Li- BV study

Valproic acid adverse effects (SEE PIC)

*GI EFFECTS* nausea/vomting indigestion *HEPATOTOXICITY* anorexia abdominal pain jaundice Pancreatitis Thrombocytopenia Hyperammonemia so should check the labs:(ATI) Platelet count C. Amylase D. Liver function

IPOP (immediate postoperative prosthesis)

- can be either hand molded or prefabricated. An IPOP is used immediately following surgery to promote body image in a client who has just had an amputation. The IPOP also facilitates early ambulation and prevents swelling of the stump.

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Osteoarthritis nursing interventions

-Heat/cold compress -Group support -Keeping with a routine -Consulting PT/OT ASAP!! ATI : A. "Apply heat to your joints to alleviate pain." C. "Avoid bending your joints to the point it becomes painful when exercising." E. "Use a firm mattress for sleeping." NOTE : use of pillows under the knees should be avoided because this can result in the development of flexion contractures. Avoid tub bath, The nurse should instruct the client to use a walk-in shower with a shower chair when bathing and to use an elevated toilet seat for toileting needs.

WHY cholinesterase inhibitor therapy CONTRAINDICATED WITH PEPTIC ULCER? -FYI

-Increased risk of GI bleeding The biological plausibility of donepezil causing GI ulceration could be due to its ulcer promoting effect through increased acid production, which is partly controlled by cholinergic vagal fibres.

Night terrors management-fyi

-Scheduled awakenings may help -Avoid sleep deprivation (prolongs deep sleep_ -Avoid stress -Reassurance by parents

Bile Acid Sequestrants MOA-fyi

-prevent resorption of bile acids from small intestine -bile acids are necessary for absorption of cholesterol

tertiary prevention examples

1. Prevent pressure ulcers after SCI 2. Promote independence after TBI 3. Referral to support groups 4. Rehab

Postpartum Hemorrhage causes

1. Uterine atony 2. Lacerations 3. Retained placental fragments 4. Forceps delivery Tissue (retained) Trauma (foreceps/lacerations Tone (atony) Thrombo (coag problems)

GCS score

A higher GCS score indicates more neurological function; in this case, a score of 13 or higher would be an ideal goal for a client with a head injury. eg. Which of the following best describes an appropriate desired outcome for a client with a traumatic head injury who has a nursing diagnosis of decreased adaptive capacity? Correct answer Glasgow Coma Scale will be 13 or higher note: B. The goal of intracranial pressure would be to have a lower pressure, 5-15 mmHG range, such as < 10 mmHg. C. Cerebral perfusion pressure should ideally be 60 mmHg to 90 mmHg D. Mean arterial pressure (MAP)would normally be between 70 mmHg and 105 mmHg

Murmur of regurgitation (SEE PIC) (BV #149)

A holosystolic murmur begins at the first heart sound (S1) and continues to the second heart sound (S2). The most common causes are a ventricular septal defect, mitral regurgitation, or tricuspid regurgitation. It is best heard at the apex with the diaphragm of the stethoscope and the client in a lateral decubitus position. Murmurs due to mitral regurgitation (abnormal reversal of blood flow from the left ventricle to the L atrium) are the most common type of heart valve disorder. The mitral valve on the left side of heart does not close properly allowing blood from the left ventricle to leak back into the left atrium when the left ventricle contracts..

type 2 DM care notes ATI

A. "Carbohydrates should comprise 45%-60% of your daily caloric intake." D. "If you drink alcohol, it should be with a meal or food." E. "It is important to have your meals spaced through the day." Carbohydrates should be 45% to 60% of total daily calorie intake. If the client's blood glucose level is well controlled, the levels should not be affected by moderate alcohol intake. Alcohol should be consumed with food, not on an empty stomach, to decrease the risk of developing hypoglycemia. An adequate meal plan with meals spaced throughout the day will help prevent changes in blood glucose levels. Incorrect: B. The client should avoid using hydrogenated oils for cooking because they contain trans fatty acids and increase the risk for hyperlipidemia. C. The client can use table sugar as an occasional substitute for other carbohydrate-containing foods.

A client with leukemia is scheduled for bone marrow transplantation. Which of the following tests and procedures need to be completed before the transplantation? (Select all that apply) A. Crossmatching of client's serum against the donor's lymphocytes B. Administration of acyclovir (Zovirax) C. Administration of ganciclovir (Cytovene) D. Deep cough and breathing exercises E. Give instruction prior to surgery

A. Crossmatching of client's serum against the donor's lymphocytes B. Administration of acyclovir (Zovirax) C. Administration of ganciclovir (Cytovene)

bone marrow transplant (BMT)

A. Crossmatching of client's serum against the donor's lymphocytes B. Administration of acyclovir (Zovirax) C. Administration of ganciclovir (Cytovene)

HMG-CoA Reductase Inhibitors

Also known as Statins, They inhibit the body's cholesterol production and usually have the suffix "STATIN".

Pregabalin (Lyrica)

Anticonvulsant/Antineuralgic Treats fibromyalgia Contraindicated for breastfeeding

a client with encephalopathy secondary to liver failure. The client has been prescribed a high calorie, low protein diet.

Chicken breast, mashed potatoes, spinach. This option meets the prescribed diet. It is high in calories and while chicken does provide protein it is a low-fat source and can be eaten in moderation on a low-protein diet. Spinach will provide additional vitamin K for this client at risk for bleeding due to liver failure.

Bile Acid Sequestrants drugs-(BV)

Cholestyramine (Questran) Colestipol (Colestid) Colesevelam (Welchol)

Donepezil (Aricept)

Cholinesterase Inhibitor (Alzheimer's)

The nurse is caring for a client who has sustained an apparent head injury in a fall in a waiting room. When stabilizing the client, in what order should the following procedures be completed?

Correct Answer: Stabilize cervical spine Ensure the client is breathing Count respirations Measure blood pressure Stabilize the client on a backboard The client who has a potential cervical spine injury should have their spine stabilized prior to other care. This is done to prevent further cord damage, which can lead to further respiratory compromise, permanent disability, and even death.

A nurse is providing home care to an elderly client with diagnoses of Type 2 diabetes and CHF. Which of the following observations is a priority concern for the nurse? A. The client reports her ankles are swollen every night before she goes to bed B. The client reports an ingrown toenail that is very painful C. The homecare aide reports the client refused her shower last week x Incorrect answer DD. The nurse notes the client has lost five pounds in the last two weeks

Correct Answer: B. The client reports an ingrown toenail that is very painful An ingrown toenail can result in serious complications in a diabetic due to poor circulation and the risk of infection.

which increased risk for PPH?-ATI

Correct Answers: A. Magnesium C. Large for gestational age neonate Postpartum hemorrhage occurs primarily due to uterine atony where there is absence of uterine contraction. The normal homeostasis after delivery involves uterine contraction that occludes the open sinuses that brought blood to the placenta. A relaxed or uncontracted uterus will not close the open sinuses, leading to hemorrhage or gradual blood loss, resulting in blood pooling and changes in vital signs. Fundal massage to contract the uterus may resolve uterine atony in cases where the fundus is not firm after delivery of placenta. Magnesium sulfate, terbutaline, and anesthesia relax the uterus causing uterine atony. Multiple gestations stretch the uterine musculature causing less contraction. Heart disease and thrombophlebitis are not proven to cause uterine atony or postpartum hemorrhage.

A nurse is caring for a client who has postpartum hemorrhage after a normal vaginal delivery. Assessment of vital signs reveals a drop in blood pressure with tachycardia. Which of the following may have increased the risk of the client's condition? (Select all that apply.) A. Magnesium B. Heart disease C. Large for gestational age neonate D. Excessive uterine contractility E. Thrombophlebitis

Correct Answers: A. Magnesium C. Large for gestational age neonate Postpartum hemorrhage occurs primarily due to uterine atony where there is absence of uterine contraction. The normal homeostasis after delivery involves uterine contraction that occludes the open sinuses that brought blood to the placenta. A relaxed or uncontracted uterus will not close the open sinuses, leading to hemorrhage or gradual blood loss, resulting in blood pooling and changes in vital signs. Fundal massage to contract the uterus may resolve uterine atony in cases where the fundus is not firm after delivery of placenta. Magnesium sulfate, terbutaline, and anesthesia relax the uterus causing uterine atony. Multiple gestations stretch the uterine musculature causing less contraction. Heart disease and thrombophlebitis are not proven to cause uterine atony or postpartum hemorrhage. Incorrect Answers:B. Heart disease is not associated with uterine atony or postpartum hemorrhage. D. Uterine atony, not excessive contractility, is associated with postpartum hemorrhage. E. Thrombophlebitis is not associated with uterine atony or postpartum hemorrhage. Vital Concept: Postpartum hemorrhage is characterized by blood loss of more than 500 mL after vaginal delivery or more than 1000 mL after cesarean delivery. It is usually caused by uterine atony. Uterine atony refers to failure of the muscular fibers of the uterine wall to contract and retract, which normally occludes the blood vessels. Causes include retained placenta, failure to progress during the second stage of labor, placenta accreta, lacerations, instrumental delivery, large-for-gestational-age (LGA) newborn, hypertensive disorders, induction of labor, and augmentation of labor with oxytocin.

night terrors intervention

Correct Answers: C. Waking the child 30-45 minutes after falling asleep for a week may be helpful. D. The parent should not attempt to wake the child when the episode is occurring. Night terrors are distinct from nightmares. Shortly after falling asleep, a child with night terrors seems to be awake and is screaming, but arousal is partial, and the child usually doesn't respond to soothing. Eventually, the child stops screaming and falls asleep again. The child usually has no memory of the event. The parent should be advised not to wake the child but to remain close by and to refrain from touching or speaking with the child unless the child awakens. Usually, the child will return to sleep quickly. In contrast, nightmares occur most often in the second half of the night. The parents are awakened by the child after the episode is over, and the child is responsive to the parent's reassurance. The child with nightmares may have difficulty returning to sleep if afraid and may also remember the dream and discuss is later. A technique that may help to prevent night terrors is to wake the child 30-45 minutes into the sleep cycle. If this is done each night for about a week, it may be helpful in resolving the night terror cycle. Incorrect Answers:A. Co-sleeping does not have an impact on night terrors. B. The child with night terrors is only partially aroused and does not respond to parental reassurance. E. Use of a night light or lamp is not helpful. Vital Concept:Night terrors are an inherited disorder in which a child has dreams during sleep that do not abate on waking. They occur in 2% of children ages 1-8 years and are not caused by psychological stress. Being overtired may trigger night terrors, and sleep deprivation is the most common trigger. Night terrors usually disappear by 12 years of age. References:

Aged r/t changes

Correct Answers: A. Progressive loss of hearing B. Decreased cough reflex C. Decreased bladder capacity E. Dehydration of intervertebral discs Older adults gradually lose the ability to hear high-frequency sounds. They also have a thickening of the tympanic membrane and sclerosis of the inner ear. Older adults have a decreased cough reflex, increased airway resistance, fewer alveoli, and a greater risk for respiratory infections. Older adults have a decreased bladder capacity and a reduction in renal blood flow. Older adults have dehydration of intervertebral discs, decreased muscle strength and mass, and decalcification of bones. Incorrect Answer:D. Older adults have increased systolic blood pressure, thickening of blood vessel walls, and decreased peripheral circulatio

Which of the following aspects would most likely be assessed using light palpation? (Select all that apply.) A. Skin moisture B. Organomegaly C. Body symmetry D. Pulsations E. Pancreatic tumor

Correct Answers: A. Skin moisture C. Body symmetry D. Pulsations When performing an assessment, the nurse uses the techniques of inspection, palpation, percussion, and auscultation to assess for various changes in the client's health. Palpation may consist of light or deep palpation. Light palpation uses only the finger pads and depresses the skin approximately 2 cm. Light palpation assesses for such factors as skin moisture, body symmetry, and pulsations. Alternatively, deep palpation is used to assess for such factors as organ enlargement or the presence of a tumor. Incorrect Asnwers: B. Organomegaly would best be identified during deep palpation. E. Pancreatic tumor would best be identified using deep palpation.

A nurse is assessing a client who has rheumatoid arthritis. Which of the following manifestations should the nurse expect? (Select all that apply.) A. Heberden's nodes B. Swelling of bilateral joints C. Ulnar deviation D. Crepitus E. Morning joint stiffness

Correct Answers: B. Swelling of bilateral joints C. Ulnar deviation E. Morning joint stiffness Rheumatoid arthritis is an autoimmune disorder affecting the synovial tissues and joints. Swelling and pain of bilateral joints is a manifestation of rheumatoid arthritis. For example, swelling, pain, warmth, erythema, and decreased function can occur in both wrists. Local inflammation of a joint is related to osteoarthritis. Rheumatoid arthritis can result in deformities of the hands and feet. In the hands, clients can develop swan-neck deformities, as well as ulnar deviation. With ulnar deviation, the fingers deviate toward the ulnar bone. Swan-neck deformities involve the flexion of the distal interphalangeal joints and the hyperextension of the proximal interphalangeal joints, giving the fingers the appearance of the curve of a swan's neck. Rheumatoid arthritis has many different manifestations affecting the joints, as well as the subcutaneous tissue, heart, kidneys, and the vascular system. One of the earliest manifestations is the development of morning stiffness of the joints. This stiffness is present upon arising and can last 1 hr or more. Incorrect Answers: A. Osteoarthritis is a noninflammatory degenerative disorder that affects the joints. Although osteoarthritis typically affects weight-bearing joints, the hands can also be impacted. The fingers can develop bony enlargements or nodules, called Bouchard's and Heberden's nodes. Bouchard's nodes affect the proximal interphalangeal joint, while Heberden's nodes are noted on the distal interphalangeal joints of the hands of a client who has osteoarthritis. D. Osteoarthritis causes progressive changes to the joint and bone structure, which results in the development of bone spurs, fissures, and disintegration of the cartilage and bone. The disintegration results in pieces of bone and cartilage floating in the synovial fluid, which can manifest as crepitus, or a grating sound.

Endolymphatic Hydrops (Meniere's Disease) 内耳膜淋巴液积水

Excessive buildup of endolymph which makes things rupture. Meniere's disease is managed through drugs and symptomatic treatment. Surgery is an option if symptoms are unmanageable. Salt intake is restricted in the belief that sodium causes water retention in the endolymph that can trigger more attacks of vertigo. Falls can occur due to vertigo, and clients are instructed to sit down or hold on to something when an attack occurs. s/s: Hearing loss Vertigo Tinnitus Aural fullness note: tremors and drowsiness are not the s/s.

GCS scale

Eyes, Motor, Speech. EYES (4): Spontaneous- 4, To voice- 3, To pain- 2, None- 1. MOTOR (6): Obeys commands- 6, Localizes pain- 5, Withdraws from pain- 4, Decorticate- 3, Decerebrate- 2, None- 1. SPEECH (5): Oriented- 5, Confused- 4, Inappropriate- 3, Sounds (garbled, mumbling, etc)- 2, None, 1. *Your pt will always be 3 or more.

Benzodiazepines MOA-fyi

Faciliate GABAa action by increasing frequency of chloride channel opening Decrease REM sleep Long half-lives and active metabolites (except: triazolam, oxazepam, and midazolam are short acting--> higher addictive potential)

cancer prevention

Female clients should have annual breast exams after the age of 40. Annual mammograms after age 40 (earlier if family history of cancer) Both male and female clients should have a colonoscopy at age 50 and then every 10 years thereafter. Both male and female clients should have a fecal occult test done every year. Annual digital exams (most often for males)

Hepatic encephalopathy symptoms

Fetor hepaticus (musty odor of the breath)(BV), changes in orientation(BV), confusion, forgetfulness, and asterixis (hand tremor) (BV) NOTE: anorexia and ascites are not the s/s. A. Complications of chronic liver disease include the development of portal hypertension, ascites, esophageal varices, biliary obstruction, and hepatic encephalopathy. Hepatic encephalopathy occurs with advanced liver failure and cirrhosis and is characterized by neurologic manifestations. Anorexia is present in a client who has liver dysfunction, but it is not an indication of hepatic encephalopathy. B. Ascites can be present in a client who has chronic liver disease. This is the result of increased portal hypertension, which increases capillary pressure and leakage of fluid from the vascular system. Other causative factors include sodium and water retention due to an inability to metabolize aldosterone as well as the inability of the liver to synthesize albumin, which reduces osmotic pressure. These factors result in a shift of fluid into the peritoneal space which can impair respirations and cause fluid and electrolyte imbalances. However, ascites is not an indication of hepatic encephalopathy.

fetor hepaticus

Fetor hepaticus, a fecal breath odor, is a finding of hepatic encephalopathy in the client who has advanced cirrhosis. It is related to the increased collateral portal circulation that results from advanced liver disease.

GTPAL

G number of tmies pregnant T carried to term 37 weeks or later P preterm delivered 20-36 weeks A abortions- ending before 20 wks L currently living children

Leuprolide MOA

GnRH agonist, so can be used to promote CONSTANT (non-pulsitile) secretion of GnRH to inhibit pituitary -Leuprolide decreases the production of testosterone (bv)to treat prostate cancer

Intermittent tube feedings

HOB @ 45 degrees feed and 1hr after feeding, admin. solution at room temp, formula is administered q4-6h in equal portions of 200-300mL over a 30m-60m time frame (30-45 min per ATI) Flush 30mL every 4 hours ATI: A nurse is providing instructions to a student nurse about administering an intermittent enteral feeding. Which of the following statements indicates understanding of this teaching? (Select all that apply.) A. Fill the feeding bag with enough formula to last 24 hr. B. Change administration set every six hours. C. Leave unused portions of formula at the bedside. D. Label the unused portion of the formula. E. Elevate the head of the client's bed for 15 min after administration. Correct Answers: B. Change administration set every six hours. D. Label the unused portion of the formula. Feeding equipment, such as the bag holding the formula, should be discarded every 6 hours to prevent bacterial contamination. Extension tubing should be changed every 24 hours. The unused portion of the formula should be labeled with the time and date the formula was opened and the client's name and room number. Incorrect Answers: A. Intermittent feedings are administered four to six times a day in equal portions, with each feeding lasting 30 to 45 min. C. The unused portion of formula should be refrigerated up to 24 hr to prevent bacterial contamination. E. The nurse should elevate the head of the client's bed for 30 to 60 min following administration to prevent aspiration. Vital Concept:Intermittent tube feedings are generally administered 4 to 6 times a day, with each feeding infusing 30 to 45 min. The feedings can be infused without a pump as long as care is taken to monitor carefully. Gastric residuals should be measured before each feeding is started.

Cryptosporidiosis symptoms 隐孢子虫病

Headache, sweating, vomiting, severe abdominal pain, diarrhea r/t AIDS AIDS (acquired immunodeficiency syndrome) occurs in the last stage of HIV (human immunodeficiency virus) infection. The CD4 T-cell that fights infection fall below 200/mm. Various opportunistic infections arise due to the insufficient number of T-cells and the overall immunocompromised status of the infected client. Opportunistic infections include tuberculosis, cryptosporidiosis, candidiasis, and pneumocystis carinii. Cryptosporidiosis is the major cause of wasting syndrome. It is caused by the Cryptosporidium parasite that thrives in the intestine. It absorbs nutrients causing weight loss and eventual wasting of body tissues. Typical symptoms of this opportunistic infection include nausea, vomiting, abdominal cramps, and diarrhea. NOTE : TB no diarrhea

Asterixis (liver flap)

Hepatic encephalopathy can be divided into four distinct changes with different manifestations at each stage. A client who has stage 2 encephalopathy can develop involuntary motor activity such as asterixis. The nurse can evaluate for the presence of asterixis by asking the client to hold an arm up with the hand dorsiflexed. The client is unable to maintain this position and within seconds, the hand falls and then returns to the dorsiflexed position. This can be referred to as "hand flapping" or a "liver flap".

Levothyroxine Contraindications

Hx of osteoporosis There is an increased risk for fractures, especially in older adults.

Aspirin Contraindications

Hypersensitivity. Relatively contraindicated in patients with active ulcer disease or asthma. Salicylate Acid Therapy Contraindications: Salicylate acid is a category D agent and should not be administered to pregnant clients. Salicylate acid is contraindicated in clients with bleeding disorders and thrombocytopenia. Salicylate acid should not be given to children or adolescents with fever or recent chickenpox due to the risk of Reye syndrome. The therapy is used for the following types of clients: Salicylate acid inhibits platelet aggregation and is often used in the treatment and prevention of thrombosis. Salicylate acid is commonly prescribed to clients with coronary artery disease to prevent thrombus formation.

which is wrong about mediterranean diet

I will limit my intake of red meat to twice weekly." This statement by the client indicates a need for further teaching. Following the Mediterranean diet, red meat should be limited to two times monthly.

A nurse has discussed multiple methods of contraception with a client. Which of the following statements by the client indicates understanding by the client? (Select all that apply.) A. If I miss a pill, I will take it as soon as I remember B. The vaginal ring stays in for 3 weeks and I remove it for a week when I have my period C. I will return to the clinic every month for the Depo-Provera shot D. The patch should be replaced once a month Graded Response: Correct Rate the quality of this questionSubmit Correct Answers: A. If I miss a pill, I will take it as soon as I remember B. The vaginal ring stays in for 3 weeks and I remove it for a week when I have my period

If a pill is missed, it should be taken as soon as possible and then the client should continue taking pills daily. Both pills can be taken at the same time. No additional contraceptive protection is needed. Emergency contraception (or "the morning after pill") is not needed. If more than 3 days are missed, a health care provider should be contacted and alternative means of contraception should be utilized. A vaginal ring is used for 3 weeks and removed for the week that the client has her period. When that week is over, a new ring is inserted. Incorrect Answers:C. The Depo-Provera injection is administered every 12 weeks (approximately every 3 months). D. The transdermal patch is changed weekly for 3 weeks, then removed for a week. Vital Concept:If two or more pills are missed, or if the client begins the pack more than 2 days late, the client should take 2 active (hormonal) pills as soon as possible and then continue taking pills daily. The client should use condoms or abstain from sex until active (hormonal) pills have been taken for 7 days in a row. If the client misses the pills in the third week of the pack, she should continue taking the active pills in the current pack daily but should discard the pack when all active pills have been taken and begin a new pack the next day. The client should not take the 7 inactive pills. If the client misses 2 or more pills during the first week and has unprotected sex, the client should use emergency contraception for maximum protection, in addition to taking today's active birth control pill.

Bethanechol (Urecholine)

Increases detrusor muscle 逼尿肌 tone to allow strong start to voiding for clients with postoperative urinary hesitancy. Precautions/interactions: do not administer IV or IM, contraindicated for clients with hypotension or decreased CO. Side effects: excessive salivation, tearing. Interventions: administer on empty stomach

Perimenopause symptoms

Irregular bleeding Hot flashes Night sweats Urogenital atrophy Sleep disturbances Mood swings Decreased libido. ATI: Vaginal pH increases Vasomotor instability occurs Vulvar tissue atrophies The symptoms that arise from this life event are due to decrease in the hormone estrogen. The signs and symptoms include erratic menstrual cycles, vulvar tissue atrophy, rising of vaginal pH, decrease in vaginal lubrication, vasomotor instability, and decrease in vaginal rugae. Psychological symptoms such as moodiness, nervousness, insomnia, headache, irritability, anxiety, inability to concentrate, and depression may also occur. Hot flashes and night sweats are physiological reactions from decrease in estrogen. Pelvic pain does not usually occur with menopause unless another condition is present.

"best and most ideal " health screening tool

It is in noninvasive, highly valid, and easy to use

Osteoarthritis (OA)symptoms

Joint pain, stiffness, pain increases with activity, decrease with rest, nodes on joints/fingers.

thyroid storm symptoms

Manifestations will include: Fever Tachycardia Increased systolic blood pressure/HTN (ATI) Abdominal pain (ATI) Nausea Vomiting Diarrhea Anxiousness with tremors Restlessness, confusion, psychotic behavior (ATI) Seizures Death can occur

Methadone adverse effects

Methadone, an opioid agonist, is used to assist clients with maintaining opioid abstinence. Common adverse effects include • Sedation (ATI) • Confusion • Respiratory depression • Dysrhythmias • Hypotension • Constipation

isosorbide mononitrate (Imdur)

Nitrate. Oral formulation only. Sustained release- designed to release a drug at a predetermined rate in order to maintain a constant drug concentration for a specific period of time with minimum side effects. 60-240 mg/day. This medication is prescribed for long-term prophylaxis against anginal attacks.(ATI)

OA vs RA

OA: 1. Occurs in older adults; equal in both sexes 2. May be *unilateral* - Knee, hip, spine, hand 3. DIP & PIP joint (distal & peripheral joint) 4. Shorter period of morning stiffness -*goes away within 30 min* 5. *Increased pain with activity* RA: 1. Occurs earlier in life 2. Women > Men 3. *Symmetrical* - hands & feet common 4. MCP & PIP joint 5. *Prolonged morning stiffness > 30 min* 6. *Increased pain with rest or inactivity* *Activity is major treatment for both disorders in preventing complications*

surgical scrub orders

Open the scrub brush package. Moisten the surgical brush. Wet the hands and arms thoroughly. Scrub the nails, fingers, hands, wrists, and forearms. Rinse the soap from hands and arms. Turn off the water and discard the brush. Hold the hands away from the body with the hands above the level of the elbows.

Bouchard's nodes

Osteoarthritis (PIP swelling 2° to osteophytes) Proximal interphalangeal (PIP)

TOUCHA nurse is caring for a client who is pregnant and has a TORCH infection. Which findings should the nurse expect? (Select all that apply). A. Joint pain B. Insomnia C. Rash D. Urinary frequency E. Decreased appetite Graded Response: Correct Correct Answers: A. Joint pain C. Rash E. Decreased appetite

Perinatal TORCH infections are a group of infections with similar presentations, including flu-like symptoms, joint pain, rash and ocular findings. The infections include toxoplasmosis; "other" (syphilis, parvovirus, and varicella zoster); rubella; cytomegalovirus (CMV); and herpes simplex virus (HSV). A rash can be a manifestation of a TORCH infection. TORCH infections have influenza-like manifestations, such as decreased appetite. Incorrect Answers: B. Malaise and fatigue are common, not insomnia. D. Urinary frequency is not a clinical finding associated with a TORCH infection. Vital Concept:TORCH stands for toxoplasmosis, other infections (syphilis, parvovirus, and varicella zoster), rubella, cytomegalovirus, and herpes simplex virus. Clients who are pregnant and have a TORCH infection will exhibit influenza-like manifestations, such as tender lymph nodes, malaise, joint pain, fever, chills, and headache. The effects of these infections include significant congenital anomalies and even death. Clients should be taught early in pregnancy about proper handwashing and hygiene. Women who are pregnant should avoid activities that increase the risk for developing TORCH infections, such as cleaning cat litter boxes and consuming raw or undercooked meats.

Dx tests to confirm HIV

Positive results of a Western blot test confirm the presence of HIV infection. Positive results of an indirect immunofluorescence assay confirm the presence of HIV infection.

risk factors for postpartum hemorrhage

Postpartum hemorrhage refers to volume of 500 ml after a vaginal birth or 1000 after c-section. The major sources of postpartum bleeding can be remembered by the 4 T's: Tone (uterine atony); Tissue (retained placenta): Trauma (injury to the birth canal); and Thrombosis (clotting problems.) The primary cause of postpartum hemorrhage is uterine atony.Uterine tear, failure to deliver the entire placenta, and impaired blood clotting are other causes.

Changes Associated with Pregnancy

Presumptive -Findings :the client notes and reports - Examples: Fatigue Nausea and vomiting Breast changes Amenorrhea Urinary frequency Quickening - Other causes: Stress Illness Oral contraceptives Endocrine disorders Infection Peristalsis Probable -Findings: the provider can detect. -Examples: Goodell, Hegar, and Chadwick signs Ballottement Positive pregnancy test -Other causes: Pelvic congestion Tumor Hydatiform mole Positive -Finding that can only be due to pregnancy -Examples: Ultrasound visualization of fetus Auscultation of fetal heart tones Palpation of fetal parts -Other causes: None

vancomycin

Red Man Syndrome or an infusion reaction that results in rashes, flushing, tachycardia and hypotension can occur as an adverse reaction. For this reason, vancomycin should be administered over a 60 minute period.

Temazepam

Restoril Benzodiazepine

Secondary prevention examples

Screenings, redirectional therapies, medications

Raloxifene (Evista) MOA

Selective estrogen receptor modulator; acts like estrogen to prevent bone resorption

rheumatoid arthritis (RA)

Slow onset of: -Fatigue -Symmetrical swollen, stiff, painful joints -Worse in the morning and better with activity -Boutonniere fingers (PIP flexion, DIP extension) -Swan fingers (PIP extension, DIP flexion) -Ulnar deviation -Subcutaneous nodules (over bony prominences and tendons) -Dry eyes and mouth -Dilated nail capillaries -Interstitial lung disease

hepatic encephalopathy stages

Stage 1: Disordered sleep, irritable, depressed, mild cognitive dysfunction Stage 2: Lethargy, confusion, disorientation, asterixis, personality changes Stage 3: Stupor, somnolent, confusd speech, unable to follow commands Stage 4: Coma

NG tube decompression suction pressure range

Starting between 40-60 mmHg is recommended. The suction level should not exceed 80 mmHg. Observe for the gastric content to flow into the tubing and then the canister.

Thyroid storm causes-fyi

Sudden events that can trigger a thyroid storm include: Suddenly stop taking your antithyroid medication. Thyroid surgery (thyroidectomy). Nonthyroid surgery. Trauma. Infection. Acute illnesses such as diabetic ketoacidosis (DKA), heart failure and a drug reaction. A sudden large amount of iodine in your body, such as from an iodinated contrast agent that's used for certain imaging procedures. Giving birth. Stroke.

Heberden's nodes

Swelling of distal interphalangeal finger joints, characteristic of osteoarthritis

A nurse is positioning a client to promote drainage from the lower lung lobes. Which of the following bed positions is the most appropriate?

The Trendelenburg position is achieved by placing the head of the bed lowered and raising the foot of the bed in a straight incline. The position is used to promote gravity drainage of the basal lung lobes. It is used in some cases to promote venous circulation.

Hepatic encephalopathy patho-fyi

The client who has advanced liver disease is at risk for the development of hepatic encephalopathy. It is the result of an inability of the liver to remove toxic substances from the blood as well as a shunting of the venous portal blood into the vascular system where it is circulated to the brain, resulting in increased levels of toxic substances such as ammonia, which increases gamma-aminobutyric acid (GABA). GABA is a neurotransmitter that causes neurologic manifestations such as altered level of consciousness in the client who has advanced cirrhosis. Early manifestations of hepatic encephalopathy include changes in mental status, such as a change in orientation. As the encephalopathy worsens, the client's level of consciousness continues to decline, eventually resulting in coma.

vasopressin MOA

The expected pharmacological action is to promote reabsorption of water within the kidney.

risk for heat/cold therapy people

The nurse should use extreme caution with clients who are very young, an older adult, fair-skinned, who have impaired cognition, and have comorbidities because they are at higher risk for fragile skin.

Which of the following information would be included on the psychosocial component of the comprehensive assessment? Select all that apply. A. Carbohydrate intake B. BMI C. Amount of sleep D. Personal habits E. Recreational activities Graded Response: Correct Rate the quality of this questionSubmit Correct Answers: C. Amount of sleep D. Personal habits E. Recreational activities

The psychosocial component of the health history focuses on relationships, environmental factors that can influence health, and practices that can promote or hinder well-being. Examples of topics included in the psychosocial component of the assessment include assessing the client's exercise patterns, recreational activities, personal habits, and sleep patterns. Vital Concept:Psychosocial well-being is important to overall health. Relationships and sources of social support, as well as individual coping mechanisms, are important factors in assessing an individual's psychosocial health.

heart failure heart sounds

The third heart sound, or S3, is an extra heart sound that occurs soon after the normal (S1 and S2) heart sounds and is associated with heart failure. S3 may be a normal finding in people under 40 years of age and some trained athletes but should disappear before middle age. It is caused by increased atrial pressure leading to increased flow rates and inflowing blood against a distended or noncompliant ventricle in mid-diastole. In patients over 40 years of age, the S3 sound is considered pathognomic for heart failure.

Thyroid storm S/s

Thyroid storm can occur as a result of excess thyroid hormone being released with a dramatic increase in metabolism. Manifestations will include: Fever (BV) Tachycardia Increased systolic blood pressure (BV) Abdominal pain (BV) Nausea Vomiting Diarrhea Anxiousness with tremors Restlessness, confusion, psychotic behavior Seizures Death can occur

aspiration intervention for stroke pt

To decrease the risk of aspiration for a stroke client, ensure the clients position is upright, that the upper back and head are supported during meals. Remind the client to tuck their chin while swallowing, to guide the food's path. Avoid lowering the head of bed during feedings. Oral care can improve the client's well-being and increase the interest for eating, but does not help prevent the potential for aspiration

Leuprolide (Lupron) indication

Treatment of advanced prostatic cancer, endometriosis, central precocious puberty, uterine leiomyomata

mediterranean diet

Typical diet of people around the Mediterranean region, focusing on olive oil, red wine, fish, grains, legumes, vegetables, and fruits, with limited amounts of red meat, fish, milk, and cheese. Following the Mediterranean diet, the client should have dairy in moderate portions daily to weekly. Following the Mediterranean diet, the intake of fish and seafood is at least two times per week. Following the Mediterranean diet, drinking wine is acceptable in moderation.

Raloxifene contraindications

VTE, pregnancy

Methimazole adverse effects

agranulocytosis (BV), hypothyroidism (so monitor sore throat) MOA: Thyroid hormone antagonist. Inhibits synthesis of thyroid hormone. Used for hyperthyroidism, preoperative thyroidectomy, thyrotoxic crisis, and thyroid storm.

Benzodiazepines contraindication

allergies to medication pregnancy narrow angle glaucoma(ATI) (Benzodiazepines can increase intraocular pressure due to the pupil-dilating effects of the medication.)

diabetes insipidus-fyi

antidiuretic hormone is not secreted adequately, or the kidney is resistant to its effect

Sucralfate (Carafate) adverse effects

constipation (2% pt) (BV), Hyperglycemia, hypophosphatemia

colesevelam adverse effects

constipation (BV), GI effects, dyspepsia

Hydroxychloroquine

corneal and macular toxicity if chronic use, need eye exam annually (BV)

celiac disease

disease caused by sensitivity to gluten eg. Tortillas contain gluten(ATI). Corn bread, mashed potatoes and lentils do not contain gluten.

Pregabalin adverse effects

dizziness, somnolence, edema (BV), weight gain, ataxia, fatigue

Vital Concept:Symptoms associated with each trimester of pregnancy vary as physiological changes of pregnancy occur. Uterine pain and significant bleeding are never normal

each pregnancy is different, many women experience significant changes throughout pregnancy that are characteristic to the changing trimesters. During the first trimester, the pregnant woman may experience nausea and vomiting, breast tenderness, emotional lability, and feelings of ambivalence toward the pregnancy. The second trimester is a slight reprieve from the early feelings of discomfort and the mother may have a renewed sense of energy compared to the first trimester. It is during the second trimester that the first flutterings of the baby can be felt. During the third trimester, the mother's body starts to prepare for childbirth and she may experience Braxton-Hicks contractions, frequent urination, varicose veins, and peripheral edema. .

Disulfiram adverse effects

hepatotoxicity (ATI)

losartan indication

hypertension, diabetic nephropathy (BV), stroke prevention

Primary prevention examples

immunizations, pollution control, nutrition, exercise

Hydroxychloroquine (Plaquenil) indication

lupus erythematosus, malaria, rheumatoid arthritis

night terrors vs nightmares

night terrors: no memory of events, deep NREM sleep (sweaty, running around...) nightmares: late in sleep cycle, comforted, vivid recall of dream, REM sleep

General survey -ati

physical appearance, body structure, mobility, behavior note: VS and pain not included

Swan finger deformity

s/s of RA

Corticosteroids, such as methylprednisolone will

suppress airway mucus production.

hepatic portal vein 肝门静脉-fyi

this makes up 75% of the blood supply of the liver; it has blood that initially supplied the intestines, pancreas, and spleen; it is largely depleted of oxygen; nutrients and toxic materials are absorbed in the intestines; blood cells and breakdown products of blood cells of the spleen are present here; endocrine secretions from the pancreas and enteroendocrine cells of the GI tract are also present here

risk-adverse

不愿承担风险的