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1
Q

Alzheimer’s risk factors

A

Family history of AD or Down Syndrome
Advanced age
Chemical Imbalances
Genetic predisposition, apolipoprotein E
Environmental agents or virus (herpes virus, metal, or toxic waste)
Previous head injury
Assigned female at birth
Ethnicity/race (AA or Hispanic)
PTSD

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2
Q

assessment tools for Alzheimers

A

mini mental state exam (MMSE)
clock drawing test
Mental cognitive assessment test (MOCA)
Brief interview for mental status
Set test using fruits, animals, colors, and towns (FACT)

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3
Q

Nursing care of Alzheimer’s patient

A

Bowel and bladder schedules
promote self care
avoid overstimulation
support group for family
reorient patient
allow rest periods
update white board
provide frequent walks to avoid wandering
secure or remove dangerous objects

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4
Q

Delirium risk factors

A

Advanced age
* Hearing or visually impaired
* Dehydrated
* Malnutrition
* Metabolic disorders
* ETOH/Drug abuse
* Pre-existing dementia
* Sleep deprived
* Receiving benzodiazepine medications

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5
Q

3 hallmark signs of delirium

A

1.Inattentiveness
2.Confusion/Disorganized
thoughts
3.Alteration in LOC

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6
Q

Signs of hypoactive delirium

A

withdrawn/drowsy
more common
harder to detect
higher risk of mortality

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7
Q

signs/ characteristics of hyperactive delirium

A

agitated
hallucinations
restless
aggressive

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8
Q

prevention of delirium

A

Glasses
* Hearing aids
* Day/night orientation
* Method of communicating if barrier
* Board in room with place & date
* Clock in view
* Noise control
* Promote sleep
* Cluster care activities

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9
Q

what are the screening tools of delirium

A

Richmond Agitation Sedation Scale (RASS)
Confusion Assessment Method(CAM)
Confusion Assessment Method for ICU (CAM-ICU)
Delirium Index (DI)

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10
Q

TX of delirium

A

identify reversible causes
avoid benzos
psychiatric consult if needed

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11
Q

Nursing interventions for delirium

A

don’t overstimulate
reorient frequently
speak in a calm voice
calming music
update board
clock in room
monitor o2
Do not overstimulate
* Anticipate and prevent or manage complications
* Urinary incontinence
* Immobility and falls
* Pressure ulcers
* Sleep disturbance
* Feeding disorders

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12
Q

risk factors of Parkinson’s

A

male
genetic
exposure to toxins
chronic use of antipsychotics (chlorpromazine)

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13
Q

4 cardinal symptoms of Parkinson’s (TRAP)

A

Tremors
Muscle rigidity
akinesia
postural instability

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14
Q

what is the goal of anticholinergic medication in the treatment of Parkinson’s?

A

reduce tremors, drooling and rigidity

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15
Q

what should you monitor for when a Parkinson’s patient is taking a dopamine agonist?

A

orthostatic hypotension, dyskinesia, hallucinations

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16
Q

what is deep brain stimulation and what should the nurse monitor for postoperatively?

A

targeted area received mild electrical stimulation to reduce tremors and rigidity
monitor for- infection, strokelike findings, brain hemorrhage

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17
Q

nursing actions for a Parkinson’s patient

A

administer meds
nutrition- at risk for aspiration, elevate HOB (45-90)
suction equipment at bedside, stool softener and fluid intake, communication strategies
implement safety precautions- falls sleep depravation, high risk tasks

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18
Q

ph normal range

A

7.35-7.45

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19
Q

PaCO2 normal range

A

35-45

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20
Q

HCO3 normal range

A

22-26

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21
Q

SaO2 normal range

A

95-100%

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22
Q

What is the acid base imbalance?
pH 7.37
PaCO2 47
HCO3 25

A

Compensated respiratory acidosis

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23
Q

What is the acid base imbalance?
pH 7.26
PaCO2 35
HCO3 16

A

Uncompensated metabolic acidosis

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24
Q

What is the acid base imbalance?
pH 7.30
PaCO2 58
HCO3 30

A

partially compensated respiratory acidosis

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25
What is the acid base imbalance? pH 7.52 PaCO2 26 HCO3 22
uncompensated respiratory alkalosis
26
risk factors for PAD
Hypertension Hyperlipidemia DM Smoking Obesity (BMI over 30) Sedentary Lifestyle Genetics Female sex Advanced age (over 50) Elevated C-reactive protein Hyperhomocysteinemia
27
clinical findings for PAD
Burning, cramping, and pain in the legs during exercise (intermittent claudication) Numbness or burning pain primarily in the feet when in bed Pain relieved by placing legs at rest in a dependent position Bruit over femoral and iliac arteries >3 sec cap refill Decreased or nonpalpable pulses Loss of hair on legs Dry, scaly, mottled skin Thick toenails Cold and cyanotic extremity Pallor of extremity with elevation Rubor of the extremity in dependent position Muscle atrophy Ulcers and possible gangrene of toes
28
Positioning for client with PAD
elevate legs but not above the heart
29
what is a medical emergency you need to worry about with PAD
Compartment syndrome
30
6 P's of Compartment syndrome
pain, paresthesia, pulselessness, pallor, poikilothermia, paralysis
31
Expected findings for a client with a DVT
Client can be asymptomatic Calf or groin pain, tenderness, and a sudden onset of edema in the extremity Warmth, edema, and induration and hardness over the involved blood vessel Changes in size (circumference) to affected leg !! SOB and CP can indicate that the embolus has moved to the lungs (PE)!!
32
diagnostics test for DVT
D dimer doppler flow Venous duplex and USN
33
complication of PVD
Pulmonary embolism
34
what does Raynaud's disease cause
vasospasm of the arteries
35
primary Raynaud's disease
Exposure to cold temp Stress Blood vessel vasospasm
36
secondary Raynaud's disease
Scleroderma Lupus Erythematosus Rheumatoid Arthritis Arterial Disease Carpal Tunnel Syndrome
37
Manifestations and assessment of a pulmonary embolism
Dyspnea, CP, apprehension, “feeling of impending doom”, hemoptysis Assessment values- Tachypnea, crackles, friction rub, S3 or S4, diaphoresis, petechiae over chest and axillae, and decrease SaO2
38
what should you do if you notice a Pulmonary embolimsm
NOTIFY the provider, assist client to comfortable position, O2, ABG, admin anticoag
39
client education for raynauds
medications side effects stop smoking exercise stress reduction limit caffeine avoid cold temperatures
40
risk factors for cellulitis
older clients weak immune system break in skin IV drug use DM
41
clinical manifestations of cellulitis
Tenderness, inflammation Skin sore or rash that spreads quickly Tight, glossy appearance of the skin Abscess w/ pus formation Fever, elev WBC’s
42
medication for cellulitis
IV antibiotics analgesics
43
COPD primary symptoms
Chronic cough Sputum production Dyspnea
44
copd chest shape
barrel chest
45
how should you instruct the client to breath with COPD
Pursed lip breathing
46
Diagnostic procedures of copd
ABG CHEST X RAY Spirometry is used to measure lung volumes and air flow. The two tests used are: Forced Vital Capacity (FVC) — maximum volume of air exhaled during a forced expiration Forced Expiratory Volume in 1 second (FEV1) — Volume of air exhaled in the first second of a maximal expiration after a maximal inspiration
47
what acid base imbalance would you expect for a client with COPD
respiratory acidosis
48
complications of COPD
pneumonia chronic atelectasis pneumothorax respiratory insufficiency/failure
49
manifestations of asthma
Dyspnea, chest tightness, anxiety or stress Physical Assessment Findings: Cough, productive or not Generalized wheezing Mucous production Use of accessory muscles Prolonged exhalation Hypoxemia and central cyanosis Tachypnea
50
what is used for quick relief of asthma symptoms
Short-acting Beta2-adrenergic agonists (SABAs) Anticholinergics
51
Long-acting medications
Corticosteroids Long-acting beta2-adrenergic agonists (LABAs)
52
diagnostic tool for asthma
pulmonary function test
53
manifestations of pneumonia
Fever Shortness of breath Tachypnea Pleuritic chest pain (sharp) Productive cough Color: yellow, blood-tinged, purulent, and/or rust-colored Crackles, wheezing Hypoxia Dull chest percussion over areas of consolidation
54
lab and diagnostic tests for Pneumonia
Sputum culture and sensitivity: Obtain specimen prior to starting abx- why? CBC: elevated WBC count = infection ABG: Hypoxemia (decreased PaO2 less than 80 mm Hg) Blood Culture: r/o organisms in the blood/sepsis BMP: identify dehydration (elevated BUN, hypernatremia)
55
Community Acquired Pneumonia (CAP)
Diagnosed in community or early in hospital admission (less than 48 hours) Most common type Often occurs as a complication of influenza
56
Healthcare Associated Pneumonia (HCAP)
Non-hospitalized patients that have extensive contact with healthcare personnel Often caused by Multidrug resistant (MDR) pathogens More likely to be resistant to antibiotics Linked to higher mortality
57
Hospital Acquired Pneumonia (HAP)
Develops 48 hours or more after hospital admission Patients can be exposed to pathogens from different sources Medical equipment Provider contact Shared facilities Caused by various pathogens
58
Ventilator Associated Pneumonia (VAP)
Sub-type of HAP When the condition manifests greater than 48 hours after the client is intubated
59
position for pneumonia patient
90 degrees, to maximize ventilation
60
nursing interventions for pneumonia patient
HOB above 30 degrees use as few sedatives as possible avoid stimulating the gag reflex with suctioning thickened fluids for swallowing problems
61
prediabetes HA1C
5.7-6.4
62
Diabetees HA1C
greater than 6.5
63
diabetes Fasting blood glucose
greater than 126
64
prediabetes fasting blood glucose
100-125
65
DKA lab tests
Blood glucose level greater than 250 mg/dL * Ketonuria (ketones in the urine) * Arterial pH of less than or equal to 7.30 * Serum bicarbonate level of less than or equal to 18 mEq/L * Positive anion gap
66
tx of DKA
Regular insulin- IV Administer sodium bicarbonate to fix acidosis Give d50 when sugar reaches 250 to minimize cerebral edema Rapid infusion of sodium chloride in first 1-3 hours Check vitals every 15 min until stable then every 4 hours Check for signs of dehydration
67
dka manifestations
hyperventilation polydipsia polyphagia lethargy stupor acetone breath blurred vision nausea/vomiting abdominal pain polyuria glucose in urine patient will be in metabolic acidosis
68
causes of HHS
infection older adults in response to stress and infection
69
HHS Manifestations
Blood glucose greater than 600mg/dL * pH greater than 7.4 * Serum bicarbonate levels greater than 15 mEq/L * Absence of ketones in urine * Serum osmolality greater than 320 mOsm/kg * Negative anion gap * Profound dehydration * Alteration in level of consciousness
70
HHS tx
Fluid replacement with isotonic normal saline * Treatment for altered mental status ‒ Airway management * Insulin administration, usually by intravenous delivery ‒ REGULAR INSULIN
71
GERD Contributing factors
Excessive ingestion of foods that relax the LES: * Chocolate, caffeine, fatty and fried foods, peppermint, spicy foods, tomatoes, citrus fruit, alcohol * Prolonged or frequent abdominal distention (from overeating) * Increase abdominal pressure * Constrictive clothing, obesity, pregnancy, bending at the waist, ascites * Medications that can relax the LES or cause increased gastric acid * Hiatal hernia * Gastritis due to Helicobacter pylori * Lying flat
72
GERD Clinical Manifestations
Report of dyspepsia (indigestion) after eating an offending food or fluid * Radiating pain (neck, jaw, or back) * Report of feeling of having a heart attack Pyrosis (burning sensation in the esophagus) * Odynophagia (pain when swallowing) * Pain that worsens with position * Pain that occurs after eating and lasts 20 min- 2 hours * Throat irritation (chronic cough, laryngitis) * Increased flatus and eructation (burping) * Pain is relieved by drinking water, sitting upright, or taking antacids * Chest congestion and wheezing * Dental caries
73
peptic ulcer risk factors
H. Pylori infection * excessive secretion of stomach acid * chronic use of NSAIDs/ Corticosteroids * Excessive alcohol consumption * Blood type O * Rare: Zollinger-Ellison Syndrome * Rare: Gastrin Secreting Tumor
74
PUD manifestations
dull aching pain * burning in the mid- epigastrium area or back * heartburn and vomiting may occur * Bleeding is possible
75
PUD diagnostic tests
Upper endoscopy * H. pylori testing (95% of non-NSAID PUD patients are positive) * Biopsy- with endoscopy * Fecal Antigen test * Urea breath test * Serological antibody * Stool culture * Bleeding ulcer * Periodic CBCs * Fecal Occult blood

Adult Health (1 decks)

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