XUABSN_Combined_1
edema
venous congestion in lower body causes high hydrostatic pressure within all the capillary beds of the extremities, leading to...
tympanoplasty tubes
ventilating tubes for ongoing fluid drainage; relieve pressure from middle ear
QRS complex
ventricular depolarization
What are delusions of reference?
fixed false beliefs and adhered to in spite of evidence to the contrary ex.) someone is trying to get a message to me through the articles in this magazine
QT interval
ventricular depolarization and repolarization
T wave
ventricular repolarization
Ciprofloxacin (Cipro)
fluoroquinolone antibiotic *s/e*: UTI and PUD; photosensitivity and chelation; rarely tendon rupture
ST segment
ventricular systole
making observations
verbalizing what is observed or perceived encourages client to recognize specific behaviors and compare perceptions with the nurse
OCPD
very serious and formal and have difficulty expressing emotions. They are overly disciplined, perfectionistic, and preoccupied with rules. They are inflexible about the way in which things must be done and have a devotion to productivity to the exclusion of personal pleasure. An intense fear of making mistakes leads to difficulty with decision-making. Recurrent obsessions and compulsions are absent in this personality disorder
What are retinoids used for R/T skin?
vitamin A derivatives that are active in proliferation and differentiation of skin cells
Preload
volume of blood in ventricles at end of diastole (atrial contraction and subsequent filling of the ventricles) << atrial pressure; venous return
What is the treatment for delusions?
focus on feelings
IV infiltration
the leaking of IV fluid into the tissue surrounding the vein. This occurs when IV fluids continue to be delivered even though the tip of the catheter is no longer in the vessel or is blocked.
MOA levodopa
the metabolic precursor of dopamine, when it crosses the blood-brain barrier, it converts to dopamine in the brain
What are the contraindications for pseudoephedrine?
severe hypertension and coronary artery disease because of drug's cardiac stimulating and vasoconstriction effects glaucoma, MAOi antidepressants
V: cardiogenic shock
severe hypotension (less than 90 mmHg sys for 30 min) despite fluid status; causes significant decrease in aortic perfusion, which leads to loss of circulation in the systemic arteries
cardiogenic shock
severe hypotension (less than 90 mmHg sys for 30 min) despite fluid status; causes significant decrease in aortic perfusion, which leads to loss of circulation in the systemic arteries
norepinephrine indication
severe hypotension and shock that persists after adequate fluid replacement
V: tonic-clonic seizure
TYPE OF GENERALIZED SEIZURE - aka grand mal seizure - load vocalization prior to seizure - loses consciousness - rhythmic jerking movements / muscle stiffening that last up to 5 min - medical assistance is necessary - 30 min + or three = medical EMERGENCY
Anaphylactic shock
severe reaction to an allergen such as penicillin, nuts, shellfish, or animal proteins
V: Anaphylactic shock
severe reaction to an allergen such as penicillin, nuts, shellfish, or animal proteins - unknown why it occurs - can occur at any time in a person's life
indications for mechanical circulatory support
severe, acute LV failure after MI, surgery or end-stage HF
Patient Protection and Affordable Care Act (ACA) - negative effect
shift of resources and energy away from public health's traditional and unique prevention-oriented, population-
Incidences for DEC *preload*
shock
Incidences of DEC *afterload* (not enough resistance)
shock septic anaphylactic shock neurogenic shock (Tx = vasopressors)
V: r/f acute tubular necrosis (ATN)
the most common cause of *AKI (acute kidney injury)* << ischemia and hypoxia w/ clogged sloughed off nephron tubule cells - exposure to nephrotoxic agents - HTN - DM - poststreptococcal infection - major surgery - MI/HF
pancytopenia
the conditions that arises in aplastic anemia wherein the bone marrows fails to produce all three types of blood cells
sympathetic nervous system
the division of the autonomic nervous system that arouses the body, mobilizing its energy in stressful situations
parasympathetic nervous system
the division of the autonomic nervous system that calms the body, conserving its energy
lung compliance
the ease with which lungs can be expanded
termination phase
the final, integral phase of the nurse-patient relationship; plan for continuing care established; evaluate goal attainment, ensure therapeutic closure
orientation and memory
the focus of this part of the mental status review is to determine if the person is delirious or has dementia
public self
the goal of increasing self-awareness by using the Johari window is to increase the size of the quadrant that represents the...
altitude
the higher the _________________, the higher the risk of suicide
communication
the imparting or exchanging of information or news
electroconvulsive therapy (ECT)
the induction of a grand mal seizure through the application of electrical current to the brain
firearms
the leading method of suicide in the United States remains ____________________ and is more common in men than women
60 mg/min
the nurse always injects IV phenobarbital into large veins at an infusion no faster than...
"the surrogate"
the nurse fulfills for the client basic needs associated with mothering
What are delusions of grandeur?
exaggerated feeling of importance, power, knowledge, or identity ex.) I am Jesus Christ
"the teacher"
the nurse identifies learning needs and provides information required by the client and/or family to improve the health situation
"the technical expert"
the nurse possesses the clinical skills necessary to perform the interventions that are in the best interest of the client
"the resource person"
the nurse provides information related to the client's health care
"the counselor"
the nurse uses "interpersonal techniques" to assist clients to learn to adapt to difficulties or changes in life experiences
clinical inquiry
the ongoing process of questioning and evaluating practice and providing informed practice
>160
undesirable LDL
>240
undesirable total cholesterol
>200
undesirable triglycerides
migraine
unilateral pain in the head that may or may not be accompanied by an aura
Noninvasive BiPAP (bilevel positive airway pressure)
use of nasal mask, nasal prongs, or full face mask <> patients with chronic respiratory insufficiency to manage acute or chronic respiratory failure without intubation and conventional mechanical ventilation; *hypoventilation*, obstructive apnea episodes, both <> bridge to weaning inspiratory (IPAP) or expiratory (EPAP)
vocal cues (paralanguage)
use of pitch, tone, tempo, or rate of speech, and volume to give shades of meaning to our spoken word
acetaminophen-aspirin-caffeine
used for migraine or tension headache
Scopolamine
used for motion sickness
Esophagogastroduodenoscopy (EGD)
used for upper GI problems - visualize the mucous membrane lining of the esophagus, stomach and duodenum - a flexible fiberoptic endoscope is used to visualize inflammations, ulcerations, tumors, or varices
dobutamine indication
used in cases of shock that require increased cardiac output without the need for blood pressure support
dantrolene
used to control muscle spasticity caused by upper motor neuron disorders and to prevent/manage malignant hyperthermia
enzymes
used to debride wounds and ulcers; remove necrotic tissue
retinoids
used to manage certain forms of acne because they cause the upper layers of the epidermis to slough away
antimicrobials
used to treat infections by bacteria, fungi, and viruses; can be use locally or systemically
What are antimicrobials used for R/T skin?
used to treat infections caused by bacteria, fungi, and viruses
corticosteroids
used to treat inflammation present in many dermatologic conditions; often applied topically
What are corticosteroids used for R/T skin?
used to treat inflammatory skin disorders
What are keratolytics used for R/T skin?
used to treat keratin-containing skin indications
keratolytics
used to treat wrinkles and sun damaged skin
MOA of phenylephrine
used when only vasoconstriction is needed -- increases BP in hypotension and shock
What is the best way to prevent Hepatitis B?
vaccine
action oriented
values differ from attitudes and beliefs in that they are...
alpha-adrenergic receptors
vasoconstriction (blood vessels)
For patients with hypotension, what is given before a medication drip is started?
vasoconstrictors (vasopressors)
Neurogenic shock
vasodilation due to overstimulation of the parasympathetic nervous system or understimulation of the sympathetic nervous system can be due to: - trauma to the spinal cord or medulla, severe emotional stress or pain, or drugs that depress the central nervous system
What is the MOA of antacids?
neutralize gastric acid -> decrease pepsin production
What makes up most of the WBCs?
neutrophils
Are panic attacks predictable?
no
Crystalloid solutions
- normal saline - hypertonic saline - hypotonic saline - Lactated Ringer's - D5W - other dextrose solutions
conversion disorder TX
Antidepressants, anxiolytics, group therapy
Opioid Antagonist Use
Antidote for opioid overdose Tx of respiratory depression caused by OD
Metoclopramide
Antiemetic
social anxiety disorder
Social anxiety disorder is an excessive fear of social situations R/T fear that one might do something embarrassing or be evaluated negatively by others
What should the nurse teach a patient with AIDS about medications?
- not a cure - there are MANY, so stick to a regimen - effectiveness of treatment is monitored by viral load and CD4 cell counts
Diphenhydramine (Benadryl)
antihistamine used to treat schizophrenia
Nursing responsibilities for a patient on etanercept (Enbrel)
- obtain tuberculin test results before treatment is started - instruct to promptly report signs of infection (this drug is a DMARD)
Cronotrope
(+) decreases heart rate (-) increased heart rate
Inotrope
(+) improves heart contractility (-) dec heart contractility (i.e. beta blocker in aftermath of MI to promote heart "rest"; "cardio protective task")
MDD criteria (DSM-5)
(1) 5+ of the following over 2 wks depressed diminished interest significant weight loss insomnia or hypersonic psychomotor agitation or retardation fatigue/loss of energy feelings of worthlessness/excessive or inappropriate guilt diminished ability to think/concentrate; indecisive recurrent thoughts of death (2) these lead to impaired functioning (3) not b/c of drugs, medical illness, other psych problem (4) no past episode
Substance-Related Disorders Predispositions (psychological)
(1) DEVELOPMENTAL << punitive superego (fixation at oral sag << diminished unconscious anxiety and inc feelings of power and self worth (self-medication) (2) PERSONALITY - low self-esteem, frequent depression, passivity, antisocial, inability to relax/defer gratification, ineffective communication skills - accompany NOT predict (self medicate for TX) (3) COGNITIVE - irrational thinking patterns (denial, projection, rationalization ) ~ (TX these too)
Substance-Related Disorders Predispositions (biological)
(1) GENETICS - esp alcoholism, 40-60% vulnerability (2) BIOCHEM - use effects certain neurotransmitters body tries to self correct by dec those neurotransmitters ~> ill and then want subs to rid of ill feeling - however, likely combo of (these factors >> addiction NOT ONE myself
positive end-expiratory pressure (PEEP) - complications
(1) Hypotension (2) decreased CO <> IV fluids (3) dysrhythmias (4) *Barotrauma* esp << high PEEP - high ventilating pressure and low compliance, pts w/ obstructive airway disease
V: TB Patho
(1) M. tuberculi is inhaled from another person's cough or sneeze (2) droplets pass down the airway, eventually settling into the bronchial tree (3) Tissue inflammation occurs (4) Immune response occurs that eventually kills off the infection (5) Scar tissue grows around the tubercle, and the bacilli become inactive (6) The bacilli continue to multiply and the macrophages degrade the bacteria; the enzymes damage lung tissue (7) Any impairment of the patient's immune system allows reactivation of TB infection
endotracheal intubation - RN role
(1) Pt. asset - vitals (2) suctioning equipment, and works (3) adm suction PRN *w/hold intubation attempts if SaO2 <90%
V: r/f AKI
- HTN - CHF - DM - multiple myeloma - chronic infection - myeloproliferative disorder (accumulation of abnormally produced cells from bone marrow) - connective tissues disorders - autoimmune diseases (3/5)
Substance-Related Disorders Predispositions (sociocultural)
(1) SOCIAL LEARNING ~ genetics ~ modeling (imitation, identification, peer grips - stress, amt of leisure downtime) (2) CONDITIONING - a learned response that occurs after repeated exposure to a stimulus << substance, environment where used (intrinsic reinforcement b/c of pleasurable experience) - the more pleasurable the more conditioning << >> repeated use (3) CULTURAL/ETHNIC - molding attitudes, acceptance of what/how much by culture, availability (Irish v. Asian)
interpreting ABGs
(1) acid v. base << pH (2) metabolic v. respiratory << abnormal HCO3 (metabolic) or abnormal PaCO2 (respiratory) (3) compensation
Noninvasive BiPAP (bilevel positive airway pressure) - caution(s)
(1) aspiration (2) rebreathing CO2 (face mask) (3) secretions, poor cough
public health core functions
(1) assessment (2) policy development (3) assurance
Synergy Model - RN characteristics
(1) clinical judgement (2) advocacy/moral agency (3) caring practices (4) collaborative (5) systemic thinking (6) response to diversity (7) clinical inquiry (8) facilitator of learning
Patient Protection and Affordable Care Act (ACA) - health promotion and prevention
(1) establishment of the National Prevention, Health Promotion, and Public Health Council (2) creation of a Prevention and Public Health Fund (3) improvement of preventive efforts by covering only proven preventive services and eliminating state cost sharing for preventive services, including immunizations recommendation
endotracheal intubation - complications
(1) hypoxemia (s/s, bradycardia, hypotension, arrest); hypercapnia ~>> (prolonged) dysrhythmias (hemodynamic instability (2) vomit <> aspiration <> lung damage (3) disconnection, machine bad, tube obstruction (4) sinusitis (inflamed sinuses) (5) tracheoesophageal fistula >> encourage need and comfort - PRN suction only, oral care, proper pressure
V: pathophysiology of asthma
(1) microbes/allergens stimulate Th1 cells (2) B cells transform into plasma cells that produce IgE (3) Th2 cells attract mast cells, eosinophils, basophils which causes inflammation (4) IgE binds to mast cells and histamine/leukotrienes are releasd (5) leukotrienes produce bronchoconstriction/histamine produces bronchospasm and inflammation
Restraint Care Standards
(1) order required for implementation, w/ TIME LIMIT (24 hrs) (2) last resort tx (3) implemented by trained personnel only (4) information given for reason/rationale (5) c- monitoring of pt rights, dignity, well-being (q15m), document everything and all aspects of (re)assessment
Synergy Model - pt characteristics
(1) participation in decision making (2) stability (3) resiliency (4) complexity (5) participation in care (6) resource availability (7) predictability (8) vulnerability
3 Mechanisms of Breathing (gas exchange in lungs is dependent on what mechanisms)
(1) phrenic nerve (2) hemoglobin levels (3) chemoreceptors (to control changes in carbon dioxide and blood pH)
why sudden decrease in compliance
(1) pneumothorax (2) mucus plugging (3) pulmonary edema
manic episode - nursing intervention
(1) safety (2) nutrition (small, frequent, high caloric meals) (3) sleep (4) interaction
Treatment modalities for schizophrenia
(1) social skills training - relationships, perception interpretation; role-playing (2) family therapy - to resource not stressor; education - recognition (3) assertive community - team approach
Code Teams - leader
(NP, Dr, ACLS qualified personnel) make Dx direct Tx
The ICU nurse is concerned the newly admitted ICU patient appears anxious and may pull out her IVs and Foley catheter. Which interventions should the nurse implement? Select ALL that apply. (a) Apply a loose stockinette over the IV site (b) Apply loose restraints (c) Assess for pain (d) Explain the purpose of each tube and device to the patient (e) Recruit family to sit with the patient at all times
(a) Apply a loose stockinette over the IV site (c) Assess for pain (d) Explain the purpose of each tube and device to the patient Rationale: There are risks to the utilization of restraints; therefore, alternatives to restraints are implemented whenever feasible. Protecting the IV site is a safe alternative, as is assessing for pain as a cause of unrest, and re-orientation are also safe alternatives.
The ICU nurse is participating in an in-service designed in response to an increased incidence of Disseminated Intravascular Coagulation, an unpredictable disease. The nurse's participation is an example of what essential element of the Synergy Model for critical care nursing? (a) Patient's characteristics drive nurses' competencies. (b) Nurses combine various sources of information to promote care. (c) Nurses have a responsibility to maintain their licensure. (d) Patients' are the customers of the hospital.
(a) Patient's characteristics drive nurses' competencies. Rationale: The essential elements of the Synergy Model support the underlying premise that patient characteristics matched with nurses' competencies promotes optimal patient outcomes.
A patient is found unresponsive, without a palpable pulse. The appropriate sequence of events in CPR is as follows: (a) call for the code team, begin resuscitation with defibrillator, implement ACLS guidelines (b) begin resuscitation, call for help, implement ACLS guidelines (c) implement ACLS guidelines for defibrillation, call for help, begin de-briefing (d) begin one-person resuscitation, call for help, utilize AED according to the ACLS guidelines
(a) call for the code team, begin resuscitation with defibrillator, implement ACLS guidelines Rationale: The AHA guidelines are once arrest is recognized, call for help, begin one or two rescuer CPR with defibrillation, and once team arrives, implement ACLS guidelines.
Static Pressure
(aka plateau pressure) at end of max inspiration volume held / preventing exhalation
manual resuscitators (MRB)
(aka, Ambu bag, BVM apparatus) first line of defense for acute *respiratory failure* if pt conscious, squeezing in time with breaths eventual hookup to machine for better pressure measurements
Rapid Response Teams (RRT)
(aka: medical emergency team (MET)) resource - team to reach H pts at the first sign of *hemodynamic instability*; rapid eval prior to cardiopulmonary arrest nurse led (US) dr led (not US) << early recognition of the deteriorating pt; << prompt notification of clinical staff trained in resuscitation
Vasopressin
(antidiuretic hormone) hormone released by posterior pituitary; raises blood pressure and enables kidneys to conserve water
V: plaque rupture
(atherosclerosis) arterial plaque calcifies over time, fissures easily, and pieces of plaque break off (plaque rupture); they travel --> STROKE
A nurse is on a committee to reduce the occurrence of hospital-acquired infections in the ICU. Her role is to conduct research to determine which interventions have been shown to be most effective in reducing these infections. She consults many different sources, and finds conflicting information. Which of the following sources should she consider the most authoritative? (a) A systematic review of qualitative studies in the Journal of Advanced Nursing (b) A meta-analysis of randomized controlled trials in the American Journal of Nursing (c) Report by the expert panel of the American Association of Critical-Care Nursing (AACN) (d) A single randomized controlled trial in the American Journal of Critical Care
(b) A meta-analysis of randomized controlled trials in the American Journal of Nursing Rationale: Lowest level of evidence is opinion, next is a single study (qualitative, descriptive, or physiologic), the next highest is a systematic review (qualitative, descriptive, or physiologic). Next is a single correlational or observational study, then systematic correlations or observational studies. The highest level of evidence begins with a single random controlled trial and nonrandomized control trial (quasi-experimental). The highest level is the systematic review of RCTs also known as a meta-analysis. (Morton/Fontaine, p. 3)
The patient in ICU is at risk for delirium. One of the evidence-based practices promoted by the American Association of Critical Care Nurses to prevent delirium, termed the ABCDE bundle, is which of the following: (a) Maintaining bedrest. (b) Limiting sedation. (c) Restricting family interaction. (d) Avoiding fluorescent lighting.
(b) Limiting sedation. Rationale: AACN ABCDE bundle to avoid delirium in the ICU patient promotes early mobility and limiting sedation (Morton/Fontaine, p. 15).
Code teams (more commonly replaced by RRTs) are accountable to American Heart Association guidelines to promote optimal outcomes of an arrest. The primary purpose of de-briefing is which of the following: (a) Assign roles for efficient and effective resuscitation. (b) For the team to collaborate on the patient's plan of care. (c) As a learning opportunity to improve future responses. (d) To ascribe blame for inefficient and ineffective resuscitation
(c) As a learning opportunity to improve future responses. Rationale: The purpose of de-briefing is to identify what went well, what can be improved, and any safety, procedural, or equipment issues which need to be addressed. (Morton/Fontaine, p. 335)
Medications for osteoporosis
*bisphosphonates* - inhibit bone resorption by suppressing osteoclast activity, thus increasing bone density and reducing the incidence of fractures by about 50% *selective estrogen receptor modulators (SERMs):* - bind to estrogen receptors and activate or inhibit them *calcitonin:* - increases bone density and reduces the risk of vertebral fractures
The nurse provides the patient in ICU a 5-minute slow back massage to promote sleep. Other nursing interventions include which of the following? Select all that apply. (a) Bathe the patient in the middle of the night. (b) Maintain a strict bed time. (c) Titrate environmental stimuli. (d) Provide large clocks. (e) Block sleep times
(c) Titrate environmental stimuli. (d) Provide large clocks. (e) Block sleep times Rationale: There are many barriers to adequate sleep in the ICU. Reducing stimuli mitigates some barriers, blocking sleep times allows care-givers and families to plan their interactions, and large clocks encourage the patient to prepare for sleep.
The Emergency Medical Treatment & Labor Act (EMTALa. contains provisions to address the transfer of patients between hospitals. The primary purpose of this act is to (a) promote equal distribution of high-risk patient admissions among local hospitals (b) reduce the amount of time and subsequent risk, of inter-facility transfers (c) avoid inappropriate transfer of patients due to the inability to pay (d) reduce the financial burden of high-frequency-use emergency departments
(c) avoid inappropriate transfer of patients due to the inability to pay Rationale: EMTALA was enacted as a part of the 1985 Omnibus legislation to ensure patients receiving Medicaid would have access to appropriate emergency care. Known as the "anti-dumping" legislation to prevent inappropriate transfers to avoid loss in revenues.
Barotrauma
(complication of *PEEP*) Injury resulting from pressure disequilibrium across body surfaces; for example, from too much pressure in the lungs EMERGENCY ~>> chest tube (<> pneumothorax)
Ms. Smith is a 78-year old patient admitted to the ICU for decompensated heart failure. Which of the following assessment findings should trigger summoning the Rapid Response Team (RRT)? (a) Oxygen saturation of 88% on room air. (b) Systolic blood pressure of 100 mmHg. (c) Reported pain level of "7" on a scale of 1 to 10. (d) The nurse believes the patient is deteriorating.
(d) The nurse believes the patient is deteriorating. Rationale: O2 of 88% is low, but the appropriate intervention would be to place the patient on oxygen. A trigger for RRT is a SBP of < 90 mmHg. There's no indication pain cannot be managed in the ICU; therefore, the intervention would be to administer medication. The nurse's intuition is listed as an acceptable trigger to enlist a RRT. (Box 14-2)
A patient arrives in the emergency department of their community hospital. The patient is determined to be enrolled in Medicaid as their primary source of payment for healthcare. Although unstable, the hospital attempts to transfer the patient to another local hospital. According to the law, which of the following conditions justify the transfer: (a) the emergency room nurse requests the transfer (b) the hospital has filled its quotient of care of the Medicaid recipient (c) the patient's inability to cover the co-pay (d) the risks of staying are worse than the benefits of transport
(d) the risks of staying are worse than the benefits of transport Rationale: A patient must be screened by the initial emergency department. A patient may be transferred if certain conditions exist including if the transfer is beneficial, if the patient requests it, there is inadequate care at the initial ED, etc. (Morton/Fontaine, p. 153-155).
Levels of evidence (in EBP)
(least stringent to most) (1) opinions of authorities or expert committees <> when higher levels NOT available (2) single descriptive, qualitative, or physiologic study (3) systemic review - a rigorous and systematic synthesis of findings from several studies in a focused are of inquiry (4) single correlational or observational study >> *precise measurement allowing for examination of relationships* (5) systemic review of (4) (6) singe randomized control trial and nonrandomized control trial (quasi experimental) (7) systemic review of (6) = *meta-analysis* (for quantitative) or *meta-synthesis* (for qualitative)
Synergy Model - outcomes
(patient) (1) functional ch (2) trust (3) satisfaction (4) comfort (5) quality of life (RN) (1) physiological changes (2) absence of complications (3) accomplishment of tx (healthcare sys) (1) recidivism (2) costs, resource utilization
Stress mitigation for critically ill - RN interventions
(physical, environmental, psychological) >> environment of healing <> holism (1) Timing interventions (*sleep* patterns, eating patterns) (2) Appropriate PRN administration (3) Alternative therapies/relaxation techniques (music, breathing techniques, etc)
panic disorder/attacks
(v. generalized anxiety disorder) trigger unspecified TX: benzos PRN
generalized anxiety disorder
(v. panic disorder/attacks) known/specific trigger(s) TX: SSRIs, anti-anxiety (taken regularly)
Capto*pril*
*ACE inhibitor* (-pril)
Lisinopril contraindications/precautions
*ACE inhibitor* (antihypertensive) *contraindications* in acute renal failure despite benefit for chronic kidney disease *interactions* other BP drugs, drugs affect K+: furosemide, digoxin
Risk factors for cataracts
*C*ongenital *A*ging *T*oxicity (steroids, etc) *A*ccidents (trauma) *R*adiation (sunlight) *A*ltered metabolism (diabetes mellitus) *C*igarette smoking
Teaching points for patients going home on drugs for asthma or COPD
*COPD:* - emphasize importance of smoking cessation (slow progression of COPD) *asthma:* - rinse mouth thoroughly after drug use (reduce potential for absorption)
Antituberculosis medication
*Isoniazid (INH)* - oral - adverse effects: peripheral neuropathy, hepatitis - nursing implications: administer pyridoxine (vitamin B6) concurrently
Neuromuscular blockers
*MOA:* bind to nicotinic receptors located on the surface of skeletal muscle
Muscle relaxants
*MOA:* inhibit upper motor neuron activity within the brain and/or spinal cord
Barbiturates
*MOA:* intensify the effect of GABA in the brain and generally depress the firing of CNS neurons *adverse effects:* - sonolence - Steven-Johnson syndrome - angioedema - resp/CNS depression *examples:* - phenobarbital (Luminal) - primidone (Mysoline)
Benzodiazepines
*MOA:* intensify the effect of GABA in the brain; bind directly to the GABA receptor *adverse effects:* - drowsiness - sedation - ataxia - resp depression - coma *examples:* - diazepam (Valium) - clonazepam (Klonopin) - lorazepam (Ativan)
Antispasmodics
*MOA:* produce antispasmodic effects directly at the muscle tissue level
Amino acid compounds
*MOA:* reduce brain excitability by suppressing positive ion influxes in a manner differently from other seizure medications; may suppress ischemia-associated glutamate release *adverse effects:* - allergic reactions - drowsiness/dizziness - irregular hearbeat - problems with coordination *examples:* - acetazolamide (Diamox) - lacosamide (Vimpat)
Phenytoin-related drugs
*MOA:* same as hydantoins *adverse effects:* - sedation - drowsiness - GI upset - prolonged bleeding time *examples:* - carbamazepine (Tegretol) - valproic acid (Depakene) *Black box warning for Depakene*: may result in hepatic failure, especially in children under 2 years
Hydantoins
*MOA:* sodium channels are desensitized; affect the threshold of neuronal firing; interfere with transduction of the excitatory neurotransmitter glutamate *adverse effects:* - somnolence - drowsiness - dizziness - nystagmus *examples:* - phenytoin (Dilantin) - ethotoin (Peganone)
Succinimides
*MOA:* suppress seizures by delaying calcium influx into neurons *adverse effects:* - drowsiness/dizziness - ataxia - weight loss - anorexia - nausea/vomiting *examples:* - ethosuximide (Zarontin) - methsuximide (Celontin) *think -tin suffix
Drug classifications for treatment of asthma
*bronchodilators:* - beta agonists - anticholinergics - methylxanthines *anti-inflammatory drugs:* - corticosteroids - leukotriene modifiers - mast cell stabilizers - monoclonal antibodies
What should the nurse do when a patient is newly diagnosed with cancer?
*Nursing goals:* - supporting the whole person - providing interventions for pain, poor nutrition, dehydration, fatigue, adverse emotional responses, altered individual and family coping, side effects of medical treatment *other considerations:* - focus on how best to communicate and care for them - remember they probably have a great deal of anxiety about their new diagnosis - give information - encourage them to talk about it - remember therapeutic communication
V: ARDS (Acute Respiratory Distress Syndrome)
*caused by:* - widespread injury of the alveoli that often occurs in the presence of shock or MODS *symptoms:* - short of breath at rest - breathing rapidly - feeling anxious - need high oxygen to maintain o2 saturation - tachypnea and tachycardia *INCREASING O2 WILL NOT HELP THEM*
Universal protocol for a patient having surgery
*Select all that apply question: choose 4* *1. Conduct a pre-procedure verification process:* - verify the correct procedure, for the correct patient, at the correct site - identify the items that must be available for the procedure (relevant data, labeled test results, any required blood products) *2. Mark the procedure site:* - site is marked and initialed before the procedure and while the patient is awake - site marking is done and initialed by licensed independent practitioner who is accountable and will be present during procedure - mark is clear and unambiguous *3. Perform a time-out:* - designated team member starts the time-out - standardized part of the process - involves all immediate members of the procedure team; all members communicate - team members agree on correct pt identity, correct site, procedure to be performed - document completion of time-out
Cefazolin Side Effects
*Serious Reactions* neutropenia thrombocytopenia anaphylaxis Stevens-Johnson syndrome nephrotoxicity seizures Clostridium difficile associated diarrhea *Common Reactions* diarrhea rash vomiting nausea abdominal pain anorexia ALT, AST elevated urticaria thrombophlebitis
Generalized seizures
*absence* (petit mal) symptoms: - lasting a few seconds - seen most often in children - stares into space, does not respond to verbal stimulation, fluttering eyelids or jerking - misdiagnosed often as ADHD or daydreaming *atonic* (drop attacks) symptoms: - falling or stumbling for no reason - lasting a few seconds *tonic-clonic* (grand mal) symptoms: - aura (preceding) - intense muscle contraction followed by alternating contraction/relaxation of muscles - crying at the beginning as air leaves lungs - loss of bowel/bladder control - disorientation and deep sleep after seizure
Types of pain
*acute pain:* an intense pain occurring over a brief time, usually from time of injury until tissue repair *chronic pain:* longer lasting pain that may persist for weeks, months, or years
Treatment of pancreatitis
*acute pancreatitis:* - bed rest - withholding food and fluids by mouth for a few days for symptoms to subside *severe cases:* - aggressive IV fluid therapy (replace fluids lost) - TPN *for acute pain:* - opioid analgesics
Tera*zosin*
*alpha 1 blocker* (antihypertensive) (-zosin) (~ beta blocker)
Drugs used to treat IBS and IBD
*anticholinergics:* act as antispasmodics to slow GI motility *constipation-dominant IBS:* Linaclotide MOA: accelerates fecal transport by drawing more water into the intestine *diarrhea-dominant IBS:* Eluxadoline MOA: acts on opioid receptors in the nervous system to lessen bowel contractions Rifaximin MOA: changes the bacterial composition of the GI tract and reduces gas
Drugs used to treat the common cold
*antitussives:* dampen the cough reflex *expectorants and mucolytics*: reduce the thickness or viscosity of bronchial secretions, thus increasing mucus flow that can then be removed more easily by coughing
Aten*olol*
*beta blocker* (-olol)
Pancreatitis
*causes:* - often associated with gallstones in women and alcoholism in men *symptoms:* - present suddenly, often after eating a fatty meal or consuming excessive amounts of alcohol - continuous severe pain in epigastric area that often radiates to the back *results in:* - pancreatic insufficiency that may necessitate insulin therapy as well as replacement of pancreatic enzymes
What test should be run on a patient with a suspected infection?
*culture and sensitivity*; to know what they grew and how to treat it others: - WBC count - WBC differential - Procalcitonin and C-reactive protein
What should be done if extravasation occurs with the adrenergic drug, norepinephrine?
*diluted phentolamine* should be injected into the area with a small-gauge hypoodermic needle ASAP to prevent sloughing and necrosis of tissue
Vision assessment
*distant vision:* - Snellen or E chart - when standing 20 ft from the chart, the patient can read the smallest line of letters with or without corrective lenses *near vision:* - Rosenbaum chart or a card with newsprint held 12-14 in from the patient's eyes - normal near visual acuity is 14/14 with or without corrective lenses
What are the indications for norepinephrine?
*drug is first-choice vasopressor for the management of sepsis and septic shock* treat severe hypotension and shock that persists after adequate fluid volume replacement
Medication for anaphylaxis
*epinephrine:* first-line drug (given subcutaneously or IM) *crystalloids or colloids:* may be needed to prevent shock if the patient presents with volume depletion *antihistamines:* may be administered (IM or IV) to prevent further release of histamine *bronchodilators:* administered (by inhalation) to relieve the acute shortness of breath caused by histamine release *high-flow oxygen:* usually administered *systemic corticosteroids:* given to dampen the delayed inflammatory response that may occur
Extravasation issues
*extravasation:* when medication leaks outside the vein and onto or into the skin, causing a reaction *if extravasation occurs:* - drug may cause serious skin and soft tissue injury - the affected area should be infiltrated immediately with 5-10 mg of phentolamine, an adrenergic blocker
Special seizure syndromes
*febrile seizure*: - tonic-clonic activity lasting 1-2 minutes - rapid return to consciousness - occurs in children usually between 3 months and 5 years of age *myoclonic seizure*: - large jerking movements of a major muscle group, such as an arm - falling from a sitting position or dropping what is held *status epilepticus* - considered a medical emergency - continuous seizure activity, which can lead to coma and death
Drugs used for MS
*goal:* provide symptomatic relief *MOA:* - help to place MS in remission by modifying associated symptoms and slowing progression of the disease
Drugs used for Alzheimer's disease
*goals:* - slow memory loss and other progressive symptoms of dementia - treat associated symptoms such as depression, anxiety, or psychoses - improve function in ADLs, behavior, and cognition *MOA:* - cholinesterase inhibitors: intensify the effect of acetylcholine at the cholinergic receptor
Drugs used for Parkinson's disease
*goals:* - to increase the ability of the patient to perform normal activities of daily living (ADLs) such as eating, walking, dressing, and bathing - NOT a cure; goal is to reduce symptoms *MOA:* - restore the balance of dopamine and acetylcholine in specific regions of the brain
Risk factors related to heredity
*heredity:* how genes are transferred from generation to generation - in cancer, an estimated 5-10% of cancers have a hereditary component - important to determine if patients have a genetic predisposition - recurring patterns of cancer within a family are a risk factor for a hereditary component, but do not necessarily indicate that a specific gene or mutation is the cause - familial cancers generally occur during old age; hereditary cancers usually happen at a younger age
PaCO2 > 45
*hypercapnia* <> hypoventilation
What is the MOA of donepezil, a common drug used to treat Alzheimer's disease?
*increases acetylcholine* in the brain by inhibiting its metabolism, leading to elevated acetylcholine levels in the cortex slows the neuronal degradation that occurs in Alzheimer's disease
Organic nitrates
*indication:* drugs of choice for *terminating* an acute angina episode *mechanism of action:* - relax both arterial and venous smooth muscle - dilation of veins reduces the amount of blood returning to the heart; reducing workload of heart - chest pain is alleviated and episodes of angina become less frequent *adverse effects:* - headache - flushing of face - dizziness - rash - anaphylaxis
Beta-adrenergic blockers
*indication:* first line drugs for preventing angina pain *mechanism of action:* - reduce the cardiac workload by slowing heart rate and reducing contractility *adverse effects:* - fatigue - insomnia - drowsiness - decreased libido - bradycardia - confusion - if drug is abruptly withdrawn, palpitations or MI
Calcium channel blockers
*indication:* used when beta blockers are not tolerated well by a patient *mechanism of action:* - blockade of calcium channels - relax arterial smooth muscle, lowering blood pressure - slow conduction velocity through the heart, decreasing heart rate and reducing cardiac workload - dilate coronary arteries and bring more oxygen to the myocardium *adverse effects:* - flushed skin - headache - dizziness - peripheral edema - nausea - constipation - hepatotoxicity - MI - HF - confusion - mood changes
Naloxone (Narcan)- opioid receptor antagonist
*indications:* complete or partial reversal of opioid effects in emergency situations when overdose is suspected *mechanism of action:* - pure opioid antagonist - blocks both mu and kappa receptors
Morphine- opioid analgesic
*indications:* symptomatic relief of severe acute and chronic pain, relieves shortness of breath associated with HF and pulmonary edema, and for acute chest pain connected with MI *mechanism of action:* Binds with both mu and kappa receptors to produce analgesia. It causes euphoria, constriction of pupils, and stimulation of cardiac muscle
V: Hypovolemic shock
*loss of blood volume* << hemorrhage, burns, excessive diuresis, or severe vomiting/diarrhea
NSAIDs
*mechanism of action*: - inhibit pain mediators at the nociceptor level - inhibit COX, an enzyme responsible for the formation of prostaglandins (inflammation and pain are reduced) *adverse effects:* - heartburn - stomach pains - ulceration - indigestion - when used in large doses, GI bleeding can occur
Fibric acid drugs
*mechanism of action:* - activate the enzyme lipoprotein lipase, which increases breakdown and elimination of triglyceride-rich particles from the plasma - sometimes used in combo with statins *adverse effects:* - flulike symptoms - myalgia (muscle pain) - nausea/vomiting - rhabdomyolysis - pancreatitis
Decongestants
*mechanism of action:* - activate the sympathetic nervous system - relieve nasal congestion associated with the common cold or allergic rhinitis *adverse effects:* - rebound congestion (use for no longer than 3-5 days) - nasal irritatiom - insomnia - nervousness - headache - dry mouth
Bile acid sequestrants
*mechanism of action:* - bind bile acids, thus increasing the excretion of cholesterol in the stool - sometimes used in combo with statins *adverse effects:* -constipation - nausea/vomiting - abdominal pain - bloating - GI obstruction
Centrally acting drugs
*mechanism of action:* - exert effects directly within the brain and spinal cord - bypasses the nociceptor level - acetaminophen: reduces fever by direct action at the level of the hypothalamus and causes dilation of peripheral blood vessels, enabling sweating and dissipation of heat *adverse effects:* - hypotension - dry mouth - constipation - drowsiness - anaphylactic reaction
HMG-CoA reductase inhibitors (Statins)
*mechanism of action:* - interferes with a critical enzyme in the synthesis of cholesterol - reduction in LDL cholesterol levels; raise level of "good" HDL cholesterol *adverse effects:* - headache - dyspepsia (indigestion) - abdominal cramping - rash or pruritis - rhabdomyolisis
Intranasal corticosteroids
*mechanism of action:* - applied directly to the nasal mucosa to prevent symptoms of allergic rhinitis - decrease the secretion of inflammatory mediators - reduce tissue edema - cause mild vasoconstriction *adverse effects:* - nasal burning or irritation - sneezing - dryness
Non-opioid antitussives
*mechanism of action:* - raise cough threshold in the CNS - suppresses the cough reflex by anesthetizing stretch receptors in the lungs - dextromethorphan is most frequently used; available in OTC cold/flu medications - does not have the same level of abuse potential as opioids
Opioid antitussives
*mechanism of action:* raise the cough threshold in the CNS - most effective antitussives - codeine and hydrocodone are most frequently used
Antihistamines
*mechanism of action:* selectively block histamine from reaching its H1 receptor, thereby alleviating allergic symptoms *adverse effects:* - dry mouth - headache - dizziness - urinary retention - nausea/vomiting
Common antidiarrheals
*opioids*: (most effective) slow peristalsis in the colon *OTC drugs for diarrhea:* - Loperamide (Imodium) - Pepto-Bismol - Psyllium preparations - Probiotic supplements containing Lactobacillus
RA Txs
*primary objectives:* - prevent joint damage and disability - reduce pain and inflammation - minimize side effects of treatment *treatments:* - rest and exercise; balanced program of rest and exercise - heat and cold (hot bath) - assistive devices and splints - promoting nutrition - surgery
Drugs for treating Peptic Ulcer Disease (PUD)
*proton pump inhibitors:* block the enzyme responsible for secreting hydrochloric acid in the stomach *H2 receptor antagonists:* suppress the volume and acidity of parietal cell secretions *antacids:* neutralize stomach acid *antibiotics:* used to eradicate H. pylori bacterium (therapy usually requires multiple antibiotics)
Manifestations of influenza
*respiratory*: - coryza (irritation/swelling of mucous membrane in the nose) - cough, initially dry - substernal burning - sore throat becoming productive *systemic*: - fever and chills - malaise - muscle aches - fatigue
Nonpharmacological therapies for pain / complimentary therapies
*select all that apply question: choose 3* - ACUPUNCTURE - PRAYER - MUSIC THERAPY - biofeedback - chiropractic - distraction - hypnotherapy and guided imagery - massage - natural products - relaxation: a. diaphragmatic breathing b. progressive muscle relaxation c. meditation (includes praying) d. music therapy
Manifestations of retinal detachment
*select all that apply question: choose 3* - floaters (irregular, dark lines or spots in the field of vision) - flashes of light - blurred vision - progressive deterioration of vision - sensation of a curtain or veil being drawn across the visual field - if the macula is involved, loss of central vision
Manifestations of impending death
*select all that apply question: choose 4* - difficulty swallowing or talking - nausea, flatus, abdominal distention - urinary and/or bowel incontinence, constipation - decreased sensation, taste, and smell - weak, slow, and/or irregular pulse - decreasing blood pressure - decreased, irregular, or Cheyne-Stokes respirations - changes in level of consciousness - restlessness, agitation - coolness, molting, cyanosis of extremities - patient verbalizes they are going to die *READ QUESTION CAREFULLY; multiple distractors in answer choices
Partial seizures
*simple partial* symptoms: - olfactory, auditory and visual hallucinations - intense emotions - twitching of arms, legs, and face *complex partial* (psychomotor symptoms: - aura (preceeding) - brief period of confusion or sleepiness afterward with no memory of seizure - fumbling with or attempting to remove clothing - no response to verbal commands
What is the general action of adrenergic drugs for shock states?
*sympathetic nervous system: fight or flight* 1. increased heart rate 2. vasoconstriction - increased blood pressure 3. increased contractility
Health education for the patient and family r/t eye surgery
*teaching the patient and family:* - how to instill eye drops - the name, dosage, schedule, duration, purpose, and side effects of medications - how and when to use the eye patch and eye shield - the importance of avoiding scratching, rubbing, touching, or squeezing the affected eye - measures to avoid constipation or straining - activity limitations, if ordered - remind patient vision may not stabilize for several weeks following surgery - emphasize importance of follow-up appointments *symptoms to report:* - eye pain or pressure - redness/cloudiness - drainage - decreased vision - floaters or flashes of light - halos around bright objects
Drugs used to treat Myocardial Infarction (MI)
*thrombolytics:* dissolve clots obstructing the coronary arteries, restoring circulation to the myocardium *antiplatelet and anticoagulant drugs*: prevent additional thrombi from forming *nitrates:* assist in the diagnosis; relieve coronary artery vasospasm *beta blockers:* reduce myocardial oxygen demand; slow impulse conduction through the heart *ACE inhibitors:* increase survival; most effective when therapy is started within 24 hours after onset of symptoms
For patients with cardiovascular disease, what type of nasal decongestant is used?
*topical nasal decongestants* - oral agents are usually contraindicated because of cardiovascular effects (increased force of myocardial contractions, increased HR & BP) topical is less likely to produce systemic effects than oral or parenteral products
What is the effect to response activation of alpha1?
*vasoconstriction* - need this drug to raise BP in shock state
V: r/f stroke
- *HTN* - high blood cholesterol - heart disease - diabetes - obesity - previous stroke/TIA - sickle cell disease - tobacco use - alcohol use - physical inactivity - oral contraceptives - family history - advanced age/men - race/ethnicity
V: alcohol withdrawal
- *the "shakes" 12-24 h after last drink* - tachycardia - diaphoresis - anorexia - insomnia - */delerium tremors/: disorientation, fever, tremors, VH (visual hallucinations), 3-5 days after the last drink* >> hospitalization
Colloid solutions
- 5% albumin - dextran 40 in normal saline - dextran 40 in D5W - dextran 70 in normal saline - hetastarch 6% in normal saline - plasma protein fraction *these are all isotonic*
V: leading causes of chronic renal failure
- DM - HTN - glomerulonephritis - PKD (polycystic kidney disease)
adjustment disorder interventions
- Establish therapeutic relationship and encourage client to share feelings - provide safe, nonthreatening, routine environment - Assess client for suicidal ideation and take precaution as needed - use music therapy, guided imagery, massage, relaxation therapy, and breathing technique.
Drugs used to treat hyperlipidemia
- HMG-CoA reductase inhibitors (statins) - bile acid sequestrants - fibric acid drugs
Nonopioid analgesics
- NSAIDs (aspirin, ibuprofen) - centrally acting drugs (acetaminophen)
What are RBCs made of?
- RBCs, or erythrocytes, are the most common type of blood cell - RBCs contain hemoglobin molecules
End of life care communications
- communicate effectively and compassionately with patient, family, and healthcare team members about end-of-life issues - recognize one's own attitudes, feelings, values, and expectations about death - demonstrate respect for patient's views and wishes - assist patient and family to cope with loss and grief
Alzheimer's disease
- a form of dementia that affects memory, thinking, and behavior - gradually gets worse over time - responsible for 70% of all dementia
V: s/s peritonitis
- abdominal pain - abdominal rigidity - rebound tenderness - pt wants to remain as still as possible - fluid shifts can result in s/s of hypotension/shock
V: cellular changes in Alzheimer's disease
- accumulation of neurofibrillary *tangles* - beta-amyloid *plaques* - cerebrocortical atrophy of the brain
Therapeutic communication r/t grieving
- active listening - silence - nonverbal support - allow them to discuss their feelings - anger may be the first reaction; allow them to express those feelings as well - answer questions about illness truthfully - encourage hope
Definition of cataract
- an opacification (clouding) of the lens of the eye - can significantly interfere with light transmission to the retina and the ability to perceive images clearly
Drugs used to treat allergic rhinitis
- antihistamines and mast cell stabilizers - intranasal corticosteroids - decongestants
PTSD S/S
- anxiety - *hypervigiliant/startle response* - depression - *guilt* - self medicating - *aggression*
What should the nurse include in the education for a patient with cancer?
- avoid crowds - healthy lifestyle - healthy diet - communicate any and all changes with PCP - attend all check-ups
What medications should a nurse caution a patient with hepatitis on?
- be careful with any and all medications - OTC medications - the liver metabolizes medications; hepatitis patients have a compromised liver - caution them of cough syrup/anything with alcohol
S/S lithium carbonate toxicity
- blurred vision - ataxia - n/v - tinnitus - excessive urination - sever diarrhea >> TX - balanced Na diet
Anaphylactic shock- symptoms
- body often responds minutes after being exposed to the allergen - itching - hives - tightness in the throat or chest - nonproductive cough - hoarse voice - as anaphylaxis progresses, drop in BP and difficulty breathing; hypotension causes reflex tachycardia
V: cystocele S/S
- bulge through vaginal canal - frequency, urgency, perineal pressure - stress incontinence (when straining)
Multiple sclerosis (MS)
- chronic, inflammatory, autoimmune disorder found mostly among young adults - characterized by damaged myelin located in the brain and spinal cord
Autism *Spectrum* Disorder - Care of Plan characteristics
- clear, concise tasks, one at a time (S/S: transitions incredibly difficult (processing delay)) - + reinforcement/praise
PTSD TX
- cognitive therapy >> changing way you think or feel about something (get rid of irrational fears) - group therapy - prolonged therapy
When taking medication for the flu, what should the nurse educate the patient on?
- complete the whole course of medication (do not stop taking when you feel better) - follow a strict regimen (same time every day)
V: consequences of IAH (Intra-abdominal hypertension)
- compression of inferior vena cava *reduces cardiac output* - increase IAP pushes up the diaphragm, compressing base of lungs causing *decreased ventilation* - pressure transmitted upward via jugular veins >> jugular distention *increased intracranial pressure / dec level of consciousness* (select all)
Side effects of iron supplements
- constipation - nausea - stools change color; may be dark green or black **do not take iron supplements with milk (decreases absorption)
What precautions should be used when disposing body fluids of a patient receiving chemotherapy?
- contact precautions - gloves and gown - mask is not necessary
Hypertonic solutions
- contain a greater concentration of solutes than plasma - when administered, plasma gains more solutes than interstitial fluid - removes water from cells and can result in dehydration
Kubler-Ross stages of coping with loss
- denial - anger - bargaining - depression - acceptance
methamphetamine withdrawal
- depressed - lethargic (sleepy)
Inotropic drugs
- digoxin - dobutamine - dopamine - epinephrine - norepinephrine - phenylephrine
Health education for older adults
- discuss the warning signs of cancer - stress the importance of seeking healthcare if any of the warning signs develop - get an annual physical examination *women:* - learn how to perform a monthly breast self-exam and emphasize the importance of continuing these and regular mammography after menopause *men:* - teach the early signs of prostate cancer - encourage them to discuss the potential benefits, risks, and uncertainties associated with prostate cancer screening to allow them to make an informed decision about this screening
Vasopressors used to treat shock
- dopamine - norepinephrine - phenylephrine - epinephrine
Adverse effects of muscle relaxants
- drowsiness/dizziness - weakness - fatigue - dry mouth - hypotension - bradycardia - respiratory depression
V: polycystic ovary syndrome
- dysfunctional hypothalamic-pituitary-ovary axis (endocrine disorder) - genetic condition - high serum androgenic hormones - leading cause of infertility
Promoting nutrition
- eating several small, low-fat, high-calorie meals and drinking 5-8 glasses of water daily - reporting continued weight loss, loss of appetite, or inability to eat for 24 hours - discussing dietary needs with the dietitian - for diarrhea, increase fluid intake
Hypertonic crystalloids- indications
- expands plasma volume by drawing water away from cells and tissues - used to treat cellular edema, especially cerebral edema - dehydrated patient with *low* blood pressure
Pernicious anemia
- failure to absorb dietary vitamin B12 - develops due to lack of intrinsic factor (vitamin B12 cannot be absorbed without IF) - a smooth, sore, beefy red tongue and diarrhea may occur - patient needs to be educated that this disease is for a lifetime; consider altering diet
negative symptoms of schizophrenia
- flat affect
ADHD TX
- formulate tasks concisely, clearly, one at a time (short, w/ break, w/ praise/positive reinforcement)
Preventing infection and injury
- hand hygiene and other measures to reduce exposure to pathogens such as avoiding people who are ill and avoiding crowds - avoiding foodborne illness by washing fruits and vegetables, proper food storage - dental hygiene measures - avoid immunizations - importance of reporting any bleeding or changes in behavior to the healthcare provider
Isotonic solutions
- have the same concentration of solutes as plasma - produce no net fluid shift when infused
V: S/S ICP (intracranial pressure)
- headache - vomiting - decreased LOC (level of consciousness) - altered pupil rxn - *cushing's triad* - confusion
V: s/s UGIB (upper GI bleed)
- hematemesis (vomit blood) - melena (dark sticky feces containing partly digested blood) - occult blood (blood in stool)
Sickle Cell Disease
- hereditary, chronic, hemolytic anemia - characterized by episodes of sickling, during which RBCs become abnormally crescent-shaped - transmitted as an autosomal recessive genetic defect - defect causes synthesis of an abnormal form of hemoglobin within RBCs - most common among people of African descent
V: MDD (major depressive disorder)
- highest lifetime prevalence of any psychiatric disorder - could result from hormonal influences, childbirth, psychosocial factors - occurs in persons w/o close interpersonal relationships
V: Cushing's Triad
- hypertension - bradycardia - irregular respirations << *DVT* << rising intracranial pressure (ICP)
S/S methamphetamine intoxication
- hypervigilant (very aware) - *grandiose thinking* << >> depression (back and forth) - restless - inc/dec HR; inc/dec BP (not definitive factors)
V: lactic acidosis in shock
- hypoperfusion ,', liver unable to convert lactic acid to sugar compounds; unable to excrete lactic acid >> too much lactic acid in body >> adverse cardiac, respiratory, neurological and brain function
Immunizations
- immune globulins provide passive immunity as protection against a known or potential exposure to an antigen - following confirmed or suspected contact with a pathogen, selected vaccines may be administered to stimulate an immediate immune response
Teaching points for patients going home on antiparkinson's disease medications
- improvement is gradual; report increasing symptoms that are similar to those noted before therapy - teach them that the drugs are not a cure, but to treat the symptoms - take medication on an empty stomach - avoid excess consumption of B6 rich foods such as bananas, wheat germ, fortified cereals, green vegetables, meat, and legumes
Blood loss anemia
- in acute blood loss, circulating RBCs are of normal size and shape, or *normocytic* - chronic blood loss depletes iron stores as RBC production attempts to maintain the RBC supply. the resulting RBCs are *microlytic* (small) and *hypochromic* (pale)
Health promotion for HIV
- in the absence of an effective immunization to prevent HIV infection, *education, counseling, and behavior modification* are the primary tools for HIV/AIDS prevention - nurses play a vital role in education about this epidemic and infection prevention
r/f for anorexia
- inability to change - activities that promote (dance, wrestling) - perfectionist personality/disorder - nutritional imbalance
ADHD
- inattention and/or hyperactivity and impulsivity - highly distractible and unable to contain stimuli. - Motor activity is excessive, and movements are random and impulsive. Onset of the disorder is difficult to diagnose in children younger than age 4 years because their characteristic behavior is much more variable than that of older children. Frequently, the disorder is not recognized until the child enters school.In diagnosing ADHD, the DSM-5 criteria are further specified according to current clinical presentation. These subtypes include a combined presentation (meeting the criteria for both inattention and hyperactivity/impulsivity), a predominantly inattentive presentation, and a predominantly hyperactive/impulsive presentation.
S/S alcohol withdrawal
- inc heart rate - inc blood pressure - tremors - irritable - n/v - 4-12 hr after last drink/decrease in drinks - delirium (hallucinations) - 2-3 days after last drink/decrease in drinks
anorexia TX
- include family << >> support system, trigger (control issues) - milieu therapy - monitoring food intake - schedule of eating - Rx, fluoxetine - cognitive-behavior therapy
Peritonitis
- inflammation of the peritoneum - serious complication of many acute abdominal disorders - usually caused by enteric bacteria entering the peritoneal cavity through a perforated ulcer, ruptured appendix, perforated diverticulum, necrotic bowel, or during abdominal surgery - manifestations: severe abdominal pain, guarding, rebound tenderness, diminished bowel sounds, nausea and vomiting, fever, malaise, tachycardia
Vasopressors- monitoring
- infusions are always run via infusion pump - require an invasive line/other monitoring devices to ensure that real-time blood pressure and pulse rates can be assessed - doses continually monitored/adjusted to ensure the desired therapeutic effect has been achieved w/o adverse effects - therapy is discontinued as soon as patient's condition stabilizes - discontinuation should be gradual (possibility of rebound hypotension and undesirable cardiac effects)
Manifestations and complications of pulmonary TB
- initial infection causes few symptoms and typically goes unnoticed until the tuberculin test becomes positive or calcified lesions are seen on chest x-ray - fatigue - weight loss - anorexia - low-grade afternoon fever and night sweats - cough; initially dry then becomes productive of purulent and/or blood-tinged sputum (this is usually when the patient seeks medical attention) complications: - tuberculosis empyema - bronchopleural fistula - rupture may allow air into pleural space, causing *pneumothorax*
Pathophysiology of muscle spasms
- involuntary contractions of a muscle or groups of muscle - the muscles become tightened and fixed, causing intense pain which usually diminishes after a few minutes
ADHD - (Possible) Causes
- lead exposure - genetics - artificial flavoring/sugar (not definitive - red dye) - premature birth - (not necessarily born << >> environment, see prior causes)
Hypotonic solutions
- lesser concentration of solutes than plasma - when administered, water moves from plasma to interstitial fluid - could result in hypotension due to movement of water out of vascular system
What should be monitored for with thrombocytopenia?
- low platelets - monitor for bleeding
What are three nursing assessments for a patient with pneumonia?
- lung sounds - o2 saturation - skin color (cyanotic)
V: Stages of shock- *Progressive* stage
- lungs, kidneys, gut, pancreas, and liver suffer decreased perfusion (organ perfusion) >> all available blood is conserved for the heart and brain >> patient may begin to show signs of MODS (multi organ dysfunction syndrome) - kidneys fail if they suffer ischemia for 20-30 mins - liver and GI also suffer ischemia
What might inhibit iron absorption?
- milk may inhibit iron absorption - hemoglobin carries oxygen, so low hemoglobin may increase pain and make a patient more tired
Pharmacotherapy goals for relieving muscle spasms
- minimize pain and discomfort - increase range of motion - improve the patient's ability to function independently
Nerve blocks- what to assess for
- monitor bowel and bladder (and anything below; paralysis is a risk) - make sure patient is able to void
Inotropics- monitoring
- monitor for extravasation - always ensure patency of IV prior to infusion - dopamine has potential to cause dysrhythmias and is given as an IV infusion only - dobutamine is given only as an IV infusion
Inotropics- adverse effects
- nausea/vomiting - headache - visual disturbances such as halos, a yellow/green tinge, or blurring - palpitations - tingling or coldness of extremities - nervousness - changes in BP
Aplastic anemia (S/S)
- onset is usually insidious, but may be sudden - fatigue - pallor - progressive weakness - exertional dyspnea - headache - tachycardia and heart failure - platelet deficiency leads to bleeding problems (bleeding gums, excessive bruising, nosebleeds)
Routes of administration for opioids
- oral/sublingual - IV - IM - subcutaneous - rectal
V: S/S ectopic pregnancy
- pain - vaginal bleeding - amennorhea - rupture=intense abdominal pain/referred shoulder pain
What are the priorities of care r/t a patient with cholecystitis (gallbladder inflammation)?
- pain control - addressing nutritional imbalance - treating infection related to potential rupture of inflamed gallbladder
Hypotonic crystalloids- indications
- patients with hypernatremia and cellular dehydration - dehydration with *normal* blood pressure
V: r/f for ectopic pregnancy
- pelvic inflammatory disease (PID) - therapeutic abortion - tubal ligation - previous ectopic pregnancy - intrauterine exposure to diethylstilbestrol (DES) - infertility - use of fertility drugs - progestin-only contraceptives - levonorgestrel (morning after pill)
Manifestations of Chron's disease
- persistent diarrhea - abdominal pain and tenderness - pain is relieved by defecation - Humira is often prescribed - do NOT stop taking medications
V: s/s guillain-barre syndrome
- progressive, usually symmetric muscle/limb weakness - absent or depressed deep tendon reflexes - paresthesia/numbness - acute inflammatory demyelinating polyneuropathy involving distal muscle weakness of lower extremities followed by more proximal muscles - autonomic dysfunction: fluctuating HR/BP, urinary retention, ileus, loss of sweating
Drugs for treating GERD
- proton pump inhibitors - H2 receptor antagonists - antacids
Aplastic anemia (possible causes)
- radiation - exposure to chemical substances such as benzene, arsenic, nitrogen mustard, certain antibiotics, and chemotherapeutic drugs - viral infections such as mono, hep C, and HIV
Pharmacotherapy goals for osteoarthritis/RA
- reduction of pain and inflammation - minimize physical disability
Inotropics- expected effects
- reverse the cardiac symptoms of shock by increasing the strength of myocardial contraction - increase cardiac output - increase amount of blood reaching vital tissues
Symptoms of angle-closure glaucoma
- severe eye and face pain - general malaise - nausea and vomiting - seeing colored halos around lights - an abrupt decrease in visual acuity - conjunctiva may be reddened - cornea may be clouded with corneal edema - pupil may be fixed at midpoint
What is the priority for a patient who is wheezing and cyanotic?
- sit them up - administer oxygen THEN get an order for it
Interventions for a patient with diarrhea r/t cancer
- sitz bath (hemorrhoids) - risk for skin breakdown (barrier cream) - diet changes - discourage tub baths
PTSD S/S of recovery
- statements of acceptance / acknowledgement of event (trigger) and its effects on life - fewer/no flashbacks - can demonstrate adaptive coping strategies - has worked through feelings of survivor's guilt - gets enough sleep - has support system / relations
V: Stages of shock- *Initial* stage
- sudden drop in tissue perfusion - SNS and RAAS are triggered >> SNS stimulates tachycardia as a compensatory mechanism >> RAAS increases blood volume and stimulates peripheral vasoconstriction in efforts to bring up BP - *S/S*: patient is anxious, pale, and extremities are cold and clammy
V: *initial* stage of shock
- sudden drop in tissue perfusion - SNS and RAAS are triggered >> inc BP/blood volume - tachycardia - *S/S*: anxious, pale, clammy, cold
Education for patients going home on seizure medication
- teach patient, family, or caregiver to keep a seizure diary of frequency, type, length, prodromal symptoms, and postictal period take medications as followed: - exactly as ordered, same manufactures brand each time. Switching brands may result in differing pharmacokinetics and alterations in seizure control - read label directions for how to take med. Some forms may not be opened or chewed, others require chewing thoroughly. When in doubt, consult with a pharmacist or other health care provider - take a missed dose as soon as it is noticed, but do not take double or extra doses to "catch up" - take with food to decrease GI upset - do not abruptly stop medications.
Acceptance stage of loss
- the person begins to come to terms with the loss and resumes activities with hopefulness of the future - some dying people reach a stage of acceptance in which they may appear to be almost devoid of emotion; the struggle is the past, and the emotional pain is gone
Things to remember about a dying patient
- they want to make many of their own choices and plans for their death - always consider including them - if patient can speak for themselves, do not allow family members to make decisions for them
V: cause of septic shock
- toxins/inflammatory mediators/response << >> widespread arterial vasodilation - increased capillary permeability >> plasma enters tissues - inflammatory mediators >> microthrombi - exotoxinsinability to clot - epinephrine/cortisol release >> reduction in insulin sensitivity >> /glycogenolysis/ (breakdown of glycogen to glucose)
Disorders related to neuropathic pain
- trigeminal neuralgia - diabetic neuropathy - sciatica - phantom limb pain - carpal tunnel syndrome - central pain syndrome - degenerative disk disease - intractable cancer pain - post-surgical pain
Vasopressors- expected effects
- used to stabilize blood pressure in patients with shock - when given IV, have rapid onsets with short durations and will immediately raise blood pressure - only used after fluid and electrolyte restoration has failed to raise BP (because of adverse effects and potential organ damage due to rapid vasoconstriction)
benzodiazepine - pt education
- well tolerated and rapid onset of action - not 1st line treatment due to potential for abuse and dependence (s-t use) - Disuse should involve tapering - Do not take with alcohol or other CNS depressants (orthostatic hypotension, anticholinergic) - *Paradoxical excitement*, symptoms opposite of desired effects occur, CALL PROVIDER - symptoms of sore throat, fever, malaise, easy bruising, or unusual bleeding - CALL PROVIDER
upper GI endoscopy
-*Esophagogastroduodenoscopy (EGD)* -directly visualizes the mucous membrane lining of the esophagus, stomach and duodenum -endoscope visualizes inflammations, ulcerations, tumors or varices -may be combined w/ ultrasound
promoting nutrition r/t leukemia
-*eating small, low-fat, high calories meals* -*drink 5-8 glasses of water daily* -report weight loss, loss of appetite or inability to eat -meet w/ dietician
tonic seizure
-20-30 second period of stiff muscles -falls occur -consciousness preserved
examples of colloids
-5% albumin -dextrain in NS -hetastarch 6% in NS -plasma protein fraction
adverse effects opioid agonists
-CNS depression -respiratory depression -nausea/vomiting -pupil constriction -constipation
leading causes of chronic renal failure
-DM -HTN -glomerulonephritis -PKD
health education r/t iron
-GI s/e can be decreased if taken w/ food (not milk) -stools may be green or black (harmless) -increase fluids/fiber to help constipation
r/f AKI
-HTN -CHF -DM -multiple myeloma -chronic infection -myeloproliferative disorder -connective tissues disorders -autoimmune diseases
r/f stroke
-HTN -high blood cholesterol -heart disease -diabetes -obesity -previous stroke/TIA -sickle cell disease -tobacco use -alcohol use -physical inactivity -oral contraceptives -family history -advanced age/men -race/ethnicity
effects of HTN on the heart
-hypertensive heart disease -LVF hypertrophy and failure -heart failure -LVF MI
AED routes of administration
-IV -PO -*gabapentin: PO*
Cardiac Index (CI)
adjustment to CO taking into consideration of one's individualized body surface area (BSA) = 2.5-4 Lpm = 1.8-2.2 = hypOperfusion
examples of crystalloids
-NS -LR -Plasma-Lyte
components of ecg
-P wave: represents depolarization of atria; usually consistent before QRS -PR interval: the time from p-wave to QRS; normal 0.12-0.2 sec -QRS complex: large waveform representing ventricular depolarization, normal width= 0.06-0.11 sec -ST segment: portion of tracing from end of QRS ti beginning of T wave, represents time from end of ventricular depolarization to repolarization, elevations=MI -T wave: deflection representing ventricular recovery seen after QRS -U wave: rare; sometimes seen in hypokalemia -QT interval: period from beginning of ventricular depolarization to end of ventricular repolarization (beginning of QRS to end of T wave)
decrease serum calcium
-PTH decreased -renal excretion increased -intestinal absorption decreased -release of calcium from bone decreased -calcitonin secreted
increase serum calcium
-PTH secreted -decreased renal excretion of calcium -increased intestinal absorption -increased release of calcium from bone -vitamin D activated
lactic acidosis in shock
-hypoperfusion=liver unable to convert lactic acid to sugar compounds -renal hypoperfusion=unable to excrete lactic acid -lactic acid=adverse cardiac, respiratory, neurological and brain function
s/s ARDS
-SOB at rest -tachypnea -anxiety -need high concentrations of inspired O2 -tachycardia -maybe febrile/hypothermic -cold extremities/cyanosis -bilateral crackles
V: s/s ARDS
-SOB at rest -tachypnea -anxiety -need high concentrations of inspired O2 -tachycardia -maybe febrile/hypothermic -cold extremities/cyanosis -bilateral crackles *GIVING O2 WILL NOT HELP*
risks of status epilepticus
-hypotension -hypoxia -cardiac dysrhythmias -permanent brain damage-->death
TB complications
-TB empyema -bronchopleural fistula -lesion rupture -pneumothorax
s/s peritonitis
-abdominal pain -abdominal rigidity -rebound tenderness -pt wants to remain as still as possible -fluid shifts can result in s/s of hypotension/shock
cellular changes in Alzheimer's disease
-accumulation of neurofibrillary tangles -beta-amyloid plaques -cerebrocortical atrophy of the brain
complementary therapies
-acupuncture -music therapy -prayer
nursing intervention r/t impaired vision
-address pt by name and identify yourself w/ each interaction -orient to time, person and place as indicated -state purpose of visit
omeprazole guidelines
-administer before food -swallow whole -2 capsule=too much sodium bicarbonate
nursing implications r/t INH
-administer pyridoxine (vitamin B6) concurrently -monitor liver function (AST/ALT); avoid hepatotoxins
characteristics of UC
-affects only large intestine -affects upper layers of intestinal mucosa -pseudopolyps -no fistulas/anal fissures -can lead to colon cancer
viral hepatitis
-alcohol intake is not necessarily contraindicated -tylenol not necessarily contraindicated -affects liver, BUT meds and immunizations -(,', not as serious as chronic hepatitis)
citrate
blood transfusions contain this substance, which binds with Ca+; therefore, multiple blood transfusions requires Ca+ supplementation
complex focal seizure
-altered LOC or loss of consciousness -can start w/ localized area of the brain but progress to both hemispheres -cognitive, affective, and psychomotor symptoms
carbamazepine adverse effects
-anemia -agranulocytosis -heart block -Steven-Johnson syndrome -respiratory depression -hepatitis -massive hepatic cellular necrosis -suicidal ideation
sequence of events in CPR
-arrest recognized -call for help -begin one/two rescuer CPR w/ defib -arrest team arrives/ACLS begins
nursing assessments for heart failure
-assess for improved myocardial function (sys BP >90 mmHg, HR <100, RR< 20/min) -assess weight -assess dizziness, drowsiness, syncope or blurred vision -monitor Na and K+ levels to normal -report SOB, night cough, edema, slow pulse, confusion, depression, rash, fever or sore throat
cyclobenzaprine hydrochloride (flexeril)
-assess for increased CNS depression -initiate fall risk precautions
nursing responsibilities r/t iron
-assess for use of drugs that may interact w/ iron (antacids, allopurinol, chloramphenicol, tetracyclines, vitamin E), GI bleeding, and manifestations of anemia -administer w/ orange juice -give elixirs w/ straw to prevent teeth staining -monitor for toxicity (nausea, diarrhea, constipation, anaphylaxis) -monitor hemoglobin/reticulocyte -schedule iron 2h before tetracycline -monitor for anaphylaxis IM/IV
role of nurse before ECT
-assessment (cardio, pulmonary, mood, mental status) -obtaining informed consent -ensure lab reports are available (blood, urine, ECG, x-ray) -record vitals 1 hour before -remove glasses, dentures, jewelry, hair pins -change in PJs -instruct client to void -administer atropine sulfate/glypyrrolate IM 30 min before -allay fears/anxieties
pathophysiology parksinson's disease
-associated w/ progressive loss of dopamine-producing cells in the substantia nigra -depletion of dopamine creates imbalance w/ acetylcholine -accumulation of Lewy bodies in brainstem, spinal cord and cortex
3 r/f ischemic stroke
-atrial fibrillation -carotid stenosis -cerebral arteriosclerosis
adverse effects ophthalmic beta blockers (timolol)
-burning -stinging
adverse effects inhaled anesthetics
-cardiovascular/respiratory depression -airway irritation -coughing -laryngospasm -bronchospasm -vomiting -immune-mediated hepatotoxicity -increased risk of uterine bleeding -malignant hyperthermia
pneumonia differences for older adults
-changes in respiratory function, ex. decreased effectiveness of cough, increased RLV -*recent influenza* -secondary bacterials pneumonia most likely to occur
nursing competencies in synergy model
-clinical judgment -advocacy and moral agency -caring practices -collaboration -systems thinking -response to diversity -clinical inquiry -facilitation of learning
heroin
-commonly abused opiate that can be injected, ingested or inhaled -intoxication: decreased RR, constricted pupils -acute complications: noncardiogenic pulmonary edema/respiratory failure -chronic complications: skin abscess, cellulitis, endocarditis, talcosis, HIV, hepatitis
adverse consequences IAP
-compression of inferior vena cava (reduces cardiac output) -reduced renal perfusion (acute tubular necrosis) -breakdown of barrier between bowel wall and bowel content -compresses the bases of the lungs (decrease ventilation) -jugular vein distention
universal protocol
-conduct a preprocedure verification process -mark the procedure site -perform a time-out
fluids for vomiting/diarrhea
-crystalloids -colloids
kubler-ross stages of grief
-denial -anger -bargaining -depression -acceptance
feedback
-descriptive rather than evaluative and focuses on the behavior rather than on the client -should be specific rather than general. -directed toward behavior that the client has the capacity to modify. -impart information rather than offer advice. -well timed
common causes of seizure in infancy/early childhood
-developmental defects -metabolic disease -birth injury -fever -inherited forms of the disease
lifestyle changes r/t dyslipidemia management
-dietary modification -physical activity -smoking cessation
BBW valproate
-discontinue at first sign of pancreatitis -women should use birth control due to teratogenicity -check for bleeding/bruising
health education for older adults (w/ cancer)
-discuss warning signs of cancer -stress importance of seeking healthcare if warning signs develop -get an annual physical exam -learn monthly breast exams -teach early signs of prostate cancer
considerations for interfaculty transport
-distance -safety of the transport environment -patient "out of hospital" time -patient's condition and potential for complications -patient's need for critical or time-sensitive intervention -traffic -weather
nursing considerations r/t hemodynamic monitoring
-documenting source of BP readings and type of technique -proper setting/activation of all alarms -assess patient first, then check pressure monitoring system -assess insertion site (kinks, clots, stopcock turned wrong way, air bubbles, etc) -if questioning catheter patency, blood/fluid aspirated to remove clot -do not flush with syringe
s/s BPH
-dribbling of urine -frequency -hesitancy -urinary retention -straining to urinate -weak urinary stream -urgency
etiology PCOS
-dysfunctional hypothalamic-pituitary-ovary axis -genetic condition -high serum androgenic hormones
s/s heart failure
-dyspnea -fatigue -activity intolerance -fluid retention
What role does the milieu play in treatment for those with eating disorder?
-eating routine -modeling behavior -monitor patients behaviors with eating
role of nurse during ECT
-ensure patient's airway is patent -observe reactions -provide support to arms and legs
s/s PUD
-epigastric abdominal pain -pain occurs 2-3 hours after eating -intense, gnawing, burning sensation relieved by food -can progress to perforation
reducing anxiety (in pt w/ cancer)
-establish therapeutic relationship by conveying warmth and empathy and listening in a nonjudgmental manner -encourage pt to acknowledge and express feelings, no matter how inappropriate they may seem to pt
r/f acute tubular necrosis
-exposure to nephrotoxic agents -HTN -DM -poststreptococcal infection -major surgery -MI/HF
anaphylactic shock
-extreme manifestation of allergic reaction -small amt of antigen>IgE stimulates degranulation of eosinophils, basophils, mast cells>histamine -massive vasodilation=hypoperfusion of tissues -shock/bronchospasm/edema of airways
warning signs that indicate that professional boundaries of the nurse-client relationship may be in jeopardy
-favoring one client's care over another -keeping secrets with a client -swapping assignments to care for a client -giving special attention -spending free time with client -frequently thinking about client -sharing personal information with client -gifts
s/s PTSD
-flashbacks -insomnia -hyperarousal -hypervigilance -social inappropriateness -legal problems/incarceration -impairment in role performance -chronic stress=dysfunction of nervous system/hypothalamus-pituitary-adrenal axis -changes in cardiac fxn -anemia -arthritis -asthma -back pain -diabetes -eczema -peptic ulcer -kidney/lung disease
V: S/S PTSD
-flashbacks -insomnia -hyperarousal -hypervigilance (enhanced sensory sensitivity) -social inappropriateness -legal problems/incarceration -impairment in role performance -chronic stress (dysfunction of nervous system/hypothalamus-pituitary-adrenal axis -changes in cardiac fxn -anemia -arthritis -asthma -back pain -diabetes -eczema -peptic ulcer -kidney/lung disease
s/s retinal detachment
-floaters -flashes of light -blurred vision -progressive vision loss -sensation of curtain being drawn down over vision -loss of central vision of macula involved
postexposure prophylaxis (hep b)
-given IM into large muscle 24h after exposure -concurrent initiation of hep b vaccines -infrequent adverse rxns -recommended for babies born to HBV+ moms, exposure to HBV
causes of PUD
-h pylori bacteria -NSAID use
preventing infection r/t leukemia
-hand hygiene/avoid crowds -*wash fruits/vegetables properly* -dental hygiene measures -avoiding immunizations -report fever, chills, burning on urination, foul-smelling urine, vaginal, or rectal discharge, skin lesions -avoid contact sports -use electric razor for shaving -avoid suppositories, tampons and enemas -increase fiber/use laxatives -avoid OTC medications that interfere w/platelet function -*report abnormal bleeding*
s/s ICP
-headache -vomiting -decreased LOC -altered pupil rxn -cushing's triad -confusion
s/s UGIB
-hematemesis -melena -occult blood
MDD
-highest lifetime prevalence of any psychiatric disorder -could result from hormonal influences, childbirth, psychosocial factors -occurs in persons w/o close interpersonal relationships
system components of hemodynamic monitoring
-hollow-tube catheter -fluid-filled pressure monitoring system composed of flush solution -IV tubing with drip chamber -noncompliant tubing -stopcocks -flush device -one or more transducers -monitor that amplifies and displays pressures and wave forms
legal implications r/t interfaculty transfer
-hospitals must provide screening examinations for every person who comes to the ED and requests care -hospital must provide stabilizing treatment or transfer/physician must document that medical risks outweigh benefits of transfer -receiving medical facility agrees to accept transfer and provide treatment -transfer is conducted by qualified personnel special cases: -risks of remaining at initial facility outweigh risks of transfer -family requests transfer -physician is not present but qualified medical personnel OKs transfer -transfer occurs w/ appropriate equipment and specialized personnel
heredity in cancer
-how genes are passed generation to generation -important to determine if its have genetic predisposition -there are limits to testing, i.e. inability to identify causative mutation does not eliminate chance of cancer
contraindications levodopa
-hypersensitivity -raise IOP (narrow angle glaucoma) -suspicious skin lesions/melanoma -concurrent use w/ MAOIs -severe cardiovascular, pulmonary, renal, hepatic or endocrine disorders -depression -PUD
V: effects of HTN on the heart
-hypertensive heart disease -LVF hypertrophy (enlarged due to larger cells) and failure -heart failure -LVF MI
indications for IAPB
-hypotension (sys BP <90 or -30 than baseline MAP) in patients w/ STEMI -low output states in patients with STEMI -cardiogenic shock that has not been quickly reversed with pharmacological agents w/ STEMI
types of shock
-hypovolemic -cardiogenic -obstructive -distributive
considerations w/ neutropenia
-impaired immunity/inflammatory response -common infections: respiratory tract, mucosa of mouth, GI tract, vagina -common manifestations: chills, malaise, fever, weakness, fatigue
major complications of hemodynamic monitoring
-infection -accidental blood loss -impaired circulation to extremity
absence seizure
-involves a brief, sudden lapse of consciousness for 5-30 seconds -more common in children -looks as though pt is staring into space for a few seconds -typical: pt briefly loses awareness of surroundings -atypical: muscle spasms w/ loss of awareness
levodopa supplement interactions
-iron -multivitamins that contain iron -pyrixidone (vitamin B6) -high protein diet
barriers to EBP
-lack of knowledge of research process -limited access to literature -lack of skill to critique literature -limited interest in scientific inquiry -limited power to change practice -time factors -lack of organizational support and commitment -volume of research published -availability of mentors
epidural blocks
-local anesthetic agents injected into the epidural space, outside the dura mater of the spinal cord -numbs everything BELOW of insertion (i.e.: in leg, then can't feel to void, walk, etc. -provides safe, effective pain relief w/o adverse effects of general anesthesia -indicated for arm, shoulder, thorax, abdomen, pelvis and LEs -left in place post-op/useful for chronic pain -*can't walk* -*can't feel urge to void*
beta 3 adrenergic receptors
-located in adipose tissue, uterus, urinary bladder and GI tract -lipolysis and increased release of free fatty acids into the blood -relaxation of smooth muscle
alpha 1 adrenergic receptors
-located in blood vessels -vasoconstriction
beta 1 adrenergic receptors
-located in heart and kidneys -increases forces of contraction -increases HR -increases speed of electrical conduction -increases renin production
beta 2 adrenergic receptors
-located in kidneys, lungs, blood vessels, pancreas and liver -bronchodilation -vasodilation -glycogenolysis/gluconeogenesis -decreased insulin secretion
alpha 2 adrenergic receptors
-located on surface membranes of target tissues/organs -inhibition of release of norepinephrine into synapses of sympathetic nervous system
atonic seizure
-loss of muscle tone for up to 15 sec -consciousness preserved -pt falls to ground
indications of ECT
-major depression -mania -schizophrenia -episodic psychosis -atypical psychosis -OCD -delirium -neuroleptic malignant syndrome -hypopituitarism -intractable seizure disorders -parkinson's
What labs require hospitalization for anorexia patients?
-malnutrition -dehydration -severe electrolyte imbalance (potassium, phosphate , magnesium) -cardiac arrhythmias -severe bradycardia (<50 beats/min) -hypothermia (<96.8) -hypotension -suicidal ideation
priorities r/t peritonitis
-manage pain -manage fluid balance -prevent infection -manage anxiety
priorities r/t cholelithiasis/cholecystitis
-managing pain r/t biliary colic or surgery -addressing nutritional imbalances r/t altered bile flow, nausea, anorexia -treating infection r/t potential perforation of acutely inflamed gallbladder
role of nurse after ECT
-monitor vitals every 15 min for first hour -position client on side to prevent aspiration -orient client -describe procedure -stay with client until fully awake -provide highly structured schedule
pain in the dying patient
-often biggest fear -subjective experience, influenced by emotions, history and culture -sometimes undertreated -no maximum allowable dose of opioid agonists -demerol contraindicated -provide general comfort measures
s/s ectopic pregnancy
-pain -vaginal bleeding -amennorhea -rupture=intense abdominal pain/referred shoulder pain
s/s crohn's
-pain in RLQ *relieved by defecation* -diarrhea -abdominal pain
s/s compartment syndrome
-pain out of proportion to injury -edema -pallor -weak/absent distal pulses
s/s open-angle glaucoma
-painless -loss of vision fields, esp periphery -elevated IOP
V: diminished perfusion of kidney
-particularly significant in LVF -stimulates the secretion of renin from the juxtaglomerular apparatus of the nephron, which initiates cycling of the RAAS
nursing management of ICD
-patient teaching (why ICD is implanted, basic parts of ICD, what to do if shock occurs, how/where leads will be implanted) -continuously monitor for development of dysrhythmias -if device fires, assess and document patient's rhythm -place magnet over ICD pocket in event of inappropriate shocks, VT stop or emergency surgery -wound care -activity restrictions for 6 weeks -psychosocial assessment
non-pharmacologic shock treatment
-place patient in recumbent position -give blood transfusions/fluids/electrolytes -treat infections
Cleft palate post op
-position PRONE or side -emergency suction at bedside -prevent injury to suture line -give water after feeding to clean suture line -no brushing teeth, hard foods, or putting things in mouth, sucking -hold and cuddle!
precautions for Kaposi's sarcoma
-private room -gowns -gloves -decontaminate all articles leaving room
pathophysiology SLE
-production of a large variety of autoantibodies against normal body components such as nucleic acids, erythrocytes, coagulation proteins, lymphocytes, and platelets -autoantibody production is due to hyperactivity of B cells because of disorder T cell function -most characteristic autoantibodies are produced in response to nucleic acids to nucleic acids (DNA, histones, ribonucleoproteins and other components of cell nucleus)
s/s guillain-barre syndrome
-progressive, usually symmetric muscle weakness -absent or depressed deep tendon reflexes -paresthesia/numbness -acute inflammatory demyelinating polyneuropathy involving distal muscle weakness of lower extremities followed by more proximal muscles -autonomic dysfunction: fluctuating HR/BP, urinary retention, ileus, loss of sweating
strategies to promote EBP
-protocols -clinical pathways -algorithms -educational interventions -increase awareness -access to databases
characteristics of normal wave forms
-rapid upstroke -clear dicrotic notch -definite end diastole
key functions of RRT
-rapidly assess critically ill patient -stabilizes the patient using an RRT protocol or provider-directed medical care -rapidly collects patient data (vital signs, radiography, lab data) -facilitates consultation with health care specialties to redirect plan of care -provides education and support to nursing staff initiating RRT call -assists with triage decisions to the appropriate care area -assists with transfer to a higher level of care if needed
strategies to eliminate stress in critically ill patient
-reduce noise -natural views -soothing artwork -calm colors -dim lights
guidelines for inhaled corticosteroids (beclomethasone)
-regular schedule -rinse mouth to prevent candiasis -not a rescue inhaler -take lowest amt required
adverse effects codeine
-respiratory depression -nausea -vomiting -constipation -dizziness -drowsiness -pruritus -drug dependence
contraindications ophthalmic beta blockers (timolol)
-respiratory/cardiac disease -asthma -COPD -heart failure -bradycardia -atrioventricular block -left ventricular dysfunction -cardiogenic shock
clonic seizure
-rhythmic jerking movements -falls occur -consciousness preserved
life experiences related to suicide
-romance-related losses -job termination -loss of a pet -family/friend committing suicide -sexual violence
dx MDD
-sad mood most of the day, nearly everyday -anhedonia -weight loss/gain -insomnia/hypersomnia -psychomotor retardation/agitation -fatigue -worthlessness -inappropriate guilt -diminished concentration -recurrent suicidal thoughts/plan
patient triggers for RRT
-staff has significant concern about patient's condition -altered mental status -HR >140/<40 -RR >22/<8 -sys BP >180/<90 -SPO2 <90 despite supplemental O2 -urine output <50 mL/4h -chest pain unrelieved by nitroglycerin -threatened loss of airway -seizure -uncontrolled pain
postexposure prophylaxis (hep a)
-standard immune globulin IM into large muscle mass within 2 weeks of exposure -age 40 and younger -rare adverse rxns -recommended for those in contact w/ hep a, childcare or food workers
initial stage of shock
-sudden drop in tissue perfusion -SNS and RAAS are triggered -tachycardia -RAAS raises blood volume -s/s: anxious, pale, clammy, cold
goal of medicine tx HIV
-suppress infection -prophylaxis opportunistic infection -stimulate hematopoiesis -treat opportunistic infection -*drugs are combined/regimen simplified to increase adherence to medication regimen*
criteria for SIRS
-tachycardia -tachypnea -hyperthermia/hypothermia -leukocytosis
pt teaching w/ corticosteroids
-take as prescribed, do not stop abruptly -notify physician of adverse/cushingoid effects -monitor weight -moderate Na -carry identification r/t steroid use
cultures
-testing done on wound, blood, or other infected body fluids are used to identify probable microorganisms by their characteristics, such as shape, growth patterns, and gram-staining qualities -organism is then subjected to sensitivity testing to antibiotics -24-48h required to grow organism -specimens should be obtained before initiating therapy
alcohol withdrawal
-the "shakes" 12-24 h after last drink -tachycardia -diaphoresis -anorexia -insomnia -DT: disorientation, fever, tremors, hallucinations
six principles of adult learning
-the need to know -the learner's self-concept -the learner's life experience -readiness to learn -orientation to learning -motivation to learn
creating a healing environment
-timing interventions to promote rest/sleep -providing pain relief -playing music -teaching mindfulness/relaxation -fostering trust -providing information -allowing control -promoting early mobilization -presencing and reassurance -humor -massage -animal therapy -cognitive techniques
phenytoin use
-tonic-clonic seizures -psychomotor seizures -nonepileptic seizures -to prevent seizures during neurosurgery/brain surgery
cause of septic shock
-toxins/inflammatory mediators= widespread arterial vasodilation -increased capillary permeability=plasma enters tissues -inflammatory mediators=microthrombi -exotoxins=inability to clot -epinephrine/cortisol=reduction in insulin sensitivity-->glycogenolysis
teaching considerations for older patients
-use large fonts -avoid medical terminology -accommodate sensory deficits -limit info to "need to know" basis -reduce environmental stress
nursing interventions r/t grieving
-use the therapeutic skill of active listening, silence and nonverbal support to provide an open environment for the pt and significant others to discuss their feelings realistically and to express anger or other negative feelings appropriately -answer questions about illness and prognosis honestly, but always encourage hope
care of comatose pt
-using artificial tears if pt does not blink -keep lights at low level -keep skin clean and dry -cover pt w/ light blanket -use adult incontinence pads/pants -turn q2h/ maintain comfortable joint position
simple focal seizure
-usually involves only one hemisphere of the brain -no LOC -symptoms r/t affected area
pre-existing conditions that affect communication
-values, attitudes and beliefs -culture and religion -social status -gender -age/development level -environment where transaction takes place
tonic-clonic seizure
-vocalization prior to seizure -loses consciousness -rhythmic jerking movements that last up to 5 min -medical assistance is necessary ->30 min=status epilepticus
spiritual assessment of dying pt
-what are spiritual aspects of patient's philosophy about life? death? -are the values/beliefs about life and death congruent w/ people who are important to pt? -which spiritual resources and rituals have significance for the pt?
transternal herniation
-when ICP is not lowered, brain tissue is compressed and forced downward in the skulls to become herniated/displaced to another region of the brain -most common type -temporal lobe is forced through the tentorial notch -compression leads to death of brain tissue -compression of brain stem=death
pt education r/t prescriptions
-when to take -how to take -side effects -complete all medications as prescribed
fluids for blood loss
-whole blood -colloids -crystalloids
What types of fluids are used for blood loss?
-whole blood if depletion of more than 30% of total volume -colloids: plasma, platelet, PaxCells
the joint commission
...includes assessment and management of pain for all patient in the standards by which it evaluates health care organizations
caution with young children
...recommended with topical medications due to the fact that they have more permeable skin and are more likely to absorb topical drugs
intimate distance
0-18 inches, the closest distance that individuals will allows between themselves and others
PR interval
0.12-0.20
1000 mcg
1 mL= x mcg
What are patients at risk for in status epilepticus?
1. hypotension 2. hypoxia 3. cardiac dysrhythmias high risk of permanent brain damage and death unless quick treatment
What are causes of ADHD?
1. lead 2. maternal smoking/drinking during pregnancy - premature birth 3. brother has ADHD (genetic)
family history of mental illness and suicide
careful assessments of ______________ should be a routine aspect of patient evaluation.
What are adverse effects of inhalation anesthetics?
1. *cardiovascular depression* - decreased blood pressure, decreased heart rate 2. respiratory depression 3. airway irritation that can progress to coughing, larynogospasms, or bronchospasms 4. vomiting 5. immune-mediated hepatotoxicity 6. malignant hyperthermia
What are the cardinal manifestations of heart failure?
1. *dyspnea* 2. *fatigue* 3. exercise intolerance 4. fluid retention
Besides pharmacologic agents, what other treatments should the nurse utilize when treating a patient in shock?
1. *put patient in recumbent position* 2. give blood transfusions, fluids, and electrolytes 3. treat infections
3-step pharmacotherapy for IBD
1. 5-aminosalicyclic acid 2. oral corticosteroids 3. immunosuppressant drugs
characteristics of suicidal individual
1. A preoccupation with death 2. A sense of isolation and withdrawal 3. Few friends or family members 4. And emotional distance from others 5. Distraction and lack of humor 6. Focus on the past 7. Hunted and dominated by hopelessness and helplessness
What vital signs should the nurse monitor for during rapid infusions for a patient in shock?
1. monitor heart rate for tachycardia 2. monitor blood pressure note abnormal and normal vital signs
thought changes in suicide
1. Command hallucinations (usually auditory) telling the patient to kill himself or herself 2. Delusions about the benefits of suicide (eg. Family will be better off) 3. An obsession with taking his or her own life
first phase of intervention
1. Do not leave the individual alone 2. Remove anything that the patient may use to hurt or kill him or herself 3. The patient should be treated initially in a secure, safe and highly supervised place 4. Assessing for available sources of self-destructive implements 5. Pay attention to the amount of stockpiled medications available to the patient
factors for suicide risk assessment
1. How serious of the clients intent to die by suicide 2. Does this person have a plan 3. If so does here she have the means 4. How lethal are the means 5. Does he or she intends to carry out this plan 6. Has the individual ever attempted suicide before
reasons to inquire about homicide
1. It is part of a complete mental status examination 2. There is linkage between the homicide and suicide - For example, in adolescents, 2 of the 4 leading causes of violent death are homicide and suicide
What are examples of crystalloids?
1. normal saline 2. hypertonic saline 3. hypotonic saline 4. Lactated Ringer's 5. Plasma-Lyte 6. 5% dextrose in water 7. 5% dextrose in normal saline
warning signs of suicide
1. Making a will 2. Getting in the house and affairs together 3. Unexpectedly visiting friends and family members 4. Purchasing a gun, hose, or rope 5. Writing a suicide note 6. Visiting a primary care physician a significant number of people see their primary care physician within three weeks before they commit suicide
What are examples of colloids?
1. normal serum albumin 2. 5% albumin 3. dextran 40 in normal saline 4. dextran 40 in D5W 5. hetastarch in 6% normal saline 6. plasma protein fraction
Appropriate order for bipolar patient
1. safety 2. nutrition 3. sleep 4. interacts appropriately with others
signs of real suicide potential
1. Threatening to harm or end one's life 2. Seeking or access to means: seeking pills, weapons, or other means 3. Evidence or expression of a suicide plan 4. Expressing ideation about suicide, wish to die or death 5. Hopelessness 6. Rage, anger, seeking revenge 7. Acting recklessly, engaging impulsively and risky behavior 8. Expressing feelings of being trapped with no way out 9. Increasing or excessive substance use 10. Withdrawing from family, friends, society 11. Anxiety, agitation, abnormal sleep 12. Dramatic changes in mood 13. Expresses no reason for living, no sense of purpose in life
What are the administration specifics related to the omeprazole?
1. administer before food intake 2. swallow tablets or capsules whole, without crushing because the drug formulations are delayed-release and long-acting 3. two 20-mg oral capsules or suspension packets are NOT equivalent to one 40-mg dose; the 20- and 40- mg dosages contain the same amount of sodium bicarbonate; thus substituting two 20-mg doses for one 40-mg dose results in administration of too much sodium bicarbonate
What are the indications for epinephrine?
1. adrenergic drug of choice for relief of anaphylactic shock 2. treatment of cardiac arrest 3. additive to local anesthetics for vasoconstrictive effects
What are the administration specifics for donepezil?
1. before administering, assess patient for allergy, orientation, and contraindications 2. administer at bedtime each day 3. *if taking oral disintegrating tablet, nurse ensure medication is dissolved on tongue* - these patients are confused and need to be watched
What are the three adrenergic receptors that are targets of catecholamines, epinephrine and norepinephrine?
1. beta1 2. beta2 3. alpha adrenergic drugs effect heart, blood vessels, and bronchi
What is the treatment for PTSD?
1. cognitive therapy 2. group therapy 3. prolonged exposure therapy - exposed to repeated and prolonged mental recounting of traumatic experience
Why are dyslipidemic drugs used?
1. decrease blood lipids 2. prevent or delay the development of atherosclerotic plaque 3. promote regression of existing atherosclerotic plaque 4. reduce morbidity and mortality from atherosclerotic cardiovascular diseases (ASCVD)
What are the black box warnings for valproate?
1. discontinue at any signs of pancreatitis - condition is life threatening 2. women of childbearing age need 2 forms of birth control 3. *check for signs of bleeding or bruising, as altered bleeding times may occur* patient must have following according to prescriber's orders: 1. platelet counts 2. bleeding time determination 3. clotting times
How does the nurse monitor for fluid overload during rapid infusions for a patient in shock?
1. edema 2. crackles 3. infiltration at IV site
What are the contraindications to use of levodopa?
1. hypersensitivity 2. narrow-angle glaucoma - drug can dilate pupils and raise intraocular pressure 3. levodopa may activate malignant melanoma - people with suspicious skin lesions or history of melanoma should not take 4. discontinue MAOI's 14 days prior to levodopa therapy to avoid severe HTN 5. use of levodopa warrants caution in patients with severe cardiovascular, pulmonary, renal, hepatic, or endocrine disorders, depression, and peptic ulcer disease
What are the administration guidelines for the inhaled corticosteroid, beclomethasone?
1. take on a regular schedule 2. after inhaling, rinse mouth and throat to prevent fungal infection (candidiasis) 3. drug is NOT a rescue inhaler, so do not take to resolve an acute asthma event 4. dose should be lowest amount of drug required to control symptoms
What are the administration specifics with gabapentin?
1. take orally 2. take with food to prevent GI upset 3. *extended-released tablets should be swallowed whole and not crushed or chewed*
Categories of drugs to treat angina
1. those that *terminate* an acute angina episode in progress 2. those that decrease the *frequency* of angina episodes *classes of antianginal drugs:* - organic nitrates - beta-adrenergic antagonists - calcium channel blockers
What are the indications for phenytoin?
1. to control tonic-clonic seizures, pyschomotor seizures, and nonepileptic seizures 2. to prevent seizure activity in patients during and following neurosurgery and brain injury
1 ml equals how many mcg
1000 mcg
Hgb normal range
12-18 g/dL
personal distance
18-40 inches, reserved for personal interactions
Prealcoholic Phase
1ST PHASE OF ALCOHOL USE DISORDER: The use of alcohol to *relieve the everyday* stress and tension of life
What are the indications for dobutamine?
cases of shock that require *increased cardiac output* without the need for BP support for patient that needs better contractility
Patient Protection and Affordable Care Act (ACA)
2010; Also known as "Obamacare," the act extended healthcare insurance to some 30 million Americans <> how to provide services to so many more people? personnel? costs?
Early Alcoholic Phase
2ND PHASE OF ALCOHOL USE DISORDER: begins with *blackouts*--brief periods of *amnesia* that occur during or immediately following a period of drinking
COMFORT scale for pain
7 points *INCLUDES* - alertness - calmness - muscle tone - movement - facial tension - respiratory response - heart rate AND mean arterial BP
pH (ABG)
7.35 - 7.45 <7.35 = Acidic >7.45= Alkaline (Basic)
colloid
proteins, starches and other large molecules that stay in blood for a long time because they are too large to easily cross capillary membranes
V: how long before MI causes irreversible cellular damage and necrosis occurs
30 minutes
Crucial Phase
3RD PHASE OF ALCOHOL USE DISORDER: the individual has lost control of his or her use, and physiological addition is clearly evident - inability to choose whether or not to drink - drinking total focus << >> anger and aggression << >> life problems
After how long will a person start showing alcohol withdrawal symptoms?
4 to 12 hours since the last drink delirium 2-3 days after
social distance
4-12 feet away, includes conversations with strangers/acquaintances
PaO2
80-100 mmHg (<, *hypoxemia*) partial pressure of oxygen measurement of amt of O2 in blood
SaO2
93-100% oxygen saturation % of Hmg bound w/ O2 in blood (*PaO2*)
partially compensated
Abnormal pH and BOTH CO2 and HCO3 are abnormal (example) PaO2: 94 (normal) pH: 7.48 (alkalosis) PaCO2: 25 (decreased) HCO3: 20 (decrease) *partially compensated respiratory alkalosis*
RBC normal range
4.2-6.2 million
Chronic Phase
4TH PHASE OF ALCOHOL USE DISORDER: characterized by emotional and physical disintegration - intoxicated more often than not - profound helplessness and self-pity - psychosis (withdrawal symptoms)
ROA donepezil (aricept)
5 mg PO at bedtime for 4-6 weeks, then increase to 10 mg daily as needed
WBC normal range
5,000-10,000/mm3
Therapeutic range for Theophylline
5-15 mcg/mL
Pulmonary Capillary Wedge Pressure (PCWP)
< hemodynamic device = *SwanGanz catheter aka pulmonary artery catheter* - PASSIVELY deflate balloon (do not draw back b/c could damage catheter) = L ventricular end diastolic measurement = 6-12 mm Hg ,', < 6, hypovolemic shock
LDL
<130 desirable; >160 undesirable
Triglycerides
<150 desirable >200 undesirable
Total Cholesterol
<200 desirable; >240 undesirable
health services pyramid
<< The Core Functions Project <> to demonstrate
peak inspiratory pressure (PIP)
<< airway resistance, faults in complicance
EBP r/t research
<< research = implementation of reserach <> strength/level of research
Sleep promotion and rest for critically ill - RN interventions
<< sleep assessment, appropriate environment, etc (1) Large clocks and calendars (2) Block sleep time (to include quiet time during day shift) (3) Use of earplugs, eye mask, etc (4) Music therapy (white noise, ocean sounds), back rub, relaxation techniques (5) Eliminate pain, comfort position (6) Titrate environmental stimuli, privacy, inform others of sleep for quiet (7) Institute bedtime routine, provide info about day/care/etc - minimize anxiety (8) Provide open visiting (no RN practices such as bath in middle of night, out of convenience; evaluate need for RN interruptions) Assess effectiveness
pressure-controlled ventilation (PCV)
<> control *plateau pressures* in conditions such as *ARDS* <> decreased compliance <> risk for barotrauma <> high FiO2 and high levels of PEEP but still has oxygen issues ~>> Monitor hemodynamic status- the mean airway and intrathoracic pressures can rise causing potential decrease CO and oxygen delivery
airway pressure release ventilation (ARPV)
<> trauma <> ARDS reduce airway pressure and lower minute volume (makes breathing easier, like reducing BP) while allowing spontaneous breathing throughout the ventilator cycle ~>> sedative state ~>> tolerated lowered FiO2 ~>> weaning to *PSV* ~>> weaning off
HDL
>40 desirable <40 undesirable
uncompensated (r/t ABGs)
Abnormal pH and EITHER CO2 or HCO3 is abnormal (example) pH: 7.52 (alkalosis) PaO2 94 (normal) PaCO2: 25 (decreased) HCO3: 24 (normal) *uncompensated respiratory alkalosis*
somatic disorder
A syndrome of multiple somatic symptoms (extreme anxiety about physical symptoms such as pain or fatigue) that cannot be explained medically and are associated w/ psychosocial distress and frequent visits to HCP to seek assistance - Symptoms are usually vague and dramatic/exaggerated - The person spends a lot of time worrying about symptoms and has high anxiety over health status (TX: analgesics, antidepressant, anxiolytics)
Code Teams - recorder
records resuscitation efforts (+ personnel involved) official time keeper for the code
Sepsis and Septic Shock
A complex type of *distributive shock* that usually begins as a bacterial or fungal infection & progresses to a dangerous condition over a period of days
distributive shock (septic, neurogenic)
A condition that occurs when there is widespread dilation of the small arterioles, small venules, or both (~ hypovolemia b/c of the dilation that then leaves empty space in the vessels and the body trying to compensate) PCWP (preload), DEC CO, INC SVR (afterload), DEC (b/c of extreme massive dilation) TX: IV fluids (b/c ~ *hypovolemic shock*), then, vasopressors
Epiglottitis
A disease in which the epiglottis becomes inflamed and enlarged and may cause an upper airway obstruction.
congestive heart failure (CHF)
A disorder in which the heart loses part of its ability to effectively pump blood, usually as a result of damage to the heart muscle and usually resulting in a backup of fluid into the lungs.
Wilms tumor (nephroblastoma)
A malignant renal tumor; embryonic in origin; encapsulated; occurs in preschool children; TX: with early detection, surgery, adjuvant chemotherapy, as well as radiation therapy postoperatively, the prognosis is good
Systematic desensitization
A plan of behavior modification designed to expose the individual gradually to the situation or object (either in reality or through fantasizing) more and more until the fear is no longer experienced
PTSD
A reaction to an extreme trauma, which is likely to cause pervasive distress to almost anyone, such as natural or man-made disasters, combat, serious accidents, being the victim of torture, terrorism rape, or other crimes _triggers_ - fireworks, dynamite, slamming door (military)
cardiogenic shock
A state in which not enough oxygen is delivered to the tissues of the body, caused by low output of blood from the heart. It can be a severe complication of a large acute myocardial infarction, as well as other conditions = PUMP problem, fluid backup PCWP (preload), INC CO, DEC SVR (afterload), INC (from natural response to tighten down vessels) TX: Inotropes <<~ dysrhythmias (HR), (SV issues) = two components of CO
(hemodynamic instability)
A state requiring pharmacologic or mechanical support to maintain a normal blood pressure or adequate cardiac output. (1) systolic blood pressure < 100; (2) mmHg and/or pulse > 100 beats per minute; <> Indicates significant intravascular volume loss.
PaCO2
ACID <> eliminated from body by lungs 35-45 mmHg partial pressure of carbon dioxide measurement of the art of CO2 in blood
cancer checkup
ACS recommendation for asymptomatic patients to incorporate __________________ into periodic health examinations
V: parksinson's disease
AN IMBALANCE OF NEUROTRANSMITTERS - associated w/ progressive loss of dopamine-producing cells >> imbalance w/ acetylcholine >> accumulation of Lewy bodies in brainstem, spinal cord and cortex
Medications used to treat tension headaches and migraines
Acetaminophen- Aspirin- Caffeine products
giving recognition
Acknowledging and indicating awareness; better than complimenting, which reflects the nurse's judgment
Alcohol Use Disorder
Alcohol exerts a *depressant* effect on the CNS, resulting in *behavioral and mood* changes proportional to the alcoholic concentration in the blood.
ACE inhibitors
Antihypertensive. Blocks ACE in lungs from converting angiotensin I to angiotensin II (powerful vasoconstrictor). Decreases BP, Decreased Aldosterone secretions, Sodium and fluid loss. *contraindications*: hypotension (check BP) *s/e*: Orthostatic Hypotension
Methotrexate
Antimetabolite
diurectic
An agent that increases the excretion of urine
What is grandiose thought content?
An idea that he or she is all-powerful or of great importance example: "I am the king— and this is my kingdom! I can do anything!"
physical appearance and dress
Body coverings-both dress and hair- manipulated by wearer which conveys a distinct message to receiver. Dress: formal, casual, stylish, sloppy. Hair: long, short, present, absent.
Benzodiazepines
Anti anxiety medications - CNS depressants potential dependency NOT discontinued abruptly following long-term use because they can produce a life-threatening withdrawal syndrome S/E: drowsiness, confusion, and lethargy. IE: Librium (chlordiazepoxide)
What medication is a patient on for generalized anxiety disorder?
Anti-anxiety medication daily -Buspar (b/c dependency not likely) - does not depress CNS - 10-14 days before full therapeutic benefits are achieved
Amiodarone
Antiarrhythmic
Enoxaparin
Anticoagulant (i.e. Lovenox)
Clozaril
Antipsychotic medication r/f *Agranulocytosis*, a potentially fatal blood disorder in which the client's white blood cell (WBC) count can drop to extremely low levels - A baseline WBC count and absolute neutrophil count (ANC) must be taken _before_ adm and _weekly_ for the first 6 months of treatment - Only a 1-week supply of medication is dispensed at one time.
Risk for Carbamazepine (Tegretol)
Aplastic anemia and agranulocytosis (should complete hematologic assessment) Stevens-Johnsons syndrome Hepatic funcition serum levels (check for toxicity)
nursing priority r/t ineffective airway clearance
Assess (q4h): -respiratory status -vital signs -breath sounds -SaO2 -skin color
pressure-support ventilation (PSV)
Assists spontaneous breathing efforts by delivering high glow of gas to a selected pressure level early in inspiration and maintaining that level throughout the inspiratory phase Their effort determines the rate, inspiratory flow, and tidal volume ,', higher pressure, less work from pt; lower pressure, more pt participation (weaning) Caution in patients with bronchospasms or other reactive airway conditions
Contraindications for timolol
Asthma/COPD, heart failure, bradycardia, atrioventricular block, left ventricle dysfunction and cardiogenic shock
Anticholinergics
Atropine GI - Slows motility, spasm Eyes - Dilates pupils *DO NOT GIVE TO GLAUCOME PTS* Heart - Increase HR Resp - bronchodilator (Atrovent)
Non-pharmacologic ways to raise blood pressure
recumbent position (lying on side knees to chest) give blood transfusion fluids electrolytes treat infection
HCO3 (bicarbonate)
BASE 22-26 mEq/L regulated by kidneys (metabolic)
What is the black box warning for fluroquinolone?
BBW for fluroquinolone, including ciprofloxacin, not only alerting health professionals to the increased disabling risk of *tendinitis and tendon rupture* but also the significant risk of peripheral neuropathy, CNS and cardiac effects, and dermatologic and hypersensitivity reactions
s/s cellulitis
red, *swollen*, painful areas
Risks for patient in status epileptics
Brain damage, hypoxia, hypOtension cardiac dysrhythmias and death
Which antiepileptic drugs can only be administered orally? A. diazepam B. phenobarbital C. gabapentin D. phenytoin
C. gabapentin
Common adverse effect of opioid agonist
CNS depression Respiratory depression N/V Pupil constriction Constipation
What are adverse effects of the opioid agonist, morphine?
CNS effects: 1. analgesia 2. CNS depression (range from drowsiness to sleep to unconsciousness) 3. decreased mental and physical activity 4. *respiratory depression* 5. nausea/vomiting 6. *pupil constriction* GI effects: 1. *constipation* (drug slows motility) 2. smooth muscle spasm in bowel and biliary tract
Methamphetamine
CNS stimulant Class: Amphetamine Major side effects: Excessive CNS stimulation; tachycardia; restlessness, insomnia, headache, palpitations, weight loss, suppression of growth in children (with long-term use), increased blood pressure, abdominal pain, anxiety, tolerance, and physical and psychological dependence. Nursing interventions: Monitor vital signs for elevated BP and HR; assess diet for inability to eat/ weight loss
Methylphenidate (Concerta (ER)/Ritalin)
CNS stimulant for ADHA - extended-release, long-acting, non amphetamine stimulant
Vyvanase
CNS stimulant for ADHD, amphetamine
Adderall
CNS stimulant, amphetamine mixture (amphetamine + dextroamphetamine)
Caution for children and topical medication
Can be absorbed quicker because their skin is more permeable
right ventricular pressure (RVP)
second pressure along *pulmonary artery catheter* from insertion
bulimia (v. anorexia)
Client eat a large quantities of food over a short period of time (binge eating), followed by inappropriate compensatory behaviors, such as self-induced vomiting (purging) ~> *metabolic acidosis*
What medication is a patient on for panic attacks?
Clonazepam (Klonopin) - benzodiazepine PRN
Common uses for nasal decongestions
Common cold Allergies Sinus -relief of nasal obstruction and discharge -relieve nasal congestion and swelling by constricting
intussusception
Common in kids with CF. Obstruction may cause fecal emesis, current jelly stools. enema---resolution=bowel movements 😏in(testine)...tussel...ception (block)
What happens with sudden withdrawal of Phenobarbital
seizures
common professional boundary concerns
self-disclosure, gift-giving, touch, friendship/romance
Fluids used for hypovolemic shock- vomiting & diarrhea
Crystalloids
Reasons for drug therapy in Dyslipidema
Decrease blood lipids Prevent/ delay development of atherosclerotic plaque Promote the regression of existing plaque Reduce morbidity and mortality from ASCVD
Adrenergic drugs are used to: A. Increase the body's immune response B. Decrease the inflammatory response C. Prevent infection from spreading D. Raise the BP and maintain perfusion to vital organs
D. Raise the BP and maintain perfusion to vital organs (goal of MAP between 80-100 mmHg)
Beta Blockers
DECREASE heart rate and DILATE arteries by blocking beta receptors (blockers ~ bouncers, slow down the "crowd"
Medications used to treat malignant hyperthermia
Dantrolene Sodium
What could happen after using Bismuth Subsaliculate (Pepto-Bismol)
Dark stool/ dark tongue- harmless will disappear once drug is stopped *ringing in ears or hearing loss- discontinue and get evaluated*
Bile Acid Sequestrants
Decrease LDL
PCSK9 inhibitors
Decrease LDL
MOA H2RAs and PPIs
Decrease gastric acid secretion
What is the desirable, borderline, and undesirable LDL cholesterol level?
Desirable = <130 Borderline = 130-159 Undesirable = >160
What is the desirable, borderline, and undesirable total serum cholesterol level?
Desirable = <200 Borderline = 200-239 Undesirable = >240
What is the desirable and undesirable HDL cholesterol level?
Desirable = >40 Undesirable = <40
Lifestyle changes for dyslipidemia
Dietary modification Physical activity Smoking cessation
What is the reason behind "switching" personalities?
self-protection coping
hypercapnia
the abnormal buildup of CO2 in blood; excessive CO2 in blood ~>> PaCO2 > 45
Black Box Warning valproate (Depakote)
Don't give when pregnant- Teratogenic medication- use two forms of birth control Stop taking at any sign of pancreatitis Check for signs of bleeding and bruising- have platelet counts and bleeding/clotting times checked per order
Alpha 1 blockers
Drugs that primarily cause arterial and venous dilation through their action on peripheral sympathetic neurons (antihypertensive)
Cardinal manifestation of Heart Failure
Dyspnea (shortness of breath) Fatigue Exercise intolerance Fluid retention
denial
EGO DEFENSE MECHANISM
What are S/S of lithium toxicity?
Early signs: vomiting, diarrhea Over 2 mEq/L: tremors, sedation, confusion Levels over 3.5 mEq/L: delirium, seizures, coma, cardiovascular collapse, death
Adverse effects of Saline Cathartics
Electrolyte imbalance -generally used for short term tx of constipation, cleaning bowel, tx of fecal impaction
MOA of Antimicrobials & Bismuth
Eliminate H. pylori infection
Common causes of seizures in children
FEVER developmental defects metabolic disease birth injury
V: Cardiogenic shock
Failure of the heart to pump sufficient blood to tissues >> severe hypotension (lower than 90 systolic for 30 mins) *can be due to:* << left HF, myocardial ischemia, MI, pulmonary embolism
Benzodiazepines are the drugs of choice in the treatment of anxiety disorders. True or False
False
Buspar has high risk for abuse and dependence. True or False?
False
Obsessive-compulsive disorder is considered an anxiety disorder. True or False?
False
Patients with anxiety disorders often show decreased amygdala response to anxiety cues. True or False?
False
Patients with general anxiety disorder frequently present to the emergency department (ED) with chest pain or dyspnea, fearing that they are dying of myocardial infarction. True or False?
False
The cognitive theory has explained anxiety as a conflict between the id and ego. True or False?
False
The diagnosis of general anxiety disorder is made primarily by history. True or False
False
The main indication for Buspar is Panic disorders and Phobias. True or False?
False
delusions
False personal beliefs inconsistent with the person's intelligence or cultural background. The individual continues to have the belief despite obvious proof that it is false or irrational
hallucinations
False sensory perceptions not associated with real external stimuli, may involve any of the five senses
crystalloid
IV solutions that contain electrolytes and other substances that closely mimic the body's ECF
asystole
the absence of contractions of the heart; cardiac standstill
V: foam cells
Formed as a result of injured endothelial cells -->sticky molecules -->attract WBCs -->macrophages ingest LDL -->foam cells -->atherosclerotic plaque
What is a crystalloid?
IV solutions that contain electrolytes and other substances that closely mimic the body's extracellular fluid (ECF) used to replace depleted fluids and to promote urine output
metabolic acidosis
HCO3 <22 (pH <7.35) << Excessive production of acids or inadequate concentration of bicarbonate for the concentration of acid within the serum *s/s* - Headache, - confusion, - restlessness, lethargy, - weakness, stupor/coma, - *Kussmaul respirations*, - n/v, - dysrhythmias, - warm and flushed skin
Route of administration: Phenobarbital
IV/PO
Who does the Baptist faith pray to?
God and Jesus
Prototype Expectorants
Guaifenesin (Robitussin, Mucinex)
Causes of Peptic Ulcer Disease (PUD)
H. pylori NSAIDs
Route of administration: phenytoin (Dilantin)
IV/PO (capsule, tablet, chewable, oral suspense)
suicide
the act of intentionally taking one's own life
metabolic alkalosis
HCO3 > 26 (pH > 7.45) Excessive loss of nonvolatile acids or excessive production of bicarbonate *s/s* - Muscle twitching, - tetany, - dizziness, - lethargy, weakness, coma - disorientation, convulsions, - n/v, - *depressed respirations*
-statin
HMG-CoA reductase inhibitor; antilipid <> inhibit the body's cholesterol production
Nurse Assessment with adrenergic drugs
HR- to make sure it doesn't go too high: less than 100 beats/min BP- to make sure it doesn't go too high or low: mean arterial pressure at least 65mmHg Fluid overload: watch for edema, crackles in lungs Unlabored breathing Serum lactate levels Arterial blood gas w/in normal levels
Incidences of INC *afterload* (too much resistance)
HTN (direct rel w/ arterial pressure) >> Tx *ACE inhibitors* L ventricle < aortic pressure R ventricle < pulmonary artery
V: DSM-5 MDD (major depressive disorder)
Have at least five of the following for a min of 2 wks... - sad mood most of the day, nearly everyday - anhedonia (inability to feel pleasure) - weight loss/gain - insomnia/hypersomnia - psychomotor retardation/agitation - fatigue - worthlessness - inappropriate guilt - diminished concentration - recurrent suicidal thoughts/plan (fill in blank)
Goals of drug therapy for PUD
Healing and prevention on more lesions --decreasing cell-destructive effects/ increasing cell protective effects
preventable hepatitis
Hepatitis A and hepatitis B are preventable diseases. -Vaccines are available -preparations also available to prevent the disease following known or suspected exposure.
How to store nitroglycerin tablets
In dry, cool, dry environment and replace every 6 months- exposure to light deactivates tablets
Causes of GERD
Incompetent lower esophageal sphincter (LES) Delayed gastric emptying Reflux of food (fatty, chocolate), fluid (carbonated, alcohol) Medication Gastric distention Smoking Recumbent posture
Niacin
Increase HDL
Stains
Increase HDL and decrease LDL
Actions of adrenergic drugs for shock states
Increase HR, increase BP, increase contractility SNS stimulation- pupil dilation
Indication for Epinephrine
Increase mean arterial pressure by increasing the cardiac index and stroke volume --Low levels: increase myocardial contractility --High levels: increase BP- vasoconstriction
Indications for Dobutamine
Increase the force of myocardial contraction with minimal increase in HR ** most useful for shock that requires increase cardiac output w/o blood pressure support
Black Box Warning for Fluoroquinolone
Increased disabling risk of tendinitis and tendon rupture Significant risk of peripheral neuropathy, CNS and cardiac effects, and dermatologic and hypersensitivity reaction
Increased Intracranial Pressure (ICP)
Increased pressure in the skull from either an increase in blood volume or CSF, or brain tissue edema, results in less arterial blood entering the high pressure area in the brain s&s severe headache, vomiting, papilledema (pupil run bad, b/c of bleeding behind eyes?)
vitamin D
Increases absorption of calcium in the small intestine
adjustment disorder TX
Individual psychotherapy, family therapy, behavior therapy, self-help groups, crisis intervention, psychopharmacology
Teaching Strategies (for critically ill)
Individualized << assessment >> goal, specific behavioral objectives, teaching content outline, methods, materials, timeline for accomplishment, evaluation meathods Integrated (w/ all members/support system) (unique) learning opportunities << vulnerability, routine pt care Patient and family centered care <> dignity, respect, participation, information sharing; collaboration; family support crucial Group learning <> sharing common experiences Incorporation of technology Ongoing Informal teaching Focus on single content Consistent message Knowledge progresses from simple to complex All about SUPPORT SYSTEM
Ear drops instillation
Infants DOWN and back (not infants) UP and back
orotracheal intubation
Insertion of an endotracheal tube into the trachea through the mouth <> unconscious (no gag reflex ~>> vomiting, aspiration) >> suctioning b/c swallowing inhibited (mouth entrance)
Appendicitis (S/S)
Intense pain on right lower side of abdomen
vasoocclusive crisis
Ischemia and pain caused by sickleshaped red blood cells that obstruct blood flow to a portion of the body.
V: The nurse is caring for a patient with Acute Kidney Injury (AKI). The nurse knows this is most often caused by which of the following?
Ischemia or hypoxia which causes acute tubular necrosis
Cancer prevention/early detection
It is the key to reduce the incidence and mortality of cancer. American Cancer Society recommends incorporating a cancer checkup into periodic health examinations. *includes:* - health counseling - teaching self-examination techniques when appropriate - examination for cancers of the thyroid, oral cavity, skin, lymph nodes, testes, and ovaries - recommends people with family history should have more frequent tests or examinations
Who might be at risk for surgical complications?
Jehova's witness; they do not receive blood products
contraindications of ECT
MI, stroke, aortic/cerebral aneurysm, severe hypertension and CHF
hypovolemic shock
the amount of blood in the body's vasculature is reduced; low blood volume causes hypotension
Code Teams - members
Leader (NP, Dr, ACLS Qualified personnel) primary nurse recorder charge nurse second nurse Rx nurse nursing supervisor RN anesthesias RT (plus) Others can perform other roles when not everyone available
What are extrapyramidal symptoms (EPS)?
MAJOR SIDE EFFECTS OF ANTIPSYCHOTICS S/S: tremors, chorea/dystonia/akinesia/akathisia (involuntary movements) - may occur as a side effect of some antipsychotic medications - variety of symptoms that originate outside the pyramidal tracts and in the basal ganglion of the brain
Indications for Dopamine
Low levels: increase renal blood flow and urine output Mid levels: increase HR, BP, and myocardial contractility High levels: vasoconstriction
What is serotonin syndrome?
MAJOR SIDE EFFECTS OF ANTIPSYCHOTICS S/S: diarrhea, nausea, vomiting, tremors, headache, agitation, restlessness, diaphoresis, and in severe cases, muscle rigidity, high fever, irregular heartbeat, seizures, unconsciousness and death, if left untreated - syndrome of symptoms related to excessive levels of serotonin in the body as a result of certain drugs or drug interactions
What is neuroleptic malignant syndrome?
MAJOR SIDE EFFECTS OF ANTIPSYCHOTICS S/S: severe muscle rigidity, *high fever*, tachycardia, fluctuations in blood pressure, diaphoresis, and rapid deterioration of mental status to stupor and coma
5-10%
the amount of cancers w/ a hereditary component
decrease gastric acid secretion
MOA histamine recept antagonists, proton pump inhibitors
Afterload
the amount of resistance to ejection of blood from the (L) ventricle (i.e. HTN)
adjustment disorder
Maladaptive rxn to an *identifiable stressor or stressors* that results in the development of clinically significant emotional or behavioral symptoms. The response occurs within 3 months after onset of the stressor and persists for no longer than 6 months after the stressor or its consequences have ended - not adapting / struggling << losing job, death of family member, divorce
positive end-expiratory pressure (PEEP)
Mechanical maintenance of pressure in the airway at the end of expiration to increase the volume of gas remaining in the lungs prevents collapse and recruits alveoli, allowing diffusion of gases across the alveolar-capillary membrane (avoid collapse of alveoli at end of expiration) Reinflates collapsed alveoli, maintains the alveoli in an open position, and improves lung compliance. This decreases shunt and improves oxygenation Recommend values: 10-15 cm H20
Platelet count (normal range)
Normal findings: -Adult/elderly/child: 140,000-400,000/mm3 -Infant: 200,000-475,000 -Newborn: 150,000-300,000 Critical values (Do NOT change b/t labs): <50,000 or >1,000,000/mm3
Cardiogenic Shock
Myocardium has lost its ability to contract effectively and maintain an adequate cardiac output
MOA Antiacids
Neutralize gastric acid
Patient teaching for medication administration for heart failure
No medication substitutes Missed dose w/in 6hrs take- but don't double up on dose Assess HR, BP, decreased symptoms of fatigue, look for dyspnea and edema (take daily weights, exam patient)
Crystalloids
Normal Saline Lactated Ringer's 3% sodium cholride 5% dextrose in NS
completely compensated
Normal pH, BOTH CO2 and HCO3 are abnormal (example) PaO2: 94 (normal) pH: 7.44 (normal but tending toward alkalosis) PaCO2: 25 (decreased, primary problems) HCO3: 18 (decreased, compensatory response) *completely compensated respiratory alkalosis*
Route of administration: gabapentin (Neurontin)
PO
Route of administration: diazepam (Valium, Diastat)
PO/IV/IM/Suppository
Decreasing Calcium
PTH decreased Renal excretion increased Intestinal absorption decreased Release of calcium from bone decreases Calcitonin secreted
Increasing Calcium
PTH secreted Decreased renal excretion of calcium Increased intestinal absorption Increased release of calcium from bone Vitamin D activated
respiratory alkalosis
PaCO2 <35 (pH > 7.45) << hyperventilation, excessive elimination of CO2 from serum *s/s* - Light-headedness, - confusion, decreased concentration, - paresthesias, - tetanic spasms (arms/legs) - dysrhythmias, - CNS lesions, s - weating, - dry mouth, - blurred vision
respiratory acidosis
PaCO2 >45 (pH <7.35) << inadequate amt of CO2 being eliminated (pulmonary malfunction or excessive production of CO2) *s/s* - Dyspnea, respiratory distress, - restlessness, - headache, - tachycardia, dysrhythmias - confusion, - lethargy, drowsiness, - decreased responsiveness
hypoxemic respiratory failure
PaO2 < 60%
hypoxemic hypercapnia respiratory failure
PaO2 <60% AND PaCO2 >55%
What regulates calcium and bone metabolism
Parathyroid hormone (PTH), calcitonin, and vitamin D
intestinal "telescoping"
Part of intestine slips into another part beneath it (intussusceptions)
Black Box Warning for dantrolene sodium
Patient should have liver function test and discontinue at first indication of hepatic impairment
counselor
Peplau's belief about which role nurses should adopt in psychiatric care
Ghon's focus
TB in apex of lung-->inflammation-->WBCs wall off infection-->tubercle form (granulomatous accumulation of WBCs, bacilli, fibrotic tissue)-->scar tissue forms-->lesions are known as ___________
Colloids
Plasmanate Gentran 40 Hespan Albuminar
Intoxication
SUBSTANCE INDUCED DISORDER, physical and mental state of exhilaration and emotional frenzy or lethargy and stupor - *development* or a *reversible* syndrome of symptoms following excessive substance use (symptoms specific, close to time of ingestion) - CNS effects (disruption in physical and psychological functioning) - judgement disturbed
Indications for Norepinephrine
Severe hypotension and shock --vasoconstriction- Increases BP, increases HR, force contraction/ cardiac output
erythrocytes
RBCs
withdrawal
SUBSTANCE INDUCED DISORDER - physiological and mental readjustment that *accompanies the discontinuation of an addictive substance* - *abrupt reduction* of something used regularly over period of time) >> disturbances in thinking, feeling, behavior
Adverse effects of inhaled anesthetics
Respiratory Depression Decreased HR/ BP Airway irritation Cough Laryngospasm/ bronchospasm Vomiting Immune-mediated hepatoxicity Increase uterine bleed
compensation (r/t ABGs)
Respiratory compensation: (1) Metabolic acidosis: inc RR (2) Metabolic alkalosis: dec Renal compensation: (1) Respiratory acidosis: inc H secretion, HCO3 reabsorption (2) Respiratory alkalosis: dec
Adverse effect of codeine used with antitussive
Respiratory depression N/V Constipation Dizziness Drowsiness Pruritus (itching) Drug dependence
MOA Misoprostol
Restores prostaglandin activity
Risk for CNS depression when using Cyclobenzapine hydrochloride (Flexeril) for muscle spasm
S/S drowsiness, dizziness, & anticholinergic effects- increased risk for fall and injury
addiction
SUBSTANCE USE DISORDER primary chronic disease of brain r/t reward, motivation, memory, related circuitry dysfunction r/t ind pathologically pursuing reward and/or relief by substance use and other behaviors ~> interpersonal/social issues physical and/or psychological probs hazardous issues ~> needing more and more to get high
Anaphylaxis
Severe allergic reaction
Obstructive Shock
Shock caused by any kind of mass or fluid accumulation and/or blood clot outside of the heart that interferes with the hearts ability to adequately pump a sufficient quantity of blood
Topical Nasal Decongestants
Should be used w/cardiovascular disease
Hyperventilation
the condition of taking abnormally fast, deep breaths >> PaCO2 )<35) being eliminated ~>> *respiratory alkalosis*
Strabismus test
Stare at one spot, cover one eye, cover other eye, if movement some degree exists = cross eyed
Glipizide
Sulfonylurea; Antidiabetic Agent
General administration teaching for extended-release medications
Swallow whole, do not crush or chew
Reye's syndrome
Syndrome which is an acute encephalopathy (inflammation of the brain and liver). * Usually follows a viral illness & linked to intake of aspirin >> acetaminophen INSTEAD S/S: emesis, confusion
V: absence seizure
TYPE OF GENERALIZED SEIZURE - aka petit mal seizure - involves a brief, sudden lapse of consciousness for 5-30 seconds - more common in children - looks as though pt is staring into space for a few seconds - /typical/: pt briefly loses awareness of surroundings - /atypical/: muscle spasms w/ loss of awareness
V: Tonic-clonic seizure
TYPE OF GENERALIZED SEIZURE: - "grand mal" seizure - commonly vocalizes loudly before the seizure - loses consciousness - rhythmic jerking movement and stiffening of muscles that can last up to 5 minutes - medical assistance necessary
V: Absence seizure
TYPE OF GENERALIZED SEIZURE: - "petit mal" seizure - brief, sudden lapse of consciousness for 5-30 seconds - more common in children than adults - blank stare - unaware of surroundings - muscle spasms
V: Acute glomerulonephritis
TYPE OF NEPHROTIC SYNDROME - inflammation and subsequent damage of the glomeruli (cluster of capillaries around the end of a kidney tubule, where waste products are filtered from the blood.) leading to hematuria (blood in urine), proteinuria (abnormal amts of protein in urine), and azotemia (abnormal amts of nitrogen in blood) ; it may be caused by primary renal disease or systemic conditions. - most common cause = strep (i.e.: patient with pharyngitis caused by Group A betahemolytic streptococcus (GABHS)) - *S/S*: dark "coca cola" urine (b/c contains RBC)
Administration guidelines for omeprazole
Take BEFORE meals 2-20mg tablets does NOT equal 40mgs
Administration teaching for inhaled corticosterioids
Take on regular schedule Rinse mouth/ throat to prevent infection Not a rescue inhaler Should not take to resolve acute asthma event
ECT mechanism of action
The exact mechanism of action by which ECT effects a therapeutic response is unknown. Some credibility has been given to the biochemical theory that ECT results in significant increases in the circulating levels of serotonin, norepinephrine, and dopamine.; could also increase GABA and/or endogenous opioids
Benzodiazepines
The most common group of antianxiety drugs, which includes Valium and Xanax.
Joint Commission expectation regarding pain management
The nurse should assess and management pain for ALL patients
air embolism
The presence of air in the veins, which can lead to cardiac arrest if it enters the heart.
Lung shape and aspiration
The shape of the right bronchus increases susceptibility of aspiration into the right middle and right lower lobes of the lung
V: septic shock
a state of severe sepsis with persistent life-threatening hypotension that is refractory (unresponsive) to fluid replacement and vasopressors - IV fluid and vasoconstrictor meds do not help this condition
tidal volume
The volume of air breathed in and out without conscious effort
V: At risk groups for TB
Those in crowded environments easing the ability to inhale the airborne TB infected droplets - nursing home residents, - healthcare workers, - prisoners, - urban residents, - Immunosuppressed - Infection with HIV, IV drug abuse, Alcoholism, Silicosis, End-stage renal disease, Low body weight Diabetes - Travel to area of world such as China or India, - Use of TNF-alfa antagonists, - Smokers
static compliance
Tidal Volume / (Static Pressure - PEEP) > better, allowing lung to be more easily distended
Uses of Hydantoins- phenytoin (Dilantin)
To control tonic-clonic seizures, psychomotor seizures, and non-epileptic seizures To prevent seizure activity during and following neurosurgery and brain injury
Tricuspid Atresia
Tricuspid valve orifice fails to develop; right ventricle is hypo plastic (underdeveloped)
Anxiety disorders are the most common type of psychiatric disorders in the US. True or False?
True
Anxiety disorders have high rates of comorbidity with major depression and alcohol and drug abuse. True or False?
True
Beta-blockers such as atenolol, nadolol, or propranolol may be useful for treatment of situational/performance anxiety. True or False
True
Caffeine-containing products, such as coffee, tea, and colas, should be discontinued (or decreased to a low reasonable level) for patient with anxiety disorders. True or False?1
True
Escitalopram (Lexapro) is likely to cause fewer hepatic enzyme interactions and may be appropriate initial choices for patients with complicated medical regimens or those who are concerned about drug interactions. True or False
True
In the central nervous system (CNS), the major mediators of the symptoms of anxiety disorders appear to be norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA). True or False?
True
Patients with significant discomfort from acute anxiety can benefit from benzodiazepines. True or False
True
Migraines
Unilateral pain in the head that may or may not be accompanied by an Aura (breeze, odor, light)
Common uses for enzymes (skin)
Used to debride wounds and ulcers- remove necrotic tissue
Common uses for retinoids (skin)
Used to manage certain forms of acne because they cause the upper layers of the epidermis to slough off
Common uses for antimicrobials (skin)
Used to treat bacteria, fungi, and viruses- local and systemic use
Common uses for corticosteroids (skin)
Used to treat inflammation present in many dermatologic conditions- topical
Common uses for keratolytics (skin)
Used to treat wrinkles and sun damaged skin
septic shock
a state of severe sepsis with persistent life-threatening hypotension that is refractory to fluid replacement and vasopressors; IV fluid and vasoconstrictor meds do not help this condition
BP, HR
VS assessment during rapid infusions
Methylphenidate (Ritalin)
a stimulant used in treating ADHD
What lab needs to be monitored with clozaril?
WBCs - risk for infection
women
____________ have a much higher rate of suicide attempts
platelet counts
_____________, bleeding time determination, and clotting times are nursing considerations for valproate
protestants
_________________ have had a higher rate of suicide than either Catholics or Jews
Which of the following classification of medication used to treat dyslipidemia has the greatest ability to increase HDL levels? a. Niacin b. PCSK9 Inhibitors c. Bile Acid Sequestrants d. Statins
a. Niacin
V: dementia
a *decline* (over time/gradual) of reasoning, memory, judgment and other cognitive functions (v. delirium - fill in the blank)
V: delirium
a *transient* (short term), usually reversible, cause of cerebral dysfunction (v. dementia - fill in the blank)
V: sepsis/septicemia
a bodywide infection that overwhelms the immune system and *causes severe multi-organ compromise/failure*
sepsis
a bodywide infection that overwhelms the immune system and causes severe multi-organ compromise
V: ulcerative colitis (UC)
a chronic inflammatory bowel disorder that affects the mucosa and submucosa of the colon and rectum - *affects only large intestine* - affects upper layers of intestinal mucosa - pseudopolyps - no fistulas/anal fissures - can lead to colon cancer
MS
a chronic neurological disorder that affects the brain and spinal cord; a demyelinating disorder that results in inflammation and damage to the myelin and other cells within the CNS
V: MS (multiple sclerosis)
a chronic neurological disorder that affects the brain and spinal cord; a demyelinating disorder that results in inflammation and damage to the myelin and other cells within the CNS
V: Ischemic stroke- pathophysiology
a clot commonly travels up in the internal carotid artery into the middle cerebral artery and becomes lodged, causing ischemia of brain tissue >> ischemia leads to cerebral infarction
dementia
a decline of reasoning, memory, judgment and other cognitive functions
respect
a feeling of deep admiration for someone or something elicited by their abilities, qualities, or achievements
Epiglottis
a flap of cartilage at the root of the tongue, which is depressed during swallowing to cover the opening of the windpipe.
Hemophilia
a group of hereditary bleeding disorders in which a blood-clotting factor is missing
paranoid personality disorder
a pattern of pervasive mistrust and suspiciousness of others, and misinterpretation of others' motives as malevolent. Oversensitive, suspicious, feels threatened. NI: clear, concise, calm, confident in stance
antisocial personality disorder
a pattern of socially irresponsible, exploitative, and guiltless behavior that reflects a general disregard for the rights of others >> exploit and manipulate others for personal gain; unconcerned with obeying the law. They have difficulty sustaining consistent employment and developing stable relationships.
ALS
a progressive neurodegenerative disease that is characterized by a loss of both upper and lower motor neurons and eventually results in respiratory failure
V: ALS (amyotrophic lateral sclerosis)
a progressive neurodegenerative disease that is characterized by a loss of both upper and lower motor neurons and eventually results in respiratory failure
love-intimacy touch
a touch indicating deep emotional feeling, such as two romantic partners holding hands or two close friends embracing
functional-professional touch
a touch used to accomplish a task, ex. measuring a customer for a suit
delirium
a transient, usually reversible, cause of cerebral dysfunction
V: aura
a unique sensation *prior to seizure* (i.e. strange light, unpleasant smell or confusing thoughts/experiences)
aura
a unique sensation prior to seizure, i.e. strange light, unpleasant smell or confusing thoughts/experiences
johari window
a visual representation of components of the self that are known or unknown to the self and to others
A client who has been diagnosed with a phobic disorder asks the nurse if there are any medications that would be beneficial in treating phobic disorders. Which of the following would be accurate responses by the nurse? Select all that apply. a. specific phobias are generally not treated with medication unless accompanied by panic attacks. b. some anti-anxiety agents have been successful in treating social phobias c. beta-blockers have been used successfully to treat phobic responses to public performance d. some antidepressant agents have been successful in diminishing symptoms of agoraphobia and social anxiety disorder (social phobia)
a, b, c, and d
On the fifth day postpartum, a woman calls her healthcare provider and reports pronounced fatigue, sadness and tearfulness. She states, "I feel so overwhelmed, I don't know what to do!" Which of the following questions is most appropriate for the healthcare provider to ask? a. "Do you ever think about harming yourself or your baby?" b. "Is there a friend or relative that come and help you care for your baby?" c. "How much sleep do you get in a twenty-four hour period?" d. "Do you blame yourself for not being able to cope with motherhood?"
a. "Do you ever think about harming yourself or your baby?"
What tool should a nurse use to differentiate occasional spontaneous behaviors of children from behaviors associated with bipolar disorder? a. "FIND" tool b. "Monotherapy" tool c. "Consensus Committee" tool d. "Risk Activity" tool
a. "FIND" tool
A client diagnosed with major depressive disorder states, "I've been feeling 'down' for 3 months. Will I ever feel like myself again?" Which reply by the nurse will best assess this client's affective symptoms? a. "Help me understand what you mean when you say, 'feeling down'?" b. "Have you been diagnosed with any physical disorder within the last 3 months?" c. "Have you ever felt this way before?" d. "People who have mood changes often feel better when spring comes."
a. "Help me understand what you mean when you say, 'feeling down'?"
An elderly client diagnosed with schizophrenia takes an antipsychotic and a beta-adrenergic blocking agent (propranolol) for hypertension. Understanding the combined side effects of these drugs, the nurse would most appropriately make which statement? a. "Rise slowly when you change position from lying to sitting or sitting to standing." b. "Wear sunscreen and try to avoid midday sun exposure." c. "Make sure you concentrate on taking slow, deep, cleansing breaths." d. "Watch your diet and try to engage in some regular physical activity.
a. "Rise slowly when you change position from lying to sitting or sitting to standing."
A client diagnosed with schizophrenia tells a nurse, "The "Shopatouliens" took my shoes out of my room last night." Which is an appropriate charting entry to describe this client's statement? a. "The client is expressing a neologism." b. "The client is experiencing a paranoia." c. "The client is experiencing command hallucinations." d. "The client is verbalizing a word salad."
a. "The client is expressing a neologism."
A client is questioning the nurse about a newly prescribed medication, acamprosate calcium (Campral). Which is the most appropriate reply by the nurse? a. "This medication will help you maintain your abstinence." b. "This medication will decrease the effect alcohol has on your body." c. "This medication will lower your risk of experiencing a complicated withdrawal." d. "This medication will cause uncomfortable symptoms if you combine it with alcohol."
a. "This medication will help you maintain your abstinence."
The healthcare provider is teaching a patient diagnosed with schizophrenia about the medication clozapine (Clozaril). Which of the following will be included in the teaching? Select all that apply. a. "You should eat a healthy diet with plenty of fruits, vegetables, and fiber." b. "Remember that it's important that you avoid all citrus and citrus juices." c. "Remember to make position changes slowly until you get used to the medication." d. "Call our office if you experience increased thirst and increased urination." e. "Let us know if you experience symptoms of infection such as fever or fatigue." f. "You'll need to come in periodically so your lipid profile can be monitored."
a. "You should eat a healthy diet with plenty of fruits, vegetables, and fiber." c. "Remember to make position changes slowly until you get used to the medication." e. "Let us know if you experience symptoms of infection such as fever or fatigue." f. "You'll need to come in periodically so your lipid profile can be monitored."
A nurse is reviewing STAT laboratory data of a client presenting in the emergency department. At what minimum blood alcohol level should a nurse expect intoxication to occur? a. 100 mg/dL b. 50 mg/dL c. 300 mg/dL d. 250 mg/dL
a. 100 mg/dL
What are the hormones that regulate calcium and bone metabolism? Select all that apply. a. Calcitonin b. Vitamin B c. Vitamin D d. Parathyroid hormone e. Magnesium
a. Calcitonin c. Vitamin D d. Parathyroid hormone
What is the term that refers to unilateral head pain that may or may not be accompanied by an aura? a. Migraine headache b. Menstrual headache c. Tension headache d. Nauseous headache
a. Migraine headache
A drug used for the classic treatment of acute opioid overdose and misuse is: a. Naloxone b. Hydromorphone c. Methadone d. Hydrocodone
a. Naloxone
What lifestyle changes will the nurse encourage clients to make in order to manage dyslipidemia? SELECT ALL THAT APPLY. a. Smoking cessation b. Reduce smoking c. Decrease physical activity d. Dietary modification e. Increase physical activity
a. Smoking cessation d. Dietary modification e. Increase physical activity
Which of the following explanations should a nurse include when teaching parents why is it difficult to diagnose a child or adolescent exhibiting symptoms of bipolar disorder? Select all that apply. a. bipolar symptoms are similar to attention deficit-hyperactivity disorder symptoms. b. children are naturally active, energetic, and spontaneous. c. the diagnosis of bipolar disorder cannot be assigned prior to the age of 18. d. genetic predisposition is not a reliable diagnostic determinant.
a. bipolar symptoms are similar to attention deficit-hyperactivity disorder symptoms. b. children are naturally active, energetic, and spontaneous.
A patient diagnosed with depression is prescribed fluoxetine (Prozac). Which of the following would the healthcare provider most likely observe if the patient experiences an adverse effect of this medication? a. decreased libido b. urinary retention c. weight loss d. bradycardia
a. decreased libido
A nurse is assessing a client diagnosed with schizophrenia. The nurse asks the client, "Do you receive special messages from certain sources, such as the television or radio?" Which potential symptom of this disorder is the nurse assessing? a. delusions of reference b. paranoia c. thought insertion d. magical thinking
a. delusions of reference
A nurse has been caring for a client diagnosed with generalized anxiety disorder (GAD). Which of the following nursing interventions would address this client's symptoms? (Select all that apply.) a. encourage the client to cognitively reframe thoughts about situations that generate anxiety. b. encourage the client to avoid any situation that causes stress. c. encourage the client to avoid caffeinated products. d. encourage the client to recognize the signs of escalating anxiety. e. encourage the client to employ newly learned relaxation techniques.
a. encourage the client to cognitively reframe thoughts about situations that generate anxiety. c. encourage the client to avoid caffeinated products. d. encourage the client to recognize the signs of escalating anxiety. e. encourage the client to employ newly learned relaxation techniques.
A patient is admitted to an inpatient psychiatric unit because of a plan to commit suicide by taking an overdose of medication. When administering medications to this patient, which of these interventions is the priority? a. ensure that the patient is not "cheeking" the medications b. monitor the patient for signs of anorexia, nausea, and xerostomia c. teach the patient how to recognize adverse effects of the medications d. monitor the patient's vital signs before administration of mediations
a. ensure that the patient is not "cheeking" the medications
A nurse is planning care for a child who is experiencing depression. Which medication is approved by the U.S. Food and Drug Administration (FDA) for the treatment of depression in children and adolescents? a. fluoxetine (Prozac) b. sertraline (Zoloft) c. paroxetine (Paxil) d. citalopram (Celexa)
a. fluoxetine (Prozac)
A client is admitted for alcohol detoxification. During detoxification, which symptoms should the nurse expect to assess? a. gross tremors, delirium, hyperactivity b. oculogyric crisis, amnesia, ataxia, and hypertension c. hallucinations, fine tremors, confabulation, and orthostatic hypotension d. disorientation, peripheral neuropathy, and hypotension
a. gross tremors, delirium, hyperactivity
The most effective nursing approach to deal with denial in a client who abuses substances is a. having the client identify the effects of substance use on his or her life. b. discussing the addictive personality. c. describing the physiologic effects of substances on the body. d. confronting the client regarding his or her hopeless life situation.
a. having the client identify the effects of substance use on his or her life.
A client diagnosed with schizoaffective disorder is admitted for social skills training. Which information should be taught by the nurse? a. how to make eye contact when communicating b. how to be a leader c. deep breathing techniques to decrease stress d. the side effects of medications
a. how to make eye contact when communicating
A patient diagnosed with bipolar disorder is experiencing the manic phase of the disorder. Which neurotransmitter alterations will the healthcare provider identify as contributing to mania? Select all that apply. a. increased norepinephrine b. increased serotonin c. decreased dopamine d. decreased GABA e. decreased acetylcholine f. increased glutamate
a. increased norepinephrine d. decreased GABA f. increased glutamate
Emergency medical personnel bring a patient to the emergency department. The patient reports overdosing on sertraline (Paxil) in a suicide attempt. Which of these would the healthcare provider identify as consistent with serotonin syndrome? Select all that apply. a. muscle rigidity b. facial grimacing c. hypothermia d. GI distress e. diaphoresis f. tachycardia
a. muscle rigidity d. GI distress e. diaphoresis f. tachycardia
The healthcare provider is teaching a group of students about the biological basis of schizophrenia. Which of the following will be included in the teaching? Select all that apply. a. prenatal exposure to influenza b. decreased norepinephrine levels c. family history of schizophrenia d. GABAergic interneuron dysregulation e. stimulation of the amygdala f. increased dopamine levels
a. prenatal exposure to influenza b. decreased norepinephrine levels c. family history of schizophrenia d. GABAergic interneuron dysregulation f. increased dopamine levels
Which nursing intervention would be most appropriate when caring for an acutely agitated client with paranoia? a. provide personal space to respect the client's boundaries. b. use therapeutic touch to increase trust and rapport. c. provide neon lights and soft music. d. maintain continual eye contact throughout the interview.
a. provide personal space to respect the client's boundaries.
During a panic attack, a patient states, "I feel like I'm going to die!" The patient is hyperventilating, tachycardic, and reports feeling upper extremity numbness and tingling. Based on this patient's presentation, the healthcare provider would anticipate which additional clinical manifestation of the panic attack? a. respiratory alkalosis b. respiratory acidosis c. hypercapnia d. Kussmaul respirations
a. respiratory alkalosis
A priority nursing diagnosis for a 25-year-old client admitted to a drug rehabilitation program 4 days ago for chronic cocaine abuse would be: a. risk for self-directed violence related to suicidal depression b. risk for self-directed violence related to hyperactivity c. disturbed sensory perception related to stimulant drug use d. risk for noncompliance related to chronic drug use
a. risk for self-directed violence related to suicidal depression
When assessing a patient with severe depression, which of the following would the healthcare provider identify as a cognitive alteration? a. somatic delusions b. anxiety c. low self-esteem d. powerlessness
a. somatic delusions
A client is admitted with a diagnosis of brief psychotic disorder, with catatonic features. Which symptoms are associated with the catatonic specifier? a. stupor, muscle rigidity, and negativism b. ataxia and akinesia c. substance abuse and cachexie d. strong ego boundaries and abstract thinking
a. stupor, muscle rigidity, and negativism
Which term should a nurse use to describe the administration of a central nervous system (CNS) depressant during alcohol withdrawal? a. substitution therapy b. codependency therapy c. deterrent therapy d. antagonist therapy
a. substitution therapy
A nurse admits an older client who is experiencing memory loss, confused thinking, and apathy. A psychiatrist suspects depression. What is the rationale for performing a mini-mental status exam? a. to rule out neurocognitive disorder b. to rule out schizophrenia c. to rule out bipolar disorder d. to rule out a personality disorder
a. to rule out neurocognitive disorder
Which of the following defense mechanisms may be observed in a patient diagnosed with obsessive-compulsive disorder (OCD)? a. undoing b. regression c. projection d. denial
a. undoing
If clozapine (Clozaril) therapy is being considered, the nurse should evaluate which laboratory test to establish a baseline for comparison in order to recognize a potentially life-threatening side effect? a. white blood cell count b. liver function studies c. blood urea nitrogen d. creatinine clearance
a. white blood cell count
therapeutic use of self
ability to use one's personality consciously and in full awareness in an attempt to establish relatedness and to structure nursing interventions
hydrocephalus
abnormal accumulation of fluid (CSF) in the brain
tracheoesophageal fistula
abnormal passageway pertaining to the trachea and esophagus (between the trachea and esophagus)
How should tolcapone be discontinued?
abrupt withdrawal can lead to serious complications *tapper over 2 weeks* to prevent adverse effects
tolcapone
abrupt withdrawal is not recommended and tapering over 2 weeks is necessary to prevent adverse effects
values
abstract standards, positive or negative, that represent an individual's ideal mode of conduct and ideal goals
V: pulmonary edema
accumulation of fluid around alveoli inhibiting O transfer << inc in hydrostatic pressure in capillary bed of lungs (similar to peripheral edema but in lungs) - sudden progressive pulmonary edema (excess fluid in lungs) --> *Adult respiratory distress syndrome (ARDS)* - most common cause = *left ventricular heart failure (LVF)*
Important to remember in therapeutic communication
acknowledge ALL emotions
second stage of intervention
addressing the underlying cause of the self-destructive behavior; if the patient has selected suicide to escape physical pain, then a comprehensive pain management program must be initiated. If the patient is depressed, then the depression must be treated with medication and psychotherapy. If the suicide attempt has been in response to the patient with schizophrenia struggling with destructive hallucinations and delusions, then these must be aggressively treated. The key remains an accurate assessment and diagnosis followed by a comprehensive treatment plan
What to do when adrenergic drug extravasates
administer phentolamine- through IV or subcutaneous around area of extravasates
What are the administration guidelines for vasopressor drugs?
administer through large vein or central line because of BBW regarding potential risk of tissue damage with extravasation
what is the first step in recovery?
admitting you have a problem
What is the first step to recovery for addiction?
admitting you have a problem & relating it to how it affects your life
Calcium Channel Blockers
agents that inhibit the entry of calcium ions into heart muscle cells, causing a slowing of the heart rate, a lessening of the demand for oxygen and nutrients, and a relaxing of the smooth muscle cells of the blood vessels to cause dilation; used to prevent or treat angina pectoris, some arrhythmias, and hypertension
What are red flags for PTSD?
aggression, best friend died guilt "it should have been me"
giving broad openings
allows the client to take the initiative in introducing the topic; emphasizes the importance of the client's role in the interaction.
S/S Autism *Spectrum* Disorder
along a spectrum with varying levels of functionality. - difficulty expressing self - transitions incredibly difficult (processing delay) - interpretation of pain varies - may be highly functional and highly intelligent despite communication impairments and repetitive or restrictive behaviors. - This information is important in creating an accurate plan of care for the client - should be understood on a continuum ranging from mild to severe.
30 minutes
amount of time in MI before irreversible cellular damage and necrosis occur
V: 30 minutes
amount of time in MI before irreversible cellular damage and necrosis occur
Palliative care
an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual -focused on the physical, mental, and spiritual distress for individuals who have an incurable illness - usually involves the combine efforts of an interprofessional team - expected outcomes: manage current manifestations of the illness and prevent new manifestations from occurring
palliative care
an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual; can begin earlier than hospice care
judgment, insight and intellect
an assessment of the patient's judgment is important; how a person has handled stress and how he or she will handle it in the future are major concerns, keep in mind that the less judgment the patient has, the greater the potential for suicide. Impaired decision making is associated with suicidal behavior in both adults and adolescents
belief
an idea that one holds to be true
birthday
an increased risk of suicide on day of one's _____________ itself for males in both the general population and the clinical population; increased risk was especially significant in males aged 35 years and older
irrational belief
an individual holds the idea as true despite the existence of objective, contradictory evidence
insulin coma therapy
an injection of insulin produced a hypoglycemic coma, which was believed to alleviate the symptoms of schizophrenia, caused many deaths
therapeutic relationship
an interaction between two people (usually a caregiver and a care receiver) in which input from both participants contributes to a climate of healing, growth promotion, and/or illness prevention
cataract
an opacification (clouding) of the lens of the eye which can significantly interfere with light transmission to the retina and the ability to perceive images clearly
epinephrine indication
anaphylactic shock
Chlordiazepoxide (Librium)
antianxiety agent, benzodiazepine substitution therapy in alcohol withdrawal
Cefazolin (Ancef)
antibiotic
Isonicotinylhydrazide (INH)
antibiotic TX for TB
Benzotropine (Cogentin)
anticholinergic drug used to treat extrapyramidal symptoms - given IM
medications linked to suicide
antidepressants, anticonvulsants, pain medication, smoking cessation medications, glucocorticoids
Drugs that can cause muscle spasms
antipsychotic drugs
microcytic/hypochromic
appearance of RBCs following chronic blood loss r/t to anemia
Evidence Based Practice (EBP)
applying best available research results when making decisions about health care decision making = research evidence + clinical expertise + patient preferences <> dynamic healthcare w/ pt focus
EBP
applying the best available research results when making decisions about healthcare
increased risk for stroke
arterial plaque calcifies over time, fissures easily, and pieces of plaque break off; they travel, leading to an...
requesting an explanation
asking "why" implies that client must defend his or her behavior or feelings
encouraging comparison
asking client to compare similarities and differences in ideas, experiences, or interpersonal relationships helps the client recognize life experiences that tend to recur as well as those aspects of life that are changeable
encouraging description of perceptions
asking the client to verbalize what is being perceived; often used with clients experiencing hallucinations
Nursing consideration for digoxin
assess HR (for full minute), if it's <60 hold the medicine and call doctor
What assessments should be done for heart failure?
assess for improved myocardial function: a. systolic blood pressure > 90 mm Hg b. heart rate < 100 beats/min c. regular, respiratory rate of 20/min d. no dyspnea e. less edema f. daily weights
What does The Joint Commission include in the standards by which it evaluates health care organizations?
assessment and management of pain for all patients (5th vital sign)
(continous positive airway pressure) CPAP/PEEP
assists spontaneous breathing patients to improve oxygenation by elevating the end-expiratory pressure in the lungs throughout the respiratory cycle. Can be used as a weaning mode and for nocturnal ventilation to splint open the UPPER airway, preventing upper airway obstruction in patients with obstructive sleep apnea Intubated and nonintubated patients. when low (2-5) PEEP is involved for intubated; if FiO2 >50% peep inc incrementally >> SaO2 >90% or PaO2 60-70
p wave
atrial depolarization
What is rationalization?
attempting to make excuses or formulate logical reasons to justify unacceptable feelings or behaviors example: John tells the rehab nurse, "I drink because it's the only way I can deal with my bad marriage and my worse job."
defending
attempting to protect someone or something from attack or defending what the client has criticized, implies that he or she has no right to express their ideas
indicating the existence of an external source of power
attributing the source of thoughts, feelings and behavior to others or to outside influences encourages the client to project blame for his or her thoughts or behaviors on others rather than accepting personal responsibility
Ziprasidone (Geodon)
atypical antipsychotic for bipolar mania, acute agitation in schizophrenia
A nursing instructor is teaching students about cirrhosis of the liver. Which of the following student statements about the complications of hepatic encephalopathy should indicate that further student teaching is needed? Select all that apply. a. "This condition is caused by the inability of the liver to convert ammonia to urea." b. "A diet rich in protein will promote hepatic healing." c. "This condition leads to a rise in serum ammonia, resulting in impaired mental functioning." d. "Neomycin and lactulose are used in the treatment of this condition." e. "In this condition, blood accumulates in the abdominal cavity."
b. "A diet rich in protein will promote hepatic healing." e. "In this condition, blood accumulates in the abdominal cavity."
A highly agitated client paces the unit and states, "I could buy and sell this place." The client's mood fluctuates from fits of laughter to outbursts of anger. Which is the most accurate documentation of this client's behavior? a. "Rates mood 8/10. Exhibiting looseness of association. Euphoric." b. "Agitated and pacing. Exhibiting grandiosity. Mood labile." c. "Mood labile. Exhibiting delusions of reference. Hyperactive." d. "Mood euthymic. Exhibiting magical thinking. Restless."
b. "Agitated and pacing. Exhibiting grandiosity. Mood labile."
A family member is seeking advice about an elderly parent who seems to worry unnecessarily about everything. The family member states, "Should I seek psychiatric help for my mother?" Which is an appropriate nursing reply? a. "My mother also worries unnecessarily. I think it is part of the aging process." b. "Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and when it impairs functioning." c. "From what you have told me, you should get her to a psychiatrist as soon as possible." d. "Anxiety is a complex phenomenon and is effectively treated only with psychotropic medications."
b. "Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and when it impairs functioning."
Parents ask a nurse how they should reply when their child, diagnosed with schizophrenia, tells them that voices command him to harm others. Which is the appropriate nursing reply? a. "Ignore what he is saying, while attempting to discover the underlying cause." b. "Focus on the feelings generated by the hallucinations and present reality." c. "Present objective evidence that the voices are not real." d. "Tell him to stop discussing the voices."
b. "Focus on the feelings generated by the hallucinations and present reality."
A mother with a history of chronic heroin use has lost custody of her children due to abuse and neglect. She has been admitted to an inpatient drug rehabilitation program. Which client statement should a nurse associate with a positive prognosis for this client? a. "I'm going to get all my children back. They need their mother." b. "I cannot control my use of heroin. It's stronger than I am." c. "Once I deal with my childhood physical abuse, recovery should be easy." d. "I'm not going to use heroin ever again. I know I've got the willpower to do it this time."
b. "I cannot control my use of heroin. It's stronger than I am."
A client with a history of heavy alcohol use is brought to an emergency department (ED) by family members who state that the client has had nothing to drink in the last 24 hours. Which client symptom should the nurse immediately report to the ED physician? a. antecubital bruising b. blood pressure of 180/100 Hg c. dehydration d. mood rating of 2/10 on numeric scale
b. blood pressure of 180/100 Hg
An isolative client was admitted 4 days ago with a diagnosis of major depressive disorder. Which nursing statement would best motivate this client to attend a therapeutic group being held in the milieu? a. "We'll go to the day room when you are ready for group." b. "I'll walk with you to the day room. Group is about to start." c. "Let me tell you about the benefits of attending this group." d. "It must be difficult for you to attend group when you feel so bad."
b. "I'll walk with you to the day room. Group is about to start."
Which statement should indicate to a nurse that an individual is experiencing a delusion? a. "I see my dead husband everywhere I go." b. "There's an alien growing in my liver." c. "I'm not going to eat my food. It smells like brimstone." d. "The IRS may audit my taxes."
b. "There's an alien growing in my liver."
A nursing instructor is teaching about the prevalence of bipolar disorder. Which student statement indicates that learning has occurred? a. "This disorder's prevalence cannot be evaluated on the basis of socioeconomic groups." b. "This disorder is more prevalent in the higher socioeconomic groups." c. "This disorder is equally prevalent in all socioeconomic groups." d. "This disorder is more prevalent in the lower socioeconomic groups."
b. "This disorder is more prevalent in the higher socioeconomic groups."
During a counseling session with a patient diagnosed with depression, the patient states, "I know my husband doesn't love me anymore." Which response by the healthcare provider demonstrates therapeutic communication? a. "Try not to think about it too much because it will make your depression worse." b. "What happened to make you think your husband doesn't love you anymore?" c. "Let's talk about what you did to cause him to stop loving you." d. "You really should try not to dwell on something that probably isn't true."
b. "What happened to make you think your husband doesn't love you anymore?"
A client refuses to go on a cruise to the Bahamas with his spouse because of fearing that the cruise ship will sink and all will drown. Using a cognitive theory perspective, the nurse should use which of these statements to explain to the spouse the etiology of this fear? a. "Your spouse may have a genetic predisposition to overreacting to potential danger." b. "Your spouse may be experiencing a distorted and unrealistic appraisal of the situation." c. "Your spouse may have high levels of brain chemicals that may distort thinking." d. "Your spouse may be unable to resolve internal conflicts, which result in projected anxiety."
b. "Your spouse may be experiencing a distorted and unrealistic appraisal of the situation."
A client has been taking lithium for several years with good symptom control. The client presents in the emergency department with blurred vision, tinnitus, and severe diarrhea. The nurse should correlate these symptoms with which lithium level? a. 2.3 mEq/L b. 1.7 mEq/L c. 3.7 mEq/L d. 1.3 mEq/L
b. 1.7 mEq/L
While reviewing a patient's lab results who was recently started on Theophylline, the nurse understands that the ideal therapeutic range is: a. < 5 mcg/mL b. 5 - 15 mcg/mL c. > 20 mcg/mL d. 0 - 5 mcg/mL
b. 5 - 15 mcg/mL
What are possible causes of peptic ulcer disease? Select all that apply. a. Eating a high fiber diet b. Infection with Helicobacter pylori c. Use of NSAIDs d. Stress (major trauma or severe illness) e. Drinking too much milk
b. Infection with Helicobacter pylori c. Use of NSAIDs d. Stress (major trauma or severe illness)
What are the two goals of therapy for peptic ulcer disease and GERD? Select all that apply. a. Redirect lesions b. Promote healing of lesions c. Prevent recurrence of lesions d. Isolate the spread of lesions
b. Promote healing of lesions c. Prevent recurrence of lesions
Mrs. Klopp is taking an expectorant that is in the form of an extended-release capsule. What should the nurse do? Select all that apply a. Open the capsule and put it into pudding. b. Request that Mrs. Klopp swallow the pill whole and intact. c. Provide Mrs. Klopp with plenty of water to assist in loosening the mucus. d. Request an order for nothing by mouth for Mrs. Klopp.
b. Request that Mrs. Klopp swallow the pill whole and intact. c. Provide Mrs. Klopp with plenty of water to assist in loosening the mucus.
A client diagnosed with schizophrenia is slow to respond and appears to be listening to unseen others. Which medication should a nurse expect a physician to order to address this type of symptom? a. Haloperidol (Haldol) to address the negative symptom b. Risperidone (Risperdal) to address the positive symptom c. Clonazepam (Klonopin) to address the positive symptom d. Clozapine (Clozaril) to address the negative symptom
b. Risperidone (Risperdal) to address the positive symptom
Which types of headaches are the acetaminophen-aspirin-caffeine combination used for? Select all that apply. a. Mild headaches b. Tension headaches c. Migraine headaches d. Spasmodic headaches e. Sinus headaches
b. Tension headaches c. Migraine headaches
A client diagnosed with chronic alcohol use disorder is being discharged from an inpatient treatment facility after detoxification. Which client outcome related to Alcoholics Anonymous (AA) would be most appropriate for a nurse to discuss with the client during discharge teaching? a. after discharge, the client will seek appropriate deterrent medications through AA. b. after discharge, the client will immediately attend 90 AA meetings in 90 days. c. after discharge, the client will rely on an AA sponsor to help control alcohol cravings. d. after discharge, the client will incorporate family in AA attendance.
b. after discharge, the client will immediately attend 90 AA meetings in 90 days.
What is the main difference between an individual diagnosed with bipolar I and bipolar II? a. an individual diagnosed with bipolar I has never had a manic episode. An individual diagnosed with bipolar II disorder has had at least one manic episode. b. an individual diagnosed with bipolar II has never had a manic episode. An individual diagnosed with bipolar I disorder has had at least one manic episode. c. an individual diagnosed with bipolar I has never had a hypomanic episode. An individual diagnosed with bipolar II disorder has had at least one manic episode d. an individual diagnosed with bipolar II has never had a hypomanic episode. An individual diagnosed with bipolar I disorder has had at least one hypomanic episode.
b. an individual diagnosed with bipolar II has never had a manic episode. An individual diagnosed with bipolar I disorder has had at least one manic episode.
A client presents in the emergency department with complaints of overwhelming anxiety. Which of the following is a priority for the nurse to assess? a. substance use history b. cardiac status c. current stressors d. risk for suicide
b. cardiac status
When talking with a patient diagnosed with schizophrenia, the healthcare provider notes the patient continually states, "I'm the man with a plan, yes I am." The healthcare provider will document this behavior as which of the following? a. tangentiality b. clang association c. word salad d. loosening of association
b. clang association
How would a nurse differentiate a client diagnosed with panic disorder from a client diagnosed with generalized anxiety disorder (GAD)? a. GAD is acute in nature, and panic disorder is chronic. b. depersonalization is commonly seen in panic disorder and absent in GAD. c. chest pain is a common GAD symptom, whereas this symptom is absent in panic disorders. d. hyperventilation is a common symptom in GAD and rare in panic disorder.
b. depersonalization is commonly seen in panic disorder and absent in GAD.
A depressed client reports to a nurse a history of divorce, job loss, family estrangement, and cocaine abuse. According to learning theory, what is the cause of this client's symptoms? a. depression is a result of abandonment b. depression is a result of repeated failures c. depression is a result of negative thinking d. depression is a result of anger turned inward
b. depression is a result of repeated failures
Laboratory results reveal elevated levels of prolactin in a client diagnosed with schizophrenia. When assessing the client, the nurse should expect to observe which symptoms? Select all that apply. a. apathy b. galactorrhea c. gynecomastia d. anhedonia e. social withdrawal
b. galactorrhea c. gynecomastia
A patient is diagnosed with mild depression. Which of the following describe a physiological alteration often associated with this diagnosis? Select all that apply. a. difficulty concentrating b. hypersomnia c. amenorrhea d. insomnia e. anorexia
b. hypersomnia d. insomnia e. anorexia
Upon admission for symptoms of alcohol withdrawal, a client states, "I haven't eaten in 3 days." Assessment reveals BP 170/100 mm Hg, P 110, R 28, and T 97 degrees F (36 degrees C) with dry skin, dry mucous membranes, and poor skin turgor. What should be the priority nursing diagnosis? a. fluid volume excess b. imbalanced nutrition: less than body requirements c. knowledge deficit d. ineffective individual coping
b. imbalanced nutrition: less than body requirements
A 19-year-old client has been admitted to the ED after snorting heroin with her boyfriend. She has pinpoint pupils and is unconscious. The client's priority nursing diagnosis is: a. disturbed sensory perception b. ineffective breathing pattern c. impaired physical mobility d. risk for imbalanced fluid volume
b. ineffective breathing pattern
A client recently discharged from an alcohol rehabilitation program is brought to the hospital in a state of prostration with severe throbbing headache, tachycardia, a beet-red face, dyspnea, and continuous vomiting. The client's significant other states the client got sick about 15 minutes after drinking a glass of wine. The nurse should be guided in assessment by the suspicion that the client: a. is exhibiting symptoms of cross dependence b. is reacting to disulfiram (Antabuse) c. has alcohol intoxication d. is having a stroke
b. is reacting to disulfiram (Antabuse)
A paranoid client presents with bizarre behaviors, neologisms, and thought insertion. Which nursing action should be prioritized to maintain this client's safety? a. assess triggers for bizarre, inappropriate behaviors b. note escalating behaviors and intervene immediately c. interpret attempts at communication d. assess for medication noncompliance
b. note escalating behaviors and intervene immediately
A patient is prescribed ziprasidone (Geodon) for the treatment of schizophrenia. Which of the following would alert the healthcare provider that the patient is experiencing an adverse effect of the medication? Select all that apply. a. seizure activity b. palpitations and syncope c. rigidity and bradykinesia d. increased temperature e. pulmonary crackles
b. palpitations and syncope c. rigidity and bradykinesia d. increased temperature e. pulmonary crackles
A client is diagnosed with schizophrenia. A physician orders haloperidol (Haldol), 50 mg bid; benztropine (Cogentin), 1 mg prn; and zolpidem (Ambien), 10 mg HS. Which client behavior would warrant the nurse to administer benztropine? a. tardive dyskinesia b. restlessness and muscle rigidity c. reports of hearing disturbing voices d. tactile hallucinations
b. restlessness and muscle rigidity
A nurse is discussing treatment options with a client whose life has been negatively impacted by claustrophobia. The nurse would expect which of the following behavioral therapies to be most commonly used in the treatment of phobias? Select all that apply. a. benzodiazepine therapy b. systematic desensitization c. assertiveness training d. aversion therapy e. imploding (flooding)
b. systematic desensitization e. imploding (flooding)
A client diagnosed with alcohol use disorder joins a community 12-step program and states, "My life is unmanageable." How should the nurse interpret this client's statement? a. the client has met the requirements to be designated as an Alcoholics Anonymous sponsor. b. the client has accomplished the first of 12 steps advocated by Alcoholics Anonymous. c. the client is using minimization as an ego defense. d. the client is ready to sign an Alcoholics Anonymous contract for sobriety.
b. the client has accomplished the first of 12 steps advocated by Alcoholics Anonymous.
A client who is diagnosed with major depressive disorder asks the nurse what causes depression. Which of these is the most accurate response? a. depression is caused by a deficiency in neurotransmitters, including serotonin and norepinephrine. b. the exact cause of depressive disorders is unknown. A number of things, including genetic, biochemical, and environmental influences, likely play a role. c. depression is a learned state of helplessness cause by ineffective parenting. d. depression is caused by intrapersonal conflict between the id and the ego
b. the exact cause of depressive disorders is unknown. A number of things, including genetic, biochemical, and environmental influences, likely play a role.
An adult client diagnosed with bipolar I disorder is prescribed lamotrigine (Lamictal), 400 mg three times a day, for mood stabilization. Which is a true statement about this medication order? a. this dosage is lower than the recommended dosage range. b. this dosage is more than twice the recommended dosage range. c. this dosage is four times higher than the recommended dosage range. d. this dosage is within the recommended dosage range
b. this dosage is more than twice the recommended dosage range.
V: Most common cause of STDs
bacteria
attitudes and beliefs
become values only when they have been acted upon
nursing precautions chemotherapy
becomes of potential carcinogenic effects, the nurse must wear gloves, mask and gown when preparing, administering or disposing medication or equipment
genuineness
being honest, direct, not using a facade
Clonazepam (Klonopin)
benzodiazepine, anti-anxiety agent - short-term intervention because the drug is addictive - Do not stop drug abruptly.
hand hygiene
best way to prevent infection
adrenergic receptors
beta 1, beta 2, and alpha, receivers of catecholamines
lower LDL
bile acid sequestrants, PCSK9 inhibitors
complete heart block
block in electrical activity at AV node. atria and ventricles beat independently; temporary pacing required
V: citrate
blood transfusions contain this substance, which binds with Ca+; therefore, *multiple blood transfusions requires Ca+ supplementation*
systems thinking
body of knowledge and tools that allow the nurse to manage whatever environmental and system resources exist for the patient/family and staff, within or across healthcare and non-healthcare systems
Aplastic anemia
bone marrow fails to produce all three types of blood cells, leading to pancytopenia
hepatitis a/b
both are preventable diseases; vaccines are available to prevent disease following known or suspected exposure
V: ischemic penumbra
brain cells that lie at the perimeter of the stroke region that are hypoperfused (dec blood flow through the organ) but are not irreversibly damaged - this term refers to the /perimeter around the core ischemic area/ - if left untreated >> ischemia and infarction
ischemic penumbra
brain cells that lie at the perimeter of the stroke region that are hypoperfused but are no irreversibly damaged; this term refers to the perimeter around the core ischemic area
What are you educating parents on for a patient with ADHD?
break up homework into small tasks
myoclonic seizure
brief, shock like jerks of muscles (rapid alternating contraction/relaxation of muscles)
beta2-adrenergic receptors
bronchodilation (lungs), vasodilation (blood vessels), liver and pancreas
What is the effect to response activation of beta2?
bronchodilation - drug needed for asthma vasodilation glycogenolysis and gluconeogenesis - hyperglycemia is adverse effect decreased insulin secretion
Adverse effect of timolol
burning/stinging
r/f cataracts
c-congenital a-aging t-toxicity a-accidents r-radiation a-altered metabolism c-cigarettes
A client who has been taking fluvoxamine (Luvox) without significant improvement asks a nurse, "I heard about something called a monoamine oxidase inhibitor (MAOI). Can't my doctor add that to my medications?" Which is an appropriate nursing reply? a. "The only disadvantage would be the exorbitant cost of the MAOI." b. "This combination of drugs can lead to delirium tremens." c. "A combination of an MAOI and Luvox can lead to a life-threatening hypertensive crisis." d. "That's a good idea. There have been good results with the combination of these two drugs."
c. "A combination of an MAOI and Luvox can lead to a life-threatening hypertensive crisis."
A patient diagnosed with bipolar disorder is prescribed lithium carbonate (Lithobid). When teaching the patient about the medication, which of these statements is a priority for the healthcare provider to include? a. "Call our office immediately if you experience any unusual bruising or bleeding." b. "You should avoid consuming dairy products when you are taking this medication." c. "Drink lots of fluids, especially if you are active during hot weather." d. "You should follow this low calorie, low sodium diet to prevent weight gain."
c. "Drink lots of fluids, especially if you are active during hot weather."
A patient is receiving care after being diagnosed with generalized anxiety disorder (GAD). Which of these statements made by the patient indicate to the healthcare provider that the patient is beginning to show signs of improvement? a. "As long as I take my medication, I can deal with anxiety." b. "Now I know that my anxiety is caused by a lack of sleep." c. "I can tell when I'm beginning to experience anxiety." d. "Situations that cause anxiety can always be avoided."
c. "I can tell when I'm beginning to experience anxiety."
A patient diagnosed with paranoid schizophrenia states, "My roommate is plotting to have others kill me." Which is the appropriate nursing response? a. "I know your roommate. He would do no such thing." b. "I can see why you feel that way." c. "I find that hard to believe." d. "Why made you think such a thing?"
c. "I find that hard to believe."
A patient presents to the clinic with a report of fatigue and difficulty concentrating. Which additional statement made by the patient would alert the healthcare provider to possible marijuana use? a. "I feel so anxious and have trouble sleeping" b. "I keep having really vivid and scary nightmares" c. "I've notices that my eyes are red lately" d. "I feel nauseous and don't feel like eating"
c. "I've notices that my eyes are red lately"
A nursing instructor is discussing various challenges in the treatment of clients diagnosed with bipolar disorder. Which student statement demonstrates an understanding of the most critical challenge in the care of these clients? a. "Treatment is compromised when clients can't sleep." b. "Treatment is compromised when clients have no insight into their problems." c. "Treatment is compromised when clients choose not to take their medications." d. "Treatment is compromised when irritability interferes with social interactions."
c. "Treatment is compromised when clients choose not to take their medications."
A 16-year-old client diagnosed with schizophrenia experiences command hallucinations to harm others. The client's parents ask a nurse, "Where do the voices come from?" Which is the appropriate nursing reply? a. "Your child's abnormal hormonal changes have precipitated auditory hallucinations." b. "Your child's hallucinations are caused by medication interactions." c. "Your child has a chemical imbalance of the brain, which leads to altered thoughts." d. "Your child has too little serotonin in the brain, causing delusions and hallucinations."
c. "Your child has a chemical imbalance of the brain, which leads to altered thoughts."
A client's wife has been making excuses for her alcoholic husband's work absences. In family therapy, she states, "I just need to work harder to get him there on time." Which is the appropriate nursing response? a. "Do you understand what the term 'enabler' means?" b. "Codependency is a typical behavior of spouses of alcoholics." c. "Your husband needs to deal with the consequences of his drinking." d. "Why do you assume responsibility for his behaviors?"
c. "Your husband needs to deal with the consequences of his drinking."
What is the most common type of shock? a. Distributive b. Cardiogenic c. Hypovolemic d. Obstructive
c. Hypovolemic
What are nociceptors? a. Nerve endings that respond to extreme cold. b. Nerve endings that respond to heat. c. Nerve endings that selectively respond to painful stimuli. d. Nerve endings that transmit serotonin.
c. Nerve endings that selectively respond to painful stimuli.
As the bedside nurse it is important to remind your patient taking a Fluoroquinolone drug for any ear infection, to immediately report signs of: a. Diarrhea b. Drowsiness c. Tendinitis d. Back pain
c. Tendinitis
During an admission assessment, a nurse notes that a client diagnosed with schizophrenia has allergies to penicillin, prochlorperazine (Compazine), and bee stings. On the basis of this assessment data, which antipsychotic medication would be contraindicated? a. Haloperidol (Haldol), because it is used only in elderly patients b. Risperidone (Risperdal), because it exacerbates symptoms of depression c. Thioridazine (Mellaril), because of cross-sensitivity among phenothiazines d. Clozapine (Clozaril), because of a cross-sensitivity to penicillin
c. Thioridazine (Mellaril), because of cross-sensitivity among phenothiazines
A college student is unable to take a final examination because of severe test anxiety. Instead of studying, the student relieves stress by attending a movie. Which priority nursing diagnosis should a campus nurse assign for this client? a. ineffective role performance R/T helplessness b. noncompliance R/T test taking c. altered coping R/T anxiety d. powerlessness R/T fear
c. altered coping R/T anxiety
When assessing a patient diagnosed with schizophrenia, which of the following will the healthcare provider identify as a negative symptom? a. hallucinations b. disorganized speech c. anhedonia d. delusions
c. anhedonia
A client diagnosed with schizophrenia states, "My psychiatrist is out to get me. I'm sad that the voice is telling me to stop him." What symptom is the client exhibiting, and what is the nurse's legal responsibility related to this symptom? a. altered thought processes; call an emergency treatment team meeting b. magical thinking; administer an antipsychotic medication c. command hallucinations; warn the psychiatrist d. persecutory delusions; orient the client to reality
c. command hallucinations; warn the psychiatrist
A patient is being observed for extrapyramidal symptoms. Which of these symptoms would alert the nurse to the possible onset of this condition? Select all that apply. a. flaccid extremities b. inability to concentrate c. facial grimacing d. tremors at rest e. restlessness f. blurred vision
c. facial grimacing d. tremors at rest e. restlessness
A client is diagnosed with persistent depressive (dysthymia) disorder. Which should a nurse classify as an affective symptom of this disorder? a. difficulty concentrating b. social isolation with a focus on self c. gloomy and pessimistic outlook on life d. low energy level
c. gloomy and pessimistic outlook on life
A depressed patient with a history of three suicide attempts has been taking fluoxetine (Prozac) for 1 week. The client suddenly presents with a bright affect, rates mood at 9/10, and is much more communicative. Which action should be the nurse's priority at this time? a. give the client off-unit privileges as positive reinforcement b. request that the psychiatrist reevaluate the current medication protocol c. increase frequency of client observation d. encourage the client to share mood improvement in group
c. increase frequency of client observation
A patient who overdosed on oxycodone is given naloxone. When assessing the patient, the healthcare provider would anticipate which of these clinical manifestations of opioid withdrawal? a. hyperthermia and euphoria b. bradycardia and hypothermia c. irritability and nausea d. depressed respirations and somnolence
c. irritability and nausea
The client hears the word "match." The client replies, "A match. I like matches. They are the light of the world. God will light the world. Let your light so shine." Which communication pattern does the nurse identify? a. word salad b. ideas of reference c. loose association d. clang association
c. loose association
Which of the following assessment findings in a patient's health history supports a diagnosis of substance dependence? a. patient demonstrates continued tardiness and absenteeism from work. b. patient has history of impaired judgment and risk-taking behaviors. c. patient experiences withdrawal symptoms when not using the substance. d. patient has history of numerous legal problems and interpersonal conflicts.
c. patient experiences withdrawal symptoms when not using the substance.
A patient is admitted to the medical unit after experiencing chest pain. Which of these additional findings would support a diagnosis of cocaine abuse? a. jaundice b. hypotension c. perforated nasal septum d. profuse diarrhea
c. perforated nasal septum
A nurse recently admitted a client to an inpatient unit after a suicide attempt. A health-care provider orders amitriptyline (Elavil) for the client. Which intervention related to this medication should be initiated to maintain this client's safety upon discharge? a. provide a 6-month supply of Elavil to ensure long-term compliance. b. provide education regarding the avoidance of foods containing tyramine. c. provide a 1-week supply of Elavil with refills contingent on follow-up appointments. d. provide a pill dispenser as a memory aid.
c. provide a 1-week supply of Elavil with refills contingent on follow-up appointments.
A patient diagnosed with obsessive-compulsive disorder (OCD) continually carries a toothbrush, and will brush and floss up to fifty times each day. The healthcare provider understands that the patient's behavior is an attempt to accomplish which of the following? a. experience pleasure b. avoid interacting with others c. relieve anxiety d. promote oral health
c. relieve anxiety
A client diagnosed with schizophrenia takes an antipsychotic agent daily. Which assessment finding should a nurse immediately report to the client's attending psychiatrist? a. respirations of 22 beats/minute b. weight gain of 8 pounds in 2 months c. temperature of 104 degrees F d. excessive salivation
c. temperature of 104 degrees F
A nurse reviews the laboratory data of a 29-year-old client suspected of having major depressive disorder. Which laboratory value would potentially rule out this diagnosis? a. sodium (Na+) level of 140 mEq/L (normal range for this age group is 135 to 145 mEq/L) b. calcium (Ca2+) level of 9.5 mg/dL (normal range for this age group is 8 to 10 mEq/L) c. thyroid-stimulating hormone (TSH) level of 6.2 U/mL (normal for this age group is 0.4 to 4.2 U/mL) d. potassium (K+) level of 4.2 mEq/L (normal range is 3.5 to 5 mEq/L)
c. thyroid-stimulating hormone (TSH) level of 6.2 U/mL (normal for this age group is 0.4 to 4.2 U/mL)
A parent has consulted the school nurse because she is concerned about her 16-year-old son and the possibility of drug abuse. What indication of substance abuse in adolescents should the nurse plan to teach the mother? a. headaches b. improved academic performance c. unexplained moodiness d. introducing new friends to family
c. unexplained moodiness
Role of Vitamin D
calcium absorption
toxic hepatitis
can arise for chronic alcohol abuse; other potential hepatotoxins include acetaminophen, benzene, carbon tetrachloride, halothane, chloroform, and poisonous mushrooms; *some medications contain alcohol* -avoid ALL alcohol use (see note about meds)
body movement and posture
can communicate three things in any situation: how people see power operating, how they feel about themselves in the situation, and how they feel about the topic of discussion
Nausea
can interfere with nutritional status - assess precipitating factors for nausea/vomiting, the frequency, and relief measures *measures to prevent or relieve nausea:* - eat soda crackers and suck on hard candy - eat soft, bland foods that are cold or room temperature - avoid unpleasant odors, and get fresh air - eat prior to but not immediately before chemo - use distraction or progressive muscle relaxation when nauseated - identify and provide preferred foods
V: Ischemic stroke
caused by a thrombus or embolus that lodges in a cerebral artery and blocks blood flow to the brain tissue _common causes/predisposing factors_ - arteriosclerosis of a cerebral artery - *atrial fibrillation* (TX coumadin) - carotid stenosis (narrowing of the blood vessels in the neck that carry blood from the heart to the brain)
hepatitis a
caused by ingestion of contaminated food or water or contracted from person to person via unsanitary conditions
V: hepatitis A (HAV)
caused by ingestion of contaminated food or water or contracted from person to person via unsanitary conditions (fecal matter)
ventricular fibrillation
causes: MI, electrocution, prolonged QT interval, circulatory failure, catheter manipulation in ventricles. clinical significance: this is a life-threatening rhythm as there is no cardiac output. management: rapid defibrillation is required. CPR and medical management may be required to regain response. this rhythm is treated long-term with an ICD.
ventricular tachycardia
causes: often an MI complication; can also be caused by pulmonary edema, ischemic chest pain and hypotension. clinical significance: this rhythm can be life-threatening if sustained due to diminished cardiac output. management: IV lidocaine is administered if the patient is hemodynamically stable. Synchronized cardioversion can be indicated or unsynchronized defibrillation in an emergency. Long-term challenges can be addressed with an implantable cardioverter-defibrillator.
premature ventricular contraction
causes: premature ventricular contractions may be especially prevalent in patients with history of MI, hypokalemia or other cardiac irritants. clinical significance: this rhythm could lead to ventricular fibrillation or tachycardia, which can be life-threatening. management: infrequent PVCs aren't treated; however, IV or PO antidysrhythmics may be administered if the rhythm persists. Potassium is replaced if hypokalemia is the underlying cause.
atrial flutter
causes: similar to atrial fibrillation; heart disease (heart failure, ischemia, following open heart surgery, valve disease); hypertension clinical significance: diminished cardiac output management: establish normal rhythm; medication could control the impulse conduction through the AV node or rhythm conversion. cardioversion, ablation, pacing and implantable devices could also be indicated.
atrial fibrillation
causes: usually associated with heart disease (heart failure, ischemia, following open heart surgery); pulmonary disease clinical significance: cardiac output may be diminished or thrombi formation, increasing the risk of stroke MI or PE. management: gain control over rate; anticoagulant therapy, cardioversion, ablation, pacing and implantable rhythm control devices
first degree heart block
causes: various medications (beta-blockers, antipsychotics, digoxin and calcium-channel blockers); coronary artery disease, infection and congenital lesions may also be a cause. clinical significance: first degree heart block may advance to further heart block, requiring treatment. management: no treatment is indicated but monitoring is required.
introducing an unrelated topic
changing the subject causes the nurse to take over the direction of the discussion, may occur in order to get to something that the nurse wants to discuss with the client or to get away from a topic that he or she would prefer not to discuss
Histonic Personality Disorder
characterized by colorful, dramatic, and extroverted behavior in excitable, emotional people. They have difficulty maintaining long-lasting relationships, although they require constant affirmation of approval and acceptance from others. This often gives rise to seductive, flirtatious behavior in efforts to reassure themselves of their attractiveness and gain approval. Self-dramatizing, attention-seeking, overly gregarious, and seductive. They use manipulative and exhibitionistic behaviors in their demands to be the center of attention.
dependent personality disorder
characterized by lack of self-confidence and extreme reliance on others to take responsibility for them, sometimes to the point of intense discomfort with being alone for even a brief period. They allow others to make decisions, feel helpless when alone, act submissively, subordinate needs to others, tolerate mistreatment by others, demean oneself to gain acceptance, and fail to function adequately in situations that require assertive or dominant behavior
schizoid personality disorder
characterized primarily by a profound defect in the ability to form personal relationships. People with this condition are often seen by others as eccentric, isolated, or lonely. Appear cold, aloof, and indifferent to others. Solitary.
Antimetabolites
chemicals that prevent cell division by inhibiting formation of substances necessary to make DNA; used in cancer chemotherapy
Systemic lupus erythematosus (SLE)
chronic inflammatory autoimmune disease that affects all body systems, including the musculoskeletal system - systemic disease, kidney failure, and infections are leading causes of death in patients with SLE, as are thromboembolic events - WBCs indicate infection; patient with SLE has low WBC so infection can be masked
What should a nurse first do when a patient has a new onset of pain?
contact the PCP
effective CPR
circulation -determine unresponsiveness and absence of breathing/pulse -place backboard under patient's chest -start compressions within 10 seconds of finding no breath or pulse -push hard and fast while: +compressing chest 100-120 bpm +compressing chest 2-2.8 inches +allowing full chest recoil +minimizing interruptions to compressions to <10 sec +rotating staff doing compressions q2min -palpate pulses (carotid/femoral) to determine effectiveness airway -open patient's airway using head tilt-chin lift maneuver (jaw thrust for spinal injury) -place oropharyngeal airway if possible -provide suction as necessary breathing -ventilate effectively using barrier mask +maintain seal around patient's mouth and nose +observe for chest rise/fall -avoid excessive ventilations +2 ventilations for 30 compressions +one ventilation q6sec for advanced airway -use end tidal CO2 and pulse ox to determine efficacy defibrillation -defib ASAP when shockable rhythm detected
V: major cause of esophageal varices
cirrhosis (engorged varicose veins developed in the lower third of the esophagus b/c of portal vein HTN << cirrhosis)
placing the event in time or sequence
clarifies the relationship of events in time so that the nurse and client can view them in perspective
(drugs)
class: lab values: pt edu:
What to do with paranoid behavior?
clear, consistent, calm, and confident in stance
making stereotyped comments
cliches and trite expressions are meaningless in a nurse-client relationship, when the nurse makes empty conversation, it encourages a like response from the client
V: peripheral edema
clinical presentation of *RVF* venous congestion w/in the lower body causes high hydrostatic pressure w/in all capillary beds of the extremities ~> edema -accumulation influenced by gravitational forces -sacral area first to be noticed
Incidences of INC *SVR*
clogged arteries (i.e. HTN, fluid overload) >> a "muscle" working harder ~>> swells Tx = vasodilators inverse rel w/ *CO*
cataract
clouding of the lens of the eye
bismuth subsalicylate
coats ulcers, protecting them from stomach acid to treat h. pylori
What is bismuth subsalicylate used for?
coats ulcers, which protects them from stomach acid to treat H. pylori other uses include treatment of diarrhea and nausea common adverse effects include black tongue and stools - this is normal & harmless
roles of code blue team
code team leader -makes diagnosis -directs treatment primary nurse -provide info to code leader -contacts attending physician -assigns roles to staff before the code team arrives, assuring organized response recorder -records resuscitation efforts and documents personnel involved -official time keeper for code charge nurse -coordinates personnel performing CPR -coordinates the care of other patients assigned to staff responding to arrest secondary nurse -coordinates use of emergency cart -prepares medications -assembles/passes equipment -defibrillates medication nurse -administers medication -manages IV therapy and drips nursing supervisor -controls crowd -arranges transfer of patient post arrest anesthesiologist/nurse anesthetist -intubates patient -manages airway/oxygen respiratory therapist -assist with manual ventilation -draws arterial blood for ABG -assists with intubation -sets up mechanical ventilator
What adverse effects can occur with narcotic antitussives?
codeine is converted to morphine and the potential for respiratory depression and death may occur -nausea -vomiting -constipation -drowsiness -pruritus -drug dependence
Fluids used for hypovolemic shock-blood loss
colloids, blood products, blood transfusion (more than 30% of own blood loss)
What should a nurse help a patient with who has a new diagnosis of cancer?
comfort them; they are probably scared
V: heroin
commonly abused opiate that can be injected, ingested or inhaled - intoxication >> decreased RR, constricted pupils - /acute/ complications >> noncardiogenic pulmonary edema/respiratory failure - /chronic/ complications >>skin abscess, cellulitis, endocarditis, talcosis (lung disease from talcum powder), HIV, hepatitis
V: s/s compartment syndrome
complaint of pain out of proportion to the degree of injury << tissue pressure exceeds perfusion pressure in a closed anatomical space (stops flow) - edema - pallor - weak/absent distal pulses
palliative inter professional care team
composed of: -physicians -nurses -social workers -chaplains -home health aides -volunteers
business of managed care
concentrating on health services on specific populations <> becoming population oriented; A population focused approach to planning, delivering, and evaluating various aspects of care delivery to achieve better outcomes in the population of interest
Incidences for INC *preload*
congestive heart failure (fluid overload, baked up, etc)
What is the contraindication of taking timolol maleate?
contraindicated in asthma, COPD, heart failure, bradycardia, atrioventricular block, left ventricular dysfunction, cardiogenic shock *bronchoconstriction effects*
accepting
conveys an attitude of reception and regard
Code Teams - charge RN
coordinates CPR personnel coordinates care of other pts assigned to this on team
Code Teams - second RN
coordinates use of emergency cart prepares Rx assembles/passes equipment
Predni*sone*
corticosteroid; anti-inflammatory (-sone)
What types of fluids are used for vomiting and diarrhea?
crystolloids: normal saline, Lactated Ringer's
A patient diagnosed with depression is prescribed a monoamine oxidase inhibitor (MAOI). When teaching the patient about the medication, which statement made by the patient indicates the need for additional teaching? a. "I can still eat out at restaurants as long as I'm careful." b. "I will miss putting soy sauce on my noodles." c. "I'm glad I can still eat hamburgers and french fries." d. "I'm glad that I can have pepperoni on my pizza."
d. "I'm glad that I can have pepperoni on my pizza."
A nurse learns at report that a newly admitted client experiencing mania is demonstrating grandiose delusions. The nurse should recognize that which client statement would provide supportive evidence of this symptom? a. "I can't stop my sexual urges. They have led me to numerous affairs." b. "My wife is distraught about my overspending." c. "The FBI is out to get me." d. "I'm the world's most perceptive attorney."
d. "I'm the world's most perceptive attorney."
A nurse is caring for a client who has been prescribed disulfiram (Antabuse) as a deterrent to alcohol relapse. Which information should the nurse include when teaching the client about this medication? a. "This medication will decrease your cravings for alcohol." b. "Only oral ingestion of alcohol will cause a reaction when taking this drug." c. "It is safe to drink beverages that have only 12% alcohol content." d. "Reactions to combining Antabuse with alcohol can occur for as long as 2 weeks after stopping the drug."
d. "Reactions to combining Antabuse with alcohol can occur for as long as 2 weeks after stopping the drug."
A nursing instructor is teaching about specific phobias. Which student statement should indicate that learning has occurred? a. "These clients do not recognize that their fear is excessive, and they rarely seek treatment." b. "These clients experience the symptoms of tachycardia, dysphagia, and diaphoresis." c. "These clients experience symptoms that mirror a cerebrovascular accident (CVA)." d. "These clients have overwhelming symptoms of panic when exposed to the phobic stimulus."
d. "These clients have overwhelming symptoms of panic when exposed to the phobic stimulus."
A client began taking lithium for the treatment of bipolar disorder approximately 1 month ago. The client asks if it is normal to have gained 12 pounds in this time frame. Which is the appropriate nursing reply? a. "What have you been eating? Weight gain is not usually associated with lithium." b. "Weight gain occurs only during the first month of treatment with this drug." c. "That's strange. Weight loss is the typical pattern." d. "Weight gain is a common but troubling side effect."
d. "Weight gain is a common but troubling side effect."
Which medication orders should a nurse anticipate for a client who has a history of complicated withdrawal from benzodiazepines? a. Carbamazepine (Tegretol) and donepezil (Aricept) b. Disulfiram (Antabuse) and lorazepam (Ativan) c. Haloperidol (Haldol) and fluoxetine (Prozac) d. Chlordiazepoxide (Librium) and phenytoin (Dilantin)
d. Chlordiazepoxide (Librium) and phenytoin (Dilantin)
Which drug is the prototype for expectorants? a. Dextromethorphan b. Pseudoephedrine c. Diphenhydramine d. Guaifenesin
d. Guaifenesin
Dyslipidemic drugs are used for all of the following reasons EXCEPT: a. Reduce morbidity and mortality from atherosclerotic cardiovascular disease b. Prevent or delay the development of atherosclerotic plaque c. Promote the regression of existing atherosclerotic plaque d. Increase blood flow to prevent formation of atherosclerotic plaque
d. Increase blood flow to prevent formation of atherosclerotic plaque
What is the main cause of GERD? a. Scar tissue b. Dry stomach lining c. Exposure of the esophagus and stomach lining to common fungal infections d. Regurgitation of duodenal bile, enzymes, and stomach acid into the esophagus and exposure of esophageal mucosa to gastric acid and pepsin.
d. Regurgitation of duodenal bile, enzymes, and stomach acid into the esophagus and exposure of esophageal mucosa to gastric acid and pepsin.
A client diagnosed with bipolar disorder: depressive episode intentionally overdoses on sertraline (Zoloft). Family reports that the client has experienced anorexia, insomnia, and recent job loss. What should be the priority nursing diagnosis for this client? a. Anxiety: severe R/T hyperactivity b. Dysfunctional grieving R/T loss of employment c. Imbalanced nutrition: less than body requirements R/T refusal to eat d. Risk for suicide R/T hopelessness
d. Risk for suicide R/T hopelessness
Which of the following classification of medication used to treat dyslipidemia is the most powerful drug class to decrease LDL levels? a. Niacin b. PCSK9 Inhibitors c. Bile Acid Sequestrants d. Statins
d. Statins
When should whole blood be administered in a patient who has had a significant hemorrhage and requires blood replacement? a. For any type of blood loss from hemorrhage b. Any time there is hemorrhage from an artery c. When a patient is hemorrhaging into the abdomen d. With depletion of more than 30% of total volume
d. With depletion of more than 30% of total volume
A client diagnosed with bipolar I disorder is distraught over insomnia experienced over the last 3 nights and a 12-pound weight loss over the past 2 weeks. Which should be this client's priority nursing diagnosis? a. knowledge deficit R/T bipolar disorder AEB concern about symptoms b. risk for suicide R/T powerlessness AEB insomnia and anorexia c. altered sleep patterns R/T mania AEB insomnia for the past 3 nights d. altered nutrition: less than body requirements R/T hyperactivity AEB weight loss
d. altered nutrition: less than body requirements R/T hyperactivity AEB weight loss
A patient diagnosed with agoraphobia is scheduled for a functional magnetic resonance imaging (fMRI) study of the brain. The healthcare provider anticipates that the scan will show increased activity in which of the following areas of this patient's brain? a. cerebellum b. medulla c. parietal lobe d. amygdala
d. amygdala
While talking to a female client diagnosed with schizophrenia, the nurse notices the client looks away from the nurse and stares at the wall while making facial grimaces. What is the most appropriate action by the nurse? a. redirect the patient to the conversation. b. tell the patient that you will be back when she is ready to listen. c. administer the ordered PRN trihexyphenidyl (Artane). d. ask the client if she is seeing something on the wall
d. ask the client if she is seeing something on the wall
A client tells the nurse at the methadone clinic that he has a prescription for methadone 40 mg daily orally. The nurse recognizes that methadone maintenance can be used as an effective drug replacement for individuals addicted to: a. amphetamines b. hallucinogens c. barbiturates d. opiates
d. opiates
A client diagnosed with brief psychotic disorder tells a nurse about voices telling him to kill the president. Which nursing diagnosis should the nurse prioritize for this client? a. altered thought process b. disturbed sensory perception c. risk for injury d. risk for violence: directed towards others
d. risk for violence: directed towards others
Warren's college roommate actively resists going out with friends whenever they invite him. He says he can't stand to be around other people and confides to Warren "They wouldn't like me anyway." Which disorder is Warren's roommate likely suffering from? a. mysophobia b. agoraphobia c. panic disorder d. social anxiety disorder (social phobia)
d. social anxiety disorder (social phobia)
A client is diagnosed with cyclothymic disorder. What client behaviors should the nurse expect to assess? a. the client fixates on hopelessness and thoughts of suicide continually. b. the client has labile moods with periods of acute mania. c. the client expresses "feeling blue most of the time." d. the client has endured periods of elation and dysphoria lasting for more than 2 years
d. the client has endured periods of elation and dysphoria lasting for more than 2 years
A client is diagnosed with bipolar disorder and admitted to an inpatient psychiatric unit. Which is the priority outcome for this client? a. the client will use problem-solving to cope adequately after discharge. b. the client will accomplish activities of daily living independently by discharge. c. the client will verbalize feelings during group sessions by discharge. d. the client will remain safe throughout hospitalization.
d. the client will remain safe throughout hospitalization.
A nurse holds the hand of a client who is withdrawing from alcohol. What is the nurse's rationale for this intervention? a. to assess for Wernicke-Korsakoff syndrome b. to assess for emotional strength c. to assess for tachycardia d. to assess for fine tremors
d. to assess for fine tremors
A nurse begins the intake assessment of a client diagnosed with bipolar I disorder. The client shouts, "You can't do this to me. Do you know who I am?" Which is the priority nursing action in this situation? a. to provide high-calorie finger foods to meet nutritional needs b. to redirect the client to the needed assessment information c. to reorient the client to person, place, time, and situation d. to provide self and client with a safe environment
d. to provide self and client with a safe environment
During the admission interview, a patient mentions to the nurse that he had increased the amount of oxycodone because the smaller dose "just wasn't doing it for me anymore." The nurse assessess this phenomenon as resulting from a. relapse b. intoxication c. withdrawal d. tolerance
d. tolerance
A client diagnosed with bipolar I disorder: manic episode refuses to take lithium carbonate because he complains that it makes him feel sick. Which of the following medications might be alternatively prescribed for mood stabilization in bipolar disorders? a. sertraline (Zoloft) b. trazodone (Desyrel) c. paroxetine (Paxil) d. valproic acid (Depakote)
d. valproic acid (Depakote)
A client who has been on the unit for 2 weeks relates a 15-year history of polysubstance abuse with several detoxifications followed by relapses. The client mentions that when he is released from the hospital, he tries to "get on with my life and put this other stuff in the past." The nurse identifies an appropriate outcome as being that client will: a. recognize his need for methadone maintenance b. identify reasons for past episodes of noncompliance c. discuss childhood factors that impact on his drug use d. view recovery is a lifelong process occurring a day at a time
d. view recovery is a lifelong process occurring a day at a time
What is the purpose of eye drops for a patient with glaucoma?
to increase or decrease the intraocular pressure (IOP)
The healthcare provider is teaching a group of students about suicide assessment and prevention. Which of the following will be included in the teaching? Select all that apply. a. there are often no warning signs before a patient commits suicide. b. it's important not to ask a patient whether they are having suicidal thoughts. c. if a patient is unsuccessful in a suicide attempt, another attempt is unlikely. d. when medication improves a patient's mood, they may attempt suicide. e. a patient who talks about suicide may be signaling others for help.
d. when medication improves a patient's mood, they may attempt suicide. e. a patient who talks about suicide may be signaling others for help.
A client is taking Clonazepam (Klonopin) for generalized anxiety disorder symptoms. In which situation should a nurse recognize that this client is at greatest risk for adverse effects from the medication? a. when the client has a knowledge deficit related to the effects of the drug b. when the client takes the drug on an empty stomach c. when the client fails to follow dietary restrictions d. when the client combines the drug with alcohol
d. when the client combines the drug with alcohol
What drug is used to prevent and manage skeletal muscle rigidity from malignant hyperthermia?
dantrolene sodium
What is the MOA of H2RAs?
decrease gastric acid secretion
What is the MOA of PPIs?
decrease gastric acid secretion
Beta Blockers
decrease heart rate and dilate arteries by blocking beta receptors Tx for systolic dysfunction; preferred treatment for diastolic dysfunction - relaxing heart to give it time to fill >> more to pump out and circulate
Air embolism S/S
decrease in SaO2, air hunger (dyspnea), SOB cyanotic, pallor (suddenly); chest pain, tachycardic anxiety; hypotensive; dec. LOC syncope (pass out), coma, cardiac arrest generalized seizures may occur
atropine sulfate
decreases secretions and counteracts vagal stimulation during ECT
V: hypoxia
deficiency in the amount of oxygen reaching the tissues stimulates arterial _vasoconstriction_ - chronic hypoxia >> chronic pulmonary vasconstriction / pulmonary hypertension
hypoxemia
deficient amount of oxygen in the blood low *PaO2*
hypoventilation
deficient movement of air into and out of the lungs, causing *hypercapnia*
Parkinson's disease
degenerative disorder of the CNS caused by death of neurons that produce the brain neurotransmitter dopamine
volume-guaranteed pressure options (VGPO)
delivers PRESCRIBED *tidal volume* while using a decelerating flow pattern by means of a pressure breath <> acutely ill <> safety for stable pts esp at night and/or have secretions
exploring
delving further into a subject, idea, experience, or relationship is especially helpful with clients who tend to remain on a superficial level of communication; nurse should refrain from probing
"the leader"
democratic leadership allows the client to be an active participant in planning his or her care
ego defense mechanisms
denial displacement
using denial
denying that a problem exists blocks discussion with the client and avoids helping the client identify and explore areas of difficulty.
Synergy Model
describes nursing practice and outcomes based on patient characteristics << pt characteristics matter << competent nurses are important to pts << pt characteristics and nurse competencies are related << synergy between two >> best results >>>> Magnet designation
>40
desirable HDL
<130
desirable LDL
<200
desirable total cholesterol
<150
desirable triglycerides
distributive shock
developed from impaired utilization of oxygen and thus production of energy by the cell, characterized by massive vasodilation
SwanGanz catheter (pulmonary artery catheter)
device w/ double lumen to measure precise diagnosis of *PCWP* b/c of placement and balloon inflation measure pressures in FRONT of it = L side (indirectly), NOT R side of heart, assuming no mitral valve issues *ballon NO MORE than 1.5 mL of air, with SPECIFIC syringe, for NO MORE than 15 secs *placement confirmed with x-ray after initial readings but BEFORE used for any other reason (not for pulmonary HTN, b/c would need to bypass R side of heart)
Tourrettes
disorder of multiple motor tics and one or more vocal tics, which *may appear simultaneously or at different periods during the illness* >> distress or interfere with social, occupational, or other important areas of functioning. - The age at onset of Tourette's disorder can be as early as 2 years, but the disorder occurs most commonly around age 6 to 7 years
What is a manic episode?
distinct period of abnormally and persistently elevated, expansive, or irritable mood, and abnormally and persistently increased goal-directed activity or energy (1) Inflated self-esteem or grandiosity (2) Decreased need for sleep (3) More talkative than usual or pressure to keep talking (4) Flight of ideas (5) Distractibility (6) Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (7) Excessive involvement in activities that have a high potential for painful consequences
preload reducer(s)
diuretic - rid body of "extra" fluid veno vasodilator (nitroglycerin) - open vessel leading into R atrium
What supplement cannot be given with levodopa?
do not give with *iron* preparations because this decreases levodopa absorption
Should the patient take an extra dose or double up if they miss a dose of digoxin?
do not take an extra dose do not take a double dose to make up for a missed dose
diplopia
double vision
How should SL nitroglycerin container be stored?
dry, cool, dark environment and replace every 6 months *exposure to light deactivates the nitroglycerin tablet*
atherosclerosis
dyslipidemia can lead to...
job loss
economic depression, poverty, low income, and ________ are associated with suicide
hemarthrosis
effusion of blood into a joint cavity <~ *hemophilia*
MOA antimicrobials/bismuth
eliminate H. pylori infection
What is the MOA of antimicrobials and bismuth?
eliminate H. pylori infection
Autism *Spectrum* Disorder
encompasses a *broad spectrum** of associated diagnoses that included autistic disorder, Rett's disorder, childhood disintegrative disorder, pervasive developmental disorder not otherwise specified, and Asperger's disorder
nursing care r/t SLE
encourage the pt and family members to discuss the effect of the disease on their lives
offering general leads
encourages client to continue
V: atherosclerosis
endothelial injury from oxidizing free radicals, shearing force of HTN, high glucose levels and elevated LDL that stems an inflammation process further clogging things up (w/ foam cells)
Priority of care in treating anemia
ensuring adequate tissue oxygenation
public health core functions - assurance
ensuring essential community-oriented health services are provide to those who may not otherwise have them
National Prevention, Health Promotion, and Public Health Council
est by the *Patient Protection and Affordable Care Act (ACA)* <> coordinates federal prevention, wellness, and public health activities and to develop a national strategy to improve the nation's health
Prevention and Public Health Fund
est by the *Patient Protection and Affordable Care Act (ACA)* <> to expand and sustain funding for prevention and public health programs
frequency of ect
every other day, TIW
narcissistic personality disorder
exaggerated sense of self-worth. They lack empathy and are hypersensitive to the evaluation of others. They believe that they have the inalienable right to receive special consideration and that their desire is sufficient justification for possessing whatever they seek. They lack humility, are overly self-centered, and exploit others to fulfill their own desires. They often do not conceive of their behavior as being inappropriate or objectionable. Because they view themselves as "superior" beings, they believe they are entitled to special rights and privileges
public distance
exceeds 12 feet, yelling at someone far away
V: osteoarthritis
excess pressure on joint, *cytokines build up* / inflammatory mediators/metalloproteases degrade cartilage
pathophysiology OA
excess pressure on joint-->cytokines/inflammatory mediators/metalloproteases degrade cartilage-->chondrocytes--> proteoglycans (excess fluid)-->eventual loss of cartilage elasticity/cracking
V: S/S BPH (benign prostatic hyperplasia)
excessive cell growth of the prostate gland - dribbling of urine - frequency - hesitancy - urinary retention - straining to urinate - weak urinary stream - urgency
polyuria
excessive urination and is a common symptom of diabetes
voicing doubt
expressing uncertainty as to the reality of client's perception
V: anaphylactic shock
extreme manifestation of allergic reaction - small amt of antigen >> IgE stimulates degranulation of eosinophils, basophils, mast cells>histamine >> massive vasodilation >> hypoperfusion of tissues (b/c dec blood vol?) >> ashock/bronchospasm/edema of airways
avoidant personality disorder
extremely sensitive to rejection and thus may lead a very socially withdrawn life (not asocial) - may be a strong desire for companionship. The extreme shyness and fear of rejection, however, create the need for unusually strong assurances of unconditional acceptance
Cardiogenic shock
failure of the heart to pump sufficient blood to tissues can be due to: - left HF, myocardial ischemia, MI, pulmonary embolism
pernicious anemia
failure to absorb dietary vitamin B12, develops due to lack of intrinsic factor (substances secreted by gastric mucosa)
What are delusions?
false personal beliefs inconsistent with the person's intelligence or cultural background; continues to have the belief despite obvious proof that it is false/irrational
s/s TB
fatigue, malaise, anorexia, weight loss, low grade fevers, night sweats, frequent productive coughs, dull chest pain, tightness or discomfort, dyspnea
anorexia (v. bulimia)
fear of gaining weight, disturbance in self-perceived weight or shape; persistent energy intake restriction leading to significantly low body weight in context of age, sex, developmental path, and physical health _hospitalization_ - HR <40 - BP (systolic) <70 << occur most often in female clients from adolescence to young adulthood; onset associated with stressful life event (college).
poison
females often use ______________ when attempting suicide
What is a common cause for seizures in infancy and early childhood?
fever
Stevens-Johnson Syndrome (SJS)
fever, cough, muscular aches and pains, headache, and lesions of the skin, mucous membranes, and eyes; the LESIONS appear as red wheals or blisters, often starting on the face, in the mouth (mucus membranes), or on the lips, neck, and extremities << med (cefazolin) ran
Nephrons
filtering units of the kidney that remove wastes from the blood and produce urine
What are events that would trigger a PTSD patient?
fireworks, slamming doors, demolish buildings
Right arterial pressure (RAP)
first pressure along *pulmonary artery catheter* from insertion - baseline - pt to inflate balloon for ease of continued insertion ~ *preload* and *CVP* ~ 2-4 mm Hg
importance of self-awareness
influences the way patients' information is analysed
delusions - TX/priority nursing intervention
focus on feelings / explore more - intervention focus: convey acceptance of the client's need for the false belief, but indicate that you do not share the belief. Do not argue or deny the belief. Use reasonable doubt as a therapeutic technique. Say, "I understand that you believe this is true, but I personally find it hard to accept"
FLACC pain scale
for 2 mos to 7 yo... facial expression leg movement activity cry consolability
lithium
for bipolar disorder Class: Mood stabilizing agent (used to treat bipolar disorder) Major side effects: Metallic taste, tremors, polyuria, polydipsia, edema weight gain Nursing interventions: Obtain baseline studies of renal, cardiac, and thyroid status because adverse effects are related to these organ systems; monitor serum lithium levels to make sure drug toxicity does not occur
CRIES pain scale
for neonates (0-6 pos) = CRYING b/c of PAIN (Requires O2 for SaO2 ,95% Increased Vital signs Expression Sleepless)
attitudes
frames of reference around which an individual organizes knowledge about his or her world; have an emotional component, may be judgmental, selective, and biased; may be positive or negative
V: AKI (Acute Kidney Injury)
frequently occurs in the setting of shock, sepsis, SIRS, or MODS (30% of patients in intensive care) *risk for developing AKI:* - HTN - chronic HF - diabetes - multiple myeloma - chronic infection - autoimmune diseases (3/5)
coagulation factors
fresh frozen plasma contains this substance and should be part of the treatment plan in DIC
V: endothelial injury
fundamental change that serves as precursor to atherosclerosis; include oxidizing free radicals, shearing force of HTN, high glucose levels and elevated LDL
endothelial injury
fundamental change that serves as precursor to atherosclerosis; include oxidizing free radicals, shearing force of HTN, high glucose levels and elevated LDL
s/s syphilis
genital chancre then rash
V: S/S syphilis
genital chancre then rash (enlarged lymph nodes) - treatable (big shot)
What does nurse monitor when administering anti-epileptic drugs via IV
give slow (60mg/min) in large vein (to prevent extravasation) Look for immediate adverse effect- watch HR and BP Bradycardia, hypotension, syncope
prostaglandin analogs
given for chronic glaucoma to increase aqueous outflow and reduce pressure; keep eyes moist
opioid antagonists
given to treat respiratory depression caused by an overdose of opioids
using silence
gives the client the opportunity to collect and organize thoughts, to think through a point, or to consider introducing a topic of greater concern than the one being discussed.
What protective equipment should a nurse wear when changing a bed for a patient with an open infection?
gown and gloves
cyanosis
gray/blue/purple skin color caused by deoxygenated hemoglobin (*need oxygen*)
public health nurses - changes experiencing
growing costs; changing demography of US pop (esp aging pop); bioterrorism threats; emergent modern-day epidemics; globally induced infections
What is the best way to prevent infection?
hand hygiene
response to diversity
he sensitivity to recognize, appreciate, and incorporate differences into the provision of care
What is the last sense a patient has when dying?
hearing
V: organs affected by HTN
heart, kidneys, eyes, brain and peripheral arteries
organs affected by HTN
heart, retina, kidneys, brain and peripheral arteries
Spiritual assessment
helpful questions: - what are the spiritual aspects of the patient's philosophy about life? death? - are the values and beliefs about life and death congruent with those of people who are important to the patient? - which spiritual resources and rituals have significance for the patient?
sitz bath
hemerrhoidectomy nursing care
cystocele
hernia of the urinary bladder
V: cystocele
hernia of the urinary bladder - TX: surgical intervention - *S/S:* bulge through vaginal canal; frequency, urgency, perineal pressure; stress incontinence (when straining)
Thiazide diuretics
inhibit Na and Cl reabsorption, where Na goes water follows >> increased urine output (increases Ca reabsorption)
Autism spectrum disorder
heterogenous group of neurodevelopmental syndromes characterized by a wide range of communication impairments and restricted, repetitive behaviors -risk for self mutilation -impaired social interaction -impaired verbal communication -disturbed personal identity
systematic review of RCTs
highest level of evidence
urticaria
hives 😏ur tics
For a patient taking digoxin, if their HR is less than 60 beats/min, what should they do?
hold dose and notify PCP
Cushing's triad
hypertension, bradycardia, irregular respirations
V: Cushing's triad
hypertension, bradycardia, irregular respirations << rising intracranial pressure (ICP) << *DVT* (3/5 question)
What are the indications for dopamine?
hypovolemic and cardiogenic shock
dopamine indication
hypovolemic and cardiogenic shock
technique for presenting reality
i. Acknowledge patient experience is real to him ii. Do not argue or agree iii. Present reality iv. Know the content of delusion, hallucination, or illusion
components of mental status review
i. Appearance ii. Affect iii. Thoughts iv. Homicidal potential v. Judgment, insight, and intellect vi. Orientation and memory
technique for therapeutic communication
i. Firm voice. ii. Consistent. iii. Accept person, reject behavior.
SOLER
i. Sit squarely facing the client. ii. Observe an open posture. iii. Lean forward toward the client. iv. Establish eye contact. v. Relax.
held on faith belief
ideas that an individual holds as true for which no objective evidence exists
Who is at a higher risk for a mental illness?
if mom has mental illness, you are more likely to have one because of genetics & environment
ankles
if patient is standing/ambulatory, fluid tends to accumulate in the __________________
sacral region
if patient is supine, fluid tends to accumulate in the ______________ region
What should a patient do if they miss a dose of digoxin?
if you forget to take your daily dose and it is within 6 hours of the time you usually take it, take your daily dose
report to provider
if, during tx of shock: -mean blood pressure >65 mmHg -HR >100 mmHg -sys BP <90 mmHg
best health promotion
immunizations (b/c prevent infection(s))
social-polite touch
impersonal yet conveys affirmation or acceptance, ex. handshake
remove jewelry
important nursing intervention r/t swelling (in arm) as a result of cellulitis
appearance
in addition to noting the dress and hygiene of patients who are depressed (eg, disheveled, unkempt and unclean clothing), the clinician should assess these individuals for physical evidence of suicidal behavior, such as wrist lacerations and neck rope burns
reduced
in aplastic anemia, the cells in the bone marrow are significantly...
3
in certain populations, such as adolescents and young adults, suicide constitutes 1 of the top ____ causes of death
Flotations of the pulmonary artery catheter
in order of insertion (from jugular)... (1) right atrial pressure (*RAP*), very small ripple = BASELINE + inflate balloon to drive catheter through (2) right ventricular pressure (*RVP*), one peak hills (~ w/ dysrhythmia ~>> vtach) (3) pulmonary artery pressure (PAP), pseudo "M" hills (4) pulmonary capillary wedge pressure (PCWP), pseudo flat *deflate balloon PASSIVELY (no pull back or could hurt catheter) (5) PAP (at rest, not obtaining PCWP reading, balloon not inflated)
transference
in psychoanalysis, the patient's transfer to the analyst of emotions linked with other relationships (such as love or hatred for a parent)
respiratory failure
inability to maintain adequate respiration as measured by arterial blood pH, PaCO2, and PaO2
dysphagia
inability to swallow food/liquid; creates high risk for aspiration
V: dysphagia
inability/difficulty to swallow food/liquid; creates high risk for aspiration (<< stroke victims) (>> nursing intervention of feeding tube, thickeners, speech therapy (constant eval), which can be delegated but must report back to nurse) - lungs high risk of aspiration
clinical judgment
includes clinical decision making, critical thinking, and a global grasp of the situation, coupled with nursing skills acquired through a process of integrating formal and informal experimental knowledge and evidence-based guidelines
causes of GERD
incompetent lower esophageal sphincter; can be exacerbated by food, fluid, medications, gastric distention, smoking, and recumbent posture
statins
increase HDL/lower LDL
How does activation of vitamin D help raise serum calcium levels?
increase activation of vitamin D leads to an increase in intestinal absorption of calcium which helps to increase serum calcium
What is the effect to response activation of beta1?
increase force of contraction increase HR increase speed of electrical conduction increase renin production
beta1-adrenergic receptors
increase heart rate, force of contraction, and speed of electrical conduction (increases renin production- kidneys)
MOA of levodopa
increase the amount of dopamine
BBW fluoroquinolones
increased disabling risk of tendinitis and tendon rupture; significant risk of peripheral neuropathy, CNS and cardiac effects, and dermatologic and hypersensitivity reactions
If a change in WBC indicates infection, what is a sign/symptom of infection?
increased temperature
MOA donepezil
increases acetylcholine in the brain by inhibiting its metabolism, leading to elevated acetylcholine levels in the cortex
friendship-warmth touch
indicates affection for another person, ex. touching a shoulder
giving reassurance
indicates to the client that there is no cause for anxiety, thereby devaluing the client's feelings; may discourage the client from further expression of feelings if he or she believes they will only be downplayed or ridiculed
agreeing or disagreeing
indicating accord with or opposition to the client's ideas or opinions; implies that the nurse has the right to pass judgment on whether the client's ideas or opinions are "right" or "wrong"; agreement prevents the client from later modifying his or her point of view without admitting error; disagreement implies inaccuracy, provoking the need for defensiveness on the part of the client
nasal obstruction and discharge
indications for nasal decongestants
What are delusions of control or influence?
individual believes certain objects or persons have control over his or her behavior ex.) dentist put a filling in my tooth; I now receive transmissions through the filling that control what I think and do
What are delusions of persecution?
individual feels threatened and believes that others intend harm or persecution toward him or her in some way ex.) FBI has bugged my room and intends to kill me
propofol
induces anesthesia
thrombophlebitis
inflammation of a vein associated with a clot formation
infective endocarditis
inflammation of endothelium that lines heart and cardiac valves. most commonly damages mitral valve, then aortic and tricuspid valves. commonly caused by bacteria that are normally present in the body. can also occur after an invasive medical or dental procedure. *symptoms*: valvular dysfunction ~> affect organ systems, chest pain, CHF, clubbing, meningitis, low back pain, arthralgia, arthritis
glomerulonephritis
inflammation of the glomeruli of the kidney
Meningitis
inflammation of the meninges (outer lining) of the brain and spinal cord
rhinitis
inflammation of the mucous membranes of the nose
V: S/S PUD (peptic ulcer disease)
inflammatory erosion in the stomach or duodenal lining - epigastric abdominal pain - *pain occurs 2-3 hours after eating* - intense, gnawing, burning sensation relieved by food - can progress to perforation
What does the nurse monitor when administrating IV antiepileptic drugs?
inject IV into *large vein* at an infusion rate *slowly* of no faster than 60 mg/min monitor patient reactions: vital signs (BP & HR) monitor IV site: extravasation
formation of foam cells
injured endothelial cells-->sticky molecules-->attract WBCs-->macrophages ingest LDL-->foam cells-->atherosclerotic plaque
nasotracheal intubation
insertion of a endotracheal tube into the trachea through the nose <> need for frequent nasotracheal suctioning <> comfort for long term, prevent airway trauma from frequent suctioning O2 before and after each suctioning + cough X Hx of epistaxis (nosebleeds) or known coagulopathy
phentolamine
instill this drug if infiltration of vasoactive medication occurs; prior to catheter removal
sexual arousal touch
intended to physically stimulate another person
pharmoconvulsive therapy
involved induction of convulsions with intramuscular injections of camphor in oil
suicide attempt
involves a serious act, such as taking a fatal amount of medication and someone intervening accidentally; without the accidental discovery, the individual would be dead
suicide equivalent
involves a situation in which the person does not attempt suicide; instead, he or she uses behavior to get some of the reactions that suicide would have caused
Supplement interactions of levodopa
iron decreases absorption
arthralgia
joint pain <> arthritis
nursing intervention r/t appendicitis
keep pt in certain positions to increase comfort (fetal position)
blind spot
known to others, not known to self
arena
known to self, known to others
facade
known to self, not known to others
anemia
lack of RBCs
V: ulcerative colitis location
large intestine
V: portal hypertension
leads to the development of *ascites* - Increased venous pressure builds w/in the vascular beds of the GI system, producing splenomegaly, *esophageal varices*, rectal varices, and eventually *ascites*
portal hypertension
leads to the development of ascites
Montelukast
leukotriene receptor antagonist = allergy med(s) *leukotriene* chemical substances that contribute to anaphylaxis; released by the immune system in allergic reactions
Hypovolemic shock
loss of blood volume can be due to: - hemorrhage, burns, excessive diuresis, or severe vomiting/diarrhea
What is conversion disorder?
loss of or change in body function that cannot be explained by any known medical disorder or pathophysiological mechanism - transmit emotional or psychological stressors into physical manifestation. - can manifest false pregnancy - appear paralysis, inability to speak, smell, numbness and deafness - Tingling or burning sensations.
What neurotransmitter is missing in Parkinson's disease?
low dopamine
Thrombocytopenia
low platelet count
What are appropriate nursing interventions for a bipolar patient?
low stimuli, promote nutrition with high-calorie finger foods
V: atherosclerosis / arteriosclerosis
main cause of CVD (cardiovascular disease) - gradual process of plaque build up in arteries <~ endothelial cell damage from the many things that rub up vs. their lining which then stimulates the inflammation process (+LDL) = PLAQUE
cirrhosis
major cause of esophageal varices
offering self
making oneself available on an unconditional basis, increasing client's feelings of self-worth
What is an adjustment disorder?
maladaptive reaction to an identifiable stressor or stressors that results in the development of clinically significant emotional or behavioral symptoms example: death, job loss, divorce
EMTALA
mandates that hospitals must provide health screening exams for anyone who requests care in the emergency department, and if that person requires care, legally the healthcare providers at that hospital must provide care to at least stabilize the patient or, if the benefits of transfer outweigh the risks, transfer the patient to another medical facility
Limitations of the EBP and research relationship
many practices little research so other sources of evidence considered; different research designs <> limitations affecting generalizability; not restricted to findings, but use personal experience too <> applicability
schizotypal personality disorder
marked by symptoms that are closer to those of schizophrenia than those in schizoid personality. Show significant peculiarities in thinking, behavior, and appearance. Aloof and isolated and behave in a bland and apathetic manner. Magical thinking, ideas of reference, illusions, and depersonalization are part of their everyday world. Bizarre speech.
respiratory effects
may occur with parenteral phenobarbital
obstructive shock
may result when any kind of mass or fluid accumulation/blood clot outside the heart interferes with the heart's ability to adequately pump a sufficient quantity of blood
death by suicide
means the person has died. It is important not to use the term successful suicide; the goal is to prevent suicide and provide treatment
peak expiratory flow rate
measure of the fastest flow of exhaled air after a maximal inspiration
systemic vascular resistance (SVR)
measurement of *afterload* A measure of the amount of resistance that must be met to eject blood out of heart
Stroke Volume (SV)
measurement of the amount of blood ejected from a ventricle in one contraction
Cardiac Output (CO)
measurement of the amount of blood ejected per minute from either ventricle of the heart = 4-8 Lpm <> how perfused are the organs = *SV* x heart rate need to adjust for surface area w/ index (CI), normal = 2.5-4 Lpm
neurogenic shock
occurs when spinal cord injury is above T6 and sympathetic nerves are affected; SNS dysfunction prevents tachycardia/peripheral vasoconstriction that should normally counteract and characterize hemorrhagic shock
Central Venous Pressure (CVP)
measures *preload* the pressure of blood in the thoracic vena cava, near the right atrium of the heart; reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system = 2-6 mm Hg
In hypercalcemia, how does the body respond?
mechanisms lower serum calcium levels to normal decrease secretion of PTH increase secretion of calcitonin 1. decrease intestinal absorption of calcium 2. decrease resorption of calcium from bone 3. increase renal excretion of calcium
biologic DMARDS
medications that can... -decrease immunity -increase risk of infection -be associated w/ an increased risk for reactivation TB
V: peritonitis
membrane that surrounds ab cavity and covers organs becomes inflamed >> bacteria (i.e. E. coli) or leakage of intestinal contents into the peritoneal cavity - increased risk for infection
What is the MOA of levodopa?
metabolic precursor of dopamine, and after levodopa crosses the blood-brain barrier, it converts to dopamine in the brain if administered without carbidopa, large doses must be taken to produce therapeutic effects
V: non alcoholic fatty liver disease (NAFD)
metabolic syndrome (hyperlipidemia, insulin resistance, obesity); other r/f include DM, protein malnutrition, HTN and sleep apnea
etiology of non alcoholic fatty liver disease
metabolic syndrome (hyperlipidemia, insulin resistance, obesity); other r/f include DM, protein malnutrition, HTN and sleep apnea
pathophysiology of asthma
microbes/allergens-->stimulate Th1 cells-->B cells transform into plasma cells that produce IgE-->Th2 cells attract mast cells, eosinophils, basophils-->inflammation-->IgE binds to mast cells-->histamine/leukotrienes released-->leukotrienes produce bronchoconstriction/histamine produces bronchospasm and inflammation
Percent of water in the body
middle-aged adult- 60% newborn- 80% older adult- 40%
premature atrial contractions
momentary interruption of atrial rhythm (can be caused by stress, caffeine, drugs)
What do patients need to be taught about lithium?
monitor for toxicity eat healthy diet with fluids and normal sodium intake
Tranylcypromine (Parnate)
monoamine oxidase inhibitors (MAOIs (antidepressant) for MDD
Phenelzine (Nardil)
monoamine oxidase inhibitors (MAOIs (antidepressant); treats depression with anxiety
risks of ECT
mortality, permanent memory loss, brain damage
chlamydia, gonococcus and syphilis
most common bacterial STIs
post streptococcal infection
most common cause of AGN
LVF
most common cause of pulmonary edema
hypovolemic shock
most common type of shock, caused by insufficient circulating volume from actual blood loss or relative blood loss from fluid shifts in the body
Stevens-Johnson Syndrome
most severe adverse effect of phenobarbital
spring
most suicides occur in which season?
V: Septic shock
multiple organ dysfunction as a result of pathogenic organisms in the blood *can be due to:* - widespread inflammatory response to bacterial, fungal, or parasitic infection
Septic shock
multiple organ dysfunction as a result of pathogenic organisms in the blood can be due to: - widespread inflammatory response to bacterial, fungal, or parasitic infection
succinylcholine
muscle relaxant to prevent injury
rapport
mutual understanding and harmony
Contraindication of levodopa
narrow-angle glaucoma, skin lesions/history of melanoma, MAOIs (to avoid severe HTN)
coarctation of the aorta
narrowing of the descending portion of the aorta, resulting in a limited flow of blood to the lower part of the body
V: natriuresis
natural diuresis (increased or excessive production of urine) promoted by the heart and brain ,', DECREASES BP
natriuresis
natural diuresis promoted by the heart and brain
What is tolerance?
need for increasingly larger or more frequent doses of a substance in order to obtain the desired effects originally produced by a lower dose
tolerance
need higher dose to get same effect (from anything)
V: coagulation factors
need to be received alongside plasma (platelets) - fresh frozen plasma contains this substance and should be part of the treatment plan in DIC (disseminated intravascular coagulopathy)
public health core functions - policy development
need to provide leadership in developing policies that support the health of the population (ie scientific knowledge base in making decisions about policy)
adverse effects aminoglycosides (gentamicin)
nephrotoxicity and ototoxicity
MOA antacids
neutralize gastric acid
RRT - limitations
no real effect on... (1) reducing readms to ICU (2) shortening ICU stay (3) reduced in-H mortality of pts d/c from ICU <> more admits (judgement call on adms), but not r/t continued care or aftermath; <> breakdown of team; team dynamics (people error/makeup
unknown
nobody ****ing knows
How do low functioning autism patients present?
non-verbal, need help with ADLs, need to know how to ask for help, aggression toward self and others
NSR
normal sinus rhythm, normal rhythm and rate 60-100
20/20
normal vision
What are saline cathartics not safe for and why?
not safe for frequent or prolonged usage because they may produce *fluid and electrolyte imbalances*
MOA saline cathartics
not well-absorbed; increase osmotic pressure in the intestinal lumen and cause water to be retained, leading to increased peristalsis and decreased intestinal transit time for the fecal mass
What is important to remember with conduct disorder?
note signs of escalation and intervene early
"the stranger"
nurse and client are strangers to each other
Appendicitis (how to relieve pain)
nurse may suggest patient hunches over in a fetal position to alleviate pain
immunizations
nurses play a vital role in health promotion/education; infection prevention for individuals and communities
countertransference
nurses project attributes onto patient because they remind them of someone
caring practices
nursing activities that create a compassionate, supportive and therapeutic environment for patients and staff with the aim of promoting comfort and healing and preventing unnecessary suffering; includes but is not limited to: vigilance, engagement, and responsiveness of caregivers, including family and healthcare personnel
rational belief
objective evidence exists to substantiate its truth
pre-interaction phase
obtain information about the client from the chart, significant others or other health team members; examine one's own feelings, fears, and anxieties about working with a particular client
V: DVT
occurs when a thrombus develops in a deep leg vein accompanied by inflammation _ <~ maybe post op origination; sedentary lifestyle - can travel as an embolism within the venous system (leg)/can lead to *pulmonary embolism*
DVT
occurs when a thrombus develops in a deep leg vein accompanied by inflammation; can travel as an embolism within the venous system/can lead to PE
V: neurogenic shock
occurs when spinal cord injury is above T6 and sympathetic nerves are affected - SNS dysfunction prevents tachycardia/peripheral vasoconstriction that should normally counteract and characterize hemorrhagic shock (fill in blank)
ventilation-perfusion mismatch
occurs when the air cannot flow into an alveolus or blood flow around an alveolus is altered; one of the most common etiologies is a PE (clot prevents gas flow to the alveolus and gaseous exchange cannot take place)
cardiogenic shock
occurs when the myocardium has lost its ability to contract efficiently and maintain an adequate cardiac output
Isotonic crystalloids- indications
often used for fluid loss due to vomiting, diarrhea, or surgical procedures
suicide gamble
one in which patients gamble their lives that they will be found in time and that the discoverer will save them
affect
one specific concern is a flat affect by the patient when describing his or her thoughts and plans of suicide and self-destructive behavior
levels of evidence
opinion-->single descriptive/qualitatative/physiological study-->systematic review of d/q/p studies-->single correlational/observational study-->systematic review of c/o studies-->single randomized/non-randomized control trial-->systematic review of RCTs
scaphoid abdomen
opposite of distended abdomen - an abdomen that dips in towards the patient when lying supine
What adverse effect and risk are there with drugs that treat muscle spasms and spasticity?
orthostatic hypotension - risk for falls and injury
What should a patient receiving gentamicin be tested for?
ototoxicity
V: criteria for SIRS (systemic inflammatory response syndrome)
overwhelming inflammatory run of the body initiated by a severe insult to the body _accompanied by_... - tachycardia - tachypnea (high respiratory rate) - hyperthermia/hypothermia (fever/temp) - leukocytosis (excess WBCs) (signs of infection) (2 questions - presentations)
nocireceptors
pain receptors
Nociceptors
pain receptors -signal from peripheral tissue --> spinal cord--> hypothalamus and cerebral cortex
acute panic attack S/S
palpitations, pounding heart, or accelerated heart rate; sweating; trembling or shaking; sensations of shortness of breath or smothering; feelings of choking; chest pain or discomfort; nausea or abdominal distress; feeling dizzy, unsteady, lightheaded, or faint; chills or heat sensations; paresthesias; derealization or depersonalization; fear of losing control or going crazy; fear of dying - TX: Offer reassurance of safety and security
In hypocalcemia, how does the body respond?
parathyroid hormone (PTH) and increased activation of vitamin D 1. decrease loss of calcium in urine 2. increased absorption of calcium from intestine 3. increase resorption of calcium from bone all mechanisms work together to raise calcium levels to normal
diminished perfusion of kidney
particularly significant in LVF, stimulates the secretion of renin from the juxtaglomerular apparatus of the nephron, which initiates cycling of the RAAS
patent ductus arteriosus
passageway between the aorta and the pulmonary artery remains open after birth
BBW dantrolene sodium
patient should have liver function tests and should be discontinued at first sign of hepatic impairment
Expected outcomes r/t impaired vision
patient will adapt to functioning in healthcare environment without experiencing injury or adverse effects related to impaired vision *remember to always announce yourself upon entering a room
blood loss
patients having surgery are at risk for what complication?
What is the black box warning for dantrolene sodium?
patients should have *liver function tests* and drug should be discontinued at the first indication of *hepatic impairment*
borderline personality disorder
pattern of intense and chaotic relationships, with affective instability and fluctuating attitudes toward other people. These individuals are impulsive, are directly and indirectly self-destructive, and lack a clear sense of identity. NI: clear, concise, matter-of-fact, not give positive reinforcement to their attention-seeking behavior by offering sympathy or attention, redirect inappropriate behavior S/S: Clinging and distancing, splitting, manipulation, self-destructive behaviors, impulsivity. Always in a state of crisis and have frequent mood swings
75
people older than ______ years have the highest rate of suicide.
married
people who are ___________ are less suicidal than are those who are single, divorced, or widowed
INH adverse effects
peripheral neuropathy, hepatotoxicity
probing
persistent questioning of the client; pushing for answers to issues the client does not wish to discuss, causes the client to feel used and valued only for what is shared with the nurse and places the client on the defensive
restraints and the critically ill
physical or chemical to restrict patient's mobility and normal access to body, or disruptive behavior (chemical) Use least amt to achieve (comfort), then weane <> c- assessment and consistency to ensure r/t to pain and not a medical condition (ie hypoxia) (physical) << accidental dislodgement of invasive therapies (trach tubes, IVs, etc), fall prevention, behavior management but valid??? <> fighting restraints?? ~> additional medical issues (skin, muscle tone impairment, circulation, nerve damage, pneumonia)
Spironolactone
potassium sparing diuretic (r/t *CHF*)
Reye's syndrome
potentially serious or deadly disorder in children that is characterized by vomiting and confusion
Medications used for seizures
potentiate GABA action: - barbiturates - benzodiazepines suppress sodium influx: - hydantoins - phenytoin-related drugs suppress calcium influx: - succinimides - amino acid compounds
What is body dysmorphic disorder?
preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others at some point during the course of the disorder, patient has performed repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to the appearance concerns appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder (TX: Antidepressant, anxiolytics and group therapy)
What are positive symptoms of schizophrenia?
present in schizo but no one else - delusions - hallucinations - disorganized thinking, - neologisms (coining of new word) - clang association ("rhyming" words)
What is the treatment for hallucinations?
present reality "i don't see that"
hallucinations - TX/priority nursing intervention
presenting reality - intervention focus: help client understand the connection between inc anxiety and the presence of hallucinations and try to distract them
adrenergic drugs
produce similar effects to those produced by stimulation of the sympathetic nervous system
goal of treatment in PUD
promote healing of lesions and prevent recurrence of lesions by decreasing cell-destructive effects or increasing cell-protective effects
pros/cons of family presence during CPR
pros -opportunity to say goodbye -support providers' ability to provide quality CPR cons -distraction -emotional wellbeing of family
What is a colloid?
proteins, starches, or other molecules that remain in the body for a long time because they are too large to easily cross the capillary membranes when circulating, they have the same effect as hypertonic solutions, drawing water molecules from the cells and tissues into the plasma through their ability to increase plasma osmolality and osmotic pressure plasma volume expanders - useful in treating hypovolemic shock due to burns, hemorrhage, or surgery
guaifenesin
prototype expectorant
MOA Sucralfate
provide barrier between mucosal erosions or ulcers and gastric secretions
MOA sucralfate
provides a barrier between mucosal erosions or ulcers and gastric secretions
What is the MOA of sucralfate?
provides barrier between mucosal erosions or ulcers and gastric secretions
Code Teams - primary nurse
provides info to team leader communicator to leader (dr) assigns roles (>> ease of organization)
verbalizing the implied
putting into words what the client has only implied or said indirectly; can also be used with the client who is mute or is otherwise experiencing impaired verbal communication; clarifies that which is implicit rather than explicit
reflecting
questions and feelings are referred back to the client so that they may be recognized and accepted, and so that the client may recognize that his or her point of view has value - a good technique to use when the client asks the nurse for advice
RRT - benefits
quicker more experienced care >> saved lives (secondarily) (1) team and empowerment morale (2) rebalancing of nurse workload and more appropriate (3) improved pt flow
niacin
raises HDL
complication of closed angle glaucoma
rapidly increased IOP places pressure on optic nerve which can lead to permanent vision loss if not corrected
Assist-control (A/C) ventilator mode
rate and tidal volume NOT present; therefore rate determine only by ventilator often used to fully support a patient, such as when the patient is first intubated or when the patient is too weak to perform the work of SPONTANEOUS BREATHING - each breath has the same *tidal volume* - doing all the work/breathing for patient
Synchronized Intermittent Mandatory Ventilation (SIMV)
rate and tidal volume present - assists pt. not work for pt. like in *A/C mode* breaths at rate of ventilator, anything above done by pt. (spontaneous) or in btw often used for WEANING
What are secondary gains?
receipt of positive reinforcement for somaticizing through added attention, sympathy, and nurturing
Conduct Disorder - TX
recognize early (warning signs - vary per kid) on and intervene
What are negative symptoms of schizophrenia?
reflective of decrees in "normal" functioning - lack of emotional expression - blunted affect, - lack of movement - neglect of ADLs, - withdrawal, poor rapport
What is denial?
refusing to acknowledge the existence of a real situation or the feelings associated with it example: a woman drinks alcohol every day and cannot stop, failing to acknowledge that she has a problem
rejecting
refusing to consider or showing contempt for the client's ideas or behaviors
long, dark winters
regions with _______________, such as Scandinavia and parts of Alaska (eg, Nome), have high suicide rates
eye behavior
regulated by social rules that dictate where, when, for how long and at whom we can look
ANP
released by the heart in response to excess water in the bloodstream; act at the nephrons to release excess water into the urine
V: ANP (atrial natriuretic peptide)
released by the heart in response to excess water in the bloodstream; act at the nephrons to release excess water into the urine ,', DECREASES BP
trust
reliability, dependability
What are the common uses of nasal decongestants?
relief of nasal obstruction and discharge 1. common cold 2. allergies 3. sinuses
health education r/t eye surgery
remind pt that vision may not stabilize for several weeks following eye surgery; new lenses will not be prescribed until pt's vision is stable
restating
repeating to the patient what the nurse believes to be the main point that the patient is trying to communicate; tone of voice rises slightly at the end of the phrase as if asking a question; let the patient know if the nurse heard what was said; encourages the patient to offer additional information
nursing intervention r/t chronic pain
report unrelieved pain to healthcare provider
dissociative disorders
repression of painful experience >> taking on "different" personality not the norm for them until switch back to "normal self" with no recall of activities when "different" self - disturbance of or alteration in the usually integrated functions of consciousness, memory, and identity - An unconscious defense mechanism in which there is separation of identity, memory, and cognition from affect; the segregation of ideas and memories about oneself from their emotional and historical underpinnings - difficult to DX b/c easy to fake << Defense/coping mechanism to protect the ego in the face of overwhelming anxiety (usually from abuse) << Possible link between DID and severe migraines and marijuana use _ TX: antidepressants
research v. EBP
research >> NEW knowledge; EBP >> translates new knowledge (research) into implementation/interventions for best possible outcomes
MOA misoprostol
restores prostaglandin activity
facial expressions
reveal thoughts and express emotions and attitudes
alcoholism (withdrawal) - priority NDX
risk for injury (SAFETY) << tremors, *CNS effects*
What is the major risk with Carbamazepine (Tegretol)?
risk of aplastic anemia & agranulocytosis most important is hematologic assessment
Kussmaul respirations
s/s of *metabolic acidosis* Deep (,', not *hyperventilation*), rapid breathing; usually the result of an accumulation of certain acids
What is the treatment for autism?
same caregiver, positive reinforcement, routines
ABGs (arterial blood gases)
sample of arterial blood used to determine adequacy of oxygenation *artery usually radial (forearm) (+ fiberoptic sensor inside)
approving or disapproving
sanctioning or denouncing the client's ideas or behavior; implies that the nurse has the right to pass judgment on whether the client's ideas or behaviors are "good" or "bad", and that the client is expected to please the nurse; the nurse's acceptance of the client is then seen as conditional depending on the client's behavior
cryptorchidism
undescended testicles, can lead to testicular cancer
hypovolemic shock
shock resulting from blood or fluid loss kidney response with renin and angiotensin cycle >> vasoconstriction (by angiotensin II) >> kidneys slow down process to conserve fluid >> *dec in urine (FIRST sign)* PCWP (preload), DEC CO, INC SVR (afterload), INC - trying to get more out with less TX: fluids, (underlying cause, blood replacement maybe)
Hypovolemic Shock
shock resulting from blood or fluid loss- insufficient circulating volume of blood/fluid
Distributive (vasogenic) Shock
shock that develops from impaired utilization of oxygen- causes massive vasodilation (anaphylactic, neurogenic, septic)
extended release tablets
should not be crushed or chewed
sickle cell anemia
sickled cells tend to clump together and obstruct capillary flow, causing ischemia and possible infarction of surrounding tissue
glomeruli
site in kidney where filatraion occurs
What is the goal of drug therapy with Alzheimer's disease?
slow loss of memory and cognition, thus preserving the independence of the individual person for as long as possible *slow disease progression*, NOT a cure
goal of drug therapy in Alzheimer's
slow the loss of memory and cognition, thus preserving the independence of the individual for as long as possible
What is dissociation?
splitting off of clusters of mental contents from conscious awareness, a mechanism central to hysterical conversion and dissociative disorder
What happens with sudden withdrawal of phenobarbital?
status epilepticus
nuchal rigidity
stiffness in cervical neck area
MOA phenylephrine
stimulates alpha-adrenergic receptors to produce vasoconstriction; constricts arterioles and raises BP
ACE inhibitors
stops the conversion of angiotensin I to angiotensin II (a vasoconstrictor) ,', VASODILATOR (Tx for HTN)
seeking clarification and validation
striving to explain what is vague and searching for mutual understanding
TIA
stroke that resolves in less than 24 hours
V: TIA (transient ischemic attack)
stroke that resolves in less than 24 hours (mini strokes; self recovery)
hemodynamic monitoring
study of how blood moves through the heart (noninvasive) vital signs (for non complex pts) (invasive) *SwanGanz catheter (pulmonary artery catheter)*
10th
suicide ranks as the _____ leading cause of death in the United States.
What is initial intervention for a patient presenting with depression and suicidal ideations?
suicide risk assessment
SI initial intervention
suicide risk assessment, One-on-one suicide observation << concern about safety
Why should family be involved for a patient with anorexia?
support, family may lead to problem (control, perfection, sports)
tracheostomy
surgical creation of an opening into the trachea through the neck
stereotypical belief
the belief describes a concept in an oversimplified or undifferentiated manner
Cataract surgery
surgical removal is only treatment used at this time; no medical treatment available to prevent or treat them - bilateral cataracts: surgery usually performed one eye at a time - usually done on an outpatient basis, using local anesthesia *procedure:* - extracapsular extraction: anterior capsule, nucleus, and cortex of the lens are removed, leaving the posterior capsule intact - surgeon makes small incision and extracts the lens - silicone or acrylic resin intraocular lens is implanted to replace the light-focusing functions of the diseased lens *complications:* (less than 1% of surgeries) - infection or inflammation - detached retina - displacement of lens - corneal edema - hemorrhage
What is the MOA of *phenylephrine*?
synthetic adrenergic drug that stimulates alpha-adrenergic receptors to produce vasoconstriction thus, it constricts arterioles and raises systolic and diastolic blood pressures
Opioid analgesics
synthetic drugs that bind to opiate receptors to relieve pain
public health core functions - assessment
systemic collection of data on population <> monitoring population's health status, available info about health of community
false (white)
t/f most suicides occur within the black population
true
t/f suicides can be prevented
What should a nurse do for a patient with swelling in the arm r/t cellulitis
take off the patient's jewelry (rings cut off blood flow; patient could lose a finger)
focusing
taking notice of a single idea or even a single word; works especially well with a client who is moving rapidly from one thought to another; [this technique is not therapeutic, however, with the client who is very anxious, focusing should not be pursued until the anxiety level has subsided] "This point seems worth looking at more closely. Perhaps you and I can discuss it together."
giving advice
telling the client what to do or how to behave implies that the nurse knows what is best and that the client is incapable of any self-direction; nurtures the client in the dependent role by discouraging independent thinking.
common side effects of ECT
temporary memory loss and confusion
V: hypovolemic shock
the *amount of blood* in the body's vasculature is *reduced* >> /hypo/tension
facilitation of learning
the ability to facilitate learning for patients/ families, nursing staff, other members of the healthcare team and community; includes both formal/informal learning
empathy
the ability to understand and share the feelings of another
endotracheal intubation - what, why
the passage of a tube through the nose (*nasotracheal*) or mouth (*orotracheal*) into the trachea to establish or maintain an open airway <> ventilation <> protection of airway from aspiration
acceptance
the person begins to come to terms with the loss and resumes activities with hopefulness for the future; some dying people reach a stage of acceptance where they seems to be almost devoid of emotion
increases
the risk for suicide _________________ in the face of a protracted, painful, progressively debilitating disease.
What is displacement?
the transfer of feelings from one target to another that is considered less threatening or that is neutral example: a client is angry with his physician, does not express it, but becomes verbally abusive with the nurse
5-15 mcg
therapeutic range theophylline
goal-oriented
therapeutic relationships are _________________ and directed at learning and growth promotion
4
there are nearly ____ times the number of completed suicides among men than among women
Why are topical medications used cautiously with infants and young children?
they have more *permeable skin* and thus are more likely to absorb the topical drug
pulmonary artery pressure (PAP)
third pressure along *pulmonary artery catheter* from insertion - resting place of catheter when not inflating balloon for PCWP reading = 15-30 / 8-15
supra ventricular tachycardia
this condition is life threatening; denotes a synchronized rapid contraction of the heart ventricles, decreasing cardiac function and will cause death if it isn't treated and corrected.
spiritually healthy patient
this pt has inner resources that help work through the grief process, ex. faith, prayer, trust in God, belief in immortality
topical
this type of nasal decongestant preparation is preferred over oral preparations for patients with cardiovascular disease
ischemic
this type of stroke is usually caused by a thrombus arising from areas of arteriosclerotic plaque in a cerebral artery
Who is at risk for developing mental illness(es)
those whose family members have one (genetic, product of your environment)
What is important to remember/educate with tourrettes?
tics can come and go
What are enzymes used for R/T skin?
to debride burn wounds, decubitus ulcers, and venous stasis ulcers promote healing by removing necrotic tissue
public health - mission
to generate organized community efforts to address the public interest in health by applying scientific and technical knowledge to prevent disease and promote health (IOM, 1988)
<40
undesirable HDL
Mechanisms the body uses for hypercalcemia and hypocalcemia
to maintain homeostasis, calcium balance in the body is regulated by: - parathyroid hormone (PTH) - calcitonin - vitamin D **study figures 48.1 and 48.2 on page 823-824
goal of drug therapy in shock
to maintain tissue perfusion and a mean arterial pressure of at least 80 to 100 mmHg
Goal of drug therapy in hypotension and shock state
to maintain tissue perfusion and mean arterial pressure of at least 80-100mmHg
self-awareness
to participate in therapeutic use of self, the nurse must possess ___________________, self-understanding, and a philosophical belief about life, death, and the overall human condition
how to improve health outcomes in US from 2012 report "For the Public's Health: Investing in a Healthier Future"
transform the way the nation invests in health to pay more attention to population-based prevention efforts
What is trauma-informed care?
trauma-informed care generally describes a philosophical approach that values awareness and understanding of trauma when assessing, planning, and implementing care - realizes the widespread impact of trauma and various paths for recovery. - recognizes the signs and symptoms of trauma in clients, families, staff, and all those involved with the system - responds by fully integrating knowledge about trauma in policies, procedures, and practices - seeks to actively resist retraumatization
What is systematic desensitization?
treatment for phobias in which the individual is taught to relax and then asked to imagine various components of the phobic stimulus on a graded hierarchy, moving from that which produces the least fear to that which produces the most example: elevator, spiders
Sinequan (Doxepin)
tricyclic antidepressant for depression and/or anxiety related to alcohol (?)
Imipramine (Tofranil)
tricyclic antidepressant for panic disorder
H. pylori medications
two or more antibiotics are given concurrently to increase effectiveness of therapy - Omeprazole, clarithromycin (Biaxin), and amoxacillin - Omeprazole, pepto bismol, Flagyl and tetracycline - Omeprazole, Biaxin, and Flagyl
fugue
type of dissociative amnesia that client travels to a new area and is unable to remember one's own identity and at least some of one's past. Can last weeks to months and usually follows a traumatic event
What foods need to be avoided with MAOi's?
tyramine - processed meat, aged cheeses, raisins, fava beans, flat italian beans, red wine, liqueurs, smoked/processed meats, caviar, pickled herring, corned beef, summer sausage, soy sauce, brewer's yeast, MSG, sauerkrau ~>> hypertensive crisis (severe occipital and/or temporal pounding headaches with occasional photophobia, sensations of choking, palpitations, and a feeling of dread
V: cryptorchidism
undescended testicles, can lead to testicular cancer
public health
what we, as a society, do collectively to assure the conditions in which people can be healthy (Institute of Medicine, 1988)
V: transternal herniation (aka uncal herniation)
when ICP is not lowered, brain tissue is compressed and forced downward in the skulls to become herniated/displaced to another region of the brain >> compression leads to death (compression of brain stem) of brain tissue
V: stroke
when a cerebral artery ruptures (<< arteriosclerosis) and can no longer bring blood to the brain tissue - often caused by a large branch of the middle cerebral artery and creates severe brain damage - small vessels in the brain can rupture, causing small areas of brain damage - major predisposing factor of hemorrhagic stroke is hypertension (cerebral artery ruptures from excessive pressure and blood leaks into the brain, causing edema, increased intracranial pressure, and tissue destruction
formulating a plan of action
when a client has a plan in mind for dealing with what is considered to be a stressful situation, it may serve to prevent anger or anxiety from escalating to an unmanageable level
V: ectopic pregnancy
when a fertilized ovum implants outside the uterus << slow ovum transport << decreased Fallopian tube motility or distorted tubal structure (past infection and scarring of the fallopian tube) - serious condition >> ruptured tube
attempting to translate words into feelings
when feelings are expressed indirectly, the nurse tries to "desymbolize" what has been said and to find clues to the underlying true feelings
status epilepticus
when phenobarbital is withdrawn suddenly
V: cause of neurogenic shock
when the SNS is disrupted by spinal cord injury, brain injury, or during anesthesia; widespread vasodilation reduces venous return to the heart which reduces the volume of blood that can be pumped out to the ventricles
cause of neurogenic shock
when the SNS is disrupted by spinal cord injury, brain injury, or during anesthesia; widespread vasodilation reduces venous return to the heart which reduces the volume of blood that can be pumped out to the ventricles
presenting reality
when the client has a misperception of the environment, the nurse defines reality or indicates his or her perception of the situation for the client
orientation phase
when the nurse and the patient meet and get to know each other; establish trust, formulate contract for interventions
working phase
when the nurse and the patient work together to solve problems and accomplish goals; promote client change
belittling feelings expressed
when the nurse misjudges the degree of the client's discomfort, a lack of empathy and understanding may be conveyed. The nurse may tell the client to "perk up" or "snap out of it." /causes the client to feel insignificant or unimportant, when one is experiencing discomfort, it is no relief to hear that others are or have been in similar situations
coup-contrecoup injury
when the skull stops abruptly, the brain continues to move forward, rotating within the skull and causing shearing of brain tissues against the skull's rough interior edges; the brain bounces off the skulls and moves in the opposite direction of the first impact, then strikes the skull and damages the opposite area
V: coup-contrecoup injury
when the skull stops abruptly, the brain continues to move forward, rotating within the skull and causing shearing of brain tissues against the skull's rough interior edges; the brain bounces off the skulls and moves in the opposite direction of the first impact, then strikes the skull and damages the opposite area >> MECHANISM OF INJURY THAT CAN RESULT IN SKULL OR BRAIN INJURIES
jesus
who do baptists address when praying?
Alternative to Restraints
why resisting? <> allow them independence/choices Address concerns Modify environment Provide diversionary activities Promote adequate rest/sleep
interpreting
with this technique the therapist seeks to make conscious that which is unconscious, to tell the client the meaning of his or her experience.
advocacy and moral agency
working on another's behalf and representing concerns of patient/family and nursing staff; serving as a moral agent in identifying and helping to resolve ethical/clinical concerns within and outside of clinical setting
collaboration
working with others (patients families, providers) in a way that promotes/encourages each person's contributions toward achieving optimal/realistic patient/family goals; involves interdisciplinary work with colleagues and community
process recordings
written reports of verbal interactions with clients
Are benzodiazepines addictive?
yes
Do patients with autism have a different interpretation of pain?
yes
Is generalized anxiety disorder predictable?
yes - can identify cause/triggers
If there is an order for pain medication and it is in range and you do not give the highest dose, can you give more if patient still experiences pain?
yes; you can give up to the max amount within the range
Mean Arterial Pressure (MAP)
~ blood pressure = [2(DBP) + SBP] / 3 = 60-110 = average BP during one cardiac cycle especially important for your more complex heart pts
Metformin instructions
•take with meals to improve absorption and to minimize GI distress. •metformin decreases the amount of glucose produced in the liver and increases tissue sensitivity to insulin. •may cause rash. •may lose weight when beginning to take med due to n/v.
