MED SURG FINAL

A 58-year-old male patient with a 60 pack-year history of cigarette smoking and a history of heavy alcohol use has been diagnosed with laryngeal cancer following a physical examination and endoscopy. The patient has been scheduled for a partial laryngectomy and is highly anxious about the consequences of this surgery. What patient education should the nurse provide for this man? "Most people who have a partial laryngectomy find that their breathing, swallowing, and speech are unchanged." "After a partial laryngectomy, most patients work with a speech therapist and regain some of their ability to speak." "A partial laryngectomy has the advantage of having only a minimal effect on your speech." "Unfortunately, the nature of a partial laryngectomy means that you can no longer use your vocal cords."

"A partial laryngectomy has the advantage of having only a minimal effect on your speech."

A 56-year-old man has sought care because the automated blood pressure machine in his pharmacy indicated a blood pressure reading of 146/96 mm Hg. He has said to the nurse, "My pressure has never been this high. Will I need to take medication to reduce it?" Which of the following responses by the nurse would be best? "Yes. Hypertension is prevalent among males; it's fortunate we caught this during your routine examination." "Quite likely, because your age places you at high risk for hypertension." "A single elevated blood pressure doesn't confirm hypertension. You'll need to have your blood pressure reassessed several times before a diagnosis can be made." "You have no need to worry. Your pressure was probably elevated because of your anxiety."

"A single elevated blood pressure doesn't confirm hypertension. You'll need to have your blood pressure reassessed several times before a diagnosis can be made."

The nurse is performing patient education for a patient who has been prescribed hydrochlorothiazide and metoprolol (Lopressor) for the treatment of hypertension. What teaching point should the nurse emphasize when teaching the patient about this medication regimen? "It's best not to take aspirin for pain while you're taking your antihypertensives." "Avoid taking over-the-counter decongestants because they can increase your blood pressure (BP)." "Most allergy medications can't be taken with BP meds, so make sure to check with your doctor or pharmacist." "If you get an infection, make sure that your care provider knows you have hypertension before he or she prescribes an antibiotic."

"Avoid taking over-the-counter decongestants because they can increase your blood pressure (BP)."

A nurse who works in a busy emergency department provides care for numerous patients who present with complaints of chest pain. Which of the following questions is most likely to help the nurse differentiate between chest pain that is attributable to angina and chest pain due to myocardial infarction (MI)? "Does resting and remaining still help your chest pain to decrease?" "Have you ever been diagnosed with high blood pressure or diabetes?" "When was the first time that you recall having chest pain?" "Does your chest pain make it difficult to move around like you normally would?"

"Does resting and remaining still help your chest pain to decrease?"

An older adult man has been diagnosed with a femoral head fracture after falling outside his home, and his health care provider has chosen open reduction with internal fixation (ORIF). How should the nurse best explain this procedure to the patient? The surgeon will give you an anesthetic and then apply a cast." "The surgeon will place plates or rods outside your hip and keep you in traction until your bones heal." "The surgeon will use pins and rods to keep your bones in place until they heal." "The surgeon will use a scope inserted through punctures in your skin to remove any bone fragments."

"The surgeon will use pins and rods to keep your bones in place until they heal."

A patient who is postoperative day 2 following a coronary artery bypass graft (CABG) has been experiencing significant pain in the region of his sternal incision. What patient teaching should the nurse perform with this patient? "Try to hug a folded blanket across your chest when you move or breathe deeply." "If possible, try to avoid coughing and breathe as shallowly as possible to relieve pressure on your incision." "The less you can move, the less pain you're likely to have in the area of your incision." "Getting you up and mobilizing as soon as possible will help with this problem."

"Try to hug a folded blanket across your chest when you move or breathe deeply."

chronic neurological disorders

#1 priority = safety Energy conservation: pace activities, schedule activities/meals w/ peaks of medications. Medications should be given on strict schedule Sit upright @ meals. Use of adaptive devices to facilitate eating. Assistive devices and energy conservation during mobility. Skin assessment Bowel and bladder management. Void/BM schedule. Commode. Catheterization or urostomy may be necessary for retention. Fluid and fiber increase & stool softeners for constipation. Continuity of care for confused patients. Consistent routines. Use distraction or redirection for confused assertive behavior Is pain causing increased confusion/restlessness? Sundowning?

seizure

#1, patient safety Seizure precautions: Padded side rails Suction at bedside O2 at bedside Fall risk Bed in low position During a seizure: Protect patient Lie on side (airway mgmt) DO NOT put anything in mouth Observe details of seizure DO NOT restrain O2 and suction if nessesary Administration of anti-seizure medications (i.e. Ativan) if not stopping. Post-Seizure: Reorient patient, they may be confused Allow to sleep Neuro vital signs EEG Assess resp and cardiac Medication education Do not abruptly stop Keep all appointments for medication monitoring

supplemental iron: what you need to know!

#1: Iron is best absorbed in the duodenum & proximal jejunum...therefore ERT/SRT counterproductive #2: Daily dosage should provide 150-200mg of elemental iron. Done in 3-4 daily doses #3:Best absorbed as Ferrous Sulfate (Fe²+) in an acidic environment. Take an hour prior to eating. #4: Undiluted Iron may stain the patient's teeth. Drink with a straw. #5: GI side effects: heartburn Constipation Diarrhea Black stools normal

Multiple Sclerosis

1st common sign: diplopia, fatigue Sensory & motor impairment Fatigue and Heat intolerance

Myasthenia Gravis

1st common signs: Ptosis (eye drooping) & diplopia Motor impairment

After receiving change-of-shift report for the following four patients with neutropenia, which patient should the nurse assess first? 66-year-old who has white pharyngeal lesions 35-year-old who has a fever of 100.8° F (38.2° C) 56-year-old who has frequent explosive diarrhea 23-year old who is complaining of severe fatigue

35-year-old who has a fever of 100.8° F (38.2° C)

upper respiratory #1

ALWAYS AIRWAY!

Dyspnea associated with congestive heart failure is primarily due to: Blockage of the pulmonary artery by an embolus Accumulation of fluid in the interstitial spaces and alveoli of the lungs Blockage of bronchi by mucous secretions Compression of the lungs by a dilated heart

Accumulation of fluid in the interstitial spaces and alveoli of the lungs

A nurse has been providing care for an older adult patient who has a number of comorbid medical conditions. The nurse has been performing frequent assessment throughout the morning due to the patient's pallor, decreased level of consciousness, and unstable vital signs. During the nurse's most recent assessment, the patient has lost consciousness and the carotid pulse is not palpable. What is the nurse's priority action? Applying oxygen by face mask Performing a rapid head-to-toe assessment Initiating cardiopulmonary resuscitation Activating the hospital's code system

Activating the hospital's code system

A 20-year-old man has been admitted to the emergency department with a femoral fracture as a result of a motorcycle accident. When the nurse is taking the patient's history, he states, "I had leukemia when I was little kid but they managed to cure it." The nurse should suspect that this patient likely had what type of leukemia? Acute lymphoid leukemia (ALL) Chronic lymphoid leukemia (CLL) Acute myeloid leukemia (AML) Chronic myeloid leukemia (CML)

Acute lymphoid leukemia (ALL)

angina: acute intervention

Administer supplemental O2 & position patient in upright position VS (HR & BP elevated) 12-lead ECG Pain relief- Nitrate then opioid analgesic if needed (Rate on a pain scale) Auscultate heart sounds (S4 or S3 gallop) Supportive & realistic assurance

ACS: Fibrinolytic Therapy

Aim to stop the infarction process by dissolving the thrombus in the coronary artery & reperfusion of the myocardium. ASAP, ideally within the first hour after onset of symptoms & preferably within the first 6 hours after onset of symptoms. Given Intravenously Inclusion criteria: chest pain typical of MI ≤6 hrs in duration, 12-lead ECG consistent with acute MI, no absolute contraindications. Monitor for signs of bleeding post-procedure!!

DI

An antidiuretic hormone (ADH) deficiency (aka vasopressin). Maintain adequate fluids Strict I&Os Daily weights Medic-Alert bracelet Avoid foods with diuretic properties Low sodium, low protein Administer vasopressin as ordered. Do not give in patient's with heart disease/CAD. Call MD if: severe or pounding headache; severe drowsiness, slow breathing, feeling very weak; little or no urinating; numbness or tingling around your mouth; chest pain or tight feeling, trouble breathing; skin changes or discoloration; or pain or loss of feeling anywhere in your body.

LRD: pneumonia

Antibiotics. Respiratory assessment. VS assessment. See treatments above. Smoking cessation. Elderly may present without fever.

Thrombocytopenia (see cancer nsg mgmt PP for further details)

Assess for bleeding. Petichea. Nose bleeds. Avoid IM injections, if necessary, apply pressure after. Soft tooth brush or use swabs for mouth care. No razors. Admin stool softeners, bearing down can cause rectal bleeding. Assess platelet labs. Administer platelets if needed.

dialysis access protection

Assess for bruit and thrill, notify if absent No blood draws or iv insertion in arm w/ access No bp taken on arm w/ access Assess for s/s infection: redness, swelling, bleeding, drainage, heat, pain

post-op thyroidectomy

Assess for hemorrhage or tracheal compression Irregular breathing Neck swelling Frequent swallowing "Fullness" at incision site Bloody drainage on dressings Pain control Semi-Fowlers positioning No flexion of neck Expect hoarseness 3-4 days post-op Assessment of s/s hypoparathyroidism Education Thyroid-hormone replacement therapy Iodine intake Regular follow up appts.

URD: obstructive sleep apnea

Assess respiratory status. Compliance with CPAP or BiPAP.

A patient who suffered a T6 lesion during a spinal cord injury (SCI) 10 days ago is progressing with treatment and rehabilitation following the immediate treatment of his injury. When preparing to help the physical therapist mobilize the patient for the first time since the injury, the nurse should prioritize which of the following assessments? Assessing the patient's blood pressure Monitoring the patient's cognition Monitoring the patient's pain level Assessing the patient's respiratory rate

BP

After a cardiac catheterization, the nurse must monitor for which primary complication? Bleeding Paresthesia Increased urine output Pain at the site of vascular access

Bleeding

URD: sinus and pharyngeal infections

Both: Antibiotic compliance. Humidity. Sleep w/ HOB >30. PO fluids. Phangyeal: Decongestants. Strep A can cause acute poststreptococcal glomerulonephritis. Assess for thrush.

A nurse is caring for a patient who is exhibiting signs and symptoms of autonomic dysreflexia. What clinical manifestations would the nurse expect in this patient? Tachycardia and hypotension Bradycardia and hypertension Tachycardia and hypertension Bradycardia and hypotension

Bradycardia and hypertension

Meniere's disease

Can be a risk for falling d/t vertigo- Contact guard assist. Nausea w/ vertigo common. During attack, place in dark and quiet room. No sudden head mvmts. Consult PT for vertigo exercises. Low Na+ diet, no caffeine. Stay hydrated.

As part of a patient's admission assessment, the nurse has assessed the patient's blood pressure (BP) and achieved a reading of 133/78. What physiological factors contribute to the patient's blood pressure reading? Cardiac output multiplied by peripheral vascular resistance The differences between preload and afterload during systole and diastole Stroke volume multiplied by total vascular space Heart rate multiplied by mean heart contractility

Cardiac output multiplied by peripheral vascular resistance

Urinary retention

Catheterization (I&O), voiding schedule, double voiding, drink small amts throughout day, running water or warm water on hand while trying to void.

Which assessment finding may indicate that reocclusion has occurred after thrombolytic therapy? Hypotension Chest pain ST segment depression Change in level of consciousness

Chest pain

A nurse in the intensive care unit is caring for a patient who is being treated for urosepsis. Over the past several hours, the patient's condition has deteriorated, and the care team believes that the patient is experiencing disseminated intravascular coagulation (DIC). What assessment should the nurse prioritize in the immediate care of this patient?

Close observation for signs of internal or external hemorrhage

Ear infection + Tympanic membrane damage

Compliance with antibiotic + steroid medications. Tylenol for fever & pain. Keep inner ear dry. Try to sneeze/cough w/ mouth open. Often result of upper resp infection.

anemia

Correct underlying cause. Blood transfusion. Nutrition (usually a need to increase iron, folic acid, or B12). Volume replacement (IV fluids to prevent hypovolemic shock). O2 administration (help the RBC that are circulating to oxygenate body). Fatigue= Energy management.

Which nursing intervention would assist in maintaining airway clearance? Restricting fluids to 1.5L per day Coughing and deep breathing every 1-2 hours Minimizing use of opioid analgesics Restricting activities

Coughing and deep breathing every 1-2 hours

The nurse has completed a head-to-toe assessment of a patient who was admitted for the treatment of heart failure (HF). Which of the following assessment findings should signal to the nurse a possible exacerbation of the patient's condition? Crackles are audible on chest auscultation. The patient's blood pressure (BP) is 144/99. The patient has put out 600 mL of dilute urine over the past 8 hours. Blood glucose testing reveals a glucose level of 158 mg/dL.

Crackles are audible on chest auscultation.

most common cause of end-stage-renal disease:

DM

LRD: TB

Detailed medication regiment necessary, compliance necessary. Hepatotoxic, assess liver labs & for jaundice. Isolation in Negative pressure room. Protect self: gown, glove, N95 mask. Pt wear mask out of room, good hand hygiene. PPD test: read in 48-72 hrs, assess for induration. CXR if + result.

The public health nurse is participating in a health fair, and she interviews a woman with a history of hypertension who is currently smoking one pack of cigarettes per day. She has had no manifestations of coronary artery disease (CAD) but a recent low-density lipoprotein (LDL) level of 154 mg/dL was found. Based on her assessment, the nurse would expect that this patient would be treated in what way? Drug therapy and smoking cessation Diet and drug therapy Diet therapy only Diet therapy and smoking cessation

Diet therapy and smoking cessation

A 70-year-old man has been diagnosed with angina pectoris and subsequently prescribed nitroglycerin spray to be used sublingually when he experiences chest pain. This drug will achieve relief of the patient's chest pain by: Blocking sympathetic stimulation of the heart and reducing oxygen demand Increasing contractility and consequent cardiac output Blocking the a-delta pain fibers in the myocardium Dilating the blood vessels and reducing preload

Dilating the blood vessels and reducing preload

A 69-year-old man has been experiencing progressive dyspnea and activity intolerance in recent months and is currently undergoing a diagnostic workup for heart failure (HF). During echocardiography, systolic HF could be differentiated from diastolic HF by appraising the patient's: Sinus rhythm Ejection fraction (EF) Stroke volume Left ventricular wall thickness

Ejection fraction (EF)

LRD: pulmonary edema

Emergency: Increasing resp distress. Correct underlying problem. Stay w/ patient. Try to calm. O2 administration. VS. Medications: Lasix

A patient with a diagnosis of prostate cancer is receiving radiation therapy, a treatment that has resulted in stomatitis. To best manage this patient's stomatitis, the nurse should: Encourage the patient's family to bring in mouthwash for the patient. Arrange for a low-residue diet for the patient and provide small, frequent meals Provide a hypertonic solution for the patient to gargle. Encourage the patient to use an oral swab rather than a regular toothbrush

Encourage the patient to use an oral swab rather than a regular toothbrush

While obtaining subjective assessment data from a patient, the nurse recognizes that a modifiable risk factor for the development of hypertension is A low calcium diet Excessive alcohol consumption A family history of hypertension Consumption of a high protein diet

Excessive alcohol consumption

eye and vision meds

Eye drops best absorbed in conjunctival sac. Stagger when multiple different drops needed

ACS: Percutaneous Coronary Intervention (PCI)

First line of treatment for patients w/ confirmed MI Goal to open affected artery within 90 minutes of arrival to healthcare facility Locate blockage, assess severity of blockage(s), determine presence of collateral circulation, & evaluate left ventricular function. Placement of drug-eluting stent(s) placed Pros: non-surgical intervention, local anesthesia, ambulatory within 24 hrs after procedure, LOS in hospital 1-3 days & patient can be back to work 5-7 days after PCI. Cons: dissection of newly dilated coronary artery, abrupt closure, or restenosis.

Alzheimer's Disease

Forgetfulness that increasingly worsens. Behavior issues r/t confusion possible.

right-sided heart failure

From left-sided HF, cor pulmonale, right ventricular MI Backup of blood into the right atrium and venous systemic circulation Jugular venous distention Hepatomegaly, splenomegaly Vascular congestion of GI tract Peripheral edema

UTI

Full course of ABX. Inc. fluid intake. Empty bladder fully: Void @2-3 hrs. Wipe front to back. Void after intercourse. Avoid unnecessary catheterization. Cranberry(?). Costovertebral tenderness (upper UTI)

ESRD

GFR decreases, Sodium & water retention, anemia, phosphorus and calcium imbalance, metabolic acidosis.

asthma

Goal for symptom mgmt & prevent exacerbation. Peek flow measurements. Inhalers, short acting for "attack", long acting for baseline prevention mgmt.

ESDR management

Goal to maintain kidney fxn & homeostasis for as long as possible Dialysis: Access protection important. Erythropointin for anemia. Assess mental status before, during, and after dialysis. Assess BP. Fatigue common. Electrolyte labs will be high in-between dialysis days. Medications Calcium & phosphorus binders Anti-htn & cardiovascular Antiseizure (develop as azotemia worsens) erythropoietin Nutrition Limit protein Fluid restriction Na, k, phos restrictions

asthma and COPD management

Hand hygiene, stay away from sick people/crowds, avoid abrupt temp changes. Energy conservation: Take breaks w/ ADLs, small, frequent meals, time bronchodilators prior to activity or meals. Drink plenty of fluids. Smoking cessation Anxious? Stay w/ patient. Purse-lip breathing, tripod position, sit upright, exhale slowly Watch O2 administration carefully, 88-92% okay. Retaining CO2?: assess mental status, ABGs.

eye and vision infection

Hand washing best prevention. Throw away cosmetics or contacts. Medication compliance w/ Abx.

Acute Decompensating Heart Failure (ADHF)

High Fowler's position Supplemental oxygen Continuous ECG monitoring Ultrafiltration: Option for patients with volume overload Decrease intravascular volume Reduces venous return and preload Loop diuretics (e.g., furosemide [Lasix]) Ultrafiltration or aquapheresis Decrease venous return (preload) Reduces the amount of volume returned to the LV during diastole High-Fowler's position IV nitroglycerin Decrease afterload Improves CO and decreases pulmonary congestion IV sodium nitroprusside (Nipride) Morphine sulfate Nesiritide (Natrecor) Improve cardiac function For patients who do not respond to conventional pharmacotherapy (e.g., diuretics, vasodilators, morphine sulfate) Inotropic therapy Digitalis B-Adrenergic agonists (e.g., dopamine) Phosphodiesterase inhibitors (e.g., milrinone) Hemodynamic monitoring Reduce anxiety Distraction, imagery Sedative medications (e.g., morphine sulfate, benzodiazepines) Improve gas exchange and oxygenation Supplemental oxygen Morphine sulfate Noninvasive ventilatory support (BiPAP

hyperthyroid

Hyperactivity w/ sustained release of thyroid hormones Thyrotoxicosis- excess T4 &/orT3 levels Grave's Disease Exophthalmos Weight loss Increased nervousness Tremors increase SNS activity Heat intolerance Thyroid storm

The staff educator is talking to a group of new emergency department nurses about hypertensive crises. The nurse educator is aware that hypertensive urgency differs from hypertensive emergency in what way?

Hypertensive emergencies are associated with evidence of target organ damage.

A medical patient has rung her call bell complaining of a severe headache, and the nurse has conducted a rapid assessment of the patient. The assessment reveals tachycardia and a blood pressure (BP) reading of 198/144. The nurse would recognize the need to treat this patient for: Primary hypertension Hypertensive emergency Hypertensive urgency Secondary hypertension

Hypertensive urgency

Myxedema: Hypothyroid tx

ICU treatment: intubation. Continual heart monitoring. Thyroid-hormone replacement medications.

The nurse is planning and providing the care of a patient with heart failure (HF). What will be the overall goals of management for this patient? Select all that apply. Improve functional status Increase cardiac contractility Extend survival Decrease pulmonary venous pressure Relieve patient symptoms

Improve functional status Extend survival Relieve patient symptoms

hypoparathryoid

Inadequate PTH Hypocalcemia Iatrogenic: damage or accidental removal during surgery Tetany Laryngospasm Painful spasm of both skeletal & smooth muscle

hyperparathyroid

Increased secretion of parathyroid hormone (PTH) Primary/Secondary/Tertiary Hypercalcemia/Hypophosphatemia Muscle weakness Constipation Fatigue Emotional disorders Short attention span Calcium loss from bones Kidney stones Serious complications: renal failure, pancreatitis, cardiac changes & long, rib, & vertebral fractures

The nurse is caring for an adult patient who had symptoms of unstable angina during admission to the hospital. The most appropriate nursing diagnosis for the discomfort associated with angina is what? Deficient knowledge about underlying disease and methods for avoiding complications Anxiety related to fear of death Ineffective cardiopulmonary tissue perfusion secondary to coronary artery disease (CAD) Noncompliance related to failure to accept necessary lifestyle changes

Ineffective cardiopulmonary tissue perfusion secondary to coronary artery disease (CAD)

hypothyroid

Insufficient thyroid hormone Primary or secondary Iodine deficiency End result of Grave's disease Fatigue/lethargic Impaired memory Depressed appearance decrease Cardiac contractility & CO/GI motility Cold intolerance Myxedema Myxedema coma

cerumen blockage

Irrigate canal w/ body temp solution. Unless specially trained, do not use instruments to pull cerumrn or foreign objects out of ear.

URD: nosebleed

Keep pt quiet & calm. Upright position. Apply direct pressure on bridge of nose. Insert small gauze into nares. If does not resolve, may need packing. Packing stays in 2-6 days. Antibiotics. Assess for resp distress. Pain mgmt. Cough/Sneeze w/ mouth open.

Urinary incontinence

Kegal exercises, voiding schedule, regular BMs, fluid modification

The nurse is caring for a patient with a diagnosis of hypoproliferative anemia. When planning this patient's care, the nurse should be aware that this type of anemia is due to what?

Lack of production of red blood cells (RBCs)

anuria

Less than 50 ml urine in 24hr period

Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)

Life-threatening Hyperosmolarity & Hyperglycemia w/ alterations in LOC. Ketosis minimal or absent R/T: infection, acute or chronic illness, meds that exacerbate hyperglycemia, surgery, dialysis. S/S: Hypotension, profound dehydration, tachycardia, variable neurologic signs. Diagnostic Results: High BG (600-1200 mg/dL) & high serum osmolarity (>350 mOsm/L). Electrolytes & BUN consistent w/ dehydration. Mental status changes/neuro deficits. Treatment: Fluid replacement, correction of electrolyte imbalance, & IV insulin administration

In teaching a patient with hypertension about controlling the condition, the nurse recognizes that: All patients with an elevated BP require medication It is not necessary to limit salt in the diet if taking a diuretic Obese persons must achieve a normal weight to in order to lower BP Lifestyle modifications are indicated for all persons with elevated BP

Lifestyle modifications are indicated for all persons with elevated BP

hypoglycemia

Low blood glucose. Less than 50-60mg/dl. Causes: Too much insulin/oral anti-diabetic meds, too little food, excessive physical activity S/S: sweating, tremor, tachycardia, palpitations, anxiety, hunger (ANS). Headache, lightheadedness, confusion, slurred speech, impaired coordination, drowsiness (CNS). Treatment Fast-acting 15g source carb (4-6oz fruit juice, 6-10 hard candy, 2-3tsp sugar/honey). BG level recheck 15min. Re-treat w/ 15g carb if >70 Once symptoms resolve, snack w/ protein and starch Unable to do by mouth? Glucagon injection (SQ or IM) 25-50ml D50W via IVP

chronic HF

Main treatment goals: Treat the underlying cause and contributing factors. Maximize CO. Provide treatment to alleviate symptoms. Improve ventricular function. Improve quality of life. Preserve target organ function. Improve mortality and morbidity.

URD: Head & Neck Cancer- post-operative: many require trach post-op, depending on surgery, may be temporary or not.

Maintain airway #1. Assess for hemorrhage or resp distress. Wound mgmt (CDI? Assess s/s infection). Drain mgmt. (output, color & amount). Suction @ bedside. PT/OT. Mobility get oob & pt use upper extremities to assist w/ mvmt of head/neck. Pain mgmt. Nutrition: NPO. May advance to soft foods or require tube feedings, depending on type of surgery. Communication may be impaired....use of dry erase boards for communication, or simple "yes" "no" questions.

Acute Pylonephritis

Major causes: bacterial infection, urinary obstruction. ABX. Follow up cultures and imaging may be needed. NSAIDS & Antipyrtetics. (see treatments for UTI)

neurologic trauma

Males age 16-20 high risk for SCI Orthostatic hypotension common. Assess prior to mobilizing. Autonomic dysreflexia: T6 injury & above. HTN, bradycardia, headache. Often caused by full bladder/bowel. Goal to stabilize patient and then progress towards learning how to live with SCI.

A patient with a newly diagnosed hypertension has a BP of 158/98 after 6 months of exercise and diet modifications. Which management strategy will be a priority for the patient? Medication will be required because the BP is still not at goal Continued BP monitoring another 3 months is all that will be necessary at this time Lifestyle modifications are no longer importance since they were not effective and medications will be started More vigorous changes in the patient's lifestyle are needed for a longer period of time before starting medications.

Medication will be required because the BP is still not at goal

A patient has sustained a long bone fracture. The nurse is preparing a care plan for this patient. Which nursing action should the nurse include in the care plan to enhance fracture healing? Limit weight-bearing and exercising during the recovery. Monitor color, temperature, and pulses of the affected extremity Avoid prolonged immobilization of the fracture fragments. Administer high doses of corticosteroids.

Monitor color, temperature, and pulses of the affected extremity

left-sided heart failure

Most common Left ventricular dysfunction (e.g., MI hypertension, CAD, cardiomyopathy) Backup of blood into the left atrium and pulmonary veins Pulmonary congestion Pulmomary Edema

Thrombolytic therapy would be appropriate for which of the following conditions? Continual blood pressure above 200/120 History of diabetic retinopathy History of significant kidney disease Myocardial infarction

Myocardial infarction

glaucoma

No cure. Med management to dec. intraocular pressure. Emphasis importance of med compliance. Leads to blindness....see safety.

Neutropenia (see cancer nsg mgmt PP for further details)

No visitors who have been ill. Patient's should bathe daily. Wear a mask out of room. Positive pressure room or room with HEPA filter. No fresh fruits or veggies. No flowers. No gardening. No cleaning the cat box. Assess absolute neutrophil count. Temp > 38.0 report.

COPD

Not curable, make meaningful & realistic goals. Goal for QOL, symptom mgmt, & exacerbation prevention.

While admitting a client scheduled for a cardiac catheterization the client states to the nurse, "I always get a rash when I eat shellfish." Following safety protocol, the most appropriate initial nursing intervention is to: Notify the physician Place a note on the chart regarding this reaction Ask the client if there are any other foods that cause such a reaction Notify the dietitian if the reaction and request a "no shellfish" diet.

Notify the physician

Urinary Tract Calculi

Pain management. Encourage mobility. Strain urine. Stone removal may be needed, assess for dec. uop after a stone removal, may indicate re-blockage. Dietary management may depend on type of stone: dec calcium for stone made from high calcium. Dec foods high in purine for stones from high uric acid. Don't "force fluids" but maintain hydration.

Which assessment is frequently obtained after percutaneous coronary intervention (pci)? PTT levels ST segment measurements Palpation of pedal pulses Glasgow Coma Scale

Palpation of pedal pulses

blood product transfusion

Patient's need a current type & screen (within last 24-48hrs) Double RN check of blood product to patient and recorded type of blood product. Need 18-20 gauge peripheral IV or central line. Stop infusion immediately for s/s reaction to infusion. Start NS bolus "wide open." Get VS. Call MD. Send blood back to blood bank for assessment. May need to administer Benadryl. Reaction can include: Fever increase over 1 degree, chills, flank pain, palpitations, anaphylaxis, tachycardia, "impending doom" Admin Per each hospital protocol. UVM MC: must be started within 30 minutes of leaving blood bank. Must be completed in 4 hours. Cannot be administered faster than 2 hours. Stay with patient for first 20 min of infusion. Get VS at 20 minutes and 60 minutes after starting infusion, and upon completion of infusion.

eye and vision safety

Poor vision inc. fall risk. Make sure pt. safe. Bed in low position. Call bell in reach. Remove unnecessary clutter from room. Do not rearrange the room. Knock & introduce self prior to touching pt. Assist w/ mobilization. Home safety- declutter furniture, no throw rugs, pad points on furniture.

cataracts

Post-op surgical care: Abx & steroid drops. No lifting, bending, stooping, blowing nose. Cough with open mouth.

Which type of chest pain is not related to physical activity and often occurs at night? Unstable angina Prinzmetal's or variant angina Stable angina Silent myocardial ischemia

Prinzmetal's or variant angina

macular degeneration

Pt. ca do Amsler grid for assessment of disease progression. Leads to blindness.....see safety.

addison's

R/T hypofunction of adrenal gland leading to deficiency of steroid hormones Acute Intervention Frequent assessment: VS, FVD, electrolyte imbalance Daily weight Corticosteroid administration Infection prevention strategies Protect against environmental extremes: light, temp, noise Home Care Lifelong corticosteroid replacement therapy Medication management s/s of corticosteroid deficiency and excess Medic Alert bracelet/medical identification & instructions Increase salt intake Teach how to take BP Emergency kit

cushing's

R/T metabolic effects of persistently elevated blood levels of glucocorticoids Medication therapy used w/ caution due to toxicity of doses.- medications inhibit adrenal fxn Assess for s/s of hormone & drug toxicity Assess for serious complications: cardiovascular, DM and infection VS Daily weight Glucose Pain Assess s/s thromboembolic event

musculoskeletal

RICE for strains and sprains. NSAIDS. Progressive weight bearing and ROM. Immobility for fractures: splints, casts, external fixation, internal fixation, traction. Open fractures (skin broken)- Tetanus shot needed Long bone fractures = inc risk for bleeding or thromboembolism CSMTs!!!! Numbness/Tingling, diminishing pulse, cool to touch may indicate compartment syndrome. Compartment syndrome- if pressure unrelieved by loosening ace wraps, splints, &/or casts, then may require surgical fasciotomy to save limb. Pin care for skeletal traction or external fixation done every 8hrs in hospital, or at least once daily at home. Skeletal or skin traction: do not remove/lift or swing weights. Skin integrity high priority. Pain management. CSMT assessment. Temporary until patient has surgery to fix problem. Pain management...may not indicate NSAIDS with long bone fractures d/t bleeding risk. Follow weight bearing status orders. PT/OT consults.

SL nitro

Relieves pain in ~3 minutes & lasts 30-60 minutes May repeat every 5 minutes x 3 doses Contact EMS if symptoms do not resolve after first dose. Tablet/Spray under tongue DO NOT combine w/ drugs used for erectile dysfunction Monitor for orthostatic hypotension Needs to be accessible to patient at all times. Store away from light and heat. Tablets packaged in light-resistant bottles with metal caps, once opened should be replaced in 6 mo. Tablet/Spray under tongue, should cause tingling sensation. Warn patient that heart rate increase, headache, dizziness or flushing may occur Change positions slowly May take prophylactically before completing an activity known to trigger an attack.

A patient newly diagnosed with hypertension asks the nurse what happens when uncontrolled hypertension is prolonged. The nurse explains that a patient with prolonged uncontrolled hypertension is at risk for developing what health problem? Renal failure Right ventricular hypertrophy Glaucoma Anemia

Renal failure

LRD: chest surg post-op care

Resp assessment & VS. Incision CDI? Pain mgmt. Chest tube mgmt. Promote IS, TCDB, ambulation.

LRD: PE

Resp assessment, place O2, VS, stay w/ pt; try to calm. Call MD. Prevention: Ambulation, SCDs, compression stockings. Fibrinolytic therapy or IVC filter: assessment of insertion site, pressure at insertion site, CSMTs distal to insertion site. Anticoagulant therapy: labs PTT/PT, INR. Anticoagulant medication education.

LRD: pneumothorax

Resp assessment: lung sounds diminished or absent. O2 admin. Assess for subcutaneous emphysema (rice krispy feeling under skin). Chest tube management: water bubbling in canister= air leak... contact MD if unable to troubleshoot (are all connections tight? Dsg CDI?). Assess drainage (color & amount). Dressing CDI? Pain mgmt. Orders for chest tube suction or water seal? Promote IS, TCDB, ambulation.

LRD: pleural effusion and empyema

Resp assessment: lung sounds diminished or absent. O2 admin. VS. Thorensentisis @ BS for effusion. Chest tube mgmt. & antibiotics for empyema. Pain mgmt, IS, TCDB, ambulation.

URD: tracheostomy care

Respiratory assessment. Sterile technique for care. Do not exceed 120mmHg on suction source. Suction ≤10 seconds. Preoxygenate for at least 30 seconds prior and after suction.

Parkinson's Disease

Rigidity in muscles and mvmt. Increasingly worsens.

most sensitive indicator of renal function

SERUM creatinine

MI: STEMI vs. NSTEMI

STEMI: ST segment elevated NSTEMI: ST segment depressed

ACS: labs

Serum Cardiac Markers Creatine Kinase (CK) Troponin: high peak, long duration CK-MB Myoglobin: quick response

LRD: Atelectasis

Shallow breathing= atelectasis. The inability to take deep breaths causes alveoli collapse. Prevention key: Incentive spirometry, ambulation, TCDB, turn q2 for immobile. Resp assessment, lungs often diminished, watch O2 sat & RR. RT consult (nebs, inhalers, or Chest PT). Pain medications to assist w/ mobility

HF: top nursing tips to remember

Sodium restriction Fluid restriction Weigh daily Left sided heart failure tends to lead to right sided heart failure. Left sided: lung symptoms (crackles, sob, prod. Cough). Right sided: peripheral edema/JVD distension Fatigue management: energy conservation methods SOB? Sit up, high fowlers, O2 admin, lung/heart assessment, medication admin (i.e. Lasix), strict I&O Set realistic, meaningful goals.

hearing loss

Some Meds can be ototoxic, make sure pt knows to tell if they have changes in hearing while on med. Stand in front of them while speaking. Try for a quiet environment. Don't' shout, but certainly speak up.

Urinary diversion

Stoma dusky= report immediately. Dec in uop, report.

Pneumothorax is characterized by which common clinical findings?Select all that apply Tachypnea Bradycardia Respiratory acidosis Shortness of breath Decreased PaO2

Tachypnea Shortness of breath Decreased PaO2 *plus tachycardia and resp alkalosis

DM sick day rules

Take insulin/anti-diabetic medications as usual Test BG & test urine for ketones q3-4hours Report elevated BG (>300mg/dl) or ketones (16.6mmol/L) to HCP If patient takes insulin, may need to supplement q3-4hrs w/ Regular If unable to follow meal plan, substitute soft foods, eating 6-8 times/day N/V/D &/or fever persists take liquids every 30-60min. to prevent dehydration Report N/V/D and fever to HCP If unable to retain fluids, may require hospitalization

The nurse has attended morning report on a busy medical unit. The nurse recognizes which patient to be at greatest risk for the development of cardiogenic shock? The patient admitted with acute renal failure. The patient admitted following a myocardial infarction (MI). The patient admitted following hypertensive urgency. The patient admitted following a stroke.

The patient admitted following a myocardial infarction (MI)

Thrombolytic therapy is being prepared for administration to an older adult patient who has presented to the emergency department with an ST-segment elevation MI (STEMI). The nurse recognizes that the primary goal of this intervention is: To restore the flow of blood through the coronary arteries To restore function to infarcted myocardial cells To relieve the patient's symptoms of chest pain and dyspnea To prevent the rupture of atheromas

To restore the flow of blood through the coronary arteries

diabetic ketoacidosis tx

Treat hyperglycemia Regular insulin IV as a continuous infusion Once BG under 250 mg/dl, nurse may need to prevent hypoglycemia by switching IVF to solution w/ Dextrose in it. Correct dehydration NS (0.9%) Rapid replacement- 2-3 L rapidly (0.5-1 L/hr for 2-3 hrs) Subsequent IVF infusion dependent upon Na level and remaining dehydration Rapid infusion increases risk for cerebral edema, monitor closely. Monitor VS, I&O, & s/s of fluid overload (crackles, JVD, edema, wght gain, SOB, full bounding pulse) Correct Electrolyte Imbalance K major concern. Frequent monitoring (q2-4hrs). May range from low to high. If high, hold replacement. K levels will decline with insulin administration IV...cautious K replacement. EKG monitoring. Watch UOP for renal fxn. Correct Acidosis Result of fat breakdown Reversed w/ insulin (Regular IV) Hourly BG- goal to decrease BG by 50-100mg/dL/hr. This approach helps in preventing cerebral edema. Once BG 250-300mg/dL, NS w/ Dextrose started to prevent quick drop in BG Do not stop IV Insulin until SQ insulintherapy started

thyroid storm tx

Treat in ICU: monitor VS/heart rhythm, adequate oxygenation, replace fluid, correct electrolyte imbalance, calm, cool, quiet environment, assist w/ restlessness. Artificial tears, pain mgmt; elevate HOB & dark glasses for exophthalmos

addisonian crisis

Treatment directed towards shock management & high dose hydrocortisone replacement & large volumes of fluid. Life threatening Caused by insufficient adrenocortical hormones or sudden decrease in these hormones. Triggers: Stress Sudden withdrawal of corticosteroid hormone replacement therapy After adrenal surgery Following sudden pituitary gland destruction S/S: Hypotension Tachycardia Dehydration Hyponatremia Hyperkalemia Hypoglycemia Fever Weakness Confusion

diabetes

Type 1: destruction of beta cells in pancreas. Type 2: insulin resistance Symptoms: Three "P"s: Polyuria, Polydipsia, & Polyphagia Monitoring: self-monitoring, continuous monitoring, Glycated Hemoglobin (HgbA1C) Type 1 DM require insulin administration. Type 2 DM: diet & exercise, oral anti-diabetic medications, then insulin when other treatments fail. Short acting insulins (usually aspart or lispro) used for slide scale (based on BG) and meal time (set amount for meal) administration. Regular insulin can also be used for meal time administration. Regular insulin is the only one that can be given I.V; often used to treat high potassium. Long acting insulin used for baseline management.

An 80-year-old man, newly diagnosed with primary hypertension, has just been started on a beta-blocker. The nurse knows that in addition to teaching the patient about his medication (i.e, side effects, purpose, and schedule), she should also focus her teaching on what? Limiting fluids in order to decrease vascular volume Maintaining a diet high in dairy to increase protein necessary to prevent organ damage Use of supportive devices such as hand rails and walkers to prevent falls stemming from postural hypotension Limiting exercise to avoid injury that can be caused by postural hypotension

Use of supportive devices such as hand rails and walkers to prevent falls stemming from postural hypotension

The nurse is discussing the role of lifestyle modifications with a patient who has a diagnosis of primary hypertension. Which of the following lifestyle modifications typically results in the greatest reduction in blood pressure (BP)? Reduction in salt intake Weight loss Vigilant blood pressure monitoring Reduction in alcohol intake

Weight loss

A 60-year-old woman has been brought to the emergency department (ED) by ambulance after she experienced a sudden onset of dyspnea and phoned 911. The woman is obese but claims an unremarkable medical history and denies chest pain. When assessing this patient, the nurse in the ED should be aware that: Dyspnea is definitive for a respiratory, rather than cardiac, etiology. The absence of known risk factors usually rules out myocardial infarction (MI) or angina as a cause of dyspnea. Women often present with an MI much differently than do men. Acute coronary syndrome (ACS) manifests with chest pain rather than with shortness of breath.

Women often present with an MI much differently than do men.

A 26-year-old woman is thankful to be alive after rear-ending a truck with her car. However, she experienced a sternal fracture from the force of her car's airbag and has been breathing shallowly to avoid exacerbating her pain. The nurse should consequently prioritize assessments related to: Respiratory acidosis Pulmonary effusion Atelectasis Pleurisy

atelectasis

SIADH

opposite of DI Hyponatremia: muscle cramping/twitching, vomiting, abdominal pain, lethargy, anorexia, confusion, coma. So much fluid that we're diluting the Na+! VS Strict I&O Measure urine specific gravity (WNL= 1.001-1.029) Daily weight Assess LOC Monitor s/s hyponatremia Fluid restriction (1L/day) HOB flat (no more than 10 degrees)- enhances venous return to heart Safety Seizure precautions (severe hyponatremia) Maintain skin integrity Oral hygiene Distraction from thirst: sugarless gum, ice. Education s/s electrolyte imbalance Tricks to maintain fluid restriction

oliguria

under 500ml of urine in 24hr period