Spring Final 2020 UACCB RN

Interventions for hypocalcemia

Calcium replacements, calcium-rich diet, decrease stimulation and fall precautions

S/sx DVT and interventions

Calf pain, local edema, venous flow studies, MRI and D-dimer Interventions: Rest, meds, oral anticoagulants

Pt teaching for PUD

Drug therapy, bland diet, avoid tobacco, avoid alcohol, yoga, meditation, herbs, vitamins and minerals

Standards for a health work environment

-Alignment w/ the American Association of Critical Care Nurses **Skilled communication, true collaboration **Effective decision making, appropriate staffing **Meaningful recognition, authentic leadership

Health teaching and health promotion w/ therapeutic communication includes

-Educating families who have a cognitively impaired member is one of the most important health-teaching duties nurses encounter **Referral to community supports **Transportation services **Help line numbers **Home-health services/meals on wheels

Common cognitive assessment tools include

-Mini-mental exam -Pentagon screen -SLUMS exam

Examples of nurse sensitive care standards

-Pt-centered outcome measures, nursing centered intervention measures, system-centered measures *CLABSI/CRBSI *CAUTI *Fall and injury prevention *HAPI *Pt experience *UAPs

4 primary goals for FTT

1. Correct nutritional deficiency 2. Catch up growth 3. Restore optimal body comp 4. Educate on requirements

Define effective communication

Improves pt outcomes, open, collaborative, respectful, mutual engagement, authenticity of contributions, clarity and goal directed

When should the mother get rhogam

28 wks and w/in 72 hours of delivery

Noticing hypercalcemia

Increase in HR and BP or if SEVERE, decrease HR and BP, monitor for clotting, severe muscle weakness, decreased reflexes, confusion and lethargic

S/sx respiratory distress

Increased RR, color changes, nasal flaring, retractions, sweating, wheezing and use of accessory muscles

Define nursing process

A research supported organizational framework for professional nursing practice, ensures delivery of thorough, individualized thinking, ongoing and constantly evolving process

Blood transfusion compatibilites

A+ gives to A+, AB+, receives A+, A-, o+ and o- o+ gives to a+, a+, b+, ab+ and receives o+, o- b+ gives to b+, ab+ and receives b+, b-, o+ and o- Ab+ gives ab+ and receives everyone a- gives a+, a-, ab+, ab- and receives a- and o- o- gives everyone and receives o- b- gives b+, b-, ab+, ab- and receives b-, o- ab- gives ab+ and ab- and receives ab-, a-, b- and o-

Steps of the nursing process include

Assessment, diagnosis, outcome identification, implementation and evaluation

Healthy people 2020

Attain high quality longer lives free of preventable disease, disability, injury and premature death, achieve health equity, eliminate disparities and improve the health of all groups, create social and physical environments that promote good health for all, development and healthy behaviors across all life stages

Types of technologies

Biomedical-physiologic monitoring, diagnostic testing, IV fluid and meds,therapeutic tx, pt focused Information-EMR acquire, manage, analyze, disseminate -Core components-data, information, knowledge Knowledge-systems that generate or process knowledge and provide clinical decision support

S/sx PUD

Bright red/coffee=ground emesis, melena, decrease BP, increase HR, weak peripheral pulse, confusion, vertigo, dizziness, syncope and decrease in H&H

Anti-anxiety drugs include

Buspirone, lorazepam, clonazepam, propanolol and xanax

Healthcare organizations integration

Consortiums, consolidations, acquisitions and mergers Horizontal integration-organizations that provide similar service come together to increase service area -Vertical integration-organizations come together to provider a full array of all levels or services. Care across the continuum.

Care delivery models include

Case method: Total care for 1 pt physical, emotional and technique are RN's responsibility, no delegation or supervision of others Functional nursing: Specific tasks for large group, similar to assembly line and coordinated by charge nurse Team nursing: Modification of functional nursing, team leader is RN, care to small group, assigns tasks r/t role progress and reported to RN then to charge nurse/manager Primary nursing: RN primary nurse, responsible for outcomes, accountable 24/7. Associate nursing role: Care provider, follows direct care and collaborator Partnership model: Coprimary nursing model, RN paired w/ assistant, provider semiprimary care

Noticing hypocalcemia

Charley horses, recent radiation near thyroid, cardo changes (HR slower or fast w/ weak, thready pulse), Trousseau's and Chvostek's

RN responsibilities w/ O2 during post-op period

Check patency of airway, maintain head positioning to open airway, remove oral airway when able, suction until clear, provide supplemental O2, chart O2 and monitor and adjust as needed

Examples of cognitive therapy

Cognitive reconstructing -Replace negative w/ positive -Consider automatic thoughts and replacing w/ new conclusions

Domains of learning

Cognitive: includes all intellectual behaviors and requires thinking Affective: deals w/ expression of feelings and development of attitudes, opinions and values Psychomotor: involves acquiring skills that require coordination and integration of mental and physical movements

Actions by the RN with FTT

Complete HTT assessment, VS, skin hair and nail assessment, provision of adequate calories, protein and other nutrients, monitor growth and nutritional status and long term monitoring and f/u

Stages of bleeding following birth

Day 3-rubra: bright red. small clots Day 10- serosa: thin, pink-brown in color Day 14- alba: yellow-white up to 8 wks

Noticing hyponatremia

Decrease blood volume, decrease BP, poor perfusion, serum level decreased, confusion, n/v, fatigue, h/a, fatigue, seizures, coma, restless, irritability, rapid and weak, thready pulse

Interventions for hypercalcemia

Decrease calcium, 0.9% NS, thiazide diuretics, meds to inhibit calcium reabsorption

Manifestations of altered metabolism

Decreased: weight gain, fatigue, anxiety, depression, decrease in temp, decrease in HR and possible decreased BP Increased: weight loss, increase energy, anxiety, increase in temp, increased HR and possibly increased BP prominent forehead, dull expression, pigment loss, palpation of thyroid gland

How to determine Naegel's rule

Determine first day of LMP, subtract 3 months and add 7 days

S/sx GERD

Dyspepsia, regurgitation, coughing, hoarse, wheezing during night,water brash, dysphagia, odynophagia, epigastric pain, generalized abd pain, belching, gas, nausea, pyrosis, globus, pharyngitis and dental caries

S/x bleeding

Ecchymosis, petechiae, purpura, nosebleeds, bloody stools/urine/vomit, bleeding gums, bleeding joints, increased menstrual bleeding, intracranial/surgical site bleeding and abnormal tests

Role in teaching and learning

Ethical responsibility to teach pts, pts have right to make informed decisions regarding care, info required to make decisions must be accurate, complete and relevant to pt's needs, language and literacy, joint commissions "speak up" help pts understand their rights when receiving care

Healthy People 1979

First framework to focus on health promotion and disease prevention instead of illness care, 1980 public health service published promoting health/preventing disease

Describe the leopold maneuvers

First- hands on upper fundus Second- hands feeling sides of baby Third- feeling head down by cervix Fourth- Standing my Mom's head, outline fetal head (what part is presenting?)

Lifestyle modifications for GERD

Healthy eating habits, small frequent meals and limit fried, fatty, spicy foods and caffeine, sit upright for 1 hour following meals,avoid smoking/alcohol use, drug therapy and Stretta

Define nurse practice act

Framework for expectations of competent practice and professional performance

Ways to prevent respiratory infections

Frequent handwashing, avoiding others who are ill and avoiding touching face ***

Organizational structures include

Functional, service-line matrix, flat and shared governance

GTPAL

G-gravida number of pregnancies T- term birth 37 wk+ P-preterm born 20-37 wk A-abortions/miscarriages L-living children

Levels of wound healing include

Hemostasis: termination of bleeding Inflammatory phase: initial increase in flow of blood elements and water out of the blood vessels into the vascular space Primary intention: wound is made surgically, skin edges are close together, minimal scarring Secondary intention: healing begins when skin edges are not close together, if purulent a drain may be needed large scarring and delayed healing Tertiary intentions: occurs with delayed suturing of wound, when contaminated wound is left open and sutured closed after the infection is controlled

Examples of opioid analgesics

Morphine, fentanyl, dilaudid, oxycodone, hydrocodone

Accident prevention for mortality by age group

Infant/toddler: prevent falls, choking and poisoning School age: wear helmet Adolescents: suicide prevention Adult: lifestyle habits Older adult: multiple meds, falls

Leading causes of mortality

Infant: Congenital anomalies, suffocation Toddler/pre-schooler: MVA, firearms, drowning and caner School age: accidents, cancer, suicide, congenital anomalies Teen: MVA, suicide and homicide Young adult: accidents, suicide and homicide Middle age: accident, cancer, heart disease Older adult: cancer, heart disease, accident and respiratory disease if 65+

Characteristics and types of organizations

Institutional providers -Types of services (general, specialty) Length of direct care services (LOS <30 days, > 30 days) Healthcare networks-interconnected units that either are owned by an institution to provide full spectrum care for both short and long term of varying specialties (primary, secondary and tertiary) Ownership- public, not for profit, for profit, ACO Teaching status-affiliation w/ a school of medicine -concerns of associated costs accreditation status -TJC

Define clinical judgement

Interpretation or conclusion about a pt's needs, concerns or health issues and the decision to take action

Types of fluid replacement and situations used

Isotonic fluids (dehydration, surgery and blood loss): 0.9% NS Hypotonic fluids (Hyperglycemia, DKA): 0.45 % NS, 0.225% NS, 0.33% NS Hypertonic fluids (Hyponatremia, cerebral edema): 3% NS, 5% NS, 10% dextrose in water, 5% dextrose in 0.9% NS, 5% dextrose in 0.45% NS, 5% dextrose in NS

Benefits of teamwork and collab

Job retention, decreased resignation, improved communication skills, economic impact (decreased length of stay for pts and increase in economic benefits)

Dietary screening tools include

Labs: albumin, blood glucose, hemoglobin a1c, lipids, electrolytes, BUN, anemia, calcium, phosphorus, vit D, DXA scan, 24 hr recall and assess hx

Standardized communication approaches

Linguistic (spoken words, written symbols), paralinguistic (nonverbal) and metacommunication (context of message)

Common medications used for tx of alcohol use disorders

Lorazepam, diazepam, chlordiazepoxide (librium), phenobarbital Recovery tx- Disulfiram (Antabuse)

Noticing and responding to ulcerative colitis

Lower abd pain, colic pain w/ relief of defecation, fatigue, anorexia, anemia, fever, dehydration and decreased weight. Interventions: find ways to decrease number of frequent blood-tinged diarrhea/stools, teach pts how to record characteristics of stools, monitor perianal for irritation and ulcers, meds, NPO PRN, diet teaching,decrease stress and surgery interventions

Basic learning principles of health teaching

Motivation to learn: addressed the desire or willingness to learn Ability to learn: depends on physical and cognitive abilities, developmental level, physical wellness and thought processes Learning environment: allows a person to attend to instruction

Define osmosis

Movement of water across a membrane

Healthy People 2000

Nation health promotion and disease prevention objectives

Risk factors for impaired metabolism

Older adults, insomnia, stress, hypo/hyper thyroid, live damage r/t alcohol, drugs and biliary obstruction and genetic factors

Opioid use disorder

Opioids, heroin, respiratory suppression and drowsiness

Maslow's hierachy of needs

Physiological (O2, fluids, nutrition, temp, elimination, shelter and sex) Safety and security (physical safety and psychological safety) Love and belonging Self-esteem Self-actualization

Nursing process r/t anxiety disorder

Planning: all healthcare settings, pt-centered improves pt outcome Implementation: counseling, teamwork and safety -promotion of self-care activities * mild-moderate levels of anxiety -calm demeanor, safety, support, encourage and reduce anxiety -severe panic levels ***calm demeanor, safety, must reduce anxiety before teaching can occur

Interventions for hypokalemia

Potassium supplements, IV/PO NEVER IM OR SQ, potassium sparing diuretics, continuous cardiac monitoring, dietary education

Risk factor modifications and changing health behaviors

Precontemplation: not intending to make changes within the next 6 months Contemplation: considering a change within the next 6 months Preparation: making small changes in preparation for a change in the next month Action: Actively engaged in strategies to change the behavior Maintenance: sustained change over time. Begins 6 months after action has started and continues

Risk factors for family violence

Pregnancy, move towards independence, attempts to leave relationship, younger than 4 y/o, viewed as "different", reminds parents of someone they don't like, unwanted pregnancy and interference w/ emotional bonding between parent and child

Signs of pregnancy

Presumptive: breast changes, fatigue Probable: changes observed by examiner (ballottement and positive UPT) Positive: attribute only to fetus (FHT and visualizing fetus)

Clinical management of cognitive impairments includes

Primary prevention-promote health lifestyle, educational and community programs, genetic counseling, practice to decrease risk of delirium Secondary prevention-screening (mini-mental exam), pentagon screen Tertiary prevention-implementation of safety measures, tx, therapeutic reorientation, stimulus/environment control, pain control, behavioral management, sensory aids and caregiver support

Levels of preventative care include

Primary prevention: health educational programs, immunizations, nutritional program, physical fitness programs Secondary prevention: focuses on those who heave health problems or illnesses and are at risk for developing complications or worsening conditions Tertiary prevention: occurs when a defect or disability is permanent or irreversible, goal is to decrease symptoms and prevent complications

Fetal positions

ROP LOP ROA LOA ROT LOT

Piaget's stages

Sensorimotor (birth- 2 years) Preoperational (2-7 years) Concrete operations (7-11 years) Formal operations (11+)

Significance of fluid and electrolyte balance

Regulating ECF volume, body fluid osmolality and plasma concentrations of electrolytes

Examples of behavioral therapy

Relaxation training, modeling, systemic desensitization, flooding, thought stopping (rubber band therapy)

Noticing hypokalemia

Respiratory changes (weak and skeletal changes) HR slow of rapid w dysrhythmias, musculoskeletal changes (strength, gait, reflexes, paralysis), assess orthostatic BP, EKG, neuro changes (irritable, anxiety, lethargy, confusion and coma)

Risks associated w/ childhood obesity

Risk for adult obesity, increase in type 2 diabetes, HTN, hyperlipidemia, CVD, respiratory and orthopedic conditions and social isolation, low self-esteem and depression

Stages of labor

Stage 1 : regular ctx to full effacement, cervix 0-10 cm Latent: 1-3 cm, mild ctx every 30-45 seconds Active: 3-7 cm, stronger ctx every 45-60 seconds Transition: 8-10 cm, ctx every 2-3 min lasting for 60-90 seconds Stage 2: Time cervix is fully dilated to the birth of the fetus Stage 3: Birth of fetus-placenta delivery Stage 4: Delivery of placenta- first 2-3 hrs after birth. CHECK LOCHIA

Normal electrolyte levels

Sodium (135-145), potassium (3.5-5.0), chloride (96-109), calcium (8.5-10.5), magnesium (1.4-2.1), phosphorous (3-4.5), BUN (8-20) and creatinine (0.6-1.2)

Erikson's stages of development

Stage 1: Trust vs/ mistrust (birth-1 year) Stage 2: Autonomy vs. shame and doubt (1-3 years) Stage 3: Initiative vs. guilt (3-6) Stage 4: Industry vs. inferiority (6-11) Stage 5: Identify vs. role confusion (puberty) Stage 6: Intimacy vs. isolation (young adult) Stage 7: Generative vs. self-absorption and stagnation (middle age) Stage 8: Integrity vs. despair (old age)

Responsibilities of RN during surgery

Surgical asepsis, assessing pt before and after surgery, open sterile packaging, notice and correct break in sterility and pass instruments and complete assistive tasks

Manifestations of HYPERthyroidism

Sweating, wt loss, increase in appetite, decreased attention span, graves (temp increase indicates storm), goiter (graded 0-2), thyrotoxicosis, ingestion of too much thyroid hormone, tearing, photophobia, eyelid lag, mood swings and fatigue

Collaborative care for electrolyte imbalances

Tx underlying condition, water replacement therapy, electrolyte supplements and replacement

Manifestations of HYPOthyroidism

Wt gain, cold intolerance, weakness, muscle aches, depression, constipation, myxedema, mental slowness, social isolation, facial edema and hypotension

Attributes of effective communication

Values and ethics, roles and responsibilities, communication and teamwork