Final Pn2 Flashcards

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1
Q

Number one cause of spine injuries in adults

A

Falls

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2
Q

Autodysreflexia prevention key?

A

Prevention

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3
Q
  • Bowel obstruction
  • Types-

Complications:

How it occurs?

S/s?

  • Nonsurgical Management
  • Nasogastric tubes
  • IV Fluid replacement/NPO
  • Increased activity
  • Pain management
  • Bowel assessment & VS
  • Surgical Management
  • Exploratory laparotomy
A

Mechanical
• Nonmechanical

Fluid & electrolyte disturbances
• Altered absorption
• Perforation
• Bacterial peritonitis
• Bowel strangulation

Intussusception-mechanical- telescoping-tunneling in
• Volvulus-mechanical- 180 degree twisting

Assessment: Noticing
• Physical Assessment
• BM, N/V, pain, hiccups
• Abdominal distension
• Peristaltic waves
• Bobborygmi- a rumbling or gurgling noise made by the movement of fluid and gas in the intestines.

• Diagnostic Assessment
• abd xray, US, CT or MRI
Hyperactive bowel sounds are often found before a blockage.
It is quite common to find one quadrant with hyperactive bowel sounds and one with none or hypoactive ones.
This is because the intestine is attempting to clear the blockage with increased peristalsis.
You may also hear high-pitched sounds and rushing noises

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4
Q
Ulcers
Duodenal most common
• -gastritis often causes
d/t
• H. pylori 
• Long-term NSAID use
• Local irritation from radiation therapy
• Accidental or intentional ingestion of corrosive materials
• Lifestyle choices

o Signs/symptoms
• Epigastric alterations in comfort
• Nausea, vomiting, upper abdominal or epigastric pain
Hemmorrage-most serious:
• Coffee-ground emesis or hematemesis (upper GI bleed)
• Black, tarry stools/melena (usually duodenal or gastric)
• Frank blood in stool (lower GI bleed or fast transit)
Perforation-serious:
• Ulcer becomes full thickness
• Sudden sharp, diffuse abd. pain, rigid board-like abd, guarding, fetal position
Physical Assessment
• Epigatric tenderness, dyspepsia
• Rigid, boardlike abdomen w/rebound tenderness & pain = perforation into peritoneal cavity
• Gastric versus duodenal ulcer pain
• Assess for fluid volume deficit/dehydration
• Orthostatics
Diagnostic assess
• Testing for H. pylori
• Chest, abdomen x-ray series (if perforation is suspected)
• EGD
• Gold standard
• Immediate diagnosis & intervention
o Management
• Managing pain
o Drug therapy
o Nutrition therapy
▪ Avoid irritating foods
▪ Sit up 30-1hr after eating
• Managing Upper GI bleeding
o Nonsurgical management
o Surgical management

  • Balanced diet
  • Regular exercise
  • Stress-reduction techniques
  • Limit foods and spices that cause gastric distress.
  • Avoid tobacco, alcohol
  • Avoid excessive use of aspirin, NSAIDs.
A

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5
Q
GERD
• Occurs as a result of backward flow of stomach contents into esophagus
• UES & LES-normally contracted
• LES relaxes & allows reflux
• Gastric contents irritate mucosa

Barrett’s epithelium
• -pre-malignant tissue that is mor resistant to acid (result of chronic acid exposure)

Esophageal stricture
• -narrowing of esophagus due to fibrosis & scarring
• -can lead to impaired swallowing

Risk Factors
• -large meals, obesity, smoking, caffeine, peppermints, chocolate

o Management **
Patients may be initially asymptomatic.
Healthy eating habits
Limitation of fried, fatty, spicy foods, and caffeine

Sit upright for one hour after eating; don’t eat before bed

• Manifestations
• Dyspepsia “indigestion”
• Coughing, hoarseness, wheezing at night
• Dysphagia
• Epigastric pain
• Pyrosis “heartburn”
• Odynophagia (painful swallowing)
• Nausea
Globus (feeling of something in back of throat)
  • History of heartburn, chest pain, asthma, hoarseness, pneumonia, dyspepsia
  • Can mimic cardiac pain with radiation to neck, jaw, back, nausea
  • GERD will be relieved with antacids, water, sitting upright
  • Risk for Aspirate gastric acid while lying down- keep head elevated in low fowlers
  • Diagnostic assessment
  • Barium swallow
  • EGD
  • Visualizes esophagus
  • Lifestyle/dietary changes
  • Endoscopic therapies
  • Drug therapy
  • -antacids (calcium carbonate, TUMS-short term!)
  • -Histamine receptor antagonists (Pepcid, Zantac)
  • -Proton pump inhibitors (Protonix, Nexium, Prilosec)
A

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6
Q

Ulcerative colitis
• Inflammation & edema of rectum & rectosigmoid colon that can extend the entire colon when extensive
• When severe, bleeding, erosions & ulcers occur
• Ulcered areas can lead to abcesses & necrosis
• Continued edema leads to narrowed colon & possible partial bowel obstruction
• Periodic remission & exacerbations; cause unknown
• Stool typically contains blood & mucus
• Patients have an unpleasant & urgent sensation to defecate
• Older adults at high risk of fluid & electrolytes imbalances due to diarrhea
• Associated with increased risk of colon cancer
• Hx
o Bowel pattern/habits, timing of symptoms with meals
o Dietary habits-spicy, fried or hot foods
o Stress/emotional distress & activity
o Recent travel
o Recent antibiotic use or NSAIDS
• S/S
o Malaise, anorexia, anemia, dehydration, fever, & weight loss are common
• Labs
o May have low hemoglobin
o Increased WBC or inflammatory markers (CRP, ESR)
• GI bleeding-considered an emergency
• Monitoring UC stools is important because:
o Periodic bleeding is not uncommon
o Even slow bleeding can lead to anemia
o Active GI bleeding can quickly lead to hypovolemia & shock
o Prudent to have 2 large-bore working IV’s at all times
• Control diarrhea-establish regular stooling pattern
o Drugs: Aminosalicylates (sulfasalazine, mesalamine)
o Glucocorticoids (during exacerbations), antidiarrheals, immunomodulators (Humira, Remicaid)
• Skin care
• Nutrition therapy (sometimes TPN if severe)
• Rest/stress reduction
• surgery to remove portion of colon, rectum and/or anus; sometimes results in ostomy
mental?
• Anxiety due to urge to defecate & diarrhea
• Depression due to social anxiety & change in eating patterns/habits
• Social service consult
• Assistance with arranging home care services
• Affording medications and/or ostomy supplies
• Management of ostomy
• HHC?

A

J

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7
Q

Gastric ulcers-complications of
Gastric-deep & penetrating
-Usually caused by H. Pylori

A

I

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8
Q

• GI bleed-signs/symptoms; treatment
s/s- black tarry stools, blood in vomit-coffee ground-like
hypovolemic shock- increased pulse, decreased BP
may be caused by esophageal bleeding, GERD, NSAIDS, alcohol, cigs, cirrhosis. Cancer, gastritis, peptic ulcer, H pylori
peptic ulcer disease is most common cause
tx- oxygen, iv fluids (isotonic-lactated ringers/NS) transfusion, VS, labs

A

J

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9
Q

Infuenza-Acute viral respiratory infection
Complications are pneumonia & death, Older adults & immunocompromised are at greatest risk, Contagious 24 hrs before symptoms & 5 days after they start
• RAPID ONSET
• *Headache, muscle aches
• *Fever, chills
• *Fatigue
• *Prolonged weakness
• *Sore throat, cough, watery nasal discharge

A
Tx-
supportive- 
• Rest
• Push fluids
• Antihistamines
• Saline gargles & throat spray
Antiviral-Tamiflu, Relenza, Rapivab
• Only given if 24-48 hrs after symptom onset
• Shorten duration & severity of influenza

Nursing care- Diagnosis based on symptoms or nasal swab
Flu vaccine-
• 3-4 most common strains from previous year used
• Recommended as IM injection (no more intranasal)
• Adults over 50, those in communal living, chronic illnesses, immunocomprised, healthcare workers, young children should receive a vaccine EVERY YEAR
• 2 weeks before antibodies are made
Cover cough/cough into arm (NOT FIST!)
Teach hand hygiene and healthy lifestyle habits

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10
Q

Pneumonia-
▪ Inflammation of the interstitial spaces, alveoli, & bronchioles
▪ Bacteria penetrate the airway mucosa & multiply in the alveoli
▪ WBC’s migrate to this area causing capillary leak, edema, & exudate
▪ Fluid collects in & around alveoli, they collapse, leading to hypoxemia
▪ Capillary leak allows spread of the infection to other areas of the lung
▪ RBC & fibrin move into the area, stiffen the lungs, reducing compliance
▪ Leads to septicemia & possible empyema

Tx-
• Monitor WBC, neutrophil counts
• Chest x-ray- May not show up for 2 or more days after symptoms present
Sputum culture

Complications:
• Dyspnea; tachypnea
-Monitor oximetry closely
-Encourage incentive spirometer
• Flushedappearance
Skin care; linen changes
• Chest pain or discomfort
• Myalgia; Headache
-analgestics
• Fever; Chills- monitor temp; treat with Tylenol; obtain blood cultures
• Cough with sputum production; hemoptysis
• Expectorants prn; push fluids
• Tachycardia
Treatment
• IV fluids/hydration; monitor I & O’s
• Oxygen PRN; ABG analysis when warranted
Antibiotics
Pulmonary hygiene
Bronchodilators
2 antibiotics:
• Pneumococcal polysaccharide vaccine (Pneumovax)
• Pneumococcal conjugate vaccine (Prevnar 13)
• CDC recommends
• Those >65 yrs get both
• Those 19-64 yrs who have chronic illnesses

A

B

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11
Q

Asthma
Rx for Asthma:
short-acting (Albuterol, Proventil), long-acting (Serevent), corticosteroid (Serevent, Advair) [Tx is effective if sx decrease]

chronic inflammatory disorder- worse at night when s/s are present
Tx for Asthma:
Bronchodilator are rescue meds because they relax and open airway (Albuterol), calm atmosphere, High-Fowler’s, IV corticosteroids if having a severe attack

⬤ Intermittent; reversible
⬤ Affects only airways, not alveoli
⬤ Occurs in two ways
➢ Inflammation obstructing lumens
➢ Airway hyperresponsiveness leading to bronchoconstriction

Complications:
⬤ Assessment: Noticing
➢ History
• Symptoms-onset, exposure, prior allergens
• Smoking
• family history-tendency is inherited but not to specific allergen (ex: anaphylaxis to shellfish)
➢ Physical assessment/clinical manifestations
• Audible wheeze, increased respiratory rate
• Increased cough
• Use of accessory muscles
• “Barrel chest” from air trapping
• Long breathing cycle
• Cyanosis

A

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12
Q

Status Asthmaticus
⬤ Severe, life-threatening, acute episode of airway obstruction
⬤ Symptoms
➢ Labored breathing, wheezing, stridor, use of accessory muscles, distended neck veins
➢ Can progress to pneumothorax & cardiac/respiratory arrest; intubation
⬤ Treatment
➢ IV fluids, potent systemic bronchodilator, steroids, epinephrine, oxygen
⬤ Wheezes stop
➢ prepare for emergent trach!

Nursing care-
labs- ABG’s
⬤ Improve air flow & GAS EXCHANGE
⬤ Self-management education
➢ Personal asthma action plan
⬤ Drug therapy
➢ Control therapy drugs (used daily; long acting)
➢ Reliever drugs (used to stop an attack; short acting)
➢ Bronchodilators
➢ Anti-inflammatory agents
A

J

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13
Q

Nursing care/tx:
COPD/bronchitis/emphysema
⬤ Copd- Includes
➢ Emphysema
➢ Chronic bronchitis
⬤ Characterized by bronchospasm & dyspnea
⬤ Tissue damage not reversible; increases in severity, eventually leads to respiratory failure

A

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14
Q

Emphysemia- Loss of lung elasticity due to breakdown of elastin
➢ Hyperinflation of lung
➢ Small airway narrowing & collapse
➢ Air trapping due to loss of elastic recoil in alveolar walls (bullae)
➢ Some alveoli are destroyed & others become large & flabby with less area for gas exchange
⬤ Hyper-inflated lung flattens diaphragm, weakening it
➢ Results in “air hunger”; not getting air; deep rapid, labored breathing

A

J

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15
Q

⬤ Bronchitis- Inflammation of bronchi & bronchioles caused by chronic exposure to irritants
➢ Inflammation, vasodilation, congestion, mucosal edema, congestion, bronchospasm
⬤ Affects only airways, not alveoli
⬤ Production of large amounts of thick mucus
➢ Bronchial walls thicken & impair airflow
➢ Chronic infections due to increased mucus
Risk factors-
⬤ Cigarette smoking is the greatest risk factor
⬤ Alpha1-antitrypsin deficiency (protein that protects the lungs); rare cause
⬤ Incidence & prevalence
➢ COPD is the fourth leading cause of morbidity & mortality in the U.S.
Complications of cpod
⬤ Hypoxemia/tissue anoxia (no O2)
⬤ Impaired alveoli results in decreased gas exchange
⬤ Acidosis (PaCO2 increases)
⬤ Respiratory infections
⬤ Cardiac failure, namely cor pulmonale
⬤ Cardiac dysrhythmias (due to hypoxia)
s/s
⬤ Assessment: Noticing
➢ History
➢ Activity tolerance
➢ General appearance
➢ Respiratory changes
⬤ Limited chest movement with emphysema due to flattened diaphragm
⬤ Wheezes inspiration & expiration
⬤ clubbing
➢ Cardiac changes
⬤ Signs of RHF
Tx/nursing care:
⬤ Improve gas exchange & reduce carbon dioxide retention
➢ Goal sats 88-90%
➢ Up in chair (esp. for meals)
➢ Bipap, intubation for CO2 retention/resp. failure
⬤ Prevent weight loss
➢ Effective coughing before meals
➢ Small meals frequently, avoid gas producing foods or lots of liquids
➢ Take bronchodilator 30 mins before eating
➢ Nutrition supplements
⬤ Minimize anxiety
⬤ Sit up leaning forward and feet on ground
➢ Pursed lip breathing; tripod position
⬤ Oxygen, bipap therapy
⬤ Drug therapy
➢ Long acting beta adrenergic agents, cholinergic antagonists, corticosteroids, nebs, oxygen
⬤ Exercise conditioning
➢ Pace activities, plan rest periods
⬤ Percussion therapy to loosen secretions
⬤ Hydration
MEDS
⬤ Beta-adrenergic agents (ex: albuterol)
⬤ Methylxanthines (ex: theophylline)
⬤ Corticosteroids (ex: prednisone)
⬤ NSAIDs
⬤ Mucolytics (ex: tessalon pearles, guaifenesin)
Home care management
⬤ Long-term use of oxygen; ed. on proper use
⬤ Pulmonary rehabilitation program
⬤ Self-management education
⬤ Drug therapy
⬤ Manifestations of infection
⬤ Breathing techniques; energy conservation
⬤ Relaxation therapy
⬤ Health care resources
⬤ Food delivery services
⬤ Transportation
⬤ cleaning

A

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16
Q
pulmonary artery hypertension
⬤ Occurs in absence of other lung disorders; sometimes idiopathic
⬤ Blood vessel constriction with increasing vascular resistance in the lung
⬤ Heart fails (cor pulmonale)
⬤ Without treatment, death within 2 years
Complications:
R sided HF
Blood clots
Arrhythmias
Bleeding- coughing up blood
Cyanosis
Tachycardia
Edema
Dizziness
Fatigue
sob
Nursing care/tx:
⬤ Drugs to reduce pulmonary artery pressures by dilating vessels & preventing clot formation
⬤ Endothelin-receptor agonists (promote vessel relaxation)
➢ Sildenafil (Viagra)
➢ Revatio
➢ When cor pulmonale is present:
• Diuretics (↓ workload of heart), digoxin ↑ contractility), oxygen
Educate healthy lifestyle
A

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17
Q
TB
• Most common bacterial infection worldwide- airborne infection affecting lungs
Complications:
▪ Assess past exposure
▪ Foreign travel
▪ BCG vaccine
▪ Persistent cough
▪ Anorexia; unintended weight loss
▪ Night sweats; fever/chills
▪ Hemoptysis; blood-streaked sputum
▪ SOB
lethargy
nursing care/tx:
push fluids
Pulmonary hygiene
Monitor gas exchange
Supplemental oxygen PRN
Optimize nutrition
Drug therapy:
• Isoniazid, Rifampin, Pyrazinamide; Ethambutol
• Initial phase is 8 weeks
• Continuation phase another 18 weeks
• Can cause liver impairment; Decrease effectiveness of BC
• Repeat sputum every 2-4 weeks; need 3 consecutive negatives
• Assessment for TB:
• 2+ weeks of cough, fever, weight loss, night sweats, weakness, chills, hemoptysis
• 
• Tx for TB:
• Isoniazide and Rifampin
A

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18
Q
Hypoxemia
Low levels of oxygen in the blood**
• BEST PRACTICES
• Verify order
• Humidification over 4L/min
• Regular skin assessment
• Ensure no smoking
• Assess & document response to therapy
• Ensure adequate oxygen during transport
• Prevention of oxygen toxicity
A

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19
Q

Otitis media
inflammatory diseases of the middle ear.
Management:
• Heating pad
• Antibiotics (ear drops best)
• Analgesics (Tylenol, ibuprofen, aspirin)
Surgical-
• Myringotomy
• Tubes placed in ear drum to allow continuous drainage

A

J

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20
Q

• Allergies
• Allergy testing:
• IgE is produced - IgG is tested for food allergies
• Pt education: Allergy testing
• discontinue allergy meds at least 5 days prior to testing, skin prick test is often done [positive if have wheal and flare]
• Safety: Allergy testing
• anaphylaxis can occur or asthma sx can be triggered
• Benadryl: Diphenhydramine
• -Antihistamine
-Use: rhinitis, allergic response
Side effects: drowsiness, urinary retention, dizziness, disturbed coordination, drying and thickening of oral and other respiratory secretions, and stomach distress

A

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21
Q

o Angioedema
is a swelling of the area beneath the skin, similar to urticaria, or hives. However, urticaria affects only the upper dermis, or top layer of skin. Angioedema affects the deeper layers, including the dermis, subcutaneous tissue, the mucosa, and submucosal tissues.
-occurs due to dander, pollen, etc.

A

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22
Q

Anaphylaxis
is a serious, life-threatening allergic reaction. The most common anaphylactic reactions are to foods, insect stings, medications and latex. If you are allergic to a substance, your immune system overreacts to this allergen by releasing chemicals that cause allergy symptoms.

s/s- wheezing, low bp, high pulse

o Treatment
• Treatment consists of vasoconstrictors
• If not treated right away, usually with epinephrine, it can result in unconsciousness or death.
• Medications
• Vasoconstrictor, Bronchodilator, Antihistamine, and Steroid
• Tracheal intubation, Cardiopulmonary resuscitation (CPR), and IV fluids

Immediate injection of epinephrine 1:1,000 aqueous solution, 0.3 to 0.5 mL intramuscularly (preferred) or subcutaneously every 5 to 15 minutes for up to three doses or 2 to 10 micrograms per minute of a 1:10,000 solution by slow I.V. infusion; endotracheal or intraosseous administration if I.V. administration isn’t possible
Bed rest until stable
Treatment-General
Airway maintenance, possibly including endotracheal intubation with assisted ventilation; tracheostomy
Cardiopulmonary resuscitation, if cardiac arrest occurs

Treatment-Diet
Nothing by mouth until stable
I.V. fluids (typically normal saline and lactated Ringer’s solution)
Avoidance of suspected food trigger(s)

o Patient education
type of allergy or allergen responsible, if possible
risk of delaying treatment for symptoms, emphasizing the importance of reporting them immediately
use of epinephrine as first and best treatment for anaphylaxis; that antihistamines and albuterol inhalation, although somewhat helpful, do not prevent or relieve the airway obstruction and are not life-saving
need for possible skin testing to determine the allergen
avoidance of exposure to known allergens, including measures to reduce exposure risk
importance of carrying and becoming familiar with an anaphylaxis kit and learning to use it before the need arises, including use of EpiPen; development of an anaphylaxis emergency action plan that lists the most common signs and symptoms of anaphylaxis and instructions for treatment
need for medical identification jewelry to identify allergy.
need to renew prescription for epinephrine auto-injector each year
need to manage other conditions and illnesses, such as asthma
importance of adhering to follow-up schedule for immunotherapy, if appropriate.

A

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23
Q
Glaucoma
Tunnel vision
-Increased ocular pressure
s/s:
• Headache or brow pain
• Nausea and vomiting
• Colored halos around lights
• Sudden blurred vision with decreased light perception

Types:
• Primary open-angle glaucoma
• Angle-closure glaucoma
Drug therapy
• Prostaglandin agonists (ex: Lumigan, Xalatan)
• Cause eye color to darken & lashes to elongate
• Cholinergic Agonsists (ex: Isopto, Pilocarpine)
• Can cause HA, flushing, increased saliva, sweating
• Beta-adrenergic blockers (ex: timpoptic, Timolol)
• Can induce hypoglycemia & potentiate BB’s (lower HR)
• Adrenergic Agonists (ex: Alphagan)
• Increase blood pressure, do not take with MAOI’s

A

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24
Q

Cataracts
• Lens loses water & increases in density, which decreases transparency
• Opacity makes it difficult to see retina
• No pain or eye redness
• Early signs
o Slightly blurred vision (smudged lens)
o Progresses to blurred & double vision
o Decreased color perception
o Progresses to blindness without surgical intervention
Post surgical Nursing care–
• Antibiotics given subconjunctivally
• Eye is unpatched, discharge usually occurs within 1 hour
• Dark glasses required
• Post op antibiotic & steroid eye drops
• Nursing Care:
• Mild itching normal
• Pain: early pain may indicate increased IOP or hemorrhage, esp. if n/v present
• Prevent infection

Bluury, dim, dull, yellow, distorted vision
Need surgery-sound waves break up lens

A

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25
Q

Meniere’s
• Usually occurs in men between 20 and 50 years old
• 3 features: tinnitus, one-sided sensorineural auditory loss & vertigo
o May also include headache, fullness of ear, n/v, nystagmus, “whirling” sensation
• Teach to move head slowly, reduce sodium, stop smoking, comply with drug therapy
• Pressure pulse treatment; labyrinthectomy

A

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26
Q
o Mentation- mental activity/status
▪ Assessment
• Level of consciousness/GCS
o Alert-can be alert but not necessarily oriented
o Lethargic-drowsy, awakes easily
o Stuporous-drowsy, difficult to wake
o Comatose-unconscious, cannot wake
A

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27
Q
o Dementia
▪ Patient care
▪ Education
▪ Medications
o Trigeminal neuralgia
▪ Nursing considerations
▪ Nursing care
A

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28
Q
o Parkinson’s Disease
• Decreased dopamine levels resulting in an imbalance between excitatory & inhibitory neuronal movements
Cardinal s/s-
• Tremor
• Muscle rigidity
• Bradykinesia-slow movement
• Postural instability
• Slow shuffling gait
• Masked like expression
• Drooling
• Dysphasia
    Most common in men Stage 1- initial-Unilateral limb movement, minimal weakness, hand & arm trembling Stage 2- mild- Bilateral limb movement, masklike face, slow, shuffling gait Stage 3- moderate- Postural instability, increased gait disturbances Stage 4- severe- Akinesia, rigidity Stage 5- complete ADL dependence • Physical assessment • Initially hand tremors that increase with stress • Rigidity assessment • Cogwheel, plastic, lead pipe • Facial expression • Shuffling gait • Emotional changes-anxiety, depression, irritability, apathy • Bowel and bladder issues-incontinence & constipation • Autonomic  nervous system changes • Language changes-slurred, slow, rapid, monotone speech • Laboratory and imaging assessment • No specific diagnostic tests

• Be patient, allow extra time
• Ensure adequate nutrition, speech therapy
• Promote mobility
• Physical, occupational therapy
• Drug therapy (to treat symptoms)
• Surgical management​
• Stereotactic pallidotomy
• Deep brain stimulation
• Fall precautions
• Promote self-esteem, focus on strengths
• Assess for depression, anxiety, insomnia
Manage s/s
Nursing care-
Monitor swallowing, eating, thicken food, sit upright when eating, suction equipment available, ROM/exercise

A

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29
Q
o Alzheimer’s dementia
• Changes in the brain as a result of amyloid-rich, neuritic plaques, neurofibrillary tangles & vascular degeneration; exact cause is unknown
• Risk factors- Advancing age >65
• Female gender
• Hx TBI or Down Syndrome
• Genetic predisposition
• PTSD, veterans
• Stages of Alzheimer’s disease
• Mild, moderate, severe
• Changes in cognition
• memory, concentration, judgment, perception, attention, learning, communication, language, processing
• Changes in behavior and personality
• Mood swings, aggressiveness, increased confusion at night
• Changes in self-management skills
• Decreased interest in personal appearance, inappropriate dress, loss of bowel & bladder, decreased appetite/forget to eat
•  
SAFETY is priority
-prevent elder abuse- support groups
Medications to help memory
Prevent injuries- wandering or difficulty transferring

Education
• Honest, open discussions
• Maintain structure & consistency at home
• Keep things familiar
• If hospitalized, don’t change rooms
• Minimize noise, stimulation, distractions
• Promote adequate sleep
• Cognitive stimulation, memory training & reminiscence therapy
• Early AD: reality orientation
• Advanced AD: validation therapy

  • Maintain ability to perform ADL’s
  • Install assistive devices where needed
  • Toileting program
  • Frequent, close, continuous monitoring
  • Patient ID badge or bracelet for wandering
  • Chair & bed alarms, video monitoring, sitter
  • Learn to recognize physical behaviors as a means of communication
  • Redirection techniques
  • Establishing wills & advanced directives early
• No reasoning, arguing, confronting
• Use calm, positive statements
• Wrap IV lines, avoid urinary catheters
• Diversional activities
• Avoid physical or chemical restraints
• Short directions
• No scatter rugs/tripping
• Avoid overstimulation
• Post calendar
• Orientation
• Routine toileting
• Door locks
• Good lightening
• Mark step edges with tape
• Remove clutter
Donezepil- improves ADL ability - function
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30
Q
Care giver fatigue
• Manage stress
• Find a case manager early on
• Maintain realistic expectations
• Support groups/meetings
• Establish advanced directives early on
• Set aside rest time away from patient/respite
• Spiritual support
• Home Care Resources
• Alzheimer’s association-seminars, audiovisual aids, publications, telephone support
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31
Q

Migraines
• Recurrent, episodic attacks of head pain
• Throbbing, unilateral, behind eye, sensitive scalp
• Nausea, sensitivity to light or sound or head movement
• Last 4-72 hrs.
Trigers:
• Caffeine, red wine, MSG’s, tyramine, etoh, missed meals, smells, fatigue, light glare, stress, weather

Priority of care if PAIN MANAGEMENT:
• Drug Therapy
• Abortive & preventive therapy
• Alternative therapies

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32
Q

Meningitis
• Inflammation of the brain and spinal cord
• Bacteria enters the CNS directly or via the blood stream
• Bacterial-streptococcus pneumonia & meningococcal meningitis-very deadly!!
put them on seizure precautions with padded rails and bed low to the ground. call light
LABS:
• CSF analysis-Gold standard
• CT scan
• Blood cultures
• Counter-immunoelectrophoresis
• if antibiotics given before CSF obtained
• CBC
• WBC usually significantly elevated
• x-rays to determine presence of infection​
• Chest, air sinuses, mastoids
Viral can go away on its own
-Hib vaccine prevents
Headache, nuchal ridgity-neck ache, photophobia (bright lights), n/v, + kernig—straight at Knee- and brewvinski sign- lay on back and flex knees-painful- indicate meningitis. Lumbar puncture and Csf- if cloudy and decrease glucose= bacterial
If clear- viral
Elevated protein and WBC with both types
Droplet precautions
Quiet, dim light, 30 degrees hob, and monitor icp (irritability is early s/s) decrease coughing and sneezing-may cause icp
Seizure precautions
Possibly anticonvulsant and antibiotics

Interventions:
• Broad-spectrum antibiotic
• Hyperosmolar agents (for increased ICP)
• Anticonvulsants
• Steroids in S. pneumonia meningitis
• Prophylaxis treatment for those in close contact with meningitis-infected patient

  • Frequent neurological assessments (Q4 hrs)
  • EX: Change in LOC might indicate increased ICP or hydrocephalus
  • Seizure precautions
  • Vitals signs
  • Standard precautions EXCEPT when a bacterial type transmitted by droplets
  • Patient & family education

Cryptococcal meningitis:
-most life threatening fungal infection in AIDS patient
Headache, changes in LOC, NV, stiff neck, blurred vision; opportunistic infection of HIV
Nursing interventions for Cryptococcal meningitis:
infection control, hand-washing
Complications of Cryptococcal meningitis:
if untreated, is fatal; can lead to brain damage or hydrocephalus

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33
Q
Seizures
o May be caused from stress, fatigue, caffeine, flashing lights
o -patient care
Side rails up and padded
Oxygen
Suction- PRN
Airway
IV access
Fall precautions

Post- VS, neuro check, reorientate, seizure precautions/padded bed rails

• Drug therapy for idiopathic
• Remove the underlying cause for secondary
Protect from injury
Do not restrain
Side lying
Nothing in mouth
Remove restrictive clothing
Observation and documentation- duration of seizure, movement, neuro status
  • Tonic-clonic seizure meds-aura
  • Lorazepam (Ativan)
  • Diazepam (Valium)
  • IV phenytoin (Dilantin) or fos phenytoin ** (Cerebyx)
  • Labs while on antiepileptics
  • Regular CBC levels (leukopenia)
  • liver function tests
  • drug level tests
  • Gingival hyperplasia-frequent oral cares

• A sudden abnormal, excessive, uncontrolled electrical discharge of neurons within the brain that may alter LOC, motor ability, and/or behavior
• Generalized-tonic-clonic
o Rigidity of the arms & legs, progresses to jerking
o May bite tongue, incontinent of urine & stool
• Partial-maintain consciousness
o Most often occur in adults; less responsive to medicine
o Commonly assoc. with aura, amnesia after
• Unclassified
o Account for about 50% of seizures, Idiopathic

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34
Q
o Status epilepticus
• Prolonged seizures that last more than 5 minutes or repeated seizures over course of 30 minutes
• Establish airway
• Large bore IV with fluids
• IV push lorazepam, diazepam
• Rectal diazepam (Diastat)
• Loading dose IV phenytoin (only with NS)
• ABG’s, r/o toxicity or acidosis

• Adhere to med regimen
• Be aware of drug–drug/drug–food interactions
• Maintain therapeutic blood levels for maximal effectiveness
• Do not administer warfarin with phenytoin
• Document and report side/adverse effects
• Vagal nerve stimulation (VNS)
• Anterior temporal lobe resection:
Continuous EEG monitoring while off meds
Removal of focal area of brain tissue
Post-op care is similar to craniotomy
• Conventional surgical procedures

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35
Q

Hypertension
o Different types
Primary – no known cause
Risk factors- fam hx, sodium, inactivity, , obesity, stress, hyperlipidemia, race (African American)
Secondary- cause is due to disease or medication- cushings, kidney disease, chromosytoma
s/s- when high- headache, dizzy, visual issues

o Treatment-
Medications- Diuretic, calcium channel blockers, ace inhibitors, angiotension receptor, beta blockers
Take bp at home, limit alcohol, DASH diet- high in fruits, veggies, low fat dairy, low in sodium and fat.
Reduce weight, reduce stress, no smoking

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36
Q

Diabetes
• Type 1- Destruction of beta cells in a genetically susceptible person
• Immune system fails to recognize body as “self” & destroys cells in the isle of langerhans

  • Type 2- Initially insulin resistance (reduced response)
  • Progresses to decreased beta cell secretion of insulin
  • Often accompanied by cardiovascular risk factors (often obese, HTN, hyperlipideamia, clot risk)
  • Neuropathy- Deterioration of nerve function resulting in a loss of autonomic responses
  • Silent MI’s
  • Delayed gastric emptying (gastroparesis)
  • Constipation
  • Urine retention/incomplete emptying
  • Orthostatic hypotension & syncope
  • Increased risk of falls

LOOK at FLASHCARDS**

Which type of diabetes is related to obesity and aging?
Type 2
Change diet and exercise before trying meds!

When mixing insulin…
Clear to cloudy!
Regular first!

oral hypoglycemics:
Only type 2 diabetes use
(metformin, glyberide)
Doesn’t work directly with/to insulin

Most common “pathy” in diabetes?
Neuropathy

s/s diabetes
polyuria, polydipsia, polyphagia

kussmaul respirations
deep and rapid RR

body trying to compensate for metabolic acidosis

T1 diabetes
autoimmune

early childhood or adulthood

don’t make insulin

T2 diabetes
insulin resistance

can progress to decrease of insulin

associated risk factors:

  • obesity
  • HTN
  • Hyperlipidemia

metformin
don’t give before CT scan, or 48 hours after

lantus
long acting, no peak

administering insulin
abdomen is best

DO NOT RUB

heat=increased absorption

injecting into scar tissue= decreased absorption

A1C
Glycosylated hemoglobin

avg glucose over 120 days

normal level 4-6

6.5 goal for diabetics

hypoglycemia s/s
clammy

shaky

irritable

sweating

headache

dizzy

excess hunger

hypoglycemia causes
too much insulin

gastroparesis

not enough food

too much physical activity in relation to insulin

DKA s/s
kussmal RR

fruity breath

ketones in urine

glucose over 300

abdominal pain/ vomiting

confusion

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37
Q

• Hyperkalemia-tx; causes of imbalances
3.5-5 normal lab
Helps maintain ICF balance- nerve function and muscles and heart contractions.
HYPO-K GI losses, diuretics, skin losses, and metabolic alkalosis,
s/s-DYSRHYTHMIAS for both hypo and hyper** , weakness of muscles, cramps, constipation of ileus, hypotension, weak pulses
engourge patient to increase high potassium, dark leafty foods, cantelope, banans, avacados , give K supplemets- NPO form- orange powder, potassium though IV- very hard on vein- mixed with lidocaine- heart monitoring- risk for dysrhythmias

HYPERkalemia- causes DKA, metabolic acidosis, salt substitutes (high in potassium) kidney failure and potassium sparring meds- (spirolactone)
s/s- dysrhythmias, muscle weakness, numbness and tingling, diarrhea
care- encourage to limit potassium foods, administer loop diuetic (furosemide), kayexalate (laxative) – insulin will help bring K from ECF to ICF- give insulin with dextrose. Calcium gluconate- can protect the heart.

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38
Q

Hypermagnesemia-signs/symptoms
Nerve and muscle function, heart function
Normal range- 1.3-2.1
Hypomag- caused by GI losses, alcohol abuse, diuretics, malnutrition
s/s hyperactive DTR, tetny, seizures, constipation (HYPED UP)
tx- foods containing magnesium, supplement- PO will cause diarrhea

HYPERmag- kidney disease, laxative or antacids
s/s – hypotension, muscle weakness, lethargy, resp or cardiac arrest (go LOW)

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39
Q

• Hypercalcemia
Inverse relationship with phospherous, normal range- 9-10.5 important for nerve, muscle, teeth, clotting
HYPOcalcemia- causes- vit D defiecency- need calcium to absorb, hypoparathyroidism, removal of thyroid gland, hyperphospate, pancreatitis
s/s- positive chovastic,- . tap on cheek and face twitches and trovosseas sign –inflate BP cuff and causes finger spasming, numbing and tingling in lips and fingers, muscle spasms, GI upset, hypotension, decreased HR
care- increase calcium, supplements
HYPERcalcium- hyperparathyroidism, bone cancer, steroid use long term use.
s/s- constipation, decreased deep tendon reflexes, kidney stones, lethargy

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40
Q

Hypo & hypernatremia
135-145 normal lab
Hyponatremia- caused from GI loss, vomiting, NG tube suctioning, diuretics, kidney disease, skin losses, SIDH (body absorbs extra fluid) heart failure, Hyperglycemia
s/s- tachycardia, hypotension, confusion-eldery, check urine and electrolyte balances in elderly. Fatigue, n/v, headache
isotonic IV fluids- sodium chloride
hypertonic for acute- 3% sodium chloride-do not to it too fast or it could cause neuro issues. , increase sodium
Hypernatremia-water depreviation, excess water, kidney failure, cushings, diabeses insipidus (peeing out mass amt.) burns, sweating
Tachycardia, muscle weakness, GI upset, administration of isotonic solution or hypotonic solution, decreas sodium and increase water intake.
o Obesity

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41
Q

What BMI range is considered obese?

• 30+

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42
Q

Hypothyroid
o Signs/symptoms
• Low HR, low resps, low temp, weight gain
• Coarse features, swelling, thick tongue, blank expression, slow speech/response
• Activity level/energy, weakness, anorexia, constipation, cold intolerance, paresthesias, changes in menses, impotence
• Depression, apathetic, withdrawn, sluggish

o Treatment
Synthroid (levothyroxine)
• Laboratory assessment
o Elevated TSH, decreased T3 & T4
• Improve gas exchange
• Prevent hypotension
• Support cognition
• Prevent myxedema coma-med adherence!
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43
Q

hyperthyroid
o signs/symptoms
o treatment; radioactive iodine tx

A

K

44
Q
• DVT
DVT-Deep Vein Thrombosis:
• blood clot in the deep veins in the extremities
DVT s/s
swelling
pain
redness
warmth
hard – calf or thigh
• DVT tx

Heparin then Warfarin
Keep Heparin until INR 2-3

Do not use Homan’s sign (can cause embolism)

• If a DVT pt can’t use anticoagulants, what would be the tx?

-IVC filter

MEDS
• Rx for DVT:
• -Heparin [protamine sulfate is antidote],
-Lovenox [given sub q - rotate sites],
-Coumadin [vit K is antidote]

• Pt education for DVT:
• -Avoid long periods of inactivity and sitting,
-use support stockings (TED Hose),
- increase fluid intake,
-take meds as prescribed,
-abstain from ETOH when on anticoags,
-Notify MD of suspicious bleeding/bruising.

• Heparin
• -Immediate anticoagulation [I.V.], increase clotting time
-prevents clots from forming [doesn’t dissolve clots]

• Pt education Heparin:
• -Notify MD of bleeding; hematuria, bleeding gums, epistaxis, bruising,
-Osteoporosis may develop if on long term heparin therapy,
-use electric razor, avoid dangerous activity.

  • Monitoring effectiveness of Heparin:
  • PTT is used to determine effectiveness. Normal aPTT is 34-45 seconds. Protamine sulfate is the antidote.

o Signs/symptoms
o Treatments

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45
Q
  • Lupus
  • What is lupus?
  • Autoimmune disease that affects the connective tissue of the body with no known cause (mainly attacks kidney). characterized by butterfly rash on the face.
s/s-
proteinuria
kidney issues
blood in urine
damage to major organs such as heart, kidneys, and lungs
• Skin involvement
• Butterfly rash
• Polyarthritis
• osteonecrosis
• Alopecia
Mouth ulcers
• Muscle atrophy
• Fever and fatigue
• Renal involvement
• Symptoms are not usually fatal
**CHART 18-11, pg. 326
  • What are the causes of lupus?
  • No known cause, possibly genetics, environmental factors, immune dysfunction, viruses, medications.
  • Diagnostics for lupus?
  • Elevated ANA titer, flat or raised rash on cheekbones, skin biopsy and protein in urine.

Treatment for lupus?
• Analgesics, corticosteroids, anti-malarials, anti-anxiety, immunosupressants, and exercise to keep joints functioning.

  • Nursing considerations for lupus?
  • educate patient on how to prevent flare-ups or worsening of symptoms, exercise, sunscreen, avoid bleach or skin irritants, avoid exposure to illness because of lowered immune system and practice good hygiene and adequate rest.
  • Complications of lupus?
  • Kidney failure, anemia, increased risk of bleeding and clotting, vasculitis, pneumonia, pericarditis, hypertension, memory problems, fever- most common flare up
  • What can cause flare ups of lupus?
  • Pregnancy, fatigue, infection, stress, surgery, and UV rays.
  • How does lupus relate to infection.inflammation?
  • immune system is weakened making the patient very susceptible to infection due to the disease itself and the medications used to treat.

o Signs/symptoms
o Nursing care
o Patient education

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46
Q
  • Sickle Cell Disease
  • abnormal formation of RBCs

sickle cell disease causes for flare ups
hypoxia (number 1)

dehydration

alcohol

stress

pregnancy

sickle cell disease priority of care
• pain control
• B12 deficiency anemia s/s
• smooth beefy red tongue
• B12 deficiency anemia tx
• B12 injections
Management
• a. Oxygen
b. Anti-sickling agents
c. Folic acid
d. Blood transfusions

• Sickle cell anemia
Patient Education
• a. Drink plenty fluids (stay well hydrated)
b. Get plenty of rest between periods of activity

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47
Q

RA-manifestations

  • Weight loss, fever, extreme fatigue
  • Subcutaneous nodules-not problematic
  • Respiratory, cardiac inflammation
  • Vasculitis
  • Periungual lesions-due to vasculitis/ischemia
  • Paresthesias-decreased circulation
  • Associated syndromes
  • Sjögren’s syndrome
  • Felty’s syndrome
  • Caplan’s syndrome
  • Nonpharmacologic interventions
  • Adequate rest
  • Proper positioning
  • Ice & heat application
  • Complementary & Integrative therapies
  • Promotion of self-management
  • Management of fatigue
  • Enhance body image
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48
Q

• Hyperparathyroidism
Parathyroid glands
• Maintain calcium & phosphate balance
• Release PTH in response to Ca+ levels
• Increased PTH hormone cause kidney reabsorption of calcium and excretion of phosphate
• Kidney stones, Ca+ deposits in soft tissues
• Decreased bone production & increased bone destruction (Bone fractures, osteoporosis, arthritis)
• Diagnosis
• Serum PTH, Ca+, Phos, xrays

s/s:
• Decreased function of parathyroid gland resulting in hypocalcemia
• Causes
• Iatrogenic
• Due to surgical removal of all parathyroid tissue
• Idiopathic
• Uncertain of cause, possibly autoimmune
• Hypomagnesemia
• Suppresses release of PTH
• Assessment
• Mild tingling, numbness, muscle contractions, tetany, loss of tooth enamel, seizures

Tx:
• Calcium replacement (calcitriol), magnesium replacement, Vitamin D (ergocalciferol)

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49
Q
  • Malnutrition/nutritional deficiencies
  • Diet/nutrition for COPD:
  • increase protein/calories, don’t drink around meals, small/frequent meals
  • Tx Venous stasis ulcers:
  • diet high in protein and nutrients to support healing, wound therapy

Nutritional Anemias:

  • Iron deficiency: decrease in iron; most common type; need more iron fortified foods,
  • Folic acid: lack of folic acid which is needed for RBC synthesis; need to eat green/leafy veggies, liver, fruits, cereals,
  • Vit B12: seen in Crohn’s; not always caused by dietary deficiency

Risk factor for anemia: poor nutrition

Crohn’s Diet
limit dairy, low-fat foods, limit fiber, eat small-frequent meals, increase fluids, nutritional supplements

gout nutrition
no shellfish or oily fish

nothing smoked

low purine
-no organ meats or red meat

no alcohol

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50
Q

• Optimizing nutrition in older adults
What enzymes are required to appropriately digest fats? (3)
• Gastric lipase, bile, and pancreatic lipase.

The majority of calories should come from?
• Carbohydrates

Not having enough fats in the diet can increase what?
• The risk for deficiencies in Vit A, D, E, and K

A healthy adult should maintain a BMI less than?
• 30

Main causes of fluid deficit?
• Vomiting, NG suction, Diarrhea, diaphoresis, diuretic use, diabetes insipidus, renal disease, third spacing, hemorrhage, hyperventilation, DKA, enteral feedings.

Who is at greatest risk for fluid deficit?
• Older adults (decrease in total body mass and total body water content-decreased thirst mechanism), infants, burn victims, hemorrhage, GI issues.
• S/S of fluid deficit
• Hyperthermia, tachycardia, thread pulse, hypotension, orthostatic hypotension, decreased CVP, increased RR, hypoxia, dizziness, syncope, confusion, weakness, fatigue, N/V, anorexia, oliguria, diminished cap refill, diaphoresis, sunken eyeballs, flattened neck veins, poor skin turgor, and tenting.

Always remember that orthostatic hypotension is a potential sign of?
Fluid volume deficit

Causes of fluid volume excess
• HF, Cirrohsis, increased glucocorticosteroid use, renal failure, interstitial to plasma fluid shifts with burns or hypertonic fluids, hypothyroidism, increased sodium/water intake, stress, steroid use

• Who is at greatest risk for fluid volume excess?
elderly age related changes to the cardiovascular and renal system.

  • S/S of fluid volume excess?
  • Edema, weight gain, SOB, abnormal breath sounds, tachycardia, bounding pulse, hypertension, increased RR, increased CVP, confusion, muscle weakness, headache, ascites, distended neck veins, pale cool skin.
  • Assessments for fluid volume excess?
  • Weight, I&O, vitals, electrolyte status, kidney function, respiratory, skin, chest x-ray, serum osmolarity. (Decreased hematocrit & hemoglobin) LOC

• What are the expected orders for someone with FVE?
• Loop diuretic
Fluid restriction
Sodium restriction

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51
Q
• Mitral valve insufficiency-causes
A backflow of blood caused by failure of the heart's mitral valve to close tightly.
Causes of this include:
Hypertrophic cardiomyopathy
Infective endocarditis
Mitral valve prolapse
Myocardial infarction
Rheumatic fever
Ruptured chordae tendineae
Scleroderma
Severe left-sided heart failure
Systemic lupus erythematosus
Trauma
Overview-Risk Factors
Congenital anomalies
Overview-Incidence
Mitral valve insufficiency can occur at any age.
It affects both sexes equally.
It is the second most common valvular problem.
A

N

52
Q

• Tracheostomy-care of client with trach
• Deep tracheal suctioning technique
• 283- no more than 15 seconds, heavily ventilate before suction, use sterile water
??

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53
Q

Biventricular heart failure
A pacemaker is a surgically implanted electronic device that provides an unnoticeable electrical current that causes your heart to beat. A biventricular pacemaker is a special type of pacemaker that paces both sides of the lower chambers of the heart (the right and left ventricles) to help treat heart failure

A

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54
Q

What are the elderly at risk for? Why?

• Malnutrition due to lack of money

A

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55
Q

Obesity-causes;

  • Physical inactivity. …
  • Overeating. …
  • Genetics. …
  • A diet high in simple carbohydrates. …
  • Frequency of eating. …
  • Medications. …
  • Psychological factors. …
  • Diseases such as hypothyroidism, insulin resistance, polycystic ovary syndrome, and Cushing’s syndrome are also contributors to obesity.

• gastric bypass complications; patient education

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56
Q

• gastric bypass complications; patient education

Negative outcomes of the Roux-en Y Gastric Bypass
-Dumping Syndrome: gastric contents empty too rapidly into the small intestine, overwhelming it’s ability to digest nutrients.

Symptoms of dumping syndrome
-nausea, vomiting, fatigue, weakness, sweating, faintness, and on occasion diarrhea. (want to avoid sugary foods)

suction-assisted lipectomy
Preoperative care of the obese patient
-past and current health history
-understanding of the procedure
-team approach for comorbidities
-respect dignity and privacy
-trapeze bar over bed for movement (strongly reinforced)
-Consider weighing, transport, and bathing procedures of the obese patient.
-wound infection
-maintaining adequate respiratory health
-venous access
-educate on the possibility of catheter, compression stockings etc.
-high risk for ulcer if consume alcohol
Postoperative care of the obese patient
-infection
-bleeding
-incisional care
-perforation
-bowel sounds
-hydration/nutrition
-kidney/cardiac/lung functioning
-early ambulation
-compression stockings
-low dose heparin
-semi to high fowlers
-pain meds for abdominal pain
-skin care
-water and sugar free liquids (30ml Q 2hr awake)
LONG TERM CARE FOLLOW UP
Special considerations for Bariatric Surgery
1st 48 hrs after surgery, most commonly seen - increased BP and P, this is normal
Larger equipment needed
Early ambulation a MUST!
Monitory VS, easily de sat
Pain management
High risk for infection - monitor wounds carefully
High risk for wound dehiscence
Hernia risk
Pneumonia and atelectasis - TCDB, incentive spirometer, early ambulation
Will have tubes, educate about that
Bariatric Surgery-Ambulatory & Home Care: Proper Diet
Eat slowly, high protein, low carbs (decrease risk of dumping syndrome), low fats, no fluids eaten with meals, avoid straws, avoid carbonated drinks.
.
Bariatric Surgery-Ambulatory & Home Care: Potential complications
Depends on type of surgery done
Combo kind: anemia, vitamin deficiency, dumping syndrome, sm. bowel obstruction, psychiatric problems
Bariatric Surgery-Ambulatory & Home Care: Long-term care follow-up
Surgery is considered successful if they lose half of their excess weight and keep it off for 5 years

Clear liquids

A

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57
Q

Oxygen therapy-appropriate use

Lowest level PRN

A

H

58
Q

Earliest symptoms of Laryngeal Cancer
• Persistent hoarsness (longer than two weeks)
Other signs and symptoms
• swelling or lump in throat, followed by dysphagia and pain when talking, burning in the throat
Advanced signs
• dyspnea, weakness, weight loss, enlarged cervical lymph nodes, pain, anemia, HALITOSIS, earaches

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59
Q

• Venous & arterial insufficiency
o Signs/symptoms
o stasis dermatitis (red/brown on low legs)

ulcers, difficult to heal, usually on ankle bone or malleolus

swollen legs

A

H

60
Q
  • Myelodysplastic syndrome
  • Myelodysplastic Syndrome (MDS)
  • low WBC, low hem, low platellets

usually diagnosed in older adults
• MDS tx
• stem cell transplant
-can’t be used in older adults

supportive care (blood transfusions)

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61
Q

leukemia
Leukemia priority of care
infection prevention

  • platelets
  • Why would you give platelets?
  • Thrombocytopenia (low platelets)

given for clotting problems

Given for hyponatremia
Potassium:
-NO IM & NO IV (can IV infuse)
-Max dose/hr= 10-20meq/hr

Tic tac toe method- compensation?

Inflammation vs infection

  • Inflammation: redness, swelling, pain. You do not have to have infection to have inflammation,
  • Infection: heat, fever, increased purulent drainage, malodorous, inflammation

Can you have inflammation without infection?
Yes, but chronic inflammation can increase your risk of infection.

What is rheumatoid arthritis?
Autoimmune disease precipitated by WBCs attacking synovial tissue

Side effect of ace inhibitors= increased potassium
Endocarditis-drug users are more likely at risk.
MAP?
Cystic Fibrosis: fat soluble vitamins, chest perfusions, increase protein, and enzymes
Thyroid Storm s/s
Tx?
Triggers?

Prealbumin 16-40 (KNOW LAB VALUE) (PROTEIN)= possible skin break down is how it determines nutritional status?
Test name to test fpr glaucoma? Tonometry
Thrombocytopenia precautions?
Priority with sickle cell- PAIN management caused by? Hypoxia?
OA vs RA?
RA-immunosuppressants

A

N

62
Q

• ABG’s-typical stuff from past exams
• ABGs: [Arterial Blood Gases]
• Normal Range—
pH: 7.35-7.45, CO2: 45-35, HCO3: 22-26

• Respiratory acidosis:

  • pH down, CO2 up, HCO3 up
  • high CO2 related to low respiratory rate [hypoventilation]


• Causes of Respiratory acidosis:
• shallow breathing, surgery/anesthesia lowering RR, narcotic use, COPD

• Tx of Respiratory acidosis:
• treatment of underlying cause, O2, bronchodilators, ambulate, Narcan [if narcotic related]
• Respiratory alkalosis:
• decreased CO2 level related to increased respiratory rate

• Causes of Respiratory alkalosis:
• anxiety (hyperventilation), fever (increases metabolic rate), pain, hypoxia

• Tx of Respiratory alkalosis:
• treatment of underlying cause, rebreathe CO2; paper bag
• Metabolic acidosis:
• addition of acid or loss of base

• Causes of Metabolic acidosis:
• -renal failure; unable to rid body of excess acid,
-diabetes; produce ketones which is an acid - DKA,
-diarrhea [loss of base; out the acidosis]

• Tx of Metabolic acidosis:
• -dialysis, insulin/fluids
- D5, antidiarrheals/antibiotics

• Metabolic alkalosis:
• loss of acid or excess base
• 
• Causes of Metabolic alkalosis:
• vomiting, GI suctioning, antacid overuse
• 
• Tx of Metabolic alkalosis:
treatment of underlying cause, antiemetics, decrease antacid use
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63
Q

Endocarditis-risk factors for development
• Endocarditis s/s
• chest pain

petechiae

fever/chills

anorexia

night sweats

  • Endocarditis risk factors
    • IV drug users (staph aureus)

-ppl w/ valve replacements

-anyone with systemic infection
• endocarditis tx
• antibiotics up to 6wks

A

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64
Q
Normal ejection fraction
55-65
ejection fraction with heart failure
below 40
-pace maker 30 and below?? Stops MI

LOW EF: can cause a rapid heartbeat to increase blood flow but this can make the heart pump ineffectively. Edema, shortness of breath, and poor perfusion are symptoms of a low EF. A low EF can be used to help determine severity of heart failure

A

I

65
Q

IV: 0.9% NS
isotonic

no fluid shift

given for dehydration

IV: 0.45% NS
Hypotonic

Lower osmolarity than blood

fluid will shift from vessel and go to cell

Given for DKA pts

IV: 3% Saline
Hypertonic

fluid is pulled from cell to vessel (dehydrates cell)

possible risk for fluid overload (hypervolemic) and swelling of brain and seizures

A

J

66
Q

CHF:
• heart isn’t pumping enough blood throughout the body- decreased cardiac output
Congestive heart failure

At home monitoring [CHF]:
patients should weight themselves daily at the same time each morning after urinating. This will help show weight gains/fluid retention. Also need to check for edema daily.

Rx for CHF:

  • Ace inhibitors (-pril) - increases sodium excretion and decreases pressure the heart must overcome to eject blood from the heart,
  • ARBs (-sartan) - reduces heart workload,
  • Vasodilators (Isosorbide) - dilates vessels; don’t affect RAAS,
  • Nitrates - relax vascular smooth muscles,
  • Beta blockers (-olol) - gives back elasticity and relaxes heart,
  • Diuretics (Lasix) - removes volume,
  • Digitalis (Digoxin) - gives force to pumps,
  • Aspirin - reduces platelet aggregation.

Diuretics:

  • closely monitor for hyponatremia, hypokalemia, and dehydration.
  • Side effects are: frequent urination, arrhythmias, muscle cramps/weakness, lethargy.

• Goals for CHF:
• decrease heart workload, improve cardiac function/symptoms, increase activity level
Rt sided failure- Always will have Lt side failure.

  • assessment of Right-sided CHF:
  • edema, JVD, irregular heart rate, enlarged liver, weight gain, elevated BNP over 100
  • Right-sided CHF:
  • right ventricle has difficulty pumping blood to the lungs - blood builds in vessels causing fluid retention

• Left heart failure

  • Left-sided CHF:
  • damage to the left ventricle - causes fluid to build up in lungs
  • assessment of Left-sided CHF:
  • SOB, dyspnea at night, cough, frothy/pink sputum, syncope, heart murmur, crackles in lungs, weight gain, elevated BNP
A

I

67
Q

Pericarditis-signs/symptoms
• Pericarditis
• inflammation of sacs around heart

concern for cardiac tamponade
• pericarditis s/s
Chest pain worse when lying flat
relieved by sitting up and leaning forward
pain worse with inspiration

• pericarditis tx
NSAIDS
Steroids

A

I

68
Q

Nutrition assessment- main nursing priority

Lab assess

A

Assure they are sticking to recommended diet

Vitamins
Protein
Glucose
Hemoglobin