General 2 Flashcards
Three Indications for getting a peritoneal dialysis instead of a haemodialysis
Difficulty with vascular access
Unstable, infection, HTN, Anticoagulant
Patient is independent, can do treatments on their self
Describe the procedure for peritoneal dialysis.
1st & Subsequent times
1st dialysate in (Warm it first) then drain
Subsequent times: Drain first then dialysate
Preprocedure: Peritoneal dialysis
VS, Labs, BS
Dry weight (before dialysate)
________
Assess access point
Difference between CAPD & APD peritoneal dialysis
CAPD = Daytime
4x - 5x
Gravity feed
Mobile
APD
Nighttime
Machine
(Otitis externa/ media), also known as swimmer’s ear, is an inflammation of the outer ear and ear canal.
(Otitis externa/media) is an inflammation of the middle ear, which is located behind the eardrum
Otitis externa, also known as swimmer’s ear (bacteria / Fungus can grow in this fluid)
Otitis media is an inflammation of the middle ear
FHR
Fetal heart rate
110 - 160
Decelerations are….
temporary decreases in the fetal heart rate (FHR) that can occur during labor.
Three types:
Early, variable, and late.
Early = Normal
Late and variable = Concerning
Early decelerations in FHR (abnormal/normal)
Late decelerations…
Causes
Early = normal
Fundal pressure, breech posistion, strong uterine contractions, vaginal examination, placement of internal monitoring equipment
Late = abnormal/ concerning
Hypoxemia due to uteroplacental insufficiency,
Occurs when the placenta doesn’t deliver enough nutrients to the fetus during pregnancy.
This can happen when the placenta doesn’t develop properly or is damaged, or when there’s insufficient blood flow to it.
Early or late decelerations
Breech baby
Fetal Hypoxemia
Strong uterine contractions
Metabolic fetal acidemia
Uteroplacental insufficiency
Early decelerations = Normal
Breech baby
Strong uterine contractions
Late decelerations = Concerning
Fetal Hypoxemia
Metabolic fetal acidemia
Uteroplacental insufficiency
During haemodialysis BP drops to 82/54
Nurse preforms the following intervention:
Reduce temperature of dialysate ( Warm fluid in veins causes vasodilation = low BP)
Adjusting rate of dialyzer flow
Place client in Trendelenburg posistion
Administration of: Fluid bolus, albumin, or Mannitol
These interventions don’t work to raise BP
Complete the following sentence:
The client is at Most risk for developing _____ due to ______
Conditions:
Hypoglycemia
Myocardial injury
Infectious disease
Fluid volume imbalance
Disequilibrium syndrome
Potential Causes:
Fluid shifts
DM
Pericardial disease
Frequent blood Transfusion
Rapid reduction of electrolytes
Most risk for developing myocardial injury due to pericardial disease
Adverse SE
Increased Intercranial Pressure ICP
Neurotoxicity
Respiratory Despression
Othrostaic HTN
Constipation/ Emesis
Urinary retention
Choose:
Beta Blockers
Nsaids
Opiods
Opiods
Myoclonus (sudden, involuntary muscle jerk, shake, or spasm.)
Hyperalgesia: increased sensitivity to pain and an extreme response to pain.
Delirium
Agitation
SE from Opiods
T or F
T
Methylnaltrexone
Common brands: Relistor
Is….
When to use…
Gut motility stimulator
It can treat constipation caused by narcotic pain medications.
After other Anticonstipation measures taken.
Fluid / Fiber
Senna - Stimulants
Docusate - Stool Softener
Lactulose or Sodium phosphate
Which 5 interventions would the nurse include in the plan of care for a client to maintain good seal during NPWT
- ID air leaks using stethoscope
- Shave hair around would
- Ensure periwound skin surface is dry
- Avoid wrinkles when applying transparent film
- Fill uneven skin surfaces with barrier skin product
- Frame the periwound area with hydrocolloid dressing
- Cut transparent film to extend 1/2 inch beyond wound perimeter
- Use as many dressing layers as needed
- ID air leaks using stethoscope
- Ensure periwound skin surface is dry
- Avoid wrinkles when applying transparent film
- Fill uneven skin surfaces with barrier skin product
- Frame the periwound area with hydrocolloid dressing
- Cut transparent film to extend 1/2 inch beyond wound perimeter
- Use as many dressing layers as needed for prevent air leaks.
Wrong:
2. Shave hair around would.
Use clippers not “shave”
- Cut transparent film to extend 1/2 inch beyond wound perimeter
Transparent film should extend 1 or 2 “ beyond wound perimeter
- Use as many dressing layers as needed for prevent air leaks.
1 or 2 layers only.
Multiple layers prevent moisture vapor transmission causing Maceration
Which of the following would a nurse do to help a client with a Negative Self-Imag3
- Set realistic goals for behavior modification
- Reward client for practicing new behaviors
- Provide positive regard for adaptive behavior only
- Encourage the client to practice behavior modification
- Help client ID Negative qualities & Experiences
- Help client ID own behavior needing change
- Reinforce self-worth with time and attention by giving one-on-one time
- Set realistic goals for behavior modification
- Reward client for practicing new behaviors
- Encourage the client to practice behavior modification
- Help client ID Negative qualities & Experiences
- Help client ID own behavior needing change
- Reinforce self-worth with time and attention by giving one-on-one time
Incorrect:
- Provide positive regard for adaptive behavior (Social or practical competence to live in society)
Nurse will give unconditional positive regard & avoid reinforcement of Negative behaviors
- Help client ID Negative qualities & Experiences
Instead, recognize positive qualities & accomplishments
Conditioner where a client will need TPN (total parental nutrition) (4)
Highly Stressed Neurological States
Burns
Sepsis
Head Trauma
No able to digest / absorb foods
TPN can’t be stopped Abruptly
If TPN bags is empty & another isn’t ready, what does the nurse do?
Infuse 10% glucose solution
Risk factors for TPN are
Hypoglycemia or Hyperglycemia
Both
Be prepared to treat both conditions
Insulin & Glucagon ready
DM patient feels: Hunger, irritated, shaky and weak
Which would the nurse suggest to help with these symptoms of hypoglycemia
6 saltine crackers
3 Graham crackers
120 mL of fruit juice
240 mL skim milk
6 - 10 hard candie
4 tbl honey
120 mL of diet soda
Decrease carb intake
Admin insulin on sliding scale base
6 saltine crackers
3 Graham crackers
120 mL of fruit juice
240 mL skim milk
6 - 10 hard candies
Wrong
4 tbl honey = Too Much, 1 tbl is needed
120 mL of diet soda
Decrease carb intake
Admin insulin on sliding scale base
79 yr old client returned home from hospital for heart failure.
The client started walking 3x weekly but has stopped the routine due to being tired.
VS:
HR 68
RR 20
SpO² 92% RA
BP 112 / 68
COMPELETE THE SENTENCE
The nurse would 1. ___________ because 2. ___________
- Advise the client to slow down on the exercise program
Inform the client to maintain the same exercise regimen
Instruct client to check ankel edema before exercising
The heart needs to contract efficiently, and exercise is one treatment measure to accomplish this.
An additional dose of the prescribed diuretic needs to be taken before exercising
Tolerance to increased activity needs to be built up and takes time
The nurse would 1.Advise the client to slow down on the exercise program because 2.Tolerance to increased activity needs to be built up and takes time
The umbilical Cord is protruding through the vagina after a patient’s “water broke “
Tell which interventions will be
INDICATED or CONTRAINDICATED
1.Administer Oxygen
2.Notify HCP
3.Monitor FHR continuous
- Increase rate flow of Oxytocin
- Gently push the cord into the vagina towards the cervix
6.Posistion client with HOB @ 30°
- Wrap cord in sterile towel saturated with warm normal saline
- Glove the hands insert 2 fingers into the vagina and exert pressure against the presenting part.
1.Administer Oxygen
2.Notify HCP
3.Monitor FHR continuous
- Wrap cord in sterile towel saturated with warm normal saline
- Glove the hands insert 2 fingers into the vagina and exert pressure against the presenting part.
(This will relieve pressure on the cord)
T or F
In Umbilic Cord Prolapse the nurse would put client in a semi fowler position and leave client to contact the HCP
F
Extreme Trendelenburg
Modified left-lateral
Knee- chest posistion
Stay with patient and summon help
5 yr old with asthma attack
Brought to ED
wheezes bilateral
Retractions noted
SpO² 90% RA
HR 112
RR 24
BP 124 / 82
Which actions would the nurse take
- Start IV line
- Obtain ABG
- Administer quick relief medicine
- Assist child into left lateral posistion
- Ask parents to wait in ED waiting room.
- Oxygen nasal Cannula 2L/m
- Place on continous cardiorespiratory & pulse Ox monitoring
- Obtain blood specimens for electrolytes, CBC, renal function test
- Start IV line
- Obtain ABG
- Administer quick relief medicine
- Place on continous cardiorespiratory & pulse Ox monitoring
- Obtain blood specimens for electrolytes, CBC, renal function test
Wrong:
Face Maks instead of Nasal Cannula (Cannula will dry out membranes)
After applying pressure to hand with severed fingers
Why wouldn’t you check to see if bleeding has stopped after 10 minutes?
Checking could dislodge clot and make bleeding start again
Fingers severed
Which actions do you take.
- Call 911
- Elevate affected hand above the heart
- Place fingers in waterproof bag
- Check victim for A,B,C
- Place waterproof bag with fingers on ice
- Apply direct pressure to amputation site with layers of dry gauze.
- Remove gauze after 10 minutes to check bleeding status
- Ensure fingers are transported to hospital
- Call 911
- Elevate affected hand above the heart
- Place fingers in waterproof bag
- Check victim for A,B,C
- Apply direct pressure to amputation site with layers of dry gauze.
- Ensure fingers are transported to hospital
Wrong:
- Place waterproof bag with fingers on ice. PLACE THEM IN ICE WATER 1PART ICE & 3 PARTS WATER
- Remove gauze after 10 minutes to check bleeding status
DONT REMOVE GAUZE. THIS CAN DISLODGE THE BLOODCLOT THAT FORMED.
Medication Safety
To promote Medication Administration safety & prevent med errors, the nurse checks atleast (1.) _____ client ID, reads the medication lable at least (2.) ______ times, and documents medication administration (3.) ________
Option 1.
1,2,3,4
Option 2.
1,2,3,4
Option 3
As soon as medication is given
Immediately before medications are given
After medications are given and after leaving the room
Before removing the medication from the system.
Nurse checks at least 2 client ID, reads medication lables at least 3 times and documents medication administration as soon as medications are given
ACE Inhibitor
Used for which diseases
Examples/ Names:
Cautions / SE
Diseases:
HTN
Coronary artery disease
Heart failure
Diabetes
Certain chronic kidney diseases
Heart attacks
Scleroderma
Names: (pril)
Captopril, Cilazapril, Enalapril, Fosinopril
Don’t take when pregnant
SE: ANGIOEDEMA / Dry Cough
Amiodarone
Common brands: Pacerone, Nexterone
Type of medication
Used to treat:
SE:
Avoid:
Antiarrhythmic
Treats: Afib
SE: Serious lung problems, liver problems, worsening irregular heart rate.
Grapefruit juice
How does Amiodarone help against Afib?
Se
Vasodilation
SE: Hypotension/ dizziness
Beta Blockers: Examples / Names
Treats:
SE
(olol)
Treats:
High blood pressure
Chest pain (angina)
Abnormal heart rate (arrhythmia)
Congestive heart failure
Heart attacks
SE: Dizzy,tired, hypotension
Oxytocin has a SE of antidiuretic effect.
This will cause (Dehydration/ Water Intoxication)
Water intoxication
Uterine Rupture can happen with oxytocin.
Give 3 symptoms of this outcome
Give a risk for Uterine Rupture with Oxytocin use
Sudden pain between contractions
Excessive vaginal bleeding
Decelerations on fetal monitor
Risk Factor = High Parity (numerous pregnancies)
CORRECRT
In dehydration what happens to K & Na levels
K = Down
Na = Up
Pacemaker
Complications include: (3)
Pericardial effusion: Build up of fluid around heart. Not putting pressure on heart
Cardiac Tamponade (Fluid collects in sac around heart. Puts Pressure on the heart and keeps it from filling properly. Drop in blood pressure that can be fatal)
Diaphragmatic pacing
Malposistioned pace maker effects the diaphragm by electrical impulses to stimulate the diaphragm to help people breathe
The following are unexpected in a patient who just had a biventricular Pacemaker placed in right subclavian area.
- Client reports pain at diaphragm level
- Hiccups that last long than normal
- Dressing is clean & dry
- Client uses left ear for talking on cell phone
- Client preforms right shoulder ROM exercise
- Client avoids lifting more than 10 lb
- Implantation site is clear and free of redness, swelling, drainage.
- Muscle contractions are noted over the diaphragm that correspond to HR
- Client reports pain at diaphragm level
- Hiccups that last long than normal
- Client preforms right shoulder ROM exercise
(Avoid lifting arm overhead) - Muscle contractions are noted over the diaphragm that correspond to HR
(Diaphragmatic pacing- bad positioning of pacemaker / lead is dislodged
Correct:
Talk on cell phone on oppsite side of which pacemaker is located.
*Avoid electromagnetic fields & telecommunications transmitters
65 yr Female
First assessment Post Op (open reduction with internal fixation of the left hip)
Mark the normal direct Post Op Findings
RR 8 BPM
SpO² 93% on 3/L min NC
Lung sounds clear to ausculation bilaterally
BP 90/ 56
HR 120 BPM
Peripheral pulses 2+ bilaterally
Drowsy, arousable and responsive to stimuli
PERRLA
Sensation in tact bilateral lower extremities
Bowel sounds hypoactive x4 quad
Urine output 20mL p/h
Surgical dressing saturated with bright red blood
No redness over pressure point
No petechiae or rashes throughout skin
SpO² 93% on 3/L min NC
Lung sounds clear to ausculation bilaterally (92 - 100 Normal postop)
Peripheral pulses 2+ bilaterally
Drowsy, arousable and responsive to stimuli
PERRLA
Sensation in tact bilateral lower extremities
Bowel sounds hypoactive x4 quad
No redness over pressure point
No petechiae or rashes throughout skin
ABNORMAL
BP = >120/ 80 due to patient pain
Tachycardia
Describe
Breech posistion (Describe Types)
Baby is born bottom end first.
3 types
Frank breech: Buttocks are down, Legs are straight up near their head
Complete breech: Buttocks are down, legs are bent at the knee, feet near their buttocks.
Footling breech: One or both of the baby’s feet are down
