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
L vs R sided HF
L = Lungs
R = Rest of body
Weight in patients w/ HF
- Weigh daily in the AM
Stable vs unstable A-fib
Stable: Alert
Unstable: AMS
What is missing on EKG of person w/ A-fib
No p-wave
Intervention for stable A-fib
vagal maneuvers, adenosine
Cardioversion for unstable a-fib
Electrical cardioversion
Oral meds for A-fib
Digoxin and anticoags
DVT stuff
- Unilateral pain, swelling, commonly in calf.
- Do not massage
D-dimer normal value
Positive = Positive for DVT
Assessment findings for PAD and PVD
PAD: Cool, dry, shiny skin
PVD: Warm, red/brown, edematous
Nursing care of PAD vs PVD
PAD: Elevate affected limb
PVD: Let affected extremity hang (do not elevate)
Meds for PAD and PVD
PAD: Antiplatelets (aspirin, clopidogrel). Statins
S/s and tx of intermittent claudication
S/s: Ambulation/ exertion pain (never present at rest)
Tx:
What 2 medications are given to patients pre-op for cataract surgery
mydriatic drops and NSAIDs
A white 65 year old patient w/ hx of smoking and type 2 DM presents to the clinic complaining that their vision has been getting progressively worse. Upon assessment, the nurse notes that the patient’s lens appears cloudy. What does the nurse suspect?
Cataracts
A patient has just had surgery to correct cataracts and is being prepared for discharge. Which signs should the nurse include in the teaching that would require the patient to contact the provider?
Pain, conjunctival injection, vision loss, sparks, flashes, floaters, N/V, excessive coughing.
How is glaucoma dx?
Increase IOP
What is the screening process for glaucoma?
Yearly screening for IOP after 40 years old.
What can occur if glaucoma is left untreated?
Permanent blindness r/t optic nerve damage.
What ophthalmic meds are used for glaucoma?
- Beta blockers (-lol)
- Adrenergic (iopdine)
- Myotic cholinesterase inhibitors (-pine)
- Prostaglandin analogs
A patient reports to the clinic with complaints of “floaters” and a curtain over their visual field. What is the suspected diagnosis?
Detached retina
Tx for detached retina
Gas bubble to hold retina back in correct place.
A patient with new diagnosis of macular degeneration is preparing for discharge. What education should be provided r/t food and dietary supplementation?
Encourage fruits, veggies, zinc-oxide, cupric oxide, betacarotene, vit C, and vit E.
What visual changes occur in patients with macular degeneration?
Central vision loss
When reviewing a patient’s chart with hearing loss, the nurse should know that which meds may contribute to/cause hearing loss?
Abx, loop diuretics, propanolol, aspirin, NSAIDs
An overweight patient presents to the clinic with complaints of persistent productive cough for the past 4 months. On assessment they appear cyanotic and the nurse hears rhonchi and wheezing during auscultation of the lungs. What diagnosis does the nurse suspect?
Chronic bronchitis
A 70 year old patient presents to the clinic with complaints of severe dyspnea. The patient is thin and upon auscultation of lungs the nurse notes diminished breath sounds. What diagnosis does the nurse suspect?
Emphysema
A patient is discharged after receiving antivirals for shingles. What education should be included regarding vaccination, management, and prevention?
Vaccination: Adults > 50 years old should get shingles vaccine
General education: Not contagious after lesions crust over (2 to 4 weeks). Monitor for infection.
Management: Antivirals, pain management
A patient has a FAST score of >4. What does this indicate?
They will require help completing ADLs
What are 3 ethical concerns regarding cultural and spiritual considerations in EOL care?
Communication of bad news, focus on decision-making, and attitudes toward advanced directives
What does “by mouth, by the clock, by the ladder” mean regarding analgesic administration?
Drugs should be taken at regular intervals, orally whenever possible, and should be prescribed starting at Step 1 (nonopioid analgesics) and titrated upward as needed
What is the goal of treatment of chronic pain using the WHO analgesic ladder?
Baseline pain control within 24 hours of assessment and initiation of treatment plan defined by resident and family
What does the nurse expect in a patient with a FAST score of 7?
Speech is lost, incontinence, cannot walk/ bed ridden
Nociceptive pain
injury to skin, mucous, or bone leading to stimulation receptors
caused by damage to the body
What is the most common medication given for Alzheimers? What is a common side effect of this medication?
- Donepezil
- GI complications
What is the only medication that can be added to donepezil?
Memantine
A nurse is caring for a patient with dementia that is showing increased signs of agitation, forgetfulness, etc. What medications may be causing this increase in symptoms?
Anti-cholinergics, benzos, analgesics, ant-hypertensives, and corticosteroids
A nurse uses the GDS to screen a patient for depression. What score suggests depression?
Score > 5
What is relevant info r/t depression meds?
- SSRIs and SNRI: Decreased sex drive
- Tricyclics: Orthostatic hypotension,
- MAOIs: Hold 10 to 14 days before surgery
What electrolyte imbalances are r/t tumor lysis syndrome?
Hyperkalemia, hyperuricemia, hyperphosphatemia, hypocalcemia.
What med is used for tx of tumor lysis syndrome? Ed?
Allopurinol. Hydrate, maintain urine output of 150mL/hr.
What foods should be recommended for a patient with iron-deficiency anemia?
Red meats/ organ meat. Vitamin C/citrus increases iron absorption.
What dietary recommendations should be made to a patient with hemolytic or folate anemia?
- Folic acid, vitamin C
- Veggies, whole grains, fruits, citrus
When reviewing a patient’s blood work, the nurse sees that the patient’s MCV is 70. What can cause this/ what type of anemia does the nurse suspect?
- Caused by blood
- iron deficiency anemia
When reviewing a patient’s blood work, the nurse sees that the patient’s MCV is 104. What type of anemia does the nurse suspect?
- Pernicious (B12) or folic deficiency
When reviewing a patient’s blood work, the nurse sees that the patient’s MCV is 90. What can cause this/ what type of anemia does the nurse suspect?
- Caused by autoimmune response
- Hemolytic anemia
What is the most effective treatment for Leukemia?
Bone marrow transplant
