Exam One Blueprint Flashcards
What are the five rights of delegation?
Right task: The task that is delegated should be appropriate for the patient and the delegatee’s scope of practice
Right circumstance: The patient’s condition, available resources, and other relevant factors should be considered
Right person: The delegatee should be competent to handle the task
Right direction and communication: Clear expectations should be communicated, and feedback should be encouraged
Right supervision: The delegatee should have the necessary supervision
Monitoring a patient with angina and giving meds - how to tell if effective?
Giving medications to a patient for angina, evaluation is are they now not having chest pain?
Staging for hodgkins/n-h lymphoma
Hodgkin’s staging:
- A or B classification
– presence of systemic symptoms when disease is found
– A is absence; B is present
- Roman numeral (I to IV)
– location and extent of disease
– stage III is above and below diaphragm; stage I is single lymph
NHL categorized by:
- level of differentiation
- cell of origin
- rate of cellular proliferation
- immunophenotype (cell surface markers)
- clinical features
Patient education with SL NTG?
- call 911 if pain is the same or worse after 5 minutes
- can be used to prevent chest pain before strenuous activities
- sit down before taking SL NTG because it can lower BP and make the patient dizzy
- may be on short and long-acting nitrates: do not take off nitro patch before SL NTG
What is the administration for SL NTG? Timing?
1 tablet placed under the tongue or between the cheek and gum at the first sign of an angina attack
1 tablet may be used every 5 minutes as needed, for up to 15 minutes.
Do not take more than 3 tablets in 15 minutes (3 can be taken, but no more than that - it should be improving pain or take it away).
- can take SL NTG preventatively
What are hypertonic IV fluids? Example? Indications?
Give small amount of IV hypertonic saline solution (3% NaCl) (10% dextrose in 0.9% sodium chloride)
Important to note:
- can cause water retention
- monitor for signs of fluid volume excess
take daily weight, assess for peripheral edema, assess for crackles in lungs
old cards:
Greater concentration of particles than plasma. causing water to move out of the cells and to be drawn into the intravascular compartment, causing the cell to shrink.
Definition: solutions that are more concentrated or have a higher osmolality than body fluids
- concentrate ECF and cause movement of water from cells into ECF by osmosis
- monitor for fluid overload, but used to treat hypovolemia and replace fluid and electrolyte
don’t want to dehydrate cells - they can shrivel
Example: 5% dextrose in 0.9% normal saline
Example: 5% dextrose in LR
They are used to treat severe hyponatremia and cerebral edema.
What are signs of bronchitis?
- cough
- clear/purulent sputum
- headache
- fever
- malaise
- dyspnea
- chest pain
Anemia caused by blood loss: acute and chronic
Acute Causes:
- Conditions or diseases that disrupt vascular integrity
- Hypovolemic shock
- Compensatory increased plasma volume with diminished O2 -carrying RBCs
———–
Chronic sources of blood loss:
- Bleeding ulcer
- Hemorrhoids
- Menstrual and postmenopausal blood loss
Fluid and electrolyte balance: What is important to consider with older adults?
- thirst mechanism decreases with age
- teach client to assess signs of dehydration
– dry mucosa
– thick oral secretions
What lab value is important to watch with loop diuretics used in patients with HTN?
hypokalemia
furosemide, bumetanide, and torsemide - cause loss of potassium
What are preventions for bronchitis?
most caused by viruses idk stay away from sick people
other triggers: pollution, chemical inhalation, smoking, chronic sinusitis, asthma
What are differences between Hodgkins and non-hodgkins lymphoma?
Hodgkin’s: genetic, occupational, gradual onset
- B symptoms correlate with worse prognosis
– fever greater than 100.4
– drenching night sweats
– weight loss exceeding 10% in 6 months
- unexplained bruising and bleeding
- high incidence of secondary cancers; important to follow up with appointments and teach this in discharge
NHL: unknown cause, many factors, no hallmark feature
- more common, but worse outcomes than compared to Hodgkin’s
- over 75 types
- primarily B, T, or NK, histiocytic and dendritic cells
- can have B symptoms
- complete remission uncommon
What are the normal values and manifestations of Hgb/Hct?
HGB
Men: 13.5-17.5
Women: 12.0-15.5
HCT
Male: 41-50%
Women: 36-44%
What are causes of neutropenia?
i can’t find the ppt for this ive searched three i thought were it
online: Neutropenia can occur due to a number of possible reasons, including infections, genetic conditions, cancer treatments, and medications.
What are serum Ca implications of multiple myeloma?
-
hypercalcemia may lead to complications such as dysrhythmias or seizures
calcium is the most important lab to monitor with multiple myeloma because it can cause cardiac rhythm issues and seizures if high
Hypercalcemia in the blood could be an indicator of multiple myeloma
Excess calcium in the blood can cause bone pain and kidney problems.
goals are to control pain and fractures because of hypocalcemia
Risks of thrombocytopenia?
bleeding risk
What can be done for patients with COPD to improve quality of life?
send them home with oxygen
can travel with oxygen
What are the indications of TEE (transesophageal echocardiogram)?
used to evaluate the heart and aorta for a number of conditions
online:
- To evaluate the cause of a stroke, such as a blood clot, valve abnormality, or plaque in the aorta
- To assess the function of prosthetic heart valves
- To evaluate for endocarditis
- To assess for aortic dissection or aneurysm
- To assess for congenital heart disease
- To assess for cardiomyopathy
- To assess for heart failure
Management of chest tubes
setup and insertion:
- consent and aware of procedure
- gather and setup equipment as per order
drainage system:
- keep tubing loosely coiled
- keep connections tight; taped
- observe: tidaling, bubbling, air leak, fluid levels
Pathophysiology of COPD?
airflow obstruction and chronic inflammation??
alveoli and bronchioles destroyed
Signs of an acute MI?
Pain
* Sympathetic nervous system stimulation
* Cardiovascular
* Nausea and vomiting
* Fever
- chest pain that has been going on for over half an hour
SL NTG taken and pain worsens or doesn’t go away after 5 minutes
Manifestations of hyponatremia
- Poor skin turgor
- Dry mucosa
- Headache
- Nausea
- Abdominal cramping
- Edema
- Crackles
- JVD
- Altered mental status
- Lethargy
- Seizures
- General weakness
Aplastic anemia
Pancytopenia: Decrease in all blood cell types
- Red blood cells (RBCs)
- White blood cells (WBCs)
- Platelets
- Hypocellular bone marrow
potentially reversible but can be fatal
Acquired Hemolytic anemia
Results from hemolysis of RBCs from extrinsic factors:
- Physical destruction
- Antibody reactions
- Infectious agents and toxins
What are treatments of pneumonia?
prompt treatment with antibiotics (bacterial)
- response generally in 48-72 hours
– decreased temp, improved breathing, decreased chest discomfort
viral - no definitive treatment
- antivirals: influenza and herpes
supportive care
- oxygen for hypoxemia
- analgesics for chest pain
- antipyretics for fever
- adjuvant drugs
- individualize rest and activity
What are the causes of anemia?
A deficiency in
Number of erythrocytes (RBCs)
Quantity or quality of hemoglobin (Hgb)
Volume of packed RBCs (hematocrit)
Not a specific disease
Manifestation of a pathological process
What are signs of pneumonia?
crackles with a diagnosis of influenza may indicate developing pneumonia
Most common:
- cough: productive or nonproductive
- green, yellow, or rust-colored sputum
- fever, chills
- dyspnea, tachypnea
- pleuritic chest pain
Physical exam:
- fine or coarse crackles
- with consolidation:
– bronchial breath sounds
– egophony
– increased fremitus (99 thing from lab)
- with pleural effusion:
– dullness to percussion
older or debilitated patients: confusion or stupor, hypothermia
can be a complication of the flu
Sickle cell anemia
Most severe
homozygous for hemoglobin S (Hgb SS)
Spleen becomes compromised
pain is the most common symptom, they will require opioids to manage
Triggered by low 02 tension in blood
Severe, painful, acute exacerbation of RBC (severe joint pain and swelling, jaundice)
Thalassemia
Causes:
A group of diseases involving inadequate production of normal Hgb
Results in decreased RBC production
Due to absent or reduced globulin protein
Abnormal Hgb synthesis
Hemolysis occurs
Hypertension (things to look out for)
Check for orthostatic hypertension
acute kidney injury/renal failure
(if BP is acute with no hx of BP check kidney function)
Potential MI/ monitor cardiac function
Neurological checks with patient is admitted for hypertensive emergency
Taking BP correctly
No smoking, exercise, or caffeine 30 minutes prior to BP
Rest quietly for 5 minutes; relax; no talking
Proper size and placement of cuff important for accuracy
Position arm at level of heart
Use auscultatory (oscillatory) method
Deflate 2 to 3 mm Hg/sec
Take in both arms; note differences
Use arm with highest BP for future
If can’t use upper arm; use forearm and radial artery or Doppler;
document site
Clean cuff between patients per agency policy
Indications for chest tubes; reasons for placement
- hemothorax
- pneumothorax
- tension pneumothorax has chest tube and water-seal drainage
are placed to drain pleural space, reestablish negative pressure, and allow lung to expand
Discharge teaching for antibiotics
adherence; don’t stop antibiotics before cycle is finished even if symptoms improve
Treatment for hyperkalemia?
- Stop oral and parenteral potassium intake
- Increase potassium excretion (diuretics, dialysis)
- Force potassium from ECF to ICF by IV insulin with dextrose
- Stabilize cardiac cell membrane by administering calcium gluconate IV
What are treatments of bronchitis?
from her blueprint:
splint chest to decrease pain with coughing
cough suppressants frequently used for nonproductive cough associated with acute bronchitis
- cough suppressants used if nonproductive cough because no sputum to get rid of
coughing and deep breathing important, even when discharged
blood cultures in 2 sites before antibiotics
treatment goal: symptom relief and prevent pneumonia; supportive
- cough suppressants, oral fluids, humidifier
- beta 2-agonist inhaler
- avoid irritants
- influenza: antivirals within 48 hours if developped
- see HCP for fever, dyspnea, or duration greater than 4 weeks
Pathophysiology of asthma?
- hx of allergic rhinitis common
- acute and chronic sinusitis might make asthma worse
heterogeneous disease characterized by a combination of bronchial hyperresponsiveness with reversible expiratory airflow limitation
Pain management for rib fractures?
- NSAIDs
- opioids
- nerve blocks
flail chest: three or more consecutive fractured ribs in 2 or more places or fractured sternum and several consecutive ribs
- unstable chest wall and paradoxical movement with breathing
What is multiple myeloma?
condition in which cancerous plasma cells proliferate in the bone marrow and destroy bone
accounts for 1.8% of all cancers
Infection risk with neutropenia
-
ANY fever, even <101 is concerning in a neutropenic patient
class review: concerned with anyone who has a fever and is neutropenic; fever is considered 99.8F for them
– indicates infection and can lead to sepsis
– high risk for developing sepsis
What are barriers to access of healthcare?
- socioeconomic factors
- stereotyping
- biases
What is the priority assessment with hypovolemia? (for this one did you mean like when giving IV fluids to fix? because hypovolemia is fluid volume deficit)
VS, tissue perfusion, mental status
Fluid resuscitation - adding more fluid into them: Monitoring signs for fluid overload while doing so
- Bounding pulse
- Difficulty breathing
- Neck vein distension in the upright position
- Presence of dependent edema
What is the most common manifestation of sickle cell anemia?
pain is the most common manifestation
requires large doses of opioids and increased fluids
Anemia of Chronic Disease/Inflammation
Can be caused by:
- Cancer
- Autoimmune and infectious disorders
- HIV, hepatitis, malaria
- Chronic inflammation
- Heart failure
- Bleeding episodes
Usually a mild anemia but can become severe if the underlying disorder is untreated
What are the SDOH?
- access to education
- economic stability
- neighborhood and built environment
- access to quality healthcare
- social and community context
Hematologic assessment: What is important to consider with the older adult regarding Hgb/Hct and WBC?
- Hgb/Hct may be slightly decreased
- WBC usually unchanged
What is respiratory acidosis? Values?
Respiratory acidosis is indicated by an arterial blood gas (ABG) with the following values:
pH: Less than 7.35
PCO2: Greater than 45 millimeters of mercury (mmHg)
HCO3: Greater than 30 milliequivalents per liter (mEq/L)
What are effective questioning techniques for health history?
Active listening, eye contact, body language, empathy.
Open ended questions
Clarifying questions
Nursing process: Planning step, what is the purpose
Long term, short term, measurable, Time frame bounded and specific.
Priority assessment with asthma?
- -A, B, C’s
- Consider degree of stress
- evaluate effectiveness of treatment with O2 sat
Nursing process: Diagnosis step, what is the purpose
The purpose of the diagnosis step in the nursing process is to identify and document a patient’s health needs and concerns. This information is then used to create a care plan for the patient.
(Basically the patients HPI)
What are the normal values and manifestations of WBC?
5,000-10,000
Complications of rib fractures?
- pain
- respiratory distress
- pneumothorax
- pneumonia
- atelectasis
What is the importance of home oxygen?
- increases quality of life
- improves survival
Manifestations of hypokalemia?
5 listed
- Cardiac most serious
- Skeletal muscle weakness (legs)
- Weakness of respiratory muscles
- Decreased GI motility
- Hyperglycemia
How can you decrease bias?
Can decrease incidence through education
What are the normal values of serum Ca?
8.5-10.2 mg/dL
Why is incentive spirometry important to use with rib fractures?
to prevent pneumonia
What are preventions for aspiration?
Keep HOB elevated with tube feeds
Staying with patient while feeding/drinking or helping them if needed
Liquid thickener
Mechanical alterations to food - puree, chopping
Modifiable risk factors for CAD
High cholesterol
Hypertension
Physical inactivity
obesity
Acute and chronic stress
Substance use
What is the normal value and function of Na?
136-145 mEq/L
its primary function is to help maintain proper fluid balance in the body, supporting nerve and muscle function by regulating the movement of fluids across cell membranes
Heparin-Induced Thrombocytopenia (HIT
Stop all heparin
Techniques of aspiration prevention?
- elevate HOB 30 degrees and have sit up for all meals
- assist with eating, drinking and taking meds as needed
- assess for gag reflex
- monitor reflux and gastric residuals (NG tube)
- early mobilization
- cough and deep breathe, incentive spirometry
- twice daily oral hygiene
Treatment for hypernatremia?
Replace fluid orally or IV with isotonic or hypotonic fluids.
Medications for COPD?
Treatments:
SABAs and oral corticosteroids
Other: anticholinergic, antibiotics, diuretics
Oxygen
Noninvasive preferred
Nursing process: Assessment step, what is the purpose
Subjective data: Current complaint, history, meds, etc
Objective data: Vital signs, I&O, Height, weight, etc
Patient education with an MRI
- they need to be screened for any implants or piercings and be honest about it because the magnet can rip the metal out of them
- educate that no metal can be in the MRI
- educate that if MRI is absolutely necessary and the patient has a pacemaker, cardiology will turn the pacemaker back on afterwards
What is the safe rate of potassium replacement?
Always dilute IV KCl, NEVER give KCl via IV push or as a bolus, and should not exceed 10 mEq/hr. Only use a pump.
What are risk factors of aspiration?
dysphagia, poor gag reflex, altered mental status
aspiration pneumonia
lol death from choking
What is metabolic alkalosis? Values?
condition where the blood pH level becomes too alkaline (above the normal range of 7.35-7.45) due to an increase in bicarbonate (HCO3-) bicarbonate level above 26 mmol/L and a blood pH greater than 7.45;
Complications of an acute MI?
Dysrhythmias
* Heart failure—decreased pumping power
* Cardiogenic shock—decreased O2 and
nutrients related to:
* Papillary muscle dysfunction or rupture
* Left Ventricular Aneurysm
* Ventricular septal wall rupture and left
ventricular free wall rupture
* Pericarditis
* Dressler syndrome
What is the pathophysiology of multiple myeloma?
cancerous plasma cells proliferate in the bone marrow and destroy bone
- develops slowly and insidiously
- skeletal pain is major manifestation
- diffuse osteoporosis develops
What is the normal value and function of BUN?
6 to 20 milligrams per deciliter (mg/dL)
its function is to measure the amount of urea nitrogen in your blood
Clinical Judgment: Tanner’s Model - what are the steps?
Noticing, Interpreting, Responding, and Reflecting; essentially, recognizing relevant cues, understanding their meaning, taking appropriate action based on that interpretation, and then evaluating the patient’s response to the action taken.
Risk assessment and guidelines for sexual activity and CAD?
(I only saw an answer about this for acute coronary syndrome)
Erectile dysfunction drugs contraindicated with nitrates
* Prophylactic nitrates before sexual activity
* When to avoid sex
– Typically 7 to 10 days post MI
* when patient can climb two flights of stairs or brisk walking
Disseminated Intravascular Coagulation (DIC)
Serious bleeding and thrombotic disorder
- Results from abnormally initiated and accelerated clotting
- Decreases in clotting factors and platelets ensue
- May lead to uncontrollable hemorrhage
- Always caused by an underlying disease or condition
What is the normal value and function of Mg?
- Cofactor in enzyme for metabolism of carbohydrates
- Required for DNA and protein synthesis
- Blood glucose control
- BP regulation
- Needed for ATP production
1.3- 2.1 milligrams per deciliter (mg/dL)
What are you supposed to do with identification of patients to maintain medication safety?
Use two patient identifiers
Exacerbation management with asthma?
oxygen, meds, monitor
asthma attack:
- how to assess treatment: can measure oxygen saturation
- don’t rely on no wheezing because it can be a “silent chest”
Manifestations of a pneumothorax
actual notes:
Small pneumothorax:
- mild tachycardia and dyspnea
Large pneumothorax:
- respiratory distress
- absent breath sounds over affected area
ummmm they suck ass.
mine: hahahahahah
- chest pain in middle of chest
- right side of chest was not moving with respirations
- difficulty breathing
- increased pressure in chest when laying down; incredibly uncomfortable
- vibration feeling in my chest when breathing
What are preventions of pneumonia?
- pneumococcal vaccines
Thrombocytopenia
abnormally low number of platelets in the blood
Normal Homeostasis
- Involved vascular endothelium, platelets, and coagulation factors. Pts often asymptomatic
- Will cause internal bleeding- can be insidious or acute
What are high-alert medications?
Meds that have the highest risk of causing patient harm.
1. Insulin
2. chemotherapy drugs
3. opioids
4. potassium
5. parenteral nutrition
6. anticoagulants
7. look alike and sound alike drugs
Iron-deficiency anemia
most susceptible and causes
Most common nutritional disorder in the world:
Most susceptible:
* Very young
* Poor diet
* Women in reproductive years
Causes:
* Inadequate dietary intake
* Malabsorption
* Blood loss
Laboratory findings
Hgb, Hct, MCV, MCH, MCHC, reticulocytes, serum iron, TIBC, bilirubin, platelets
What are nursing interventions of ineffective airway clearance?
- adequate oxygenation?
- teach coughing and splinting if able
- assess respirations
- improve breathing techniques
- clear the airway
teach patient how to splint chest with pneumonia and coughing for airway clearance
RN vs LPN vs UAP scope of practice
Treatment for hypertension
drug therapy - 2 primary actions; HTN & Stage 2 treatment
Drug therapy:
- two primary actions:
– decrease circulating blood volume
– reduce SVR (systemic vascular resistance)
- adrenergic inhibiting agents
- ACE inhibitors
- A-II receptor blockers
- calcium channel blockers (CCB)
- direct vasodilators
- diuretics
HTN: nonpharmacologic treatment and first line pharmacologic drug (diuretic)
Stage 2 HTN: nonpharmacologic therapy and 2 antihypertensives from 2 different classes
Treatment for hypermagnesemia?
Prevention first—restrict magnesium intake in high-risk patients.
When a patient has symptoms:
* IV CaCl or calcium gluconate
* Fluids and IV furosemide to promote urinary excretion
* Dialysis
What is subjective vs objective data?
Patients perspective vs actual data
Normal vs abnormal findings of EKG monitoring
- if someone comes in with a low heart rate, you would put them on EKG monitoring in the ER to see what is coming up
- used if any abnormality found
Manifestations of hyperkalemia?
- Dysrhythmias
- Fatigue, confusion
- Tetany, muscle cramps
- Weak or paralyzed skeletal muscles
- Abdominal cramping or diarrhea
Expected findings of chronic HF?
Fatigue
* Dyspnea
* Orthopnea
* Paroxysmal nocturnal dyspnea
* Cough
* Tachycardia
* Palpitations
* Edema
* Dependent, liver, abdominal cavity, lungs
* Edema may be pitting in nature
* Changes in urine output
* Nocturia
* Skin changes
* Neurological manifestations
* Mental status and behavioral changes
* Sleep problems
* Chest pain
* Weight changes
Cobalamin Deficiency/Folic acid deficiency
Causes:
- General manifestations of anemia develop slowly due to tissue hypoxia
GI problems:
- Neuromuscular problems
Causes megaloblastic anemia
Folic acid is needed for DNA synthesis
RBC formation and maturation
What are isotonic IV fluids? Example? Indications?
Examples of isotonic IV fluids: 0.9% normal saline (NaCl), 5% dextrose in water (D5W), and Lactated Ringer’s solution (LR).
Uses of isotonic IV fluids
Fluid volume deficit (hypovolemia)
Vomiting
Diarrhea
Shock
Metabolic acidosis
Resuscitation
Blood and blood product administration
What is a priority with CAD?
- chest pain is a priority
- chest pain lasting longer than 20 minutes is a characteristic of an acute MI
- first intervention with chest pain is an ECG
What is error prevention regarding medication safety?
just typing from my head and pharm - but reporting any errors, doing 2 patient identifiers, doing the 3 checks of medication administration
What are signs of blood transfusion reactions?
fever
online:
Mild reactions: Fever, Chills, Itching, Hives, Nausea, Vomiting, and Soreness at the IV site.
Moderate reactions: Rapid heartbeat, Low blood pressure, Difficulty breathing, Chest pain, and Anaphylaxis (a severe allergic reaction).
Severe reactions: Hemolytic reaction (destruction of red blood cells), Renal failure, Disseminated intravascular coagulation (DIC), and Death.
Manifestations of hypomagnesemia?
- Resembles hypocalcemia
- Muscle cramps, tremors
- Hyperactive deep tendon reflexes
- Chvostek’s and Trousseau’s signs
- Confusion, vertigo, seizures
- Dysrhythmias
What are causes of ineffective airway clearance?
- TB, lung cancer
Nursing process: Implementation step, what is the purpose
Independent nursing intervention
Collaborative: Dependent and interdependent
Patient education for hypertension
Lifestyle modification:
- weight reduction
- DASH eating plan
- dietary sodium reduction
- moderation of alcohol intake
- physical activity (150 mins/week)
- avoid tobacco products
- management of risk factors
- teach home BP monitoring; target BP, lifestyle changes, what medications are and why
- patient adherence
What is respiratory alkalosis? Values?
there’s not enough carbon dioxide in the blood.
Blood gas values for respiratory alkalosis
pH: Greater than 7.45
PaCO2: Less than 35 mm Hg
HCO3- Decreased concentration
Manifestations of hyponatremia?
- Mild: headache, irritability, difficulty concentrating
- More severe: confusion, vomiting, seizures, coma
What should you monitor for in a patient with hemophilia?
signs of bleeding:
- bruising
- joint pain and swelling
- hematuria
- blood in stool
- prolonged bleeding after injuries or procedures
- any unexplained bleeding
also closely monitoring their clotting factor levels through blood tests
one way to find internal bleeding is through the occult blood test
Troubleshooting chest tubes
- keep below chest
- mark and measure drainage
- avoid overturning unit
- don’t break the unit
- no milking or stripping chest tubes
- monitor water levels and gentle bubbling
- dry suction: turn dial to ordered amount
- may clamp chest tubes BRIEFLY to change drainage unit
- monitor for complications
Contraindications of MRI?
- magnet can change function of pacemakers
- no metal implants or connections
Treatments for hypokalemia?
treated with oral or intravenous potassium supplements. Treatments depend on the severity of the condition
Always dilute IV KCl, NEVER give KCl via IV push or as a bolus, and should not exceed 10 mEq/hr.
Interventions for blood transfusion reactions?
Stp transfusion give normal saline
- NSS is the only solution compatible because it is isotonic with blood
Treatment for hyponatremia?
seizure precautions
For severe hyponatremia: Give a small amount of IV hypertonic saline solution (3% NaCl).
For mild: limit fluid intake
Non-modifiable risk factors of heart failure?
- age
- sex
- family history
- race
- ethnicity
Emergency treatment for an acute MI?
STEMI
Cardiac cath?
Nitro and aspirin
What in a patient indicates that HTN is secondary to another problem?
a sudden increase in BP in a patient with no history of HTN
- will need treatment
- usually inpatient; admitted and treated
secondary HTN: elevated BP with a specific cause; sudden development
- clinical findings relate to underlying cause
- treatment aimed at removing or treating underlying cause
What are long-term complications of sickle cell anemia?
Can lead to shutdown of RBC production
What is neutropenia?
when the ANC (absolute neutrophil count) is less than 1000 cells/uL
What is the normal value and function of K?
3.5-5.0 mEq/L
nerve and muscle function, particularly in the heart, by helping to carry electrical signals to cells throughout the body.
What is considered a hypertensive crisis - what BP values?
SBP > 180mmHg
and/or
DBP >120 mmHg
What is important to consider regarding activity with patients who have anemia?
- alternate rest and activity
- vigorous exercise too quickly could make you feel exhausted because your body isn’t getting enough oxygen
Lifestyle modifications to include in teaching plan for CAD
- need to emphasize non-modifiable vs modifiable risk factors
- focus on modifiable risk factors
Hemolytic anemia
Destruction or hemolysis of RBCs at a rate that exceeds production
- Caused by problems intrinsic (hereditary) or extrinsic (external factors) to the RBCs
What are the normal values of ABGs?
pH: 7.35–7.45
Partial pressure of oxygen (PaO2): 75–100 millimeters of mercury (mmHg)
Partial pressure of carbon dioxide (PaCO2): 35–45 mmHg
Bicarbonate (HCO3): 22–26 milliequivalents per liter (mEq/L
Causes of hypertension
Primary HTN:
- altered endothelial function
- increased SNS activity
- increased sodium intake
- overproduction of sodium-retaining hormones
- overweight
- diabetes
- tobacco
- excess alcohol
Secondary HTN: elevated BP with a specific cause; sudden development; underlying cause
- cirrhosis
- aortic problems
- drug-related
- endocrine, neurologic, renal problems
- pregnancy-induced
- sleep apnea
- if someone comes in with a sudden increase in BP with no history of HTN, they will need to be admitted and treated
Priority assessment of heart failure?
- My guess is labs, fluids, heart monitor?
- labs, assess vital signs, oxygen saturation, presentation
What are the types of anemia?
Iron-deficiency anemia
Thalassemia
Megaloblastic Anemias
Anemia of Chronis Disease
Anemia of Inflammation
Aplastic Anemia
Anemia caused by blood loss: Acute and Chronic
Hemolytic Anemia
Sickle-cell Disease
Acquired Hemolytic Anemia
Hemochromatosis
Thrombocytopenia
- Immune Thrombocytopenua Purpura (ITP)
- Heparin- Induced Thrombocytopenia
- Thrombocytopenia from decreased platlet production
Hemophilia von Willebrand Disease
Disseminated Intravascular coagulation
Concerning findings of chronic HF?
- Pleural effusion
- Dysrhythmias and dyssynchronous contraction
- Atrial and ventricular
- Left ventricular thrombus
- Hepatomegaly
- Cardiorenal syndrome
- Anemia
Lab values: K, BNP, Na, and creatinine with heart failure
K: monitor for hypokalemia with diuretics and digoxin
BNP: higher levels = higher risk of failure
Na: should be limited intake idfk
Creatinine: elevated levels common in HF
I think all she cares about is potassium level. below 3 for heart failure
Treatment for hodgkins and non-hodgkins lymphoma
Hodgkin’s:
- treatment depends on the process of categorizing the extent and severity of the symptoms
– early: 2-4 cycles
– unfavorable: 4-6 cycles
– advanced: 6-8 cycles
- try to minimize short and long-term complications
- site radiation; remission, then chemo and stem cell transplant
NHL:
- chemo
- radiation
- stem cell transplant
What risks are associated with hemophilia?
bleeding risk
What is crisis management for sickle cell anemia?
Care is directed toward:
- Preventing sequelae from disease
- Alleviating manifestations from complications
- Minimizing end-organ damage
- Continuously assessing for and promptly treating serious sequelae
SBAR
Situation:
Background
Assessment
Recommendation
Medication adherence in teaching plan for CAD
- medication for CAD is effective if no chest pain
- need to continue taking the medication especially if they have no chest pain
Management of CAD
idk just typing - medication, changing modifiable risk factors, medication adherence
Treatment of hypomagnesemia?
- Treat underlying cause
- Oral supplements
- Increase dietary intake
- Parenteral IV or IM magnesium when severe
Anemia is diagnosed based on..
Diagnosed based on
* Complete blood count (CBC)
* Reticulocyte count
* Peripheral blood smear
Who has a higher incidence of tuberculosis?
immigrants
What are nursing considerations of TEE (transesophageal echocardiogram)?
- patient must be NPO because something is going down their throat
What are the 11 Rights of medication administration?
R patient
R medication
R dose
R route
R time
R reason
R assessment
R response
R document
R to education
R to refuse
Fluid and Electrolyte balance: what is homeostasis? what are shifts?
“homeostasis” refers to the body’s ability to maintain a stable internal environment by regulating the levels of fluids and electrolytes within specific ranges, ensuring proper bodily functions
“shifts” indicate a change in the distribution of fluids and electrolytes between different compartments within the body, potentially disrupting this stable balance.
Daily weight teachings with heart failure?
take daily weights
notify HCP if increase of 3 pounds in 2 days OR 3-5 pounds in a week
- let them know that this will occur before getting shortness of breath
- low sodium can cause seizures
Hemochromatosis
Iron overload disorder:
Genetic
What is the most accurate means of assessing volume status in patients?
daily weights
What are precautions to take with a patient who has neutropenia?
have a very high risk of infection and death from sepsis
- strict hand hygiene
- avoiding large crowds and sick people
- food safety by thorough washing fruits and vegetables, cooking meat thoroughly, not sharing personal items
- report any potential infection to HCP
Types of blood transfusion reactions?
Acute or Delayed
Hemophilia and von Willebrand Disease
von Willebrand disease is a related disorder involving deficiency of von Willebrand coagulation factor (Factor VIII)
What is the focus of teaching when taking health history?
Modifiable vs non-modifiable risk factors
What is the treatment for hemophilia?
-Diagnose which kind of hemophilia.
Prevantative care
replacement therapy
treatment of complications
What are the treatments for anemia? (General)
nursing interventions
Interventions:
Nursing care varies
Patients with fatigue
- Alternate rest and activity
- Prioritize activities
*Accommodate energy levels
*Maximize O2 supply for vital functions
severe anemia: because of the fatigue, you need to alternate rest and activity
- Aid to minimize risk of injury from falls
- Monitor cardiorespiratory response
- Evaluate nutritional needs
Precautions with thrombocytopenia?
medication precautions
- avoid ASA and other drugs that affect platelet function or production
- avoid IM injections
Priority assessment of COPD?
- tripod position: used to sit up and breathe better
- evaluate effectiveness of treatment with O2 sat
- vital signs, lung sounds, and breathing pattern
- Diaphragmatic breathing
What are the manifestations of anemia?
class review: basic symptoms are low blood count, fatigue, palpitations
**Integumentary:
- Pallor
– Decreased Hgb
– Decreased blood flow to the skin
- Jaundice
– Increased concentration of serum bilirubin
- Pruritus
– Increased serum and skin bile salt concentrations
**Cardiopulmonary
- Result from heart and lungs trying to provide adequate O2 to tissues
- Cardiac output maintained by increasing heart rate and stroke volume
Hgb levels are often used to determine severity of anemia
Manifestations vary based on how fast anemia has evolved, its severity, and any coexisting disease
Why is important to follow up after treatment for Hodgkin’s?
high risk of secondary malignancies (secondary cancers) from chemotherapy
Megaloblastic Anemias
Group of disorders
- Caused by impaired DNA synthesis
- Presence of large RBCs (megaloblasts)
Majority result from deficiency in:
- Cobalamin (vitamin B12)
- Folic acid
Non-modifiable risk factors for CAD
- Age
- Gender
- Ethnicity
- Family history
- Genetics
What are the indications for SL NTG?
to treat episodes of angina (chest pain) in people who have coronary artery disease (narrowing of the blood vessels that supply blood to the heart).
It is also used just before activities that may cause episodes of angina in order to prevent the angina from occurring
What is the first thing to do with someone who has chest pain?
get EKG to determine if acute heart attack is being experienced or something else
What are fluid compartments?
ECF includes fluid outside cells, comprising intravascular, interstitial, and transcellular fluids.
ICF- inside the cells
What should you do if you see signs of blood transfusion reactions?
stop transfusion and infuse normal saline (0.9%)
What are the three components of cultural competency?
- awareness
- sensitivity
- adaptation of care
integrate culturally-based therapies along with Western medicine
ask about beliefs, support systems
old card just as extra info:
- services to meet unique diverse needs of patients with consideration to culture
- recognize that culture matters in certain clinical encounters
- recognize limits of knowledge of a patient’s situation
- avoid generalizing assumptions
- be aware of provider and patient biases
- ensure mutual understanding through patient centered communication
- respectfully asking open ended questions about patient’s circumstances and values when appropriate
- understand health related behaviors resulting from cultural beliefs
- recognize values stemming from individual experience and cultural background
Discharge teaching for asthma
how to give inhalers
Nursing process: Evaluation step, what is the purpose
Evaluate client’s response
Form judgements about whether or not goals were met …go back to planning stage
Manifestations of hypermagnesemia?
- Hypotension
- Facial flushing
- Lethargy
- Nausea and vomiting
- Impaired deep tendon reflexes
- Muscle paralysis
- Respiratory and cardiac arrest
What is the purpose of Holter monitoring?
It is a monitor that is keep on for an extended time to basically keep a diary
- used to figure out what is going on with the patient
What should you monitor to assess for kidney damage in hypertension?
CRT – what is that? creatinine? was in her BP
kidneys: nephrosclerosis leads to chronic kidney disease
want to monitor BUN and creatinine
treated with diuretics so want to watch potassium levels
If you see someone with absent breath sounds coming in from an MVA, what do you suspect?
pneumothorax
treatment: chest tube
Therapeutic vs non-therapeutic techniques in communication
“therapeutic techniques” are methods designed to actively listen, validate patient feelings, and promote a positive nurse-patient relationship
“non-therapeutic techniques” hinder effective communication by interrupting, giving unsolicited advice, or minimizing patient concerns, potentially harming the therapeutic relationship
Manifestations of hypernatremia?
- Thirst
- Changes in mental status (drowsiness, restlessness, confusion, lethargy, seizures, coma)
- Symptoms of fluid volume deficit
Medications used with asthma?
- inhaled corticosteroids and rescue inhalers common for newly diagnosed asthma
- SABA
LABA - methylxanthines
- anticholinergic drugs
- three classes of antiinflammatory:
– corticosteroids
– leukotriene modifiers
– monoclonal antibodies
— anti-IgE
— anti-interleukin 5
What are hypotonic IV fluids? Example? Indications?
0.45% sodium chloride
Diarrhea or vomiting.
Heart failure.
online: Hypotonic solutions are given to treat cellular dehydration, hypernatremia, and to provide fluid for the kidneys to excrete waste. They are also used for patients with diarrhea, vomiting, or heart failure.
old card information:
Lesser concentration of particles than plasma
- should be administered slowly to prevent cellular edema
– causes cells to swell
- used for dehydration
- definition: solutions that are more dilute or have a lower osmolality than body tissues
Example: 0.45% NSS
Sickle cell disease (general)
Group of inherited, autosomal recessive disorders:
- An abnormal form of Hgb in RBC
- Genetic disorder usually identified during routine neonatal screening
- Incurable, significantly affects quality of life
What is the normal value and function of creatinine?
0.6-1.2 mg/dL for men
0.5 - 1.1 mg/dL for women
What, regarding medications, is common with hypertension?
- nonadherence!
- assess this with patients; ask them if they are taking their medication
What is metabolic acidosis? Values?
Metabolic acidosis is indicated by low bicarbonate levels and a low pH in the blood.
Bicarbonate:
Normal range: 22–29 mEq/L
Metabolic acidosis: 12–22 mEq/L
Severe metabolic acidosis: Less than 12 mEq/L
pH Normal range: 7.35–7.45 and Metabolic acidosis: Less than 7.35.
Modifiable risk factors of heart failure?
- smoking
- high blood pressure
- unhealthy diet
- lack of physical activity
- heavy alcohol use
- diabetes (if type 2)
- obesity
- illicit drug use
- poor nutrition
Patient teaching with Holter monitoring?
- patient will press a button on the monitor whenever they are having symptoms
- the monitor will flag is anything is showing
- it is basically a keeping a diary showing if anything is triggering symptoms
- patient keeps diary of symptoms and activities
