HESI remediation 3

Hyperthyroidism sign & symptoms

- irritability, agitation, mood swings - nervousness and fine tremors of the hands - heat intolerance - weight loss - smooth soft skin and hair - palpitations, tachycardia, atrial fibrillation - diarrhea - exophthalmos (bulging eyeballs) - diaphoresis - hypertension - enlarged thyroid gland (goiter)

Hypothyroidism sign & symptoms

- lethargy and fatigue - weakness muscle aches, paresthesias - intolerance to cold - weight gain - dry skin and hair and loss of body hair - bradycardia - constipation - generalized puffiness and edema around the eyes (myxedema) - forgetfulness and loss of memory - menstrual issues - cardiac enlargement heart failure may occur

Crohn's disease diet

- low fiber - high protein diet with vitamins and iron supplements - avoid gas forming foods such as milk, whole wheat grains, nuts, raw fruits, vegetables, pepper, alcohol, caffeine

A client has a prescription for one liter of 0.9% Normal Saline solution to infuse over twelve hours. The IV administration set delivers 15 drops/ml. The nurse should set the drop rate at how many drops per minute? (Enter numeric value only, round to the nearest whole number.)

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deep vein thrombosis need to know

- remove sequential compression devices (SCDs) before allowing patient to get out of bed. - Notify nurse if patient complains of pain in leg or if discoloration develops in extremities. - When applying elastic stockings, instruct patient to avoid activities that promote venous stasis (e.g., crossing legs, wearing garters). - Elevate legs while sitting and before applying stockings to improve venous return. - DO NOT MASSAGE PATIENT'S LEGS - avoid wrinkles in stockings

seizure info

* Do not move or forcefully restrain the child during a tonic-clonic seizure, and do not place anything in the mouth during a seizure. Tonic-Clonic Seizure During the Seizure * Remain calm. Time seizure episode. If child is standing or seated, ease child down to the floor. Turn child to one side. Place pillow or folded blanket under child's head. Loosen restrictive clothing. Remove eyeglasses. Clear area of any hazards or hard objects. Allow seizure to end without interference. * Do not: • Attempt to restrain child or use force to control their movements. • Put anything in child's mouth. • Give any food or liquids.

defense mechanisms

*DisplacementRedirecting negative emotions perceived as unacceptable or threatening to a safer focus *IntellectualizationOverthinking a challenging situation or impulse to avoid dealing with the emotions it elicit *RationalizationExplaining personal actions in a way that enhances one's own self-image *Reaction formationResponding to negative thoughts or feelings by demonstrating opposite emotions and actions *SublimationChanneling unacceptable emotions or impulses into acceptable actions or responses

Which questions are applicable in determining nursing malpractice? Select all that apply. One, some, or all responses may be correct.

- "Was reasonable care provided?" - "Was there a breach of nursing duty?" - "Was there an act of omission that resulted in harm?" - "Except for the nurse's action, would the injury have occurred?" Nursing malpractice is described as the failure to do or not do what a reasonably careful nurse would do under the circumstances. The elements that must be present to determine malpractice include whether the nurse fulfilled the legal duties to provide reasonable care and foresee a risk of injury under certain circumstances and whether there was a breach of duty and whether any injury resulted if there was a breach of duty. If harm occurs, the nurse can be charged with malpractice, regardless of the intent.

Which nursing actions should be implemented to reduce the risk of the development of acute respiratory distress syndrome (ARDS)?

- Practicing scrupulous infection control guidelines. - Adhering to aspiration precautions for clients with impaired swallowing and gag reflex. - Raising the head of the bed to 30-45° for clients receiving enteral feedings.

Treatment of aplastic anemia

- RBC TRANFUSION - platelet tranfusion - High-dose Cyclophosphamide to suppress immune system - bone marrow transplant - Antithymocyte globulin (ATG) or antilymphocyte globulin (ALG) is the principal drug treatment used for AA. The rationale for using ATG is based on the theory that AA may be a result of autoimmunity. The use of immunosuppressive therapy, including cyclosporin A (CSA) and ATG, with the addition of human recombinant granulocyte or granulocyte-macrophage colony-stimulating factor (G-CSF or GM-CSF) and methylprednisolone (to prevent ATG serum sickness), has greatly improved the prognosis for patients with AA. - * During administration of ATG, whether into a central venous catheter or peripheral vein, the nurse must pay special attention to the infusion to prevent extravasation. Meticulous care of the venous access catheter is essential because of the child's susceptibility to infection. Although anaphylactic reactions to ATG are rare, make emergency preparations in advance, and have epinephrine and oxygen readily available. The nurse should observe for immediate reactions to ATG, which include fever and skin rash. Delayed reactions (serum sickness) may also occur within 7 to 14 days of a course of ATG, and the manifestations are similar to those in immediate reactions. The symptoms are reversed, and in the case of serum sickness may be prevented, with corticosteroids.

acute pancreatitis sign & symptoms

- abdominal pain including sudden onset at a mid-epigastric or left upper quadrant location with radiation to the back -

Diagnosis of aplastic anemia

- bone marrow biopsy - blood test analysis of RBC, WBC and platelets

Crohn's disease sign & symptoms

- fever - cramp like and colicky pain after meals - diarrhea (semisolid) which may contain mucus and pus - abdominal distention - anorexia, nausea, and vomiting - weight loss - anemia - dehydration - electrolyte imbalances - malnutrition

Thyroid storm sign & symptoms

- fever - tachycardia - systolic hypertension - nausea, vomiting, and diarrhea - agitation, tremors, and anxiety - irritability, agitation, restlessness, confusion, and seizures - delirium and coma * can be caused by stress, manipulation of thyroid gland, infection, release of thyroid hormone into blood stream

hernias in children

- umbilical hernia is a common hernia observed in infants. An umbilical hernia usually is an isolated defect, but it may be associated with other congenital anomalies, such as Down syndrome (trisomy 21) and trisomies 13 and 18. - Inguinal hernias account for approximately 80% of all childhood hernias and occur more frequently in boys than in girls. An inguinal hernia that cannot be reduced easily is called an incarcerated hernia. A strangulated inguinal hernia is one in which the blood supply to the herniated organ is impaired. If left untreated, both incarcerated and strangulated hernias will progress to necrotic bowel.

A client with dementia has a diminished gag reflex. The nurse is instructing a caregiver in now to safety assist the client during feeding. What techniques should the nurse include in the teaching plan?

-Do not rush the client and offer frequent rest periods. - Check the client's open mouth for pocketed food. -Verify that the client has swallowed the food between bites. To help minimize the risk of aspiration with a client who has diminished gag reflex due to dementia, (have the client sit upright and bend their chin towards the chest while swallowing), do not rush them, check their mouth for pocketed food and that the food has been swallowed before taking another bite of food.

Chron's disease

A chronic inflammatory bowel disease that affects but most commonly affects the end of the small bowel (ileum) and the beginning of the colon. leads to thickening and scarring, a narrowed lumen, fistulas, ulcerations, and abscesses. characterized by remissions and exacerbations

hernia

A hernia is a protrusion of a portion of an organ or organs through an abnormal opening. The danger from herniation arises when the organ protruding through the opening is constricted to the extent that circulation is impaired or when the protruding organs encroach on and impair the function of other structures.

A client with a blunt chest trauma has developed a tension pneumothorax. Which piece of equipment should a nurse anticipate and obtain immediately for the healthcare provider to use to help assist the client with this condition?

A large bore needle. The initial management of a tension pneumothorax is the insertion of a large bore needle in the second intercostal space in the midclavicular line of the affected side to relieve some of the trapped air on that side of the pleural cavity causing the lung to collapse. The procedure is followed by the placement of a chest tube in the 4th intercostal space and is attached to a water seal until the lung re-inflates.

APGAR scoring

A= appearance (color all pink, pink and blue, blue [pale]) P= pulse (>100, < 100, absent) G= grimace (cough, grimace, no response) A= activity (flexed, flaccid, limp) R= respirations (strong cry, weak cry, absent) Apgar scoring system (Carlo, 2011). The score is based on observation of heart rate, respiratory effort, muscle tone, reflex irritability, and color (Table 7-1). Each item is given a score of 0, 1, or 2. Evaluations of all five categories are made 1 and 5 minutes after birth and are repeated every 5 minutes until the infant's condition stabilizes. Total scores of 0 to 3 represent severe distress, scores of 4 to 6 signify moderate difficulty, and scores of 7 to 10 indicate absence of difficulty in adjusting to extrauterine life. Many healthy newborns do not achieve a score of 10 because the body is not completely pink.

The nurse notices declining patient outcomes and develops an evidence-based practice project to improve safety and quality of care. While designing data collection, the nurse chooses to relate outcomes specifically to nursing care. Which organization's data is best for comparison within the project?

ANA NDNQI. The nurse has chosen to link the outcome to nursing interventions, which is exemplified in the American Nurse Association's National Database of Nursing Quality Indicators (NDNQI).

seizure med children info

Children taking phenobarbital or phenytoin should receive adequate vitamin D and folic acid because deficiencies of both have been associated with these drugs. Phenytoin should not be taken with milk.

leukocytosis

Abnormally high WBC count

Absence seizures (petit mal)

Absence seizure (formerly called petit mal) usually occurs only in children and rarely continues beyond adolescence. This type of seizure may cease altogether as the child matures, or it may evolve into another type of seizure. The typical clinical manifestation of a simple absence seizure is a brief staring spell resembling "daydreaming" that lasts less than 10 seconds, so it often goes unnoticed. In complex absence seizures, the blank stare is accompanied by some type of movement (e.g., blinking, chewing, hand gestures) and can last up to 20 seconds. When untreated, seizures may occur up to 100 times a day. An electroencephalogram (EEG) demonstrates a 3-Hz (cycles per second) spike-and-wave pattern that is unique to this type of seizure. Hyperventilation and flashing lights can precipitate absence seizures.

A first grade teacher tells the school nurse that she is having trouble keeping the attention of one of the students. The child gets off track and will not stay engaged. The teacher states that the student gets bored and just stares off into space and daydreams several times during the day. What should the nurse suspect about this child's behavior?

Absence seizures. Children of this age group are in the industry vs inferiority developmental stage according to Erickson and more often than not; strive to please a teacher and work hard in school. The child with staring spells and inattention may be experiencing absence seizures formerly called "petit mal seizures". These seizures do not have the typical stiffening and jerking of muscles, associated with seizures, but consists of brief periods of loss of consciousness and blank staring. The child may appear as though he or she is daydreaming.

The nurse is caring for a client with chronic hepatic failure who has developed refractory ascites who has not responded to traditional diuretics. Which action should the nurse take to manage the accumulation of ascites?

Administer mannitol. According to a NIH study, if a client has not responded to traditional antidiuretics such as lasix or spirolactone, mannitol has shown to help the improving the response of diuretics in producing urinary output and lowering of sodium levels in refractory ascites. Therefore, in order to manage the client's ascites, the nurse should administer mannitol.

ascites possible complication

All patients with ascites have the potential to develop (spontaneous bacterial peritonitis (SBP) ) from bacteria in the collected ascitic fluid. In some patients, mild symptoms such as low-grade fever and loss of appetite occur. In others, there may be abdominal pain, fever, and change in mental status. When performing an abdominal assessment, listen for bowel sounds and assess for abdominal wall rigidity. Quinolones such as norfloxacin (Noroxin) are the drugs of choice for SBP. If the patient is allergic to this class of antibiotics, combination antibiotics like trimethoprim-sulfamethoxazole (Bactrim) are given.

aplastic anemia

Aplastic anemia occurs because of damage to stem cells inside bone marrow, which is the sponge-like tissue within your bones. Many diseases and conditions can damage the stem cells in bone marrow. As a result, the bone marrow makes fewer red blood cells, white blood cells, and platelets. The most common cause of bone marrow damage is from your immune system attacking and destroying the stem cells in your bone marrow, which is a kind of autoimmune disorder. The genes you inherit from your parents, some medicines, and certain toxins in the environment may also cause aplastic anemia. Aplastic anemia can develop suddenly or slowly, and it can be mild or severe. Signs and symptoms of aplastic anemia include fatigue, infections that last a long time, and easy bruising or bleeding. The low levels of blood cells also increase your risk for complications such as bleeding, leukemia, or other serious blood disorders. Without treatment, aplastic anemia can lead to serious medical conditions such as arrhythmia and heart failure. To diagnose aplastic anemia, your doctor will order tests to determine whether you have low numbers of cells in your bone marrow and blood.

Secondary Prevention

Assess disaster survivors; conduct rapid needs assessment; use individual and population-based triage for care; provide psychological first aid.

The nurse is caring for a client with a fractured left hip. During the admission assessment, the nurse notes petechiae and an increased heart rate. Which action should the nurse perform next?

Assess the client's breath sounds. A client with a fractured hip is at an increased risk for fat embolism syndrome (FES). The fat emboli can travel throughout the circulatory system and block capillaries (resulting in petechiae) or small vessels supplying vital organs, including the lungs. (The nurse should assess the client's breath sounds to determine if emboli have traveled to the client's lungs)

A 7-year-old child is referred for evaluation due to poor performance in school assignments and disruptive behavior. The parents report that the child has difficulty waiting in lines, is often "on the go," and is unable to sit still at school and at home. What behavioral disorder should be suspected?

Attention deficit hyperactivity disorder. Children with attention deficit hyperactivity disorder (ADHD) are typically diagnosed between the ages of 4 and 18. Symptoms of ADHD include impulsivity, high energy levels, and inattentiveness; symptoms must be present in more than one setting.

The nurse is teaching the parent of a 14-day-old infant. Which method of obtaining a temperature is best to teach the parent?

Axillary. An accurate temperature reading depends on the correct application of each particular method. Axillary temperature is recommended for infants younger than 1 month old.

Acute pancreatitis causes

Cholelithiasis (gallstones) - excessive alcohol consumption - hyperlipidemia ( high cholesterol) - hypercalcemia -peptic ulcer disease - hyperparathyroidism ( An excess of the hormone made by four small glands in the neck (parathyroid glands) specifically hypercalcemia - viral or bacterial disease - ingested medications - low blood flow to the pancreas a

some churn's disease medication info

Both infliximab and certolizumab pegol must be given in a health care setting, such as a physician's office, via parenteral routes. Adalimumab (Humira) is self-administered by subcutaneous injection every other week. If needed, instruct patients on how to give themselves a subcutaneous injection. Teach patients to report injection site reactions, including redness and swelling. Remind them that headache, abdominal pain, and nausea and vomiting are common side effects. Teach them to avoid crowds, such as malls and large shopping centers, and people with infection. Reinforce the need to report any infection, including a cold or sore throat, to the health care provider immediately. Natalizumab is given IV under medical supervision every 4 weeks for moderate to severe CD and is given when other drugs are not effective. Although the use of this drug has decreased the length of hospital stays ( Dudley-Brown et al., 2009), natalizumab can cause progressive multifocal leukoencephalopathy (PML), a deadly infection that affects the brain. Before giving the drug, be sure that the patient is free of all infections. Teach patients the importance of reporting any cognitive, motor, or sensory changes immediately to the health care provider.

cereal palsy

Cerebral palsy is a group of disorders that affect movement and muscle tone or posture. It's caused by damage that occurs to the immature brain as it develops, most often before birth.

cerebral palsy

Cerebral palsy is a group of disorders that affect movement and muscle tone or posture. It's caused by damage that occurs to the immature brain as it develops, most often before birth. Signs and symptoms appear during infancy or preschool years. In general, cerebral palsy causes impaired movement associated with abnormal reflexes, floppiness or rigidity of the limbs and trunk, abnormal posture, involuntary movements, unsteady walking, or some combination of these. People with cerebral palsy can have problems swallowing and commonly have eye muscle imbalance, in which the eyes don't focus on the same object. They also might have reduced range of motion at various joints of their bodies due to muscle stiffness. The manifestations of cerebral palsy vary widely from one child to another. A child with CP may have persistence of primitive reflexes, delayed gross motor development, abnormal muscle tone, and lack of progression through developmental milestones. Abnormal posturing with inability to maintain normal posture and balance may be present, as well as spasticity or uncontrollable movements in the extremities. Also seen are disturbances of gait (particularly ataxia and toe walking), seizures, attention-deficit disorder, sensory impairment, failure of automatic reactions (equilibrium), and speech and swallowing impairments.

The nurse uses an acuity-based model to determine staffing needs on the unit. The nurse determines the required level of care by evaluating the health status progress of the clients based on the admitting disease process. Which outcome is the nurse evaluating?

Clinical. Acuity-based models are used to help determine nurse staffing needs. Patient acuity is based on many factors, including clinical, functional, quality-of-life, risk-reduction, protective factor, therapeutic alliance, and satisfaction outcomes. Clinical outcomes focus solely on the degree of health problem resolution.

Studies indicate that severe traumatic brain injury in young children increases the likelihood of which outcome?

Cognitive impairment. Research indicates that traumatic brain injury (TBI) in young children may result in long-term effects. Severe TBI has been associated with poor cognitive outcomes; the degree of cognitive impairment is directly related to the severity of the injury.

What is the most important action for the nurse who is implementing a standing order?

Compare the order with the client's current status. The implementation of standing orders requires the nurse to use clinical judgment. Comparing the client's current status with the order is one way to apply clinical judgment.

A client with stage 3 Alzheimer's disease is admitted to a behavioral health hospital. Due to the progression of the disease, the client is experiencing an increase in amnesia and agnosia, and has declined to the point of not recognizing familiar objects and people. Which action should the nurse take to help reduce the client's fear and anxiety and adjust to the new setting?

Cover mirrors and pictures if they are upsetting the client. Agnosia is the inability to recognize familiar objects or people. Clients that experience this cognitive impairment do not recognize themselves in a mirror; this may result in the client thinking that there is a stranger in the room. Covering the mirror provides the client with an increased sense of safety.

When counseling parents about developmental milestones for their 4-year-old child, the nurse is correct to include which fine motor skill?

Cutting with scissors. Fine motor skills include small movements involving the intrinsic muscles of the hands and fingers. A 4-year-old should have developed the fine motor skills required to cut paper with scissors.

The nurse is planning an evidence-based practice project on the topic of early mobility due to high rates of morbidity and mortality in the unit. Which step should the nurse perform first?

Define a specific practice question. The first step of the evidence-based model is to define a specific practice question (or PICO-t) to guide the literature review and project decisions.

A newly admitted client diagnosed with schizophrenia who is physically healthy believes that they are in the process of dying and their body is actively decaying and falling apart. Which intervention for this client should the nurse implement?

Discuss what they are feeling and acknowledge their fear and anxiety. The client's delusion of dying and their body decaying is their reality. The nurse should identify and focus on the client's feelings and discuss those and try to divert the client's preoccupation of the delusion.

A 3-year-old client being treated for sepsis has begun bleeding from multiple sites. The nurse's assessment reveals widespread petechiae and bleeding from the nose, mouth, and rectum. Laboratory results reveal a prolonged prothrombin time (PT), elevated d-dimer, and low platelet count. Which disorder should the nurse suspect?

Disseminated intravascular coagulation. Disseminated intravascular coagulation (DIC) occurs as a complication of another underlying condition such as sepsis and is characterized by abnormal generation of fibrin and thrombin leading to the destruction of clotting factors. The first observable sign of acute DIC is often bleeding from multiple sites. Prolonged PT, a low platelet count, and elevated d-dimer are considered reliable predictors of DIC.

A client who has a duodenal ulcer is prescribed sucralfate. Which information should the nurse include when teaching the client about this medication?

Do not take sucralfate within 30 minutes of taking antacids. Sucralfate binds with bile acids and pepsin to protect stomach mucosa. Because antacids may interfere with the effects of sucralfate, it should not be taken within 30 minutes of taking antacids.

Autism spectrum disorders (ASD) primarily manifest in children at what developmental stage?

Early childhood. Autism spectrum disorders (ASD) are serious developmental disorders that impair the ability to communicate and interact. ASD impairments generally appear during early childhood, primarily from 18-36 months of age.

Tertiary Prevention

Ensure that community service linkages are available to individuals and families; conduct community outreach; participate in planning efforts for the community's "new normal

The nurse is reviewing the history of a client who presents with upper abdominal pain. Which entry in the client's history may cause the nurse to suspect acute pancreatitis?

Excessive alcohol consumption. Acute pancreatitis is an inflammatory condition that can be caused by toxic factors, such as excessive alcohol consumption. The client may experience vomiting, diarrhea, melena, and restlessness associated with pain.

possible respiratory complications from ascites

Excessive ascitic fluid volume may cause the patient to have respiratory problems. He or she may develop hepatopulmonary syndrome. Dyspnea develops as a result of increased intra-abdominal pressure, which limits thoracic expansion and diaphragmatic excursion. Auscultate lungs every 4 to 8 hours for crackles that could indicate pulmonary complications, depending on the patient's overall condition. For the patient with hepatopulmonary syndrome, monitor his or her oxygen saturation with pulse oximetry. If needed, apply oxygen therapy to ease breathing. Elevate the head of the bed to at least 30 degrees or as high as the patient wants to improve breathing. This position, with his or her feet elevated to decrease dependent ankle edema, often relieves dyspnea. Weigh the patient daily, or delegate and supervise this activity.

jaundice skin irritation interventions

For skin irritation and pruritus associated with jaundice, teach the patient to use cool rather than warm water on the skin and to not use an excessive amount of soap. Teach unlicensed assistive personnel to use lotion to soothe the skin. Assess for open skin areas from scratching, which could become infected.

The nurse is interviewing a client who has recently been admitted for evaluation of a thought disorder manifested by paranoid behavior. According to the client's mother, the client was previously treated for anxiety, but has become more isolated and withdrawn over the last few weeks. He refuses to leave his room, and he states that he is the "King of Mars" and someone is trying to assassinate him. Which type of delusion should the nurse document?

Grandiose. Individuals may suffer from several different types of delusions. In this example, the client is experiencing grandiose delusions (irrational ideas regarding his self-worth and identity), as well as persecutory delusions (thoughts of being persecuted or treated malevolently).

catheter bundle

Hand hygiene • Maximal barrier precautions upon insertion • Chlorhexidine skin antisepsis • Optimal catheter site selection and post-placement care with avoidance of the femoral vein for central venous access in adult patients • Daily review of line necessity with prompt removal of unnecessary lines. Other helpful interventions include use of a check list for sterility during the procedure, a line cart with all equipment, and a stop sign on the door of the room to stop unnecessary traffic through the room during the procedure.

Causes of acquired aplastic anemia

Human parvovirus infection, hepatitis, or overwhelming infection •radiation or chemotherapy • Immune disorders such as eosinophilic fasciitis and hypoimmunoglobulinemia • Drugs such as certain chemotherapeutic agents, anticonvulsants, and antibiotics • Industrial and household chemicals, including benzene and its derivatives, which are found in petroleum products, dyes, paint remover, shellac, and lacquers • Infiltration and replacement of myeloid elements, such as in leukemia or the lymphomas • Idiopathic (in most cases no identifiable precipitating cause found)

ICP treatment

Hypertonic saline, given in concentrations ranging from 3% to 23.4%, can also be used to treat increased ICP. Some studies suggest that hypertonic saline is as equally effective as mannitol for reducing increased ICP. Adverse effects include electrolyte abnormalities, hypotension, pulmonary edema, acute renal failure, hemolysis, central pontine myelinolysis, coagulopathy, and dysrhythmias.[

The medical-surgical nurse is receiving a client from the post-anesthesia care unit. The nurse notes that the client has received IV morphine every 2 hours for pain, and recent lab reports indicate an increased PaCO 2 level. Which assessment finding should the nurse expect for the client?

Hypoventilation. Opioid drugs, such as morphine, can cause decreased rate and depth of breathing. A client who has been receiving IV morphine every 2 hours may experience hypoventilation, resulting in retention of carbon dioxide and increased PaCO2.

A client has a swollen, bruised, sprained ankle and states that the current pain level has risen from a 3 to a 5 on a 10 point scale. Which analgesic medication would most likely be prescribed to relieve this pain?

Ibuprofen. Ibuprofen is indicated for mild to moderate pain relief. It is also a non-steroidal anti-inflammatory drug (NSAID) which inhibits the synthesis of prostaglandins which then inhibits the cellular response to inflammation.

The emergency room nurse prepares for an influx of clients within 24-to-36 hours as a hurricane watch has just been issued for the surrounding area. Which characteristic of a disaster is the nurse using to prepare?

Imminence. imminent (about to happen) Imminence describes how soon the disaster will occur, as opposed to predictability, which is whether the event will occur at all and if it will, when.

thyroid storm interventions

Implement emergency treatment if signs of thyroid storm are present: • Administer acetaminophen as prescribed to decrease temperature. Aspirin is contraindicated because it releases T4 from protein-binding sites and increases free T4 levels. • Provide cool sponge baths, or apply ice packs to patient's axilla and groin areas. If high temperature continues, obtain prescription for a hypothermia blanket to decrease fever. • Administer PTU as prescribed to prevent further synthesis and release of thyroid hormones. • Administer propranolol as prescribed to block sympathetic nervous system (SNS) effects. • Administer IV fluids as prescribed to provide adequate hydration and prevent vascular collapse. • Monitor for fluid volume deficit, which may occur because of increased fluid excretion by the kidneys or excessive diaphoresis. • Carefully monitor I&O hourly. Decreasing output with normal specific gravity may indicate decreased cardiac output, whereas decreasing output with increased specific gravity can signal dehydration. Detects fluid overload or inadequate fluid replacement. • Administer sodium iodide as prescribed, 1 hr after administering PTU. If given before PTU, sodium iodide can exacerbate symptoms in susceptible persons. • Administer small doses of insulin as prescribed. Hyperglycemia can occur as an effect of thyroid storm because of the hypermetabolic state. Insulin controls hyperglycemia. • Administer supplemental O2 as necessary because O2 demands are increased as metabolism increases.

postmortem care

In general, close the patient's eyes, replace dentures, wash the body as needed (placing pads under the perineum to absorb urine and feces), and remove tubes and dressings (if appropriate). The patient's body is straightened, leaving the pillow to support the head and prevent pooling of blood and discoloration of the face.

During assessment of the thorax and lungs, which technique should the nurse use to assess the client's AP diameter?

Inspection. The nurse uses inspection to observe and compare the antero-posterior (AP) diameter with the transverse diameter of the chest.

A mother is visiting her one-month-old infant who was delivered at 27-weeks gestation and is currently in the neonatal intensive care unit (NICU). Which is the best way for the nurse to encourage parent-infant bonding?

Invite the parents to participate in diaper changes. Parents of preterm infants often have feelings of helplessness and powerlessness and may experience alteration in the bonding process due to their infants having to remain hospitalized in the NICU until stable to be discharged home. The NICU nurse can support the parents by inviting them to participate in bonding activities, such as diaper changing. Bottle feeding would not be safge as the infant at 31-weeks-old has a gag-swallow reflex which is immature and not functionally developed yet.

Why is meperidine (Demerol) contraindicated for pain relief in clients with sickle cell disease?

It can induce seizures. Normeperidine, a metabolite of meperidine (Demerol), is a stimulant that can induce seizure activity in clients with sickle cell disease.

Intracranial pressure (ICP) monitoring is required for a child with a severe brain injury. To obtain the most accurate readings, a catheter is inserted into which area of the brain?

Lateral ventricle. ICP monitoring is indicated for clients with suspected ICP elevation, such as those with a severe traumatic brain injury. The most accurate ICP readings are obtained by inserting an intraventricular catheter into the lateral ventricle.

The nurse organizes and facilitates a smoking cessation support group in the community. Which group characteristic should the nurse focus the most on?

Maintenance functions.

ascites treatment

Management of ascites focuses on sodium restriction, diuretics, and fluid removal. Patients may be encouraged to limit sodium intake to 2 g/day 0r 2,000mg/day.[22] Patients with severe ascites may need to restrict their sodium intake to 250 to 500 mg/day. Very low sodium intake can result in reduced nutritional intake and subsequent problems associated with malnutrition. The patient is usually not on restricted fluids unless severe ascites develops. When caring for patients with ascites, accurately assess and monitor fluid and electrolyte balance. Albumin infusion may be used to help maintain intravascular volume and adequate urine output by increasing plasma colloid oncotic pressure. Diuretic therapy is an important part of management. Often a combination of drugs that work at multiple sites of the nephron is more effective than a single agent. Spironolactone (Aldactone) is an effective diuretic, even in patients with severe ascites. Spironolactone is also an antagonist of aldosterone and is potassium sparing. Other potassium-sparing diuretics include amiloride (Midamor) and triamterene (Dyrenium). A high-potency loop diuretic, such as furosemide (Lasix), is frequently used in combination with a potassium-sparing drug. Tolvaptan (Samsca), a vasopressin-receptor antagonist, is used to correct hyponatremia, which is often seen in patients with cirrhosis. It causes an increase in water excretion, resulting in an increase in serum sodium concentration. A paracentesis is a sterile procedure in which a catheter is used to withdraw fluid from the abdominal cavity. This procedure can be used to diagnose a medical condition or relieve pain, pressure, or difficulty breathing. In the patient with cirrhosis, this procedure is reserved for the person with impaired respiration or abdominal discomfort caused by severe ascites who does not respond to diuretic therapy. It is only a temporary measure of palliation because the fluid tends to reaccumulate rapidly. Supportive measures to control abdominal ascites include nutrition therapy, drug therapy, paracentesis, and respiratory support. The patient's fluid and electrolyte balance is also carefully monitored. If the patient is jaundiced, he or she will likely scratch the skin because the excess bilirubin products cause irritation and pruritus (itching).

A client comes to the emergency department with severe and gnawing epigastric pain. The client reports accidently doubling the warfarin sodium dose for the last three days. What should the nurse expect to find upon assessment?

Melena. Bleeding can occur at any point in the gastrointestinal system. Abnormally high doses of warfarin sodium, an anticoagulant, can cause bleeding to occur in otherwise healthy clients. Upon assessment, the nurse should expect to find melena, or blackened stool.

What action should the nurse take to reduce the risk of infection for a client with acute pancreatitis?

Monitor WBC count. Clients with acute pancreatitis are at an increased risk for bacterial infection. The nurse should closely monitor the WBC count and intervene as necessary.

naltrexone

Naltrexone is used to help narcotic dependents who have stopped taking narcotics to stay drug-free. It is also used to help alcoholics stay alcohol-free. The medicine is not a cure for addiction. Naltrexone blocks the euphoric and sedative effects of opioids such as heroin, morphine, and codeine. Naltrexone binds and blocks opioid receptors, and reduces and suppresses opioid cravings.

Ibuprofen is an nonsteroidal anti-inflammatory drugs (NSAIDS) which is commonly used for muscle strains and aches. Which should the nurse recognize as a serious side effect of ibuprofen?

Nephrotoxicity. NSAIDs have nephrotoxic effects and should be avoided in patients with kidney disease.

The nurse is reviewing the white blood cell differential for an infant admitted for suspected sepsis in the client's electronic medical record. The nurse should expect the client to have elevated levels of which cells?

Neutrophils. Neutrophils are phagocytic immune cells that are recruited to sites of infection early in the immunologic response cycle, known as the "first responders". An acute bacterial infection increases the need for neutrophils,

The nurse is reviewing an electronic medical record (EMR) of a four-year-old child who is scheduled for an outpatient cardiac catheterization. The child has midazolam prescribed pre-procedure to alleviate anxiety. Which prescription should the nurse seek further clarification from the healthcare provider?

Parents may administered the medication just prior to coming to hospital. Midazolam is commonly prescribed to decrease anxiety in children undergoing surgical procedures. When midazolam is administered to children, there should be a Pediatric Advance Life Support (PALS) certified personnel and resuscitative equipment accompanying the child to the procedure room. Children older than 3 years should be NPO of solid and non-clear liquids for a minimum of 6 hours and may have clear liquids up to two hours prior to sedation. The practical nurse (PN) needs to contact the healthcare provider and request for a new prescription to be written and the parents to be notified of the new prescription.

Primary Prevention

Participate in community disaster exercises; assist in development of the disaster management plan for the agency/community; pre-identify vulnerable populations.

Which treatment regimen reduces the risk of pneumococcal infection in a pediatric client with sickle cell anemia?

Penicillin prophylaxis. Epidemiologic studies suggest that penicillin prophylaxis significantly reduces the risk of pneumococcal infection in children with sickle cell disease, especially before they are to have an invasive procedure such as dental work.

Psychosocial Assessment

Perform a psychosocial assessment to determine the patient's level of anxiety, coping ability, and support systems. Provide information and offer support as needed. Anxiety or fear affects the patient's ability to learn, cope, and cooperate with teaching and operative procedures. Manifestations of anxiety include anger, crying, restlessness, profuse sweating, increased pulse rate, palpitations, sleeplessness, diarrhea, and urinary frequency.

The nurse is assessing a client with conjunctivitis. Which sign or symptom indicates that a referral to the ophthalmologist is needed?

Photophobia.

An emergency department nurse is triaging an unaccompanied, unconscious client. Upon inspection the nurse notices some paradoxical movement of the anterior lower chest area. The client's blood pressure is 88/54mmHg. The heart rate is 112 beats per minute and the client's oxygen saturation via pulse oximetry is 91% on room air. Based on these findings which condition should the nurse suspect?

Pleural effusion. Percussion is used to assess pulmonary resonance. A dull sound indicates the presence of solid tissue, such as the liver in the right lower chest, or an abnormal accumulation of fluid, such as an effusion.

The nurse is assessing a 4-year old child. Which best descirbe this chiild's concept of illness?

Possesses magical thoughts of how and why illness occurs.

The nurse plans a diabetic educational program based on the number of clients in the community with the disease. Which rate is the nurse reviewing to determine the need for this program?

Prevalence. Prevalence rates depict the number of clients in a population with a disease and therefore can assist nurses in needs assessment and program planning.

Primary Prevention

Primary Prevention—intervening before health effects occur, through measures such as vaccinations, altering risky behaviors (poor eating habits, tobacco use), and banning substances known to be associated with a disease or health condition. Primary prevention efforts focus on both the general population and on specific vulnerable groups (e.g., the homeless, HIV-positive persons, certain immigrant groups) to improve the general health status and to reduce the incidence of specific diseases such as TB. An example of a primary prevention intervention is the provision of health education and training for daycare workers regarding health and hygiene issues, such as proper hand hygiene, diapering, and food preparation and storage. Immunizations are another example of primary prevention.

what is primary prevention

Primary prevention is aimed at altering the susceptibility or reducing the exposure of persons who are at risk for developing a specific disease. Primary prevention includes general health promotion and specific protective measures in the prepathogenesis stage, which are designed to improve the health and well-being of the population. Nursing activities include health teaching and counseling to promote healthy living and lifestyles. Specific protective measures aimed at preventing certain risk conditions or diseases—such as immunizations, the removal of harmful environmental substances, protection from ultraviolet rays, or the proper use of car safety seats for infants and children—are also primary prevention activities

Which assessment finding should the nurse anticipate in a client experiencing an acute asthma exacerbation?

Prolonged phase of forced expiration. The nurse should expect to observe a prolonged phase of force expiration, frequent unproductive cough, increased nasal secretions, and breathlessness in the client experiencing acute asthma exacerbation.

acute pancreatitis interventions

Providing Comfort and Emotional Support Pain management is a major priority in acute pancreatitis. Administration of around-the-clock analgesics to achieve pain relief is essential. Morphine, fentanyl, or hydromorphone are the commonly used narcotics for pain control.[37] Relaxation techniques and the knee-chest position can also assist in pain control. Maintaining Surveillance for Complications The patient must be routinely monitored for signs of local or systemic complications (Box 22-8). Intensive monitoring of each of the organ systems is imperative because organ failure is a major indicator of the severity of the disease.[19] The patient must be closely monitored for signs and symptoms of pancreatic infection, which include increased abdominal pain and tenderness, fever, and increased white blood cell count

The nurse is assessing a 16-month old child whose mother is concerned that her 16-month old child is not spontanesously speaking any meaningful words. The child uses gestures and appears to have difficulty following verbal directions. What is the next action the nurse should take?

Reassure the mother that this may be a variation of normal development. Indications for a referral for possible communication Impairment should be made if a toddler by the age of two is not speaking meaningful words spontaneously, consistently uses gestures rather than vocalizations, appears to have difficulty in following verbal directions and fails to respond consistently to sound.

The nurse working at a community blood pressure screening health fair suggests that all the screenings should be performed by calibrated automated blood pressure cuff machines. Which screening test selection criterion concerns the nurse?

Reliability. By using calibrated automated blood pressure cuff machines, it helps ensure the reliability and consistency of the blood pressure readings.

The nurse delegates medication administration to a licensed nurse who accepts the assignment without further questions. A client develops mild bradycardia within 1-hour of administration of verapamil. No vital signs were documented prior to medication administration. Which feedback to the licensed nurse is most productive after noting the mild bradycardia?

Reviewing medication information and workflows is an important learning process. The nurse must provide evaluation and feedback for delegated tasks, both positive and constructive. Noting the outcome of mild bradycardia with a review of the workflow and concerns regarding medication knowledge creates a positive learning culture.

Which is recognized as a contributing factor to the development of anorexia nervosa in adolescents?

Rigid family rules. Anorexia nervosa is a disorder found primarily in adolescents. A dysfunctional family life is felt to be a contributing factor to this condition. Dysfunction in the home may result from overprotectiveness, rigidity, or an inability to resolve conflicts.

Secondary Prevention

Secondary Prevention—screening to identify diseases in the earliest stages, before the onset of signs and symptoms, through measures such as mammography and regular blood pressure testing.

Why do you get hypoglycemia with liver failure?

The liver stores glucose in a form called glycogen. In the presence of liver failure, the abilities of the liver to generate new glucose and to release glucose are impaired.

What is secondary prevention?

Secondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression, thereby preventing disability or complications. Screening programs in which asymptomatic persons are tested to detect early stages of a disease are the most frequent form of secondary prevention. Early case finding and prompt treatment activities are directed toward preventing the transmission of communicable diseases, such as the spread of impetigo in a school. Preventing or slowing the development of a particular disease or condition and preventing complications from a disease, such as scoliosis in teenage girls, are also examples of secondary prevention.

The school nurse participates in scoliosis screening for all 6 th grade students. Which level of community health promotion is the nurse exemplifying?

Secondary prevention/Second intervention. Secondary prevention includes preventing the spread of a disease or screening for early detection of the condition in attempt to prevent the condition from worsening or progressing.

multiple organ failure from acute pancreatitis

Severe acute pancreatitis (SAP), involving multiple organ failure, occurs in approximately 25% of cases but accounts for 98% of deaths associated with acute pancreatitis. Complications of acute pancreatitis include pancreatic abscess, hemorrhage, pancreatic pseudocyst, fistula formation, and transient hypoglycemia. Acute, life-threatening complications include renal failure, hemorrhagic pancreatitis, septicemia, acute respiratory distress syndrome (ARDS), shock, and disseminated intravascular coagulation (DIC).

A client is admitted for a thyroid scan to rule out Graves Disease. The nurse has delegated care of this client to an unlicensed assistive personnel (UAP). Which is the most important data that the UAP should report to the nurse immediately?

Temperature change from 99.1 to 100.1°F (37.3-37.8°C). For the client with Graves disease (hyperthyroidism), an increase in temperature may indicate worsening of the condition and the onset of a thyroid storm. An increase of 1° F should be reported immediately.

Tertiary Prevention

Tertiary Prevention—managing disease post diagnosis to slow or stop disease progression through measures such as chemotherapy, rehabili- tation, and screening for complications.

What is tertiary prevention?

Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for persons who have experienced a loss of function resulting from a disease process or injury. Nursing activities include education to prevent deterioration of a person's condition, direct nursing care, and referrals to resources that can help clients minimize the loss of function.

PICC line need to know

The INS recommendation for flushing PICC lines not actively used is 5 mL of heparin (10 units/mL) in a 10-mL syringe at least daily when using a non-valved catheter and at least weekly with a valved catheter. Use 10 mL of sterile saline to flush before and after medication administration; 20 mL of sterile saline is flushed after drawing blood. Always use 10-mL barrel syringes to flush any central line because the pressure exerted by a smaller barrel poses a risk for rupturing the catheter.

A nurse riding public transportation notices a child experiencing an asthma attack. The mother of the child pulls out of her purse a medicated discus dispenser of salmeterol xinafoate, a long-acting beta2 agonist, and immediately administers to the child. What is the anticipated outcome of the administration of this medication to this child?

The child's asthma attack will be unresponsive to the administration of the medication. During an asthma attack long-acting beta2 agonist (LABAs) delivered by inhaler directly to the bronchioles will have little effect. LABAs are used as a preventive medication and need time to build up an effect LABAs should be co-administered with inhaled steroids. Clients need to be instructed not to use LABAs to relieve an asthma attack or if wheezing becomes worse.

While assessing a client's health history, the nurse notes that the client has been prescribed enoxaparin (Lovenox). Which health outcome would indicate this medication is effective?

The client does not develop deep vein thrombosis (DVT) after abdominal surgery. Enoxaparin (Lovenox) is a low-molecular-weight heparin (LMWH) that is used to prevent DVT, pulmonary embolism, unstable angina, acute MI, and coronary artery thrombosis.

The nurse is caring for a client in acute respiratory failure. Which goal should the nurse include in the care plan?

The client has a PaO2 greater than 80 mmHg within 2-4 hours of initiation of treatment. Acute respiratory failure generally results from a primary lung dysfunction. When treating a client with acute respiratory failure, the client should have adequate gas exchange within 2 to 4 hours of initiating treatment. A PaO2 greater than 80 mmHg indicates adequate ventilation.

A client arrives to the emergency department (ED) via ambulance for a suspected stroke. According to the client's spouse, the stroke-like symptoms occurred approximately 1.5 hours ago. An IV of 0.9% Normal Saline is infusing at 75ml/hr. The client has no airway compromise and no arrhythmias have been detected. Admission blood work has been drawn and sent to lab. What should the nurse anticipate as the next action in the client's care?

The client transported to radiology for CT scan without contrast. Standard of care for clients suspected of a stroke includes a CT scan without contrast within 30 minutes upon arrival to the ED to determine whether they are eligible to receive fibrinolytic therapy. Clients diagnosed with an acute ischemic stroke are eligible. Clients with a hemorrhagic stroke are not. Clients may receive the recombinant tissue plasminogen activator (rtPA) if given within 3-4.5 hours after the onset of the stroke symptoms.

first stage of labor

The first stage of labor is considered to last from the onset of regular uterine contractions to full effacement and dilation of the cervix. Commonly the onset of labor is difficult to establish because the woman may be admitted to the labor unit just before birth, and the beginning of labor may be only an estimate. The first stage is much longer than the second and third stages combined. Great variability is the rule, however, depending on the factors discussed previously in this chapter. The first stage of labor has traditionally been divided into three phases: a latent phase, an active phase, and a transition phase. During the latent phase there is more progress in effacement of the cervix and little increase in descent. During the active and transition phases there is more rapid dilation of the cervix and increased rate of descent of the presenting part.

second stage of labor

The second stage of labor lasts from the time the cervix is fully dilated to the birth of the fetus. It is composed of two phases: the latent (passive fetal descent) phase and the active pushing phase. During the latent phase the fetus continues to descend passively through the birth canal and rotate to an anterior position as a result of ongoing uterine contractions. The urge to bear down during this phase is not strong, and some women do not experience it at all. During the active pushing phase the woman has strong urges to bear down as the presenting part of the fetus descends and presses on the stretch receptors of the pelvic floor.

third stage of labor

The third stage of labor lasts from the birth of the fetus until the placenta is delivered.

The nurse is preparing a client for an esophagogastroduodenoscopy (EGD) following an episode of acute gastrointestinal bleeding. The client asks why the EGD is being performed. Which reason should the nurse give?

To locate the source of bleeding. An esophagogastroduodenoscopy (EGD) involves passing an endoscope through the mouth, esophagus, and stomach. It is performed while the client is sedated to assess and determine the exact source of bleeding in the upper gastrointestinal tract.

A client presents with persistent cough, fatigue, loss of appetite, and bloody sputum. The nurse should recognize that the client is exhibiting symptoms of which condition?

Tuberculosis.

who can and cannot use a bedside commode?

Use of a bedside commode may be appropriate if the patient is weak or unsteady, is at risk for falling, or becomes short of breath when ambulating. (It should not be used for the patient who is unable to stand, who is maintained on strict bed rest, or who is at safety risk in an upright position.)

Vitamin B12 deficiency

Vitamin B12 deficiency is a condition present in over 20% of older adults. Malabsorption causes the majority of cases; however, pernicious anemia accounts for about one fifth of known cases. Causes of malabsorption include gastritis, alcoholism, gastric surgery, inflammatory bowel disease, autoimmune disorders, and long-term use of proton-pump inhibitors (PPIs) or histamine-2 (H2) blockers (Chaparro & Mauricio, 2013). In pernicious anemia, degeneration of the parietal cells in the gastric mucosa leads to a decrease in production of the intrinsic factor, resulting in reduced absorption of vitamin B12. Vitamin B12 deficiency impairs the production of red blood cells (RBCs). This results in large, oval, fragile cells that have a short lifetime. Persons with pernicious anemia are typically treated with injections of vitamin B12 as oral vitamin B12 is not well absorbed

The Declaration of Alma-Ata and the Global Strategy on Diet, Physical Activity, and Health are reviewed at a community health nursing meeting to incorporate global health goals in the community. Which healthcare organization is responsible for these landmark documents?

World Health Organization. The Declaration of Alma-Ata defines the goals and objectives for unequivocal healthcare for all and the Global Strategy on Diet, Physical Activity, and Health outlines global strategies to decrease two health risks responsible for more than half of all global mortality. The World Health Organization is responsible for both landmark documents.

A mother is worried that her three-year-old toddler may have inherited hemophilia because the toddler has few scattered bruises on thier body from playing on the playground and the father of the baby has hemophilia. What is the most common inheritance pattern in clients with hemophilia?

X-linked recessive. Male infants will only inherit the disease if the mother happens to be a carrier of the gene and the infant inherits the faulty "X" chromosome from their mother.

how to assess arteriovenous graft (AVG)

_Normally, a thrill (buzzing sensation) can be felt by palpating the fistula -auscultate for bruit (rushing sound) can be heard with a stethoscope

albumin

albumin often is used to determine liver function. Albumin is synthesized in the liver and accounts for almost half of the total serum protein in the human body. Albumin levels should be included on the initial chemistry profile for nutritional screening purposes. The synthesis of protein may be affected by nonnutritional factors such as cirrhosis, acute stress, congestive heart failure, and hypoxia. Decreased levels may be caused by renal and liver disorders, altered fluid status, medications, chronic diseases, and malnutrition. Elevated levels may result from decreased fluid balance (dehydration), exercise, or medications.

pancreatic enzymes

amylase, lipase, trypsin

Hypothyroidism

condition of hyposecretion of the thyroid gland causing low thyroid levels in the blood. T4 is low and TSH is elevated.

the family of a client is requesting that an experimental medication is provided to a client with multi- organ system failure after a drug overdose. the client's healthcare provider is not in agreement with the family and the client does not have an advance directive. what is the best approach to determine this client's care?

consult with the medical ethics committee

Hyperthyroidism

excessive activity of the thyroid gland. characterized by an increased rate of body metabolism. T3, T4 elevated TSH is low

Which type of therapy is most helpful for a teen with depression in an outpatient setting?

group Treatment for a teen with depression is multidimensional. Group therapy is especially helpful for adolescents in the outpatient setting because it is in a structured environment and the adolescent can be comfortable when relating to their peers in a positive way.

The nurse is designing a targeted program for smoking cessation aimed at the largest population segment of smokers. Which organization is the best partnership for the nurse to pursue?

high school There are more high-school smokers than adult smokers. Targeting smoking cessation requires reaching the largest number of smokers in this group, so the high school partnership will be most beneficial.

Pancytopenia

is a condition that occurs when a person has low counts for all three types of blood cells: red blood cells, white blood cells, and platelets.

A client is experiencing dyspnea, respirations 24 breaths/ minute, O2 saturation of 89% on room air, nasal flaring, and audible expiratory and inspiratory wheezing noted three feet away. Which set of arterial blood gas (ABG) results is consistent with the nurse's assessment of this client?

pH 7.28; PaCO2 55; HCO3 24. The client is experiencing respiratory acidosis so pH will be below normal, with elevated PaCO2.

PICC line

peripherally inserted central catheter (PICC) is a long catheter inserted through a vein of the antecubital fossa (inner aspect of the bend of the arm) or the middle of the upper arm. Nurses who insert these CVADs require special training and certification. In adults, the PICC length ranges from 18 to 29 inches (45-74 cm) with the tip residing in the superior vena cava (SVC) ideally at the caval-atrial junction (CAJ) (Fig. 13-6). Placement of the catheter tip in veins distal to the SVC is avoided. Insertion methods using guidewires and ultrasound systems greatly improve insertion success. The basilic vein is the preferred site for insertion; the cephalic vein can be used if necessary. Sterile technique is used for insertion to reduce the risk for catheter-related bloodstream infection (CR-BSI). Before the catheter can be used for infusion, a chest x-ray indicating that the tip resides in the lower SVC is required when the catheter is not placed under fluoroscopy or with the use of the electrocardiogram tip locator technique. PICCs can be used for blood sampling; however, lumen sizes of 4 Fr or larger are recommended. Using lumens with small diameters may not yield a sample capable of producing the needed test results. In addition, frequent entry into any central line should be minimized and treated with strict aseptic technique to prevent CR-BSI. Transfusion of blood through a PICC usually requires the use of an infusion pump. Packed red blood cells are cold and viscous. The length of the catheter adds resistance and may prevent the blood from infusing within the 4-hour limit.

fourth stage of labor

the first 1-4 hours after delivery of the placenta. The fourth stage of labor begins with the delivery of the placenta and includes at least the first 2 hours after birth. During this stage the woman begins to recover physically from birth, so it is an important time to observe for complications, such as abnormal bleeding

Agnosia

the inability to recognize familiar objects or people

infant intramuscular site

vastus lateralis use 22 to 25 gauge needle

important info for arteriovenous graft

• Never perform BP measurements, insertion of IV lines, and venipuncture in the extremity with the vascular access. • These special precautions are taken to prevent infection and clotting of the vascular access. • When a patient is hospitalized, hang signs in patient's room or label the arm with a band that says "No BP, blood draws, or IV in this arm."