Uworld

Ketorolac (TORADOL)

- a highly POTENT NONSTEROIDAL ANTI-INFLAMMATORY DRUG (NSAID) ofte used for pain and available in iv form -HOWEVER, NSAIDS (indomethacin, ibuprofen, naproxen, ketorolac) are NEPHROTOXIC and should be avoided in clients with kidney disease -also the client should not be given 2 types of NSAIDS Simultaneously (naproxen plus ibuprofen) as they can be toxic to the stomach and kidneys

Synchronized cardioversion is indicated for

-Ventricular tachycardia with a pulse -supraventricular tachyardia -atrial fibrillation with a rapid ventricular response

In general, venipunctures is contraindicated in upper extremeities affected by

-Weakness -paralysis -infection -arteriovenous fistula or graft (used for hemodialysis) -impaired lymphatic drainage (prior mastectomy )

Word salad

-a mix of words, and/or phrases having no meaning except to the client EXAMPLE: "Her what comes table, sky, apple"

First-degree atriventricular (AV) block can be associated with

-beta-adrenergic blocker drugs, such as atenolol , as they delay conduction at the AV NODE -this is reflected as prolonged PR interval on ECG -although first-degree AV block should be monitored for progression, it is an expected adverse drug effect -only second- or third- degree heart block should be the priority

Ethambutal (for Active TB)

-causes ocular toxicity and clients will need frequent eye examinations -(THINK E FOR EYES)

Physiologic anorexia

-decrease in nutritional need and appetite -occurs when the very high metabolic demands of infancy slow to keep lace with the moderate growth during toddlerhood -During this phase, toddlers are increasingly PICKY about their FOOD CHOICES and eating schedules -parents sometimes fear the child is not consuming enough calories, but intake over several days usually meets nutrititonal and energy needs -parents should AVOID FORCING FOOD or PRESSURING toddlers to eat more, which can lead to poor eating habits in the future

Complications of rapid, complete bladder decompression

-hypotension and bradycardia - With sudden release of bladder obstruction, cardiovascular autonomic activity occurs and the blood pressure and heart rate are reduced due to the excitation of the parasympathetic system

glucocorticoids with aspirin or nonsteroidal anti-inflammatory drugs

-increase risk for gi bleading or ulceration

Clinical manifesttions of heart failure

-pale, cool, extremities due to reduced perfusion to the systemic circulation -Periorbital edema (puffiness around the eyes) and RAPID WEIGHT GAIN due to systemic venous congestion and fluid retention -reduction in the number of wet diapers due to reduced perfusion to the kidneys

Children's beliefs about death: Age 10-12

-understands that death is final and eventually affects everyone -Thinks about how a death will affect them personally

Formal operational

11+ years -abstract thinking and reasoning

Preoperational

2 to 7 years -Improved language, poor causality (magical thinking), egocentrism

ICP should not exceed

25mm Hg

Concrete operational

7 -11 years -Able to reason if concrete objects are used to teach

Prevention of ventilator -associated pneumonia

General: -hand hygiene -Noninvasive ventilation when possible -daily sedation and weaning protocols -orogastric tubes Prevent aspiration: - semirecumbent position (30-45 angle) -aspiration of subglottic secretions -endotracheal tube cuff pressure >20 cm H20 Reduce colonization -oral antiseptics -routine prophylaxis not recommended -avoid proton pump inhibitors and histamine receptor blocking agents if possible

Signs and symptoms of heart failure (infant with tetralogy of fallot)

Impaired myocardial contractility -tachycardia -pale, cool extremities -weak peripheral pulses -decreased blood pressure -decreased urinary output -activity intolerance, weakness/fatigue -loss of appetite Pulmonary congestion -dyspnea -tachypnea -orthopnea Systemic venous congestion -hepatomegaly -peripheral edema (periorbital in children) -neck vein distension -weight gain -ascities

Magnesium Toxicity Clinical features

Mild: Nausea, flushing, headache, hyporeflexia Moderate: areflexia, hypocalcemia, somnolence Severe: Respiratory paralysis, cardiac arrest Treatment: -stop magnesium therapy -give intravenous calcium gluconate bolus

syphilis manifestations

Primary: painless genital ulcer (Chancre) Secondary -Diffuse rash (palms and soles) -lymphadenopathy (epitrochlear) -condyloma latum -oral lesions -hepatitis Latent -asymptomatic Tertiary -CNS (tabes dorsalis, dementia) -cardiovascular (aortic aneurysm/insufficiency) -cutaneous (gummas)

Children's beliefs about death: Age 6-9

Understands the concrete finality of death -difficulty in perceiving their own death; may be preoccupied with the medical or physical aspects of dying

Hormonal contraception (estrogen with or without progestin)

places women at a 2- to 4- fold increased risk fo developing BLOOD CLOTS due to resulting hypercoagulobility -hormone levels vary among contraceptives and higher levels of hormone content correlate to an increased risk of adverse thrombotic events (stroke, myocardial infarction) -Clients who are prescribed oral contraceptive pills containing estrogen should be educated on potential warning signs (chest pain, vision loss, severe leg pain) -in addition, clients should be instructed NOT TO SMOKE while taking combined OCPs due to an increased risk of blood clots Irregular bleeding and spotting between menses are common side effects of combined OCPs -breast tenderness is a common side effect of combined OCPs and dose not warrant emergent reportin gto hcp

Loose associations

rapid shifting from one idea to another, with little or no connection to logic or rationality "the world turns as the world turns on a ball at the beach, but all the world's stagecoach and i took the bus home"

Operative vaginal delivery (Vacuum/forceps)

Indications: -protracted 2nd stage of labor -fetal heart rate abnormalities -maternal contraindications to pushing Fetal complications -lacertions -cephalohematoma -facial nerve palsy -intracranial hemorrhage -should dystocia Maternal complications -genitourinary tract injury -urinary retention -hemorrhage

Sulfonylureas

(GLYBURIDE) -STIMUMLATE insulin release via the pancreas and carry a risk for severe and prolonged HYPOGLYCEMIA in the geriatric population due to potential DELAYED ELIMINATION -avoidance of these drugs is recommended by the BEERS CRITERIA -instead other medications that are at lower risk for hypoglycemia in the geriatric population due to potential DELAYED ELIMINATION -Avoidance of these drugs is recommended by the BEERS CRITERIA -instead, other meds that are lower risk for hypoglycemia should be used (METFORMIN)

Bumetanide

- a potent loop diuretic (furosemide, torsemide) used to treat edema associated with heart failure and liver and renal disease -the diuretic inhibits reabsorption of sodium and water from the tubules and promotes renal excretion of water and potassium -the nurse should question the bumetanide prescriptin as the client with heart failure has hypokalmeia (potassium < 3.5) and is already at increased risk for life-threatening cardiac dysrhythmias associated with this electrolyte imbalance

Torsades de pointes

"twisiting of the points" -a polymorphic ventricular tachycardia characterized by QRS complexes that change size and shape in a characteristic TWISTING PATTERN -Torsades de pointes is usually due to a prolonged QT INTERVAL (more than half the RR interval) which is the result of electrolyte imbalances, especially HYPOMAGNESEMIA, or some medications -the first-line treatment is IV MAGNESIUM -treatment may also include defibrillation and discontinuation of any QT-prolonging medications

Methotrexate

(Rhematrex) -classified as a folate, antimetabolite, antineoplastic, immunosuppresant drug used to treat various malignancies and as a nonbiologic disease-modifying antirheumatic drug (DMARD) used to treat rheumatoid arthritis and psoriasis Methotrexate can cause BONE MARROW SUPPRESSION resulting in anemia, leukopenia, and thrombocytopenia -Leukopenia and its immunosuppressant effects can increase susceptibilith to infection -Clients should be educated about routing killed (inactivated) vaccines (influenza, pneumococcal) and avoiding crowds and persons with known infections -live vaccines (herpes zoster) are contraindicated in clients receiving immunosuppressants, such as methotrexate -ALCOHOL should be AVOIDED in clients taking methotrexate as it is hepatotoxic and drinking alchol increases the clients risk for hepatotoxicity

The following should be taught to clients taking TETRACYCLINES

(TETRACYCLINE, DOXYCYCLINE, MINOCYCLINE) 1. Take on a empty stomach- for optimum absorption, tertracycline should be taken 1 hour before or 2 hours after meals 2. Avoid ANTACIDS OR DAIRY PRODUCTS - tetracycliens should not be taken with iron supplements, antacids, or dairy products as they bind with the drug and decrease its absorption 3. take with a full glass of water- tetracyclines can cause pill-induced esophagitis and gastrities; the risk can be reduced by taking with a full glass of water and remaining upright after pill ingestion 4. Photosensitivty- severe sunbrun can occur with tetracycline. The client should use sunblock Medications such as tetracycline and rifampin can decrease the effectiveness of oral contraceptives; additional contraceptive techniques will be needed

Probable Signs

(objective) -observed by the HCP during assessment and examination (cervical changes, positive pregnancy test) -uterine and cervical changes :goodell's sign, chadwick sign, hegar sign, uterine enlargement -Braxton hicks contractions -ballottement -fetal outline palpation -uterine and funic souffle -skin pigmenation: chloasma, linea nigra, areola darkening -striae gravidarum -positive pregnancy tests

DESMOPRESSIN

- A medication often used to treat central diabetes insipidus, a disease characterized by reduced antidiuretic hormone (ADH) levels that may result in dehydration and hypernatremia -Desmopressin mimics the effects of naturally occuring ADH, which INCREASES RENAL WATER ABSORPTION AND CONCENTRATES URINE -however, this effect also increases the risk for WATER INTOXICATION FROM DECREASED URINE OUTPUT -clients receiving desmopressin mut have their fluid and electrolyte status closely monitored for symptoms of WATER INTOXICATION/HYPONATREMIA (headache, mental status changes, weakness) -the nurse should immediately notify the hcp of client reports of water intoxication symotoms , as severe hyponatremia may progress to seizure, neurologic damage, or death -Clients on desmopressin are often on FLUID RESTRICTION

Malignant hyperthermia (MH)

- A rare life-threatening inherited muscle abnormality that is triggered by certain drugs used to induce general anesthesia in susceptible clients -the triggering agent leads to excessive release of calcium from the muscles, leading to sustained muscle contraction and rigidity -it can occur in the operating room or in the post-anestheisa care unit (PACU) -the most specific characteristic signs and symptoms of MH include HYPERCAPNIA (EARLIEST SIGN), generalized muscle rigidity (jaw, trunk, extremities), and hyperthermia -HYPOTHERMIA is a later sign and can confirm a suspicion of MH. -the nurse monitors the temp as it can rise 1 degree celsius every 5 mins and can exceed 105 F -The nurse would notify the hcp indicating the need for immediate treatment ( DANTROLENE, cooling blanekt , fluid resuscitation)

Herpes zoster, or shingles

- a characteristic unilateral, linear pattern of fluid-filled blisters -affected clients commonly report pain and itching -herpes zoster infection is due to the varicella -zoster virus (VZV), which also causes chickenpox -after initial VZW infection (chickenpox) in early childhood, the virus remains dormant in the sensory nerves, reactivation of VZV when the immune system is compromised (aging, immunosuppression( results in the formation of lesions along the distribution of one or more such nerves (dermatomal distribution) -vaccination can prevent shingles -if this rash is determined to be due to shingles, the affected area should be convered to prevent the spread of infection. tHerefrore, it is a priority to ask if this client has had chicken pox

Ulcerative colitis (UC)

- a chronic inflammatory bowel disease characterized by INFLAMMATION AND UCERATION OF THE LARGE INTESTINE (COLON) that results in abdominal pain, frequent bouts of BLOODY DIARRHEA, ANOREXIA, AND ANEMIA. The nurse planning care for a cient with UC should: -Manage pain: intestinal inflammation often produces severe abdominal pain that limits treatment compliance. Provide prescribed analgesics to promot comfort and treatment adherence -ADDRESS PSYCHOSOCIAL NEEDS: chronic illness may increase the risk of hopelessness and/or depression due to prolonged treatment and fustration over lack of improvement or symptom control. Encourage clients to discuss emotions and feelings -ASSESS FLUID BALANCE: diarrhea, blood loss, and poor oral intak contribute to dehydration. Strict intake and output monitoring helps ensure adequate fluid intake and prevent dehyrdation -EVALUATE TREATMENT ADHERENCE: UC exacerbations may be spontaneous or may be precipitated by certain foods or lack of adherence to prescribed treatments (medications). Assess compliance with prescribed treaments and provide education as needed to promote adherence -PROMOTE NUTRITION: pain after eating may lead to anorexia and intestinal inflammation decreases nutritent absorption; both result in nutritional deficiency. Help clients select NUTRIENT-DENSE, HIGH-PROTEIN FOODS TO PROMOTE RECOVERY AND MEET NUTRITIONAL NEEDS

Peritonitis

- a common but serious complication of peritoneal dialysis that typically occurs as a result of contaminaition during infusion connections or disconnections -typically, the earliest indication of peritonitis is the presence of CLOUDY PERITONEAL EFFLUENT -later manifestations include low-grade fever, chills, generalized abdominal pain, and REBOUND Tenderness - To detect rebound tenerness, one hand is pressed firmly into the abdominal wall and quickly withdrawn -rebound tenderness is present when there is pain on removal, indicating inflammation on the peritoneal cavity -the nurse should collect peritoneal effluent from the drainage bag for culture and sensitivity -Treament of peritonitis is antibiotic therapy based on the culture results -antibiotics may be added to dialysate, given orally, or adminstered IV

Diabetes Insipidus

- a condition in which antidiuretic hormone (ADH) is insufficiently produced or suppressed -neurogenic DI results from manipulation or interference with ADH release, transport, or synthesis -it sometimes occurs after manipulation of the pituitary or other parts of the brain during surgery, brain tumors, head injury, or central nervous system infections -it is characterized by polydipsia (increased thirst) and polyuria (increased urine output; up to 20L/DAY) and can lead to DEHYDRATION resulting in weight loss , hypernatremia, and a high serum osmolality -urine is dilute and copious and a low specific gravity (<1.003)

Hypospadias

- a congenital defect in which the urethral opening is on the UNDERSIDE OF THE PENIS -except in very mild cases, the conditon is typically corrected around age 6-12 months by SURGICALLY REDIRECTING THE URETHRA to the penis tip -CIRCUMCISION IS DELAYED so the foreskin can be used to reconstruct the urethra -if not corrected, clients may have toilet training difficulties, more frequent urinary tract infections, and inability to achieve erections later in life Postoperatively, the client wil have a catheter or STENT TO MAINTAIN PATENCY while the new meatus heals -Urinary OUTPUT is an important indication urethral patency -fluids are encouraged and the hourly output is documented -absence of urinary output for over an hour indicates that a kind or obstruction may have occurred and requires immediate follow up

Hiatal hernia

- a group of medical condtions characterized by abnormal movement of the stomach and/or esophagogastric junction into the chest due to a weakness in the diaphragm -although hiatal hernias may be asymptomatic, many people experience heartburn, chest pain, dysphagia, and shortness of breath when the abdominal organs move into the chest -symptoms of hiatal hernias are often exacerbated by INCREASED ABDOMINAL PRESSURE, WHICH PROMOTES upward movement of abdominal organs -clients with hiatal hernias who are obese are often encouraged to lose excess weight by performing light activites (short walkes) because obesity increases abdominal pressure -however, nurses should teach clients to avoid activities that promote straining (weight lifting) which increases abdominal pressure

Hemophilia Treatment consists of

- a hereditary bleeding disorder caused by a deficiency in coagulation proteins Treatment consists of replacing the missing clotting factor and teaching the client about injury prevention, including: -avoid medications such as ibuprofen and aspirin that have platelet inhibition properties -avoid intramuscular injections; subcutaneous injections are preferred -Avoid contact sports and safety hazards; noncontact activities (swimming, jogging, tennis) and use of protective equipment (helmets, padding) are encouraged -Dental hygiene is necessary to prevent gum bleeding and soft toothbrushes should be used -MedicAlert bracelets should be worn at all times

Scabies

- a highly contagious skin infestation of the sacroptes scabiei mite -Scabies spreads easily via direct person-person contact (skilled nursing facility, day care, prision) -the pregnant female mite burrows intothe outer skin layer to lay eggs and feces, leaving a superficial burrow track -intense itching especially at night, occurs due to the body's inflammatory response to the mite's eggs and feces -Treatment for scabies typically involves 1 or 2 applications of a scabicide cream (5% permethrin) -for infants and children, permethrin should be massaged into ALL SKIN SURFACES FROM HEAD TO THE FEET, avoiding contact with the eyes -Even after effetive treatent, itching often continues for several weeks, -ALL PERSONS IN CLOSE CONTACT with the client during the lengthy 30-60- day incubation period (time from infestation to symptom onset) should also seek treatmetn -To preven reinfection, clothing and linens should be washed and dried on the hottest settings -Discarding stuffed animals is not required, Nonwashable belongings can be sealed in plastic bags for >/_ days because scabies mites can surviv away from skin for only 2-3 dyas -FUMIGATION of living areas IS NOT NECESSARY

West nile virus

- a mosquito borne disease (encephalitis) that occurs mainly during the summer months, especially during humid weather -prevention focuses on avoiding mosquitoes and using an insect repellent -prevention also includes wearing long sleeves, long pants, and light colors and avoiding outdoor activities at dawn and dusk when mosquitoes are most active -West nile virus is transmitted by an infected mosquito bite. PREVENTION FOCUSES ON AVOIDING MOSQUITOES and using a mosquito repellant -prevention also includes keeping arms and legs covered with light-colored clothing and avoiding outdoor activities at dawn and dusk

Absolute contraindications to thrombolytics

-prior intracranial hemorrhage -structural cerebrovascular lesion (ARTERIOVENOUS MALFORMATION, aneurysm) -Ischemic stroke within 3 months (EXCEPT within 3hr) -Suspected aortic dissection -active bleeding or bleeding diathesis -signifcant head trauma within 3 months

Alzheimer disease (AD)

- a progressive neurodegenerative disease that causes reduced cognitive function (dementia) in older individuals (most commonly age>60) -Converstation becomes progressively more difficult, and the client experiences word-finding difficulty -The best way for the nurse to obtain information and communicate is to use simple statements and questions -facing the client allows the client to visualize the speaker's face and helps reduce distraction -providing a quiet environment turning off the television, closing the door) removes cometing or distracting stimuli

Malignant hyperthermia (MH)

- a rare but life-threatening INHERITED MUSCLE ABNORMALITY that is triggered by specific, INHALED ANESTHETIC AGENTS and the depolarizing muscle relaxaNt succinylcholine (Anectine) used to induce general anesthesia -In MH-susceptible clients, the triggering agent leads to excessive release of calcium from the muscles, leading to sustained muscle contraction and RIGIDITY (usually of the jaw and upper body [EARLY SIGN]), INCREASED OXYGEN DEMAND AND METABOLISM, AND DANGEROUSLY HIGH TEMPERATURE -as MH is an INHERITED CONDITION, proper screening and a thorough preoperative nursing assessment and health history can minimize the client;s risk

Palifermin

- a recombinant human keratinocyte growth factor, PREVENTS oral mucositis in clients diagnosed with hematologic malignancies -(it does NOT HELP WITH PAIN)

Sumatriptan

- a selective serotonin agonist prescribed to TREAT MIGRAINE HEADACHES, which are though to be caused by dilated CRANIAL BLOOD VESSELS -TRIPTAN DRUGS, like sumatriptan, work by CONSTRICTING CRANIAL BLOOD VESSELS, and clients should be instructed to take a dose at the first sign of a migraine to help prevent and relieve symptoms Sumatriptan is contraindicated in clients with CORONARY ARTERY DISEASE and UNCONTROLLED HYPERTENSION because its vasoconstrictive properties increase the risk of angina , hypertensive urgency, decreased cardiac perfusion, and acute myocardial infarction -the nurse should question the client about a past medical history of uncontrolled hypertension and report this to the hcp Because of its serotonergic effects, clients already taking selective serotonin reuptake inhibitros (sertaline, paroxetine) or selective norepinephrine reuptake inhibitors (venlafaxine, duloxetine) should be monitored for signs of serotonin syndrome

Thyroid storm

- a serious and potentially life-threatening emergency for clients with GRAVES disease -this condition occurs when the thyroid gland releases large amounts of thyroid hormone in response to stress (trauma, surgery, infection) -characteristic features include tachycardia, hypertension, cardiac arrhythmias (atrial fibrillation) and FEVER up to 104-106 -other findings include severe nausea, vomiting, anxiety , ALTERED MENTATION, and seizures Thyroid strom is a life-threatening complication of GRAVES disease. -FEVER, ALTERED MENTATION, AND EXCESS AUTONOMIC ACTIVITY (severe hypertension, tachycardia) are common

Wernicke Encephalopathy

- a serious complication that manifests as altered mental status, Oculomtor dysfunction, and ataxia -Clients are prescribed thiamine to prevent this condition

A Colles' fracture

- a type of wrist fracture (distal radius fracture) that causes a characteristic dinner fork deformity of the wrist -it usually occurs when the cleint tries to break a fall with an outstretched arm or hand, and lands on the heel of the hand -it is one of th emost common fractures in women age >50 and is realted to osteopenia or osteoporosis While the client is undergoing evaluation , nursing interventions should include -performing a neurovascular assessment (pulse temp., color cap refill, sensation movement). THis is prioroty nursing action as neurovascula insufficiency related to swelling (compartment syndrome) or arterial/nerve damage by the bone fragments is associated with a colles' fracture. If neurovascular status is compromosed urgent reduction of the fraction is indicated -ADMNINISTERING ANALGESIA TO PRMOTE COMFORT -aPPLY an ice pack to the wrist to help reduce edema and inflammation -Elevating the extremity on a pillow above heart level to reduce edema -Instructing the client to move the fingers to reduce edema, increase venous return, and help improve range of motion

Duchenne muscular dystrophy

- an X-linked recessive (carried by females and affecting males) -disorder that causes the progressive replacement of dystrophin , a protein needed for muscle stabilization , with connective tissue -the proximal lower extremities and pelvis are affected first -in response to proximal muscle weakness, the calf muscles hypertrophy (pseudohypertophy) initially and are later replaced by fat and connective tissue -children with duchenne muscular dystrophy raise themselves to a standing position using the classic GOWER SIGN. MANEUVER (PLACING hands on the thighs to push up stand) and walk on tiptoes -parents may also report frequent tripping and falling

Placenta Previa

- an abnormal implantation of the placenta resulting in partial or complete covering of the cervical os (OPENING) - The condition is diagnosed by ultrasound -in clients reporting PAINLESS VAGINAL BLEEDING AFTER 20 WEEKS GESTATION, placenta previa should be suspected -Placenta previa found early in pregnancy may resolve by the third trimester, but women with persistent placenta previa or hemorrhage REQUIRE CESAREAN BIRTH -A TYPE AND SCREEN to determine blood type and Rh status is appropriate due to the potential for excessive blood loss and need for blood transfusion -fetal well-being is assessed via continous electronic fetal monitoring to help determine appropriate timing for birth -large bore IV ACCESS IS ESTABLISHED in anticipation of fluid resuscitation and administration of blood products -the client should also be monitored frequently for any changes in bleeding via pad counts -Digital vaginal examinations are contraindicated in the presence of vaginal bleeding of unknown origin . WHen placenta previa is present, manual manipulation of the cervix can damage placental blood vessels, causing subsequent bleeding that can progress to hemorrhage -client with placenta previa are on PELVIC REST (no intercours, nothing per vagina)

hypertensive crisis

- an elevation in blood pressure >180 mmHg SYSTOLIC and/or >120 mm hg DIASTOLIC with evidence of organ damage ( kidney damage, retinopathy) -the goal of treatment is to slowly lower BP using IV antihypertensive medications (vasodilators) to limit end-organ damage -once the client's condition is stabilized, oral antihypertensives are prescribed and IV medications are titrated off

Jaundice

-best assessed in natural lighting, with gentle pressure to the skin over a firm surface such as the nose, forehead, or sternum -it first appears on the FACE and extends to the TRUNKS and eventually the entire body -Jaundice within the FIRST 24 HOURS IS PATHOLOGICAL. IT is usually related to problems of the liver -JAUNDICE AFTER 24 HOURS is referred to as physiological jaundice and is related to the increased amount of unconjucated bilirubin in the system

Oropharyngeal candidiasis (or thrush) (moniliasis)

- an infection of the mucuous membranes generally caused by the yeastlike fungus candida albivcans -the fungus causes pearly, "milk -curd" lesions in the oral or laryngeal mucosa that may bleed when removed -IMMUNOSUPRRESEDD INDIVIDUALS SUCH AS those taking corticosteroid medication, clients undergoing chemotherapy or radiation, or clients with immune deficiency states (AIDS) have an increased incidence -Clients receiving prolonged or high-dose ANTIBIOTIC treatment are at increased risk as the normal microbial flor of the mouth is reduced, allowing other opportunistic infections to arise -individuals with DENTURES and infants also comminly experience monilial infections -treatment is antifungal medications (nystatin) and proper oral hygiene

Ferrous sulfate

- an oral iron supplement prescribed to prevent or treat iron deficiency anemia, which occurs when the body lacks sufficient iron , as an essential mineral in the formation of new RBCs -low iron levels may result from malabsorption, insufficient intake, increased requirements (pregancy), or blood loss -the nurse should AVOID administering CALCIUM SUPPLEMENTS or antacids with or within 1 hour of ferrous sulfate because CALCIUM decreases iron absorption -taking an iron supplement with vitamin C (orange juice) further enhances duodenal acidity and increases absorption . An acid-rich environmnet enhances iron absorption, so oral supplements should be taken 1 hr before or 2 hours after meals

Radiation therapy to the head and neck

- can decrease a client's oral intake due to the development of mucositis (inflammation of the mouth, esophagus, and oropharynx) and xerostomia (dry mouth) -these adverse side effects affect speech, taste, and ability to swallow and can have a significant impact on the client's nutriotnal status The nurse teaches the client to: -avoid irritants such as spicy, acidic, dry, or crumbly foods; coffee; and alcohol -consume supplemental nutritional drinks (ENSURE), which are often easier to swallow -use ARTIFICIAL SALIVA to manage xerostomia and the production of thick saliva due to altered salivary gland function -sipping water throughout the day is equally effective and less expensive -topical anesthetics (lidocaine) have been found to increase comfort and improve oral intake in clients with mucositis due to radiation therapy -Clients on radiation therapy need to maintain more frequent (before andafter meals, at bedtime) oral hygiene (using soft toothbrush, rinsing with baking soda solution) due to the drying effects of mucositits

Children's beliefs about death Birth to age 2

- no understanding of death -sensitive to loss and separation; may be distressed by changes in the environment, caregivers and regular routines

3 principles of informed consent include:

- the surgeon explains the diagnosis, planned procedure with risks and benefits, expected outcome, alternate treatments, and prognosis without surgery -The client indicates understanding of the information -the client is competent and gives voluntary consent THe nurse is responsible for witnessing the client's signature and ensuring that the client is competent and understands information provided by the surgeon. -clients unconscious or under the influence of mind-altering drugs (opiodis) cannot provide consent -if the sedated client requires procedures not listed on the consent form, the cleint's medical power of attorney, legal guardian, or next of kin should be contacted so that the surgeon can explain the situation and obtain consent

Septic arthritis

- this client is exhibitng localized (pain, limited range of motion) and SYTEMIC INFECTION SYPMPTOMS (fever) which may indicate spetic arthritis -a septic hip is considered a SURGICAL EMERGENCY -the hip joint is prone to develop avascular necrosis (damage to the femoral head) from compromised blood supply due to infection or injury (fracture) -This can result in sequelae that are significant in both the short term (Sepsis, death) and long term(joint destruction) -management includes culturing synovial fluid and blood, giving antibiotics, and debriding the infected joint

Red man syndrome (RMS)

-A condition that can occur with RAPID IV VANCOMYCIN administration -It is characterized by flushing, erythema, and pruritus, typically on the face, neck, and chest -muscle pain, spasms, dyspnea, and hypotension may also occur -RMS is usually a RATE-RELATED INFUSION reaction and not an allergic reaction -it can be reduced by infusing VANCOMYCIN OVER A MIN OF 60 MINUTES -it can be difficult to differentiate severe RMS from anaphlyaxis as flushing and hypotension can occur in both condtions -however, HIVES, ANGIOEDEMA (LIP SWELLING), WHEEZING, AND RESPIRATORY DISTRESS ARE MORE SUGGESTIVE OF ANAPHLYAXIS - THE client exhibiting signs and symptoms suggestive of anaphlyaxis should have the vancomycin infusion stopped immediately and be treated with intramuscular epinephrine. The infusion must not be started if anaphlyaxis is suspected. A slowed infusion rate or pre-medications will not prevent a future anaphlyactic response

Failure to capture

-A demand electronic pacemaker should deliver an impulse when it senses an intrinsic pacemaker drop below a predetermined rate. -Bradycardia with failure to capture (pacer spike with no QRS complex) indicates malfunction and requires immediate notification of the hcp -occurs when the pacemaker sends an impulse to the ventricle, but the myocardium does not depolarize (pacer spike with no QRS complex; no palpable pulse beat ); this is usually associated with pacer lead (wire) displacement or battery failure -the malfunction can result in bradycardia (pulse <60/min) or asystole and decreased cardiac output; the nurse should perform an assessment and notify the hcp provider immediately

Drug/ supplements that affect warfarin : INCREASE WARFARIN EFFECT

-Acetaminophen, Nonsteroidal anti-inflammatory drugs -antibiotics/antifungal agents -amiodarone -cranberry juice, ginko biloba, vitamin E -omeprazole -thyroid hormone -Selective serotonin reuptake inhibitors

Clients with CHRONIC KIDNEY DISEASE (DIET)

-Are at risk for fluid overload and hyperkalemia -clients should AVOID SALT SUBSTITUTES ,which typically contain POTASSIUM CHLORIDE and may contribute to hyperkalemia To avoid further complications and prevent progressive kidney damage, clients with CKD are advised to follow certain dietary restrictions including: 1. Sodium restriction- avoid high sodium foods such as cured meats, pickled foods, canned soups, frankfurters, cold cuts, soy sauce, and salad dressings 2. Potassium restricition- avoid high-potassiym foods such as raw carrots, tomatoes, and orange juice 3. Fluid intake monitoring- monitor fluid intake closely and accutately, being careful to include foods that are liquid-based (popsicles, gelatin) because fluid is often restricted 4. LOW PROTEIN DIET (eat 0.6-0.8) g/kg/day of protein to help prevent progression of kidney disease. If the client is already on hemodialysis, increased protein intake is recommended to prevent malnutrition 5. LOW PHOSPHORUS DIET- avoid foods high in phosphorus (chicken, turkey, dairy)

delirium Tremens can be prevented with

-BENZODIAZEPINE administration during hosptialization

Children's beliefs about death: Age 3-5

-Believes that death is reversible -thoughts may include magical thinking and fantasy (they wish that a person would die)

Hirchsprung Disease Clinical features

-Bilious vomiting -Abdominal distension -failure to pass meconium -Failure of internal anal sphincter relaxation -Enlarged colon (megacolon) -aganglionic segment lacks nerve cells and causes distal interstinal obsrtuction

Sensorimotor

-Birth to 2 years -Learning by sens and movement, exploration , early verbal skills

When both MDIs are to be taken at the same time

-Clients are instructed to take the SABA first to open the airways and then the Inhaled corticosteroid (fluticasone, beclomethasone) to provide better delivery of the medication - it is important for the nurse to clarify indications and sequencing as the SABA is a rescu drug taken on an as-needed basis and is not always taken with the ICS Taking the albuterol inhaler apart, washing the mouthpiece (not canister) under warm running water, and letting it air dry at least 1-2 times a WEEK is recommeneded -medication particles can deposit in the mouthpiece and prevent a full dose of medication from being dispensed. -Taking the ICS inhaler apart and CLEANING IT EVERY DAY IS RECOMMENDED

PAC

-Conctraction starting form an ectopic focus in the atrium (other than the sinus node) and coming sooner than the next sinus beat -the P wave has a different shape than the P wave that originated in the sinus node

Immediate treatment for Malignant hyperthermia

-DANTROLENE -COOLING BLANKET -FLUID RESUSCITATION

CBT involves 5 basic components

-Education about the client's specific disorder -Self-observation and monitoring- the client learns how to monitor anxiety, identify triggers, and assess the severity -Physical control strategies- deep breathing and muscle relaxation exercises -Cognitive restructuring-learning new ways to reframe thinking patterns, challenging negative thoughts -Behavioral strategies-focusing on situations that cause anxiety and practicing new coping behaviors, desensitization to provoking situations or events

Nursing interventions to control ICP include:

-Elevating the head of the bed to 30 degrees with the head/neck in a neutral position to reduce venous congestion -ADMINISTERING STOOL SOFTNERS to reduce the risk of straining (valsalva maneuver) -MANAGING PAIN well while monitoring sedation -MANAGING FEVER (cool sponges, ice, antipyretics) while preventing shivering -MAINTAINING A CALM ENVIRONMENT WITH MINIMAL NOISE (alarms, television, hall noise) -Ensuring ADEQUATE OXYGENATION -HYPERVENTALITING AND PREOXYGENATING the client BEFORE SUCTIONING; REDUCING CO2 (a potent cerebral vasodilator) by hyperventilation induces vasoconstriction and reduces ICP Metabolic demands (pain, straining, agitation, shivering, fever, hypoxia) increase brain blood supply and raise ICP -Stimulation increases oxygen metabolism within the brain, increasing the risk for irreversible brain damage in increased ICP. LIMIT PERFORMING interventions unless absolutely necessary and AVOID PERFORMING INTERVENTIONS IN CLUSTERS -the nurse should suction a max of 10 seconds and only as necessary to remove secretions. Prolonged suctioning increase ICP

Postprocedure instructions include:

-Expect the passage of chalky, white stool until all barium contrast has been expelled -TAKE A LAXATIVE (magnesium hyroxide [milk of magnesia]) to assist in expelling the barium. Retained barium can lead to fecal impaction -Drink plenty of fluids to promot hydration and eat a high-fiber diet to prevent constipation

MUSLIM clients : aspects of care

-Facilitating client to face kaaba in the holy city of mecca, generally Northeastward from North america , during prayer- Reitual Daily prayers occur 5 times a day, and dying clients may pray more often -MODESTY-care providers should be the same sex as the client whenever possible. The female client may require a hijab (traditional head covering) and/or gown to cover most of the body -providing foods that are halal (lawful) or accpetable for consumption (NO PORK)-kosher and vegeterian meals are acceptable if a specific halal menu is unavailable. During ramadan, the sick and dying are not required to fast with other Muslims from dawn until sunset. If the client chooses to fast, meals and medications should be rescheduled accordingly -Postmortem care of the muslim client involves ritual watching, usually performed by family members, in preparation for burial. Burial occurs quickly after death, sometimes the same day -In islam, the family is the most important unit, and family presence brings strength to the individual. Multiple visitors should be accommodated unless they interfere with care

Hypertensive disorder of pregnancy

-GESTATIONAL HYPERTENSION is new-onset high blood pressure (>/_ 140/90mmhg) that occurs after 20 WEEKS gestation without protein uria -the development of PROTEINURIA WITH HYPERTENSION indicates PREECLAMPSIA which may manifest with symptoms such as HEADACHE, VISUAL DISTURBANCES, AND FACIAL SWELLING. -complications of preeclampsia may include thrombocytopenia, liver dysfunction, and renal insufficiency -client with preeclampsia must be monitored closely for sudden worsening, which can lead to serious complications including ECLAMPSIA and/or HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets)

Newborns whose mothers have DIABETES MELLITUS are at increased risk for complications after birth

-HYPOGLYCEMIA -HYPOCALCEMIA -HYPERBILIRUBINEMIA -RESPIRATORY DISTRESS SYNDROME -During intrauterine life, exposure to elevated maternal glucose levels causes the fetus to produce high levels of insulin -after birthk the newborn loese the maternal supply of glucose but continues to produce high levels of insulin , as during intrauterine life, increasing the risk of hypoglycemia (blood glucose <40-35 mg/dL -symptoms of hypoglycemia usually noted in the first several hours after birth, include JITTERINESS, IRRITABILITY, HYPOTONIA, apnea, lethargy, and temperature instability -IMMEDIATE intervention is required to prevent neurologic damage

Peripheral arterial disease

-Hardening of the arterial walls, which constricts blood flow and impairs transportation of nutrients of tissues -Diminished pulses, nonhealing ulcers on a toe, -shiny, hairless extremities -intermittend claudication (ischemic muscle pain) -cool dry, shiny skin -gangrene -thick, brittle nails -small circular, deep ulcers

Ventricular Tachycardia

-Heart rate >100 -Regular rhythm -Wide QRS (>0.12 Sec or >3 small squares) -has a ventricular rate of 150-250/min and originates from foci firing repeatedly in the ventricle

Fasting for more than 1 or 2 days can cause a number of health problems:

-Increased STRESS- when fasting, the body goes into "starvation mode"; metabolism slows down and cortisol production increases -MUSCLED DAMAGE- in starvation mode, the body breaks down muscle and converts amino acids to glucose -fluid loss-glycogen stores in the liver are also broken down as an energy source; this metabolic process releases water, resulting in fluid loss -Increased hunger-appetite hormones are suppressed during a fast; however, when regular eating habits are resumed , appetite will be increased -depletion of essential nutrients -fatigue, headache, dehydration, dizziness, and muscle weakness

-Risk factors for cervical cancer

-Infection with High-risk HPV strains (16,18) -History of sexually transmitted diseases -Early onset of sexual activity -Multiple or high-risk sexual partners -immunosuppression -oral contraceptive use -low socioeconomic use -tobacco use Almost all cases of cervical cancer result from persistent infection due to human papillomavirus (HPV), a primary risk factor -HPV is the most common sexually transmitted infection but is usually transient and resolves spontaneously -persistnet hpv infection can cause abnormal changes in cervical epithelial tissue that slowly progress to invasive cancer if not treated

Risk factors for cervical cancer

-Infection with high-risk HPV strains (16,18) -history of sexually transmitted diseases -early onset of sexual activity -multiple or high-risk sexual partners -immunosuppression -oral contraceptive use -low socioeconomic status -tobacco use -almost all cases of cervical cancer result from persistent infection due to human paollomavirus (HPV), a primary risk factor -HPV is the most common sexually transmitted infection but is usually transient and resolves spontaneously -however, persistent HPV infection can cause abnormal changes in cervical epithelial tissue that slowly progress to invasive cancer if not treated most other risk factors for cervical caner are related to behaviors that INCREASE THE CLIENT'S RISK OF CONTRACTING HPV or an inability to clear the infection -Clients who have multiple sex partners or inititate sexual activity at an early age (<18) increase their risk for exposure to HPV -clients with weakened immunity (HIV, immuosuppressive therapy (may have an impaired ability to clear HPV, which increases the risk for cervical cancer due to persistent infection

Drugs commonly assoicated with orthostatic hypotension include

-MOST ANTIHYPERTENSIVE MEDICATION, particlulary sympathtetic blockers such as beta blockers and and alpha blockers (terazosin) - antipsychotic medications (olanzapine, risperidone) and antidepressants (selective serotonin reuptake inhibitors) 3. Volume-depleting medications such as diuretics (furosemide, hydrochlorothiazide) 5. Vasodilator medications (nitroglycerine, hydralazine) 5. Narcotics (morphine)

Two groups of commonly used drugs that have the potential to cause problems for clients with asthma

-Nonsteroidal anti-inflammatory drugs -Beta-adrenergic antagonists -Ibuprofen (Motrin) and Aspirin are common over-the-counter anti-inflammatory drugs that are effective in relieving pain, discomfort, and fever -about 10%-20% of asthmatics are sensitive to these medications and can experience SEVERE BRONCHOSPASM after ingestion. This is prevalent in clients with nasal polyposis

Postoperative nursing care after a laparoscopic cholecystectomy focuses on:

-Prevention of complications -Carbon dioxide (CO2) is used to inflate and expand the abdominal cavity during laparoscopic proceudres to allow insertion of surgical instruments and better visualization of the abdominal organs -CO2 can irritate the phrenic nerve and diaphragm, causing shallow breathing and REFERRED PAIN TO THE RIGHT SHOULDER -The nurse should assist the client with early ambulation and deep breathing to facilitate dissipation of the CO2 used during surgery -Early ambulation not only improves breathing, but also decreases the risk of thromboembolism and stimulates peristalsis

Treatment of frostbite should include the following:

-Remove clothing and jewelry to prevent constriction -DO NOT MASSAGE, rub, or squeeze the area involved. injured tissue is easily damaged -Immerse the affected area in water heated to 98.6-102.2, preferably in a whirlpool. Higher temperatures do not significantly decrease rewarming time but can intensify pain -Avoid heavy blankets or clothing to prevent tissue sloughing -provide analgesia as the REWARMING procedure is EXTREMELY PAINFUL -as thawing occurs, the injured area will become edematous and may blister. ELEVATE the injured area after rewarming to reduce edema -Keep wounds open immediately after a water bath or whirlpool treatment and allow them to dry before applying LOOSE, NONADHERENT, STERILE DRESSINGS -Monitor for signs of compartment syndrome

To de-escalate a violent situation and ensure the safety of the client and others, the nurse should:

-Remove other clients from the area -keep a safe distance from the client with a clear path to safety -maintain a calm demeanor, keeping the hands visible -use clear, non threatening communication focusing on MUTUAL GOALS (during periods of extreme anxiety and stress, clients are prone to irrational thinking. The nurse should AVOID REASONING (explaining the dangers of refusing treatment) until the situation has been de-escalated and the client is no longer in crisis

Drugs/ supplements that affect warfarin: DECREASE WARFARIN EFFECT

-Rifampin -carbamazepine -oral contraceptives -ginseng -st john's wort -vitamin k-rich foods (spinach, broccoli, liver)

To help identify elevated CO levels in the home, the nurse can ask about

-SIMILAR SYMPTOMS in other family members or an illness in an indoor pet that developed at the same time -fuel-burning heating/cooking appliances; risk of CO toxicity increases in the fall and winter due to increased used of heat sources in an enclosed space

nystatin

-TREATS FUNGAL INFECTIONS LIKE (OROPHARYNGEAL CANDIDIASIS (OR THRUSH/ MONILIASIS)

Preprocedure of Barium Enema

-Take a cathartic (magnesium citrate, polyethylene glycol) to empty stool from the colon -follow a clear liquid diet the day before the procedure to aid in bowel preparation and to prevent dehydration; avoid red and purple liquids -do not eat or drink anything for 8 hours before the test -expect to be placed in various positions during the procedure. You may experience abdominal cramping and an urge to defecate

EpiPen : The client and caregiver should be taught the following principles

-The epipen should always be available for emergency use and so should be taken along (in purse, pocket, backpack) when the client leaves home -the epipen should be given when the client first notices any anaphylactic symptoms, such as tightening or swelling of the airway , difficulty breathing, wheezing, stridor, or shock -the injection should be given in the mid-outer thigh and can be given through clothing -the client should receive emergency care as soon as possible by calling 911 or going to the emergency department for further problems

Chronic kidney disease are at risk fo

-The kidneys regulate fluid volume and pressure -because renal damage often results in elevated blood pressure, clients with chronic kidney disease are at risk for uncontrolled hypertension and hypertensive emergencies -Hypertensive encephalopahy is a type of hypertensive crisis characterized by nausea, vomiting, and headache -treatment is urgent (within 1 hour) to prevent damage to the heart, kidney, and brain -the client should check blood pressure at home, if possible and then proceed to the emergency department for further assessment and treatment (titration of antihypertensive medication)

Overactive bladder meds

-Tolderodine, oxybutynin, and solifenacin are antimuscarinic/anticholinergic medications used to overactive bladder and urge urinary incontinence -they decrease urinary urgency and frequency -The most common side effects are anticholinergic (Dry mouth, constipation, cognitive dysfunction) -the client's report of not urinating the entire day while at work may indicat that the dosage is too hgih and is causing urinary retention -urinary retention can lead to bladder infections and distension -this client should experience a reduction in the number of times needed to urinate, but the number should not decrease below typical urination frequency -the nurse should also teach the client how to manage the comon side effects of dry mouth, constipation, and mild dizziness

Lifestyle and dietary measures that may prevent GERD and Associated symtoms include:

-Weight loss, as excessive abdominal fat may increase gastric pressure -small, frequent meals with sips of water or fluids to help facilitate the passage of stomach contents into the small intestine and prevent reflux from becoming overly full during meals -avoiding GERD triggers such as caffeine, alcohol, nicotine, high-fat foods, chocolates, spicy foods, peppermint, and carbonated beverages -chewing gum to promote salivation, which may help neutralize and clear acid from the esophagus -sleeping with the head of the bed elevated -refraining from eating at bedtime and/or lying down immediately after eating

Premature ventricular contractions (PVC)

-a PVC is a contraction coming from an ectopic focus in the ventricles -it is a premature (early) conduction of a QRS complex -PVCs are wide and distorted in shape compared to a QRS conducted through the normal conduction pathway -PVCs can be associaed with stimulatns (Caffeine), medications (DIGOXIN), heart diseases, electrolyte imblances, hypoxia, and emotional stress -PVC are USUALLY NOT HARMFUL in the client with a HEALTHY HEART -In the client with myocardial ischemia/infarction, PVCs indicate ventricular irritability and increase the risk for the rhythm to deteriorate into a life-threatening dysrhythmia (ventricular tachycardia, ventricular fibrillation) -the nurse should assess the client's physiological response, including apical-radial pulse -TREATMENT is based on the underying cause of the PVC (oxygne for hypoxia, reduction of caffeine intake, electrolyte replacement)

Cervical cap

-a barrier method of contaception used with spermicide -the reusable cup-shaped cap is placed over the cervix before intercourse to block sperm from the uterus -to allow time for sperm to die, the cap should remain in place for >/_6 HOURS AFTER INTERCOURSE but should not remain for more than 48 hours -the cap may remain in place for multiple acts of intercourse, but clients should confirm correct placement and insert additional spermicide into the vagina each time -prior to insertion, spermicide is applied to the cervical cap to maximize contraceptive effectiveness. Spermicide should be applied INSIDE THE CAP, along the rim of the cap, and in the groove on the underside of the cap -Use of cervical caps during menses (or during the postpartum period in clients with lochia discharge) increases the risk of TOXIC SHOCK SYNDROME; an alternate contraceptive method should be used during this time

Carbidopa-levodopa

-a combination antiparkinsonian medication used to reduce physical symptoms of PD by increasing dopamine levels in the brain -levodopa is converted to dopamine in the brain but is largely metabolized before reaching the brain -Carbidopa does not have a therapeutic effect on PD but prevents breakdown of levodopa before reaching the brain, which makes levodopa more effective Client teaching includes: -Implementing FALL PRECAUTIONS (Changing positions slowly , removing rugs) as orthostatic hypotension is a common side effect -Knowing that carbidopa-levodopa takes SEVERAL WEEKS to reach its MAXIMUM EFFECTIVENESS -Understanding that harmless discoloration (red, brown, black) of secretions (urine, perspiration, saliva) may occur while taking carbidopa-levodopa -AVOIDING HIGH-PROTEIN MEALS, which interfere with the absorption of carbidopa-levodopa -dyskinesia (facial or eyelid twitching, tongue protrusion, facial grimacing) may indicate overdose or toxicty and should be reported to hcp -Carbidopa-levodopa often decreases , but does not elimnate, tremor and rigidity

Isoniazid

-a first-line antitubercular drug used to treat latent or active tuberculosis -the nurse should question this prescription as increased liver function tests (alanine aminotransferase, aspartate aminotransferase) can indicate development of drug-induced HEPATITIS

Molar pregnancy

-a hydatidiform mole, is a type of gestational trophoblastic disease that results from abnormal fertilization -it causes RAPIDLY GROWING TROPHOBLASTIC TISSUE that is initially benign but may lead to GESTATIONAL TROPHOBLASTIC NEOPLASIA (GTN) (Invasive mole, CHORIOCARCINOMA) -IF trophoblastic tissue continues to grow or metastasize after evacuation of a molar pregnancy, levels of human chorionic gonadotropin (hCG), a hormone that is also used to diagnose pregnancy, will continue to increase -therefore, the nurse should emphasize the importance of AVOIDING PREGNANCY during follow-up care to allow hcp to monitor for RISING HCG LEVELS, which may indicate malignant GTN -Weekly monitoring of hCG levels is required at first, followed by continued MONITORING FOR 6-12 MONTHS

Tiotropium

-a long-acting, 24 hour, anticholinergicm inhaled medication used to control chronic obstructive pulmonary disease -it is administered most commonly using a capsule-inhaler system called the handihaler -the powdered medication dose is contained in a capsule -the client places the capsule in the inhaler device and pushes a button on the side of the device which pokes a hole in the capsule. As the client inhales, the powder is dispersed through the hole -it is important to teach the client proper administration pior to the first dose, emphasizing that the CAPSULE SHOULD NOT BE SWALLOWED and that the BUTTON ON THE INHALER MUST BE PUSHED to allow for medication dispersion -during future appts, the nurse should assess/reassess the client's ability to use this medication correctly -Tiotropium is a CONTROLLER MEDICATION FOR COPD with a peak effect of APPROXIMATELY 1 WEEK, therfore it should not be used as a rescue medication. Clients must discontinue ipratropium before taking tiotropium as both are anticholinergic -Anticholinergic inhalded medications (ipratropium, tiotropium, umeclidinium) do not reduce inflammation in the airway. Instead, they RELAX the airway by blocking parasympathetic bronchoconstriction. THey also help dry up airway secretions

Magnetic resonance cholangiopancreatography (MRCP)

-a noninvasive diagnostic test used to visualize the biliary, hepatic, and pancreatic ducts via MRI -MRCP uses oral or IV gadolinium (noniodine contrast material) and is a safer, less-invasive alternative to endoscopic retrograde cholangiopancreatography to determine the causse of cholecystitis, cholethiasis, or biliary obstruction - the nures must asses for contraindications before the procedure , including the presence of certain metal and/or electrical implants (aneurysm clip, pacemaker, cochlear implant) or any previous allergy or reaction to gadolinium -a client with a history of rash following prior IV contrast administration should be assessed to determine the type of contrast that caused the reaction -although allergies to iodine-based contrast material are more common, the nurse must rule out a gadolinium allergy -PREGNANCY also is a contraindication for MRCP as gadolinium crosses the placenta and may adversely affect the fetus -delayed /irregular meneses may be a normal variation in some clients; however, delayed menses may indicate pregancy and should be reported for further investigation prior to MRCP -many clients should be NPO for 4 hours prior to the procedure to allow better visualization of the anatomical features

Misoprostol (cytotec)

-a prostaglandin E1 is a cervical ripening agent -cervical ripening is a process that normally occurs before the onset of labor in which the cervix softens and becomes more pliable so that dilation and effacement can occur more easily during contractions -mechanical or pharmacologic cervical ripening methods stimulate this process and increases the client's probablity of achieving a vaginal birth In addition to ripening the cervix, prostaglandins (misoprostol, dinoprostone) can STIMULATE FREQUENT CONTRACTIONS. Therefore, administration of misoprostol is contraindicated if: -The client is receiving another uterotonic simultaneously (oxytocin) - the client has a HISTORY OF UTERINE SURGERY (cesarean birth) due to an increased risk of uterine rupture at the surgical scar site - the client has an abnormal fetal heart rate pattern or uterine tachysystole (>5 contractions in 10 mins) -The hcp prescribes misoprostol ORALLY or VAGINALLY for labor induction. RECTAL administration is only appropriate during PPH

Osteomalacia

-a reversible bone disorder caused by vitamin D deficiency and is characterized by WEAK, SOFT, AND PAINFUL bones that can easily fracture or become deformed -In vitaminD deficiency, calcium and phosphorus cannot be absorbed from the gastrointestinal tract and are unavailable for calcification of bone tissue -Vitamin D deficiency is also associated with increased RISK OF FALLS, especially in elderly clients, due to muscle weakness

Trichomoniasis

-a sexually transmitted infection caused by Trichomonas vaginalis -infected clients may be asymptomatic but usually seek care when profuse, frothy, yellow-greeen , malodorous vagina dischagre is noted -Pruritus, dysuria, and dyspareunia (pain during sexz) may also occur -oral metronidazole (Flagyl) is the most common drug used to treat trichomoniasis Client education includes -Abstain from sexual intercourse until the infection is CLEAReD (about 1 week after treatment) -Avoid drinking alchol while taking metronidazole and for 3 days after completion of therapy because the combination can cause flushing, nausea/vomiting, and severe abdominal pain -have partners treated simultaneously to avoid reinfection. Use condoms to prevent the infection in the future -Know that potential side effects of metronidazole may include a METALLIC TASTE, Gastrointesinal upset, or DARK-COLORED URINE

Carbon monoxide

-a toxic inhalant that enters the blood and binds more readily to hemoglobin than oxygen does -when hemoglobin is saturated with CO2, the pulse oximiter reading is falsely normal as conventional devices detect saturated hemoglobin only and cannot differentiate between CO and oxygen -the diagnosis of CO poisoning is often missed in the ED because symptoms are nonspecific (headache, dizziness, fatigue, nausea, dyspnea) and the pulse oximiter reading often appears within normal limits -a SERUM CARBOXYHEMOGLOBIN test is needed to confirm the diagnosis -Normal values are <5% in nonsmokers and slightly high (<10%) in smokers -this client with CO poisoning is the highest priority for treatment and REQUIRES IMMEDIATE ADMINSTRATION OF 100% OXYGEN to increase the rate at which CO dissipates from the blood to prevent tissue hypoxia and severe hypoxemia

Rapid response team

-activated to marshal additional experienced and specialized resources for an acute need to try to prevent a client from deterioration into a code/arrest situation -the team has critical care expertise to provide immediate attention to UNSTABLE clients in non critical care units and usually consists of a respiratory therapist, a critical nurse, and a physician or advanced practice registered nurse Recommended criteria to consider according to the institute for healthcare improvement include the following: 1. any provider worried about the client's condition OR 2. An ACUTE CHANGE in any of the following: -Heart rate <40 or >130 -systolic blood pressure <90 mm Hg -Respiratory rate <8 or >28/min -oxygen saturation <90 despite oxygen -Urine output <50ml/4hr -Level of consciousness

IV magnesium sulfate

-administered for seizure (eclampsia) prophylaxis in pregnant clients with pre-eclampsia - a loading dose of 4-6 g of magnesium sulfate, followed by a maintenence dose of 1-2g/hr, helps achieve THEREPEUTIC MAGNESIUM levels of 4-7 mEq/L -Magnesium toxicity may occur when magnesium levels are >7 mE/L, which causes central nervous system depression and blocks neuromuscular transmission -absent or decreased deep tendon reflexes (DTRs) are the EARLIEST SIGN OF MAGNESIUM TOXICITY -DTRs, scored on a scale of 0 to 4+, should be frequently assessed during magnesium sulfate infusion; normal findings are 2+ -if toxicity is not recognized early (Decreasing DTRs) client can progress to respiratory depression (<12 breaths/min), followed by cardia arrest -administration of calcium gluconate (antidote) is recommended in the event of cardio respiratory compromise

Varicella immunization

-administered to prevent infection of varicella zoster, commonly known as chickpox -side effects of the immunization include discomfort, redness, and a few vesicles at the injection site -covering the vesicles with clothing or a small bandage will reduce the risk of transmission from any exudate -once vesicles have dried or crusted, a dressing is no longer necessary

Mantoux test

-administered to screen for tuberculosis (TB) -The forearm is injected with 0.1 ml of the PPD, and the client returns in 48-72 hours to have the site assesed for induration ( a raised area) -redness alone is not read as a positive response -an induration >15 mm is conisdered a postive response in any client -however a positive PPD test does not mean that the client has active TB infection , but rather that the client has been exposed to TB and has developed an immune response -positive sputum cultures, chest x-rays, and the presence of symptoms confirm that the client has active disease

Thrombolytic therapy

-aims to stop the infarction process, dissolve the thrombus in the coronary artery, and reperfuse the myocardium -the treatment is used when facilities do not have an interventional cardiac catheterization laboratory or when such a facility is too far away to transfuse the client safely -client selection is important because all thrombolytics lyse the pathologic clot but may also lyse other clots (at a postoperative site) -minor or majore bleeding can be a complication Inclusion criteria for thrombohemolytic therapy in clients with acute myocardial infarction include chest pain lasting </_ 12 hours, 12-lead ECG findings indicating acute ST-elevation myocardial infarction, and NO ABSOLUTE CONTRAINDICATIONS

Anaphlactic shock

-an acute onset and manifestation usually developed quickly (20-30 mins) -circulatory failure and respiratory manifestations, including laryngeal edema (from inflammation) and bronchoconstriction (primarily from release of histamine) can lead to cardiac/respiratory arrest The management of anaphylactic shock includes: 1. Ensure patent airway, administer oxygen 2. Remove insect stinger if present 3. IM epinephrine is the drug of choice and should be given to this client. Epinephrine stimulates both alpha and beta adrenergic receptors and dilates bronchial smooth muscle (beta 2) and providies vasoconstriction (alpha 1) . The IM route (mid anterior lateral thigh) is better than the subcutaneous route. REPEAT DOSE EVERY 5-15 MINS 4. place in recumbent position and ELEVATE LEGS 5. Maintaine blood pressure with IV fluids, volume expanders, or vasopressors 6. Bronchodilator (inhaled beta agonist) such as ALBUTEROL is administered to dilate the small airways and reverse bronchoconstriction 7. ANTIHISTAMINE (diphenhydramine) is administered to modify the hypersensitivity reaction and releive pruritius 8. CORTICOSTEROIDS (methylprednisolone) are administered to decrease airway inflammation and swelling associated with the allegic reaction 9. anticipate cricothyrotomy or tracheostomy with SEVERE LARYNGEAL EDEMA

Toxic epidermal necrolysis

-an acute skin disorder, most commonly associated with a medication reaction, taht result in widespread erythema, BLISTERING, EPIDERMAL SHEDDING, keratoconjunctivitis, and skin erosion (deuded skin) -it is a severe form of STEVEN'S-JOHNSON SYNDROME -the major cause of DEATH related to toxic epidermal necolysis is SEPSIS ; therfore, infection prevention is critical Basic supportive care includes: -wound care: sterile, moist dressings are applied to open areas of skin -Infection prevention: Strict sterile technique and REVERSE ISOLATION decrease infection risk. The nurse should also monitor for any signs of infection (fever) -Fluids and nutrition: Vital signs and urine output are monitored for signs of hypovolemia. Oral feeding should be initiated early to promote wound healing; a nasogastric tube may be necessary -hypothermia prevention: Maintain a room temperature of 85F OR MORE, and use passive rewarming methods such as sterile, single-use warming blankers or digitally regulated warming pads -PAIN MANAGEMENT : Analgesics are administered around the clock and before painful procedures -EYE CARE: sterile cool compressess are applied to relieve discomfort. Lubricants may relieve dryness and prevent corneal abrasion

Osteogeneis Imperfecta

-brittle bone disease) -a rare genetic condition resulting in impaired synthesis of COLLAGEN by osteoblasts -Collagen allows bone to be somewhat flexible while still maintaining strength -impaired collagen causes bones to be frail and EASILY FRACTURED -clinical manifestations can range from mild defects to lethal disease in utero OI is usually transmitted by autosomal dominant inheritance

Guillain-Barre syndrome (GBS)

-an acute, immune-mediated polyneuropathy that is most often accompanied by ascending muscle weakness and absent deep-tendon reflexes -many clients have a history of antecedent respiratory tract or GI infection -lower-extremity weakness progresses over hours to days to involve the thorax, arms, and cranial nerves -however, neuromuscular respiratory failure is the most life-threatening complication Early signs indicating impending respiratory failure include: -Inability to cough -shallopw respirations -dyspnea and hypoxia -inability to lift the head or eye brows Assesssing the client's pulmonary function by serial spirometry is also recommended -Measurement of forced vital capacity (FVC) is the gold standard for assessing ventilation; a decline in FVC indicates impending respiratory arrest requiring endotracheal intubation

Phenytoin therapeutic index

-an antiseizure medicatin with a therapeutic index of 10-20 mcg/mL -tube feedings decrease phenytoin absorption, which reduces serum drug concentrations and may preciptiate seizures -the nurse should pause tube feedings for 1-2 hours before and after phenytoin administration to ensure adequate absorption -phenytoin toxicity produces nystagmus, dysarthria , ataxia, and encephalopathy

Marfan syndrome

-an autosomal dominant disorder affecting the connective tissues of the body -abnormalities are mainly seen in the cardiovascular, musculoskeletal, and ocular systems -clients with marfan syndrome are very tall and thin, with disproportionately long arms, legs, and finers -cardiovascula manifestations of marfan syndrome include ABNORMALITIES OF THE AORTA and CARDIAC VALVES, including aneurysms, tears (dissection), and leaky heart valves that may require replacement or repair -therefore, competitive or contact sports are discouraged due to the risk of cardiac injury and sudden death -THE client may also experience crowding of the teeth from a very high-arched palate. Preventitive antibiotics prior to dental work may be needed to provide prophylaxis agains infective endocarditits, espeicallly in clients with an artificial valve replacement -these clients may have an increased risk for scoliosis, especially during the adolescent years of increased growth; therefore, the child should be monitored regulary for curvature of the spine -Ocular problems (LENS DISLOCATION [ECTOPIA LENTIS]), retinal detachment, cataracts, glaucoma) can be common for the child with marfan syndrome. Annual eye examination with an opthalmoologist are important to monitor for developing issues

Activated charcoal

-an important treatment in early acetylsalicylic acid (ASA) toxicity; it is recommended for gastrointestinal decontamination in clients with clinical signs of ASA poisoning (disorientation, vomiting, hyperpnea, diaphoresis, restlessness) as well as in those who are asymptomatic -Activated charcoal binds to available salicylates, thus limiting further absorption in the small intestine and enhancing elimination

Bacterial meningitis

-an infection that causes inflammation of the membranes covering the brain and spinal cord (meninges) -inflammation and bacterial growth within the meninges lead to increased cerebrospinal fluid (cSF) volume and INCREASED INTRACRANIAL PRESSURE -without intervention, increased ICP may lead to NERVE ISCHEMIA and permanent functional impairment (hearing loss visual impairment, paralysis). brain herniation, or death THe nurse should perform the following interventions: -Maintain the head of the bed elevated at 30 degrees with the head and neck midline to reduce ICP by promoting drainage of cerebral venous blood and CSF -implement seizure precautions due to poetential neurologic irritablity from increased ICP ensure a restful environment (quiet, dimly lit, cool temperature) by REDUCING potentially irritable stimuli -the nurse should initiate DROPLET precuation

Bell's Palsy

-an inflammation of cranial nerve VII (FACIAL) that causes motor and sensory alteration -clients are usually managed as outpatients, with corticosteroids to reduce inflammation, and taught eye/oral care -In Bell's palsy, the eyelids do not close properly . THis may result in eye dryness and risk of corneal abrasions. However weakness of the lower eyelid may cause excessive tearing due to overflow in some clients -Facial muscle weakness results in poor chewing and food retention -LOSS OF FOREHEAD AND BROW MOVEMENTS -INABILITY TO CLOSE EYS AND DROOPING OF EYELIDS -LOSS OF NASOLABIAL FOLDS AND DROOPING OF LOWER LIP

Shoulder Dystocia

-an obstetrical emergency in which the fetal head emerges but the anterior shoulder remains wedged behind the maternal symphysis pubis -the nurse may initially observe the FETAL HEAD RETRACTING BACK toward the maternal perineum after birth of the head (turtle signs) -the condition is frequently associated with MACROSOMIA (fetal weight >8 lb 13 oz) secondary to gestational diabetes mellitus -however the occurence of shoulder dystocia is unpredictable and may be related to maternal facotrs such as suboptimal pelvic shape, obesity, or short stature, rather than fetal size -The nurse's primary responsibilities during shoulder dystocia include performing the MCROBERTS MANEUVER (Sharp flexion of maternal thighs toward abdomen to widen space between pubic bone and sacrum) and applying SUPRAPUBIC PRESSURE (DOWNWARD PRESSURE applied to maternal pubic bone to dislodge fetal shoulder)

Topical capsaicin cream (ZOSTRIX)

-an over-the counter analgesic that effectively relieves minor pain (osteoarthritis, neuralgia) -the nurse should instruct the client to wait at least 30 mins after massaging the cream into the hands before washing to ensure ADEQUATE ABSORBTION -the client should avoid contact with mucous membranes (nose, mouth, eyes) or skin that is intact, as capsaicin is a component of hot peppers and can cause burning -when applying cream to other areas of the body (knee) the client should wear gloves or wash hands immediatley after application -heat with capsaicin is contraindicated as heat causes vasodilation , which increases medication absorption and can possibly lead to a chemical burn -local irritaton (Burning, stinging, erythema) quite common and usually subsides within the first week of regular use. If the client experiences persistent pain, redness, or blistering, the cream should be d/ced and hcp notified -Topical capsicin is often used concurrently with ACETAMINOPHEN and NSAIDS (Naproxen, celecoxib) to effectively treat osteoarthritis pain. Capsaicin should be used regularly (3-4 times daily ) for long periods (weeks to months) to achieve the desired effect

IV opiods given during pregnancy

-butorphanol tartrate (Stadol) and nalbuphine hydrochloride (Nubain) -IV opiods are safest for clients will GIVE BIRTH 2-4 HOURS AFTER ADMINISTRATION so that the opiod effect has time to wear off before the birth -IV opiods are also best for client in ACTIVE LABOR or those with a WELL-ESTABLISHED CONTRACTION PATTERN because opioid administration may slow labor progression in the latent phase

Sepsis

-an overwhelming response to infection that causes impaired organ function -septic shock occurs when sepsis causes cardiovascular collapse and/or impairs the body's ability to maintain normal metabolic and cellular processes Manifestations of septic shock include: -Fever or hypothermia (>100.4 F; <96.8)- either fever or low body temp is found in sepsis and septic shock. fever occurs in response to infection, whereas low body temp can occur as shock worsens due to metabolic alteration and inadequate tissue perfusion -Hypotension-Systolic blood pressure <90 mm HG or mean arterial pressure <65 mm Hg in a client with infection may indicate septic shock. Altered perfusion from hypotension may cause LACTIC ACID accumulation and metabolic acidosis -PROLONGED CAPILLARY REFILL- a refill time>3-4 seconds in adults indicate inadequate tissue perfusion as a result of altered peripheral circulation and hypotension -TACHYCARDIA- a resting heart rate> 90/min is common in septic shock to compensate for decreased systemic vascular tone and hypotension WBC COUNT >12,000 or IMMATURE NEUTROPHILS (BANDS) OF >10% - AN increased WBC count, especially with bands, indicates severe infection -clients with septic shock typically develop urine output (<0.5 mL/kg/hr) due to inadequate organ perfusion

Erythropoietin (and anemia)

-anemia associated with chronic kidney disease is treated with recombinant human erythropoietin -therapy is initiated when hemoglobins is <10 g/dL to alleviate the symptoms of anemia (fatigue) and the need for blood transfusion -therapy should be discontinued or the dose reduced for hemoglobin >11 g/dL to prevent venous thromboembolism and adverse cardiovascular outcomes from blood thickened by high concentrations of RBCs HYPERTENSION is a major adverse effect of erythropoeitin administration -therefore, uncontrolled hypertension is a CONTRAINDICATION to recombinant erythropoeietin therapy -Blood pressure should be well controlled prior to administering erythropoietin -Erythropoetin is administered Intravenously or in any subcutaneous area (NOT IntramuscularlY)

Dicyclomine

-anticholinergic/antispasmodic drug prescribed to manage symptoms of intestinal hypermotility in clients with irritable bowel syndrome -dicyclomine is CONTRAINDICATED in client with PARALYTIC ILEUS as it decreases intestinal motility and would exacerbate the condition the nurse should question this prescription

Following open radical prostatectomy

-any rectal interventions such as suppositories or enemas must be avoided to prevent stress on the suture ines and problems with healing in the surgical area -the client should not strain when having a bowel movement for these reasons -therefore interventions to PREVENT CONSTIPATION ARE AN IMPORTANT PART of the post op care and discharge teaching -prevention of constipation is particularly important while the client remains on opioid analgesics, which can cause constipation -STRAINING, SUPPOSITORIES, AND ENEMAS are CONTRAINDICATED in these clients, and interventions should be implemented to prevent constipation

If ineffective breastfeeding occurs, the nurse should

-assess the baby's sucking reflex and physical condition -assess the mother's breastfeeding techniques)positioning, behavior/anxiety during breastfeeding) -teach how to express milke by hand and use and electric pump to enhance milk production -refer to lactation consultatant for a thorough assessment and breastfeeding plan if ineffective breastfeeding occurs longer than 24 hours

Preconception counseling

-assesses for pregnancy risk factors and implements appropriate interventions to promot a healthy pregnancy -some behaviors the client may begin independently include eating a nutritous diet; exercising; abstaining from alcohol, tobacco, and illicit drugs; and taking folic acid supplements -Obesity (BMI >30 kg/m2) during pregnancy is associated with an increased risk for fetal/maternal complications (eg gestational diabetes, hypertension, cesarean birth) -achieving a NORMAL BMI (18.5-24.9) is optimal -No amount of alcohol is considered safe in pregnancy; complete ABSTINENCE FROM ALCOHOL is recommended to avoid FETAL ALCOHOL SYNDROME -smoking cessation is encouraged due to its association with fetal growth restriction; illicit drugs may also cause fetal harm -FOLIC ACID supplementation of at least 400 mcg per day for 3 months before preganncy is recommended to reduce the incidence of neural tube defects. Neural tube development begins around the third week following conception, before a women may realize that she is pregnant -Finally clients should visit their hcp to discuss pregnancy's effect on certain health conditions (asthma, diabetes) and check for RUBELLA IMMUNITY. Rubella vaccination should be given if the client is NONIMMUNE, AND PREGNANCY should be avoided for at least 4 WEEKS AFTER VACCINATION -Regular vistis with a dentist can help prevent peridontal disease, which is associated with poor pregnancy outcomes (preterm birth, low birth weight)

When caring for clients with external fixation, the nurse can help prevent infection and maintain extremity and device integrity by:

-assessing the pin sites regularly for new, increased, and/or purulent drainage and checking the skin surrounding the pins for erythema, warmth, pain, or breakdown -assessing for signs of compartment syndrome (decreased pulses coolness, pain, numbness) -perfroming pin site care with a sterile cleaning solution (chlorhexidine, sterile normal saline) and gauze -monitoring pins and device for loosening and reporting to the hcp if they are loose -the nurse should never manipulate loos pins but should instead notify the hcp immediatley if loose pins are noted on assessment -the nurse should promote early mobilization for clients with external fixation devices. Some clients may begin walking with physical therapy the day after surgery

Clinical features of melanoma (ABCDE)

-asymmetry: when bisected, the 2 sides are not identical -Border irregularities: Uneven edges, pigment fading off -Color variegation: variable mixtures of brown, tan, black, and red -Diameter: >/_6 mm -Evolving: Lesions changing in size, shape, or color; new lesion

Client with pneumonia and asthma

-at risk for problems related to AIRWAY MANAGEMENT and should be ASSESSED FIRST -clients with symptomatic asthma will receive inhaled beta agonists (albuterol); however, even after medication, it is a priority to assess this client's lung sounds, work of breathing , and level of conscousness to determine respiratory status -A SUDDEN DECREASE IN WHEEZING may signal the development of SILENT CHEST, where airflow is rapidly reduced due to increased bronchial constriction -this scenario can quickly progess to STATUS ASTHMATICUS, respiratory failure, unconsciousness, and death

Peripheral IV (PIV) catheter sites should be changed nor more frequently than every

72-96 hours unless signs of complications develop

Large anterior wall MI

-can affect the pumping ability of the left ventricle, putting the client at risk for developing heart failure and cardiogenic shock -the new development of pulmonary congestion on X-RAY, auscultation of a new S3 heart sounds, crackles on auscultation of breath sounds, or jugular venous distension can signal HEART Failure and should be reported immediately to the HCP

CONTINUOUS SUCTION

-can be applied to decompress the stomach if a double lumem Salem sump tube is in place -the larger lumen is attached to suction and the smaller lumen (within the larger one) is open to the atmosphere -checking for residual volume is not an appropriate intervention because the salem sump is attached to continous suction for decompression and is not being used to administer enteral feeding -The AIR VENT (blue pigtail) MUST REMAIN OPEN as it provides a continous flow of atmospheric air through the drainage tube at its distal end (to prevent excessive suction force) -this prevents damage to the gastric mucosa -if gastric content refulex, 10-20mL of air can be injected into the air vent -however, the air vent is kept above the level of the client's stomach to prevent reflux

cognitive behavioral therapy

-can be effective in treating anxiety disorders , eating disorders, depressive disorders, and medical conditions such as insomnia and smoking -These types of disorders are characterized by maladaptive reactions to STESS, ANXIETY, AND CONFLICT -CBT requires that the client learn the skill of self-observation and to apply more adaptive coping interventions

Clients in Ventricular Tachycardia (VT)

-can be pulseless or have a pulse -Treatment is based o this important initiial assessment -VT with a pulse should be further assessed for clinical stability or instability -Signs of instability include HYPOTENSION, ALTERED MENTAL STATUS, SIGNS OF SHOCK, CHEST PAIN, AND ACUTE HEART FAILURE -The unstable client in VT with a pulse is treated with synchronized cardioversion -The stable client in VT with a pulse is treated with antiarrhythmic medications (amiodorane, procainamide, sotalol) -CPR and defibrillation should be initiated only in a client who is pulseless

abrupt discontinuation of antihypertensive medications

-can cause REBOUND HYPERTENSION and possibly HYPERTENSIVE CRISIS (blurred vision, dizziness, severe headache, shortness of breath)

Angiotensin converting enzyme (ACE) inhibitors

-captopril, enalapril, lisinopril, ramipril) -prevent the pathological enlargement of the left ventricle of the heart -they work by blocking a crucial step in the renin-angiotensin -aldosterone system, the main hormonal mechanism involved in blood pressure regulation Interrupting this step of the Renin-angiotensin-aldosterone system has following effects: 1. Shortage of angiotensin II results in an absence of the vasoconstrictive responses (orthostatic reflex, renal blood flow regulation) causing ORTHOSTATIC HYPOTENSION. Clients may be more prone to experiencing orthostatic hypotension . Clients may be more prone to experiencing orthostatic hypotension early in treatment with ACE inhibitors and should be taught ways to prevent it 2. Shortage of aldosterone causes HYPERKALEMIA. ALDOSTERONE SAVES SODIUM AND PUSHES POTASSIUM OUT OF THE BODY 3. ACE inhibitors are CONTRAINDICATD in pregnancy due to teratogenic effects on the fetus (oligohydramnios, fetal kidney injury) The other important side effects of ACE inhibitors, COUGH and ANGIOEDEMA, are thought to be due to the accumulation of bradykinin

Acute otitis media

-caused by a blocked eustachian tube, which leads to a buildup of purulent fluid and inflammation in the middle ear -manifestations include a red and bulging tympanic membrane, inner ear pressure (which can rupture the tympanic membrane if not treated, pain, and fever -Clients also may have rhinorrhea, nausea, or vomiting -when assessing a toddler (age 1-3) the nurse should use the otoscope last because it often distresses client in this age group, especially when pain is present -the nurse should insert the speculum only as far as the outer cartilaginous part of the external auditory canal . Advancing the speculum into the bony interior part causes pain and could damage the typanic membrane -the nurse should educate the parents on how to avoid future occurences of acute otitis media, which includes recommending influenza and pneumococcal conjugate vaccinations

Fifth disease

-caused by parvovirus B 19 -"slapped-cheek", erythema infectiosum ) -symptoms in addition to a bright red facial rash , include fever and general flulike symtoms -it is harmless unless the client has a hemolytic/immunodeficient condition -pregnant women should avoid contact with infected individuals as the virus can be transmitted to the fetus and caus anemia

Isoniazid

-causes hepatotoxicity -peripheral neuropathy INH (N=NEUROPATHY; H= hepatotoxicty baseline liver function tests should be obtained -clients should be advised to watch for signs and symotoms of hepatoxicity (jaundice anorexia)

Tension pneumothorax

-causes marked compression and shifting of mediastinal stuctures (tracheal deviation), including the heart and great vessels resulting in reduced cardiac output and hypotension -this is a life threatening emergency -the client should have emergency LARGE-BORE NEEDLE DECOMPRESSION, followed by chest tube placement, to relieve the compression of the mediastinal structures

Liver cirrhosis

-causes portal hypertension and splenomegaly -an enlarged spleen sequestrates platelets, causing thrombocytopenia -spontaneous bleeding requires further investigation after addressing a client with possible cardiac tamponade

Social Anxiety Disorder

-characterized by an excessive and persistent fear of social or performance situations in which the client is exposed to strangers and the possibility of scrutiny by others -Examples of such social interactions include meeting unfamiliar people, being observed eating or drinking in public and give a speech -the client may fear criticism, embarrassment, humiliation, and rejection from unfamiliar people in unfamiliar social situations and will exhibit physical symptoms of anxiety such as sweating, trembling, palpitations, diarrhea, and blushing

Parkinson disease

-characterized by decreased dopamine levels -uncontrolled acetylcholine - formation of abnormal protein cluster (lewy bodies) in the brain PD causes both physical and neurological (mood alterations, dementia) symptoms

Borderline personality disorder

-live in fear of rejection and abondonment -to avoid abandonment, they use manipulation and control, often unconsciously, to preven a person from leaving -the manipulative behavior may be a positive nature, such as the use of flattery, or a negative nature, such as distancing from the other person -an individual with BPD may also engage in self harm or suicidal behavior in an attempt to gain attention from the other person and keep that person from leaving

The nurse's priority for a client with OI is carefully handling to minimize additional fractures. Care of the infant with OI includes:

-checking blood pressure manually to avoid cuff over-tightening, which may occur with automatic blood pressure cuffs -lifting the infant by slipping a hand over the broadest areas of the body (back, buttocks) so the pressure is distributed -repositioning the infant frequently using supportive devices and gel padding to avoid molding of the soft bones of the skull

Inclusion criteria for thrombolytic therapy in clients with acute myocardial infarction

-chest pain lasting </_12 hours -12 lead ECG findings indicating acute ST elevation myocardial infarction -NO ABSOLUTE CONTRAINDICATIONS (history of cerebral arteriovenous malformation)

Clozapine

-client MUST have a WBC count of >/_3500 /mm3 and an absolute neutrophil count (ANC) of >/_2000 /mm3 before starting clozapine , so it is critical to obtain a BASELINE COMPLETE BLOOD COUNT and ANC -Because agranulocytosis is reversible if caught early, the client's WBC count and ANC must also be monitored regularly throughout the course of clozapine therapy (initially once a week) -clients should also contact the health care provider immediately if they develop FEVER OR SORE THROAT, which can indicate infection due to neutropenia

tetralogy of fallot

-clients often develop chronic pulmonary regurgitation -insufficient flow int the pulmonary vasculature causes the right ventricle to work harder, leading to right ventricular hypertrophy and a subsequent reduction in right ventricular function and cardiac output -the decrease in forward blood flow causes blood to back up into venous circulation, resulting in HEART FAILURE

Postpartum urinary retention

-commonly related to decreased bladder sensation (due to regional anesthesia, prolonged labor, or perineal trauma) and postpartum diuresis -urinary retention can cause BLADDER DISTENSION , which may be noted by a DISPLACED and/or BOGGY UTERUS, or by a palpable bladder If bldder distension cannot be resolved with spontaneous voiding, IN-AND-OUT CATHETERIZATION may be indicated, especially if the client : -Is unable to ambulate to the restroom or void into a bedpan -Has NOT VOIDED WITHIN 6-8 HOURS after delivery or removal of the indwelling urinary catheter after cesarean delivery -Has difficulty EMPTYING BLADDER COMPLETELY (Voiding <100 ml frequently )

Peripherally inserted central venous catheters (PICC)

-commonly used for long term antibiotic administration, chemotherapy treatments, and nutritional support with total parenteral nutrition -Complications related to the PICC are occulusion of the catheter, phlebitis, air embolism, and infection due to bacterial contamination -prior to a central line dressing change, the nurse performs hand hygiene -the central line dressing is performed using STERILE TECHNIQUE with the nurse wearing a mask to prevent contamination of the site with microogranisms or respiratory secretions -during injection cap and tubing changes, the client is instructed to HOLD THE BREATH (perform the valsalva maneuver) tp prevent air from entering the line, traveling to the hear, and forming an air embolism -WHen performing the dressing change, the client should be instructed to TURN THE HEAD AWAY from the PICC site to prevent potential contamination of the insertion site by microorganisms from the client's respiratory tract -During dressing, injection caps and tubing changes, the client is placed in the supine position. If airembolism is suspected, the client should be placed in trendelenburg position (head down) on the left side, causing any existing air to rise and become trapped in the right atrium

Complications of mononucleosis

-complications include airway obstruction (stidor, difficult breathing) from swollen lymph nodes around the neck and sever abdonimal pain (splenic rupture) symptoms may include fatigue, fever, sore throat, splenomegaly, hepatomegaly, and swollen lymph nodes -treatment for mononucleosis is management of symptoms

Dietary Fiber

-composed of indigestible complex carbohydrates that absorb and RETAIN WATER, which increases stool bulk and makes stool softer and easier to pass -consuming a diet high in fiber-rich foods (fruits, vegetables, legumes, whole grains) improves stool elimination, which helps prevent constipation and decreases the risk of colorectal cancer -fiber-rich foods tend to have a low glycemic load (less sugar per serving) and are nutrient dense, yet they have lower caloric density -clients may also experience increased Satiety as fiber absorbs water and produces fullness -this may help reduce caloric intake, improve blood glucose control, and promote weight loss -fiber binds to cholesterol in the intestines, which reduces serum cholesterol levels by decreasing the amount of dietary cholesterol that enters the bloodstream -Decreasing serum cholesterol levels helps reduce vascular plaque build up and atherosclerosis - a high intake of fiber-rich foods directly correlates with a reduced risk of vascular diseases, including coronary artery disease and stroke

Acute respiratory Failure

-defined as inadequate gas exchange that is intrapulmonary (pneumonia, pulmonary embolism) or extrapulmonary (head injury, opioid overdose) in origin -Respiratory failure associated with an alteration in O2 transfer or absorption is type 1 hypoxemic failure (acute respiratory distress syndrome, pulmonary edema, shock) -respiratory failure associated with Carbon dioxide (CO2) retention is type 2 hypercapnic, or ventilaroty failure (chronic obstructive pulmonary disease, myasthenia gravis, flail chest ABG VALUES that indicate the presence of ARF are PaO2</_ 60 mm Hg or PaCO2 >/_50 -ARF occurs quickly over time (minutes to hours) and so there is no physiologic compensation and pH is </_7.30 -immediate intervention with high O2 concentrations is indicated, and noninvasive or invasive, positive-pressure mechanical ventilation may be necessary

Cystic fibrosis

-diet high in fat and calories is recommended dude to defective digestive enzmes and impaired nutrient absorption

Barium Enema

-lower gastrointestinal series -uses fluorscopy to visualize the colon outlined by contrast to detect polyps, ulcers, tumors, and diverticula -This procedure is contradicated for clients with acute diverticulitis as it may rupture inflamed diverticula and cause subqsequent peritonitis

Clients with sepsis are at risk for developing

-disseminated intravascular coagulation, a condition that initially causes clotting within the microvessels -platelets and clotting factors are consumed in clotting and become unavailable for body use, leading to bleeding complications -the initial clotting also disrupts blood flow to extremities and organs -Signs of DIC, include frank external bleeding (venipuncture site bleeding), signs of internal bleeding (PETECHIAE, Ecchymosis, hematuria, hematemesis, and bloody stools), and respiratory distress ( bleeding/clotting into lungs) -Signs of DIC need immediate assessment and emergency intervention -rapid replacement of clotting factors (fresh frozen plasma), platelets, and blood is needed to save the client from death

Manifestations of infiltration

-edema -coolness to touch around the insertion site monitor for edema related to infiltration under the involved limb -infiltrate fluid may leak into loose skin, causing edema in dependent areas without obvious signs of infiltration at the PIV site, particularly in the elderly

Signs of phlebitis

-erythema, edema, warmth, pain, and palpable venous cord

IV catheter should not be removed or replaced more frequently than

-every 72-96 hours -unless signs of complications (infiltration, infection, phlebitis)

Small bowel follow through

-examines the anatomy and function of the small intestine using x-ray images taken in succession -barium is ingestedm and x-ray images are taken every 15-60 minutes to visualize the barium as it passes through the small intestines -using this technique, decreased motility (ileus), increased motility (malabsorption syndromes), fistulas, or obstructions are identified Clients should be instructed as follows: -fast 8 hours prior to the examination -the test usually takes 60-120 minutes, but if obstruction or decreased motility is present, it can take longer -drink plenty of fluids after the examination to facilitate barium removal. CHALKY STOOLS may be present 24-72 hours after the examination -if brown stools do not return after 72 hours or abdominal pain or fullness is present, contact the hcp

lacatase Deficiency

-experience varying degrees of gastrointestinal symptoms after ingesting milk products, including flatulence, diarhhea, bloating, and cramping -this is due to a deficiency of the enzyme lactase, which is required for digestion of lactose -treatment includes RESTRICTING LACTOSE-CONTAINING FOODS IN THE DIET -these clients may also take lactase enzyme replacements (LACTAID) to decrease symptoms -Supplementation of calcium and vitamin D is recommended due to insufficent intake of fortified milk -MILK AND ICECREAM contain the HIGHEST AMOUNTS of LACTOSE and should be restricted depending on the client's individual tolerance -Some dairy products, included aged cheeses and live-culture yogurts, contain little to no lactose and can be tolerated by most clients with lactase deficiency -Lactase deficiency is not an immune reaction (allergy) to milk products. Rather , the gastrointestinal symptoms are due to a deficiency of the enzyme lactase and the resultant inability to digest lactose

Typical symptoms of mania

-extreme hyperactivity -delusions and hallucinations -grandiosity -elation -poor judgement -aggressiveness - impulsivity - pressure of speech -insomnia -flight of ideas -sometimes hostility

Emergent call is warranted if a client:

-falls -deteriorates signifcantly or dies -has critical laboratory results -needs a prescription that requires clarification -leaves against medical advice or runs away - REfuses KEY TREATMENTS in a relevant period

An emergent call is warranted if a client

-falls -deteriorates significantly or dies -has critical laboratory results -needs a prescription that requires clarification -leaves against medical advice or runs away -refuses key treatments in a relevant period The hcp should be called after the initiation of hosptial protocols (stroke, code blue) and after a concerning assessment finding (significant change in vital signs, unilateral drift, change in level of consciousness, signs of trauma after a fall) -administration of heparin is normally discontinued prior to surgery due to risk of bleeding and should be clarified wit the HCP

Risk factors of skin cancer

-family or personal history of skin cnacer -celtic ancestry traits (light skin, red or blond hair, blue or green eyes, many freckles) -aging -atypical or high number of moles because some skin cancers develop from pre-existing moles -immunosuppresiion (immunosuppressant medications, HIV), which lowers the body's ability to defend against cancerous mutations -ultraviolet light exposure (chronic sun exposure, outdoor occupation, tanning bed use, history of severe sunburns)

NON-modifiable breast cancer risk factors include:

-female sex and age >/_50 -first -degree relative (mother or sister) with history of breast cancer -BRCA1 AND BRCA2 genetic mutations -personal history of endometrial or ovarian cancer -menarche before age 12 or menopause after age 55

Metronidazole (flagyl)

-first-line anti-infective drug used to treat infectious diarrhea caused by c diff

Levofloxacin

-fluoroquinolone antibiotic prescribed to treat urinary tract infections

MRI uses

-gadolinium contrast

Problems with swallowing and the gag reflex would indicate damage to the which nerves

-glossopharyngel and vagus nerves (cranial nerves 9 and 10)

Rotator cuff

-group of 4 shoulder muscles and tendons that attach to the humeral head -it allows for rotation of the arm -a partial or full thickness rotator cuff tear can occur gradually over time as a result of agin, repetitive use, or an injury to the shoulder -it can also occur as a result of a sports injury involving repetitive overhead arm motion (swimming, tennis baseball, weight lifting) Characterisitc symptoms of rotator cuff injury usually include SHOULDER PAIN AND WEAKNESS -SEVERE PAIN when the arm is abducted between 60 and 120 degrees (painful arc) is characteristic

Nursing interventions directed at improving the social interaction skills of a client with SCHIZOPHRENIA include the follwing:

-making brief, frequent contacts -accepting the client unconditionally by minimizing expectations and demands -assessing the client's readiness for longer contacts with the nurse and/or other staff and clients -being with or close by the client during group activities -offering positive reinforcement when the client interacts with others social isolation and impaired social interaction are common negative symptoms of schizpphrenia -the client will seek to be alone to relieve anxiety associated with being around others -the nurse needs to be accepting pf

Hemophilia

-group of disorders characterized by deficiencies in production or use of COAGULATION PROTEINS (FACTOR 8, FACTOR 9) resulting in impaired clot formation and increased risk for uncontrolled bleeding -Hemophilia is typically identified by prolonged or excessive bleeding, severe bruising, or joint bleeding (hemarthrosis) after injuries or procedures -Administration of supplemental IV clotting factors (factor 8 , factor 9) is the primary treatement for acute bleeding in clients with hemophilia -cleints with hemophilia have increased risk of hemarthrosis (bleeding in joint) -in addition to administration of IV clotting facotrs, hemarthrosis is managed with REST, ICE, COMPRESSION, AND ELEVATION (RICE) -application of ice or cold packs promotes local vasoconstriction and clot formation -the affected joint should be maintained in the EXTENDED position to prevent flexion contracture -FREQUENT NEUROLOGIC ASSESSMENTS are required for clients with hemophilia who have suspected (facial laceration in this client) or confirmed head trauma, as neurologic alteration may indicate intracranial bleeding When caring for clients with hemophilia, the nurse should eliminate factros that increase bleeding risk r promote complications from bleeding NSAIDs (aspirin, ibuprofen) are avoided as they inhibit platelet aggregation, which increases bleeding risk

Basic life support

-guidelines to perform cardiopulmonary resuscitation (CPR) for cliets experiencing cardiac arrest Essential components of adult cpr include: -Chest compressions are performed at a rate of 100-120/min and a depth of 2.0-2.4 inches allowing complete chest recoil between compression -Defibrillator pads are placed on the right upper chest just below the clavicle, and on the LEFT LATERAL CHEST, near the anterior axillary line below the nipple line -During CPR, compressions are paused every 2 mins to assess the client's pulse. This pause should be no longer than 10 seconds to minimize delays between compression cycles -manual breaths are administered at a rate of 2 breaths per 30 chest compressions in clients without advanced airways or once every 6 seconds without chest compression interruption with advanced airway placement

Carbon monoxide (CO)

-has a much stronger bond to Hgb than oxygen does -consequently, CO displaces oxygen from Hgb, CAUSING HYPOXIA that is not reflected by a pulse oximeter reading -the nurse's primary action is to administer HIGHLY CONCENTRATED (100%) OXYGEN USING A NONREBREATHER MASK AT 15L/MIN in order to reverse this displacement of oxygen -The conventional pulse oximeter is NOT EFFECTIVE in identifying hypoxia in CO poisoning -diagnosis requires co-oximetry of a blood gas sample -the priority action is to adminser 100% oxygen using a nonrebreather mask to treat hypoxia and help eliminate CO

anaphylactic shock

-has an acute onset (20-30 mins) caused by a systemic IgE-mediated hypersensitivity allergic reaction to drugs (antibiotics), foods (shellfish, peanuts), diagnostic agents (contrast), biologic agents (blood, vaccines), and venom (bees, snakes) and results in circulatory failure, laryngeal edema, and severe bronchoconstriction Management of anaphlylactic shock includes: 1. Stop the infusion that is causing the reaction and call for HELP (rapid response team) 2. Ensure patent airway, then administer oxygen via a high flow nonrebreather mask and prepare for intubation if needed 3. Give epinephrine intramusculalry. Epinephrine counteracts the effect of the histamines, released, dilating bronchial smooth muscles and providing vasoconstriction. most deaths from anaphylaxis are due to delaying epinephrine. Maintain blood pressure with normal saline IV fluid 4. administer adjunctive therapies: BRONCHODILATORS (albuterol) to dilate the small airways and revers bronchoconstriction, ANTIHISTAMINES (diphenhydramine) to modify the hypersensitivity reaction , and corticosterids (methylprednisolone) to decrease airway inflammation and swelling associated with the allergic reaction 5. Continue to reassess vital signs for any changes

Shingles

-herpes zoster -reactivation of the varicella-zoster (Chicken pox) virus -it is more likeley to occur when a client's immune system is compromised by disease (HIV infection) or treatments (Chemotherapy) -Shingles lesions that are OPEN may transmit the infectio by BOTH AIR AND CONTACT -THE client with DISSEMINATED SHINGLES that are NOT CRUSTED over will require CONTACT PRECAUTIONS, AIRBORNE PRECAUTIONS, and a NEGATIVE AIRflow ROOM to prevant transmission of the infection to others in the hospital -Negative airflow pulls air from the hospital environmnet into the room, and the air from the hospital room then goes directly to the outside rather recirculating in the rest of the hospital -LOCALIZED SHINGLES require only standard precautions for clents with intact immune systems and contained/covered lesions

Preterm newborns are high risk for

-high risk for COLD STRESS due to immaturity of the thermoregulatory center in the brain, inadequate subcutaneous fat, and an inability to initiate shivering -these atributes make it difficult for the preterm newborn to maintain normal body temperature (axillary temp of 97.7-99.5) -COVERING THE SCALE with warmed blankets protects against conductive heat loss, which may occur when the newborn's skin comes into contact with a cooler surface -skin-to-skin contact with the parents for stable, preterm newborns promotes thermoregulation through conduction of body heat to the newborn -RADIANT WARMERS and incubaters provide heat through convection and are routinely used to help newborns regulate their core temperatures -providing CARE underneath the radiant warmer protects newborns from convection heat loss by reducing exposure to the cooler ambient enviroment and air drafts -Drying the newborn completely of amniotic fluid immediately follwoing birth protects the newborn from heat loss by evaporation and should occur prior or simultaneously with other intervention -preterm newborn should be transferred from the birthing room to the icu via a PREWARMED INCUBATOR to prevent heat loss by convection

Modifiable breast cancer risk factors

-hormone therapy with estrogen and /or progesterone (increased risk if taken after menopause) -postmenopausal weight gain and obesity as fat cells store estrogen -history of smoking and alchol consumption -dietary fat intake -sedentary lifestyle

Inflammatory breast cancer

-in this aggressive form of cancer, breast lymph channels are blocked by cancer cells, creating breast tissue that becomes red, warm, and has an orange peel (peau d'orange) , pitting appearance on the skin surgace -the nurse would be most concerned about this client and make an immediate referral to the health care provider for examination and evaluation

The Babinski reflex

-present at birht and dissappears at 1 year -the toes hyperextend and fan out when the lateral surface of the sole is stroked in an upward motion -Absent babinksi or a week reflex may indicate a neurological defect

modified radical mastectomy

-includes removal of axillary lymph nodes that are involved in lymphatic drainage of the arm -any trauma (extravasation) to the arm on the operative side can result in LYMPHEDEMA CHARACTERIZED BY painful and legthy swelling, as normal lymphatic circulation is impaired by scarring -Therefore, starting an IV line in this arm is CONTRAINDICATED -The nurse should insert the iV line into the most distal site of the unaffected side -for client safety, it is also important to ensure documentation of the mastectomy history, place a RESTRICTED EXTREMITY ARMBAND on the affectd arm, and place a sign above the client's bed notifying hospital staff of necessary mastectomy precautions (no blood pressure measurement, venipuncture, or iv lines) -keeping the affected arm in a dependent position for a long time can increase lymphedema. The client should be reminded that raising the limb helps drainage

Lactational mastitis

-infection and inflammation of breast tissue -may result from inadequate milk duct drainage or poor breastfeeding technique -Bacteria from the infant's nasopharynx or mother's skin can enter the nipple, escpially if it is damaged, and ultiply in stagnant milk -Manifestations include fever, muscle achesm and breast pain and inflammation (warmth, redness, edema) Staphylococcus aureaus is the most common causative organism and requires antibiotic treatment In addition , the nurse should encourage the client to : -continue breastfeeding frequently (Every 2-3 hrs) to ensure adequate milk drainage -ensure proper breastfeeding technique (alternate newborn feeding positions, proper latch -apply WARM COMPRESSES and massage the breast to facilitate complete emptying . Cool compresses can also be used between breastfeedin as needed for comfort -Ensure adequate rest, nutrition, and hydration -releive pain and inflammation with analgesic compatible with breastfeeding (acetaminophen, ibuprofen) -wash hands before and after feeding

Acute pericarditis

-inflammation of the membranous sac (pericardium) surrounding the exterior of the heart, which can cause an increase in the amount of fluid in the pericardium (pericardial effusion) -if pericardial effusions accumulate rapidly or are very large, they may compress the heart, altering the mechanics of the cardiac cycle (cardiac tamponadE) -cardiac tamponade decreases atrioventricular filling and impairs the heart's ability to contract and eject blood -it is life threatening without prompt recognition and treatment

Oral mucositis

-inflammation or ulceration of the oral mucosa, results from chemotherapy or radiation therapy -ORAL hygiene practices that minimize oral mucositits and promote comfort include the following: -Cleansing the mouth with normal saline after meals and at bedtime to promote oral health -use a soft-bristle toothbrush to decrease gum irritation -application of prescribed viscious lidocaine HCL (xylocaine) to alleviate oral pain -use of water-soluble lubricating agents to mositen mouth tissues that may become dry due to therapy -avoidance of hot liquids and spacy/acidic foods, which can cause oral discomfort -CLients with mucositis should avoid antiseptic mouthwashes with alcohol as they are irritating to mucuous membranes -Administering of PALIFERMIN , a recombinant keratinocyte growth factor, PREVENTS ORAL MUCOSTITIS in clients diagnosed with hematologic malignancies. HOWEVER, IT does NOT help with PAIN

Beclomethasone

-inhaled corticosteroid (ICS) normally used as a long-term, first-line drug to control chronic airway inflammation

Cystic Fibrosis

-inherited AUTOSOMAL RECESSIVE disorder of the exocrine glands that results in physiologic alterations in the respiratory, gastrointestinal, and reproductive systems -it is theorized that the chloride transport alternation and resulting thickend mucus inhibit normal ciliary action and cough clearance, and the lungs become clogged with mucus -the thickened mucus harbors bacteria -overtime, airways develop chronic colonization and frequent respiratory infections result -bronchial hygiene therapy, such as manual CHEST PHYSIOTHERAPY, is used, -For physio therapy, various positions are used, and this should be performed before meals to avoid stomach and resultant regurgitation or vomiting -Decreased ability to digest fats and proteins and absorb fat-soluble vitamins -pancreatic enzyme supplements are used. THey tend to be hungry and under weight due to a decreased ability to use fat and its calories

How to reduce referrred pain to the right shoulder after a post laparoscopic cholecystectomy problem

-interventions for alleviation include the SIMS position, deep breathing, ambulation, and analgesics

Lumbar puncture

-involves removing a sample of cerbrospianl fluid through a needle inserted between vertebrae -elvated intracranial pressure is a contraindication to performing a lumbar puncture -the client is placed in the fetal position or sitting and leaning over a table -CONTINUED LEAKING FLUID indicates that the site did not seal off and a blood patch (autologous blood into the epidural space) is required -fluids are encouraged to help replace the cerbrospinal fluid -the client should LIE FLAT FOR AT LEAST 4 HOURS. The prone or supine posiiton is recommended to help prevent a headche -5%-30% of clients have the common complication of headche. it is thought to be a result of leakage of fluid through the dural puncture site. The symptom is treated and is normally self-limitng

Arterial Steal Syndrome

-is an Arteriovenous fistula complication that occurs when the anastomosed vein "steals" too much arterial blood, causing DISTAL EXTREMITY ISCHEMIA -symptoms occur distal to the AVF, including SKIN, PALLOR, PAIN, NUMBNESS, TINGLING, DIMINISHED PULSES, AND POOR CAPILLARY REFILL -Without prompt intervention, ischemia may lead to limb necrosis

major side effect of metformin

-lactic acidosis -GI disturbances (metallic taste in the mouth, nausea, and diarrhea) -unlike insulin, metformin does not usually cause hypoglycemia

clients receiving transplanted organs are prescribed

-lifelong immunosuppressive medications (cyclosporine, mycophenolate) to PREVENT REJECTION -Posttransplant infection is the most common cause of death -signs of infection may include fever>100.4 F, productive or dry cough, and changes in secretions; however, comon signs of infection (redness, swelling) may be absent due to immunosuppression -critical postoperative infection control measures incorporate vigilant hand washing, aseptic technique for line/dressing changes, and possibly reverse isolation

Tonsillectomy

-may be indicated in some cases of chronic tonsillitis, peritonsillar abscess, or obstructive sleep apnea -postoperative bleeding is a primary concern after a tonsillectomy because the surgical site is not easily visualized and is vulnerable to irritation and trauma from swallowing and coughing -the nurse should observe for signs of postoperative bleeding (frequent, increased swallowing or clearing of the throat; vomiting bright red blood) and notify the health care provider -Excpected post op findings include EAR PAIN when swallowing (referred pain from the throat) and low-grade fever (<101F); analgesiscs (acetaminophen may be administered as needed -superficial infection at the surgical site is common causes white, fluid-filled exudate in the throat with halitosis (bad breath); this is not concerning because it usually resolve spontaneously after 5-10 days -drinking through a straw creates suction that causes localized pressure at the back of the throat and may contribute to bleeding . The client should avoid use of straws or other pointed objects in the mouth -ROUTINE suctioning can cause trauma to the surgical site and induce bleeding. suction equipment should be available but used only for emergency airway obstruction

Post-traumatic stress disorder (PTSD)

-may occur in people who have seen or experienced a terrifying, traumatic event (war, tornado, rape, plane, crash) There are 3 categories of PTSD symptoms 1. REEXPERIENCING THE TRAUMATIC EVENT Examples include intrusive memories, flashbacks, recurring nightmares, and feelings of intense distress/loss of control or strong physical reactions to event reminders (rapid pounding, heart; gastrointestinal distress; diaphoresis) 2. AVOIDING REMINDERS OF THE TRAUMA Examples include avoidance of activities, places, thoughts, or other triggers that could serve as reminders; feeling detached and emotionally numb; loss of interest in life; inability to set goals; and amnesia about important details of the event 3. INCREASED ANXIETY AND EMOTIONAL AROUSAL Examples include insomnia, irritiability , outbursts of rage, persistent anger and/or fear, difficulty concentrating , hypervigilance, and exaggerated startle response

Antiretroviral therapy

-medication regimen consisting of multiple drugs fro managing and preventing progression of HIV infections -ART impairs viral replication at multiple points, which leads to decreased viral loads and INCREASED CD4 (helper t cell counts) -When educating clients about ART, it is critical to explain that treatment is lifelong and requires strict adherence -Even clients with undetectable viral loads remain infected with HIV -th discontinuation of , or poor adherence to, ART results in the progression of HIV (which may lead to AIDS) and promotes VIRAL DRUG RESISTANCE

Duchenne Muscular dystrophy (DMD)

-most common form of child hood MD -the conditon is X-linked recessive (carried by females and affects males) and is due to lack of a protein called DYSTROPHIN needed for muscle stabilization -Disease onset is age 2-5 years -Muscles of the proximal lower extremities and pelvis are affected first -Calf muscles hypertrophy (pseudohypertrophy) initially in response to proximal muscle weakness and are later replaced by fat and connective tissue -The GOWER SIGN involves the use of one's hands to rise from a squat or form a chair to compensate for proximal muscle weakness -There is NO EFFECTIVE CURE. Most children are wheelchair bound by adolescense and die by age 20-30 from respiratory failure

hypovolemic shock

-most commonly occurs from blood loss but can occur in any condition that reduces intravascular volume -classified as either an ABSOLUTE (hemorrhage, surgery, gastrointestinal bleeding, vomiting, diarrhea) or a relative (pancreatitis, sepsis) fluid loss -reduced intravascular volume results in decreased venous return, decreased stroke volume and cardiac output, inadequate tissue perfusion and impaired cellular metabolism Clinical manifestations of hypovolemic shock are associated with INADEQUATE TISSUE PERFUSION and include: -change in mental status -tachycardia with thready pulse -cool, clammy skin -oliguria -tachypnea Decreased urine output <0.5 ml/kg/hr despite fluid replacement indicates inadequate perfusion to the kidneys and is a manifestion of hypovolemic shock in a client with normal renal function hypovolemic shock is associated with decreased intravascular volume and central venous pressure (<2 mm Hg)

Major adverse effect of statin

-muscle cramps and liver injury

The synchronizer switch

-must be turned on when cardioversion is planned -the synchronize circuit in the defibrillator is programmed to deliver a shock on the R WAVE of the QRS complex on the electrocardiogram -this allows the unit to sense this client's rhythm and time the shock to avoid having it occur during the TWAVE -a shock delivered during the T wave could cause this patient to go into a more lethal rhythm (ventricular tachycardia, ventricula fibrillation). if this client becomes PULSELESS, THE synchronize function should be TURNED OFF and the nurse should proceed with defibrillation

clinical Features of cardiac tamponade

-narrowed pulse pressure -muffled heart sounds -distended neck veins -Clinical features include HYPOTENSION or narrow pulse pressure, MUFFLED HEART SOUNDS, and NECK VEIN DISTENSION (BECK TRIAD) -in addition, pulsus paradoxus (systolic blood pressure decrease >19 mm Hg during inhalation), chest pain, tachypnea, and tachycardia may be present

Tumor lysis syndrome

-occurs due to rapid lysis of cells and the resulting release of intracellular potassium and phosphorus into serum -Phosphorus binds to calcium leading to HYPOCALCEMIA -THE breakdown of cellular nucleic acids causes severe HYPERURICEMIA -IV hydration and hypouricemic medication s(allopurinol) are prescribed to promote purine excretion and prevent acute kidney injury

HIRCHSPRUNG DISEASE (HD)

-occurs when a child is born with some sections of the distal large intestine MISSING NERVE CELLS, rendering the internal anal sphincter unable to relax -As a result, there is no peristalsis and stool is not passed -these newborns exhibit symptoms of DISTAL INTESTINAL OBSTRUCTION -they have distended abdomen and will not pass meconium within the expected 24-48 hours -they also have difficulty feeding and often vomit green bile -surgical removal of the defecative section of bowel is necessary and colostomy may be required -A POTENTIALLY FATAL COMPLICATION is HIRSCHSPRUNG ENTEROCOLITIS, an inflammation of the colon, which can lead to SEPSIS AND DEATH -Enterocolitis will present with fever; lethargy; explosive, foul-smelling diarrhea; and rapidly worsening abdominal distension

Gastroesophageal reflux disease

-occurs when chronic reflux of stomach contents causes inflammation of the esophageal mucosa -the lower esophageal sphincter (LES) normally prevents stomach contents from entering the esophagus -any factor that DECREASES THE TONE OF THE LES (caffeine, alcohol), delays gastric emptying (fatty foods), or increases gastric pressure (large meals) can precipitate GERD

Precipitous birth

-occurs when labor lasts <3 hours from contraction onset until birth -signs of imminent birth include INVOLUNTARY PUSHING/BEARING DOWN with contractions, GRUNTING, or report of sensations of having a bowel movement -if a client arrives at the hospital in SECOND-STAGE LABOR (pushing), the nurse rapidly assesses whether birth is imminent by apply gloves and OBSERVING THE PERINEUM for bulging or crowing of the presenting fetal part -If the health care provider is not present , the nurse stays with the client, ensures safe Client positioning (not standing or on the toilet) and is preparted to act as a birth attendant) -the nurse may direct others to perform needed actions (contact provider, assess fetal heart tones, initiate IV ACCESS)

Chronic venous insufficiency

-occurs when the valves in the veins of the lower extremities consistently fail to keep venous blood moving forward, which causes chronic increased venous pressure -the increased pressure pushes fluid out of the vascular space and intop the surround tissues, where tissue enzymes break down red blood cells -The destruction of red blood cells releases HEMOSIDERIN (a reddish-brown protein that stores iron) , WHICH causes a brownish SKIN DISCOLORATION; chronic edema and inflammation cause the tissue to harden and appear leathery -affected skin is highly prone to breakdown and ulcerations (Venous leg ulcers) commonly on the inside of the ankle

Stragegies to promote intake for toddlers include the following:

-offering 2-3 high qulaity food choices -keeping food portions small (1-2 tablespoons per serving) -exposing the child to new foods repeatedly -avoiding distractions (television, toys) during meals/snacks

Highest risk for hospital-acquired MRSA are

-older adults and those with suppressed immunity, long history of antibiotic use, or invasive tubes or lines (hemodialysis clients) -clients in the intensive care unit are especially at risk for mRSa -the 80 yr old client with copd in the icu on the vent has several of these risk factors -COPD is a chronic illness that can affect the immune system, and clients experience exacerbations that may require frequent antibiotic and corticosteroid use -this client is elderly and also has an invasive tube from the ventilator

Proton pump inhibitors

-omeprazole -associated with increased risk of pneumonia, clostridium difficile diarrhea, and calcium malabsorption (osteoporosis)

Nonrebreather mask

-oxygen delivery device used in a medical emergency -consists of a facemask with an attached reservoir bag and a one-way valve between the bag and mask that prevents exhaled air from entering the bag and diluting the oxygen concentration -the liter flow must be high enough (up to 15L/min) to keep the reservoir bag at least 2/3 inflated during inhalation and to prevent the buildup of carbon dioxide in the bag -it can deliver up to 95%-100% oxygen concentration if properly maintained during use -proper care of the device includes monitoring the reservior bag to assure continual inflation during inhlation -monitoring the 2 exhalation (flutter) valves that cover the ports on each side of the mask; and keeping the mask secured to the face by adjusting the tightness of the head strap to minimize leaks

Romberg test

-part of a focused neurologic examination, assesses client's perceptions of their head in space (vestibular function) and body in space (proprioception) -it is used to determine the reason for loss of coordination (ataxia) -clients are asked to stand with the feet together and hands at the sides of the body -they are asked to CLOSE THEIR EYES while ability to maintain balance is assessed -a loss of balance is considered to be a POSITIVE ROMBERG SIGN aand indicates that ATAXIA IS SENSORY in nauture rather than cerebellar -clients demonstrating a postive rombergs tests are likely to have ATAXIA, or be prone to lose balance, and would require ASSISTANCE WITH AMBULATION

Sinusoidal fetal heart rate (FHR)

-pattern is characterized by repetitive, wave-like fluctuations with absent variability and no response to contractions - it is usually an ominous finding requiring immediate intervention - a sinusoidal pattern (category III FHR tracing) is suggestive of severe fetal anemia potentially due to fetomaternal hemorrhage (Abdominal trauma) or some fetal infections (PARVOVIRUS B19) -if a sinusoidal pattern noted, especially after abdominal trauma (fall, motor vehicle collision, injury), the nurse should notify the hcp immediately, initiate intrauterine resusciation (positioning, IV fluids, oxygen) and anticipate and expedited birth

Ear examination under age 3

-pinna pulled down and back

Ear examination over age 3

-pinna pulled up and back

General interventions to maintain gastric suction using a salem sump tube include:

-place the client in SEMI-FOWLER'S POSITION to help keep the tube from lying against the stomach wall; this is done to help prevent gastric reflux -Provide MOUTH CARE EVERY 4 HOURS as this helps to maintain moisture of oral mucosa and promote client comfort -TURN OFF SUCTION BRIEFLY DURING AUSCULTATION as the suction sound can be mistaken for bowel sounds -keeping the air vent (blue pigtail) open and above the level of the client's stomach -inspect the drainage system for patency

Statins (rosuvastatin, atorvastatin, simvastatin)

-potential adverse effects include hepatic dyfunction (normal ALT 10-40) and muscle injury

Metoclopramide (Reglan)

-prescribed for the treatment of delayed gastic emptying, gastroesophageal reflux (GERD) and as an antiemetic -Similar to antipsychotic drugs, metoclopramide use is associated with EXTRAPYRAMIDAL ADVERSE EFFECTS, including TARDIVE DYSKINESIA (TD) -this is especially common in older adults with long-term use -the client should call the hcp immediately if TD symptoms develop, including uncontrollable movements such as -protruding and twisting of the tongue -lip smacking -puffing of cheeks -chewing movements -frowning or blinking of eyes -twisting fingers -twisted or rotated neck (torticollis)

Symptom management for minor sunburns

-protecting the burned area from further sun exposure (avoid going outside during midday when the sun's rays are hottest) -promoting increased fluid intak to avoid dehyration -Providing pain releif with over-the-counter analgesics such as ibuprofen and acetaminiphen -Reducign inflammation and pain by taking tepid baths; using cool compresses and applying soothing protective lotions or gels (aloe vera, calamine) to the sunburned area

-To ensure appropriate and effective handoff communication, the nurse should:

-provide identifying information (cleint's name and room number ) -Note care priorities and upcoming or outstanding tasks (time to replace a medication infusion bag, need to perform delayed wound care and cause of delay) -Provide exact, pertinent information (medication dose, time, measuable outcomes) -include multidisciplinary plans (RADIOLOGY EXAMINATIONS , family meetings, physical therapy) -Relay significant client changes in a clear manner (assessment, interventions, outcomes, evaluations)

Positive airflow

-pull fresh air from outside into the hospital room, and then the air from the room would circulate throughout the rest of the hospital -positive airflow would be use for protection isoation in a client who is immunocompromised

Myxedema Coma

-refers to a state of severe hypothyroidism causing decreased level of consciousness (lethargy, stupor) that my progress to a comatose state -Myxedema coma is characterized by HYPOTHERMIA, BRADYCARDIA, HYPOTENSION, AND HYPOVENTILATION -HYPOVENTILATION may occur as a result of respiratory muscle fatigue and mechanical obstruction by and edematous tongue -cleints with signs of respiratory failure (slow or shallow breathing, low oxygen saturation) require emergency endotracheal intubation and mechanical ventilation -the nurse should provide respiratory support (ventilation with a bag-valve-mask) and prepare to assist with intubation

Positive (diagnostic) signs of pregnancy

-represent conclusive evidence of pregnancy and cannot be attributed to any other etilogy These signs include a discernible fETAL HEARTBEAT held by doppler device, ULTRASOUND VISUALIZATION of the fetus, and fETAL MOVEMENT paplated or observed by the hcp

A teaching plan for a client prescribed RIFAMPIN

-rifampin changes the color of body fluids (urine, sweat) due to its body-wide distribution. Tears can turn red, making contact lenses appear discolored. Clients should WEAR EYEGLASSES INSTEAD OF SOFT CONTACT LENSES while taking this medication -Women should use NONHORMONAL BIRTH CONTROL methods while taking this drug as it can decrease the effectiveness of ORAL CONTRACEPTIVES -CANC CAUSE HEPATOTOXICITY (should be advised to watch for signs and symptoms such as jaundice , anorexia)

Histrionic personality disorder

-self-dramatizing, exaggerated or shallow emotional expression -ATTENTION-SEEKING, needs to be the center of attention -overly friendly and seductive, attempts to keep others engaged -Demands immediate gratification and has little tolerance for fustration An individual with histrionic personality disorder displays these behaviors and characteristics persistently. The signs and symptoms are maladaptive and have a negative impact on the client's social, interpersonal, and occupational life

Albuterol

-short-acting beta agonist (SABA) Administered as a quick-relief rescue drug to releive symptoms (wheezing, breathlessness, chest tightness) associated with intermittent or persistent asthma

Cord (newborn)

-should be opaque or whitish-blue with TWO ARTERIES AND ONE VEIN and covered with WHARTON'S jelly -the presence of only one umbilical artery and vein is associated with heart or kidney malformation -the cord should also be assessed for bleeding -it will become dry and darker within 24 hours and detach from the body within 2 WEEKSs

Presumptive signs

-subjective signs of pregnancy are self-reported by the client (Breast tenderness, nausea, amenorrhea) -these signs may be related to other medical conditions and therfore cannot be considered diagnostic of pregnancy -amenorrhea -nausea and vomiting -urinary frequency -breast tenderness -quickening -excessive fatigue

Bishop Score

-system for the assessment and rating of CERVICAL FAVORABILITY and READINESS FOR INDUCTION OF LABOR -The cervix is scored (0-3) on consistency position, dilation, effacement, and station of the fetal presenting part -A HIGHER BISHOP score indicates an increased likelihood of successful induction that result in vaginal birth -For nulliparous women, a score >/_ 6-8 usually indicates that induction will be successful

Most reliable indicator of the CLIENT'S PAIN

-the client's SELF-REPORT OF SYMPTOMS is always the most reliable indicator of the client's pain -the nurse does not have the ability to determine the extent of pain the client is experiencing- only the client can repport this -in the nonverbal client, the nurse may use NONVERBAL Pain scales such as the WONG-BAKER PAIN RATING SCALE

Testicular cancer

-the most common form of cancer in men age 15-35 -when diagnosed early, it is highly curable -clients at high risk for developing a tumor (history of undescended testis) are encouraged to perfrom a monthly TSE Client instructions for a TSE include: -Perform TSE MONTHLY on the SAME DAY (easy to remember) -perform TSE WHILE TAKING A WARM SHOWER or bath as warm temps will relax the scrotal tissue and make the testis hang lower in the scrotum -use BOTH HANDS to feel each testis separate;y -palpate each testical gently, using the thumb and the first 2 fingers -check that the testicle is normally egg-shaped and movable with a smooth surface Clinical findings that should be reported to the hcp: 1. Painless, hardened lump on testes 2. Scrotal swelling or heaviness 3. Dull ache in pelvis or scotum

Sputum Culture and Sensitivity testing

-used to identify infectious organisms in the respiratory tract and determine which antimicrobials are most effective at treating the identified organism Nurses assisting a client to collect sputum should instruct the client to: -Rinse the mouth with water before collecting the sputum sample to reduce bacteria in the mouth and prevent specimen contamination by oral flora -Avoid touching the inside of the sterile container or lid to avoid accidental specimen contamination by normal flora of the skin -Inhale deeply several times and then cough forcefully, which promotes expectoration of lower lung secretions and increases sample volume -assum a sitting or upright position before specimen collection, if possible , to promot cough strength during collection

Obstructive sleep apnea (OSA)

-the most common type of breathing disorder during sleep and is characterized by repeated periods of apnea (>10 seconds) and diminished airflow (hypopnea) -a partial or complete obstruction occurs due to upper airway narrowing that results from relaxation of the pharyngeal muscles or from the tongue falling back on the posterior pharynx due to gravity -during periods of apnea, desaturation (hypoxemia) and hypercapnia occur; these stimulate the client to arouse and breathe momentarily to restore airflow -these cycles of apnea and restored airflow can occur several hundred times per night, resulting in restless and fragmented sleep -partners of clients with OSA witness lOUD SNORING, APNEA episodes, and waking with gasping or a choking sensation -During the day , cleints expereince morning HEADACHES, IRRITABILITY, AND EXCESSIVE SLEEPINESS -EXCESSIVE DAYTIME SLEEPINESS can lead to poor work performance, motor vehicle crashes, and increased mortality -frequent (not difficult) arousal from sleep is associated with OSA

Plantar creases (newborn)

-the number of plantar creases on the bottom of the feet is indicative of the neonates' age -The more creases over the greater proportion of the foot, the more mature the neonate

Breast cancer

-the unregulated growth of abnormal breast tissue cells and the second most common cause of cancer death among women -when palpated the breast lump is usually described as HARD, IRREGULALRY SHAPED, NON-MOBILE, AND NONTENDER -MAMMOGRAPHY USUALLY DETECTS BREAST CANCER

NSAIDs are contraindicated in heart failure because

-they contribut to SODIM RETENTION, and therefore fluid retention

Growth hormone deficiency

-this biosynthetic hormone is administered via subcutaneous injection on a daily basis -despite replacement therapy, the child may still have a final height less than normal -treatment is most successful when diagnosis and replacement therapy begin early in the child's life -when to stop therapy is decided by the client, family , and provider -growth less than 1 inch per year and bone age of 14 years in girls and 16 years in boys are the criteria often to stop therapy

Codependent behaviors

-those that allow the codependent person to maintain control by fulfilling the needs of the addict first -behaviors such as keeping the addiction, suffering physical or psychological abuse from the addict, not allow the addict to suffer the consequences of actions, and mking excuses for the addict's habit are hallmarks of codependncy -if the addict isnt happy, the codependent person will try to make the addict happy -CODEPENDENT PERSONS will FOCUS all their attention ON OTHERS at the expense of their OWN SENSE OF SELF -codependent spouses, friends, and family members keep the client from focusing on treatmentl this behavior is COUNTERPRODUCTIVE TO BOTH THEMSELVES and the client

Phlebostatic axis

-to measure pressures accurately using continual arterial and/or pulmonary artery pressure monitoring, the zeroing stopcock of the transducer system must be placed at the phelbostatic axis -this anatomical location, with the client in the supine position, is at the 4th ICS, at the midway point of the AP diameter (1/2 AP) of the chest wall -if the transducer is placed too low, the reading will be falsely high; if placed too high, the reading will be falsely low -this concept is similar to the positioning of the arm in relation to the level of the heart when measuring blood pressure indirectly using a sphygmomanometer or noninvasive bp-monitoring device -the upper arm should be at the level of the phlebostatic axis

Absence seizures

-typically occur in children. The presentation is classic and includes the following: 1. Daydreaming episodes of brief (<10 seconds) staring spells 2. Absence of warning and postictal phases 3. Absence of other form of epileptic actiity (no myoclonus or tonic-clonic activity) 4. unresponsiveness during the seizure 5. No memory of the seizure

Ethambutol

-used in combination with other antitubercular drugs (isoniazid, rifampin, pyrazinamide) to treat active tuberculosis -the client must have baseline and periodic eye examinations during therapy as OPTIC NEURITIS is a potentially reversible adverse effect -the client is instructed to report signs of decreased visual acuity and loss of color (red-green) discrimination

The neonatal heel stick (heel lancing)

-used to collect a blood sample to assess capilllary glucose and perform newborn screening for inhertied disorders (congenital hypothyroidism, phenylketonuria) Proper techniques is essential for minimizing discomfort and preventing complications and includes: - select a location on the MEDIAL or LATERAL Side of the OUTER ASPECT OF THE HEEL. Avoid the center of the heel to prevent accidental insult to the calcaneus. Puncture should not occur over edematous or infected skin -Warm the heel for several mins with a warm towel compress or approved single-use instant heal pack to promote vasodilation. Cleanse the intended puncture site with alcohol. SUCROSE AND NONNUTRITIVE SUCKING on a pacifier may reduce procedureal pain -USE an AUTOMATIC LANCET, which controls the depth of puncture. Lancing the heel to deeply can result in penetration of the calcneous bone, leading to osteochondritis or osteomyelitis -an acceptable alternat method of blood collection in the neonate is venipuncture (drawing blood from a vein) -venipuncture is considered less painful and often requires fewer punctures to obtain a sample, especially if a larger volume is needed

Mediastinal Chest tubes

-used to drain air or fluid from the mediastinal space and/or pericardial cavity (after cardiac surgery) -obstruction (clot) of the chest tube will result in excess fluid build up in the pericardium, leading to inhibited cardiac contractility and eventual diagnosis of cardiac tamponade -Cardiac tamponande is a life threatening form of obstructive shock marked by decreased cardiac output and eventually obstructive cardiac arrest if untreated -if chest tube drainage is markedly decreased, the nurse should quickly assess for signs of cardiac tamponande and if not such signs are present should troubleshoot other possible causes of chest tube occlusion

Operative Vagina Birth

-uses VACUUM EXTRACTOR or FORCEPS to shorten the second (pushing) stage of labor -indications may be maternal (exhaustion, cardiac or cerbrovascular disease) or fetal (abnormal fetal heart rate, arrest of rotation) -in a forceps-assisted birth, the hcp gently applies the blades to the sides of the fetal head and locks the handles in place -the HCP applies traction to the forceps DURING CONTRACTIONS TO FACILITATE rotation and descent of the fetal head -the NURSE SHOULD NEVER APPLY FUNDAL PRESSURE during an operative vaginal birth because it may cause uterine rupture -nurse notifies the HCOP when contractions are palpated so that downward. outward traction can be applied to the forceps or a vacuum extractor during the contraction, which helps facilitate the birth -nurse ensures that the client's bladder is empty, monitors for contractions, and documents the time that forceps or a vacuum extractor was applied -fundal pressure should never be applied during this procedure or labor/birth

Venous insufficiency characteristics

-varicose veins -warm thick, indurated skin - bronze-brown pigmentation -large, irregular superficial ulcer with drainage -Edema

risk factors for pulmonary embolism

-venous stasis -hypercoagulobility of blood -endothelial damage postoperative client is at greatest risk due to the presence of following 4 risk factors -abdominal cesaren section surgery (endothelial damange) -engorged pelvic vessels from pregnancy (venous statsis, hypercoagulability of blood) -inactivity /immobility >/_6 hours related to positioning during surgery and the immediate post op period and epidural anesthesia (venous stasis) -postpartum state (hypercoagulability of blood)

Children's beliefs about death: Adolescence

-views death on an adult level -understands that their own death is inevitable, but it is a difficult concept for them to perceive -able to think about spiritual and religous aspects of death

Healthcare catheter-associated UTIs : steps to prevent infections in clients with urinary catheters include the following:

-wash hands thoroughly and regularly -perform routine perineal hygiene with SOAP AND WATER each shift and after bowel movemnts -keep drainage system off the floor or contaminated surfaces -Keep the catheter bag below the level of the bladder -ensure each client has a seperate, clean contatiner to empty collection bag and measure urine -use sterile technique when collecting a urine specimen -facilitate drainage of urine from tube to bag to prevent pooling of urine in the tube in the tube or backflow into the bladder -avoid prolonged kinking, clamping, or obstruction of the catheter tubing -encourage oral fluid intake in clients who are awake and if not contraindicated -secure the catheter in accordance with hospital policy (tape or velcro device) -inspect the catheter and tubing for integrity, secure connections, and possible kinks

Epstein's pearls

-white, pearl-like epithelial cysts on gum margins and the palate -they are benign and usually DISAPPEAR WITHIN A FEW WEEKS

Dysarthria

-worsening ability to speak -may also have dysphagia and respiratory distress; this client should be seen first

Bell's palsy client teaching should include the following:

1. Eye care: use glasses during the day; wear a patch (or tape the eyelids) at night to protect the exposed eye. Use artificial tears during the day as needed to prevent excess drying of the cornea 2. Oral care: Chew on the unaffected side to prevent food trapping; a soft diet is recommended. Maintain good ORAL HYGIENE after every meal to prevent problems from accumulated residual food (parotitis, dental caries)

Sequence for donning PPE

1. Hand hygiene 2. Gown-fully cover torso from neck to knees, arms to end of wrists, and wrap around back; fasten in back of neck and waist 3. Mask or respirator- secure ties or elastic bands at middle of head and neck; fit flexible band to nose bridge; fit snugly to face and below chin; fit-check respirator 4. Goggles or face shield- place over face and eyes and adjust fit; may be combined with mask (visor) 5. Gloves-don and extend to cover wrist of isolation gown

Clients at risk for developing orthostatic hypotension should be instructed to

1. Take meds at betime, if approved by hcp 2. rise sloly from a supine to standing position, in stages (Especially in the morning 3. Avoid activities that reduce venous return and worsen orthostatic hypotension (straining, coughing, walking in hot weather) 4. Maintain adequate hydration)

TST

1. injection of purified protein derivative solution under the first skin layer of the forearm 2. Evaluation of the injection site 48-72 HOURS later the health care practitioner inspects and palpates the site to determin if a local skin reaction has occurred -induration (not redness) indicates a positive test, which means that the individual has been exposed to TB, has developed antibodies, and is infected with TB bacteria -Further testing is needed to determine the presence of latent TB infection or active TB disease -presence of symptoms, positive sputum culture, and chest x-ray abnormalities confirm active TB The QuantiFERON-TB (QFT) blood test is an alternative to TST that measures how the immune system reacts to TB bacteria -lIke TST, a positive QFT test only indicates that the individual has been infected with TB bacteria -Although the test is more expensive, it requires only a single visit to the hcp and results are available in 24 HOURS

Administering Rectal suppository in children

<3 years old position: supine with knees and feet raised -suppository guided against rectal wall -fifth finger >3 years old position: side-lying with knees flexed Pediatric administration of rectal suppositories is similar to the adult technique, with a few key modifications due to the small size of a child's colon and varying developmental needs -age-appropriate explanations and/or distractions should be implemented to reduce distress -toddlers and infants may benefit from distraction with a toy; preschoolers and older children can be instructed to take deep breaths or count during the procedure Basic steps for suppository administration include the following 1. Apply clean gloves, and position the client appropriately based on age and size (infant supine with knees and feet raised, older child sidelying with knees bent) 2. Lubricate the tip of the suppositry with water-soluble jelly. Petroleum-based products can reduce absorption 3. Insert the suppository past the internal sphincter using the fifth finger if the child is under 3 years. Use of the index finger may cause injury to the colon or sphincters in children younger than age 3 years 4. Angle suppository and guide it along the rectal wall. The suppository should remain in contact with the rectal mucosa (and not be buried inside stool) to ensure systemic absorption 5. Hold the buttocks together for several minutes, or until the urge to defecate has passed, to prevent immediate expulsion 6. If a bowel movement occurs within 10-30 mins, observe for the presence of the suppository

Human Immunodeficiency Virus

A viral infection of the CD4 (helperT) Cells, resulting in progressive immune system impairment -Clients with HIV are susceptible to opportunistic infections that typically occur during periods of low CD4+ counts To reduce the risk of infection, nurses should educate clients with HIV to: -Obtain and remain up to date on vaccinatins, including the annual influenza vaccination -Avoid eating undercooked meats (steak that is pink) and having contact with feces (cat litter box) because both are sources of TOXOPLASMA GONDII, an opportunistic parasite that causes encephalitis -Avoid drinking water from poorly sanitized (developing countries) or potentially contaminated (rivers, wells) sources because it may contain infectious pathogens (cryptosporidium, isospora, giardia). Instead , use bottled or purified water when drinkin and brushing teeth -Educate clients with HIV to always use synthetic barriers (condoms) during sex to reduce risk of transmitting HIV and being infected with additional HIV strains or other sexually transmitted infections. Clients with an undetectable viral load have a lower risk of transmitting HIV to a sexual partner but should still use barrier contraception

ACHES with contraceptive use

A- abdominal pain --> ischemic bowel C- chest pain --> pulmonary embolism or myocardial infarction H- headches--> stroke E- Eye problems--> retinal blood vessel ischemia S- severe leg pain --> deep venous thromboembolsim

Amytrophic lateral Sclerosis (ALS)

Characterized by the progressive loss of motor neurons in the brainstem and spinal cord -clients have spasticity, muscle weakness, and atrophy -Neurons involved in swallowing and respiratory function are eventually impaired, leading to aspiration, respiratory failure and death -care of clients with ALS focuses on maintaining respiratory function, adequate nutrition, and quality of life -there is no cure, and death usually occurs within 5 years of diagnosis -The clients with ALS and worsening ability to speak (DYSARTHRIA) may also have dysphagia and respiratory distress; this client should be seen first

Colonoscopy instructions

Colonoscopy evaluates colonic mucosa -therefore, clients should follow instructions to keep the colon clean with no stool left for better visualization during the procedure. These instructions include: 1. CLEAR LIQUID DIET THE DAY BEFORE 2.NOTHING BY MOUTH 8-12 HOURS PRIOR TO THE EXAMINATION 3. The HCP provider prescribes a BOWEL-CLEANSING AGENT such as a CATHARTIC, ENEMA, OR POLYETHYLENE GLYCOL the day before the test. The type of prep depends on the hcp's preference and client health status

Carbon monoxide poisoning

Epidemiology -smoke inhalation -defective heating systems -gas motors operating in poorly venitlated areas Manifestations Mild-moderate: -Headache, confusion -malaise, dizziness, nausea Severe -Seizure, syncope, coma -myocardial ischemia, arrhythmias Diagnosis -ABG: carboxyhemoglobin level -ECG +/- cardiac enzymes Treatment -high flow 100% oxygen -intubation/hyperbaric oxygen (severe)

Lithium Toxicity

Features Acute: Gastrointestinal finding- nausea, vomiting, diarrhea; neurologic findings occur later Chronic: Neurologic -ataxia, sluggishness, confusion, agitation, neuromuscular excitability (coarse tremor) Severe TOXICITY - Seizures and encephalopathy Serum levels >/_ 1.5 and /or even the mildest symptoms of lithium toxicity must be reported to the hcp

Myocardial infarction presentation

Ischemic chest pain -described as pressure, heaviness, tightness -may radiate to jaw, arm, back, or upper abdomen -lasts more than 30 mins -not improved with rest or position change -worsens with exertion Associated Symptoms -shortness of breath -nausea and vomiting -sweating -anxiety -indigestion -dizziness -fatigue and weakness Aytpical presentation -associated symptoms with no chest pain -more common in women, older adults and clients with neuropathy (diabetes)

If nonreassuring FHR patterns (late decelerations, fetal tachycardia, bradycardia) occur, the nurse should..

STOP OXYTOCIN IMMEDIATELY to decrease uterin stimulation and increase blood flow to the fetus (simply decreasing the dose is inappropriate) Other appropriate actions include: -repositioning client to a side-lying position, which increases placental blood flow -Administering oxygen via face mask at 8-10 L/min and an IV fluid bolus to improve oxygen availability and blood volume to the fetus. These interventions are most effective after repositioning to maximize blood and oxygen delivery -preparing to administer a subcutaenous injection of terbutaline to relax the uterus if other interventions are unsuccessful -notifying the hcp after implementing initial intervention (positioning, oxygen, fluids,). Another nurse can also notify the HCP while the primary nurse is implementing resuscitiative measures -Documenting findings actions, and HCP notification as soon as possible

Syphilis in pregnancy

Screening -universal at first prenatal visit -third trimester and delivery (if high risk) Serologic Tests -nontreponemal -treponemal Treatment- Intramuscula penicillin G benzathine Pregnancy effects -intrauterine fetal demise -preterm labor The only adequate prenatal treatment is IM penicillin injection (benzathine, penicillin G) -expected outcomes include resolution of maternal infection and prevention of treatment of fetal infection -if a pregnant client has a penicillin allergy, the nurse should anticipate penicillin desensitization so that adequate treatment can be provided

Radioactive Iodine

Treats hyperthyroidism by partially damagin or destroying the thyroid gland -RAI has a delayed response , requiring up to 3 months for maximal effect -after treatment, the client emits radiation, and excreted BODILY FLUIDS ARE RADIOACTIVE -The nurse teaches HOME PRECAUTIONS to protect those who come in contact with the client -Depending on the dosage, clients should use the following precautions for up to 1week 1. Limit close contact and time spent with pregnant women and children 2. Use a separate toilet, and flush 2 or 3 times after each use to remove urine residue -use disposable cups, plates, and utensils and do not share foods that could transfer saliva 3. Isolate personal laundry (clothing linens) and wash it separately 4. sleep in a separate bed from others 5. Do not sit near others for a prolonged time (train or flight travel) 6. After RAI thearpy, breat milk excreted by the client is radiactive and can permanently damage an infant's thyroid -Breastfeeding should be stopped 6 weeks before treatment to prevent RAI from accumulating in the breasts after treatment. Breastfeeding is not resumed with the current child but can be resumed with future pregnancies

Clients taking desmopressin for diabetes are at risk for

WATER INTOXICATION and HYPONATREMIA -ClIENTS REports of headache, mental status change, and/or muscle weakness may indicate hyponatremia from water intoxication and should be reprted to the hcp immediately

Anticholinergic medications

benztropine , trihexyphenidyl -commonly used to treat tremor in these clients -HOWEVER , in clients with benign protatic hyperplasia or GLAUCOMA, caution must be taken as anticholinergic drugs can precepitate URINARY RETENTION and an ACUTE GLAUCOMA EPISODE -as a result, such medications are contraindicated in these clients

Toddlers (Age 1-3)

display an egocentric approach as they strive for autonomy -the attempt to control their experiences through intense emotional displays such as temper tantrums or forceful negative responses (no!) -Hospitalization results in loss of a toddler's usual routines and rituals, often resulting in regressive behavior -the toddler may also be frequently separated from the parents, leading to SEPERATION ANXIETY -nursing care activites should be similar to home routines, such as providing preferred snacks and anticipating nap time -the toddler should be given options rather than asked yes/no questions to limit the potential negative responses -it is also important to encourage participation and presence of the parents whenever possible

Frostbite

involves tissue freezing, resulting in ice crystal formation in intracellular spaces that causes peripheral vasoconstriction, reduced blood flow, vascular stasis, and cell damage -superficial frostbite can manifest as mottled, blue, or waxy yellow skin -Deeper frostbite may cause skin to appear white and hard and unable to sense touch -this can eventually progess to gangrene