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Questions and Answers
What is the preferred daily sodium intake for individuals with dietary restrictions?
Which signs and symptoms are associated with bile duct tumors?
What characterizes acute pancreatitis?
What is the primary function of immunoglobulin (IG) in passive immunity for hepatitis A and B?
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What is a common consequence of diabetic neuropathy?
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Which of the following is a key characteristic of chronic pancreatitis?
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What is one of the risks associated with the use of insulin pumps?
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What are the liver labs crucial for assessing liver function?
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What is the required treatment for pernicious anemia?
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Which of the following is a common symptom of Polycythemia Vera?
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What should be prioritized in managing CHF and fluid overload?
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What distinguishes STEMI from NSTEMI on an EKG?
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What is an important consideration when administering Digoxin to a patient?
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What is a primary lifestyle recommendation for managing GERD?
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In the case of a perforated peptic ulcer, which intervention is critical?
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What is a key side effect of Nitroglycerin when administered sublingually?
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What is the correct measure to take if a patient shows signs of overdose from opioids?
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Which of the following is NOT a risk factor for developing osteoporosis?
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Which assessment findings are commonly associated with bronchitis?
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Identify the correct intervention for managing a patient with PAOD.
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What is the appropriate position to place a patient experiencing an air embolism?
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Which is a common complication associated with TURP procedures?
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Which of the following is a true statement regarding pneumonia treatment?
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What should be monitored for a patient receiving daily weights related to fluid status assessment?
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Which medications are used for lowering triglycerides?
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What is a key dietary recommendation for managing Ulcerative Colitis?
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When monitoring a patient on aminoglycosides, which side effect should be closely watched?
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What is the immediate post-operative care directive for an amputation?
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During blood administration, which of the following is NOT part of the standard protocol?
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What is the primary intervention for managing nephrolithiasis?
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Which of the following symptoms are typically associated with acute pyelonephritis?
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What should be monitored closely post-thyroidectomy?
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Which medication class is used to reduce tremors in Parkinson's disease?
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What is a potential complication of untreated hyperthyroidism?
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What lifestyle change is recommended for preventing cerebrovascular accidents (CVA)?
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Which of the following is a common complication of hypertension?
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Which intervention is contraindicated for patients taking ACE inhibitors?
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Study Notes
Sodium Diet Restrictions
- Recommended sodium intake: less than 2400 mg per day, ideally 1500 mg.
- Avoid added salt.
- Fresh foods are better than canned.
- Drain, wash, and cook canned foods in tap water to remove excess sodium.
Therapeutic Communication
- Involves establishing rapport and building trust with the patient.
- Uses active listening, empathy, and non-judgmental language.
- Encourages patient participation and expression of feelings.
Prioritization
- Uses Maslow’s hierarchy of needs to determine the most urgent needs.
- Focuses on airway, breathing, and circulation (ABCs).
- Prioritizes based on patient's condition, risks, and urgency.
Delegation
- Assigning tasks to qualified individuals.
- Nurses retain accountability for delegated tasks.
- RNs can delegate tasks to LPNs and CNAs.
Liver Location
- Located in the right upper quadrant (RUQ) of the abdomen, under the diaphragm.
Passive Immunity Hepatitis A & B
- Immunoglobulin (IG) provides passive immunity for 6-8 weeks.
- IG deactivates the virus.
- Administer within two weeks of exposure.
Waste Products of Diabetes
- Excess glucose leaks into urine.
- Urine contains glucose, ketones, sodium, potassium, and chloride.
Diabetic Neuropathy
- Nerve damage leads to paresthesia (tingling) and numbness.
- Increased risk of foot amputation due to loss of pain sensation.
Diabetic Resources
- Glucose monitors
- Insulin education
- Meal planning resources
Diabetic Treatment
- Glycemic control
- Exercise
- Stress reduction
- Self-monitoring of blood glucose
Insulin Pumps
- Same risk of infection as subcutaneous injections.
- Continuous blood glucose monitoring.
- Improved glycemic control with less insulin.
- Deliver rapid-acting insulin.
- Risk of hypoglycemia at peak times.
Peaks of Insulin
- Rapid-acting ("log"): 30 minutes to 1 hour.
- Short-acting ("R"): 2-3 hours.
- Intermediate-acting ("N"): 4-12 hours.
- Long-acting (glargine & detemir): No peak.
Choose My Plate Recommendations
- Fruits: 1-2 cups daily.
- Vegetables: 2-3 cups daily.
- Grains: 5-8 ounces daily.
- Protein: 5-6.5 ounces daily.
- Dairy: 3 cups daily.
- Oils: 5-7 teaspoons daily.
Important Liver Labs
- Alanine aminotransferase (ALT)
- Aspartate aminotransferase (AST)
- Gamma-glutamyl transferase (GGT)
- Albumin
- Prothrombin time (PT)
Biliary Tumor S&S
- Jaundice
- Itching
- Abdominal pain
- Weight loss
Liver Transplant
- Treats life-threatening end-stage liver disease.
- Requires successful immunosuppression.
- Immunosuppressant drugs increase risk of infection.
Acute Pancreatitis
- Reversible.
- Patient should be NPO (nothing by mouth).
- Isolated inflammation.
- Systemic inflammatory response.
- Grey Turner's sign (flank discoloration).
- Cullen's sign (umbilical discoloration).
- Risk of sepsis and organ failure.
Chronic Pancreatitis
- Not reversible.
- Progressive destruction of the pancreas.
- Healthy cells replaced by scar tissue.
- Decreased ability to release enzymes: lipase, amylase, trypsin.
- Most common causes: alcohol and smoking.
- Long-term glucose intolerance, insulin deficiency, pancreatic insufficiency, malabsorption, and malnutrition.
Pernicious Anemia
- Vitamin B12 deficiency.
- Requires monthly injections for life.
- Deficiency in intrinsic factor (protein needed for B12 absorption).
Polycythemia Vera
- Excess red blood cells (RBCs).
- Causes red, ruddy complexion.
- Treatment: Therapeutic phlebotomy (blood removal) and aspirin.
CHF/ Fluid Overload Priority & Interventions
- Rest.
- Small, frequent meals.
- High Fowler's position with pillows tucked under arms.
- Increase tissue perfusion.
- TED hose to prevent venous thromboembolism.
Professionalism in The Clinical Setting
- Maintain a professional appearance and demeanor.
- Adhere to ethical principles.
- Demonstrate respect for patients, colleagues, and healthcare professionals.
- Provide patient-centered care.
- Advocate for patients' rights and wellbeing.
Acute Coronary Syndrome Labs
- Unstable angina: Chest pain with a normal electrocardiogram (EKG).
- ST-segment elevation myocardial infarction (STEMI): ST elevation on EKG indicates significant heart damage.
- Non-ST-segment elevation myocardial infarction (NSTEMI): High cardiac biomarkers, but EKG is normal.
CHF Medications & Interactions with Electrolytes
- Digoxin: Increases force of contraction and slows heart rate.
- Assess apical pulse and potassium levels.
- Hyperkalemia can lead to digoxin toxicity.
Medications and Their Side Effects
- ACE Inhibitors: "Pril" - Side effect: Cough.
- ARBs: "Sartan" - Alternative for patients unable to tolerate ACE inhibitors.
- Diuretics - Side effect: Electrolyte loss, Sprinolactone is a potassium-sparing diuretic.
- Beta Blockers
- Vasodilators
- Calcium Channel Blockers: "Dipine" - Side effect: Slows contraction, contraindicated in systolic heart failure.
- Morphine: Vasodilator
GERD Lifestyle Teaching
- Low-fat meals.
- Avoid fatty foods.
- Sleep with head of bed elevated.
- Avoid tight clothing.
- Don't eat or drink 2-3 hours before bed.
- Don't lie supine 2-3 hours after eating.
- Avoid bending or lifting heavy objects.
- Avoid stimulants.
Dosage Calculation
- Understand medication dosages and units of measurement.
- Use correct formulas to calculate dosages.
- Double-check calculations to prevent errors.
Peptic Ulcer Disease PCs & Interventions
-
Hemorrhage:
- Stabilize shock.
- Progressive NPO (nothing by mouth).
- Nasogastric tube (NGT) placement.
-
Perforation:
- Erosion of the ulcer into the peritoneal cavity.
- Requires intravenous fluids (IVFs), NGT, antibiotics (ABX), and surgical closure.
-
Penetration:
- Erosion of the ulcer into adjacent cavities.
- Requires IVF, NGT, ABX, and surgical closure.
-
Pyloric obstruction:
- Edema or scar tissue around the ulcer near the pylorus.
- NGT to low suction, IVF, clear progressive diet, antacids, pyloroplasty or antrectomy.
Hip Replacement Post-Op
- 6 Ps: Pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia (temperature difference).
- Abduction pillow to prevent hip dislocation.
- Avoid turning to the affected side.
- Prevent blood clots (DVT, PE).
- Prevent pulmonary complications (pneumonia).
- Prevent skin breakdown.
Angina Prevention
- Limit physical exertion.
- Avoid strong emotions.
- Eat small meals.
- Avoid temperature extremes.
- No smoking.
- Limit sexual activity.
Nitroglycerin
- Vasodilator.
- One tablet every five minutes (up to three).
- Sublingual administration.
- Take before activity that may trigger angina.
- Side Effects: Headache, hypotension, and skin flushing.
Hyperlipidemia Medications
- Statins: Lower cholesterol.
- Bile acid sequestrants: "Chole" - Bind with bile acids in the gut to reduce cholesterol absorption.
- Triglyceride-lowering drugs: Fibrates, niacin, and fish oil.
CAD Risk Factors and Medications
- Gender
- Race
- Hereditary
- Smoking
- Hypertension
- Hyperlipidemia
- Diabetes
- Elevated homocysteine levels
- Oral contraceptives
- Obesity
- Physical inactivity
Complications of CHF
- Left-sided heart failure: Lung complications (pulmonary edema).
- Right-sided heart failure: Peripheral complications (edema in legs and feet).
Ulcerative Colitis Priority
- Perforation: Rigid, board-like abdomen.
- Diet: Low-residue, high-calorie, high-protein, vitamin supplements.
- I&O Monitoring
- Daily weight
- Medications: Antidiarrheals, antibiotics, corticosteroids, and bulk agents.
Aminoglycoside Nursing Implications
- "Micin" Drugs
- Adverse effects: Ototoxicity (hearing loss), nephrotoxicity (kidney damage), and neurotoxicity.
- Monitor peak and trough levels to ensure therapeutic dosage and minimize toxicity.
Post Op Amputation
- Avoid ACE wrap (tight elastic bandage).
- Elevate with foot of the bed (not pillows).
- Keep tourniquet at bedside.
- Report positive sputum cultures and night sweats to the health department.
TB Reporting & transmission
- Airborne precautions immediately.
- Aerolized droplet transmission.
- Report to the health department.
- S&S: Positive sputum culture, night sweats.
Percutaneous Transluminal Coronary Angioplasty
- Procedure performed in the catheterization lab.
- Catheter inserted into the femoral artery and threaded to the plaque location.
- Balloon-tipped catheter is inflated to crack the atheroma.
- May be performed multiple times.
IBS Diet Modifications
- Restrict irritating foods and gradually reintroduce them.
- High fiber diet and bulk formers.
- Chew food thoroughly.
- Avoid fluids with meals.
- Keep a food diary to identify problematic foods.
Blood Administration Protocol
- 18-gauge needle.
- Baseline vital signs (VS).
- Informed consent.
- Start blood transfusion within 30 minutes of retrieving blood from the blood bank.
- Complete transfusion within 4 hours.
- Double-check blood product at bedside with another RN.
- Remain with patient for the first 15 minutes.
- Retake VS after 15 minutes.
- Take VS hourly during the transfusion.
Assessing Fluid Status
- Daily weights: 2.2 kg = 1 lb.
- Intake and output (I&Os) monitoring.
Surgery Classification
- Minor - Involves minimal risk, short recovery time (ex: cataract surgery).
- Major - Involves higher risk, long recovery time (ex: open heart surgery).
- Emergent - Must be performed immediately to save life (ex: appendicitis).
- Urgent - Requires prompt attention, but not immediately life-threatening (ex: ruptured spleen).
- Elective - Procedure is not an immediate necessity, can be planned (ex: knee replacement).
Opioid Administration Implications
- Frequent pain assessment.
- Monitor VS before, during, and after opioid administration.
- Assess Level of Consciousness (LOC) and gastrointestinal (GI) function.
- Assess for overdose signs: Cold, clammy skin, confusion, pinpoint pupils, decreased heart rate, respiratory rate, and blood pressure.
OA Living Modifications
- Symptoms typically resolve with rest.
- Worsen at the end of the day.
Bronchitis Assessment Findings
- "Blue Bloaters"
- Cyanotic (blue) and dusky (grey) appearance.
- Productive cough.
- Use of accessory muscles (tripod position)
- Clubbing (abnormal widening of the fingertips).
- Weight gain.
- Enlarged heart.
Osteoporosis Risk Factors
- Small frame.
- Postmenopausal status.
- Lack of weight-bearing exercise.
- Prolonged immobility.
- Long-term steroid use.
- Deficiency in calcium and vitamin D.
- Smoking.
Heparin Precautions
- Partial Thromboplastin Time (PTT): 21-35 seconds.
- Monitor vital signs and labs.
- Observe for signs of bleeding.
- Implement bleeding precautions.
- Avoid aspirin and green leafy vegetables (contain vitamin K, which can counteract heparin).
PAOD Interventions and Lifestyle Modifications
- Antiplatelet medications.
- Statins to lower cholesterol.
- Vasodilators.
- Smoking cessation.
- Exercise.
- Diabetes control.
- Angioplasty or bypass surgery.
Pneumonia Priority Treatment & Assessment Findings
- Signs & Symptoms: Fever, tachypnea (rapid breathing), dyspnea (shortness of breath), tachycardia (rapid heart rate), wheezing, rhonchi, pleuritic chest pain.
- Treatment: Bronchodilators, oxygen therapy, rest, high fluid intake, pulmonary hygiene, and antibiotics.
Surgical Time Out
- Performed before any surgery to verify correct patient, procedure, and site.
- Ensures a safe and error-free surgical process.
Proper Documentation
- Accurate, complete, and concise documentation of all patient care activities.
- Follows legal and ethical guidelines.
- Ensures clear communication between healthcare professionals.
Air Embolism Interventions
- Left side Trendelenburg position.
- Apply oxygen immediately.
Bowel Revision Surgeries
- Total protocolectomy with permanent ileostomy: Liquid stool, potential skin irritation.
- Total protocolectomy with continent ileostomy: Pouch created under the skin, self-catheterization.
- Ileostomy and ascending colostomy: Dehydration and skin irritation.
- Transverse and sigmoid colostomy: Constipation.
Emphysema Interventions
- Pursed-lip breathing to eliminate trapped air.
- Bronchodilators (short-acting: albuterol).
- Supplemental oxygen.
- High Fowler's position.
- Breathing techniques.
- Pulmonary hygiene.
- Pace activities.
- Allow rest.
- Cooler room temperature.
- Small, frequent meals.
- Flu and pneumonia vaccines.
- Reduce respiratory infections.
TURP Complications and Nursing Interventions
- Complications: Urethral stricture, bleeding, clots obstructing catheter flow.
- Interventions: Bladder irrigation, assess for bleeding and clots, antispasmodics, teach perineal exercises, stool softeners, encourage fluid intake, educate client to monitor for bleeding up to two weeks after surgery.
Addison's Lab Monitoring
- Low levels of cortisol, sodium, and blood glucose.
- High levels of potassium.
- Treat with insulin with dextrose to lower potassium levels and Kayexalate.
CVA Prevention
- Healthy lifestyle.
- Smoking cessation.
Urinary Diversion Complications
- Infection.
- Dehiscence (wound opening).
- Urinary leakage.
- Ureteral obstruction.
- Small bowel obstruction.
- Stoma gangrene.
- It is not normal to see stool in the urinary diversion drainage.
Nephrolithiasis Interventions
- Allow stone to pass on its own (first-line treatment).
- Narcotics for pain relief.
- NSAIDs for pain and inflammation.
- Antiemetics to control nausea and vomiting.
- Surgical treatment if stone does not pass within 6-8 weeks.
- Surgical procedures: Ureteroscopy, percutaneous nephrolithotomy, extracorporeal shock wave lithotripsy.
Pyelonephritis Signs and Symptoms
- Acute: Flank pain, costovertebral angle (CVA) tenderness, dysuria (painful urination), malaise, pus cells, bacteria, and white blood cells (WBCs) in the urine.
- Chronic: Vague flank pain, fatigue, headache, occasional fever, bacteriuria (bacteria in urine).
Hemorrhagic CVA Treatment
- Optimize cerebral perfusion (blood flow to the brain).
- Decrease intracranial pressure (ICP).
Thyroidectomy Nursing Implications
-
Pre-op:
- Antithyroid medications until symptoms disappear.
- Beta blockers.
- Stop blood thinners weeks before surgery.
-
Post-op:
- Periodically assess surgical dressing.
- Observe sides and back of neck for bleeding (internal bleeding).
- Monitor for feeling of fullness at the incision site.
- Monitor respiratory status.
- Semi-Fowler's position with head supported for comfort.
- IVFs.
- Instruct patient to limit speech.
- Provide over-bed table to reduce neck strain.
- Get out of bed (OOB) as soon as possible.
- High-calorie diet.
- Monitor for tetany (muscle spasms) due to hypocalcemia.
Hyperthyroidism Priority Treatment
- Treatment: Radioactive iodine therapy, antithyroid agents, iodides, thyroidectomy.
- Monitor for potential complication: Thyroid storm - Severe form of hyperthyroidism, fatal if untreated.
- Thyroid storm signs & symptoms: High fever, tachycardia, same symptoms as hyperthyroidism.
- Treat the underlying cause and provide supportive care.
Parkinson's Medications
- Anticholinergics: Reduce tremors.
- Dopamine receptor agonists: First-line treatment.
- Levodopa: Increases dopamine levels in the brain.
HTN Complications
- Damages blood vessels throughout the body, especially target organs.
- Outcomes: Myocardial infarction (MI), chronic kidney disease (CKD), cerebrovascular accident (CVA, stroke), impaired vision.
Bladder Cancer Risk Factors
- Smoking.
- Exposure to chemicals.
- Chronic urinary tract infections (UTIs).
- High urinary pH.
- High cholesterol intake.
- Pelvic radiation therapy.
- Metastasis.
Addison's Medication, Treatment, and Goals
- Medications: "Sone" drugs (corticosteroids)
-
Treatment:
- Fluid balance.
- Monitor for fluid volume deficit.
- Prevent hypoglycemia.
- Frequent vital signs.
- Daily weight.
- Intake & Output (I&O) monitoring.
- Hormone replacement therapy.
-
Goals:
- Prevent Addisonian crisis.
- Manage hypoglycemia.
ACE Inhibitors
- "Pril" - Act in the lungs to inhibit the conversion of angiotensin I to angiotensin II.
- Angiotensin II is a powerful constrictor and stimulator of aldosterone release, resulting in slight potassium elevation.
- Side effects: Pancytopenia (low blood cell count), angioedema (swelling), cough, hypotension.
- Contraindicated in: Hyperkalemia and impaired renal function..
- Take on an empty stomach.
Prevention of Ischemic Stroke
- Reduce blood clot formation (thrombosis).
Identification of Cardiac Rhythms on an ECG Strip
- Normal sinus rhythm (NSR): Regular rhythm with a rate of 60-100 beats per minute (bpm).
- Sinus tachycardia: Regular rhythm with a rate of 100-160 bpm.
- Sinus bradycardia: Regular rhythm with a rate of less than 60 bpm.
- Atrial fibrillation (AFib): Irregular rhythm with no discernable P waves.
- Ventricular tachycardia (VTach): Rapid rhythm originating in the ventricles.
- Ventricular fibrillation (VFib): Chaotic rhythm with no organized electrical activity.
- Asystole: Absence of electrical activity on the EKG.
Correlate EKG with Physiological Events of the Heart
- Refer to Roger's study guide for a detailed correlation of EKG rhythms with physiological events of the heart.
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Test your knowledge on dietary restrictions, symptoms of bile duct tumors, and the characteristics of pancreatitis. This quiz also covers immunoglobulin functions in hepatitis, consequences of diabetic neuropathy, and essential liver labs. Perfect for healthcare students and professionals!
