FINAL 222 !! Flashcards
Management of Small Pox
Doesnt respond to antibx, passed by air droplet, obtainted by hanglind contamintaed materials
Clean everywhere/wear everything = private room, resp protection, gown, gloves and mask.
If exposed to radioactive dust, what do you do?
Place pt in shower.
signs and symptoms of peritonitis
Abd pain, tenderness over involved area, rebound tenderness, muscle rigidity, muscle spasm, fever, abd distention, nausea, vomiting, tachycardia, tachypnea, ascites
S/S of dumping syndrome
Generalized weakness, sweating, palpitations, dizziness/lightheadedness, abd cramping, borborygmi (stomach gurgles heard w/o stethescope), urge to defecate, urge to lay down. Epigastric fullness. Lasts about an hour.
MNGMNT calls for a decrease in intake rate. high fat, high protein, low carb.
What to do for client during dumping syndrome?
Have them lie down afer eating,
Care of pt with TPN
VS Q4-8, daily weights, monitor insertion site for development of bacterial or fungal growth, check BS Q4-6, begin infusing slowly and wean off slowly, infuse with a pump only, change bag and tubing Q24hrs
nursing care for peptic ulcer disease
Adequate rest, bland diet(6 small meals/day), H2 blockers(pepsid) and PPI(protonix, prilosec, prevacid), antacid, antibx for H pylori (need multiple antibx=biaxin, amoxicillin, tetracyclin, PCN)
H2 receptor antagonists
Pepsid=decreases acid secretion in the sotach by sinding to an enzmye on the parietal cells.
used for PUD
Proton pump inhibitors (PPI)
block ATPase enzyme that is important for the secretion of HCL acid. more effective then H2 blockers in decresing gastric acid secretion
Prilosec, prevacid, protonix, nexium
used for PUD
anticholinergic drugs
used occasionally for PUD, decreases vagal stimulation of HCL acid
s/e=dry mouth, flushing, thirst, blurred vision, tachycardia, dilated pupils
Cytoprotective drugs
Carafate (COATS) used for short term tx - covers the ulcerm protecting it from acid, used for esophagus, duodenum and stomach, accelerates ulcer healing, action is most effective at a low pH- give 30 min before or 30 min after an antacid
post op EGD
ausculate bowel sounds and do a complete abd assessment, keep NPO until return of gag reflex, use warm NS gargles for sore throat, check temp q 15-30 min for 1-2 hrs (spike in temp=perforation)
S/S of cirrhosis
EARLY=anorexia, heartburn, n/v, changes in bowel habits, pain-dull heavy in RUQ, fever, weight loss, fatigue, hepatomegaly, splenomegaly. Clay colored stool.
LATE=jaundice, edema, ascites, thrombocytopenia, leukopenia, anemia, coagulation disorders, angiomia,palmar, erythema, enecphalopathy, peripheral neuropathy, hyperaldosteroneism.
What to teach pt prior to fecal occult blood test
to avoid red meats, and NSAIDS 7 days prior to the exam.
Crohns diet
high in veggies, B12 IM or via nasal inhalers. high-cal protein shakes.
high-calorie,high vitmain, high-protein, low residue, milk-free.
Nursing care for crohns pt
maint fluid and electrolyte balance w/ IV therapy, maintain activity/rest balance bypacing activites and taking frequent breaks, promote effective coping by encouraging the expression of feelings.
Drug therapy=antimicrobial agents, corticosteriods, immunosupressants, immunodulators, TPN.
Managment of ulcerative colitis
high cal, high protein, nonspicy foods, caffeine-free, low residue (BRAT diet)
- low residue provides foods high in fiber = decreases fecal matter. (bananas, hard-boiled eggs, chicken, toast, rice, applesauce.
eat small frequent meals, vitamin and iron supp.
Corticosteriods for Ulcerative colitis (UC)
oral prednisone (mild and moderate UC)
retention enemas (deliever drugs into the desecending colon and beyond)
monitor for cushing syndrome (moon face buffalo hump), HTN, hirsutism, and mood swings
Immunosupressive drugs for UC
6-mercaptopurine, 6-MP
s/e bone marrow suppression, infection (take with food and mike, increase fluids 1800-2400 ml/d to decrease nephrotoxicity)
med for refactory UC
remicade - monoclonal antibody against TNF
This will increase when a small bowel obstruction is resolving.
hunger
care of pt with gout
Monitor serum uric acid levels (treatment effectiveness), cradle on foot of bed (keep heavy blankets off toes).
Teach pt to avoid excessive alcohol drinking, as well as
Home care instructions for pt w/ systemic lupus erythematous
avoid sun, wash w mild soap, avoid lotions, plaquenil (antimalarial for skin lesions) - decreases the absorption of UV light to the skin- decreasing rash, gey eye exam q6 months (causes retinal toxicity)
meds for back pain
Analgesics (NSAIDS), muscle relaxants (flexeril)
Post op laminectomy
compare neuromuscular assessment with pre-op findings(report any numbness/tingling), assess for bowel and bladder function, place pillow between the legs and log roll as one unit (use turn sheet)
post op management of AKA (above the knee amputation)
avoid sitting in chair for >hr, avoid pilllows under surgical extermity to prevent flexion contracture, lie on abd for 30 mins 3-4 times/d, position the hip in extension while prone.
compression banage immediately after to surgery, adm meds for phantom pain.
Teach pt to: avoid dangling limb, active ROM to all joints, crutch walking (dont exceed longer then 5 mins to avoid edema), limb care, recognition of complications (infection and hemorrhage)
Teaching crutch use
Teach client to use short strides, look ahead, not at feet. dont rest armpits on the crutch-can cause axillary damage.
predisposing factors to pelvic inflammatory disease (PID)
young female <24, multiple sex partners, new sex partner, chlamydia can be unknowingly transmitted during intercourse. Partner may have urethritis.
predisposing factors to development of cervial cancer
unprotected sexual intercourse with multiple partners, early age of sexual activity, twice as high in african americans, having HPV, smokers
post mastectomy
semi-fowlers with arm on pillow, flexion.extension of fingers immediatley, stress importance of wearing well fitted prosthesis, elevated affected side with distal joint higher than proximal, watch for edema on affected arm, limit arm exercises 24hrs post op, adduction and external rotation arm exercises after wound has healed.
if there is lymph node dissection - venapuncture and BP cuffs are not allowed on the affected arm.
Wear gloves when gardening.
Teach to rotate shoulder, Teach exersise like walking hand up wall or brushing hair.
If you see the NA applying heat intervene. Heat is contraindicated.
predisposing factors r/t breast cancer
female, age over 50, family history of breast CA, estrogen replacement thearapy for menopause.
post op vag hysterectomy
monitor for bladder distention (may have to straight cath)
post op abd hysterectomy
leg exercises and early post op ambulation tp prevent DVT and pneumonia.
Path of endometriosis
ectopic endometrial tissues “menstruate” – blood collects in cystlike nodules (bluish-black color) called chocolate cysts – rupture – acute pain – irritation – formation of adhesions – fix the affected area to a new site.
pt teaching r/t csytocele
kegal exercises can help treat them, use a pessary - ring like device placed in vag to support structures, helps alleviate discomfort, better bladder control, less urinary incontinence.
If TPN mixture is above 20% concentration use which line?
If TPN is below 20% concentration use which line?
Above 20% use a Central line.
If the mixture is in less than 20% glucose then use a periheral line.
Why is an xray used to verify TPN line placement?
To prevent chance of pneumothorax. Xrays is used to verify placement
Patient teaching for cirrhosis management
No drug use or ETOH. Low Sodium High Potassium, I&O, Daily weights, High Calorie diet. Protein may be restricted, Monitor for bleeding, Rest and teach safety.
Lab values related to cirrhosis
Increase in ALT, AST, PT, INr, And NH4
Decrease in RBC, WBC, Platelets, Albumin, H&H
Increase in Creatanin
Decrease in NA
Increase in Billirubin in Serum, urine and stool
How is Hepatitis B transmitted
Body Fluid transmission, Needle sticks, Sharing IV drugs. Sexually transmitted, Remains contagious for months to years.
NURSES MUST BE CAREFUL WHEN CHANGING BED PANS.
Hepatitis A Transmission
Spread Oral to fecal route. Seen in high rates in instituitional inmates, male homosexuals, Poor populations.
Genital herpes teaching
They dont need to come in contact with the virus for reoccurrence to happen.
Avoid all sexual contact when lesions are present to avoid transmission of the virus.
Recurrent episodes may be triggered by emotional stress and menses.
Drugs used to treat genital herpes
No cure, Acyclovir(Zoviraz) shortens teh duration of attacks. (antiviral)
Treat with antiviral agents
What can happen if chlamydia is left untreated
can result in PID and infection of the epididymis, eptopic pregnanct, men and women can become infertile.
Treatment for Chlamydia
Easily treated with vibramycin and zithromax
Both partners need to be treated before engaging in sexual acitiviy again.
Treat for gonorrhea as well, usuall if have one they have the other. (This world just thinks were all whores!!!! lol)
S/s of tertiary syphilis (3rd stage)
Large degenerative gummas form as a result of hypersensitivity reactions (skin, bone, nervous system)
mental retardations, blindness, and physical instability
Transmission of gonorrhea
spread via vaginal, anal, or oral contact
Risk factors for peptic ulcers
NSAID use, having h.pylori, ETOH, lots of caffeine in diet, having a family history of PUD
Meds for cirrhosis
drugs are used sparingly because they are difficult for failing liver to metabolize.
Drugs to redue ammonia levels in body:
lactulose (promotes the excretion of ammonia in the stool, given orally of NG tube) or lactilol and nonabsorbable antibiotics- neomycin sulfate, broad spectrum, given to act as an intestinal antiseptic, destroys normal flora in bowel, diminishing protein breakdown and decreasing rate of ammonia production.
Patient teaching for cirrhosis
Consume a diet that adheres to guidelines set by doc, nurse, or nutrionist.
If have excessive fluid in abd, follow the low-sodium diet.
Eat small, frequent meals that are nutrtionally well balanced.
Drink supp liqiuids (ensure ) and take multi-vit
Take diuertic or preventive beta blocker. if experience muscle weakness, irregular heartbeat, or light-headedness, contact doc.
Take lactulose as prescribed to maintain two or three BMs/day.
Do Not take any other med (prescription or OTC) unless prescribed by doc.
Dont not consume alcohol.
nonsurgical management of cirrrhosis
avoid alcohol.
For ascities-paracentisis, comfort measure=may need O2, elevate HOB, encourage to sit in chair, nutrition=low sodium, drug therapy=diuretic
Teach to wash with cool rather than warm water on sking and to use and excessive amount of soap.
Surgical management for cirrhosis
For ascities= shunt may be placed to divert ascites into the venous system. Transjuglar intrahepatic portal-systemic shunt (TIPS) used to cntrol long-term ascities and reduce variceal bleeding.
Labs r/t Hep B
elevated ALT and AST, serum total bilirubin levels are elevated as well as elevated bilirubin in urine.
in order to diganosis HBsAg and/or anti-HBc IgM must be present.
That pt is infectious as long as HBsAg (hep B surface antigen) is present in blood.
The presence of antibodies to hep B surface antibody (HbsAb) in the blood indicates recovery and immunity to hep B.
Care of pt with Hep B
fuck me just wrote this all out and accidently deleted it, come back to it later…..
complications of pancreatitis
pulmonary complications= pleuritic pain, pleual effusions, and pulmonary infiltrates.
usually have decreased pancreatic secretions and bicarb
Medical management for pancreatitis
pancreatic enzymes are essential dietary supplements.
Opioid analgesic for pain.
Pancrelipase (Cotazym, Viokase)- contains amylase, lipase, and protease.
Drugs to decrease gastric acid (H2 blocers or PPIs). Gastric acid destroys the lipase needed to break down fats.
TPN or TEN may be neccessary because of protein and fat malabsorption resulting in significate weight loss and decreased muscle mass.
S/S of cholecystitis
episodic or vague upper abd pain or discomfort that can radiate to the right shoulder.
Pain triggered bt a high-fat or high-volume meal.
Anorexia.
Nause and/or vomitting.
Dyspepsia (indigestion)
Eructation (burp)
Flatulence
feeling of abd fullness
Rebound or tenderness
Fever
Jaundice, clay colored stools, dark urine, steatorrhea (most common in chronic cases)
Post op cholesystectomy
incisional pain control, encourage to cough and deep breath, may need antiemetics for n/v, NPO until fully awake, assess surgical site for signs of infection, begin ambulation ASAP to prevent DVT and promote peristalsis.
Priority care for patient with T0tube is to avoid raising the drainage system above the level of the gallbladder.
Complication of pelvic fracture
internal bleeding which can result in death.
pelvis is very vascular and is close to major organs and blood vessels
Fracture assessment
look for a change in bone alignment, limb may be internally or externally rotated, observe for extermity shortening or change in bone shape. ask the pt to gently move involved body or area distal to injury=if pain occurs, stop the movemnt immediately. if skin intact area arounnd by be bruised.
Assess neurovascular, skin color and temp, sensation, mobility, pain, and pulses distal to fracture. check cap refill
What do you teach about use of crutches
Lead with the affected limb.
Up the stairs with the good foot. Down the stairs with the bad foot.
Carry weight on palms of hands and not in the armpits.
Adjust crutch so arms are slightly bent. And you have 2-15 cm gap between crutch and armpit.
Post op teaching for a Below Knee Amputation (BKA) includes?
Wrap dressing in a figure 8 pattern to form botom of the stump for prosthesis. Have client push it against pillow. **Change the sock if it becomes stretched out. **
client must lay prone or on stomach for 30 minutes 3-4 times a day.
Avoid dangling
Load em up (Phantom pain is real pain)
No lotions or creams
Be aware of hemmorage or infection. Keep a tourniquet in the room in case of hemmorage.
POst op care for a pt. who has had a lumbar lamenectomy incliudes?
o Ask them if their pain, numbness, tingling, burning is a new pain, or did they have this prior to procedure???
o If it’s a new pain – this is significant.
o Compare Pre-op and Post-Op Function
o Edema, ascending and descending – this will be dependant upon where they’ve had the surgery – need to know if it’s cervical or lumbar
o Cervical – concern – cerebral edema
• check pupils
• headache
• could lead to respiratory distress
• airway, depth of breathing
o Bladder & Bowel
• MONITOR OUTPUT!!!
• Bowel & bladder ability to urinate,
• Range of motion
The nurse instructs the client with a right BKA to lie on the stomach for at least 30
minutes a day. The client asks the nurse, “Why do I need to lie on my stomach?”
Which statement would be the most appropriate statement by the nurse?
1. “This position will help your lungs expand better.”
2. “Lying on your stomach will help prevent contractures.”
3. “Many times this will help decrease pain in the limb.”
4. “The position will take pressure off your backside.”
2.
The recovery room nurse is caring for a client that has just had a left BKA. Which
intervention should the nurse implement?
1. Assess the client’s surgical dressing every two (2) hours.
2. Do not allow the client to see the residual limb.
3. Keep a large tourniquet at the client’s bedside.
4. Perform passive range-of-motion exercises to the right leg.
3.
The male nurse is helping his friend cut wood with an electric saw. His friend cut two
fingers of his left hand off with the saw. Which action should the nurse implement
first?
1. Wrap the left hand with towels and apply pressure.
2. Instruct the neighbor to hold his hand above his head.
3. Apply pressure to the radial artery of the left hand.
4. Go into the neighbor’s house and call 911.
- Wrapping the hand with towels would be
appropriate, but it is not the first intervention. - Holding the arm above the head will help decrease
the bleeding, but it is not the first intervention.
3. Applying direct pressure to the artery
above the amputated parts will help decrease
the bleeding immediately and is the
first intervention the nurse should implement.
Then the nurse should instruct the
client to hold the hand above the head,
apply towels, and call 911. - Calling 911 should
A person’s right thumb was accidentally severed with an axe. The amputated right
thumb was recovered. Which action would preserve the thumb so that it could possibly
be reattached in surgery?
1. Place the right thumb directly on some ice.
2. Put the right thumb in a glass of warm water.
3. Wrap the thumb in a clean piece of material.
4. Secure the thumb in a plastic bag and place on ice.
4.
The Jewish client with peripheral vascular disease is scheduled for a left AKA. Which
question would be most important for the operating room nurse to ask the client?
1. “Have you made any special arrangements for your amputated limb?”
2. “What types of food would you like to eat while you’re in the hospital?”
3. “Would like the rabbi to visit you while you are in the recovery room?”
4. “Will you start checking your other foot at least once a day for cuts?”
- The jewish faith demands the body be buried whole.
The client is three (3) hours postoperative left AKA. The client tells the nurse, “My
left foot is killing me. Please do something.” Which intervention should the nurse
implement?
1. Explain to the client that his left leg has been amputated.
2. Medicate the client with a narcotic analgesic immediately.
3. Instruct the client on how to perform biofeedback exercises.
4. Place the client’s residual limb in the dependent position.
- Load em up
The nurse is caring for a client with a right below the knee amputation. There is a large
amount of bright red blood on the client’s residual limb dressing. Which intervention
should the nurse implement first?
1. Notify the client’s surgeon immediately.
2. Assess the client’s blood pressure and pulse.
3. Reinforce the dressing with additional dressing.
4. Check the client’s last hemoglobin and hematocrit level.
- Are they hemmoraging?
The client admitted with a diagnosis of a fractured hip is complaining of severe pain.
Which pain management technique would be best for the nurse to implement for this
client?
1. Adjust the patient-controlled analgesia (PCA) machine for a lower dose.
2. Ensure that the weights of the Buck’s traction are off the floor and hang freely.
3. Raise the head of the bed to 45 degrees and the foot to 15 degrees.
4. Turn the client to the affected leg using pillows to support the other leg.
- The health-care provider orders the dosage on
a PCA. Unless a range of dosages or new order
is obtained, a lower dose will not help pain.
2. Weights from traction should be off the
floor and hanging freely. Buck’s traction is
used to reduce muscle spasms preoperatively
in clients who have fractured hips. - Raising the head of the bed or the foot will
alter the traction. - Turning the client to the affected side would
increase pain rather than relieve it.
Nursing care for Intra Crnial Pressure (ICP)
Elevate HOB to 30 degrees.
Decrease environmental stimuli.
No suction schedule
No turn or position schedule
Check bp and spo2 O2 must get to brain!
Check LOC Hourly.
Whoot whoot
Nursing care for meniere’s disease
• For N/V, give rectal or IV:
o Anti-histamines (MECLIZINE)
o Anticholinergics (MECLIZINE)
o Benzos
• Pt on complete bed rest
o Quiet, darkened room
• Sedation
• LOW NA+ DIET (trying to get rid of fluid to reduce swelling)
• Avoid caffeine & nicotine
• Teach pt to avoid vertigo / teach pt safety
The client is diagnosed with Menière’s disease. Which statement by the client supports
that the client understands the medical management for this disease?
1. “After intravenous antibiotic therapy, I will be cured.”
2. “I will have to use a hearing aid for the rest of my life.”
3. “I must adhere to a low-sodium diet, 2000 mg/day.”
4. “I should sleep with the head of my bed elevated.”
3.
Which ototoxic medication should the nurse administer cautiously?
- An oral calcium-channel blocker.
- An intravenous aminoglycoside antibiotic.
- An intravenous glucocorticoid.
- An oral loop diuretic.
- Calcium channel blockers are not going to
affect the client’s hearing.
2. Aminoglycoside antibiotics are ototoxic.
Overdosage of these medications can cause
the client to go deaf, which is why peak and
trough serum levels are drawn while the
client is taking a medication of this type.
These antibiotics are also very nephrotoxic. - Steroids cause many adverse effects, but
damage to the ear is not one of them. - Administering an intravenous push loop diuretic
too fast can cause auditory nerve damage,
but an oral loop diuretic does not.
The 65-year-old male client who is complaining of blurred vision reports that he thinks
his glasses need to be cleaned all the time. He denies any type of pain in his eyes. Based
on these signs/symptoms, which eye disorder would the nurse suspect the client has?
1. Corneal dystrophy.
2. Conjunctivitis.
3. Diabetic retinopathy.
4. Cataracts.
4.
The nurse is administering eye drops to the client. Which guidelines should the nurse
adhere to when instilling the drops into one eye? Select all that apply.
1. Do not touch the tip of the medication container to the eye.
2. Apply gently pressure on the outer canthus of the eye.
3. Apply sterile gloves prior to instilling eye drops.
4. Hold the lower lid down and instill drops into the conjunctiva.
5. Gently pat the skin to absorb excess eye drops that run onto the cheek.
1. Touching the tip of the container to the
eye could cause eye injury or an eye infection.
2. Gentle pressure should be applied on the
inner canthus near the bridge of the nose for
one (1) or two (2) minutes after instilling eye
drops.
3. The nurse should wash hands prior to and after
instilling medications; this is not a sterile procedure.
4. Medication should not be placed directly
on the eye but in the lower part of the eye.
5. Eye drops are meant to go in the eye, not on
the skin, so the nurse should use a clean tissue
to remove excess medication.
Drugs for Glaucoma?
Use drops daily as ordered.
Beta blockers (like Betopic, Timoptic, and diamox) decrease aqueous humor production, There is some tranisent discomfort but use must be continued.
Cholinergics might also be administered. PiloCarpine may be used. It is a pupil constrictor which allows the aqueous humor outflow to increase via duct system not being blocked,
Use tissue on inner part of eye to stop beta blocker action of reducing heart rate. KEEP ATROPINE SULFATE ON HAND.
The client is diagnosed with an acute exacerbation of Crohn’s disease. Which assessment
data would warrant immediate attention?
1. The client’s white blood cell is 10.0 (103).
2. The client’s serum amylase is 100 units/dL.
3. The client’s potassium level is 3.3 mEq/L.
4. The client’s blood glucose is 148 mg/dL.
- This WBC level is WNL and would not warrant
immediate intervention. - This amylase level is within normal limits
(50–180 units/dL).
3. This potassium level is low as a result of
excessive diarrhea and puts the client at
risk for cardiac dysrhythmias. Therefore
these assessment data warrant immediate
intervention. - The client’s blood glucose level is elevated, but
it would not warrant immediate intervention
for a client with Crohn’s disease that has hypokalemia.
Which data indicate the client with end-stage liver failure is improving?
- The client has a tympanic wave.
- The client is able to perform asterixis.
- The client is confused and lethargic.
- The client’s abdominal girth has decreased.
- The tympanic wave indicates ascites, which is
not an indicator of improving health. - Asterixis is a flapping of the hands, which indicates
an elevated ammonia level. - Confusion and lethargy indicate increased
ammonia level.
4. A decrease in the abdominal girth indicates
an improvement in the ascitic fluid.
S/s of gall bladder disease or complications
RUQ pain. Pain is increased when the pt eats high fat foods.
6f’s
Fat, female, forty, fertile, family hx, fair skinned
Sedentary lifestlye.
they will not want to Cough and Deep Breathe.
S/S of Breast CA or cancer
Early Menarche, late menopause, Obese, Family history, HRT, Check tail of Spence. Fixed and painless
On tests in the past there was a diagram. The right upper quadrant was where the tail of spence was located.
The client who had a right modified radical mastectomy four (4) years before is being
admitted for a cardiac workup for chest pain. Which intervention would be most important
for the nurse to implement?
1. Determine when the client had chemotherapy last.
2. Ask the client if she received Adriamycin, an antineoplastic agent.
3. Post a message at the head of the bed to not use the right arm.
4. Examine the chest wall for cancer sites.
- No iv or bp on right arm
The client has had a mastectomy for cancer of the breast and asks the nurse about a
Tram Flap procedure. Which information should the nurse explain to the client?
1. The surgeon will insert a saline-filled sac under the skin to simulate a breast.
2. The surgeon will pull the client’s own tissue under the skin to create a breast.
3. The surgeon will use tissue from inside the mouth to make a nipple.
4. The surgeon can make the breast any size the client wants the breast to be.
2.
The client who is four (4) months pregnant finds a lump in her breast and the biopsy is
positive for stage II cancer of the breast. Which treatment would the nurse anticipate
the HCP recommending to the client?
1. A lumpectomy to be performed after the baby is born.
2. A modified radical mastectomy.
3. Radiation therapy to the chest wall only.
4. Chemotherapy only until the baby is born.
- is the only one that is not threatening to pt and baby and yet obtains an immediate action.
Post stapendectomy instructions
Use stairs not elevator, Cough or sneeze with mouth open, local anesthesia will be used, Due to increase in serosanguinous fluid, hearing will be great intially, then it will go away and return as fluid returns.
Meniere’s disease is a result of?
An increase in endolymph tissue.
The nurse writes a problem of “anticipatory grieving” for a client diagnosed with ovarian
cancer. Which nursing intervention would be priority for this client?
1. Request the HCP to order an antidepressant medication.
2. Refer the client to a CanSurmount volunteer for counseling.
3. Encourage the client to verbalize feelings about having cancer.
4. Give the client an advance directive form to fill out.
- An antidepressant may be needed at some
time, but at this point the nurse should offer
his or her time and interest and encourage the
client to discuss the feeling of having cancer. - CanSurmount volunteers are extremely helpful
in talking about having cancer with the client,
but they do not provide counseling. The
programs work on the basis of the fact that
someone who has had cancer and gone through
treatment can relate to the client about to
begin treatment.
3. The nurse should plan to spend time with
the client and allow the client to discuss the
feelings of having cancer, dying, fear of the
treatments, and any other concerns. - The client will need to complete an advance
directive, but this action does not address the
client’s grieving process.
Psychological support r/t colon cancer diagnosis
Encourage pt to verbalize feelings about the diagnosis, treatment, and anticipated alteration inbody functions if colostomy is planned.
Pt teaching for colostomy care
Teach pt and family:
The normal appearanced of the stoma.
s/s of complications.
measurent of the stoma
the choice, use, care and application of the appropriate appliance to cover stoma
measure to protect the skin adjacent to the stoma
nutrition changes to control gas and odor
Resumption of normal activities, including work, travel, and sexual intercourse
Goal of pt with osteoarthritis
to stay as active as possible
post op cerebral angiography
check dressing for bleeding and swellng around site, apply ice pack to site, keep the extermity straight and immoblized, maintain pressure dresing fro 2 hours.
Check the extermity for adequate cirulation: skin color and temp, pulses distal to injection site, cap refill
If bleeding is present, maintain manual pressure on the site and notify physcian.
Assess VA and do neuro checks, increase oral or IV fluids.
management of a TIA
upon arrival to ED, pt is stablized. complete neuro ass is done, and routine lab work, electrocardiogram and CT are done.
If elderly, pt with diabetes, symptoms lasting longer than 10 mins, or motor or speech difficulties are often admitted.
Pt usually will be discharged on an anti-coag,teach them about bleeding risk.
predisposing factors to embolic stroke
Embolic stroke can occur in pts with nonvalvular artia fibrillation, ischemic heart disease, rheumatic heart disease, and mural thrombi after an MI or insertion of a prosthetic heart valve
management of stroke with t-PA
Give drug within 3 hours after the first stroke symptoms.
Need informed consent
Dosage is based on pts actual weight
Montior VS frequentl
observe for signs of intracerebral hemorrhage and other signs of bleeding.
neuro checks
do not place invasive tubes such as NG of cath until patient is stable to prevent bleeding
d/c infusion if pt reports severe headache or has severe HTN, n/v
Do CT scan 24 hrs after the treatment started.
how to communicate with a stroke pt that has commuincation issues
present one idea or thought in a sentence.
Use simple one-step commands rather that ask the pt to do multiple tasks.
Speak slowly but not loudly, use cues or gestures as needed.
Avoid yes nad no questions for pts with expressive aphasia because they often give automatic responses that may be incorrect.
Use alternative forms of communication if needed, such as computer, communication board, or flash cards.
Hemorrhagic stroke
usuallt aburpt onset during the day, sudden and may be gradual if caused by HTN. usually a deepening stupor or coma. Associated with HTN and vessel disorders. Possible permanent neurologic deficits.
care of pt post stroke
montior for neuro changes, worsening of neuro problems may occur 24-48 hrs after their stroke. reassess neuro status every 1 to 4.
most at risk for ICP resulting from edema during first 72hours after onset of stroke. be alert for s/s of increased ICP
S/S of increased ICP
Decreased LOC, behavior changes: restless, irritable, confused, headache, N/V, change in speech pattern, aphasia, slurred speech, change in sensorimotor status, pupillary changes:dilated and nonreactive or constricted and nonreactive, cranial nerve dysfunction, ataxia, seziures (usually within first 24 hrs after stroke), cushings triad, sever HTN, widened pulse pressure, bradycardia, decerebrate (extensor) posture, decorticate (flexion) posture.
prevention of Increased ICP
avoid flexion or extension of the neck, maintain head in the midline, neurtal position. Lof roll during turning to avoid extreme hip flexion, keep HOB at 30 degrees.
Control fevers
Keep CO2 levels low (35-38) to avoid vasodilation. keep PO2 levels between 80-100 to avoid hypoxemia, which can cause cerebral visodilation.
Drugs used to treat an increase of ICP
Mannitol (osmitrol), an osmotic diuretic, is used to treat cerebral edema by pulling water out of extracellular space of the edematous brain tissue. Lasix is usually used with this as adjunctive therapy to reduce incidence of rebound from mannitol.
Opiods may be used for vent pts that become agitated due to pain.
care of pt post spinal cord injury
Airway management:
position pt to maximize ventilation, identify ot requiring actual/potential airway insertion, insert oral or nasal airway as appropriate, remove secretions by encouraging coughing or by suction, encourage slow deep breathing, assistive with incentive spirometer, ausculate breath sounds, suction as needed, admin O2 as needed, position to alleviate dyspnea.
Positioning: neurologic:
immobilize or support the affected body part, maintain proper body alignment, postition with head an neck in alignment, log roll turn, apply an othosis collar, apply and maintain splintin ot bracing device, use traction-monitor pin site and device setup.
Drugs for spinal cord injury
Methylprednisolone (solu-medrol) - decreased inflammation, montior for signs of infection, elevated serum glucose, and stress ulcers.
Dextran, a plasma expander, may be used to increase capillary blood flow within the spinal cord and to prevent or treat hypotension.
Tizanidine (Zanaflex, sirdalud). centrally acting skeletal muscle relaxant, may help cnotrol severe muscle spasiticty.
celecoxib (celebrx) may be used to prevent or treat heterotopic ossification (bony overgrowth)
Patho of Amyotropic lateral sclerosis (ALS) or Lou gehrigs disease
A result of loss of lower motor neurons found in the spinal cord and brainstem, the msucles they connect to weaken, atrophy, and die.
Death typically occurs within 3 years of diagnosis.
management of ALS
no cure for ALS, so end-of-life care is needed.
Give meds for pain, fatigue, spasticity, excessive secretions, sleep distrubances.
keep comfortable.
refer to hospice.
S/S of multiple slcerosis (MS)
muscle weakness and spasticity, fatigue, intention tremors, dysmetria(inability to direct ot limit movement), numbness of tingling sensations, hypalgesia (decreased sensitivity to pain), atazia (decresed motor control), dysarthria (slurred speech), dysphagia, dipolpia (double vision), nystagmus (involuntary eye movements), scotomoas (changes in perioheral vision), decreased visual and hearing acuity, tinnitus, vertigo, bowel and bladder dysfunction, memory loss, impaired judgement.
Diagnostics for MS
no definitive test for MS.
Usually will have abnormal cerebrospinal fluid (CSF) findings - elevated protein level and slight increase in WBCs.
McDonald criteria may be used:
two events or “attacks” seperated in time and space
MRI evidence consistent with MS
CSF findings
Anaylsis of evoked potentials as a meansof identifying a second attack.
S/S of myasthenia Graves (MG)
Progessive muscle weakness (proximal) that usually improves with rest, poor posture, ocular palsies, ptosis, weak or incomplete eye closure, diplopia, resp compromise, loss of bowel and bladder control, fatigue, muscle achiness, parathesias, decreased smell and taste.
