UNIT 6-9 med surg
Which assessment findings would indicate that this client's death is imminent
Signs a patient's death is close would include those things you mentioned, but do not forget that we would also see mottling of the skin of the lower limbs as well.
If you are caring for a client that is being treated for AKI and daily weights have been ordered, if he has a weight gain of 4 pounds (1.8 kg) over the past 48 hours, what nursing diagnosis is suggested by this assessment finding? What does this weight gain signify?
"Excess Fluid Volume". This patient would probably have crackles in their lung sounds and show at least minimal edema- especially in feet and lower legs (and you stated both of these things). And the kidneys are not keeping up with filtering the blood to remove excessive fluid from the body.
If you are performing a shift assessment of a client with aldosteronism, what assessments should you include?
Excess aldosterone in body leading to hypertension, excess fluid volume, edema, etc. We would assess BP, assess K+ levels, and urine output (we would expect lower then normal output).
What are the directions you would provide for this diabetic patient if she needed to have a 24 hour urine performed to check for creatinine? Does she have to avoid any activities or any meds while doing this test? Does it have to start in the morning?
A 24 hour urine is performed as you stated- patient starts the test by voiding and discarding that first void. All other urine for the next 24 hours is collected and placed into the designated container. At the final time of test being done, the patient empties bladder one last time and that last sample is also included in the collection container. And typically a serum creatinine lab test is drawn midway (or so) through the collection process.
If a patient presents to the clinic reporting symptoms that suggest diabetes, what criteria would support checking blood levels for the diagnosis of diabetes? Thoughts on this?
A fasting blood sugar of 126 mg/dl or higher! This means that their blood sugar is higher then the desired 70-100 even with fasting for the past 8-12 hours! This indicated that the body is unable to allow body's insulin to act on this and bring the sugar levels down.
you are aware of the demographic changes that affect the provision of health care. Which phenomena is currently undergoing the most rapid and profound change in the demographics that impacts the health of our nation?
A growing number of people are living to a very old age. And average life expectancy is higher than it has ever been. But with more old people alive comes with more diseases and chronic conditions that need to be treated.
Why don't we talk about the HgbA1C test- I already asked someone why the test should only be run every 3-6 months, but I will ask you what does the result mean? Why is it desired to have a A1C of 6% or less- 6% percent of what? And what does a higher number mean???
A hemoglobin A1c (HbA1c) test measures the amount of blood sugar (glucose) attached to hemoglobin. Hemoglobin is the part of your red blood cells. An HbA1c test shows what the average amount of glucose attached to hemoglobin has been over the past three months. The higher the glucose concentration in blood, the higher the level of HbA1c.
After completing blood gases you find that your assigned patient has acute metabolic alkalosis, what would those blood gases pH, pCO2 and HCO3 look like? Please use these normals pH=7.35-7.45, paCO2=35-45 and Bicarb= 22-26.
A high pH and a corresponding high bicarb level.
What are your thoughts as to the cause of many client care dilemmas at the end of life involving the family's psychosocial needs?
A lot of problems can arise at end of life between caregivers and family of the patient including poor communication between the family and the care team. We need to educate patient's family on what to expect in the final stages of life. And I really love that you mentioned about abiding by the patient's cultural/spiritual practices.
You review the lab report of your adult client's findings & it indicates a glomerular filtration rate (GFR) of 58 mL/min. You should recognize what implication of this diagnostic finding? Is this normal? Would there be other lab findings to investigate? Lab values that would be askew?
As we age, our kidneys do not function as well as they once did when we were younger. One way to identify that is the GFR- glomerular filtration rate. It drops as we get older. The GFR measures the amount of blood (per minute) that the kidneys filter. So a GFR of 58 means that 58 mL of blood is filtered per minute. Adults are usually anywhere around 90-120 mL/min. But as I stated, that # decreases with age. I believe a GFR of 60 or higher may be anticipated in a elderly person. Below that is suspect to kidney damage/failure. A GFR closer to 20 may indicate need for dialysis. So a GFR of 58 would not be looked over, instead cause need for further investigation to rule out kidney issues. We would want to get a BUN and creatinine. Maybe even do an ultrasound of the kidneys to determine adequate blood flow or presence of obstruction somewhere.
If you are assessing a client whose respiratory disease is characterized by chronic hyperinflation of the lungs, and he has had this issues for years, what would the you most likely assess/observe in this client?
Chronic bronchitis. With chronic bronchitis the patient would cough and produce sputum for at least 3 months in a consecutive 2 year time frame. With chronic bronchitis we would have excess mucous produced which would cause a chronic cough, thickening of the bronchial walls, narrowing of the bronchial airway, reduced ciliary function, and there may be mucous that plugs the airways. With chronic bronchitis we would also have severely damaged and fibrosed alveoli
If you are assigned a client that has been taking corticosteroids for several months and is now experiencing muscle wasting, what suggestions would you make to address this adverse effect? What should you recommend?
Consumption of a high-protein diet would be the desired nutritional addition to this person's dietary plan. Protein encourages new tissue/muscle development.
The client is oriented to name only. The client's family is very upset because, before having surgery, the client had no cognitive deficits. The client is subsequently diagnosed with postoperative delirium. How should you explain this to the client's family?
Delirium of this type (of this other patient scenario) is treatable and her cognition will return to previous levels. As the meds wear off, she should return to her pre-surgery status.
If you are assessing a client admitted with renal stones, what factors lead to this condition or should be assessed?
Dietary history. Family history of renal stones, and Medication history should all be considered.
A diabetes nurse educator is teaching a group of clients with type 1 diabetes about "sick day rules." What guideline applies to periods of illness in a diabetic client?
Do not eliminate insulin when nauseated and vomiting
What would be something to share with her and her sugars for when she is sick with a cold, the flu, a stomach bug? WILL her sugars potentially be impacted at all when illness strikes? If so, how and what would you teach her about this?
Due to the stress of illness on the body, glucose levels will be what we call "labile"- fluctuating back and forth- high, low, high again, even higher, etc. So a diabetic that is sick should be instructed that this may happen and to check sugars more frequently while ill.
You are the nurse that is writing a care plan for a client who has returned from surgery 2 hours ago. Which measure should you implement to most decrease the client's risk of developing pulmonary emboli (PE)?
Early ambulation, moving legs while in bed (or use of TED hose or SCD stockings while in bed)
If you were caring for this patient and you recognize that he has prescriptions for numerous different medications for the treatment of varied health problems. In addition, he has experienced occasional episodes of dizziness and lightheadedness since your last visit. You should identify what potential issues? And then on the topic of the elderly
Elderly are at risk for polypharmacy. They get too many meds from too many different sources. And it is unintentional. The patient then is at risk for falls related to polypharmacy and impaired balance.
If you are assessing a client with acromegaly, name 3-4 finding(s) you would most likely assess?
Enlarged feet; Broad nose, Enlarged tongue; and Carpal tunnel syndrome.
A client is brought to the emergency department by the paramedics. The client is a type 2 diabetic and is experiencing hyperglycemic hyperosmolar syndrome (HHS). You should identify what components of HHS?
HHS is just as you have said: HIGH Blood sugar level (of 600 or greater), excessive thirst, dry (cotton) mouth, increased voiding, glycosuria, dehydration with hypernatremia, & confusion. We would probably have this patient on an insulin drip, with very frequent blood glucose checks. He would probably be in ICU until stable.
What type of client is at a greater risk for the development of hypothyroidism?
Hashimoto disease or has a history of hyperthyroidism. The treatment modalities for hyperthyroidism such as thyroidectomy, pharmacological therapy, or radioactive iodine therapy prevent the thyroid from producing too much thyroid hormone but can result in producing none or not enough.
And specifically if we are treating a client diagnosed with metastatic cancer... If you note that the client is exhibiting signs of loss, grief, and intense sadness, the client is most likely in what stage of Elizabeth Kubler Ross' death and dying?
I would like to answer your question about what stage this patient may be in according to Elizabeth Kubler Ross' stages of death and dying? for people who are preparing for the quiz. I would say this patient in in the DEPRESSION phase of Elizabeth Kublers Ross death and dying state. This would be considered stage 4.Complicated grief and mourning are characterized by prolonged feelings of sadness and feelings of general worthlessness or hopelessness that persist long after the death, prolonged symptoms (depression, anxiety, insomnia, fatigue) that interfere with activities of daily living, or self-destructive behaviors such as alcohol or substance abuse and suicidal ideation or attempts
If you were caring for this patient over a period of time and he kept having bruising or injuries with vague explanations for these injuries, you could possibly suspect that he may be the victim of abuse. What is your primary responsibility with this suspicion?
I agree that if there are suspicious marks/bruising that we are obliged to report our suspicions to adult protective services. We only need suspicion. They (APS) will check it out to determine if it is abuse or not.
A man was also going through "Broken Heart Syndrome". Have you heard of this? Do you believe it is a "true" issue? Do you think this is what has caused his failure to thrive that he is in now?
I truly believe that Broken Heart Syndrome is a thing. I have seen it in my professional life and I have seen it in my personal life with family members
If you are teaching a client about type 2 diabetes and the primary treatment for type 2 diabetes, what would the patient say to you to indicate they understand what you taught them?
I would hope that our diabetic patient would say something similar to, "I will make sure to follow the weight loss plan designed by the dietitian." This would indicate an understanding of the need to follow a healthy diet, therefore losing some weight and balance out blood sugars. Eating healthy is just one important point in the treatment of diabetes. Getting to learn their own body, feeling confident with checking and determining best response to body's blood sugars are indeed important.
What do we do if he has not eaten anything all day and he says he wants a big piece of Boston cream pie, but he is diabetic and has heart issues? Do we find a good alternative, or let him have it?
If I am within days of dying and I want pie, give me pie. I appreciate your concerns about staying with healthy choices that would be included in his usual diet, but any calories are better than no calories. More than likely the patient will only eat a few bites, but why not make them happy?
And then could you also tell us what lab findings would indicate that a patient that recently had a thyroidectomy suffered parathyroid gland injury or removal when the thyroidectomy was done?
If the patient had a thyroidectomy, things we would assess to determine if all/part of the parathyroid was removed would be : checking labs for hypocalcemia (since the parathyroid regulates clacium levels). As nurses we could also ask the patient, "Do you feel any muscle twitches or spasms?" As that could be something to indicate an issue with the parathyroid.
Let's say you test his blood sugar when he is found unconscious. The client's Medic Alert bracelet indicates that the client has type 1 diabetes and the client's blood glucose is 35 mg/dL. You would anticipate what intervention immediately?
If we obtained a blood glucose reading of 35 (or below 70 range and unresponsive), we would expect/anticipate injection with administration of 50% dextrose in water (aka D50) through an IV line. We need immediate reversal of this low blood sugar reading and with injecting 50% dextrose, the patient would be responsive within just a few short minutes.
The patient's condition worsens over time to the point that he states that he can no longer do things for himself. The time has come to go to some sort of an assisted living center. What factor should you recognize as impacting the client's life most significantly with this move to assisted living?
In the elderly, as they transition out of their homes and into assisted living, we must keep in mind the importance of maintaining the person's independence/autonomy. Regardless of a person's age, no one wants to feel dependent on others to get their daily activities accomplished. Loss of independence can lead to loss of desire to live
If you are caring for a client at risk for atelectasis, you implement a first-line measure to prevent atelectasis development in the client. What is an example of a first-line measure to minimize atelectasis?
Incentive spirometry (in addition to turn, cough, deep breathing exercises, re-positioning, and getting the patient up and moving around).
You and an interdisciplinary team are planning the care of a client with bronchiectasis. What aspects of care should you anticipate? Tell me 2-3 things at least.
Increasing fluid intake would thin out resp. secretions, making it easier to suction them or have the patient cough them out. We would also want to perform chest physiotherapy. This will also help dislodge secretions deep in the chest. Also assist them to stop smoking. Another care tip would be to encourage the patient to sleep with another pillow- or elevated- to assist with ability to breathe. But the one thing I want to correct is that instead of antibiotics to treat this, it would be anticipated that it would be antimicrobials to treat this patient. Antimicrobials are broader spectrum antibiotics. Antibiotics specifically target bacteria and are used to treat bacterial infections. However, antimicrobials encompass a broader range that acts on microbes including bacteria, fungi, viruses, protozoa.
Definitely listen to lung sounds (which I do see you said & would expect crackles) to assess retention of fluid. So here is a question.... Can you describe urinary retention? What is it? Who is impacted by it? What are the S&S of it? What are treatments for it?
It is not a good thing to have as it increases a patient's chances of developing a UTI. And remember that certain medications can cause the bladder to not function properly. Your interventions anticipated with a patent with urinary retention are correct. The only thing I would add would be that sometimes, I have seen this after surgeries, if a patient is unable to void, we would give a liter of IV fluid bolus to make sure the bladder was full enough to stimulate the need to void. If they can not void after this, that is when the scan and straight cath may be used.
While assisting with a central line insertion, you note the client's oxygen saturation rapidly dropping. The client reports shortness of breath and becomes tachypneic. You suspect a pneumothorax has developed. What further assessment findings support the presence of a pneumothorax?
It is resp acidosis that this patient currently has as his acid-base imbalance. A pneumothorax will have decreased lung sounds, pain on that side, inability to take breaths, dyspnea, increased pulse, decreased oxygen saturation.
What happens if you are the home health nurse for this man when he is home and he tells you he takes multiple meds for varied health issues, but also tells you that he has also begun taking some herbal remedies, as well as vitamins and an aspirin a day. What should you be sure to include in the patient's teaching with your first visit after he shares this information?
It is so important to know ALL meds & herbs the patient is taking. By informing the staff of all meds & herbs, staff can check all things for potential interactions. Many people, regardless of age, hear about a herb that helps with sleep, depression, anxiety, etc. and so they try it without consulting with their provider. There have been some very undesired effects because of this
what is a hemoglobin A1C test? What are they testing? Why does this test just get done once every 3-6 months? Why could we not do it sooner, or why would it be pointless to do it every month? what are your thoughts if this patient's HgbA1C were always at 6.0% or less when she has her appointments.... would she still be here in the office with us today, or would she be here, regardless of what her labs showed?
It is the best test to tell us about glycemic control over a 3 or more month period of time. And yes, RBC's live about 90-120 days. So testing any sooner would be pointless and a unnecessary expense to the patient. So to expand on what you said so as to answer the question I asked about a patient having a HgbA1C of 6%. Yes, it is considered a normal finding, so if this patient consistently stayed at a 6% HgbA1C with each visit, we would be very happy and her appointments would be less frequent (maybe only once to twice a year) because this shows that whatever she is doing to control her diabetes is working well for her and she is compliant with the treatment. So we would be happy! She probably would not be in the
A peak flow meter measures highest airflow during which type of breath?
It measures highest airflow from a forced exhalation.
So diabetes... a bad disease... the client asks the nurse what causes diabetic neuropathy. What would be your answer? And then also answer this please- Talk to me about this gestational diabetes this patient in the case study had 10 years ago... How do you explain that gestational diabetes is a result of what etiologic factor(s)?
It occurs to pregnant women due to the effects of hormonal changes during pregnancy. And then they are at greater risk of developing DMII ten years or more from the time of this pregnancy. throw in here that diabetic neuropathy takes time to develop, tends to develop in patients that are not well controlled with their sugars year after year, AND research can not tell exactly what causes it, but their are patients more likely to develop it (those I mentioned- poorly controlled diabetics).
Why is this statement true?? The younger you are when you start smoking, the higher your risk of lung cancer.
It only makes sense that the longer your lungs are exposed to all of those harmful chemicals, the more damage is being done- especially if you started smoking before your lungs fully developed as an adult.
If you are caring for a client with bronchiectasis and when you auscultate lung sounds, it reveals the presence of copious secretions. And then what intervention should you prioritize in this client's care (the one with bronchiectasis)?
Keeping the airway open as much as possible by various methods and thinning secretions.
If you have a client who is receiving care from family at home, and the patient is in the terminal phase of a chronic illness, when discussing the option of hospice care with a health care provider, the client and family explain through an interpreter that they do not want hospice care. The client immigrated to the United States several years ago and does not speak English as primary language. Because of all of this information, what are 3-4 potential barriers to care for this client and family?
Lack of an understanding of hospice care; A language barrier, and a mistrust of the health care system
If you were working at a large, long-term care facility and you recognized the threat that the flu (or I guess we could also interchange the flu with Covid) was a big threat to this age population, what would it be important for you to educate the rest of the staff about for the threat posed by this resp. illness in older, frail adults? What action should you prioritize to reduce the incidence and prevalence of influenza/covid in the facility?
Nutrition and rest would make a difference with this population, but it would also be VERY important to make sure residents received flu shots every fall (and Covid shot/booster as soon as possible) to ward off the possibility of them getting flu in first place. I am so happy that you mentioned that! When Covid first broke out, it was nursing care facilities/living centers hardest hit with fatalities.
A client asks you why he has had to keep getting larger & larger doses of his pain medication for his metastatic bone cancer, and it does not seem to affect him. What is your best response to the need for higher and higher doses?
Over time you become more tolerant of the drug. This would require larger doses of the drug in order to be effective. I have taken care of some oncology patients who surprised me by still being alive after the large doses they were on- and still complaining about pain! And when you would call a doc to report it, they often would increase the doses!
If you were to implement a comprehensive plan to reduce falls on a gerontologic unit (or even this man's house), what risk factors should you identify? Can you come up with 2-3 things to discuss please?
People are living longer than ever, but with age comes all the diseases and body breakdowns attributed to advanced age. I agree with all the things you mentioned about to help reduce falls in the elderly. To your items I would add: medication effects, poor lighting, & sensory impairment. You mentioned the lighting, but remember (and I know that you do) that there are some medications that cause dizziness or lowers blood pressure, increasing chance of falls. And if the patient has poor vision, hearing, or balance (which a majority of elderly do), this places them at higher risk of falls as well. The list we made together serves as a pretty comprehensive one to always address when caring for our aged population!
If you are an asthma nurse educator who is working with a group of adolescent asthma clients, what intervention is most likely to prevent asthma exacerbations among these clients in the future?
People with asthma should always take their daily meds- to try and avoid any asthma attacks. They should also know how to recognize and avoid their triggers.
in a postoperative client that has a shallow respiratory pattern and is reluctant to cough or to begin mobilizing, what should you address as the client's increased risk for what complication?
Pneumonia or a greater risk of atelectasis. Next, if nothing is done a partial or complete pneumothorax on that side! So we have to get them up and moving, as well as turn, cough, deep breathe, or use incentive spirometer.
You are assessing an adult client following a motor vehicle accident. You observe that the client has an increased use of accessory muscles and is reporting chest pain and shortness of breath. You should recognize the possibility of what condition?
Pneumothorax and I would assess lung sounds, look for chest symmetry when breathing, assess pain, VS, pulse oximetry, and check for tracheal deviation. A good candidate for a chest tube to be placed.
Diabetes Mellitus Type 2
Polyuria - the need to frequently urinate, particularly at night. Polydipsia - increased thirst & need for fluids. Polyphagia - an increased appetite.
A client with type 1 diabetes has told the nurse that his most recent urine test for ketones was positive. What is the nurse's most plausible conclusion based on this assessment finding? What does it mean if ketones are present in urine?
Positive urine for ketones, their insulin levels are inadequate. As you stated, they are breaking down muscle/fat for energy instead of using glucose for the energy. Ketones are a byproduct of that process.
You are the case manager for a group of clients with COPD & you are providing health education. What is most important for you to assess when providing instructions on self-management to these clients?
Recognizing and avoiding triggers such as toxins and chemicals that are being breathed in
If a hypotensive patient also has a diagnosis of deficient fluid volume, the patient's kidneys will compensate by secreting what substance?
Renin is indeed what would be secreted when the body (specifically) recognizes hypovolemia. This will start the whole renin-angiotensin-aldosterone cascade to tell the body to hold onto sodium (and therefore water), instead of excrete them. This will keep body to retain fluid in order to bring blood pressure back up to acceptable levels.
You evaluate the following arterial blood gas values in a client's labs: pH= 7.48, PaO2= 98 mm Hg, PaCO2= 28 mm Hg, and HCO3= 22 mEq/L. Which client condition(s) do you correlate with these results?
Resp. alkalosis. More than likely from hyperventilating. A brown paper bag is an excellent idea and works (and is very cheap). Treating the cause of the hyperventilation would be needed as well- was it an anxiety attack? Calm them, then address the source of their anxiety.
If you had a patient that had an arterial blood gas of: pH of 7.48, CO2 of 32 and HCO3 of 24, how do you interpret this client's acid-base status?
Respiratory alkalosis
What is one of the biggest concerns with a person with this condition? What is it and why is it a concern? If you would be caring for a 30-year-old female client with Cushing syndrome, what psychosocial nursing diagnosis could the nurse most likely prioritize when planning the client's care?
Risk for injury related to associated weakness of Cushings. I would probably assess and put them on fall risk precautions and assistance getting up from bed. And the psychosocial one for a 30 year old female may very well be a disturbed body image related to changes in physical appearance that take place due to the disease.
If you are teaching a group of clients with type 1 diabetes about "sick day rules." What guideline applies to periods of illness in a diabetic client?
Sick day rules- - Do not eliminate insulin when nauseated and vomiting
With that being said, we should assess how the brother is dealing with the patient's increased needs for care. What concerns would we assess for, for this caregiver?
Since the caregiver is also on the advanced age side of life the first thing that we would want to assess would be their physical and mental capabilities. We would want to ensure that they are safe and capable of caring for their brother.Next we would want to assess them for caregiver burnout. Early detection and intervention of caregiver strain can lead to more self awareness of the caregiver of their own needs, and prevent elder abuse from occurring.Early interventions could include support groups, respite care, therapy for the caregiver, local social services (such as rides, meals on wheels, or financial services), or even religious services.
If you are caring for a client whose medical history includes chronic fatigue and poorly controlled back pain, these medical diagnoses should alert you to the possibility of what consequent health problem? What should you assess for with this patient?
Someone (of any age) with a chronic illness, or chronic pain are at risk for Depression. Day after day of suffering and not being able to do things you want/need to for yourself definitely puts that patient at risk for having depressive thoughts/actions.
Your patient complains of shortness of breath and chest pain. Pulse oximeter reading is 84%. The patient has decreased lung sounds in the left lung with a right sided tracheal deviation and you notice that the left lung is not expanding like the right side. You call the medical emergency team (Rapid Response Team), who obtains a portable chest X-ray and they immediately place a chest tube on the left anterior chest wall. What did the chest X-ray show? What would be your next 2-3 interventions?
Spontaneous/tension pneumothorax requiring immediate placement of a chest tube. Our case study patient had diminished (if not absent breath sounds) on the left side. With atelectasis you would still be able to auscultate sounds on left, but they would be very diminished and you would (potentially) hear crackles. With atelectasis we would also see: cough, sputum production, dyspnea, tachypnea, and/or diminished chest expansion. Now both would cause (or have potential to cause) a tracheal deviation. Remember that pneumothorax - is the presence of air or gas in the pleural cavity. If we could "see" this patient face to face, his chest would not rise and fall on left side with pneumothorax, while with atelectasis, you would still have symmetry- just diminished on that affected side.Auscultating lung sounds, placing chest tube, measuring the drainage from the chest tube, assessing for pain levels and administering prescribed pain meds as ordered if necessary.
3-4 facts about stress incontinence
Stress incontinence occurs when someone is sneezing, laughing, coughing, or running, and it happens when there is extra pressure put on the bladder
What types of patients face the greatest risk for aspiration?
Stroke victims, patients with neuromuscular diseases (such as Parkinsons, Huntingtons, MS, etc.), and then also anyone unable to sit in a sitting/elevated position during meals and for drinking fluids.
If you are developing a teaching plan for an adult client with asthma, what teaching point should have the highest priority in the plan of care that you are developing?
Take prescribed medication correctly as scheduled. To find out and avoid triggers
What are 3-4 activities that would describe the primary palliative care functions of the nurse?
That they provide assessment of symptoms, manage basic nursing problems, and use therapeutic communication skills with clients.
An ABG reveals the following results: pH 7.28, PaCO2 38 mm Hg, HCO3- 20 mEq/L. What is the acid-base disorder? What could have caused this?
The Ph and bicarbonate are low, but the PaCO2 is normal, this is suggestive of metabolic acidosis. The PaCO2 is the determining factor on whether it is respiratory or metabolic.
What should the nurse describe about the role of the kidneys in metabolic acidosis? How would you describe the role of the lungs in metabolic acidosis?
The action you stated allows the H+ ions to be excreted, and acid not to be formed. The bicarb being conserved (held on to) helps buffer the acid already in the bloodstream. This assists with returning the body to homeostasis (as you stated).
What assessment finding should prompt you to inform the physician that your client may be exhibiting signs of acute kidney injury (AKI)?
The assessment findings that should prompt you to inform the physician that your client may be exhibiting signs of acute kidney injury... presence of protein and/or glucose and/or blood in the urine, but MOST importantly- a decrease in hourly urine outputs. The average desired amt. of urine per hour is 30mL/hour. Any less than that over a few hours' time would potentially indicate an issue needing investigated!
The ESKD client's diet should include what modifications?
The body is no longer able to excrete it out through urine, so it can build to dangerous levels in between dialysis sessions if the client is not careful. That is one of the labs drawn each dialysis session to determine where their potassium level is at! So one thing to point out is that salt substitutes are HIGH in potassium, so they (clients) need to use herbs to replace salt!
Which age-related physiologic change contributes to heart disease being the leading cause of death in older adults?
The changes that occure in the reproductive system are thinning of the vaginal wall, shortening of the vagina, and loss of elasticity. Addtionally, there can be a decrease in vaginal secretions that can result in vaginal itching, dryness, and decreased acidity. Other changes are atrophy of the ovaries and uterus and decreased pubococcygeal muscle tone. All of these changes can contribute to pain during intercourse.
If a client is reporting pain from surgery earlier that day, and you are preparing to administer the client's first scheduled dose of pain med, prior to administering the drug, you would prioritize what assessment(s)?
The clients rating of her pain is a very important tool to use to assess this client's physiologic status. And when administering meds (of any type to any patient) we always need to complete the 5+5 rights AND assess for any allergies- just a basic requirement for medication administration.
Results of a client's 24-hour urine sample indicate osmolality of 510 mOsm/kg, which is within reference range. What conclusion can you make from this assessment finding in regards to the quality, quantity and character of the urine?
The given osmolality of that urine, being in a normal range, would be considered showing that the kidneys are working well and the client is sufficiently hydrated.
If you have admitted an elderly patient (could even be this patient in the DQ), and you are developing a care plan for this older adult, which factors should you identify as positive attributes that enhance coping in this age group?
The important factors that indicate positive coping would include things such as: the patient has effective adaptation skills (they do not let change 'throw them"; the patient has increased life experience (they have experienced a lot of things in different ways)- I guess you could use the phrase "they have been around the block a time or two"; and the patient displays resiliency during change.
neuropathy in her feet- what are our responsibilities (nurses') related to this finding? What if she cannot reach her feet? And then if you are caring for a client with a diagnosis of Addison disease, what sign or symptom is most closely associated with this health problem?
The important thing to assess and educate about someone with neuropathy is care for the feet. Patients should always wear hard soled shoe, they should assess their feet for sores everyday- including between toes, tops and bottoms of feet. And with exposure to extreme temperatures (extreme heat and extreme cold ) they should check actual temp. since feet are numbed and unable to register being burned or frostbitten until too late. And watch out for using heating pads- those can be a source of burns as well! Avoid hot water bottles, heating pads, and do not enter a bath without checking the temperature of the water. This needs to be added to daily foot care question!!I hate to tell you, but not just pregnant people have a hard time reaching feet.... people with excess belly fat can also have difficulty doing it as well, so yes, if the patient is unable to check feet, he/she should have a trusted person to check feet everyday- preferably the same person every time so they know how feet looked at the last check! And the
If you are assessing this patient for palliative care needs and the client indicates he has been saving his PRN analgesics until the pain is intense because his pain control has been inadequate, what education is he needing? There are several things that can be discussed. And then if you could discuss the difference between different types of pain- (acute vs. chronic), how would you differentiate between the two? Can a person have acute pain AND chronic pain at the same time? What might be examples of this?
The patient needs to be educated on the fact that pain medications work best when they are taken at the first signs of pain. They do not work as well if the patient waits until the pain is intense. I would also educate them on some nonpharmacologic ways to help with pain. Some of examples of this would be massage therapy or acupuncture. These ways to reduce pain could possibly complement the pain medications.Acute pain is pain that involves tissue damage and usually has a short duration and will resolve within the normal healing process. Examples of this would be pain from surgery, burns, or trauma. Chronic pain can be present throughout a person's life. It can be intermittent, have flares of occurrence, or be continuous. Some examples of this would be osteoarthritis pain and peripheral neuropathy from diabetes. You can have both kinds of pain. A cancer patient can have chronic pain that is continuous but then also have acute pain if they are receiving painful procedures during cancer treatment Medication should be taken when pain levels are low so the pain is easier to reduce. Saving them (pills/pain meds) to take 'for later' not wise, not safe. Taking pain med when pain levels low to moderate achieve pain control much better than taking them once pain in high levels. Acute pain- short lived, but intense. Examples would be pain associated with a broken bone, recent surgery. Chronic pain is longer lasting (potentially for the remainder of the person's life). Examples would be arthritis, low back pain, cancer, etc.
You are part of the health care team at an oncology center. A client has been diagnosed with leukemia and the prognosis is poor, but the client is not yet aware of the prognosis. How can the bad news best be conveyed to the client?
The prognosis should be delivered with the client at eye level. A good communication technique meant to strengthen the therapeutic bond.
what statements might this patient (or another person) make about recent signs & symptoms he was having that would make you interpret them (these statements) as being suggestive of diabetes?
The statements that may be made that may strike a suspicion that the patient has diabetes would be surrounding the things you have mentioned. Polydipsia. polyphagia, and polyuria. Polyuria - the need to frequently urinate, particularly at night. Polydipsia - increased thirst & need for fluids. Polyphagia - an increased appetite. So saying such as, ""Lately, I drink and drink and can't seem to quench my thirst", would make us ponder the ramifications of that.
If you were caring for a patient with chronic obstructive pulmonary disease (COPD) that has just developed respiratory distress, and his vital signs are: pulse ox 88% on 2L/min via nasal cannula; dyspnea at rest; respirations 36/minute, and reports shortness of breath. Would this patient have interference in alveolar-capillary diffusion that results in carbon dioxide retention? Why or why not? Would this patient benefit from pursed lip breathing? Why or why not? And should the nurse elevate the head of the bed no more than 20 degrees? Why or why not?
There is interference in the alveolar diffusion due to the damage of the alveoli, and yes, he would benefit from pursed lip breathing. Now the third thing- yes, I agree we would elevate the head of the bed, which would assist in his breathing effort, HOWEVER he should be elevated much more than 20 degrees. He should be elevated at least 45 degrees to get the full effect of his needs.
talk to me about kidney stones- aka renal calculi- what are some talking points to share and things to assess for as for risk factors for why this patient may have them?
They can be caused by may things like diet, medication and more finding the cause depends on where are stones are. Pain and hematuria are the most common symptoms to watch out for. Education for a patient might look like knowing the signs and symptoms to look our for, follow up care, prevention of it happening again, importance of fluid intake and proper diet and also medication education. Treatment of stones could be medication, removal or letting them pass on their own. This would depend on the type and severity staying well hydrated and possibly changing the diet (depending on what lab tells you the stone was comprised of), as well as go to the bathroom frequently- when the urge hits. Stagnant urine that just sits has a greater chance of settling out & forming stones.
Can someone with chronic pain also suffer from acute pain? Or is their pain tolerance such that they do not feel acute pain?
Think about someone with chronic hip pain from arthritis. Somedays that hip pain is so rough it is hard for the person to move around and do her daily activities. And then one day, she is driving to the grocery and gets in a car accident and breaks her wrist. She would have acute pain (broken wrist) and chronic pain (hip/arthritis). People can experience chronic pain and acute pain at the same time. Someone with chronic pain does not suffer LESS acute pain.
What would you do if a different, elderly client tells you that she has had occasional constipation over the last few months? What intervention should you first suggest?Do we go right to enemas and suppositories as they have been proven to give results?
This patient should indeed increase daily intake of water. Remember that the elderly lose their thirst drive, so oftentimes are needing more to drink each day. If just increasing water does not work, add fiber- either pre-made, such as Metamucil, or high fiber foods such as fruits, veggies, prunes,
Do you think he would be open to this discussion, or is he in denial about his dying?
This patient, Mr. Davis, would definitely be a candidate for hospice- either in the home, in the hospice, in assisted living facility, or in a specialized hospice center.
With a patient like this we would observe patient for decreased kidney function & be getting frequent blood tests. What tests would be performed, what would be desired results, and how does this tell us about kidney function?
Urine specific gravity would be another important test and it measures the density of urine- so the higher the number, the more dense the urine- meaning it is concentrated. So a patient with dehydration would have a higher than normal specific gravity value. And yes, BUN and creatinine would also be elevated in values. Finally, you did add to your list is a patient's Glomerular Filtration Rate (aka GFR). It would be decreased, indicating the kidney is not filtering urine as well as it should be. It (GFR) estimates how much blood passes through each glomerulus each minute. So those are the main tests to determine kidney function.
What factors place a patient at greatest risk of developing end stage kidney disease (ESKD)?
diabetes and HTN being the top two factors. There is also trauma, genetics (the patient may have polycystic kidney disease), etc.
We would give Vassopressin-2 receptor antagonists or loop diuretics with increased salt intake to a patient for this. What therapeutic effect are we monitoring after either of these drugs is given?
Vasopressin or loop diuretics will be given with the intent to increase the body's serum sodium concentration. This will make the urine less concentrated and return the body's sodium levels to normal.the therapeutic effect we hope to see is that the patient will increase urine production and excretion, leading to balanced fluid volume in the body. We would go one step further and plan on assessing daily weights, & F&E balances.
If you are caring for a client in metabolic alkalosis and he also has an NG tube set to low intermittent suction for a diagnosis of bowel obstruction, why might we put this patient on cimetidine?
We conclude that cimetidine administration may be used in preventing metabolic alkalosis associated with gastric fluid loss by inhibiting gastric secretion of HCl.
One of the functions of nursing care of the terminally ill is to support the client and their family as they come to terms with the diagnosis and progression of the disease process. How should nurses support clients and their families during this process? You have named a few, but how about patients in general? Can you name an additional 2-3 things?
We should try to appreciate and understand the illness from the client's perspective. We should assist clients with performing a life review. And we should provide interventions that facilitate end-of-life closure. There are more things that could be done- and you mentioned some, and keep in mind that these things may not be the best course of action for EVERY patient coming to grips with the end of their life. It should help the majority though.
What is the preferred intervention to alleviate this client's airflow obstruction while suffering an asthma attack?
We would administer an inhaled beta-adrenergic agonist (such as albuterol) to assist with dilating his resp tract to allow increased airflow.
You are assessing a client's pain while the client awaits surgery. The client is tearful, hesitant to move, and grimacing, but rates his pain as a 2 on a 0-to-10 pain scale. How should you best respond to this assessment finding?
We would need to delve deeper into what is happening with this patient and we would also want to reeducate/reinforce teaching about the pain scale number system. Maybe he is not understanding the scale. We may need to give him examples of a few of the numbers "Zero means you have no pain. A 2-3 score would indicate mild pain that is more of a nuisance than anything and a mild pain reliever would probably decrease it. A 5-6 is pain that needs medicating for and is discomfort enough to distract you from your activities. A score of 9-10 is so severe that all you want to do is curl up into a ball and cry. That you can not imagine any worse pain than what you are feeling." Something like that.
A nurse is caring for a client with type 1 diabetes who is being discharged home tomorrow. What is the best way to assess the client's ability to prepare and self-administer insulin? What are your thoughts?
We would watch them do a return demonstration of correctly preparing and administering their own injection of insulin.
If you are caring for an older female client that has had numerous bouts of bacterial cystitis in the last 6 months, what are several questions you should ask? Not teaching points- questions to her to determine if you can figure out why this is happening as frequently as it is for this patient?
What medications they are on, how much water they drink in a day, if they void before and after sexual activity, if they take frequent bubble baths, if they use feminine hygiene products frequently, etc. I would ask all of these that you mentioned. I really like that you asked about if they have diabetes- it definitely increases chances of UTI's in men or women!
When planning Mr. Davis' care, you should recognize a heightened risk of what nursing diagnosis/diagnoses? What are your thoughts on this?
What would you think if I told you that Anxiety may be the issue involved? He is worried/anxious that he is a burden to his brother. He is worried/anxious his finances are almost depleted. And we most definitely would want to assess the brother for any signs and symptoms of caregiver role strain as he could indeed be suffering from that. And when a caregiver is overtired, overstressed, and overworked he is definitely more apt to do something he may not do- such as lash out at the brother (the patient) or get sick enough he ends up in a hospital.
You are caring for an elderly client who is being treated for a serious respiratory infection. Since the time of admission, the client has been disoriented and agitated to varying degrees. Appropriate referrals were made and the client was subsequently diagnosed with dementia. What nursing diagnoses should you prioritize when planning this client's care?
What you have shared is definitely a possibility, but I would probably select acute confusion. I would probably use the word acute, rather than chronic since it just set in and the patient is aggressive and agitated. So I would say, "Acute confusion related to dementia as evidence by behavioral changes and memory impairment". So we were both thinking along the same path (focusing on the things that their confusion and agitation could cause)
What assessment findings would suggest that a client is experiencing bronchospasm?
Wheezes, labored, rapid breathing, and mucous production.
Is there a difference between an advanced directive, a living will, and a DNR order, OR are they all the same thing?
While both advance directives and DNR documents are advance medical directives, they serve different purposes. A DNR is a different document. A DNR says that if your heart stops or you stop breathing, medical professionals should not attempt to revive you.This is very different from a living will, which only goes into effect if you are unable to communicate your wishes for care. A living will is a document that you can use to give instructions regarding treatment if you become terminally ill or are in a persistent vegetative state and unable to communicate your instructions.
You are caring for a client with diabetes insipidus & are reviewing laboratory results. What is an expected urinalysis finding with this patient with DI?
Would have LARGE amounts of dilute urine, and as you stated, that would impact specific gravity of the urine. A urinary specific gravity of 1.005 or less is what we would find. You were three for three Becca!
If you have implemented a bladder retraining program for an older adult client by placing the client on a timed voiding schedule. You perform an ultrasonic bladder scan after each void and the client typically has approximately 50 mL of urine remaining in her bladder after voiding. What would be your response to this finding?
Yes, 50 mL of urine left in bladder is a 'normal' amount to find. There would be no cause for concern. No one is capable of squeezing every last drop of urine out of their bladder when they void.
How does her being African American play a significant role in her developing diabetes mellitus type 2? Or does it? What is the normal age of onset?
Yes, African Americans are higher risk for diabetes than a Caucasian. And yes, the average onset for DMII is early to mid 40's, even though some pre-teens are being diagnosed with it- attributed to diet and stagnant activity.
As the nurse, we also have to take into account his cultural requirements regarding the dying process and death. Would you anticipate the patient going through a grieving process before he dies? Or what do you think his mental state is at this time?
Yes, it is possible that the patient can go through the grieving process and be in denial of what is happening.
What would be an expected therapeutic effect for a client who is prescribed a drug whose action is to block a hormone's receptor site?
diabetes is never cured. It can be so well controlled that a patient who once required medicine for it no longer needs it, but they are still considered a diabetic patient. Yes, if something (another drug/hormone) is blocking a receptor site, then the hormone or drug needing that receptor site will have less of an effect. Or the action of it could be blocked completely- depending on if there are any receptor sites open on any cells or not
What are 2-3 teaching points for the patient that admits to you, "I take sodium bicarbonate after every meal to prevent heartburn"? What are your thoughts on this?
Yes, someone who consumes sodium bicarb (aka baking soda) for heartburn daily is a big no-no. As you stated, it can throw off the acid base balance of that patient if done that frequently. So we would want to tell them to do something different if the acid reflux occurred that often- - maybe the doctor needs to order a prescription that helps reduce the amount of acid the stomach produces. Maybe you need to teach about foods that increase the likelihood of acid reflux- and to avoid those- - as well as not eating large meals too close to bed time.
What is metabolic syndrome?
a group of five symptoms that increase the risk of heart disease, stroke, and diabetes. A person is diagnosed when they have a combination of symptoms.
copious
a lot or much
What assessment finding is most closely associated with the characteristic signs and symptoms of asthma?
airway constriction leading to bilateral wheezes, tachypnea, dyspnea, cyanosis, decreased oxygen saturation, etc.
let's discuss a patient with hyperparathyroidism. If you were caring for this type of patient, what level of activity would you expect to promote for them to follow?
ambulation and activity as tolerated would be recommended. Weight bearing exercise (such as walking) helps deposit calcium in the bones to make them stronger. Sitting id never good for anyone!
If you are assessing a client diagnosed with Graves disease, what physical characteristics of Graves disease would you expect to find? What would be priority interventions for this patient?
an autoimmune disorder that results in the overproduction of thyroid hormones. The main S&S are: unintended weight loss, an intolerance of heat, muscle weakness (all of which you shared), fatigue and protrusion or bulging of the eyeballs from their sockets. The biggest and most significant is the exophthalmos (bulging eyes).
What guidelines should you specify in the a client's meal plan that has hyperthyroidism- what should he/she eat and how often?
guidelines you should specify in the client's meal plan that has hyperthyroidism is what you have stated- - smaller, more frequent meals with plenty of carbs because this type of patient burns off a lot of calories.
What is Hashimoto's thyroiditis disease??
autoimmune issue leading to hypothyroid condition. It is the leading cause of someone having hypothroid.
What issue has most often presented challenging ethical issues, especially in the context of palliative care?
bility of technology to prolong life beyond meaningful quality of life. You mentioned some good ones too
A client is asking for a breakthrough dose of analgesia. The pain-medication prescriptions are written as a combination of an opioid analgesic and a nonsteroidal anti-inflammatory drug (NSAID) given together. What is the primary rationale for administering pain medication in this manner? In addition, she has experienced occasional episodes of dizziness and lightheadedness since her discharge. You should identify what probable nursing diagnoses?
by combining an opioid with a NSAID, it will achieve better pain control than with one medication. This is not an uncommon practice. Even combining two non opioids- such as stair stepping Tylenol with Advil (NSAID). We need to assist our patients in managing and conquering pain! The question about nursing diagnoses... Risk for falls related to polypharmacy and impaired balance.
Diabetes Insipidous
caused by either a deficiency of ADH or a lack of response to ADH in the kidneys. This can result from various factors, including damage to the hypothalamus, pituitary gland, or the nephrons in the kidneys. can lead to hypernatremia (high sodium levels) if the excessive water loss is not adequately compensated for by fluid intake. results in the excessive retention of water, leading to concentrated urine and hyponatremia leads to the excretion of large volumes of dilute urine, causing hypernatremia due to the loss of free water
What are several signs and symptoms with a diagnosis of asthma?
chest tightness, wheezing, cough
You are aware of the high incidence and prevalence of fluid volume deficit among older adults. What related health education should you provide to an older adult?
health education to provide to an older adult since they are known to have fluid deficits... remind the patient to drink frequently, even if they don't feel thirsty (so I am just rewording what you shared)
What is the most life-threatening effect of kidney injury for which you should monitor the client with kidney injury secondary to diabetic nephropathy?
high levels of potassium is our most life threatening consequence of decreased kidney function. Hyperkalemia can cause life threatening dysrhythmias of the heart, leading to cardiac death!
Why are elderly women (post menopause) more susceptible to UTI's?
hormone levels are decreased in menopausal women- thereby setting them up for a greater chance to acquire a UTI. And age related changes with incomplete emptying are also present (placing them at greater risk as well).
Can you explain to your readers what are some common features among all hormones (not just the hormones impacted by the pituitary)? What do you think? And then what is a negative feedback mechanism? Why do hormones work on this type system? (and yes, I know there are a few that do not work on negative feedback, but talk to me about the ones that do).
hormones need to travel far distances from where they are produced to the organ they affect. The other thing I would add is that most hormones transport through the blood to their target organ/gland.And the way you explained a negative feedback system is also correct. The hormone is produced and secreted when the body senses a deficiency in the level of that hormone. I always think of a negative feedback system as an example of a furnace. When the house gets colder than the temperature set on the thermostat, the furnace turns on to reheat the house.
Besides what this patient in the case scenario has happening, what are some other common reasons for a patient to become in a state of resp. acidosis? What could cause inadequate ventilation, leading to resp. acidosis?
how about taking too much or too high of a dose of opioid analgesics? Opioids, such as morphine, dilaudid, etc. cause respiratory depression. There is such a thing as too much of a good thing. So if they take a higher dose or take doses too frequently, one of the side effects could be respiratory depression that could lead to respiratory acidosis. Short, shallow breaths, decreased resp. rate, etc. This is why it is important to find that perfect balance for our surgical patients to keep the pain relieved, but not overmedicate!
What does his results of his ABGs indicate?
how efficiently the lungs provide oxygen to the body and subsequently remove carbon dioxide.
What would be the anticipated treatment/intervention for this state? Why might this patient have this imbalance?
hyperventilation caused this- for whatever reason. And finally, the "fix" would include breathing into a paper bag will as this would allow the patient to breath in higher levels of CO2, helping to even out O2/CO2 levels to normal.
What are several expected therapeutic effects of a bronchodilator?
increased expiratory flow rate and relief of dyspnea
You are working on the renal transplant unit. To reduce the risk of infection in a client with a transplanted kidney, it is imperative for you to do what?
make sure to do diligent handwashing
The body needs iodine for the thyroid to function. What food would be the best source of iodine for the body?
iodine- iodized table salt. Thank you! You may have also heard that shellfish also contain iodine- and some does, however it is not always readily available or affordable for all people to include in their daily diets. You book mentions table salt only!
What are risk factors for bronchiectasis & what is it? S&S?? And yet another one...
is a long-term, progressive condition where the airways of the lungs become widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection (remember 'warm, dark, moist'). The most common symptoms of bronchiectasis include: a persistent cough that usually brings up phlegm (sputum). The patient with this may also have hemoptysis (coughing up blood). Risk factors would include someone that already has a lung infection such as pneumonia or TB.
A client has just been diagnosed with type 2 diabetes. The physician has prescribed an oral antidiabetic agent that will inhibit the production of glucose by the liver and thereby aid in the control of blood glucose. What type of oral antidiabetic agent did the health care provider prescribe for this client (what classification of drug)?
it is indeed describing metformin, but that type of drug is classified as a biguanide.
What must be absent/present to say patient is deceased?
it is the criteria you stated. Cessation of respirations and heart function.
If you are administering Mantoux tests to children who are being registered for kindergarten in the community, how should you administer this test (method)?
it should be placed on the patient's inner forearm. The skin should be cleansed first with an alcohol swab, allow for it to dry completely and then administer 0.1 mL of PPD intradermally. A bump should form under the skin. The patient should be instructed not to touch or put pressure on the bump and the TB skin test should be read in 48-72 hours for results.
What function does the kidney perform to assist in restoring acid-base balance?
kidneys assist by either excreting or holding onto bicarbonate in acid base imbalances
Diabetes is just one of many, so let's talk about a client with Cushing syndrome that has been hospitalized after a fall. The dietician consulted works with the client to improve the client's nutritional intake. What are 2-3 foods that a client with Cushing syndrome should eat to optimize health?
low fat, low carb, foods high in protein, foods high in calcium, and foods high in vitamin D
most common s/s of Addisons disease
muscle weakness
Prerenal Kidney Injury
nothing wrong with the kidney itself, decrease in the normal amount of blood and fluid in the body to go to the kidneys and perfuse them. Causes include: Severe blood loss and low blood pressure related to major surgery, severe infection (sepsis), or injury. Medicines that interfere with the blood supply to the kidneys. And severe dehydration caused by excessive fluid loss. If it (pre renal causes) is not reversed or treated successfully and quickly, prerenal acute kidney injury can cause tissue death in the kidneys and lead to intrarenal acute kidney injury. external to the kidney, reduces systemic circultion causing a reduction in renal blood flow and lead to decreased glomular perfusion and filtration fo the kidneys
Postrenal kidney injury
occurs when an obstruction in the urinary tract below the kidneys causes waste to build up in the kidneys. Of the three types, this is the least common type of kidney failure. A blockage in the urinary tract may cause urine to build up in one or both kidneys. Over time, this fluid buildup can prevent the normal flow of urine out of the kidney. Causes include: Kidney stones in the ureters or the urethra, an enlarged prostate, or anything that puts pressure on the urethra, causing urine to back up in the bladder. Other causes: a bladder that doesn't empty properly, blood clots in the ureters or urethra, cancer of the prostate. Response to fluid repletion is still regarded as the gold standard in the differentiation between prerenal and intrarenal AKI. Return of renal function to baseline within 24 to 72 hours is considered to indicate prerenal AKI, whereas persistent/progressive renal failure indicates intrarenal disease.
if a patient with ESKD is scheduled for the creation of a fistula for hemodialysis, what should you tell the patient about the fistula itself- not hemodialysis, but the purpose and what exactly is a fistula?
oftentimes the fistula is in the forearm, but I have seen them in the upper arm as well. And yes, the fistula can not be used until well healed and capable of withstanding the rigors of a dialysis session. Clients need to be educate that that is their lifeline and to 'baby' it all the time- including restrictions on tight clothing, lifting no more than 10 pounds, not carrying a purse (or backpack) on it, no BPs or blood draws from that arm.
If a client has been admitted to the medical unit with a diagnosis of ureteral colic secondary to urolithiasis, when planning the client's admission assessment, you should be aware that what signs and symptoms are characteristic of this diagnosis?
pain in the urinary tract, urinary frequency, and hematuria
If you have a client with prolonged signs and symptoms of genitourinary dysfunction scheduled for diagnostic testing, what signs and symptoms are particularly suggestive of urinary tract disease?
pain, changes in voiding and gastrointestinal symptoms. The pain is often caused by distension of a portion of the urinary tract due to obstructed urine flow or inflammation and swelling of tissues. Some common changes in voiding are frequency, urgency, dysuria, hesitancy, incontinence, enuresis, polyuria and hematuria. The most seen signs and symptoms for gastrointestinal issues with urinary tract diseases are diarrhea, nausea, vomiting, abdominal discomfort and abdominal distension
If you are caring for a client at risk for an Addisonian crisis, what associated signs and symptoms should you monitor the client?
pallor, tachypnea, & hypotension
What are the S&S of early lung cancer that would cause concern (enough for a doctor or nurse hearing the patient stating he/she has these early symptoms that would make your radar go off)??
patient stating that they have had a consistent cough that has been bothering them
What role will you have in implementing a behavioral therapy approach for a client with stress incontinence?
pelvic floor exercises, aka Kegel exercises, would be a good thing to teach a patient to help lessen the stress incontinence they have.
What are the risks for empyema (not emphysema) & what is it?
pus is in that pleural space. And it can be the result of pneumonia or a different resp. Infections
What things would you do (assessments & interventions) with a recent kidney transplant if he has a large urine output (> 2500 mL in an 8 hour time) since recent transplantation?
putting out large quantities of urine is watch for hypovolemia and its problems such as hypotension, risk for falls, etc. Oh... don't forget to monitor electrolytes (monitoring them). When a kidney transplant is complete the amount of urine produced is an indicator of rejection. Large amounts of urine are not uncommon with kidney transplant. It's when they don't produce urine is when the problems arise
yperventilation is the most common cause of which acid-base imbalance?
resp. alkalosis
Which test would be the best and most accurate diagnostic test for type 2 diabetes? Why do you feel your answer is the best overall predictor for diabetic control?
risk factors that a patient has that puts them at HIGH risk for developing diabetes- - A large waist (carrying abdominal fat), a high triglyceride level, reduced HDL or "good" cholesterol, increased blood pressure, and elevated fasting blood sugars. And I would probably select the HgbA1C is the best test for measuring overall glycemic control over a period of time. Know that this test is very important and used all the time to determine average blood sugars over a 3-6 month period of time. No cheating on this test! For a fasting blood glucose the patient could just eat real well the day before the test and have a good outcome on the test. HgbA1C not easy to do that!
is slight hematuria expected or not after a patient has a cystoscopy?
slight hematuria is expected after a cystoscopy. The amount should diminish each day after the procedure. If it does not, or bleeding increases, the provider must be contacted!
What are risk factors for bladder cancer? What puts a patient at risk for this and who is more prone to get it (is there a difference in men or women)?
smoking- more common in men
If you took his blood pressure several hours after returning from this surgery and you note that the client's hand has gone into flexion contractions, which laboratory result finding do you correlate with this condition? Why? And what is the name of this sign of flexion of the hand?
specifically assess for hypocalcemia and its associated signs and symptoms in a parathyroidectomy patient.
If a doctor was considering the use of dialysis in a client whose renal function is progressively declining, when is renal replacement therapy (aka dialysis) indicated?
that is when dialysis, or a form of filtering blood, will be determined as the patient's kidneys are no longer able to keep up with the body's demands/needs.
With this patient you should be providing the patient resources on how to manage the disease at home and the signs she should be looking out for while at home. What would some of these be and are there outside resources available? Are there support groups?
the American Diabetes Association would be a good resource, but here in the area, hospitals or communities may have support groups that could be attended- either face to face or virtually
with a client that has ESKD & receives continuous ambulatory peritoneal dialysis, if you were assisting with that and you observe that the dialysate drainage fluid is cloudy, what is your most appropriate action? Does the color mean anything?
the cloudy effluent. Infection. May have to send to the lab to identify the type of bacteria it is in order to know how to best treat.
making end of life better than it could have been. Please tell me what goal of care should you (as his nurse) prioritize when working with anyone from the elderly population?
the goal of care for all elderly (hospice or not) would be helping older adults use their strengths to optimize their independence. As we age, an especially when older people move to assisted living or a nursing home, they lose their independence. We need to make sure to allow them as much independence as possible- in their decisions about their day, their care, their activities.
What about if you suspect she has a fluid volume deficit? Would that impact her specific gravity, and if so, how (increase?/decrease?) ?
the higher the #, the 'denser" or more concentrated, or more solutes found in that urine. Indicating concentrated urine.
What would you anticipate as a treatment that will be ordered or that could be done? Name several. How will the body try and compensate for this imbalance?
the kidneys' role is what you have said... they will excrete HCO3 (bicarb) out through the urine to attempt to make a more acidic environment.
A client in kidney disease partially loses the ability to regulate changes in pH. What is the cause of this partial inability?
the kidneys, if functioning minimally, or not at all, are unable to excrete anything, including potassium, H+ ions, as well as unable to produce or excrete bicarb. So this ends in an undesired situation of the body being out of acid base balance, and having to reply on being fixed by external methods.
You need to provide the parents with information that includes potential causative agents for an asthmatic reaction in their child. What potential causative agents should you describe? And if you are not too tired doing that, what should you teach a client that a peak flow meter measures what value?
the peak flow meter is as you have stated- a means to measure current lung status. Each peson has a different green, yellow, and red zone. The important thing is that green means "Go" and that means continue with meds as scheduled. "Yellow" means caution- and patient should take rescue meds and monitor status. "Red" zone means get into the nearest family asthma doc, urgent care, or Emergency Dept. and be seen so as to get started on nebulizers and steroids.
Intrarenal (aka intrinsic) kidney injury
there has been direct damage to the kidneys that causes a sudden loss in kidney function. Causes of intarenal kidney injury include: tubular necrosis, acute glomerulonephritis, uncontrolled HTN, and acute interstitial nephritis. Nephrotoxic medicines (such chemotherapy agents, contrast dyes, & the "mycin" drugs, etc.) damage the inner structures of the kidney, resulting in the intra renal issues.
SIADH
typically caused by an overproduction or excessive release of antidiuretic hormone (ADH or vasopressin) by the pituitary gland, the hypothalamus, or sometimes by tumors or medications. can lead to a dilutional hyponatremia (low sodium levels) in the blood because of the excess water retention, which can have serious neurological effects.
What causes a state of metabolic alkalosis?
vomiting for awhile, diuretic use, hypovolemia or hypokalemia. The body can compensate by the kidneys excreting bicarbonate to help retain CO2 in the blood.
A client has been taking prednisone for several weeks after experiencing a hypersensitivity reaction. To prevent adrenal insufficiency, the nurse should ensure that the client knows to do what action?
we need to teach patient that they should not come off the drug quickly and before scheduled to do so. The dosage should be tapered as we near the end of completion of taking the med.
A urinalysis includes what assessment parameters? What things are being examined/assessed?
we would assess in a simple urinalysis would be: the things you have stated, including specific gravity of the client's urine, testing for the presence of glucose in the client's urine (as you stated), microscopic examination of urine sediment for RBCs (presence of blood- which you stated), and microscopic examination of urine sediment for casts.
And you are caring for a client admitted to the medical-surgical unit after an injury. The client states "I hurt so bad. I suffer from chronic pain anyway, and now it is so much worse." When planning the client's care, what variables should the nurse consider?
we would need to assess how the presence of pain affects clients and families. We need to seek out resources that can assist the client with pain management. And we need to educate about the advantages and disadvantages of available pain-relief strategies
What do you do about client that had an indwelling urinary catheter removed after having it in place for 10 days (due to an acute illness). Just two hours after removal of the catheter, the client tells you that the he is experiencing urinary urgency resulting in several small-volume voids. What is your best response to his statement? What knowledge can you share about this patient's issues?
when I worked on a endo/renal unit, I have seen as much as 24 pound weight gain in 3 days!!!! Unbelieveable. I can only imagine what damage that causes the human body to gain all that weight so suddenly, then to have it all pulled back off in 5-6 hours!
A client with type 2 diabetes has been managing his blood glucose levels using diet and metformin. Following an ordered increase in the client's daily dose of metformin, the nurse should prioritize which of the following assessments?
when a patient is on metformin we would want to monitor his/her creatinine and BUN levels. Metformin does not cause kidney damage, but since the kidneys process and clear the drug out of your system via urine, if the kidneys are not functioning properly, metformin can build up in your system and cause a condition called lactic acidosis. This is a dangerous state for the patient. Metformin and lifestyle changes may be enough to keep HgbA1C levels low- implying good glycemic control.
If a client has a deficiency of aldosterone, which assessment finding(s) would you correlate with this condition?
you would need to do with the patient with low levels of aldosterone. To summarize and clarify the list: I would assess: for S&S of hypotension, hyponatremia, hyperkalemia, and metabolic acidosis. Tests such as urinalysis, blood testing for plasma renin activity, electrolytes and serum aldosterone levels can aid in diagnosis.... would be we would want to monitor urine output (as we would expect it to be higher than normal)- so also S&S of dehydration.
