Adult care final exam Flashcards
56 year old male presents with blisters on one side of the body in a line near the ribs. Patient has hx of chicken pox as a child. What diagnosis does the nurse suspect?
The nurse should suspect herpes zoster (shingles)
A patient presents with inflamed, scaly lesions. They state that these lesions seem to come and go but they can never get rid of it for good. What does the nurse suspect? How might this be treated?
- Psoriasis vulgaris
- Treated with topical steroids, topical tar, and UV light therapy.
A patient presents to the clinic complaining of rash on their wrist. When you ask to see the rash, they take their watch off to reveal it. What condition does the nurse suspect? How is this treated?
- Contact Dermatitis
- Treated with steroids and removal of the triggering agent. (watch, poison ivy, etc.)
A patient presents with pruritic (itchy) blisters near their wrist. They denied having any possible contact with poison ivy or any other possible triggers for contact dermatitis. What might the nurse suspect? How will this be treated?
- Scabies
- Permethrin cream. Wash linens, clothes, etc.
A patient has recently been diagnosed with terminal cancer and has a prognosis of 3 months to live. Which type of consult for EOL care would be appropriate for this patient?
Hospice care
What type of care would be recommended to a family caregiver experiencing burnout?
Respite care
When can palliative care be suggested?
Any time during an illness, terminal or not.
When caring for a hospice patient, a family member asks the nurse why their family member is no longer receiving their chemo treatments. What is the most appropriate response?
When in hospice care, the priority is not treating the disease, but instead promoting comfort of the patient.
A nurse is caring for a patient at the end of life. They begin to display dyspnea, what nursing interventions can be done to address this finding?
-Pharm: Opiods, bronchodilators, diuretics
Non-pharm: Humidified O2, counseling, pursed lip breathing, energy conservation, fans, HOB elevation, music and massage.
The nurse knows that which of the following are considered signs of death:
A. Decreased urinary output
B. Increased urinary output
C. Blurred vision
D. Agitation
E. Nausea and vomiting
A, D
What is important to remember regarding ethics during EOL care?
Respect cultural/ personal preferences r/t death and grieving process.
A nurse is caring for a patient with chronic pain. The patient reports their current pain as 3 or 4 out of 10. What might be given and what is a SE to look out for?
- May be given an NSAID.
- NSAIDs can cause GI bleed
How much acetaminophen can be given daily to an adult on Ladder step one of the WHO analgesic ladder?
4000mg/daily
A patient with hx of chronic pain rates their pain as 9 out of 10. What may be given and what is a SE to look out for?
- May be given opioids
- Constipation may occur. Use miralax, Senna, etc.
A patient with chronic pain currently has an Rx for transdermal fentanyl. What are some advantages of this medication?
Non-enteral administration, Change q72h, Steady blood levels
A patient with chronic pain is seeking non-pharmacological therapies that may help their pain. What could the nurse suggest?
Socialization or recreational art therapies (movies, art therapy, music therapy). Behavioral therapy (hypnosis, relaxation, guided imagery) . PT (massage, US, exercise, heat and cold) . TENS
Why do older adults become acutely confused (delirium) and how do we recognize and intervene appropriately?
Intervention: resolve the cause
Recognize: Acute onset and similar s/s to dementia.
Discuss issues related to ensuring safe use of drug therapy in the older person.
- Use BEERs criteria
- Use 1 pharmacy
- Have medication list
- Medication reconciliation
Explain the interaction between normal aging and responses to drug therapy in older people
- Renal and liver function decrease and gastric acid becomes more alkaline (medications take longer to be broken down). May need to start w/ lower doses.
Recognize the gerontological nurse role in interprofessional collaboration
- Med reconciliation
- Assessment
Define frailty:
- Presence of 3 co-morbid conditions, ex. HTN, DM, Cancer
- Needs assistance with at least 2 ADLs
- Dx of at least 1 geriatric syndrome (Immobility, falls, polypharm, delirium, frailty, constipation, incontinence)
How to assess frailty
- Assess ability to complete ADLs.
Recognize factors of frailty
- Weakness, low walking speed, unintentional weight loss, exhaustion, low physical activity.
Ischemic stroke cause and management
- Caused by embolism/ blockage.
- t-PA
Hemorrhagic stroke cause and management
- Aneurysm rupture.
- Surgery. DO NOT give anticoagulants
TIA assessment
Normal stroke symptoms that resolve within 24 hours
FAST assessment (stroke)
- Face
- Asymmetry
- Speech
- Time
Eligibility for t-PA
- Must be given within 3 hours for most effective result
- Only given with ischemic stroke
Dysphagia assessment and complications
Assessment: Speech therapy (swallow study), thick liquids best.
Complications: Aspiration
Diet considerations/ fluid restriction for heart failure
- No more than 2g NA