with ½ cup of vinegar and drain. Vinegar is effective against Pseudomonas and other organisms and eliminates odors. • Remove the catheter as early as possible. Intermittent catheterization and external catheters are alternatives that are associated with fewer cases of bacteriuria and CAUTI. • Ensure that UAP: • Maintain unobstructed downhill flow of urine. • Empty the collecting bag regularly and accurately record the urine output. • Provide perineal care (once or twice a day and when needed), cleaning the meatus-catheter junction with soap and water. • Do not use lotion or powder near the catheter. • Anchor catheter using a securement device. Anchor catheter to upper thigh in women and lower abdomen in men to prevent catheter movement and urethral tension.

What are the comparison in relation to ulcerative colitis and crohns disease?

Ulcerative Colitus Location Usually starts in rectum and spreads in a continuous pattern up the colon Cancer Increased incidence of colorectal cancer after 10 yrs of disease Strictures occassional Crohns Disease Location Occurs anywhere along GI tract. Most common site is distal ileum Cancer Increased incidence of small intestinal cancer Increased incidence of colorectal cancer but less than with ulcerative colitis Strictures Common

What is the patient and caregiver teaching of GERD?

a chronic symptom of muscosal damage caused by reflux of stomach acid into the lower esophagus 1. Explain the reason for a low-fat diet. 2. Have the patient to eat small, frequent meals to prevent gastric distention. 3. Explain the reason for avoiding alcohol, smoking (causes an almost immediate, marked decrease in lower esophageal sphincter pressure), and beverages that contain caffeine. 4. Tell the patient to not lie down for 2-3 hr after eating, wear tight clothing around the waist, or bend over (especially after eating). 5. Have the patient avoid eating within 3 hr of bedtime. 6. Have the patient to sleep with head of bed elevated on 4- to 6-in blocks (gravity fosters esophageal emptying). 7. Provide information about drugs, including reason for their use and common side effects. 8. Discuss strategies for weight reduction if appropriate. 9. Encourage patient and caregiver to share concerns about lifestyle changes and living with a chronic problem.

What are the risk factors for colorectal cancer?

• Alcohol (≥4 drinks/wk) • Cigarette smoking • Family history of colorectal cancer (first-degree relative) • Family or personal history of familial adenomatous polyposis (FAP) • Family or personal history of hereditary nonpolyposis colorectal cancer (HNPCC) syndrome • Obesity (body mass index ≥30 kg/m2) • Personal history of colorectal cancer, inflammatory bowel disease, or diabetes • Red meat (≥7 servings/wk)

What are the physical manifestations for EOL of respiratory system?

• Increased respiratory rate • Cheyne-Stokes respiration • Inability to cough or clear secretions resulting in grunting, gurgling, or noisy congested breathing (death rattle or terminal secretions) • Irregular breathing, gradually slowing down to terminal gasps (may be described as guppy breathing)

What are the clinical manifestations of DKA?( Select all that apply)

• Profound deficiency in insulin characterized by hyperglycemia, ketosis, acidosis, and dehydration Clinical manifestations •3 Ps - polyuria, polydipsia, polyphagia •Dehydration - dry mucous membranes, tachycardia •Lethargy, weakness •Soft, sunken eyes •Abdominal pain •Anorexia •Nausea and vomiting •Sweet, fruity odor •Kussmaul respirations •Comatose Laboratory findings •Blood glucose level 250 mg/dL or greater •Arterial blood pH less than 7.30 •Serum bicarbonate level less than 16 mEq/L •Moderate to large ketones in the urine or serum

What are the factors associated with peptic ulcer?

•A condition characterized by erosion of the GI mucosa from the digestive action of HCl acid and pepsin. Types: duodenal, gastric •Contributing factors •Helicobacter pylori (H. pylori) •Medication-induced injury •NSAIDs •Lifestyle •Alcohol intake •Smoking •Coffee •Stress and depression •Stress-related mucosal disease (SRMD)

What are the clinical manifestations for BPH? ( Select all that apply)

•A condition in which the prostate gland increases in size, disrupting the outflow of urine from the bladder through the urethra. Clinical manifestations •Nocturia, urinary frequency, urgency, dysuria, bladder pain, and incontinence. •Nocturia is often the first symptom that the patient notices. •Decrease in the caliber and force of the urinary stream •Difficulty in starting a stream •Intermittency (stopping and starting stream several times while voiding) •Dribbling at the end of urination

What are the location and type of ostomy?

•A surgically created opening on the abdomen that allows the discharge of body waste when the normal elimination route is no longer possible. •The outermost part that is visible is a stoma. The stoma is the result of the large or small bowel being brought to the outside of the abdomen and sutured in place. When a stoma is created as a fecal diversion, feces will drain through the stoma instead of the anus. •Ostomies are named according to their location and type. Look at ostomy pics

What are the nursing diagnoses appropriate for sickle cell crisis?

•Abnormal shape or form of RBC •Sickling episodes are triggered by hypoxia from infection, high altitude, emotional or physical stress, and/or blood loss. •Other causes include dehydration, acidosis, hypothermia and decreased plasma volume. •Sickle cell crisis is severe, painful, acute exacerbation of RBC sickling causing a vaso-occlusive crisis. Normal RBC -are compact and flexible enabling them to squeeze through small capillaries Sickled RBCs -are stiff and angular, causing them to become stuck in small capillaries

What is bladder cancer, risk factors and clinical manifestations?

•About half of bladder cancers are related to cigarette smoking. •Other risk factors include exposure to dyes used in the rubber and other industries; women treated with radiation for cervical cancer; patients who received cyclophosphamide, docetaxel, or gemcitabine; and those who have indwelling catheters for long periods. •People with chronic, recurrent urinary tract stones, often in the bladder, and chronic lower UTIs have an increased risk for squamous cell cancer of the bladder. Clinical manifestations •Microscopic or gross, painless hematuria (chronic or intermittent) is the most common manifestation of bladder cancer. •Bladder irritability with dysuria, frequency, and urgency may occur.

What are the auscultation of abdomen?

•Auscultate before percussion. •Use the diaphragm of the stethoscope to auscultate bowel for high pitched sounds. Use the bell of the stethoscope to detect lower pitched sounds. •Warm the stethoscope in your hands before auscultating to help prevent abdominal muscle contraction. •Listen in the epigastrium and in all 4 quadrants. Start in the right lower quadrant. •Listen for bowel sounds for at least 2 minutes. Determine if they are normal, hypoactive, or hyperactive.

What are the clinical manifestations, diagnostics( indicate if you are diagnosed with DM)

•Chronic multisystem disease characterized by hyperglycemia from abnormal insulin production, impaired insulin use, or both. •Types of DM •Type 1 = autoimmune disorder in which the body develops antibodies against insulin and/or the pancreatic β cells that make insulin •Type 2 = combination of inadequate insulin secretion and insulin resistance Clinical manifestations •Polyuria, polydipsia, and polyphagia •Weight loss may occur •Weakness and fatigue •Ketoacidosis •Recurrent infections •Recurrent vaginal yeast or candida infections •Prolonged wound healing •Vision problems Diagnostics •A1C of 6.5% or higher •Fasting plasma glucose (FPG) level of 126 mg/dL (7.0 mmol/L) or greater. Fasting is defined as no caloric intake for at least 8 hours •A 2-hour plasma glucose level of 200 mg/dL (11.1 mmol/L) or greater during an OGTT, using a glucose load of 75 g •A random plasma glucose level of 200 mg/dL (11.1 mmol/L) or greater

What are the GI and neurological manifestations for pernicious anemia?

•Cobalamin deficiency (Vitamin B12) due to absence of intrinsic factor (IF) •Clinical manifestations include the manifestations of anemia (+) Gastrointestinal manifestations •Sore, red, beefy, and shiny tongue •Anorexia •Nausea, and vomiting •Abdominal pain Neuromuscular manifestations •Muscle weakness •Paresthesia of the feet and hands •Reduced vibratory and position senses •Impaired thought processes ranging from confusion to dementia

What is an EGD?

•Directly visualizes mucosal lining of esophagus, stomach, and duodenum with flexible endoscope. •Test may use video imaging to visualize stomach motility. •Detects inflammation, ulcerations, tumors, varices, or Mallory-Weiss tears. Biopsies may be taken. Before: •Keep patient NPO for 8 hr. Ensure consent form is signed. Give preoperative medication if ordered. Explain to patient that local anesthesia may be sprayed on throat before insertion of scope and that patient will be sedated during procedure. After: •Keep patient NPO until gag reflex returns. Gently tickle back of throat to determine reflex. Use warm saline gargles for relief of sore throat. Check temperature q15-30min for 1-2 hr (sudden temperature spike is sign of perforation).

What is diverticulosis and diverticulitis?

•Diverticula are saccular dilations or outpouchings of the mucosa that develop in the colon. •Diverticulosis is the presence of multiple noninflamed diverticula. •Diverticulitis is inflammation of 1 or more diverticula, resulting in perforation into the peritoneum. •Most patients with diverticulosis have no symptoms. Those with symptoms typically have abdominal pain, bloating, flatulence, and changes in bowel habits. •Diagnosed with sigmoidoscopy or colonoscopy.

What are the clinical manifestations of appendicitis?

•Inflammation of the appendix, a narrow blind tube that extends from the inferior part of the cecum. Clinical manifestations •Begins with dull periumbilical pain, followed by anorexia, nausea, and vomiting. •Pain is persistent and continuous, eventually shifting to the right lower quadrant and localizing at McBurney's point. •A low-grade fever may develop. •Localized tenderness, rigidity, rebound tenderness, and muscle guarding. • Coughing, sneezing, and deep inhalation worsen pain. • The patient usually prefers to lie still, often with the right leg flexed.

How is brain death diagnosed?

•Irreversible loss of all brain functions •Requires a clinical diagnosis •Criteria to meet diagnosis of brain death •Coma •Unresponsiveness •Absence of brainstem reflexes •Apnea

What are the 5 major categories of nephrolithiasis and nutritional therapy?

•Kidney stone disease •Calculus = stone •Lithiasis = stone formation •5 major categories of stones •Calcium oxalate •Calcium phosphate •Uric acid Calcium High: Milk, cheese, ice cream, yogurt, sauces containing milk; all beans (except green beans), lentils; fish with fine bones (e.g., sardines, kippers, herring, salmon); dried fruits, nuts; Ovaltine, chocolate, cocoa Oxalate High: Dark roughage, spinach, rhubarb, asparagus, cabbage, tomatoes, beets, nuts, celery, parsley, runner beans; chocolate, cocoa, instant coffee, Ovaltine, tea; Worcestershire sauce Purine High: Sardines, herring, mussels, liver, kidney, goose, venison, meat soups, sweetbreads Moderate: Chicken, salmon, crab, veal, mutton, bacon, pork, beef, ham

What are the common causes of HHNS?

•Life-threatening syndrome that can occur in the patient with diabetes who is able to make enough insulin to prevent DKA, but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion. Common causes •UTIs •Pneumonia •Sepsis •Acute illness •Newly diagnosed Type II diabetes mellitus •Use of corticosteroids •The main difference between HHS and DKA is that the patient with HHS usually has enough circulating insulin so that ketoacidosis does not occur. Clinical manifestations •Somnolence, coma, seizures, hemiparesis, and aphasia Laboratory values HHS •Blood glucose level greater than 600 mg/dL (33.33 mmol/L) and a marked increase in serum osmolality. •Ketone bodies are absent or minimal in both blood and urine.

What are the clinical manifestations of hypoglycemia? ( Select all that apply)

•Low blood glucose levels less than 70 mg/dL Clinical manifestations •Cold, clammy skin •Numbness of fingers, toes, and mouth •Tachycardia •Emotional changes •Headache •Nervousness, tremors •Faintness, dizziness •Unsteady gait, slurred speech •Changes in vision •Hunger •Seizures, coma

What are the n/v and clear liquids?

•Nausea is a feeling of discomfort in the epigastrium with a conscious desire to vomit. •Vomiting is the forceful ejection of partially digested food and secretions (emesis) from the upper GI tract. •Interprofessional care involves treating the underlying cause, recognizing and correcting any complications, and providing symptomatic relief. •Drug therapy •Antiemetics •Nutritional therapy •Intravenous fluids •Begin with clear liquids once symptoms have subsided. Clear liquids include: •Water (plain, carbonated or flavored) •Fruit juices without pulp •Carbonated drinks •Gelatin •Tea •Coffee without milk or cream •Clear, fat-free broth •Sports drink (gatorade) •Ice pops •Hard candy

What are the perimenopause and menopause?

•Perimenopause is a normal life transition for women that begins with the first signs of change in menstrual cycles and ends after cessation of menses. •Menstrual changes can include shorter or longer cycles, less frequent cycles, lighter cycles, or heavier cycles. •Menopause is a normal physiologic cessation of menses associated with declining ovarian function that ends in cessation of the menstrual cycle and ovulation. •Natural menopause is diagnosed retrospectively after 12 months of no periods. The average age for a woman is 52 years. The age can vary from 40 to 58 years. •FSH testing can confirm a diagnosis of menopause. •FSH levels are increased in menopause. •When a woman's FSH blood level is consistently elevated to 30 mIU/mL or higher, and she has not had a menstrual period for a year, it is generally accepted that she has reached menopause.

What are the clinical manifestations for Hodgkin's Lymphoma?

•Proliferation of Reed-Sternberg (abnormal, giant, multinucleated) cells in the lymph nodes Clinical manifestations •Gradual onset •Cervical, axillary, or inguinal lymph node enlargement •Movable and nontender Other symptoms: weight loss, fatigue, weakness, fever, chills, tachycardia or night sweats

What are the common risk factors for Erectile Dysfunction?

•The inability to attain or maintain an erection that allows satisfactory sexual activity. Clinical manifestations •Inability to attain or maintain an erection Drug Induced • Alcohol • Antiandrogens • Antihypertensives • Antilipidemic agents • Major tranquilizers (diazepam [Valium], alprazolam [Xanax]) • Marijuana, cocaine • Nicotine • Tricyclic antidepressants (e.g., amitriptyline [Elavil]) Endocrine • Diabetes • Hypogonadism • Obesity Genitourinary • Radical prostatectomy • Renal failure Neurologic • Cerebrovascular disease • Parkinson's disease • Trauma to the spinal cord • Tumors or transection of spinal cord Psychologic • Anxiety • Depression • Stress Vascular • Atherosclerosis • Hypertension • Peripheral vascular disease Other • Aging

What is the assessment of the spleen?

•To palpate the spleen, move to the patient's left side. •Place your right hand under the patient, and support and press the patient's left lower rib cage forward. •Place your left hand below the left costal margin and press it in toward the spleen. Ask the patient to breathe deeply. •Normal findings: nonpalpable spleen •Abnormal findings: Palpable spleen. •If it is palpable, do not continue because manual compression of an enlarged spleen may cause it to rupture.

How do you care for an ostomy and what are the characteristics of a stoma?

•Two major aspects of nursing care for the patient with an ostomy are • Patient and caregiver teaching about ostomy care • Emotional support as the patient copes with a radical change in body image •An appropriate pouching system is vital to protect the skin and provide dependable stool collection. • Adhesive skin barrier and a pouch to collect the feces. • Use a transparent pouch in the initial postoperative period so that you can easily assess stoma viability and pouch application by the patient. •Each time the pouch is changed, assess the skin for irritation. •If the peristomal skin is irritated and raw, more products may have to be applied. •Do not allow feces to remain on the skin or irritation will quickly develop. •If a pouch has failed, it must be changed at once. Characteristic Color Rose to brick- red (visible stoma mucosa) Pale ( may indicate anemia) Blanching, dark red to purple ( indicates inadequate blood supply) Edema Mild to moderate edema ( normal in initial postop period. Trauma to the stoma) moderate to severe edema( obstruction of the stoma, allergic reaction to food, gastroenteritis) Bleeding small amount( oozing from stoma mucosa when touched is normal because of its high vacularity) Moderate to large amount ( could indicate lower GI bleeding, coagulation factor deficency, stomal varices secondary to portal hypertension).

What are the lab values for a complete blood count?

•White blood cell count Normal value: 5000-10,000/μL (5-10 × 109/L) •Red blood cell count Normal value: Female: 4.2-5.4 × 106/μL (4.2-5.4 × 1012/L); Male: 4.7-6.1 × 106/μL (4.7-6.1 × 1012/L) •Hemoglobin (Hgb) Normal: Female: 12-16 g/dL (120-160 g/L); Male: 14-18 g/dL (140-180 g/L) •Hematocrit (Hct) Normal: Female: 37%-47% (0.37-0.47); Male: 42%-52% (0.42-0.52) •Platelet count Normal value: 150,000-400,000 × 103/L (150-400 × 109/L) •Absolute neutrophil count Normal: 2,500 and 6,000 cells/uL Neutropenia: ANC <1000 cells/uL Severe neutropenia: ANC <500 cells/uL