FINAL EXAM Study Guide Version Part 2 Flashcards by David Bracho

What different tests are done when a patient comes into the hospital with a fever of unknown origin? In other words, what is a septic panel of tests?

CBC, Chem 25, Urinalysis, CMP, Lumbar Puncture, CT (so a shotgun workup..)

Blood culture on two different arms

UTI, Pneumonia, Meningitis (Common sources)

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Recognize the signs and symptoms of compartment syndrome and what to do about it.

Compartment Syndrome (Muscles expand, pushes against nerves and arteries) EMERGENCY → fasciotomy

CUT THAT LEG OPEN, its pretty brutal
pain is unrelieved by anything

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OSTEOPOROSIS

Osteoporosis: Its in the name lol, Porous bones, brittle bones

Med management

Nutrition and Exercise
Calcium + Vitamin D
Boniva + Fosamax (Don’t eat or drink for 30 mins after med) Stand up during this time.

Nurse management:

Education, keep patient safe, fall precaution.

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OSTEOARTHRITIS

Slowly progressive non-inflammatory degeneration of articular cartilage, usually affecting the weight bearing joints- spine, knees, hips.

Med Management:

Tylenol
NSAIDs
Corticosteroid injections
Joint replacement

Nurse Management:

Nutrition plus lose weight
ADL’s
ROM
Home safety and point protection
Non-Pharm stuff like ice packs

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ISCHEMIC STROKE

Result of plaque formation and blood clots that causes the narrowing of the lumen of a blood vessel. When the blood vessel occludes completely infarction occurs - BAD!

HTN and DM → atherosclerotic disease → plaque buildup → stroke

1st thing to do - CT scan because quick to figure out what kind of a stroke pt has

Pts receive TPA to break up the clot and to restore blood flow
TPA can only be given in a 4 hour window from when the symptoms started
CI of TPA: hematological disorder, systolic BP >200, recent surgery (within 3 months), recent GI bleed, recent CPR, recent head trauma, pregnancy (case by case)
Make sure benefits of TPA outweigh the risks
Pt on Coumadin - we must reverse the Coumadin with fresh frozen plasma IV and Vit K subq
If patient is on Xarelto, Pradaxa, elequis - there is no treatment becasuse these blood thinners are non-reversable

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ISCHEMIC STROKE

MEDICAL MANAGEMENT

1st thing - ABC’s!!!!!!!!

Endotracheal intubation and mechanical ventilation if necessary
Thrombolytic therapy (tPA), within 3 hours of onset
Anticoagulation therapy, IV fluids
ASA therapy - chew
Cardiac monitoring - watch for atrial fib
GI decompression - NGT - no bowel sounds
Activity- bedrest and passive ROM, fall precautions
Nutritional support- Enteral feeding tube or TPN
Swallow precautions: aphasia may cause aspiration
Antihypertensive medications: Nitrates- NTG
Histamine 2 blocker antagonists: Pepcid - start right away to prevent stress ulcers
Anticonvulsants: Dilantin - SE: gingival hyperplasia (see dentist every 6m)
Glucocorticoid: dexamethasone - Decadron - decreases inflammation
Indwelling urinary catheter
Seizure precautions - side rails up with padding
Monitoring vital signs: ICP (1st sign of increasing ICP is LOC), neurovitals
Osmotic diuretics: Mannitol - decreases water levels in brain
Occupational, physical, and speech therapy
Labs:
- CBC - monitor elevated WBC - infection
- Electrolytes - make sure K+ >4 and MG++ >2
- ABG’s - check pH
- PT, PTT - monitor for bleeding
Diet: Low Na+, Increased K+, Low cholesterol - know for exam

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ISCHEMIC STROKE

NURSING MANAGEMENT

Semi-Fowlers position to decrease pressure and swelling, we want to keep patients brain higher than the body
Maintain diet as ordered
O2 and fluids
Maintain position, patency, and low suction of the NG tube
Maintain and record vitals signs, neurovitals, labs, and oxygen status
Swallow precautions, fall precautions, supportive care
Carotid ultrasound - to see how much blockage

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HEMORRHAGIC STROKE

Bleeding into the brain tissue, the ventricles, or the subarachnoid space

Higher mortality
May be due to spontaneous rupture of small vessels primarily related to hypertension; subarachnoid hemorrhage due to a ruptured aneurysm; or intracerebral hemorrhage related to amyloid angiopathy, arterial venous malformations (AVMs), intracranial aneurysms, or medications such as anticoagulants
ICP increases when there is blood in the subarachnoid place
Manifestations:
Severe headache, early and sudden LOC, vomiting w/o feeling nauseous

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HEMORRHAGIC STROKE

MEDICAL MANAGEMENT

Control of hypertension: bring BP down gradually - 20% per 24 hour period, don’t want to being BP too low too fast
Diagnosis: CT scan (fastest), cerebral angiography, and lumbar puncture if CT is negative and ICP is not elevated to confirm subarachnoid hemorrhage
Care is primarily supportive - bec nothing we can do
Bed rest with sedation
Oxygen
Treatment of vasospasm, increased ICP, hypertension, potential seizures, and prevention of further bleeding

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HEAD TRAUMA

Classified by type of fracture, hemorrhage, or trauma to the brain

Fractures: depressed, comminuted, linear, basal skull fracture

Hemorrhages: epidural, subdural, intracerebral, subarachnoid

Trauma: concussion or contusion (brusing to brain)

Brain injury results in edema or hypoxia

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HEAD TRAUMA

CLINIAL MANIFESTATIONS

Disorientation to time, place, or person
Paresthesia
Positive Babinski’s reflex
Decreased LOC - 1st sign
Ottorrhea & Rhinorrhea - signs of CSF leakage
Clear fluid is tested with litmus paper for glucose, if (+) then it is CSF
Unequal pupil size and loss of pupil reaction

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CEREBRAL ANEURYSM

Definition: Dilation or localized weakness of the middle layer of an artery

Cerebral aneurysms usually arise at arterial bifurcations in the Circle of Willis and it’s branches.
Classified by type: Saccular (berry), Fusiform, Mucotic
Causes: atherosclerosis, trauma, congenital weakness, syphilis
Patho: enlargement of aneurysm compresses nerves; enlargement will finally result in dissolution of the wall and rupture the aneurysm; rupture results in subarachnoid hemorrhage
Assessment findings: diplopia, ptosis, severe headache, hemiparesis, nuchal rigidity, decreased LOC, seizure activity, vomiting, blurred vision

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CEREBRAL ANEURYSM

MEDICAL MANAGEMENT

IV therapy: fluids if needed
Oxygen therapy to keep Sv02 > 95 %
Position: semi-Fowlers; Activity: bedrest
Monitoring: VS, telemetry, ICP, neuro VS, arterial line
Precautions: seizure and aneurysm bleed, rupture
Anticonvulsants: Dilantin
Glucocorticoid: Decadron
Histamine antagonists: Pepcid, Zantac
Antihypertensives: Hydralazine (Apresoline)
Intubation and mechanical ventilation if needed
Antifibrinolytic: Amicar

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CEREBRAL ANEURYSM

NURSING MANAGEMENT

Administer fluids; maintain saline lock
Monitor VS, Neuro vitals, intake and output, O2
Maintain quiet, calm environment, allay fears, anxiety
Assess headache pain; Prevent Valsalva’s maneuver; prevent constipation
Assess for signs of increased ICP, meningeal irritation
Maintain seizure and aneurysm precautions
Alter ADL’s to compensate for neuro deficits

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SEIZURES

Involuntary muscle contractions caused by paroxysmal, uncontrolled discharge of electrical impulses from nerve cells; neurons firing asynchronously

Causes of seizures:

Idiopathic, Head injury, SLE, DM, Hypoglycemia, metabolic disturbances, Brain tumor, hypertension, Infection, septicemia, dehydration, Anoxia, alcohol and barbiturate withdrawal

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SIMPLE PARTIAL SEIZURE

Simple partial: consciousness remains intact; patients do not lose posture, and do not lose consciousness, may stare off into space (little kids staring off in classrooms example)

SIMPLE PARTIAL- symptoms confined to one hemisphere→ May have motor (change in posture), sensory (hallucinations), or autonomic (flushing, tachycardia) symptoms; No loss of consciousness.

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COMPLEX PARTIAL SEIZURE

Complex partial: patient partially or completely loses consciousness

COMPLEX PARTIAL- Begins in one focal area, but spreads to both hemispheres→ Loss of consciousness, aura of visual disturbances; post-ictal symptoms

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ABSENCE (PETIT MAL)

GENERALIZED SEIZURES

Generalized seizures: involve the whole brain. Patient loses consciousness and ability to maintain posture.

ABSENCE (PETIT MAL):

Sudden onset; lasts 5-10 seconds
Can have 100 daily w/o people realizing
Precipitated by stress, hyperventilation, hypoglycemia, fatigue, flashing lights
Differentiated from daydreaming

SYMPTOMS: Loss of responsiveness, but continued ability to maintain posture control, Staring spell, Twitching eyelids, Lip smacking, No post-ictal symptoms

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TONIC-CLONIC (GRAND MAL)

GENERALIZED SEIZURE

Generalized seizures: involve the whole brain. Patient loses consciousness and ability to maintain posture.

Grand-mal -

Major motor seizure activity
Violent total body seizure; both sides of brain

SYMPTOMS: Aura then loss of consciousness and falling, Tonic (stiffening of the body) first (20-40 seconds) then clonic (jerking of the extremities) after; Cyanosis, tongue or cheek biting, excessive salivation and incontinence may occur; Post-ictal symptoms: patient has no memory of the seizure

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ATONIC SEIZURE

GENERALIZED SEIZURE

Generalized seizures: involve the whole brain. Patient loses consciousness and ability to maintain posture.

ATONIC SEIZURES:

Drop and fall attack
Patient needs to wear protective helmet at all times- hard to be compliant

SYMPTOMS: Loss of posture tone, Loss of consciousness

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UNCLASSIFED SEIZURES

FEBRILE

Seizure threshold lowered by elevated temperature.
Only one seizure per fever
Common in 4% of population under age 5; tend to occur in small children that have very high fevers
Occurs when temperature is rapidly rising

SYMPTOMS: Lasts less than 5 minutes, Generalized, transient, and non-progressive; Doesn’t generally result in brain damage; EEG is normal after 2 weeks

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SEIZURE PHASES

Prodromal phase: signs or activity that precede a seizure. Patient may or may not be aware.

Aural phase: A sensory warning that precedes a seizure

Ictal phase: Full seizure; patients will have the tonic (stiffening) & clonic (muscle contractions)

Post-ictal phase: period of recovery after a seizure. Patient may be very lethargic and fatigued. (can sleep 10-12 hours)

(phase 1 & 2 do not happen for all people)

NOTE: THE CANINE IMAGE IS A GREAT REPRESENTATION OF THE HUMAN PHASES

STATUS EPILPTICUS

Prolonged or frequent repetition of seizures without interruption

Results in anoxia; Can cause cardiac and respiratory arrest
May be fatal !!!!!
Tonic-clonic status epilepticus is most dangerous because it can cause acidosis, arrhythmias, resp arrest.
Consciousness not regained between seizures
Lasts more than 30 minutes
May involve any type of seizure
Permanent brain damage may result; Neurological emergency
Patients given big doses of Valium- start with 10 mg IV push and go up from there; have to quiet the brain down→ give benzos followed by anti-seizure med
Assessment findings: loss of consciousness, dyspnea, fixed and dilated pupils, incontinent of bowel and bladder

STATUS EPILEPTICUS

DIAGNOSTIC TEST FINDINGS

EEG: abnormal wave patterns, focus of seizure activity

CT scan: a space-occupying lesion

MRI: pathologic changes

Brain mapping: identification of seizure areas; possible ablation of foci

STATUS EPILEPTICUS

MEDICAL MANAGEMENT

Monitor V.S., I/O, and neurovital signs; Activity: bedrest; seizure precautions; Diet: General
IV therapy: fluids as needed
Labs: Glucose, electrolytes, anticonvulsant drug levels

Meds: Anticonvulsants: Depakote,Tegretol, Dilantin, Zarontin, Luminal, Neurontin, Lamictal, Topomax

If a patient has hx of seizures- need to find out what meds he/she is taking; all seizure meds have therapeutic blood level
Ativan (Lorazepam) or Valium (Diazepam) for status epilepticus. Must be given IV push !!!

STATUS EPILEPTICUS

NURSING INTERVENTIONS

Maintain patient’s diet, Maintain seizure precautions; protect patient from injury during seizure, Assess post-ictal state: record time of sleep period, Maintain a patent airway, Monitor ABC’s
First thing to do when patient seizes in front of you: check time & mentally record it/write it down!! To have duration of seizure activity → review in mind what happened preceding the seizure (resp pattern, pupils, weakness,.. Etc. && also check these post seizure)
When you see signs of hypoxia/cyanosis: try to give blow by oxygen

MENINGITIS

DEFINITION: Inflammation of the brain and spinal cord meninges. Most commonly caused by a bacterial infection, but can be viral.

TYPES:

Septic: due to bacteria (Streptococcus pneumoniae, Neisseria meningitidis)

Aseptic: due to viral infection, lymphoma, leukemia, or brain abscess

Most commonly in adults: Bacterial infection: Neisseria meningitidis and Streptococcus pneumoniae

Neisseria meningitidis is transmitted by secretions or aerosol contamination, and infection is most likely in dense community groups such as college campuses.

Manifestations include SEVERE headache, fever, chills, systemic infection, petechial rash (seen with an infection; little red dots on hands/arms), changes in LOC, behavioral changes, nuchal rigidity (stiff neck→ chin to chest hard to do-one of the hallmark signs), positive Kernig’s sign, positive Brudzinski’s sign, and photophobia, tachycardia

Neuro Assessment findings: decreased level of consciousness; cranial nerve palsies: most commonly ptosis (eyes drooping), diplopia, facial weakness, tinnitus (ringing in ears), vertigo, and deafness; focal motor weakness, ataxia, seizures

MENINGITIS

DIAGNOSTIC FINDINGS

Cultures: identify source of infection in blood, urine, nose, throat secretions, sputum
CT scan or X-rays: assess for fractures, abscesses, or signs of infection in the chest, skull, and sinuses.
Lumbar puncture (diagnostic gold standard): elevated CSF pressure; cloudy, turbid, or clear in appearance with WBC elevation, increased protein; decreased glucose → all positive for meningitis. Culture and sensitivity will identify bacteria unless cause is viral.

MENINGITIS

MEDICAL MANAGEMENT

IV therapy; electrolyte replacement→ keep pt hydrated
Oxygen therapy, Monitor VS, ECG, ICP, Neurovitals, Oxygen saturation, I/O, Activity: Bedrest, quiet, darkened room
Ondansetron: when patients can’t hold down food/are nauseous this is given
Early, High dose Antibiotics: Penicillin, Ampicillin, or Chloramphenicol, or one of the Cephalosporins; Vancomycin alone or in combination with Rifampin for resistant strains.
Dexamethasone, (Decadron): given rather than prednisone because it is stronger and needed to decrease inflammation in the brain
Treat dehydration, shock, and seizures → to determine shock watch for urine output and bp
Antipyretics/ Analgesics: Tylenol, Advil
Glucocorticoid: Decadron
Osmotic Diuretic: Mannitol→ stronger than lasix, bumex; decreases cerebral edema
Isolation precautions, Seizure precautions: pads around bed rails and patient to remain on bedrest.
Anticonvulsants: Dilantin, Phenobarbital

MENINGITIS

NURSING MANGEMENT

Maintain dimly lit, quiet environment (limit amount of visitors), asses for headache, semi-fowler’s position, Use cooling blanket or tepid bath to control temp, Provide nutrition as appropriate, Provide skin care, Report meningococcal meningitis to local health authorities, Assess for rehab and refer if appropriate, Provide home care instruction, Assess for infection spread to family members and friends or personal contacts.

Possible complications:

Visual impairment, optic neuritis, deafness, personality changes, headache, seizures, paresis, and death

NEUROGENIC BLADDER

DEFINITION: An interruption of normal bladder innervation

Three types of neurogenic bladder may occur:

1. Spastic: upper motor neuron problem, Involuntary or frequent scanty urination without a feeling of bladder fullness, Possible spontaneous spasms of the arms and legs, Increased anal sphincter tone

2. Flaccid: lower motor neuron lesion, Overflow incontinence, Diminished anal sphincter tone, Greatly distended bladder with an accompanying feeling of bladder fullness (most at risk for UTI)

3. Mixed: cortical damage from some disorder or trauma, Dulled perception of bladder fullness, Diminished ability to empty the bladder, Urgency that can’t be controlled

All are at risk for UTI, urolithiasis, renal failure
Bladder program: patient goes to bathroom every hour/ 2 hrs/etc.; encourage patient to go on regular basis and drink fluids

Causes: Cerebral disorders (stroke, brain tumor, Parkinson’s disease, multiple sclerosis, dementia), Chronic alcoholism, Herpes zoster, Collagen diseases such as SLE, Disorders of peripheral innervation, Heavy metal toxicity, Spinal cord disease or trauma, Atherosclerosis, Acute infectious diseases such as transverse myelitis

NEUROGENIC BLADDER

NURSING INTERVENTIONS

Maintain patient’s diet and fluid intake, Assess renal status, Monitor VS and intake and output, Administer medications as prescribed, Indwelling catheter- strict aseptic technique, Assess for signs and symptoms of infection, Provide patient teaching if required for aseptic technique in self-catheterization, Patient teaching for intermittent self-catheterization, follow dietary measures to prevent renal calculi

NEUROGENIC BLADDER

MEDICAL MANAGEMENT

Encourage fluids, monitor VS and I&O, asses renal status
Tx: Valsalva’s maneuver, indwelling urinary catheter, intermittent self-catheterization
Antispasmodics: if there are many bladder spasms; Pro-Banthine, Urispas, Dicyclomine
Alpha-adrenergic blockers: Hytrin, Cardura

SPINAL TRAUMA

Spinal Cord Injury: traumatic injury to the spinal cord that results in sensory & motor deficits

Two types:

Paraplegia: paralysis of the legs
Quadriplegia: paralysis of all four extremities

Causes: car accidents, falls, gun shots, stab wounds, shallow water dive, infection, tumor, congenital

Patho: injury may result in complete transection of the spinal cord; associated edema & hemorrhage from the injury cause ischemia; necrosis & scar tissue form in area of the traumatized cord

Assessment findings:

Paralysis below the level of the injury, Paresthesia below the level of the injury, Neck pain, Loss of bowel and bladder control, Respiratory distress, Numbness and tingling, Flaccid muscle, Absence of reflexes below the level of the injury, Loss of perspiration below the level of the injury

Diagnostic findings:

Spinal x-rays: vertebral fracture
CT and MRI scan: spinal cord edema, vertebral fracture, spinal cord compression

SPINAL TRAUMA

COMPLICATIONS

Respiratory System: Cervical injury or fracture above C4-total loss of resp muscle function. Mechanical ventilation required to keep patient alive

Cardiovascular system: Cord injury above T6 decreases SNS effects. Bradycardia occurs as a result of unopposed PNS on the heart and peripheral vasodilation causes hypotension.

Urinary system: Retention is common as is spinal shock. The bladder is atonic and becomes overdistended. Foley catheter is needed to drain bladder.

Integumentary system: Tremendous potential for skin breakdown. Pressure ulcers occur quickly and lead to major sepsis and infection.

GI system: Cord injury above T5 creates primary problems of hypomotility. Contributes to paralytic ileus and gastric distension. NG tube may be needed for relief of distension.

Peripheral problems: DVT is common problem especially in first 3 months. PE is leading cause of death.

AUTONOIC DYSREFLEXIA

Massive uncompensated cardiovascular reaction mediated by the SNS. Occurs in response to visceral stimulation in spinal cord lesions above T7.

Life threatening situation- if not resolved can lead to status epilepticus, stroke, and death
Most common precipitating cause is overdistended bladder or rectum.
Manifestations include hypertension (up to 300 mmHg), blurred vision, throbbing headache, marked diaphoresis above level of lesion, bradycardia (30-40 bpm), piloerection, nasal congestion, and nausea.

Treatment is relief of cause- empty bladder or rectum!!–> suppository, foley catheter & then treat hypertension slowly

AUTONOMIC DYSREFLEXIA

MEDICAL MANAGEMENT

Maintenance of vertebral alignment: Stryker turning frame, Crutchfield tongs, Halo brace, Cervical collar → keep alignment !
Specialized bed: rotation (Rotorest, Tilt and Turn, Paragon)
Position: flat, neck immobilized
Endotracheal intubation and mechanical ventilation, NG tube with GI decompression
IV therapy as needed; saline lock; replacement of electrolytes
Diet: High protein
Foley catheter
Labs: CBC, Electrolytes, Glucose, ABG’s, urine osmolality, urine specific gravity
Meds:
Glucocorticoids: Decadron, Solumedrol,
Anticonvulsants: Dilantin,
Histamine antagonists: Tagamet, Zantac
Antacids: Maalox, Mucosal barrier: Carafate
Antianxiety agents: Valium
Antihypertensive agents: Hyperstat, Apresoline
Muscle Relaxants: Dantrium → for preventing muscle spasms
Laxative: Bisacodyl

AUTONOMIC DYSREFLEXIA

NURSING MANAGEMENT

Monitor the patient’s resp status, provide suctioning as needed. Monitor neuro status and neurovitals, Monitor vital signs, ECG, I/O, labs, arterial BP, O2, Keep patient flat, maintain body alignment, Turn patient using logrolling technique
Administer fluids and electrolyte replacements, Administer meds as prescribed
Initiate bowel and bladder retraining, Assess for spinal shock and autonomic dysreflexia
S/S of autonomic dysreflexia: UTI and URI
Provide skin care: Provide heel and elbow protectors and sheepskin; maintain skin integrity
Apply antiembolism stockings, Provide Passive ROM exercises; use assistive devices, Encourage patient to express his feelings about changes in his body image, altered mobility, changes in sexual expression and function, Provide sexual counseling, Provide for rehabilitation; reinforce independence, Access resources to begin home care provisions and set-up for patient needs.
Complications:
Spinal shock, autonomic dysreflexia, resp. distress, osteomyelitis, pressure ulcers
Possible surgical interventions: laminectomy, spinal fusion

ICP

INTRACRANIAL PRESSURE

Because the skull can’t expand, an increase in brain tissue, CSF, or blood, results in increased ICP

Increased ICP results in decreased cerebral circulation and anoxia, which can lead to permanent brain damage.
Early sign if increased ICP:
confusion, changes in patients level of consciousness, changes in condition: restlessness, confusion, drowsiness, increased respiratory effort, & purposeless movements; pupillary changes and impaired ocular movements, weakness in one extremity or one side, headache that is constant, increasing in intensity, or aggravated by movement or straining
Late sign of increased ICP:
Respiratory and vasomotor changes; Projectile vomiting
VS: increase in systolic blood pressure, widening of pulse pressure, and slowing of the heart rate; pulse may fluctuate rapidly from tachycardia to bradycardia and temperature increase
Cushing’s triad: bradycardia, hypertension, and bradypnea
Further deterioration of LOC; stupor to coma
Hemiplegia, decortication, decerebration, or flaccidity
Respiratory pattern alterations including Cheyne-Stokes breathing & arrest
Loss of brain stem reflexes: pupil, gag, corneal, and swallowing

CALCULATE CPP

CEREBRAL PERFUSION PRESSURE

CCP (cerebral perfusion pressure) is closely linked to ICP
CCP = MAP (mean arterial pressure) – ICP
Normal CCP is 70 to 100
A CCP of less than 50 results in permanent neurologic damage

GLAUCOMA OPEN ANGLE

Glaucoma is increased intraocular pressure with peripheral vision loss

Open Angle Glaucoma

Develops slow with NO symptoms of pain or pressure
Nothing noticed until suddenly vision is compromised
Tx: B-adrenergic receptor blocker (Timoptic), alpha-adrenergic agent (Epifrin), cholinergic agent (miotics), carbonic anhydrase inhibitors (hyperosmotic agents)

CLOSE ANGLE GLAUCOMA

ACUTE

Sudden excruciating pain, n/v
colored halos around lights
frosted cornea
OCULAR EMERGENCY; immediate care topical cholinergic, hyperosmotic agents with LASER peripheral iridotomy

SUB-ACUTE / CHRONIC

Appear gradually
Colored halos
Eye or brow pain
Tx for chronic same as open angle

Treatment for the patient with hearing loss and Meniere’s disease

Meniere’s Disease - Increased endolymph causes rupture, mixes high-K endolymph with low-K periplymph, leads to damaged cochlear hair cells

Vertigo with n/v, tinnitus, ear fullness, hearing loss, sudden drop attack

Tx: treating symptoms not disease

stabilize self during attack, antihistamines, anticholinergics, benzodiazepines (valium/diazepam), antiemetic (Zofran), antivert

Geriatric patients: end of life care

Palliative care vs. Hospice

Palliative care:

comfort, can still receive treatments
possible to graduate from palliative care
ex: after ARF if kidneys start functioning again

Hospice:

end of life comfort;
6 months or less left to live,
tx: analgesics

Why is HIV becoming more prevalent in the geriatric community

Because older patients think that because they are old, they are not likely to get pregnant or get someone pregnant, so they do not use protection.

Responsibility of the nurse in

pre-op care of the patient

Pre-op will be centered on the checklist, consent, and patient understanding of the surgery they are to have.
Begins when the decision to proceed with surgical intervention is made and ends with the transfer of the patient onto the operating room (OR) bed
Checklist: know that one exists (page 423) Has the procedure been explained to the pt? Have they consented to receive blood? Are they an organ donor? DO the have DNR? Is there an H&P? Are they NPO, are they on heparin?
Consent: Freely given without coercion, must be 18, staff must witness signature
Understanding of surgery: Discuss advance directives, patient education on benefits of controlling pain, time with patient/family and give therapeutic touch.

Responsibility of the nurse

intra-operatively

Begins when the patient is transferred onto the OR bed and ends with admission to the PACU (post anesthesia care unit)
The intra-op will focus on the “time-out” to ensure the right part of the patient is being operated on

“Time out” is when you stop and make sure you’re

Operating on the right person
Right place and
Right area of body
Everyone knows their roles

Responsibility of the nurse in the

post-operative period

Post-op will be focused on the safe awakening of the patient from anesthesia and what to do if the patient is not breathing well or if they are bleeding from their incision, or if their vital signs are not stable.

Begins with the admission of the patient to the PACU and ends with a follow-up evaluation in the clinical setting or home
Safe Awakening: Maintain ventilation and prevent hypoxemia and hypercapnia. (page 457)
Patient not breathing: (page 457) Hypopharyngeal obstruction. Tilt head back with neck supportive and open the jaws to open airway. Use a tongue suppressor. Use a endotracheal tube, when can they be extubated?

Patient bleeding from incision: (page 459) If bleeding is evident.

Sterile gauze pad and a pressure dressing are applied.
Site of the bleeding is elevated to heart level if possible.
Patient is placed in the shock position.
If hemorrhage is suspected but cannot be visualized, the patient is taken back to the OR for emergency exploration

Vital signs not stable: shock might ensue, give IV fluids, specifically lactated Ringer solution, 0.9% sodium chloride. Give O2

How do geriatric patients differ from adult patients in terms of medication administration?

Need to reduce doses
Treat the patient, not the numbers (Well focus on that, but not primarily)

Why is compliance with medications difficult for geriatric patients?

We over prescribe them
Be aware of cost, as many cannot afford, so they don’t fill or take them.
Will resort to pill rationing (cutting pills in half)

What are advanced directives and the power of attorney for patients?

Advance health care directives

instructions given by individuals specifying what actions should be taken for their health in the event that they are no longer able to make decisions due to illness or incapacity.
A living will is one form of advance directive, leaving instructions for treatment.
Another form of authorization is the power of attorney for health care. People may have one or the other or a combination of both.

Power of Attorney

A durable power of attorney allows a competent person - (the “principal”) to appoint an agent to make decisions for the principal when the principal is incapacitated and unable to make decisions.

What substances are most commonly abused today?

Alcohol and opioids

Know the second part of the Neuro lecture, neuromuscular disorders- ALS

Multiple Sclerosis (MS)

SS: INTENTION tremors

Parkinson’s triad

S/S: RESTING tremors, shuffling gait, bradykinesia (slow movements)
Tx: L-dopa

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FINAL EXAM Study Guide Version Part 2 Flashcards

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