uworld pn/hurst PN, NCBSN

correctional insulin

(ie,sliding scale)dose given to correct hyperglycemia

PTSD symptoms

-Flashbacks in which the individual relives the event -Avoidance of emotional experiences and of talking about emotions with others -Reduced ability to feel emotions -Excessive arousal/ having trouble falling asleep -Difficulties with memory and concentration -Feelings of apprehension, including nervous tremors -Impulsive outbursts of behavior -Anxiety -Relieving the event -Detachment

emphysema manifestations

-Manifests severe dyspnea even at rest. -Barrel chest shape -Tachypnea -Decrease activity level -Diminished breath sounds with prolonged expiration air trapping -Use of accessory muscles to breathe -Prolongation of the expiratory phase -Breath sounds are diminished. -Hyperresonant percussive tone might be heard. -AP > lateral -purse lip breathing -tripod position(leaning forward) decrease gas exchange muffled heart tones over distended lungs shortness of breath ecercise intolerance

Disulfram-like reaction

-Metronidazole -Certain cephalopsorins -Procarbazine -1st gen sulfonylureas

ethambutol

-Reduces carbohydrate polymerization of mycobacterium cell wall by blocking arabinosyltransferase. -Use: Mycobacterium tuberculosis. -Toxicity: can cause blurred vision optic neuropathy (red-green color blindness).

In therapeutic communication avoid

-ask why

who to see first? 1.a child patient restless and drooling 2.a child patient with appendicitis with right lower quadrants pain and vomiting

1

Causes of fluid volume deficit

1)decreased intake 2)increased excretion 3)fluid shift 4)strenuous exercise 5)extreme heat/dryness 6)fever (increased metabolic rate) 1. Loss of fluid from anywhere 2. Third spacing burns ascites 3. Diseases with polyuria DM

normal potassium levels

3.5-5.0 mEq/L

BUN

6-20 mg/dL

In acute blood loss

Acute blood loss is a medical emergency , the nurse should lower the head of the bed, or placing the patient on supine to mantain blood flow to the brain and other vital organs

Benzodiazepines

Alprazolam(Xanax) Lorazepam(Ativan) Clonazepam Antivan Antianxiety drugs Give a bedtime, due to sedative effects should not stop treatment abruptly

Floppy muscle tone

Classic symptom of downs syndrome/trisomy

inappropriate use of indewlling catheter

Convinience or replacement for nursing care when a client is elderly,confused, incontinent,or voids frequently For obtaining a urine culture whe the client can follow instrcutions and void voluntarily Postoperatively for prolonged periods when other indications are not present

cause of hypokalemia in alcoholics

Decreased Magnesium - low magnesium--> persistent hypokalemia despite treatment

Peritonitis Signs and Symptoms

Diminished bowel sounds Tachycardia & Tachypnea Abdominal Distention Hiccups Respiratory Distress Decrease in H&H, pulse ox Increased WBC count (20,000 and above) Diffuse pain Psoas Positioning Abd. Tenderness Guarding Rigidity High fever Hypovolemia Decreased Urinary output

bed rest induces

Diuresis. Thick blood.

How do the kidneys help treat respiratory alkalosis?

Excrete bicarb and retain Hydrogen

heart block

Heart block is an abnormal heart rhythm where the heart beats too slowly (bradycardia). In this condition, the electrical signals that tell the heart to contract are partially or totally blocked between the upper chambers (atria) and the lower chambers (ventricles). arrhythmia in which there is interference with the normal transmission of electric impulses from the SA node to the Purkinje fibers

IDEA for slow heart rate and low BP

Isoproterenol Dopamine Epinephrine Atropine

Simvastatin

Statin drug; prescribed to lower cholesterol and reduce the risk of atherosclerosis and coronary artery disease. Take during the evening or at bed time

calcium and phosphorus

The most important minerals stored in bones are:

Sublimation and reaction formation

Transforming unacceptable thoughts or needs into acceptable actions Aperson may turn into boxing to deal with agression

Need ____ to use Calcium

Vitamin D

tuberculosis sighns and symptoms

anorexia night sweats weight loss purulent blood stinge sputum shortness of breath dyspnea hemoptysis low grade fever

Bacille Calmette-Guerin (BCG)

first vaccine for TB developed in 1921

Repiratory Alkalosis causes

hyperventilation

carbidopa-levodopa itended effects

improve spontaneous activities bradyenesia/slowdown of movements tremor and rigidity

peak flow meter

is used to measure peak expiratory flow rate most gelpful on patients with moderate to severe asthma

resporatory alkalosis

pH above 7.45 PCO2 less than 35 basic breathing too fast

position for a patient with ascites

side lying with the head elevated

Hypotonic solutions rehydrate

without causing no HTN

BURNS during Potassium infusion

yes

Amniotic fluid embolism

An extremely rare, life-threatening condition that occurs when amniotic fluid and fetal cells enter the pregnant woman's pulmonary and circulatory system through the placenta via the umbilical veins, causing an exaggerated allergic response from the woman's body

Oxytocin given before labor

An induction with Pitocin means your doctor or midwife will induce your labor using a medicine called Pitocin, which is a synthetic version of oxytocin. Oxytocin is the hormone that your body naturally produces to induce contractions, as well as serving as the famous "love" hormone.Oct 11, 2016

barium enema

An x-ray exam using an opaque contrast medium to examine the lower GI tract

tramadol

Analgesic

ARBs

Angiotensin receptor blockers sartan;valsartan,losartan,telmisartan can cause hyperkalemia

Gabapentin (Neurontin)

Anti-epileptic,anticonvulsant

Allopurinol (Zyloprim)

Anti-gout

Oxybutynin

Anticholinergic medication, helps decrease bladder spams.Dry mouth"Xerostomia" often occurs.

Phenytoin (Dilantin) Rx

Anticonvulsant

Phenytoin (Dilantin)

Anticonvulsant. SEs: Nysagmus, diplopia, EOM palsies, ataxia, gingival hyperplasia. Phenytoin is an anti-epileptic drug, also called an anticonvulsant. Phenytoin works by slowing down impulses in the brain that cause seizures. Phenytoin is used to control seizures.

Escitalopram (Lexapro)

Antidepressant, SSRI

Sucralfate (Carafate)

Antiulcer Agent, mucosa protectant, should be given before meals(ac)to coat the mucosa to prevent irritation before meals, It should also be administered 30 min to 2 hours before other medications to prevent these medications from binding to sucralfate , rendering the medication less effective. Adheres to injured gastric ulcers upon contact with gastric acids; protective action for up to 6 hours, has no systemic effects. Used for gastric and duodenal ulcers and GERD. Administer on an empty stomach at least one hour before meals and do not administer within 30 minutes of antacids.

For a pt with history of stroke left side weakness

Apply color coded,non slip socks to the clients feet Place bedside commode on the right side of the bed Remind pt to call assitance to before toiletting

Foods lowest in potassium

Asparagus,green beans,corn,cucumbers,okra,onions,green peas,green peppers,apple products,grapes,grape fruits,peaches,pears,pinepples,chickenm turkey,shrimp,tuna,eggs,breads amd pasta made white flour

When a medication error occurs

Assess the patient and stabilize the patient first then notify doctor, after implementing prescription, notify the client and nurse manager about the error and fill up an incident report

How does bedrest induce diuresis?

By release of ANP and decreased production of ADH

Preparing for colonoscopy

Consume clear liquid diet the day before Drink prescribed cleansing agent,cathartic,enema or polyethyline glycol the day before the test NPO 8-10 hours before

Dexamethasone (Decadron)

Corticosteroid used to treate cerebral edema

A nurse has performed teaching with a client diagnosed with Cushing's disease. Which statement by the client would best indicate understanding of the teaching?

"I will be retaining sodium and water due to the increased amount of aldosterone." Correct: Cushing's is a disease that results in increased secretion of aldosterone. Having too much aldosterone causes the client to be at risk for fluid volume excess (FVE) due to the increased retention of both sodium and water.

ACE inhibitors:

"PRIL" Captopril, Enalapril, Afosiopril ,lisonopril,ramipril Antihypertensive. Blocks ACE in lungs from converting angiotensin I to angiotensin II (powerful vasoconstrictor). Decreases BP, Decreased Aldosterone secretions, Sodium and fluid loss. Check BP before giving (hypotension) *Orthostatic Hypotension Can cause hyperkalemia

somnolent

(adj.) sleepy, drowsy; inducing sleep

Opioids side effects

* sedation * resp. depression * constipation * nausea and vomiting * itching * constricting pupils * confusion * hypotension * urinary retention

priority action during hypokalemia

*RESPIRATORY STATUS SHOULD BE ASSESSED FIRST IN ANY PATIENT WHO MIGHT HAVE HYPOKALEMIA**

Epinephrine used for

- anaphylactic shock - cardiac arrest Neurotransmitter secreted by the adrenal medulla in response to stress. Also known as adrenaline.

Tuberculosis signs and symptoms

-Symptoms not always initially apparent -Minor cough and mild fever -Disease progresses to breathing difficulty, fatigue, maliase, weight loss, chest pain, wheezing, coughing up blood,night sweats,chronic fever, weight loss, cough, sputum production

multiple myeloma signs and symptoms

-bone pain [especially of the back and chest] -weakness -fatigue -pallor [anemia] -abnormal bleeding [and coagulation times] -hepato/splenomegaly -bleeding -platelet abnormalities

Creatine normal range

0.3-1.3

Creatine levels

0.6-1.3 mg/dL

Therapeutic Communication Techniques

1) ACTIVE LISTENING - Shows clients that they have your undivided attention 2) OPEN-ENDED QUESTIONS - Used initially to encourage clients to tell their story in their own way. Ask questions in a language that a client can understand 3) CLARIFYING - Questioning clients about specific details in greater depth or directing them toward relevant parts of the history. 4) SUMMARIZING - Validates the accuracy of the story. specific responses that encourage the expression of feelings and ideas and convey acceptance and respect

*Oral Care for the Unconscious*

1. Do initial steps. 2. Drape towel over pillow and a towel under residents chin 3. Turn resident onto unaffected side. 4. Put on gloves 5. Place an emesis basin under resident's chin. 6. Dip swab in cleaning solution of 1/2 mouthwash and 1/2 water and wipe teeth, gums, tongue and inside surfaces of mouth, changing swab frequently. 7. Rinse with clean swab dipped in water. 8. Check teeth mouth, tongue, and lips for odor, cracking, sores, bleeding and discoloration. Check for loose teeth. Report any unusual findings to the nurse. 9. Cover lips with a thin layer of moisturizer. 11. Remove gloves 12. Do final steps.

Urine Specific Gravity

1.010-1.030

Examples of hypotonic solutions:

1/2 NS 0.33% NS D2.5W

Normal platelet count

150,000-400,000

A client is admitted following a severe burn. What changes related to fluid status would the nurse anticipate?

2. Hypovolemia 3. Third spacing 5. Low CVP 6. Increased urine specific gravity Correct: Causes of fluid volume deficit (hypovolemia) include loss of fluid from anywhere as well as third spacing of fluid that occurs with such things as burns. Burns can result in fluid loss from the burn area as well as the third spacing, which increases the risk for hypovolemia and shock. As the fluid volume decreases, the BP and CVP both decrease. Remember, less volume, less pressure. Also, when the fluid volume becomes depleted, the urine output will decrease in an effort to hold on to the fluid (compensate) or the kidneys are not being perfused. You will see the urine specific gravity increase because the small amount of urine being produced will be very concentrated.

Normal HCO3 is

22-26 HCO3 is a base

Determine delivery date

288 days, lat day of menstrual period,ovulation occurs at the 14th day of menstrual cycle ultrasound is the most accurate minus 3 months add 7 days

Dopamine MOA

3 drugs in one (DA, beta1 and alpha1) • DA effects --> lowers BP (Lower doses) • Beta 1 effects and alpha 1 effects (higher doses) ******************************************************* FYI!!!!! DA receptors 1mcg/kg/min o Beta 3-10mcg/kg/min o Alpha and beta 10-20mcg/kg/min

PaCO2 normal range

35 - 45 mmHg Represents the partial pressure of carbon dioxide in the arterial blood Directly influenced by the function of the respiratory system This drives us to breathe.

A child with congenital heart defect,weighs 88 lb is prescribed furosemide 1 mg/kg PO q8h Available solution 10 mg/mL How many mL of furosemide should be adminitered

4 use dimensional analysis or convert 88 lb to kg =40 kg 40 kg x 1 mg of furosemide=40 furosemide/ dose 40/10 x mL=4

recommended dose of acetaminophen in 24 hours

4 gms in 24 hours to prevent liver injury

Normal WBC count

4,000-11,000

Fowler position

45-60 degrees

Parkland formula

4mg/ kg of body weight, and the first half within the first 8 hours

sumatripan

5-HT1B,D,F agonist (inactive at other receptors) • Use: drug of choice for Rx severe acute migraines, cluster headaches. Highly effective, rapidly reduce or abort headache in over 70% of patients. • Mech: activation of prejunctional 5-HT receptors on sensory nerves results in blockade of trigeminovascular system; inhibited release of inflam. peptides decreases vasodilation; secondary mech: vasoconstriction via 5-HT 1D • SFX: recurrent migraine, coronary spasm in patients with CV disease. Metab. in liver -> hepatic failure is a contraindication

diabetic HgbA1C

6.4 or 7%

BUN levels

8-21

normal paO2

80-100

Normal calcium value

9-10.5

Sinus Bradycardia

<60 bpm

Displacement example

A client is angry at his doctor, does not express it, but becomes verbally abusive with the nurse.

HHS (Hyperglycemic Hyperosmolar State)

A complication of type 2 DM severe hyperglycemia develops:.lethargy, blurry vision and altered level of consciousness Glucose can reach up to to 600> levels bicarbonate 18> mEq normal anion gap serum osmolality of >320 mOsm

cardiac pharmacology nuclear stress test

A pharmacological nuclear stress test is a diagnostic test used to evaluate blood flow to the heart. During the test, a small amount of radioactive tracer is injected into a vein. A special camera, called a gamma camera, detects the radiation released by the tracer to produce computer images of the heart. Stop drinking caffeine for 24 hours before NPO or smoke for at least 4 hours

sprain

A sprain is a strech and or tear of a ligament from trauma to ajoint. RICE: rest,ice,compression,elevation nonsteroidal anitiiflamatory drugs(ibuprofen)

lisinopril

ACE inhibitor, antihypertensive does not lower heart rate

What mediaction create risk for hyperkalemia

ACE inhibitors -pril and angiotensin II receptors blockers ARBs ACE inhibitors decrease secretion of aldosterone, potassium rises, placing the pt for risk for hyperkalemia specially those with renal problems

Desmopressin

ADH agonist

factors of colorectal cancer

Abdominal pain blood in stools change in bowel habits low hemoglobin unexplained weight loss anemia obstruction impaired intestinal absorption colon polyps familial history inflammatory bowel disease Chron's diase ulcerative colitis history of other cancers

Meniere's disease :

Abnormal condition within the labyrinth of the inner ear that can lead to a progressive loss of hearing. The symptoms are dizziness or vertigo, hearing loss, and tinnitus (ringing in the ears).

A newly pregnant woman asks the nurse what to expect in the early stages of pregnancy. Which developmental task will the client need to accomplish during this stage?

Accepting the pregnancy and the physical changes involved. Correct Response During the first trimester, the maternal focus is directed toward acceptance of the pregnancy and adjustment to the minor discomforts. The other developmental tasks will be accomplished later in the pregnancy.

When caring for patients advanced dementia,confusion, and a history of falls

Activate bed alarm before leaving the room place bedside comode next to bed place patient close to the nurses station

Give what to increase potassium in hypokalemia?

Aldactone Potassium

genital herpes self care

Always wera globes when apply medication to lesions Avoid stress, to avoid future outbreaks Soak i warm bath several times for soothing

In a disaster situation what clients can be discharge

Ambulatory clients and self-care clients: Ambulatory clients and self-care clients who need little or no assistance are the first clients to be safely discharged, transferred or relocated.

Meconium illeuls

Cystic fibrosis

Patient with fluid volume deficit will have ____ skin turgor

Decreased

Phenytoin Sodium

Dilantin, Kapseals Antiepileptic Increases Na ion extrusion from neurons & cardiac myocytes

What do hypertonic solutions do to fluid in the body?

Draw fluid INTO the VASCULAR SPACE from the cell

S/S of hypermagnesemia

Flushing Warmth Too much sedative

A client with heart faliure has gained 5 lb over the last past 3 days what medication do you anticipate

Furosemide In heart faliure,cardiac output is reduced because the heart is unable to pump blood adequately.This reduction in cardiac output reduces perfusion to the vital organs, including the kidneys.Decrease renal blood flow can trigger the kidneys to activate renin-angiotensin system as a compensatory mechanism, which increase blood volume by increasing water resorption in the kidneys. This compensatory mechanism results in fluid volume excess and dilutional hyponatremia(more free water than sodium).Dilutional hyponatremia can be treated with fluid restriction,loop diuretics, and ACE inhibitors(lisonopril,captopril),Furosemide works by promoting free water to be wxcreted following hemoconcentration and increased sodium levels

situations in which health care team should use the client's advance directives

GCS <7 itracerbral hemorrhage with aphasia

Kayexelate does what?

Gets rid of K+ slow and late K-exits-late exchanges sodium for potassium in the GI tract Sodium serum goes up leading to dehydration so push fluids

Metabolic acidosis = hyper/hypokalemia?

Hyperkalemia

metabolic acidosis

Hyperkalemia

What type of fluid to use with client with hyponatremia?

Hypertonic

Which type of fluid is packed with particles?

Hypertonic

D5 1/2 NS

Hypertonic Common maintenance fluid Replaces fluid loss KCl added for maintenance or replacement

Alcohol supress the release of ADH causing

Hypomagnesemia alcohol causes diuresis and the loss of magnesium

What kind of fluid is used in the client who has HTN, renal or cardiac disease because of n/v, burns, hemorrage?

Hypotonic 1/2 NS 0.33% NS D2.5W

Adalimubab

Ifliximab, adalimubab,etanercept are tumor necrosis factor inhibitors TNF, that supress the inflammatory response in autoimmune response in autoimmune diseases like RA.Chron's disease and psoriasis. Due to immunosupressive action patients are at risk for infection.A patient with a current or chronic infection should not take TNF inhibitor

red man syndrome

Is a condition that can occur with rapid Iv vancomycin administration: flushing erythma pruritus(face,neck and chest) Muscle spasms,pain dyspnea hypotension It can be reduce by infusing vancomysin over a period of 60 minutes. Can be confuse with anaphalaxis due to both having hypotension as one the s/e

Isosorbide dinitrate(Isordil)

Is a long acting nitrate medication prescribed to prevent angina in pt with CAD

Drug to treat hyperkalemia

Kayexalate

safety using crutches

Keep a clear path to the bathroom Remove satter rugs Use a small back pack/shoulder bag to hold personal items Keep environment clear of clutter Look foward not down when walking wear non skid soled slippers or socks , shoes without laces

Caring for a patinet undergoing thoracenthesis, post proced ure

Level of alertness Lung sounds Oxygen saturation Respiratory system Watch for s/s of pneumothorax, including the level of alertness, respiratory rate, increased respiratory effort, respiratory distress, low oxygen saturation, absent breath sounds,and lung sounds.

Causes of metabolic alkalosis

Loop diuretics Vomiting Antacid use Hyperaldosteronism post-hypercapnia alkalosis NG suctioning Vomiting Diuretics Saline responsive (volume contraction)-most common Loss of acid/too much base Loss of upper GI content Too many antacids Too much IV bicarb

Life style modification in meniere's disease

Low sodium diet Do not need to restrict potassium Avoid caffeine,alcohol,nicotine avoid flikering lightsnwatch television adher to prescribed therapies avoid sudden changes in position, during vertigo participate in vestibular therapy obtain walking assistance

Which electrolytes act like sedatives?

Magnesium and calcium

A client who sustained a head injury has been diagnosed with SIADH. Which nursing action is necessary?

Maintain fluid restriction.The client with SIADH retains too much water. Treatment includes fluid restriction.

Anticoagulants and Thrombolytics

Meaning: Anticoagulant = Anti platelet aggregation, while Thrombolytics = Anti - thrombus. Used to prevent the formation of blood clots or dissolve blood clots Heparin Enoxaparin Rivaroxaban Apixaban

nasogastric intubation

Measure mask and lubricate Have pt estend neck back slightly geintly insert tune pass nasopharyx advance tube to the marked point berify tube placement

LPN/LVN scope of practice

Monitoring RN findings Reinforcing Education Routine Medication Routine procedures (eg catheterization) Ostomy Care Tube patency and and enteral feeding Specific Assessments

Celecoxib

NSAID

common applications of dropplet precautions

Nisseira meningitis Haemophilius influenza B Diphtheria pertusis Group A streptoccocus hickenpox, influenza, measles, German measles, mumps, smallpox, severe acute respiratory syndrome (SARS)

35-45

Normal PaCO2 level

violation ofprivacy and confidentiality

Oncology nurse viewing ED patient records PN leaves report sheet at the cafeteria UAP tells the client that the hospital that roomate is getting dyalisis

Antiemetic drugs

Ondanestron

Standard fall precautions

Orientation to room and call light Call light within reach Bed in lowest position Uncluttered room Non slip socks or shoes well lit room belongins within reach

How does hyperparathyroidism cause hypercalcemia?

PTH pulls calcium from the bone and puts it in the blood (too much PTH, too much calcium in the blood)

How hypokalemia is treated

Place the patient on a high-potassium diet. If increasing dietary potassium is insufficient to treat moderate hypokalemia, provide oral potassium supplements. A patient who has severe hypokalemia or who can't take oral supplements may need I.V. potassium replacement therapy. For more on I.V. potassium administration, see If the patient is on a diuretic, switch to a potassium-sparing one, such as spironolactone.

Patients on BR are at risk for:

Pneumonia, dehydration, DVT, kidney stone

Which laboratory test should be assessed by the nurse prior to administering radioactive iodine (RAI) to a female client?

Pregnancy test RAI crosses the placenta and will affect the development of the fetus. If RAI is administered to a client who is pregnant, the fetus can experience mental retardation, hypothyroidism, and develop increased cancer risk. It is imperative that a pregnancy test should be prescribed prior to administering RAI. RAI should not be administered to a client who has a positive pregnancy test.

Rationalization and depression

Rationalization Use excuses to explain away threatening circumastances " I did poorly on the test because the questions were so tricky"

mitral regurgitation

Reflux of blood from left ventricle into left atrium during systole

Reinforce information with a pt with COPD, and purse lip breathing

Relax neck and shoulders Inhale for 2 seconds through nose keeping mouth closed exhale for 4 seconds lips through pursed lips as if it blowing through a straw, for as long as you can.

R - A - C - E

Rescue or remove clients Activate fire alarm system Contain fire by closing doors and windows Extinguish flames (with fire extinguisher)

A client presents to the emergency department (ED) with flu symptoms, fever, and chills. The nurse notes that the vital signs are: T 102.8°F (39.3°C), P 128, RR 30, B/P 154/88. ABG results are: pH-7.5, PaCO2 32, HCO3 23. What acid/base imbalance does the nurse determine that this client has developed?

Respiratory alkalosis This client has a high fever. Hyperventilation due to anxiety, pain, shock, severe infection, fever, and liver failure can lead to respiratory alkalosis. Here, the ABGs reflect respiratory alkalosis. pH > 7.45, PCO2 < 35, HCO3 normal.

aspirin overdose

Respiratory alkalosis -stimulates the respiratory center and causes and increase in respiratory rate and depth (blow off CO2)

The nurse is preparing to administer magnesium sulfate IV to an alcoholic client with hypomagnesemia. Prior to the initiation of IV magnesium, which assessment data would be important for the nurse to document?

Respiratory rate 4. Deep Tendon Reflexes (DTRs) 5. Urinary output Correct: As you learned, magnesium acts like a sedative. Since we know that magnesium can cause respiratory depression, the nurse should always have a baseline respiratory assessment prior to initiating an infusion of magnesium. Muscle tone and DTRs can also become depressed, so a baseline assessment of DTRs would be very important. How is magnesium excreted? That's right! Through the kidneys. The nurse should always assess kidney function and urinary output prior to and during IV magnesium administration because of the risk of magnesium toxicity if it is being retained.

How is muscle tone in hypomagnesemia and hypocalcemia?

Rigid, tight

During a seizure

Safety is priority: Assist to lie down,while protecting the head and position to the side to mantain airways to prevent aspiration Loose restrictive clothing and clear area near the pt administer oxygen if the pt is in hypoxia (cyanosis, pallor) record and document and duration of the siezure

Denial and projection

Satisfies both Id & Superego; Example: kicking or punching something

The clinic nurse is evaluating an older male client who reports having trouble urinating. After the client uses the bathroom, which method should the nurse use to check for post-void residual (PVR)?

Scan the bladder, using a portable ultrasound scanner. Correct Response Urinary retention and incomplete bladder emptying can result from urethral obstruction, as seen in benign prostatic hyperplasia (BPH). The nurse can palpate the area from the umbilicus towards the symphysis pubis. An empty bladder rests behind the symphysis pubis and should not be palpable. The nurse can also percuss this area. A urine-filled bladder produces a dull sound. But a bladder ultrasound is the most effective technique since it will digitally register bladder volume. Routine catheterization to check for PVR is not recommended. Abdominal rebound tenderness will not determine urinary retention.

Risk for cancer

Scar from surgically repaired fracture a person who works outdoors, gardener and landscaper parents have history of squamous cell carcinoma' a person with fair skin, red hair who has blistering sunburns, exposure to sun ultraviolet light

How do the kidneys help in respiratory acidosis?

Secrete bicarb into blood

Levothyroxine (Synthroid) :

Should be taken on an empty stomach in the morning

Drug to HELP (not fix) acidosis?

Sodium bicarb

A nurse on a surgical unit is assigned a client who had a total thyroidectomy 3 days ago. As the nurse enters the room which nursing assessment is the priority for this client?

States hands are tingling. Rationale: Hypocalcemia is a severe complication of a thyroidectomy due to damage to the parathyroid. The negative feedback of a low parathyroid hormone (PTH) results in a decrease in serum calcium. PTH regulates the amount of calcium levels in the blood. Symptoms of hypocalcemia include numbness, and tingling on the extremities and face. As the calcium levels decrease the client may present with tetany and spasm of the larynx.

The nurse is teaching a class on health promotion to a group of college students living in a university dormitory. Which information should the nurse include? (

Students should ensure their meningitis vaccines are current. Correct! Students should maintain good hand hygiene practices. Correct! Students should seek treatment for upper respiratory infections promptly. Correct! Students should obtain a flu vaccine annually. Correct! College students who live closely together in group housing such as a dormitory are at greater risk for the spread of diseases, especially bacterial meningitis. As part of health promotion, it is essential the students' meningitis vaccines are current. The Centers for Disease Control & Prevention (CDC) recommends the meningitis A vaccine booster at about age 16, which protects against the meningitis serogroups A, C, W and Y. The CDC also recommends the meningitis B vaccine between ages 16 and 18, which protects against serogroup B. Bacterial meningitis often presents as an upper airway infection, so these infections should be treated promptly. The CDC recommends a flu shot annually for all adults and children. Good hand hygiene prevents the spread of many diseases. The pneumococcal vaccine is not required or necessary in this age group.

enalprilil adverse effects, that should be reported inmmediately to the PHCP

Swelling of the tongue, called Angioedema ACE inhibitors like enalapril, lisinopril,captopril

ECG changes with hyperkalemia

Tall and peaked T waves Flat or absent P waves V fib

Misoprostol (Cytotec) side effects for baby

The baby can also be permanently harmed, potentially developing forms of brain damage such as hypoxic-ischemic encephalopathy (HIE) and intracranial hemorrhage leading to cerebral palsy and intellectual disability. In some cases, the mother and/or baby may lose their lives as the result of Cytotec misuse.

pH 7.32, PaCO2 36, PaO2 83, SaO2 95, HCO3 19

The client with an initial aspirin overdose will have a respiratory alkalosis. This ABG result indicates metabolic acidosis. The pH is less than 7.35 (acidotic); the PaCO2 is within normal limits, and the bicarb is low (less than 22), which creates acidosis.

calciunm and phophate

The phosphate builds up in your body and binds to calcium, which, in turn, lowers your calcium levels. When your calcium levels get too low, glands in your neck (called the parathyroid glands) pull the extra calcium your body needs out of your bones.

pH 7.28, PaCO2 28, PaO2 72, SaO2 90, HCO3 16

This ABG indicates partially compensated metabolic acidosis. The problem in the stem would initially result in a respiratory problem. The pH is low (acidosis). The PaCO2 is low (alkalosis) as the body tries to compensate by decreasing the acid in the body. The metabolic chemical, bicarb, is low (acidosis) which matches the acidotic pH. Since the pH, PaCO2, and bicarb are all abnormal, we know that partial compensation has occurred.

endotracheal suctioning procedure

Tracheostomy suctioning Preoxigenate 100%, and allow reoxygenation in between suctioning Suction only while withdrawing the catheter from the airway Use sterile technique through the procedure Limit suctioning to ≤10 sec on each suction pass suction longer than 10 seconds can lead to alveoli collapse and hypoxemia Rationale:ET is performed to remove pulmonary secretions and maintain airway patency in the pt who is unable to remove secretions independently.It promotes gas exchange and prevent alveolar collapse, buy inappropriate technique increases the risk for pneumonia, hypoxemia, or bleeding.

When documenting client care

Use accurate,detailed,and objectuve statements(wjat you see and hear)taht is free from biased language or personal judgement Data gathered by direct measurement Observation Statements Nursing actions and interventions Vital signs, condition in which patient was found,pt reactiom,time,place,statemnts made by the pt,Dr was notified and will continue to monitor

wound irrigation steps

Verifying the client's ID assembly necessary stuff Don gown, face mask with shield, and sterile gloves fill a 30-6- mL syringe with nonirritating irrigation fluid.(saline) and attach an 18 or 19 irrigation tip angiocatheter Irrigate 1 inch above the area, using steady, gentle stream from the innermost part of the wound to the outermost margin until drainage is clear. If required obtain cultures after irrigation using sterile culturette swabs, swabbing from the center of the wound toward the outer margin. Gently dry the skin with sterile gauze sponges to prevent microorganisms growth and skin irritation from residual moisture, and apply a dressing.

Patho of burns

Vessels damaged --> Increased capillary permiability/leaking --> Plasma seeps out of tissue --> Vascular volume decreases --> Shock

Causes of hypokalemia

Vomiting NG suction Diuretics Not eating

murmur

abnormal swishing sound caused by improper closure of the heart valves

allopurinol is not effective treating

acute gout the pt can take NASAIDs or clochicine

Too little aldosterone causes

addison's disease

what medication can cause nephrotoxicity

aminoglycosidesvancomycin,NASAiD

Topical Capsaicin

analgesic wash off after 30 nibutes

phosphorous sources

animal protein, meats and dairy, fish, whole grain Anything with protein has phophorous

heparin

anticoagulant administered subQ to prevent DVT

Mitarzapine

antidepressant

atopic dermatitis(eczema) appropriate hygene

apply emollientimmediately after a bath

Potential side effect of magnesium

arrhythmias

apppendicitis pain

at the umbilicus

to prevent postprandial hyperglycemia

basal insuin glargine /latus and rapid acting insulin lantus/Novolog even if sugar levels are normal

Lipolysis

breakdown of fat

Percutaneous nephrolithotripsy

breaks and removes kidney stones, and can lead to severe pain.Provide pain medication.

S/S of bleeding:

bruising, blood in stool or urine, epistaxis, heavy menstrual bleeding

A patient with end-stage renal disease has pruritus. When the patient asks what causes this, what is the nurse's best response? Pruritus, seen in patients with end-stage renal disease, is caused by high levels of:

calcium

Steroids decrease serum

calcium

Diltiazem (Cardizem)

calcium channel blocker HTN

Right schemic stroke

can experince confusion,sperince hemiplagia defecit of spatial perception, are at risk for falls Make sure the pt wears non slid socks, activate bed alarm

clonidine/methydopa

central aplha agonist decrease the sympathetic response from the brainstem, to peripheral vessels,resulting in decrease peripheral vascular resistance and vasolidation

intravenous infusion steps

clamp tubing after is attached to IV bag, next uncap the proximal spike and attach to IV bag, then elevate IV bag and open roller clamp slowly

frontal lobes function

control skilled voluntary movements of limbs and trunk coordinate muscles involved in speech control voluntary movements of eyes and eyelids concentration, problem-solving, and planning higher order processing like executive funtion personality behavioral changes

hemoptysis:

coughing up blood

What might ADH problems

craniotomy: surgical opening to the skull head injury sinus surgery transsphenoidal hypophysectomy: removal of the pituitary gland any condition that could lead to ICP

urine out put during shock

decreases

displacemnet

displacemnet:Transfering thoughts and feelings toward one person or object onto another person or object "A person who is angry with a boss comes home and yells at the spuse"

Beneficence

doing good

Restlessness is a sign of:

dyspnea,hypoxia

18 mo developmental milestone

eats with spoon

polycytemia vera instructions

elevate legs when sitting Increase fluid intake during hot weather and exercise report tenderness and swelling of the legs

Positive pregnancy signs

fetal heartbeat ultrasound image

Rimfampin

forTB

Impetigo

highly contagious bacterial skin infection characterized by isolated pustules that become crusted and rupture

To prevent esophagitis when taking risedronate and aledronate

increase water intake

tendinitis.

inflammation of a tendon

oral mucositis

inflammation of the oral mucous membranes

introjection

integrating the beliefs and values of another individual into one's own ego structure Taking on the qualities or attitudes of others without thought or examination eg;Taking political views of a favorite celebrity

Dicyclomine

is an antipasmodic drug that decreases intestinal mobilty and is contraindicated in pts with paralytic ileus. Anticholinergic/antipasmodic drug prescribed to manage symptoms of intestinal hypermobilty in pts with irritable bowel syndrome.

Regular insulin

is short acting, that reaches peak effect 2-5 hours after sub Q administration

acidotic patient is

lethargic

Reye syndrome symptoms

lethargy, vomiting, hyperventilation, organ changes, coma, seizures fever profuse vomiting neurologic impairment disordered HEPATIC function Encephalopathy and hepatic dysfunction

coarse crackles

loud, bubbly noise heard during inspiration; not cleared by a cough

Deadliest skin cancer

malignant melanoma

if an automatic bp overinflates,displays error message

may cause inaccurate reading, pain and bruising the nurse should tag equipment out of service for maintenance BP should be taken with a manual cuff, 30 mg Hg above the pressure at which the client's brachial pulse disappear

rapid recall

means normal skion turgor

To prevent hypercalcemia

move start weight nearing exercises

car seat safety for 2 year olds and below

must be place rear facin , in the center away from airbag, harness should be secure snuggly ,at the hip and between legs, avloid using blankets, bulky coatsor sleep sacks between new born and harness

KCl side effects

nausea, vomiting, diarrhea; gas, stomach pain; or. the appearance of a potassium chloride tablet in your stool.

family education regarding end of life stage

pain relief measures are priority and should not be delayed or denied continue speaking to the client even if the patient does not respond Sense of hearing is the last to go Support cultural prefernces

patients who can have respiratory acidosis

post-operative patients who underwent thoracic or abdominal surgeries, breathing shallow,also those receiving narcotics,or sleeping pills decreasing resp rate retaining C0₂, also those with pneumothorax, pneumonia. Hypoventilation and impaired gas exchange. Sleepy, hard to arouse, headache, low 0₂ levels, hypoxia,

a fiber-rich diet

prevents colo rectal cancer improves glycemic control promotes weight loss reduce risk of vascula disease regulates BM

Denial

psychoanalytic defense mechanism by which people refuse to believe or even to perceive painful reality, thoughts,feelings, or events

Why is Vancomycin administer slow, at least 60 minutes

red man syndrome

A client with chronic stable angina is prescribed nitroglycerin (nitro dur) 0.4 mg topical patch , the patch is applied at 0730, what intervention the PN should take

remove patch at 1930

tripoid position and epiglotitis

rooling occurs in up to 80% of children with epiglottitis. Typical position called the tripod position. The patient prefers to sit up on his or her hands with head leaning slightly forward and tongue sticking out. This position is preferred because it allows maximum air entry into the lungs.

fine crackles (rales)

short popping sound heard during inspiration. Usually heard at the bases. Inhaled air suddenly opens small deflated air passages (alveoli).

ethical dilemmas and ethical choices

situations in which individuals are required to define right and wrong conduct assess the patient's knowledge, use open end questions

risks fpr peripheral artery disease

smoking DM hyperlipidemia oral contraceptive Obesity (a body mass index over 30) High blood pressure. High cholesterol. Increasing age, especially after reaching 50 years of age. A family history of peripheral artery disease, heart disease or stroke. symptoms, most notably leg pain when walking (claudication).Claudication symptoms include muscle pain or cramping in your legs or arms that's triggered by activity, such as walking, but disappears after a few minutes of rest. The location of the pain depends on the location of the clogged or narrowed artery. Calf pain is the most common location. Peripheral artery disease signs and symptoms include: Painful cramping in one or both of your hips, thighs or calf muscles after certain activities, such as walking or climbing stairs (claudication) Leg numbness or weakness Coldness in your lower leg or foot, especially when compared with the other side Sores on your toes, feet or legs that won't heal A change in the color of your legs Hair loss or slower hair growth on your feet and legs Slower growth of your toenails Shiny skin on your legs No pulse or a weak pulse in your legs or feet Erectile dysfunction in men

Atorvastatin (Lipitor) Simvastatin (Zocor)

statin drug given to lower cholesterol,which can reduce the risk for CAD and atherosclerosis

for achilden with autism spectrum in the hospital

structural routine and consistency ask the parents the child's usual patterns and habits, for a typical day like mealtimes, bath time, and playtime

when taking potassium what should you instruct the pateint to do

take it with plenty of water and sit upright for a period after ward

photosensitivity is common when taking what meds

tetracycline,thiazide diuretics, and sulfonamides

examples of breach client confidentially in social media

texts sharing pt about a their condition express personal opinion or feeling regarding pt condition or situation tell others about PHI,name, diagnosi,history,examination results,or treatement and maybe discuss only in private setting with satff memebers who are directly involved in the client's care sharing phi while referring to a clint by diagnosi,nick name, or room number

myocardial infarction

the occlusion of one or more coronary arteries caused by plaque buildup (heart attack) s/s:indigestion,yaw,shoulder,dyspnea,diaphoresis,nausea,vomiting

hinder

to delay; to stop or prevent from happening

paranoid personality disorder

type of personality disorder characterized by extreme suspiciousness or mistrust of others Have intense need to control de enviroment Express their suspicion by arguing,complaining,making sarcastic comments. or being stabborn,are self suffiecient and mantain a high degree of control of the environment

Anesthesia and opioid analgesics may cause:

urinary hesitancy and retention for up to 3 days following surgery,s[ecially abdominal or pelvic surgery,specially abdominal surgery or pelvic surgery. Instruct to initiate attempts to void(eg; standing) and may require urinary catheterization.

oral care for patients with oral cancer

use water based lip lubricant avoind hot,spicy/acidic foods use soft bristtle tooth brush clean mouth with normal saline after after meals and bed time viscous ludocaineHCI (xylocaine)

Meniere's disease

usually in people ages 30 to 60 years. It usually affects only the ear. The cause is unknown but the symptoms are related to an accumulation of fluid in the inner ear. Some things that have been found to trigger attacks include alcohol, nicotine, stress, and certain stimuli such as bright lights and sudden movements of the head. Signs and Symptoms. Some patients with Meniere disease have more serious symptoms than others. Acute attacks occur at intervals and last for hours to days. The frequency of attacks often can be reduced with medical treatment. During an acute attack, the classic symptoms are hearing loss and vertigo accompanied by pallor, sweating, nausea, and vomiting. The hearing loss is unilateral, meaning that only one ear is affected. Tinnitus accompanies acute attacks. It is heard as a low buzzing sound that sometimes becomes a roar. Hearing usually improves between attacks but some loss of low-frequency sounds may remain. Patients who have had many attacks may eventually have permanent sensorineural hearing loss. Vertigo is a sensation of movement that causes dizziness and nausea. Patients may say that the room seems to be spinning or that they feel like they are spinning. A feeling of fullness and pressure in the ear often precedes a vertigo attack. Attacks may last several minutes to several hours. Sudden movement during an attack of vertigo can cause vomiting. patient describes hearing and balance disturbances as described earlier. An audiogram often reveals a loss of the ability to hear low-frequency sounds. If the caloric test or electronystagmography is done, the patient with Meniere disease has a severe attack of vertigo. A 1267glycerol test involves audiometry testing before and after giving the patient oral glycerol (a diuretic that draws fluid from the inner ear). Improved hearing after glycerol is given suggests Meniere disease. Meniere disease is actually diagnosed by ruling out other conditions that can cause similar symptoms. Therefore the physician is likely to order a number of radiographs and other tests to detect any neurologic, allergic, or endocrine disorders. Medical Treatment. Meniere disease may be treated medically or surgically (see Complementary and Alternative Therapies box). Drugs prescribed during an acute attack include atropine, epinephrine, benzodiazepines such as diazepam (Valium), antihistamines, antiemetics, anticholinergics, vasodilators, and diuretics. Drugs that may be prescribed between attacks in an attempt to reduce their frequency and severity are diuretics and drugs that help to control vertigo. Meclizine and transdermal scopolamine are less sedating than many other agents and may allow the patient to maintain a more normal life. Complementary and Alternative Therapies Biofeedback, self-hypnosis, and relaxation techniques may be recommended to help the patient learn to live with Meniere disease. A low-sodium diet and diuretics seem to increase the length of time between attacks by reducing edema in the inner ear. If moderate sodium restriction is not effective, the patient may be put on a strict sodium-free diet (see Nutritional Considerations box). Caffeine, nicotine, and alcohol are discouraged. Vestibular rehabilitation is a series of exercises performed to help the patient develop a tolerance for vertigo. It begins with moving the eyes and the head up and down and side to side and progresses to more vigorous activity. Usually the physical therapist teaches vestibular rehabilitation. Most patients respond positively to conservative medical treatment. Pressure pulse treatment is a more recent development that reduces dizziness and tinnitus for some people. It is a device that fits into the external ear and delivers pressure to the middle ear intermittently. Patients use it at home three times a day for 5 minutes each time.

treatement for hypermagnesemia

ventilator calcium gluconate safety precaurions

temporal lobe

visual and auditory input and pass experiences injury to this area causes loss understand verball or written language

EGD (esophagogastroduodenoscopy)

visual examination of the esophagus, stomach, and duodenum, fever might indicate a sign of infection frpm perforation

Capsaicin

wait 30 minutes after applying then wash

enozeparin(Lovenox) nursing interventions:

watch heparin induced thrombocytopenia

A patient with MRSA septic arthritis was prescribed IV Vancomycin, which finding is most concerningh?

wheezing and hives duto development of Red man syndrome

scheduled prandial insulin

(ie, fixed) is used to prevent hyperglycemia

render

(v.) to cause to become; to perform; to deliver officially; to process, extract

Linezolid (Zyvox)

- Oxazolidinone class, antibiotic with monoamine oxidase inhibitor properties prescribed for vancomycin and methicillin-resistant bacteria, pneumonia, and skin infections > Binds to bacterial 23S ribosomal RNA of the 50S subunit inhibiting bacterial translation and protein synthesis and is mainly bacteriostatic - Bacteriostatic - Cover MRSA, VRE - used for uncomplicated/complicated skin and soft-tissue infections - CI > Concurrent use or within 2 weeks of MAO inhibitors - Caution with diabetes patients on insulin or hypoglycemia agents SE > HA/Diarrhea - NOTES > IV to PO ratio is 1:1 > Store oral suspension at room temp and use within 21 days after reconstitution. Prior to administration mix gently by inverting bottle * do not shake * - IV: require light protection during the administration Headaches area side effects, acetaminophen is not contraindicated, Abstain of consuming tyramine containing foods to avoid severe hypertension Diarrhea is a common adverse side effect, increased diarrhea or fever might indicate complications of the regimen like serotonin syndrome and C.difficile

reaction formation (defense mechanism)

- Preventing unacceptable thoughts or behaviors from being expressed by exaggerating opposite thoughts or types of behaviors. EX: Jane hates nursing. She attended nursing school to please her parents. During career day, she speaks to prospective students about the excellence of nursing as a career.

risk factors for skin cancer

-Family history -Prolonged sun exposure -Fair skin -Sun burns -Red hair -Blue eyes -Multiple freckles -aging -high number of moles -immunosuppressant medication outdoor occupaion

hypertropic pyloric stenosis

-Thickening and tightening of the pyloric sphincter, creating an obstruction -Doesn't allow the gastric contents to empty into the duodenum -Causes projectile vomiting. No bile in emesis. -Infants remain hungry following feed and will want to eat again -Etiology unknown but family history is frequent -Hypergastinemia -Prostaglandin E infusion (infants with patent ductus arteriosus), -Infants < 1 month who received erythromycin -More common in males

seizure precautions include:

-ensure rescue equipment is at bedside -inspect client's environment for items that may cause injury in event of seizure -assist client at risk for seizure with ambulation and transferring -advise all caregivers and family not to put anything in client's mouth in event of seizure (with exception of status epilepticus) -advise caregivers and family not to restrain in event of seizure but to lower to bed/floor, protect head, move nearby furniture, provide privacy, put on side with head flexed slightly forward, and loosen clothing to prevent injury -in event of seizure, stay with client and call for help -admin meds as ordered -note duration of seizure and sequence and type of movement -after seizure, explain what happened to client and provide comfort and quiet -document the seizure along with precipitating factors along with description of event and report it to provide

Atropine uses

-increase HR -relax smooth muscle in GI tract, GU & respiratory -suppress salivation and resp secretions during surgery

Lyme Disease Education

-prevent -remove tick with blunt tips as close to skin. disinfect skin before and after -follow up up to 30 days -f/u more often those with severe symptoms Flu like s/s (headache,fver, fatigue,myalgia) bull eye rash or not erythema migrans Rx doxycycline,amoxicillin complication;carditis,chronic arthritis,meningotis,facial paralysis Prevention: insect repellent,avoid tall grass and thick underbrush and hike on center of trails,wear long sleeve shirts tucked into pants, long pants tucked into socks or noots, and closed toe shoes

ACE inhibitors

-pril Are prescribed to treate hypertension This medication interfere with the conversion of angiotensin I to angiotensin II,which lowers blood pressure by reducing vasoconstriction and promote excretion.ACE inhitor also inhibit ventricular remodeling after an MI , which reduces the risk of MI

The nurse is preparing a teaching plan for a client newly diagnosed with fluid retention and heart failure. What should the nurse advise the client to avoid?

. Chicken noodle soup Deli-ham sandwiches 2. Effervescent soluble medications Think about fluid volume excess and heart failure. Things such as effervescent soluble medications and canned/processed foods should be avoided because they all contain a lot of sodium which increases fluid retention. Therefore, the chicken noodle soup and the cold cut deli-ham sandwiches should be avoided.

A client is admitted with hypocalcemia. Which treatment would the nurse anticipate for this client?

. PO Calcium Vitamin D 4. Sevelamer hydrochloride Correct: Since this client has hypocalcemia, PO Calcium replacement would be an appropriate treatment. Now, let's look at the others that are not as obvious. Vitamin D helps to improve calcium absorption, which will help increase the calcium levels. So, what is sevelamer hydrochloride and how will this help hypocalcemia? Well, it is a phosphate binder. And remember that we said if you bind the phosphorus, the phosphorus levels go down. And since phosphorus and calcium have inverse relationships, as the phosphorus levels go down, the calcium levels will go up!

Seizure precautions (most important)

1) Do not put anything in a client's mouth (except for status epilepticus, where an airway is needed) in the event of a seizure 2) Do not restrain a client in an event of a seizure. Lower him to the floor or bed. Protect head, remove nearby furniture, provide privacy, put client on his side with head flexed slightly forward, loose clothing to prevent injury 3) Stay with the client and call for help 4) Administer medication as ordered 5) After seizure, explained what happened to client. Provide comfort. 6) Document thoroughly: duration, behavior, description, length, injury, aura, postictal state, and report to provider

Incentive Spirometry steps?

1) Sit upright 2) Exhale 3) Insert mouthpiece 4) Inhale for 3 seconds, and then HOLD for 10 seconds

A client with chronic liver disease has ascites and is being treated with an albumin infusion. What should the nurse anticipate and monitor in this client?

1. Fluid volume excess Albumin is a hypertonic solution. This type of solution will draw fluid from the cell into the vascular space. This builds up the volume in the vascular space. Therefore, the nurse must watch for fluid volume excess. Hypertonic solutions are used in clients who have 3rd spacing, severe edema, or ascites.

The emergency department nurse is monitoring a client being admitted in diabetic ketoacidosis (DKA). Which arterial blood gas value would be expected?

1. pH 7.32 2. PaCO2 32 Rationale 1., &2. Correct: In DKA, the client is acidotic. Normal pH is 7.35-7.45. A pH of 7.32 indicates acidosis and will be expected for a client in DKA. Normal PaCO2 is 35-45. Remember CO2 is considered an acid. The client in DKA will have an increased respiratory rate, so the PaCO2 will either be normal or low. This value of 32 is low and is an expected finding as the body is compensating for the acidosis. Normal HCO3 is 22-26. HCO3 is a base. Initially, the acids bind to the bicarb to reduce the acid levels. Therefore, the HCO3 would be less than 22. So, in DKA, the expected initial finding is a low HCO3?. Keep in mind that with acidosis, as the body compensates later, the kidneys will retain bicarb and you will see the bicarb levels increase. Normal PaO2 is 80-100. An expected finding in DKA will be normal or increased PaO2, not decreased. The client in DKA is kussmauling to blow off the CO2 (acid), so the oxygen saturation of blood will be high if there is no respiratory issue. In this question you are not told that there is a respiratory problem, so you would not expect a low oxygen saturation level.

Normal mag value

1.2-2.1

Normal magnesium levels

1.5-3.0 mEq/L

What information on burn prevention strategies should the nurse include when providing an education program at a community center?

1.Clean the lint trap on the clothes dryer after each use. 2.Do not hold a child while holding a hot drink. 3.Home hot water heater should be set at a maximum of 120°F (48.8°C). Rationale: Lint that accumulates in the lint trap of a dryer can cause a fire, so the lint trap should be cleaned after each use. A hot beverage can easily spill on a child by accident when trying to handle both the beverage and child at the same time. Home hot water heater should be set at a maximum of 120°F (48.8°C), especially when small children, the elderly, or diabetics are in the home. Space heaters need space at least three feet (0.91 meters) away from anything that can burn.

When ascending stairs with a cane, the client should:

1.Step up with the stronger leg first 2.Move the cane next,while the bearing weight on the stronger leg 3.Finally,move the weaker leg "UP with GOOD and DOWn with the BAD" the cane always moves before the weaker leg.

removing PPE after assessing a pt in airborne base precaustions,which item should you remove first

1.gloves 2.gloves and face shield 3.gown 4.mask and respirator

nasogastric tube inserction for gastric decompression:

1.hand hygene, clean gloves 2.place in high forwlers 3.Assess nares and oral cavities and select naris 4.Measure and mark the tube 5.curve 4-6'' of tube around index finger and release 6.lubricate end of tube with water and solluble jelly 7.instruct the client to extend neck neck back slightly 8.gently insert tube past the nasopharynx ,aiming tio downward 9.Rotate tube if slightly resistance is meet, allow for rest periods 10.continue insertion until just above the oropharynx 11.ask to flex head forward and swallow small sips of water or dry if NPO 12.Advance tube to the marked point 13.verify tube placement and anchor

normal prothrombin time

11-16 seconds

Hgb female

12-16 g/dL

Hgb males

13.2-17.3

Normal Sodium value

135-145

Chest compression for infants

2 thumb encircling hands technique 2 finger compression technique just below the nipple line Single rescuerperforming infant CPR should use 30:2compressions -to- breath ratio Acompression to breath ratio of 15 :2 when 2 rescuers are involved Give 30 chest compressions at a rate of >100/min applied to one third the depth of the chest (1.5 in) Check bracial pulse for no longer than 10 seconds During an unwitnes collapse , a single rescuer should shout for help activate emergency response sytem(eg; call emergency services via mobile device if aoutside health cares setting)and tghen provide 2 min of CPR,at the rate of at least 100 compressions/min before retrieving theAED The rescuer should deliver cghest compressions to an infant ata depth equal to one third of the chest ;s anterior-posterior diameter (ie; aproz 1.5 in [4cm])and allow recoill between compression Initial client evaluation(eg; assess brachial pulse) and retrieval of automatic external defribillator(iel afterc 2 min of CPR unwitnessed collapsed with a single rescuer)

A client is admitted with prolonged nausea and vomiting. The client's admission sodium level is 149 mEq/L (149 mmol/L). What action by the nurse would be most appropriate at this time?

2. Perform neurological assessment Did you recognize that the sodium level of 149 is too high? The normal sodium level is 135-145 mEq/L (135-145 mmol/L). Think about the testing strategy that we mentioned to you. Look for neuro changes when the sodium level is not within normal limits. The brain does not like it when the sodium level is messed up. So, performing a neurological assessment on this client would be important.

A PN collects dta on several older adults, which finding is the highest priority to report to RN charge nurse? 1.A client taking metoprolol who has a pulse of 54/min and a bp of 154/82 2.A client with pneumonia who is receiving IV fluids and has a new S3 heart sound

2.A client with pneumonia who is receiving IV fluids and has a new S3 heart sound S3 sounds occurs when blood from the atrium is pumped into a non compliant ventricle S3 is heard after S2(ventricular gallop) It may present as normal in young adukts An S3 in older adults might indicate volume overload or heart failure

What immediate action should the occupational health nurse take once flames have been extinguished from a burned victim? 1. Remove jewelry. 2. Wrap in a clean blanket. 3. Cover burns with clean, dry cloth. 4. Briefly soak burned area in cool water

4. Briefly soak burned area in cool water. Rationale 4. Correct: Although all options are correct, the priority is to stop the burning process. Just putting out the flames is not enough to stop the burning process. You need to apply cool water briefly (no more than 10 minutes) to soak the burn area. Any longer can cause extensive heat loss.

Parkland burn formula

4mL x body weight (kg) x percentage of body surface= total fluid requirement in mL for 24 hours to calculate what the IV will run at NOW, take that # and divide it by 2, now divide it by (8-however long it took to get to the ER) to get your hourly IV flow rate divide by 1000 half to be given in 1st 8 hours, 1/4 in second 8 hours and 1/4 in last 8 hours...starting at the time of the burn, not arrival to ER

Prediabetic HgbA1C

5,7-6.4%

How often change stoma

5-10 days to prevent skin irritation drink plenty of fluids, decrease gas-forming foods

what patient can share room with a patient with leukemia

A client with minimal change nephrotic syndrome

Anorexia Nervosa (AN)

A disorder with both psychologic and physiologic components that begins with dieting to lose weight and manifests into an inappropriate self-control behavior; continued restrictive eating may lead to starvation and eventually death.

Huntington's disease

A human genetic disease or autosomal dominant inheritance caused by a dominant allele; characterized by uncontrollable body movements and degeneration of the nervous system; usually fatal 10 to 20 years after the onset of symptoms. Progressive nerve degeneration, impaired movement, swallow, speech, cognitive difficulties, chorea Clients who have a family member should undergo genetic testing before planning to start a family

compartment syndrome

A serous postiprative complication, is caused by decreased blood flow ro the tissue distal to the injury eschemic necrosis Cause:from decrease compartment size ,can cause restrictive dressing,splint or cats.Increase pressure within the compartment(bleeding ,inflamamtion,edema) Earliest symptoms include pain and numbness that are unrlieved by medications,next are absent pulse ,pallor,coolness,swelling, decrease movement and cynosis Assess neurovascular staus and report to the doctor position limb to the level of the heart

colonoscopy post procedure

A small amountv of rectal bleeding and abdominal cramping are expected.Abdominal cramping occurs as the bowel contractsto expail air that was blown into the colon(insufflated)during the procedure. Notify doctor if the pt experices synptoms of bowel perforation(eg,severe abdominal pain,distention,excessive rectal bleeding)

UAP scope of practice

ADLs Hygiene Linen Change Routine, Stable Vitals Documenting Input/Output Positioning PROM Document daily weight Apply protective skin ointment

Acetylsalicylic Acid (Aspirin)

ASA

Lithium toxicity

Acute: nausea,vomiting,diarrhea, neuro s/s come later Chronic:Neurological -ataxia,sluggish,confuse,agitation,neuromuscular excitabilty(coarse tremor)

What to report to the state board of nursing

Adimistering,hydromorphone without prescription Documenting intervention that was not performed Stealing narcotics Walkin off duty un the m iddle of the shift Practice outside the scope of practice

Administration of vaccines to a child with hemophilia

Administer Vaccines via subQ to prevent intravascular hematoma Use the smallest gauge needle Firm continuous pressure should be applied at the site for 5 minutes, without rubbing or massaging due to the risk for hematoma formation or bleeding

for thromboembilism prevention

Administer anticoagulants Apply sequential compression devices Ambulate regularly 4 to 6 times as tolerated Remind to point and flex the feet while in bed

To prevent intracranial pressure

Administer stool softener Dim lights when not providing care Matain body in midline position position head 30 degrees Avoid coughing Keep a patient calmenvironment(dim light, limit visitors) Treate meatbolic demands(eg; hypoxia,pain,fever)Treate fever agressively(eg; acetaminophen) and avoid shivering promote venous return

Sodium Polyesterene Sulfonate retention enemaKayexalate)

Administered for pt with high serum potassium levels

potassium sparing

Aldactone (spironolactone)

betablockers - why are contraindicated in bradycardia

All betablockers(eg; diltiazem,verapimil)can decrease HR, and should be held in patient with bradycardia

LPN duties in preventing falls

Alterations in gait,balance, and range of motion place the patient at higher risk for falling.Evaluating the person for gait and balance defecits requires assessment and is a function pf the PN.

The client has been prescribed 0.6 units of insulin/kg /day. The client weighs 214 pounds (97 kg). What is the amount of insulin the client can receive in a day? (Round to the nearest whole number)

Answer: 58 units per day 97 kg x 0.6 units = 58.2 units = 58 units The average adult dose of insulin is 0.4-1.0 units/kg/day. Rounding Rules for Whole Units: 0.1 -0.4 = round down to whole unit 0.5-0.9 = round up to whole unit

A client who had a cerebral vascular accident (CVA) is now having Cheyne-Stokes respirations ranging from 12-30 breaths/minute. BP 158/108, HR 46. Based on this assessment, which acid/base imbalance does the nurse anticipate that this client will develop?

Answer:Respiratory acidosis Rationale Causes of respiratory acidosis include any causes of decreased respiratory drive, such as drugs (narcotics) or central nervous system disorders. With a massive cerebral vascular accident (CVA or stroke), the respiratory center in the brain is impaired and affects oxygenation. Cheyne-Stokes respirations are characterized by progressively deeper and sometimes faster respirations followed by periods of apnea. This leads to acidosis and often times respiratory arrest. Compensation for metabolic acidosis caused by disorders like DKA includes tachypnea with deep respirations called Kussmaul's respirations. Here, we have a respiratory problem, not a problem that started with a metabolic issue.

Valsalva maneuver

Any forced expiratory effort against a closed airway such as when an individual holds his or her breath and tightens his or her muscles in a concerted, strenuous effort to move a heavy object or change positions in bed. Bearing down inspect for skin breakdown measure post-void urinate q2h void-hold for 30 seconds and try again

the PHCP prescribed seizure precautions:

Apply pads to the side rails Have oxygen supplementation available set up bedside suction equipemnt

Lidocaine 5% patches (lidoderm)

Approved for postherpetic neuralgia (Shingles) NOTES > Can cut into small pieces before removing backing > Do not apply more than 3 patches at one time

Kayexalate Kionex Kalexate

Are Sodium polyesterine sulfonate,used to treat hyperkalemiaby exchnging sodium for potassium acorss the mucus membranes of the bowel, excreting potassium via stool.

things the patient should consider before starting research study

Ask about risk, consequences, and benefits before sign consent before sign understand duration and obligation Ask to explain verbally what he/she understood or repeat instructions and explanation about the treatment The pt is not obligated to stay in study

A client sustains a high-voltage electrical injury while at work. Which interventions should the occupational health nurse initiate?

Assess entry and exit wound. Monitor vital signs. Place on a spine board. Connect to cardiac monitor. Apply cervical collar to neck. Rationale: You need to understand that high-voltage current of electricity damages the vascular system and the nerves nearby. This alteration in the vascular system can damage vital organs, so we worry about organ failure. Electrical burns have two wounds: an entrance burn wound that is generally small and an exit burn wound that is much larger. The electricity goes throughout the body causing damage, and then exits the body. So look for 2 burn wounds. Remember, vessels, nerves, and organs can be damaged. The nurse needs to monitor vital signs frequently, especially those assessing the respiratory and cardiac systems, since we worry about organ damage. Electricity can damage the heart muscle, so the client is at risk for dysrhythmias within 24 hours following an electrical burn. Put the client on continuous cardiac monitoring during this time. Why place the client on a spine board and put a c-collar on? Contact with electricity can cause muscle contractions strong enough to fracture bones, or vertebrae. The force of the electricity can actually throw the victim forcefully.

chest tube drainage system

Assess the patient Assess the chest tube drainage system for patency and troubleshoot any concerns Ensure the safety/emergency equipment is attached to the bed Promote lung expansion (deep breathing and coughing exercises, position changes, and ambulation as required) The following should be documented and assessed according to agency policy: Presence of air leaks Fluctuation of water in water-seal chamber Amount of suction Amount of drainage and type Presence of crepitus (subcutaneous emphysema) Breath sounds Patient comfort level or pain level Appearance of insertion site and/or dressing

A postpartum nurse receives report on a couplet.Which task can be assigned to unlicensed assitive personnel?

Assist the mother with morning hygene Document the mother's intake and out put Obtain the newborn's axillary temperature Swaddle the newborn after diper changes

After catarct surgery

Avoid activities that increase intraocular pressure, sexual intercourse, straining, heavy lifting, wear an eye patch at night, report signs of severe pain, increase fluid intake, take docusate daily

Aortic root repair

Avoid lifting heavy objects Anticoagulant like warfarin for life weight fain of 3> in a week should be reported

Patient Teaching-Discharge Planning with Oxygen

Avoid: keep electrical devices maintained and plugs grounded smoking Vaseline keep fire extinguisher available keep canister away 15 to 20 ft away from fire sources keep the prescribed rate have smoke detectors

Late decelerations

Bad (placental insufficiency) LION Late decelerations occur when a fall in the level of oxygen in the fetal blood triggers chemoreceptors in the fetus to cause reflex constriction of blood vessels in nonvital peripheral areas in order to divert more blood flow to vital organs such as the adrenal glands, heart, and brain.

Fetal Heart Variability

Baseline FHR Variability Baseline variability is defined as fluctuations in the fetal heart rate of more than 2 cycles per minute. No distinction is made between short-term variability (or beat-to-beat variability or R-R wave period differences in the electrocardiogram) and long-term variability.

A child suddenly collapses, you check the child and he/she still not breathing with a pulse of 50/min. After calling emergency services and delivers rescue breaths per 2 minutes, the child still not breathing, pale and has a pulse of 49/min, what is the nurses next action

Begin chest compressions

carvedilol major side effects

Betablocker: bradycardia bronchospams hypotension depression i,potence

When gathering data from a client with bulimia nervosa

Binge eating: Frequently consuming unusually large amounts of food in one sitting and feeling that eating behavior is out of control. Common causes of this symptom Binge eating can have causes that aren't due to underlying disease. Examples include overindulging at holiday celebrations or consuming lots of calories preparation for an athletic event such as a marathon. Self induced vomiting: pt frequently leaves table during meals to go to the restroom Tooth enamel decay

medications that help reduce serum calcium are

Biphophates(etidronate-Didronel) and Calcitonin

blood administration

Blood typing and cross matching Signed consent form Check blood according to policy 2 RN bedside check Vital signs before infusion Vital signs when blood hits patient VS 15 minutes & 30 minsAfter the initial 15 minutes increase infusion rate. Must be completed within 4 hours of product leaving the blood bank.

When taking ethambutol (Myambutol), Pt is instructed to report what immediately

Blurred vision decreased in visual acuity loss of color discrimination

In order for an ABG to be considered "compensated,"....

Both CO2 and HCO3 are abnormal

Beta blockers side effects

Bradycardia Bronchosspasms hypotension depression impotence

How to treat resp alkalosis

Breathe into paper bag Sedate to decrease RR Treat cause Do not wait for kidneys to kick in

S/S of hypercalcemia

Brittle bones Kidney stones Too much sedative

Why does patient need to be on heart monitor while receiving IV Calcium?

Calcium wil widen the QRS complex

An elderly client arrives at the emergency room reporting a severe headache and blurred vision. The client indicates having awakened this morning with flu-like symptoms including nausea, vomiting and dizziness. The nurse notes the client appears very weak with shortness of breath and dark cherry red lips. Based on assessment findings, what life-threatening problem does the nurse expect?

Carbon monoxide poisoning Rationale Carbon monoxide is a colorless, odorless, tasteless gas which permeates the blood stream, displacing the oxygen in hemoglobin. Symptoms are often confused with other illnesses, such as the flu. Assuming exposure is not fatal, the client may also experience extreme weakness, dizziness and blurred vision with confusion. Additionally, the carbon monoxide will cause lips and skin to become red in color. Without treatment, the client will die.

When is scheduled for a cardiac catherization:

Cardiac catherization involves injection of iodine contrats using a catheter to examine for obstructed arteries. Complications include allergic reactions,lactic acidosis,and kidney injury. Contrast is avoided when the patient has Hx of allergic reactions to contrast,took metformin in the last 24 hrs, or have renal impairment

ADH problems appear on

Carniotomy Head injury Pituitary tumors Sinus injury Transsphenoidal hypophysectomy increased intracranial pressure

Instruction for mothers in third trimester who will travel by plane

Carry a copy of up-to-datev medical record Increase fluid intake Secure the belt below the abdomenand across your hips Wear compressio hose and loos e fiting clothes avoid zika areas

Things that make you retain CO2: Mid abdominal incision Narcotics/sleeping pills Pneumothorax Collapsed lung

Causes of respiratory acidosis

What to watch for with hypotonic fluids?

Cellular edema which could lead to fluid volume deficit

Medication administration

Check laboratory values before administering anticoagulants Compare medication,dosagem and route to prescription prior to administration Discard any unlabeled medications 1.the right client 2.the right medication 3.the right dose 4.the right time 5.the right route 6.the right documentation label the medications as soon as they are preparedindividual dos epackage should be open at the patients bed sideand place in a medication cup before administer wash your hands

Patients taking TNF

Check recent tuberculin,TNF can activate tuberculosis If the patient has an acute or chronic infection Should receive annual inactivated influenza vaccine Should not receive live attenuated vaccine

Assisting with an amniotomy(artificial rapture of membranes) AROM

Check the clients temperature at least every 2 hours Monitor the fetal HR before and after amniotomy as compression of the prolapsed cord can cause fetal bradycardia Note the color,odor and concistency of teh amniotic fluid Perform perineal care and change absorbent pads as needed Provide frequent peri care, and assist to up right position

before a transfusion

Check vital signs

Ezetimibe

Cholesterol absorption inhibitor Hyperlipidemia Inhibits cholesterol absorption from the small intestine,wich reduces the rsik of atherosclerosis and helps to treate coronary artery disease

development of peripheral artery disease

Cigarette smoking DM hyperlipedemia

wound care of actual or suspected rabies

Clean the wound thoroughly;with povodine or soap water apply a bulky dressing. Advise the patient to have a tetanus booster if immunizations are not current. Patient should see a physician for antibiotic therapy. Follow local protocol to assess whether the animal has rabies. If the animal shows signs of rabies or cannot be located, previously unvaccinated people should receive the vaccine intramuscularly at 0, 3, 7, and 14 days. In addition, these people should also receive rabies immune globulin (HRIG) at the same time as the first dose of the vaccine to provide rapid protection that persists until the vaccine works. If the victim was bitten on the face or head, the virus may reach the central nervous system more quickly. Therefore treatment may be started before the disease is confirmed in the animal. All animal bites should be taken seriously because of the risk of wound infections and rabies. Rabies is an infection of the central nervous system that is almost always fatal.

suicide safety:

Clients who attempted suicide are at risk for additional attempts and should be discharge home with a plan that promotesthe pt's safety(have a list of resources for quick reference,removing dangerous items from the home,recognize signs of suicidal ideation). A sudden positive outlook or calmness may b e a sign that teh clients is planning on following an atempt and feels hopeful for the resolution

assigments that are not acceptable for preganant nurses

Clients with TORCH should not be assigned to pregnant nurses Toxoplasmosis Herpes Other: Parvovirus,B19, varicella-zoster virus, Cytomegalovirus, Herpex simplex virus Can cause fetal abnormalities

RA teaching

Clients with rheumatoid arthritis are taught symptom management techniques and lifestyle modifications to orotect joints by preventing contractures with range of motion exercises,allowing for oeriods of rest,and using moist heat for stiffness and cold pack for joint pain

Patient that should be seen firts

Clients with third-degree AV block should be assessed immediately due to potential for life threatening consequences(eg, shock, syncope,asystole)cause by decreased cardiac output and severe bradycardia.The client requires permanent peace maker

RN scope of practice

Clinical Assessment Initial Client Education Discharge Education Clinical Judgement Initiating Blood Transfusion

cold compress

Cold induces vasoconstriction should be applied for 15-20 minutes at 59* to relieve pain, inflammation and edema, or swelling and should beobserve for adverse reactions such as burning skin, erythema, extreme paleness or cyanosis

24 urine collection for cushing's syndrome

Collect urine in a dark container,record the time ,empty bladder discard the first urine and collect all the 24 hour refrigerate,

intussusception

Common in kids with CF. Obstruction may cause fecal emesis, current jelly stools. enema---resolution=bowel movements Inconsolable crying and drawing up of the legs toward the abdomen in a chilkd age 6 to 36 months stools containg mucus and blood"currant jelly" stools and vomiting is consider an emergency and the pt should be seen immediately for further evaluation, to avoid perforation and blood supply obstruction

A client who has been given steroids for a prolonged period to treat asthma, reports dizziness, tingling of the fingers, and muscle weakness. What action should the nurse take first?

Connect client to a cardiac monitor These symptoms are indicative of hypokalemia and metabolic alkalosis. What do steroids do to the body? Steroids make you retain sodium and excrete potassium. So, you could become hypokalemic. Low potassium levels cause an increase in the reabsorption of bicarb by the kidneys. That is why you sometimes see metabolic alkalosis with Cushing's disease and prolonged steroid use. What electrolyte imbalance do we see with metabolic alkalosis? It's hypokalemia. So, if you have a client who is hypokalemic then they may have muscle weakness, hypotension and life threatening arrhythmias. And we know when the potassium is messed up, we should always think about the heart first. Connect the client to the cardiac monitor. The priority is going to be checking the heart rhythm because a low potassium can cause a life-threatening arrhythmia. The symptoms are most likely due to low potassium levels. This could lead to life-threatening arrhythmias. How would you fix this problem? Yes, give potassium,

Corticosteroids can cause

Corticosteroid drugs — including cortisone, hydrocortisone and prednisone — are useful in treating many conditions, such as rashes,allergies, lupus and asthma.rheumatoid arthritis,Addison's disease help suppress the immune system in order to prevent organ rejection in transplant recipients S/S: Sings of infection, Corticosteroids might mask sings of infection such as inflammation, redness, tenderness, heat, redness, fever, and edema, and can trigger Addisonian crisis Elevated pressure in the eyes (glaucoma) Fluid retention, causing swelling in your lower legs High blood pressure Problems with mood swings, memory and behavior and other psychological effects, such as confusion or delirium Weight gain, with fat deposits in your abdomen, face and the back of your neck Clouding of the lens in one or both eyes (cataracts) High blood sugar, which can trigger or worsen diabetes Increased risk of infections, especially with common bacterial, viral and fungal microorganisms Thinning bones (osteoporosis) and fractures Suppressed adrenal gland hormone production, which may result in a variety of signs and symptoms, including severe fatigue, loss of appetite, nausea and muscle weakness Thin skin, bruising and slower wound healing Fungal infection in the mouth (oral thrush) Hoarseness Topical corticosteroids can lead to thin skin, red skin lesions and acne. injected corticosteroids can cause temporary side effects near the site of the injection, including skin thinning, loss of color in the skin, and intense pain — also known as post-injection flare. Other signs and symptoms may include facial flushing, insomnia and high blood sugar. Doctors usually limit corticosteroid injections to three or four a year, depending on each patient's situation. Wear a medical alert bracelet. This or similar identification is recommended if you've been using corticosteroids for a long time.

Prednisone(Corticosteroid)side effects

Cushing-like symptoms; immunosuppression, cataracts, acne, osteoporosis, hypertension, peptic ulcers, hyperglycemia, psychosis. Muscle wasting, osteoporosis, a spike in glucose levels, hyperglycemia, hypokalemia, glaucoma, insomnia, delayed wound healing

what are examples of hypertonic solutions

D10W 3%NS 5%NS D5LR D5 1/2 NS D5 NS TPN!! ALBUMIN

Examples of hypertonic solutions

D10W, 3%NS, 5%NS, D5LR, D5-1/2NS, D5NS, TPN, Albumin D10W, 3%NS, 5%NS, TPN, Albumin

Causes of metabolic acidosis?

DKA Starvation Renal failure Severe diarrhea

unilateral edema is a sign of

DVT ahigh priority circulatory problem in which a lower leg clot may be disloged,travel, and cause life threatening complications(eg; pulmonary embolism)

oliguria

Decreased urine output

An elderly patient has Alzheimer's disease and is not drinking enough water

Dehydrated , sodium levels are low, BP will go doen and will be weak, this will lead to renal faliure

A patient with post -op left total knee replacement use a cane walking down the stairs

Descend with th cane on the step first, followed by the left leg, and then the right leg

complications of transphenoidal phypophysectomy

Diabete sinsipidus and shock

What causes hypomagnesemia?

Diarrhea Alcoholism

Avoid Salt Substitutes with

Digoxin and K supplements b/c they are potassium based,Visartan for HTN,

Hydromorphone IV

Dilaudid

Plan of care for a pt with active varicella, with open moist lesions,

Don gloves,N85 respirator, when enter room Do not assign pregnant women to Place single use, disposable thermometer and stethoscope Place in priv=cate room with negative air pressure Request discontinuation of isolation once all lesion are dry and crusted

drugs that can be crushed

Double and extra estrenght like acetaminophen and sulfamethoxazole

For pertussis infections what prewcautions to take

Droplet precaution Monitor for airway obstruction offer small sips of water frequently

ACE inhibitors effects

Dry cough hypotension reflex tachycardia hyperkalemia angioedemaw

Naegele's Rule

EDB=(LMP-3 months) + 7 days First day of the last menstrual cycle - 3 months + 7 days

daily weights

Easiest way to monitor fluid status void first, same clothes Same time and same scale

osteomalacia home care instruction:

Eat food rich in vitamin D Engage in physical activity to increase bone strenght Use a cane to help get arounf better

to reduce medical errors

Electronic records keep prescriptions organized, notes allergies clearly, reduces costs by avoiding duplicate tests, and can reduce staffing needs. care rounds hand off communication

For patients with frostbite

Elevate extremities after rewarming Medicate Provide continuous warm water soaks Remove clothing and jewelry avoids heavy blankets apply nonaherent sterile dressing Watch for compartment syndrome

Instructions for patients with polycytemia vera

Elevate the legs and feet when sitting Icrease fluid intake during exercise and hot weather Report swelling or tenderness in the legs Weart compression stocking

How does Kayexalate work?

Exchanges potassium for sodium in the GI tract (give K, take Na) to decrease serum K Could become dehydrated so push fluids

too much aldosterone will cause what

FVE retain sodium and water, blood volume goes up Cushing's and hyperaldosteronism or Conn's syndrome

Prioritization of care

First level: Airway Breathing circulation and cardiac(become first priority in cardiac arrest) vital signs Second degree: Altered mental status Acute pain untreated medical problems (hyperglycemia,in patients with DM) chronic pain acute elimination issues abnormal respiratory results risk for infection safety

How to treat respiratory acidosis?

Fix the breathing problem

Metronidazole

Flagyl Antibacterial/Antiprotozoal It can treat various infections, including certain types of vaginal infections. It can also treat skin redness and pimples caused by rosacea. S/E:GI upset

Levofloxacin(Levaquin)

Fluoroquinolone Antibiotic 2 hours should pass between the drug digestion and taking aluminum/magnesium antiacids,iron supplement,multivitamines with zinc, or sucralfate.All of these subtances can bind to 98% of the drug making it ineffective.

Helping toddlers to cope with hospitalization

Follow as many home routines as possible Sleep in the child hospital room at night Take child to play room often

In reviewing apiritual need before surgery

Follow up with the pt regarding the nature or religious needs or practices

Major problems with oral potassium

GI upset so give it with food

Digoxin and what to report to PHCP

GI: anorexia,nausea,vomiting, and abdominal pain nerological manifestations include ;ethargy,fatigue,weakness, and confusion. visual symptoms are characteristic and include alterations in color vision,scotomas, and blindness. Cardiac arrythmia is the most dangerous symptom.Digoxin can result in bradycardia an heart block , which can cause dizziness pr lightheadness.Pts are instructed to check the pulse and tell the HCP if it low or has skipped beats.

While performing wound care to a donor skin graft site, the nurse notes some scabbing around the edges and a dark collection of blood. What is the nurse's next action?

Gently remove the debris and re-dress the wound. Rationale: What likes to live in the scabs and dried blood? Bacteria. That is why it is important to remove the debris to prevent infection.

Remember this about IV Calcium

Give slowly Must be on heart monitor

4 year old developmental milestones

Gross motor: Walks down stairs with alternating feet Balances on 1 foot Catches a ball use spoon and fork walk up and down the stairs Fine motor:Draws a square,cuts with scisor, ties a simple knot,d Language:names more than two colors,likes telling stories Social cognitive:begins imaginative/group play recognize analogies,ofet focus on sefl

Causes of fluid volume excess

HF, renal failure, cirrhosis, increased Na intake, increased aldosterone secretion, decreased albumin levels, SIADH

Do not use isotonic solutions in client with:

HTN, hypernatremia, or renal disease because isotonic solutions can cause FVE

Rule of Nines (adult)

Head and neck 9%, Back 18%, Chest 9%, Abdomen 9%, Arms 9% each, Groin 1%, Upper Leg 9% each, Lower Leg 9% each. 36% torso

fluid Retention: Think _____ problems first

Heart

Atropine for Bradycardia

Hemodynamically Unstable pts w/o systemic compensation Bradycardia: Sinus rhythm <60

nondiabetes result

HgbA1C <5.7%

Regular insulin

Humulin R, Novolin R

Give glucose and insulin to treat

Hyperkalemia

Causes of hypercalcemia

Hyperparathyroidism Thiazides Immobilization

Eclampsia clinical features(severe preeclampsia+ seizures)

Hypertension Proteinuria Severe headache Visual disturbances Right upper quadrant or epigastric pain 3-4 minute of tonic clonic seizure, usually self limited Persistent headache or blurred vision could indicate postpartum preeclampsia.The majority develop symptoms before birth;however, a small percentage develop the complication until several days after birth. If untreated could lead to seizures and death,additional signs and symptoms are high blood pressure,proteinuria,and edema.

Patient has third spacing, edema, burn, or ascites - what type of fluid to use on this patient?

Hypertonic

Is the patient with resp alkalosis hyper/hypo ventilating?

Hyperventilating

causes of Resp alkalosis (loss of CO2 in the lungs)

Hyperventilation (hysterical client) Aspirin overdose (stimulates resp center)

nervous.shaky,Jittery,Cold.Clammy,Fast heart

Hypoglycemia

Metabolic alkalosis = hyper/hypokalemia?

Hypokalemia

Anytime you give IV insulin worry about

Hypokalemia Hypoglycemia

Hypoventilating or hyperventilating causes repiratory acidosis?

Hypoventilating

Restlessness - think ____ first

Hypoxia

Tinea corporis (ringworm)

I. Pathophysiology A. Infection 1. Exposure to contaminated soil 2. Exposure to infected animals or people B. Growth and transmission facilitating factors 1. Warm and moist environments (showers and pools) 2. Shared towels or clothing II. Signs A. Location: Glabrous skin (skin that is normally hairless) (excludes palms, soles, groin) B. Characteristics 1. *Round, erythematous, Scaling, pruritic Plaques* 2. Annular Lesion (hence the name Ringworm) a. Raised, advancing border b. *Plaque with central clearing* i. No central clearing after Corticosteroid use 3. Postinflammatory pigmentation changes III. Management A. Prevent re-infection (see pathophysiology above) B. Topical Antifungal applied twice daily for 2-3 weeks 1. Technique a. Apply to infected and normal skin 2 cm beyond affected area b. Continue for 7 days after symptom resolution 2. First line: Imidazoles (e.g. Clotrimazole) 3. Refractory cases: Naftin, Lamisil, Loprox, Mentax

treatement for anaphalaxis

IM epinephrine

discharge education for the cleint with hearing impairement

Implement: have the client repeat back teaching Ensure adequate lighting in room sit directly infront of teh pt use printed materialswith pictures and illustrations

Best way to handle unprofessinal reponse by PCP

In response to unprofessional conduct,the priority is to shift the focus of teh conversation back to the clients needs.After the cliebt's needs are met, the nurse can now focus to address the unprofessional behavior(eg; filing a report)

Respirations increase or decrease in fluid volume deficit?

Increase - body sees loss of volume as hypoxia

Cardiac Glycosides (Digoxin)

Increase force and velocity of myocardial contractions >>improve stroke volume and CO Slows the conduction rate >>allowing for increased ventricular filling Therapeutic Uses: -Heart Failure -Atrial Fibrillation Precautions/Interactions: -Thiazide or loop diuretics increase risk of hypokalemia and precipitate digoxin toxicity -ACEs and ARBs increase risk of hyperkalemia -verapamil (CCB) increases toxicity risk - Omeprazole may increase Digoxin levels Side Effects: -Digoxin Toxicity: anorexia, N/V, abdominal pain, fatigue, weakness, diplopia, blurred vision, yellow/green/white halos around objects Interventions/Education: -assess apical pulse for 1 min prior to administration -notify Dr if HR is less than 60 (adult), less than 70 (child), or less than 90 (infant) -monitor for s/s of digoxin toxicity, hypokalemia, and hypomagnesemia -notify Dr of any sudden increase in pulse rate that previously been normal or low -maintain therapeutic digoxin level (0.8-2.0); toxic levels >2.4 Management of digoxin toxicity: -D/C digoxin and potassium wasting meds -treat dysrhythmias with phenytoin or lidocaine -treat bradycardia with atropine -for excess overdose, administer digibind to prevent absorption Hypokalemia: -IV potassium Hyperkalemia: - If a pt is experiencing weight gain and orthopenia

Benclomethasone meter dose inhaler (inhaled corticosteroid) for long term control of chronic inflammation

Inhaled beclomethasone is used to prevent asthma attacks. It is not used to relieve an asthma attack that has already started. Instruction: Rinse mouth after use use albuterol inhaler for acute episodes use 5 min after using albuterol inhaler if need both

How do glucose and insulin treat hyperkalemia?

Insulin carries glucose and potassium into the CELL.

Serotonin Syndrome

Is a potential accumulation of serotonin agitation diaphoresis tachycardia autonomic instability and hypertension diarrhea and hyperactive bowel sounds clonus tremor hyperreflexia mydriasis

Osteomalacia/rickets

Is a vitamin D deficency weak , soft and painful bones that can fracture easilyand become easily deformed, this patient shouild be placed on high risk for falls. Eat more Calcium rich foods,Phosphorous,vitamin D, over the counter vitamin D

Septhic arthritis(infectous arthritis)

Is an acute joint inflammation due to infection Fever)may not be present in the elderly or immunocompromised) joint swelling with effusion limited range of motion moderate to severe pain severe pulsating pain Erythema, warmth, effusion(synovial fluid)

sexual activity after miocradial infarction

It is safe to resume sexual activity if the patient can walk 1 mile or climb 2 flight of stairs

Levetiracetam

Keppra Anticonvulsant antisizure

Causes of hyperkalemia

Kidney trouble Aldactone (makes you retain K)

How is potassium excreted?

Kidneys

sings and symptoms of metabolic alkalosis

LOC hypokalemia

blood tinged sputum

Left CHF Strep pneumonia Tuberculosis prolonged, severe coughing bronchitis nosebleeds Blood-tinged sputum occurs when the sputum has visible streaks of blood in it.

Methotrexate uses

Leukemia, lymphomas, choriocarcinoma, sarcoma, rheumatoid arthritis.

initial post procedure plan after a thoracenthesis

Level of alertness Lung sounds Oxygen saturation Respiratory pattern

patients with the highest priority

Life threatening physiological problems(eg, airway,breathing, circulation)

Sleep apnea teaching for morbid obese

Limit alcohol intake Lose weght Avoid sedative medications(eg; benzodiazepines,certain antidepressants,antihistamines,opiates) use CPAP biPAP

Medications that are allowed before dyalisis

Lispro(fast acting) phosphate binders(calcium carbonate, acetate) Vit E

Proton Pump Inhibitors (PPIs)

Long term therapy of PPI,(eg;omeprazole,pantoprazole,esomeprazole), may decrease absorption of calcium and promote osteoporosis.Hospitalized patients have an increase of diarrhea caused by C.Diff.PPI prevents production of acid preventing colonization of pathogens, this increase the risk of pneumonias.

A client is admitted to the ICU with diabetes insipidus following a head injury. Which finding would the nurse anticipate in this client?

Low urine specific gravity Correct: Diabetes insipidus is a condition that results from decreased ADH production. Therefore, the client will be diuresing large volumes of water which leads to a fluid volume deficit. We worry about shock in these clients. Keep in mind that concentrated makes #s go up and dilute makes #s go down in reference to specific gravity, sodium, and hematocrit. Here, the urine is very dilute which means the urine specific gravity will be low.

DOPAMINE for Acute HF

Lower doses: mainly dopaminergic (renal and mesenteric vasodilation Higher doses: Dopaminergic and B1 (vasodilation w/cardiac stimulation) Large doses: Stimulate alpha receptors (vasoconstriction) USES: Treat shock that persists after adequate fluid volume replacement ADVERSE: Arrhythmia

What to assign to an AUP whith a pt woth cranial nerve VIII

Make sure personal items are within reach Cranial nerve VIII damage includes: Loss of hearing, dizziness, presentation of vertigo, nausea, vomiting, ataxia, and nystagmus, and motion sickness.Pt should be in high risk for fall precautions

Theomboembolic deterrent stockings TED hose

Make sure stockings are free of folds,rolls or wrinkles wounds should be cover by hydrocolloid or like before ted hose application Select size larger to avoid frictionagainst leg laceration Roll down any excess lenght at the top of the stocking Instruct that the ted will only be worn at night

normal hemoglobin levels

Male: 13-18 g/100mL Female: 12-16 g/100mL

Marfan syndrome

Marfan syndrome (MFS) is a genetic disorder of the connective tissue. The degree to which people are affected varies. People with Marfan tend to be tall and thin, with long arms, legs, fingers, and toes. They also typically have flexible joints and scoliosis. genetic connective tissue disorder that can cause a ruptured aorta

post operative cognitive dysfunction

Memory impaiment and problem with concentration,language comprehension and social integration.Some clients might cry easily and become teary.The risk increase in advance age, cognitive deficits,longer oeprative times,intraoperative complications, and post surgical infections.POCD can occur days to weeks after following surgery. Most symptoms resolve after healing has occurred 4-6 weeks but in others the condition becomes permanent.

A client arrives at the clinic with reports of persistent vomiting, weakness and leg cramps. The nurse notes that the client is irritable. BP 102/58, HR 108, RR 14. Based on this data, what acid/base imbalance does the nurse expect?

Metabolic alkalosis Symptoms of alkalosis are often due to associated potassium loss and may include irritability, weakness, and cramping. Excessive vomiting eliminates gastric acid and potassium, leading to metabolic alkalosis.

Caring for a 38 year old female with stress incontinence

Minimize smoke, caffeine and alcohol intake Perform kegel exercises Urinate every 2 hours while awake use incontinence pads as needed occurs during physical activities, sneezing, laughing, coughing, caused by weak pelvic floor muscles(from childbirth, aging, obesity)

The nurse is initiating a client assessment. What signs and symptoms would validate the client's diagnosis of Cushing's disease?

Mood alterations Lipolysis Truncal obesity Hirsutism rationale: The client will experience mood swings. Several of the clinical manifestations of Cushing's are related to significant physical changes which can result in periods of depression for the client. Another clinical manifestation is lipolysis which is the breakdown of adipose tissue and the thinning of the extremities. Truncal obesity (apple-shaped obesity) is the distribution of adipose tissue located in the abdominal area. Hirsutism is when a female develops male characteristics such as increased hair on the face. When the adrenal cortex is stimulated there is an increase production of adrenal androgen. This results in the increased production of testosterone, a sex hormone.

Celebrex

NSAID

Pill induced esophagitis caused by

NSAIDs, KCl, Alendronate (Bisphosphonate) Doxy (tetracyclines)

Sodium - think ____ changes

Neuro

Because potassium is vital to many body functions, hypokalemia causes multisystemic signs and symptoms. Assess for the following red flags.

Neuromuscular alerts: Skeletal muscle weakness, especially in the legs, is a sign of a moderate potassium loss. As weakness progresses, the patient develops paresthesia and leg cramps. Deep tendon reflexes may be decreased or absent and respiratory muscles can become paralyzed. Because potassium affects cell function, hypokalemia can lead to rhabdomyolysis. Cardiovascular alerts: The patient's pulse may be weak and irregular, and he may have orthostatic hypotension. Electrocardiograms may show a flattened T wave, a depressed ST segment, and a characteristic U wave. Arrhythmias associated with hypotension are premature ventricular contractions and ventricular tachycardia and fibrillation. Watch for hypokalemia in a patient taking digoxin, especially if he's also taking a diuretic; hypokalemia can potentiate the action of the digoxin and cause a toxic reaction.

a respiratory rate of 68 in a day old infant

Newborn normally have resoiratory rate of 30-60/min with pauses lasting <20 seconds Sustained tachypnea,nasal flaring,retraction, and grunting are signs of newborn respiratory distress Respiratory distress may be related to retained amniotic fluid in the lungs (more commonly after a C/S birt) meconium, aspiration, or infection.The newborn should be placed on continous monitoring and may require respiratory support(eg,oxygen,continous positive airway pressure)until underlying cause is corrected and respiuratory status is resolved.

Droplet precautions

Niesseria Meningitis Haemophilius influenza type B Diphtheria Mumps Rubella Pertussis Group A streptococcus(strep throat) Viral influenza Surgical mask Private room spiderman! sepsis, scarlet fever, streptococcal pharyngitis, parvovirus, pneumonia, pertussis, influenza, diptheria, epiglottitis, rubella, mumps, meningitis, mycoplasma or meningeal pneumonia, adeNovirus (Private room and mask)

Isoproterenol

Non-Selective beta agonists- also have B1 agonist properties on the heart (tachycardia, arrhythmias and worsening of angina pectoris) that limit their use

22-26

Normal HCO3 level

Causes of hypokalemia:

Not enough intake: Inadequate potassium intake causes a drop in the body's overall potassium level. Too much output: Intestinal fluids contain large amounts of potassium. Severe gastrointestinal fluid losses from suction, lavage, diarrhea, or prolonged vomiting can deplete the body's potassium supply. Potassium also can be depleted through the kidneys by osmotic diuresis from high urine glucose levels. Drugs can cause problems: Diuretics (especially thiazide and furosemide), corticosteroids, insulin, cisplatin, and certain antibiotics (gentamicin, carbenicillin, and amphotericin B, for instance) also cause potassium loss. Excessive insulin secretion, whether endogenous or exogenous, may shift potassium into the cells. Potassium levels also drop when adrenergic drugs such as epinephrine and albuterol are used to treat asthma. Diseases can wreak havoc too: Disorders associated with hypokalemia are hepatic disease, hyperaldosteronism, acute alcoholism, heart failure, and malabsorption syndrome.

For oral candidiasis, the patient was prescribed nystatin oral suspension

Nystatin is an antifungal medication, used to treat mucocutaneous candidal infections,9oral, intestinal, vaginal, skin) Remove denture and soak them into nystatin Inspect the oral mucous membranes thoroughly before administration Instruct to swish the suspension in the mouth for several minutes Shake the bottle of suspension thoroughly before measuring the dose

Tumor lyisis syndrome

Occurs to rapid lysis of cells and the resulting release of intracellular potassium and phophorous into serum.Phosphorous binds to calcium, leading to hypocalcemia.The breakdown of cellularnucleic acids causes sever hyperuricemia. IV hydration and hypouricemic medications(eg; allopurinol) are prescribed to promote excretion and prevent acute kidney injury.

soft retrain plan of care

Offer fluids, nutrition, and toileting q2h as needed perform neurovascular checks of extremities every hour release restrains to perform ROM exercises every 2 hour

ABGs of metabolic acidosis

PC0₂ greater than 45

highest priority in patients with endocarditis

Pain and pallor in one foot, hemiplegia,painful, cold foot/leg

pH: 7.26 PCO2: 51 HCO3: 29

Partially compensated respiratory acidosis

emancipated minor

Person younger than 18 years of age who lives independently, is totally self-supporting, is married or divorced, is a parent even if not married, or is in the military and possesses decision-making rights.Person who is not 18 but has the same legal rights as an adult

Can give what medications to treat hypocalcemia?

Phosphate binders Renagel PhosLo Calcium Carbonate

What can you give to hypercalcemia patient to decrease calcium?

Phospho soda Fleet enema Calcitonin

Fall precations dutiest for UAP

Place bedside commode as close as possible to the bed. Remind the patient to change position slowly Report observations of changes immediately.(Vital signs) Place bedside commode,cane,walkers,personal items, bed in low, and locked call light within reach. Provode non skid socks or shoes Keep area clutter free,dry and free of obstacles(IV infusion tuning and poles, electronic devices wires and cords) The greatest risk for fall occur during the night admission

comfort measure for patients with cirrhosis and ascites, peripheral edema, shortness of breath, fatigue and generalized discomfort

Place the patient in semi-Fowlers Provide alternating air pressure mattress Use music to provide distraction

after a craniotomy

Post op patient are at risk for meningitis Assess wound drain amount, report immediately saturated dressing >50 mL per shift instruct to avoif sneezing, coughing and strainning administer stool softener

Dabigratan

Pradaxa,Angiomax Blood thinners It can treat and prevent blood clots, reducing the risk of stroke. Anticoagulants that often prevent thrombotic events in atrial fibrillation events, pulmonary embolism,DVT. Direct thrombin inhibitor S/E:risk for bleeding

metabolic alkalosis causes

Primary Cause: Retention of base or removal of acid from body fluids; Contributing Causes: Excessive gastric drainage, Vomiting, Potassium depletion (diuretic therapy), Burns, Excessive Sodium Bicarb admin,loss of upper GI contents,NG tube excesive suction,too many antiacids,

Misoprostol (Cytotec)

Prostaglandin E analog Used w/ NSAIDs to prevent gastric ulcers Can induce labor Can cause diarrhea, abdominal pain, dysmenorrhea, spotting Take w/ meals and at bedtime used for ripening designed to prevent stomach ulcers,

Esomeprazole (Nexium)

Proton Pump Inhibitor (PPI). Specifically H+/K+ ATPase pump. Tx: first line for peptic ulcer dz and GERD.

Dumping syndrome

Rapid emptying of gastric contents into small intestines. Client experience ab pain, nausea, vomiting, explosive diarrhea, weakness, dizziness, palpitations & tachycardia.

Methadone used for

Relieve severe pain and suppress coughing Maintenance programs for heroin addicts

Reinforcing education in removing pubic lice(pediculosis pubis)(ie;crabs)

Remove nits from pubic hair with a fine-toothed nit comb. sexual partners should also receive treatement. Wash clothes and linens with hot water wash pubic hair with lice treatement shampoo"permetrin"

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

Remove other clients from the area Keep safe distance from the client with a clear path to safety mantain a clam demeanor,keeping the hands visible Use clear,nonthreatening communication,focusing on mutual goals During a period of extreme anxiety rhe nurse should avoind reasoning

Causes of hypermagnesemia?

Renal failure Excessive mg intake (antacids)

Check what before and during IV Mg?

Renal function

fentanyl transdermal patch application

Replace every 72 hours Remove old patch before applying a new Fold in half so that edges adhere iand mmediately discard Apply on intact skin Do not touch adhesive area of the patch, fentanyl which can be absorbed into your body too fast through the skin of your hand. If any of the medicine does get on your hand, rinse the area right away with a lot of clear water. Do not use soap or other cleansers. Apply the patch to a dry, flat skin area on your upper arm, chest, or back. Choose a place where the skin is not very oily and is free of scars, cuts, burns, or irritation. Do not apply this medicine to areas that have received radiation treatment. The patch will stay in place better if it is applied to an area with little or no hair. If you need to apply the patch to a hairy area, you may first clip the hair with scissors, but do not shave it off. If you need to clean the area before applying the medicine, use only plain water. Do not use soaps, other cleansers, lotions, or anything that contains oils or alcohol. Be sure that the skin is completely dry before applying the medicine. Remove the liner covering the sticky side of the skin patch. Then press the patch firmly in place, using the palm of your hand, for a minimum of 30 seconds. Make sure that the entire adhesive surface is attached to your skin, especially around the edges. If the patch becomes loose, tape the edges with first aid tape. If the patch falls off after applying it, throw it away and apply a new patch in a different area. If you need to apply more than 1 patch at a time, place the patches far enough apart so that the edges do not touch or overlap each other. Wash your hands with a lot of clear water after applying the medicine. Do not use soap or other cleansers.

ROME (acid/base mnemonic)

Respiratory Opposite Metabolic Equal Meaning: If pH and CO2 go in opposite directions= Respiratory acidosis/alkalosis If pH and CO2 go in the same (equal) direction: Metabolic acidosis/alkalosis)

cholelithiasis and acute cholecystitis

Right upper-quadrant pain to the right shoulder ,low grade fever chills Cardinal symptoms of acute cholecystitis from cholelitiasis include pain int the right upper quadrant RUQ with referred pain to the right shoulder and scapula.Patient often report fatty food ingestion 1-3 hours before initioal onset of pain.Associated symptoms include low grade fever, chills,nausea,vomiting,and anorexia. During acute attack of cholecytitis,inflammation of the mucus linig and gallbladder wall occurs as a result of gallstones obstruction of the cycstic bile duct.The inflammation and increased pressure in the gallbladder from the blocked bile duct result in Murphy's sign:palpitation over the right quadrant causes pain and inability to inhale deeply.Labs show leukocytosis. Rationale Cardinal signs of acute calculous cholecystitis include pain in the right upper quadrant and referred pain to the right shoulder and scapula a few hours after eating high fat foods.ssocuated symptoms include low-grade fever,chills,nausea,vomiting, and anorexia.ii9pyu 'iuygh

After using albuterol and beclomethasone inhalers:

Rinse your mouth well after using the beclomethasone inhlaer Use albuterol inhaler immediately for acute asthma symptoms Use beclomethasone inhaler 5 minutes after the albuterol if you nedd both During acute episodes of asthma(wheezing,breathlesness,tight chest)short acting beta agonist are used (SABAs)(eg;albuterol)

methotrexate for RA, what is most important to address

Risk for infection Leukopenia and its immunosuppressant effects can increase the risk of infection. Instruct to obtain routine killed(inactivated)vaccines(influenza and pneumoccocal and avoid crowds and persons with known infections. Live vaccines(eg;herpes zoster)are contarindicated Alcohol should be avoided to prevent hepatic damage

actions that qualify someone for depression screening

School disciplinary issues due to absentism and angry outbursts Lost 8 lb over the last 3 weeks without trying Ofen sleeps on class Quit sports after years of performing exemplary in this area S/S; hypersomnolence or insomnia,napping during daily activities Low self steem;withdrawal from previous enjoyable activities,outburst of angry,agressive, or delinquent behavior,(Ibandalism, absentism)inappropriate sexual behavior,weigh gain or loss

Specific gravity,Na and hematocrit in a patient with SIADH

Serum sodium will be low because of the FVE Urine is going to be concentrated because excess ADH is causing the retention of fluids by the kidneys in the vascular space Urine sodium s going to be high

polystyrene sulfoante

Sodium polystyrene sulfonate is used to treat hyperkalemia (increased amounts of potassium in the body). Sodium polystyrene sulfonate is in a class of medications called potassium-removing agents. It works by removing excess potassium from the body.

A client is admitted to the cardiac floor in heart failure. The lung sounds reveal crackles bilaterally, and the BP is 160/98. The client has been on diuretics at home and the potassium level is 3.3 mEq/L (3.3 mmol/L). Which diuretic would the nurse anticipate being prescribed for this client to minimize potassium loss?

Spironolactone Rationale 1. Correct: The client's potassium level is low. Spironolactone is a potassium sparing diuretic which would cause the potassium to be retained.

Prednisone

Steroid It can treat many diseases and conditions, especially those associated with inflammation. Prednisone is used to treat conditions such as arthritis, blood disorders, breathing problems, severe allergies, skin diseases, cancer, eye problems, and immune system disorders. Prednisone belongs to a class of drugs known as corticosteroids.

A client was admitted with reports of prolonged diarrhea. The client's admission potassium level was 3.3 mEq/L (3.3 mmol/L) and is receiving an IV of D5 ½ NS with 20 mEq KCL at 125 mL/hr. The UAP reports an 8 hour urinary output of 200 mL. The previous 8 hour urinary output was 250 ml. What should be the nurse's priority action?

Stop the IV potassium infusion. Rationale 3. Correct: First, you need to recall that potassium is excreted by the kidneys. If the kidneys are not working well, the serum potassium will go up! You always monitor the urinary output before and during IV potassium administration. Since the urine output has decreased below 30 mL/hr, we know that the urinary output is not adequate. Therefore, the client could start retaining too much potassium. The priority action would be to stop the infusion and then follow this action by notifying the healthcare provider.

Nitrates

Sublingual nitroglycerin may be prescribed to alleviate an exacerbation of acute angina in pt with history of chronic angina.nitrates promote vasolidation improving blood flow relieving chest pain

glyburide/metformin

Sulfonylurea/Antidiabetic - Biguanide s/e hypoglycemia and weight gain Advice of use of sun screen

first degree burn

Superficial burns through only the epidermis.Blanche rdness

APPLYING KNEE HIGH ELASTIC STOCKING

Supplies: Elastic Stocking Knock, Introduce, Curtain, Explain 1. supine position (lying down in bed) 2. turn stocking inside out 3. pull over toe, foot & heel 4. then pull up leg (no twists or wrinkles) 5. Call Light, Bed Locked & Lowest Position, Open Curtain & Wash Hands

for bacterial meningitis placed on droplet precaution

Surgical mask private room proper hand hygene dedicated medical rquipment

Nurse is reinforcing education to apregnant woman with asymptomatic hypothyroidsm regarding levothyroxine therapy during pregnancy

Symptoms should improve in 4 weeks thyroid hormones are critical for fetal development therapy should not be stopped even if sympthoms resolve

The nurse is preparing to speak at a community center about strategies on how to prevent the transmission of human immunodeficiency virus (HIV). Which of the following statements would be appropriate for the nurse to include?

Testing for HIV is recommended for individuals with an increased risk. Correct! Condom use during all sexual activity significantly decreases the risk of contracting HIV. Correct! Pre-exposure prophylaxis (PrEP) with antiviral drugs will significantly reduce the risk of contracting HIV. Correct Response Antiviral medications started immediately after exposure can reduce the risk of developing HIV. Correct Response Pre-exposure prophylaxis (PrEP) reduces the risk of contracting HIV through a medication regimen taken prior to potential exposure to the virus, and postexposure prophylaxis decreases the risk of HIV infection after exposure to HIV. HIV testing is recommended as part of regular medical care. Condom use during oral, vaginal and anal sexual activity decreases the risk of contracting HIV. HIV is not transmitted by mosquitoes.

Polycythemia Vera (PV) treatement

The bone marrow produces too many RBC, causing the blood to become to thick leading to venus stasis This problem is treated with phlebotomy

Chest Tube Collection Chamber

The chest tube connects directly to the collection chamber, which collects drainage from the pleural cavity. The chamber is calibrated to measure the drainage. The outer surface of the chamber has a "write-on" surface to document the date, time, and amount of fluid. Report abnormal urine out put

carbidopa-levodopa

The combination of levodopa and carbidopa is used to treat the symptoms of Parkinson's disease and Parkinson's-like symptoms that may develop after encephalitis (swelling of the brain) or injury to the nervous system caused by carbon monoxide poisoning or manganese poisoning.

Cool and clammy extremities occur with fluid volume deficit because

The peripheral vasoconstriction is an effort to shunt the blood to the vital organs, and this causes the extremities to be cold and clammy.

complications of long time vegab diets

The tingling sensation of the feet and hands due to deficiency of vitamin B12, it can affect the nervous system, peripheral nerves, spinal cord and brain. Gait problems, memory and dementia.

Oral care for patients with Diabetes

They are more susceptible to periodontal disease, so they must visit the dentist every 3-4 months, clean teeth up to 4x a day, & handle oral tissues gently with minimum trauma

pH 7.50, PaCO2 42, PaO2 63, SaO2 91, HCO3 28

This ABG result indicates metabolic alkalosis. The pH is high, PaCO?2 is normal and HCO?3 is high. Normal pH is 7.35-7.45, normal PaCO?2 is 35-45, normal HCO?3 is 22-26.

How is magnesium excreted?

Through kidneys and GI tract

Descending stairs with cane

To prevent fall safter a total knee replacement ,clients should use a casne to provide maximum support when climbing up and dwon the stairs.Hold teh cane on the strongest side and move the cane befor emoving the weaker side,regardles of direction.Allow 2 points of support on the floor at all times: When descending : 1.Lead with cane 2.Bring the weaker leg down next 3.Finally step down with the stronger leg

Why do feeding tube clients tend to get dehydrated?

Total nutrition except water

For an ankle sprain what interventions should we follow

Treatement for a sparain during the acute injuruy phase(first 24-48 hrs) consist of rest Elevate the leg on pillows,with the ankle above heart level Take ibuprofen as pescribed for relief of pain wrap the ankle with an elastic compression bandage

Dopamine uses

Treatment of shock (i.e. MI, open heart surgery, renal failure, cardiac decompensation) which persists after adequate fluid volume replacement Shock (increases renal perfusion), heart failure. Ionotropic and chronotorpic.

albuterol (side effects/adverse reactions)

Tremors, nervousness, restlessness Dizziness, reflex tachycardia Hallucinations Cardiac dysrhythmias Nervousness Restlessness Tremors Palpitations PARADOXICAL BRONCHOSPASMS

ECG changes with hypokalemia

U waves PVCs V tach

pH: 7.56 PCO2: 31 HCO3: 25

Uncomensated respiratory alkalosis

pH: 7.32 PCO2: 41 HCO3: 20

Uncompensated metabolic acidosis

Levetriacetam (mechanism, use, toxicity)

Unknown mechanism; used for simple, complex, and tonic-clonic seizures Pharmacology Neurology it prevents seizure development antiepieleptic

Pursed-lip breathing (PLB)

Used to prolong exhalation and thereby prevent bronchiolar collapse and air trapping

Which clinical manifestation does the nurse expect to see in a client diagnosed with Addison's disease?

Vitiligo Hyperkalemia Confusion Rationale: Clients with Addison's disease may present with nonspecific symptoms of confusion. As the continual reduced functioning of the adrenal medulla and adrenal cortex occurs, the client will present with cognitive impairment, delusions, and hallucinations. The reduced blood cortisol increases the adrenocorticotropic hormones (ACTH) and the melanocyte-stimulating activity. The feedback mechanism results in the hyperpigmentation of skin. A deficiency of mineralocorticoids will result in the decreased excretion of potassium which results in hyperkalemia. The client diagnosed with Addison's disease will present with hypotension. The decrease in the production of the adrenal cortex steroids results in the increased excretion of sodium. The sodium loss can cause severe dehydration, decreased circulation, and hypotension. The reduced glucocorticoid will result in weight loss not gain. This reduction is due to changes in the carbohydrate, fat, and protein metabolism.

Atrial paced rhythm

What EKG finding?

candidates for insertion of an indewlling urinary catheter

Women in labor receiving spinal anesthesia, and undergoing Cesarian section Acute urinary incontinence Urinary obstruction or retention,or a need for strict intake and output in critical ill pts Perioperative use for a surgical procedure such as urologic surgery or prolonged surgeries, or when doses of fluid or diuretics are given during surgery During prolonged immobilization when bed rest is essential To improve end-of-life comfort To facilitate healing of an open perineal or sacral wounds incontinent clients The use of a urinary indwelling catheter should be minimal during hospitalization Appropriate use includes: urinary obstruction or retention, some perioperative circumstances, required prolonged immobilization, end of life comfort, facilitating the healing of an open perineal or sacral wound. Indwelling urinary catheters should not be used for convenience or as a substitute for nursing care

Assess uribary output before and during IV potassium

YES!

Chvosteks

__________ sign is muscle spasms and twitching around mouth, throat, and cheeks associated with hypocalcemia Tap cheek (C is for Cheek) and cheek twitches Hypomagnesmia and hypocalcemia

Trousseau's

____________ sign is when the pressure from the blood pressure cuff induces muscle spasms in distal extremities with hypocalcemia Pump of BP cuff and hand tremors Hypomagnesemia and hypocalcemia

myasthenia gravis (MG)

a chronic autoimmune disease that affects the neuromuscular junction and produces serious weakness of voluntary muscles, lack of acetylcholine a chronic disease characterized by muscle weakness and thought to be caused by a defect in the transmission of impulses from nerve to muscle cell autoimmune neuromuscular disorder characterized by weakness of voluntary muscles treated with pyridostigmine

flat effect

a lack of emotional responsiveness

What to report

abuse(under age, elder, mentally ill)even if abuse is bein denied( dependance on the abuser, dementia)STI in achild,Gonorrhea

PC0₂ greater than 45

acidic

NC0³ bicarb

acidic 22-26 basic

PH of 6.8

acidosis

Anticonvulsant

administered to prevent seizures such as those associated with epilepsy

Who is at higher rsik for MI

advanced age female older adults pts with DM neuropathy

Ballard score

after birth test used to estimate gestational age, performed after 46 hrs, Most accurate at 12-20 hrs and is based on sum of neuromuscular and physical maturity score the higher the number the more mature. 12 scores , 6 physical + 6 neurological =weeks gestation

7.8

alkalosis

Amniotomy

also known as artificial rupture of membranes (AROM) and by the lay description "breaking the water," influencing the speed of labor, allowing for more direct monitoring of fetal status, and qualitative assessment of the amniotic fluid. Nurse responsibilities: Temperature checks q2h Monitor fetal heart rate before and after Note color, odor, consistency of the amniotic fluid Perform peri care and change absorbent pads as needed

bulimia nervosa

an eating disorder characterized by episodes of overeating, usually of high-calorie foods, followed by vomiting, laxative use, fasting, or excessive exercise

Repiratory Alkalosis signs and symptoms include

an inability to concentrate, light-headedness, numbness and tingling, tinnitus and loss of consciousness. The loss of CO2 from the lungs would be the problem with respiratory alkalosis

A client, admitted to the surgical unit post left thoracotomy, is drowsy. Vital signs on admit are T 99.8ºF (37.6ºC), HR 94, R 16/shallow, BP 100/68. ABGs are pH 7.33, PCO2 48, HCO3 24. What action should the nurse initiate?

answer: Have client take deep breaths. Rationale 1. Correct: This client had chest surgery and the pCO2 is high. What are you worried about? Hypoventilation. Yes, the client is probably hurting due to the incision and does not want to take deep breaths. In order to get rid of the excess CO2 the client needs to turn, cough, and deep breathe. Incentive spirometry can be provided to assist the client with this effort. This client has mild respiratory acidosis after surgery. The nurse can fix this by waking the client up and instructing the client to take deep breaths or have the client use incentive spirometry. Breathing faster will only work for a few minutes. The problem is the client needs to breathe deeper to get more oxygen to the tissue and more CO2 out of the lungs. Hyperventilating will lead to respiratory alkalosis. Do not medicate at the moment, No more sedation! The client is not breathing enough. This client needs to take deep breaths.

medications for active tuberculosis

antibiotics: ethambutol isoniazid INH rifampin, pyrazinamide

tolterodine

anticholinergic

medications held before dyalisis

antihypertensives to prevent hypotension and some water-soluble medications vitamins B and C, and folic acid antibiotics and digoxin,furosemide,antibiotics,

Methotrexate(Rheumatrex)

antineoplastic ,immunosupressant,DMARD for reumathoid arthritis and psoriasis S/E:bone marrow supression resulting in anemia,leukopenia and thrombocytopenia.

Community Acquired Pneumonia (CAP)

any pneumonia that results from contagious infection outside of a hospital or clinic crackles productive cough pleuritic chest pain fever chills dyspnea bronchial breath sounds

bladder irritants that contribute to stress incotinence

artificial sweetners,caffeine,citrus juices,alcohol,carbonihadrated drinks,nicotine

therapeutic communication

asking for clarification voicing doubt helps to dispel misconceptions or delusions without directly confronting the client's beliefs encorage the client to share information

After transfusion

assess vital signs every 15 minutes for the first half hm then every 30 minutes

Potassium chloride

avilable in extended release tablets,capsules,dissolve packets,effervescent tablets and as an oral liquid)

therapeutic communication no no

avoid asking "why"

A DNR with advnce directives

avoid resucitation wishes are respected , even when the advance directives change wishes at the last minute Clients wishes are honored over family's wishes

high fall risk precations

bed alrm high risk fall signs room close to nurses's station color coded socls and wristbands

bradycardia is an adverse effects of what medications:

betablockers,calcium channel blockers and digoxin

Myambutol used to treat TB, what is adverse side effect of it

blurred vision

retina detachment

blurred vision with possible floaters or shadows is part of the visual field,flashes of light,floaters,sense of curtain being drawn Cover both eyes with pathes to prvent further damage

neuropathy of the legs

burning,tingling, or loss of sensation

Verapimil

calcium channel blocker Sometimes used in prevention of migraines reduce neurovascular inflammation redusing occurrence of migraines Verapimil can affect cardiad system,pulse rates should be checked prior due to possibole bradycardia, hold medication if pulse rate is less than 60 b/m grapefruit (including in juice form) should be avoided as it increases verapimil serum levels reducing hepatic clearance, the pt should add fiber to prevent constipation.this medication id for chronic prevention and for non acute For acute migraines the pt should take non steroidal antiiflamatory drugs like naproxen,triptan

atrial fibrilation

can have bradycardia or tachycardia medications that are safe are: heparin and lisinopril

Naproxen/NASAID

can increase thrombotic events (heart attack,stroke) in clients with cardiovascular disease CAD

Isoniazid for TB

causes peripheral neuritis

When taking ethambutol (Myambutol), Pt is instructed to report what immediately?

changes in vision

what to do if a patient has fluid accumulation in the third space

check blood pressure

what to worry when a patient exhibits FVE and

check lung field for wet lung sounds

Lactulose is adminsitered in patients who

cirrhosis and hepatic encephalopathy

mixing unsulins

clean top with alcohol inject air to nph inject air to regular draw regualr draw nph

statement and action that indicates acceptance after ileostomy

client is able to look and touch the stoma

before spiking an IV bag

close roller clamp on the IV tubing

the skin during shock

cold and clammy,because peripheral vasoconstriction conservs blood to vital body organs in the trunk and head during FVD

deshisence

collect vital signs cover area with sterile normal saline notify health care provider place cliebt in low fowler with knees lightly flexed

Formula method

convert lb to kg prescribed dose/available medication x available volume-mL dose round to whole number

4 yr old developmental mile stones

copy and draw a square hop with one foot

pnemonia signs and symptoms

cough with or wothout sputum tachypnea shortness of breath Use: incentive spirometer,ambulation, and cough deep breathing

Foods highest in potassium

cruciferous vegetables,legumes,potatoes,green leafy veggies,tomatoes,raw carrots.Dried fruits,melons avocados,oranges,mangos,nectarines,nectarines,banas,milk and milk oroducts,most fish and shellfish,most beef products,posrk,whole grains,granola,bran

SIADH

decrease serum osmolality high urine specific gravity low serum sodium Increase ADH, increase total body water resulting in low serum osmolality.ADH is secreted and water is retained, urine output is decreased and concentrated resulting in high specific gravity.

During an asthma exacerbattion the nurse should

decrease sources of a client's a xiety during an asthama exacerbation, as anxiety exacerbates symptoms.If a family member is contribuiting to anxiety, the nurse should attemp to redirect people to calm the client or the family(eg' breathing techniques)

crede maneuver is primarily used for patients with what

decreased bladder tone or areflexia and low outlet resistance.

Respiratory Acidosis signs and symptoms include

decreased respiratory rate, hyportension and a decrease in level of consciousness. Remember, if it's respiratory acidosis, it traces back to the lungs. This problem describes a metabolic issue.

Injury to Parietal lobe causes...

deficit sensation

Prolonged bed rest puts the older adult at risk for

dehydration and fluid volume defecit could develop pneumonia, DVT

Bismuth subsalicylate (Pepto-Bismol)

destroys the cell wall of H. pylori and does not affect gastric acid secretion Antidiarrheal Anti-secretory...fun fact...DONT GIVE TO KIDS because aspirin is in it! Can cause Reye syndrome

Hypoglycemia symptoms

diaporesis headaches hunger tachycardia confusion

Calcium channel blockers that lower HR

diltiazem, verapimil should be held in pts with bradycardia

-ide ending

diuretics

Non-maleficence

do no harm

alzeihmer medication

donepezil ravastigmine help improve cognition

patient with chronic bronchitis complaints to be exhausted all day due to coughing all night and not being able to sleep, feels thick mucous in the chest and throat, what can help?

drink 1-3 L of water a day sleep with cool mist humidifier take guanifesin(robitussin) before bedtime use abdominal breathing and a hough cough before bed time chest physiotherapy

BP of a patient when going into shock

drops and pulse rate number will increase, will feel weak and thready

drugs that should not be crushed:

enteric coated tablets and slowextended /sustained release

Conn's

excess aldosterone (zona glomerulosa). hypertension. water retention ____________________ syndrome is a disorder of the adrenal glands due to excessive production of aldosterone. Retain sodium and water

polyuria

excessive production of urine can lead to shock

Kidneys remove excess acid and bicarbonate

excretion or can retain bicar and hydrogen by returning them to the blood

peak flow meter instructions

exhale as quickly and forcibly through the mouthpiece to obtain a peak flow reading

FLACC

face, legs, activity, cry, consolability

D5 1/2 NS side effects

fever, infection at the site of injection, blood clot or inflammation surrounding the site of injection, leakage of fluid into the surrounding tissues (extravasation), and. too much fluid in the blood (hypervolemia). hypernatremia (high levels of sodium), fluid retention, high blood pressure, heart failure, intraventricular hemorrhage in neonates, injection site reactions, kidney damage, electrolyte abnormalities, and

legal emancipation

finacial independent Parent Married Active military high school graduate

ureteral stone pain

flank pain radiating to the groin is seing with renal colic(ureteral stones)

Levofloaxin

fluroquinolone antibiotic to treat UTI

What can be assessed in a child with meningitis for possible complication?

fonatenelles For increase intracranial pressure

purazynamide

for TB

Clients receiving ACE inhibitors should be monitor for if renal insufficiency is present

for hyperkalemia

phentanyl patch

for moderate to severe chronic pain provide continous analgesia for upto 24 hrs it takes 17 hours to reach full potential should not be used pot op

Disulfram helps with

for the treatment of alcoholism, is an aversion therapy The patient begins to feel intense nausea/vomiting, headache.flush skin, sweating, dyspnea.,confusion,tachycardia,hypotension Make note of any potential hidden alcohol on any everyday items

endometritis

foul smell comming from the uterine wall

Allopurinol

frequently used in prevention of gout report rash even if mild immediately,suspend the medication and contact your PHCP the rash, followed by Steven Jonhson syndrome and toxic epidermal necrolysis It takes months before medication is effective take it with a full glass of water and increase water intake daily take medication with a meal or following a meal

ADH

from adenohypophysis antidiuretic hormone (vasopressin) makes you retain water

arterial pulse

full and bounding

pH: 7.45 PCO2: 52 HCO3: 35

fully compensated metabolic alkalosis, because the pH is still within the (higher end of the) normal range Fully compensated metabolic alkalosis

nephrotoxicity is adverse effect of

furosemide iv

if a patient doesnt recognize a medication should you administer or withold

further investigate to ensure that appropriate med is being administered before reasuring and educating the client about the medication

To prevent pruritus

give antihistamine

Sulfonylureas

glipizide, glyburide, glimepiride

vision in primary open angle glaucoma

gradual loss of peripheral vision, tunnel vision

tyberculosis mandatory precautions

hand washing N95 respirator Neg air oressure isolation clean gloves disposable gown goggles/face shield

prevent horizontal violence

harassment,bullying,disparing behaviors Verbal(belittling,gossip, using hostile tone of voice) non verbal(ignoring,eye rolling) Analyzy work place culture creation of reporting anonymously staff education

hypertonic feeding tube formulas

have a high concentration of carbs, and or lipids, which can cause GI upset during initiation

Metabolic Acidosis signs and symptoms include

headache, confusion, increased respiratory rate and depth, drowsiness, and nausea and vomiting. This can occur in cases of diarrhea, when more bicarb is lost through the lower GI tract.

Thiazides

help retain calcium

Hirschsprung disease

hereditary defect causing the absence of enteric nervous system congenital aganglionic megacolon, a child is born with a lack of specialized nerve cells in some sections of the distal intestine, this in turn causes the internal anal sphincter to relax.as result , there is no peristalsis and stool is passed.Newborns exhibit dustal intestinal onstruction,(distended abdomen,difficulty feeding, vomit green bile)and do not pass meconium

neonatal abstinence syndrome (withdrawal)

high pitch cry,abnormal sleep pattern,increased muscle tone hyperactive primitive reflexes,irritabilty,hypertonia,jitter,seizure,diarrhea,vomiting,feeding intolerance,sweating,nasal congestion,sneezing,pupillary dilation,frequent yawning

A client with diabetes unsipidus is in ICU following a head injury, what is ancticipated to see in the lab results?

high serum sodium high serum osmolality los urine osmolality

Clonidine

highly potent antihypertensive,do not discontinue abruptly, it can cause rebound hypertension, precipitation of angina s/e: dizziness, change positions slowly, drowsiness, do not take with alcohol,dry mouth

Risk for cervical cancer

history of unprotected sex with multiple partners positive HPV result treatement for chlamydia in the past long time smoker

Anaphalaxis s/s

hives angioedema wheezing respuratory distress

getting from a chair with crutches

hold the hand grips of both crutches in the hand of the affected side move to the char edge and hold the arm rest with the hand of the unaffected side The use the crutches armrest and unaffected leg for support when raising

Hypokalemia causes

hyperpolarizes cardiac electrical conduction pathways increasing the risk fpr dysrrthmias, potassoium should be administered as a peiority

thyroid replacement side effects

hyperthyroidsm(diarrhea,weight loss,palpitations, tacgycardia,sweating,heat intolerance)

Acidotic patient gets what type of IV solution?

hypertonic solution

Respiratory alkalosis includes

hyperventilation and tachypnea which does not describe the characteristics of Cheyne-Stokes respirations. The client is hyperventilating so CO2 (acid) is being blown off. The pH says alkalosis. The most common cause of metabolic alkalosis is vomiting, and this is clearly a respiratory problem, not metabolic. HCO?3 is in normal range and remember the pH says alkalosis.

Fluid Volume Excess (FVE)

hypervolemia Is too much fluid in the body, too much fluid in the vascular space

Sulfonylureas side effects

hypoglycemia, weight gain disulfram like reaction

metabolic alkalosis

hypokalemia

Alkalotic patient gets what type of IV solution?

hypotonic solution

0.45% NaCl

hypotonic solution,provide more free water than sodium in pt with heart faliure can worsen fluid overload and hyponatremia

Wchich comorbidity of a client who started thyroid replacement should the PN report to the HP

hystory of arrhythmias

When a patient with severe headache begings to projectile vomit

immediately report to RN charge nurse it could be ICP, pbtain a full set of vital signs,elevate the bed

Receptive aphasia

impairment or loss of language comprehension(eg,speech, reading) caused bt neurological condition(stroke or traumatic injury)aphasia or dysphasia mean the same Ask simple yes or no questions Use hand gestures or pictures(eg;communication board) Remain patient and calm

mitral valve prolapse

improper closure of the mitral valve the patient might have palpitations,dizziness and light headness,stay hydrated, avoid caffeine and alcohol, and exerciase regularly, tahe prescribed betablockers

PEG tube function assesment

in and out movement of the PEG tube eg;<0.25 in especially when coughing

Repression

in psychoanalytic theory, the basic defense mechanism that banishes from consciousness anxiety-arousing thoughts, feelings, and memories eg;A peron who was raped cannot recall the evnt

during shock the respiratory rate

increase

isotonic solutions will make blood pressure to

increase

A female client who is sexually active has has 3 UTIs in a period of 12 months.Which instructions should the nurse reinforce about preventing UTI recurrence

increase fluid intake of fluids void immediately after intercourse wear cotton underwear take antibiotis as prescribed wipe front to backtake showers instead of baths avoid spermicidals contraceptive jelly do not use diaphragm until problem is resolved avoid douching and other femenine products like powders or deodorants

Acute mastitis treatment

increase fluid intake, ibuprofen prn

soaking of perineal pad < 1 hour

indicates excessibe bleeding that requires intervention

major risks for endometrial cancer

infrequent and anovoluntary menstrual cycles,(polycistic ovary syndrome,infertility) obesity and tamoxifen therapy

acute attack of meniere disease

initiate fall precaution

leg pain during activity that is relieved at rest

intermitent claudication is a sign of peripheral artery disease

Normal PaO2

is 80-100.

Fifth disease (erythema infectiosum)

is a childhood disease caused by the human parvovirus. This common community-acquired disease does not usually require treatment, but respiratory isolation is recommended for 7 days following the onset of symptoms. The initial stage of the disease presents as red cheeks that appear to be "slapped" or "slapped cheeks" with circumoral pallor

Arterio venus graft

is a connection of an artery to a vein using a synthetic material to graft hemodyalisis access site.Post operative infection usually manifest approximately 3-5 days after the surgery(fever,purulent drainage, swelling) and may cause thrombosis(clotting),graft faliure,systemic infection.

Oxycodon

is a morphine like medication S/E:constipation Pts mightvtale Senna or docusate

carotid endartectomy

is a superficial procedure that removes atherosclerotic plaque from the carotid artery. Diminishing risk for transient ischemic attack or stroke Post-op risks: cerebral ischemia and infarction as well as bleeding. BP is closely monitored during the first 24 hours post-op.HTN might strain the surgical site and trigger hematoma formation, which can cause hemorrhage or airway obstruction. Systolic blood pressure is maintained at 100-150 mmHg to ensure adequate cerebral perfusion and avoidance of hemorrhage or strain.

pneumonia

is an inflammatory process of the lung caused bt an infectious or non infectous agent.Any condition such as advanced age >65, that compromises the rspiratory system mechanism to mantain the sterility of teh lower airway can increase the risk for pneumonia: Age 65 and older , presence of coexisting diseases,decrease gag/cough reflex,decrease immune response and lung fuction. Young age<2 immature immune system Central nervous sytem depression or decrease level of conciousness decrease gag/cough reflex and risk for aspiration Immunisupression or malnutrition:impaired ability to fight infection Immobilty,smoking, infection:ineffective airway clearance

infectous mononucleosis

is caused by Epstein-Barr -virus Typically seing in teens from sharing drinks,kissing or other exposure to saliva S/S:fatigue,fever,sore throat,splenomegaly,hepatomegaly, and swollen lymph nodes. Treatment includes:hydration,rst,control of pain, and reducing fever as necessary.Sore throat is treated saline gargles or anesthetic torches.Ibuprofen or acetaminophen Complication:Airway obstruction,(stridor,difficulty breathing)from swollen lymph nodes around the neck and sevefre abdominal pain(splenis rapture. Avoid contact sports such as soccer to prevent injury to the s[leen or liver.

The most common defense mechanism used by alcoholics

is denial

Alkalotic patient

is excitable

weaning

is less difficult for mother and child when done gradually, over tge weeks or months, based on readiness or baby cues, which avoids engorgement,grdual weaning occurs around the 6th month with introduction of solids.Weaning from bottles around first birthday introducing cups

Ethambutol (Myambutol)

is used to treat tuberculosis but can result in ocular toxicity that causes loss of vision and red-green color discrimination .visual acuity and color discrimination must be assessed regularly

TB drugs that cause hepatotoxicity

isoniazid INH rifampin, pyrazinamide

To help cope with crisis

keep lines of communication openand offer support encourage to talk about what is experienced and feelings

In SIADH

leads to excessive water absorption by the kidneys Low serum osmolality and low serum sodium are the results of increased body (dilution) As ADH is secreted and water is retained, urine output is decreased and concentrated,resulting in high specific gravity SIADH is a condition that results in decreased ADH, Too much ADH causes increased total body water, resulting in low serum sodium. As ADH is secreted and water is retained, urine output is decreased and concentrated resulting in high specific gravity

Lidocaine

local anesthetic

vitiligo

localized loss of skin pigmentation characterized by milk-white patches

Bumetanide

loop diuretic treate pulmonary edema

Furosemide (Lasix)

loop diuretic, non potasium sparing diuretic low potassium could lead to dysrrthmias toxicity if taken with digoxin

hypokalemia is an adverse effets of

loop diuretics like furosemide even if infused slow

without ADH what happens?

lose water leading to shock

Management of urge incontinence:

loss of execess weight, anticholinergic medicationd(eg;oxybutrin),avoidance of bladder irritant s,spelvic floor exercises and bladder trainning.Dry mouth is common adverse efffect of anticholinergic meds.

Heparin infusion

low platelet count is bad, monitor and report (normal platelet count is 150,000-400,000) requires close monitoring by the nurse Monitor the partial thromboplastin time

calcium gluconate is an antidote for

mag toxicity it reverses thye affects of mag toxity prevents arrthymia

Crede maneuver

massage from top of bladder to bottom by starting above the pubic bone and rocking the palm of the hand steadily downward

DKA, starvation,renal faliure, severe diarrhea

metabolic acidosis

effects of teratogenics

microcephaly and cleft palate

A glucose of 140

might ve normal in a person with infection

When administer Vancomycin to elederly patients

monitor BUN and Creatine levels 2-3 tines a week to avoid kidney damage specially in those older than 60 and renal faliure Monitor Vancomycin levels

sitting down in a chair with crutches

move close to the chair. back up hold both crutches together with one hand on the affected side hold the arm rest with the other hand and lower body

heart attak atypical symptoms

nausea,vomiting,belching,indigestion,diaphoresis, dizziness and fatigue

sleep hygiene

nonpharmacologic recommendations like reviewing and changing lifestyles and environment that help an individual get a better night's sleep keep a consistent schedule avoid daytime nap,if do so be 20-30 min Maintain a regular sleep routine. Don't stay in bed awake for more than 5-10 minutes. Don't watch TV or read in bed. Drink caffeinated drinks with caution or avoid at least 4 hours before bedtime Prepare the environment, make room dark,quiet and cool Avoid inappropriate substances that interfere with sleep. Exercise regularly. Have a quiet, comfortable bedroom. avoid brain-stimulating activities like using a computer Reduce fluid intake before bedtime A client unable to sleep after 20 minutes should get out of bed If you are a 'clock watcher' at night, hide the clock.

risks for colorectal cancer

obesity high alcohol/long time cigarette consumption increasing age (<50) high fat, protein diet that includes high intake of red meat mornidly obese family hx history of gastrectomy or IBS ulcerative colitis

Point of highest pressure in infants

occiput it the patient is sedated or critical ill, assess for pressure sores, ischemia, shearing due to infant sliding down, place infant < degrees to reduce pressure and prevent sliding, do not apply baby powder or donut pillows, apply moist barriers, reposition pulse oximeter q4h,

Naloxone (Narcan)

opiate antagonist, reverses opioid induced resiratory depression

furosemide can cause

ototoxicity administration should not excede 4 mg/min in doses for 120 mg. formula :

Meckel's diverticulum

outpouching of distal ileum remnant of the umbilical cord that should be disintegrated at 8 weeks in utero s/s:bright rectal bleeding

Which initial arterial blood gas (ABG) results would the nurse likely see in a client who has overdosed on acetylsalicylic acid (ASA)?

pH 7.48, PaCO2 30, PaO2 88, SaO2 92, HCO3 24 This ABG result indicates respiratory alkalosis. Initially, acetylsalicylic acid stimulates the respiratory center and causes an increase in respiratory rate and depth. This causes respiratory alkalosis by blowing off CO2 and causing the pH to increase. Losing CO2 (acid) makes the client more alkalotic, which is reflected with an increased pH, decreased PaCO?2 and normal HCO?3.

Analyzing ABG

pH acid 7.35=7.45 base PaCO 35-45 acid / resp HCO3 22-26 base/kidneys or metabolic in order

Normal ABG values

pH: 7.35-7.45 PCO2: 35-45 PO2: 60-80 Bicarb: 22-26 BE: 2-6

cardinal signs of acute colecystitis from cholelithiais

pain in the right upper quadrant(RUQ) with referren pain to the right shoulder and scapula,fatty food ingestion prior is reported before the initial onset of pain,low grade fever,chills,nausea,vomiting, and anorexia. Labs result in leukocytosis,Murphy's sign;palpitation over the RUQ causes pain and inability to inhale deeply

Infiltration

pallor,cool and swelling,pale, and IV stops running

positioning

paracentesis:semi-fowlers to high fowlers,so that the fluid accumulates in the lower abdomen where the trocar will be inserted to drain Before lumbar puncture: place pt in the side-lying, fetal position or hunched seated position After lumbar puncture: place the pt supine for 4-12 hours to minimize the risk for lumbar headache from the loss of CSF Sims position: for enema administration left side-lying with right hip and knees flexed. After liver biopsy: placed the pt in the right side position, for >3 hours afterward to promote direct internal pressure of the liver against itself, which minimizes bleeding. After cardiac catheterization via femoral entry :palce tye pt flat or in low fowler position with affected extremity straight for 4-6 hours to avoid pressure at the insertion site and prevent hemorrhage or hematoma RECAP: Parasentheis, place upright After a liver biopsy, pt should be in a right side-lying position tp prevent hemorrhage After femoral cardiac catheterization, clients should remain flat. After a lumbar puncture, clients should be flat to minimize the risk for headache.

Who can receive live attenuated intranasal influenza vaccine

patients 2-49 years but should not be given to those who are immunocompromised,pregnant, or age <2 years

What patients cannot use accupunture

patients taking anticoagulants bleeding disorders

Donning Sterile Gloves

perform hand hygiene and remove the outer glove package Open the inner glove package by folding back the edges,place over a clean surface Use nondominant hand to grasp cuff on the inside of the dominant hand glove Pull dominant hand glove Place dominant hand fingers under cuff on outside of the nondominant glove with the thumb pulled away to prevent contact with skin of thye nondominat hand Pull-on nondominant hand glove

perinatal mood disorders:

perinatal mood disorders can occur at any time during pregnancy but are more common in the immediate postpartum period. Clients with postpartum depression might feel intense and persistent anxiety, anger, guilt and sadness. A mother showing irritability and disinterest in caring for the newborn and offered a referral for follow up care.

A pt comes with a right tbia/fibula fracture , what will delay wound healing

peripheral artery disease nutrition adequate circulation age

teratogenic medications

phentoyn lithium valproate Isotretinoin Ace inhibotors Methotrexate Warfarin

A pt with schizophrenia spends time in the dayroom, sitting in a corner watching television, but does not initiate conversation or social interaction with others, or staff.What is the most appropriate activity for teh pt?

play board games with a staff member

potential post abdominal surgery infections

pneumonia surgical site infection peritonitis signs of infection:cough,tachypnea,and shortness of breath,warmth or redness around the incision, purupen drainage from the incision, rigid painful abdomen

Patients with end-stage renal disease will be unable excreting

potassium

What laboratory should be reviewed in septic shock

potassium level of 5.9mEq/L serum potassium level 3.5-5 mEq/L The most significant manifestation of hyperkalemia are disturbances in cardiac conduction and the development of potentially life threatening cardiac dysrhythmias

aldactone saves

potassium so watch for hyperkalemia

Do not comnbine Linezolid with SSRI due to:

potential to cause serotin syndrome

Dibagatran

pradaxa anticoagulant

Acid supressing medication should be taken:

proton pumop inhibitor,H2 blockers, should be taken 30 minutes before a meal

Projection

psychoanalytic defense mechanism by which people disguise their own threatening impulses by attributing them to others

Reaction formation

psychoanalytic defense mechanism by which the ego unconsciously switches unacceptable impulses into their opposites. Thus, people may express feelings that are the opposite of their anxiety-arousing unconscious feelings. Behaving in a manner or expressing a feeling of opposite of one's true feelings.

Regression

psychoanalytic defense mechanism in which an individual faced with anxiety retreats to a more infantile psychosexual stage, where some psychic energy remains fixated An adult has a tempertantrum

Tuberculosis can affect

pulmonary extrapulmonary meninges genitourinary bone joints GI

nerovascular checks

pulse,color,skin,temperature,sensation,movement

magnesium toxicity what to check besides labs

respiratory rate less than 12

earlier signs of hypoxia

restlessness and tachycardia

Intracranial Pressure (ICP)

result from the obstruction of the cerebra spinal fluid flow.This can progress to haring loss,learning disabilities, and brain damage Bulging/tense fontanells and increasing head circumference

Causes of respiratory acidosis

retention of C0₂ by: Hypoventilation, rapid shallow respiration,acute aspirin overdose

black spots in the field of vision

retina detachment

antituberculosis medications that cause hepatitis

rimfampin,isoniazid,pyrazinamide

NASAIDs increase

risk of thrombotic events(MI,stroke)specially in pt with cardiovascular disease,call doctor for clarification if the pt was prescribed NASAIDs

When a burn is red, moist and covered in shiny fluid vesicles in what stages is this documented?

second degree(partial thickness) moist, weeping, with blisters and shiny fluid vesicles and moderate to severe pain, both the epidermis and the dermis is damage

children with hemophilia

should avoid aspirin and NSAIDs due to the risk of bleeding Acetaminiphen is recommended

instructions after coronary artery bypass

shower no bathing do not apply lotion to incision medications do not lift objects heavier than 5 kg no drving for 4-6 weeks resume sexual activity after walk a mile or climb 2 flight of stairs Report: chest pain or SOB during rest, signs of infection

Indications of inhalation injury

singed facial hair, hoarse voice,burned cloathing around the chest and neck prepare for emergency intubation

A patient has develop diarrhea 24 hours after the initiation of contious enteral tube feeding with hypertonic formula, what intervention is appropriate

slow the rate of tube feeding

when a pt reports no improvement of depression after taking antidepressives

some antidepressnats take 1-4 wks to work oe ahow impeovement assess if pt is non compliant due to side effects(nausea, weoght gain, sexual dysfunction)

What reduces serum calcium

steroids

NASAIDS can cause

stomach upset and should be taken with food

What sign/symptom would indictate to the nurse that a client has had an inhalation injury?

stridor Swallowing difficulty Singed nasal hair Wheezing Correct: Substernal/intercostal retraction and stridor are bad signs. Remember you will see difficulty swallowing, singed nasal and facial hair, and wheezing.

Methylphenidate side effects

stumulant loss of apettite restlessness weight loss delayed growth hypertension tachycardia heart palpitation tics restlessness,insomnia misuse, diversion,adiction of the medication

Vit E, gingko should be held before

surgery because the risk for bleeding

cholecystectomy

surgical removal of the gallbladder laparascopy or open surgery signs of infection might occur 3-7 days after surgery with fever, elevated WBC and fatigue

Angionedema

swelling thatv usually affects areas of the face(lips, tongue)larynx, extremities,GI tract and genitalia,it often start in the face and quickly become life threatening as it progresses to the airways.Angioedema is an adverse effect of ACE inhibitors

if an AUP is falsifying documentation on the charting , and how to handle it

te best initial result is to assess and validate the charge nurse's perception.Doing the test and comparing reulst randomnly/intermittently will give data to disprove this concern. When deliverate inaccurate documentation is suspected ,gather evidence before confronting the staff member.One way of doing this is by checking the dat personally and comparing it to whar was been documented.

With FVD, why do respirations increase?

the body perceives decreased blood volume as hypoxia

With hypoventilation

the body starts accumulating C0₂ in the blood ,the body becomes acidic To compensate the lungs in minutes

with hyperventilation

the lungs excretion of CO₂ ↑,decreasing C0₂ in the blood respiratory causing alkalosis PC0₂ will decrease faster

When you see a patient with an enlarge abdomen

the pateint might be hypotensive

diltiazem extended release tablets for an orthox jewish

the patient might refuse due to religious beliefs , ask pharmacist if an alternate form is available

tripoid position

the patient prefers to sit up and lean forward, with the weight of her upper body supported by her hands on her thighs or knees

keeping the lights dim might increase

the rsik for falls

venous stasis

the temporary cessation or slowing of the venous blood flow from prolonged inmobility

With FVD

the with addison's disease patient starts losing sodium and water

higher risk for oral candidiasis

those taking antibiotics immunosuppressed elderly with dentures

Cushing's triad

three classic signs—bradycardia, hypertension, and bradypnea—seen with pressure on the medulla as a result of brain stem herniation r/t ICP (HTN, bradycardia, irritability, sleep, widening pulse pressure)

-lol

to laugh out loud! BETA BLOKERS Propranolol Atenolol Metoprolol Labetalol

Oxytocin after delivery

to prevent bleeding studies have shown that oxytocin given to a woman during or immediately after the birth of her baby is effective in reducing excessive bleeding after vaginal birth.

SIADH is

too much ADH is produced causing kidneys to retain too much water FVE decrease urine output causing the person to become hypervolemic urine is concentrated and the blood is diluted because the FVE is in the vascular space decrease serum osmolality increase urine osmolality

Carbidpoa/levodopa

treatment for bradydiskenesia in parkinsin;s disease,can inprome tremor and ridigity S/E: orthostatic hypotension confusion hallucination delusion agitation psychosis

circumstances where minors can consent without parental consent

treatment for substance abuse psychuatric disorders sexually transmitted disorders (emergency situations e.g; dehydration ,the patient has possible sepsis )

Timolol (Timoptic)

treatment of glaucoma contraindicated in patients with bradycardia

medical emancipation

treatment of pregnancy, drug abuse, and STI = all minors Marriage, joining the armed forces, living away from home and earning an independent living make a minor emancipated Parenting another minor also makes emancipated Emergency care ( all sates), infection,mental health and substance abuse treatement,contraception

grand mal seizure

type of severe seizure with tonic-clonic convulsion

isotonic solutions make blood pressure go?

up

when a person is immobile and bearing weight the serum calcium levels will go?

up the patient can develop kidney stones

Discharge after vasectomy

use alternative birth control after cleared by PHCP

Misoprostol (Cytotec) side effects

uterine tachysistole (5 contractions in 10 min) -Diarrhea, -abdominal pain, -N&V, -gas, -headache, -cramping, -uterine contractions, -dysmenorrhea (painful bleeding) Uterine hyperstimulation/tachysystole. Impairment of uteroplacental blood flow. Maternal hemorrhaging. Uterine rupture. Amniotic fluid embolism. Pelvic pain. Retained placenta. Shock. Placental abruption (when used in women with preeclampsia) In the mother, some of these complications may necessitate a hysterectomy (removal of the uterus). administered by vaginal pill, rather than through IV or a removable vaginal insert like other labor drugs (Pitocin, Cervidil). The Cytotec pill may be cut into quarters in order to give a smaller dosage at one time.

Zika mode of transmission

via mosquitoes,sexual contact, and infected bodily fluids,can cause microcephaly,developmental dysfucntion, and encephalitis encourage female pt pregnant or planning yo become pregnat should postpone trip to affected areas

3 developmental milestones:

walks up satirs with alternating feet pedals trycicle jumps forward draws a circle feed self without helpgrips crayon with fingers i stead fist says 3-4 word sentences ask why questions states own name

clean catch for culture and sensitivity female

wash hands clean vulva front to back with antiseptic prior to urinating, urinate before passing the container into the stream for collection and remove before flow ends do not touch unside rimof the container

over flow incontinence

when neurologic disorder or anatomic obstruction from pelvic organs or the prostate limits bladder emptying until the bladder is overdistended blocked urethra constant dribbling of urine, bladder not completly empty p voiding, blockage, bladder weakness. Tx: bladder retraining

eleminating aged cheese, processed meats and food containing tyramine

when taking monoamine oxidase inhibitors,trynocylpromine,phenelzine

concentrated urine

when the osmolarity of the kidney filtrate exiting the body is greater than 300 mOsm.

pertussis

whooping cough; highly contagious bacterial infection of the pharynx, larynx, and trachea caused by Bordetella pertussis set srandard and droplet precautions

serum potassium in metabolic alkalosis

will be down

potassium in metabolic acidosis

will be up

if you lose alot of blood

your body will retain fluid

Pancreatitis signs and symptoms

• Abdominal pain present in the mid-epigastric or LUQ • Pain is more severe when lying down and may radiate to the back or flank area • Abdominal tenderness with decreased or absent bowel sounds • Nausea and vomiting • May have symptoms of shock: due to panceratic hemorrhage • Bulky, pale foul smelling stools (steatorrhea) • Hypocalcemia due to fixation of calcium in area of fat necrosis

metabolic acidosis causes

• Incomplete oxidation of fatty acids. May be due to (1) diabetic ketoacidosis, (2) starvation, or (3) shock, resulting in lactic acidosis. • Abnormal loss of alkaline substances. This may be caused by deep, prolonged vomiting (leading to excessive loss of base products) or severe diarrhea and loss of pancreatic secretions. • Renal insufficiency and failure: kidneys lose ability to compensate for acid overload; thus, H⁺ ions are not excreted, nor is HCO₃⁻ retained in normal amounts. • Salicylate poisoning due to accumulation of ketone bodies produced as a result of the increased metabolic rate. Hyperkalemia: muscle weakness,muscle twiching, flacid paralysis,arrythmias,kaussmal respirations

High Alert Medications in Acute Care Settings

• Insulin - subcutaneous and IV • Opiates and Narcotics - IV, transdermal, oral • Injectable Potassium Chloride or Phosphate Concentrate • Intravenous Anticoagulants (Heparin) • Sodium Chloride Solutions above 0.9 percent concentration (Joint Commission, 1999).

hypertonic solutions

• Used to treat situations of hyponatremia and hypovolemia. • Administer slowly; can cause intravascular volume overload; carefully monitor serum sodium, lung sounds, and blood pressure. Solutions. • Dextrose 5% in 0.45% or half-strength NaCl (normal saline). • Dextrose 5% in 0.9% NaCl (normal saline). • Dextrose 5% in Lactated Ringer's.

post extubation care

•Assess for airway trauma •Assess RR, rhythm, quality, breath sounds, pulse oximetry •Assess vital signs •Vigorous pulmonary hygiene every 2 hours •Keep oxygen device in place Administer warmed air,hummidified oxygen via mask place on high fowler's provide oral care instruct to often cough,deep breathe and use incentive spirometer rationale: recently extubated patients are at risk for aspiration, airway obstruction(laryngeal edema or spasms) and respiratory distress. Place the pt NPO until swallow reflex has been evaluated