Adult 1 Final - EDITED - Copy.docx

A chart of insulin Description automatically generatedFluids, Electrolytes, and Blood (6 questions) **Differentiate between types of anemia (pernicious, iron deficiency, folic acid etc.)** **[Pernicious Anemia] "Vitamin B12 anemia"** - **Cause:** deficiency of B12 or lack of intrinsic factor se...

A chart of insulin Description automatically generatedFluids, Electrolytes, and Blood (6 questions) **Differentiate between types of anemia (pernicious, iron deficiency, folic acid etc.)** **[Pernicious Anemia] "Vitamin B12 anemia"** - **Cause:** deficiency of B12 or lack of intrinsic factor secreted by GI tract - **S/S:** pallor, tachycardia, confusion, angular cheilosis, smooth red tongue, fatigue, irritability, diarrhea, [tingling], dizziness, tachypnea, SOB on exertion, sensitivity to cold - **Diagnostics:** B12 panel, Schilling test → no longer used in practice - **Management:** - PO B12 supplements (normal blood count w/in 4-8 weeks) for dietary absence - for intrinsic factor absence lifelong monthly IM injection, erythropoietin. **[Iron Deficiency Anemia]** - **Cause:** low dietary intake of iron for hemoglobin synthesis → most common cause GI bleed - **S/S:** pallor, tachycardia, fatigue, irritability, angular cheilosis, smooth red tongue, brittle ridged nails, dizziness, tachypnea, SOB on exertion, sensitivity to cold, tingling - **Diagnostics:** bone marrow aspiration → definitive, lab values for iron stores and hemoglobin levels - **Management:** iron supplements → empty stomach, 1-2 hrs after meal, IV if oral fails, increase iron rich foods (meat, dark leafy greens, beets, dried beans), increase vitamin C intake = enhanced absorption of erythropoietin **[Sickle Cell Disease]** - **Cause:** inheritance of the sickle hemoglobin gene leading to defective hemoglobin molecules - **S/S:** jaundice, hypoxia, thrombosis, pain, tachycardia, cardiac murmurs, cardiomegaly, increased risk of infection - **Diagnostics:** low hematocrit, sickled cells in blood, WBC and platelet count elevated due to chronic inflammation - **Management:** hematopoietic stem cell transplant, hydroxyurea, folic acids, vaccinations, antibiotics, hydration, RBC transfusions, supplemental oxygen, pain management **Priority actions when administering a blood transfusion.** - Signed informed consent on chart - Type and cross → two identifiers, data collection, collectors initials - The order for transfusion and the presence of a signed patient consent must be verified - Once the blood bank issues the blood component and it arrives at the patients location, the health care providers have to verify: - The exact spelling of patients name - Patient medical record number - Patient ID band - Blood to be administered - Number of units to be transfused - Compatibility - Expiration dates - No discoloration or weird appearance to the blood product **Blood products and proper uses.** **[Whole blood cells]** - **Use:** when large amounts of blood needs to be replaced or when individual blood components are not able to be replaced - Consists of RBCs, WBCs, platelets, and plasma **[Red blood cells]** - **Use**: blood loss due to trauma, surgical loss, offset chemo side effects, anemias **[Fresh frozen plasma:]** - **Use:** replace coagulation factors (hemophilia) (coag factors II, V, VII, IX, X, XI), active bleeding, massive hemorrhage, DIC, extensive burns, antithrombin III deficiency **[Platelets]** - **Use:** thrombocytopenia (platelet count \>20,000), aplastic anemia, chemo induced bone marrow suppression, active bleeding **[Granulocytes]** - **Use:** severe neutropenia (\>500 absolute neutrophil count (ANC) = increase risk of infection), life threatening fungal/bacterial infections not responding to antibiotic therapy, neonatal sepsis, neutrophil dysfunction **[Cryoprecipitate antihemolytic factor (CRYO)]** - contains clotting factors - **Use:** control bleeding in hemophilia A, correct low fibrinogen levels, treat von Willebrand disease and other clotting disorders **[Albumin]** - **Use:** hypovolemia, hypoalbuminemia, burns, adult respiratory distress, severe nephrosis, cardiopulmonary bypass surgery, hypoproteinemia **Recognizing and intervening for various transfusion reactions.** **[Febrile non-hemolytic reaction]** - 90% of all blood product reactions - **Onset:** 2 hours - **Cause:** donors blood fighting hosts - **S/S:** chills, [fever] (1 C/2 F higher than before transfusion), flushing, hypotension, tachycardia - **NA:** STOP transfusion, administer antipyretics, IV NS w/ new IV tubing - **Prevention:** WBC filtering **[Acute hemolytic reaction]** - **Onset:** immediate or with next transfusion - **Cause:** wrong blood type or Rh factor → potentially life threatening - **S/S:** fever, chills, low back pain, nausea, chest tightness, dyspnea, anxiety, hemoglobinuria (Hgb destroyed = RBCs in urine), hypotension - **NA:** STOP transfusion, remove blood tubing from IV access and send to lab w/ urine sample, IV infusion of NS w/ new IV, monitor VS and fluid status - **Prevention:** Label products correctly, accurately identify recipients **[Allergic reaction]** - **Onset:** during or up to 24 hours after transfusion - **Cause:** sensitivity to component of blood product - **S/S:** urticaria (hives), itching, flushing, bronchospasm, laryngeal edema, hypotension, sometimes **anaphylaxis** - **NA:** STOP transfusion, IV NS w/ new tubing, give antihistamines, if physician directs restart infusion slowly, severe reactions need epinephrine, corticosteroids, and oxygen, send blood/tubing and urine to lab - **Prevention:** premedicate patient before future infusions **[Transfusion related acute lung injury (TRALI)]** - most common transfusion mortality in US - **Onset:** w/in 6 hours → often w/ in 2 - Cause: accumulation and activation of neutrophils in pulmonary epithelium - **S/S:** SOB, hypoxia (O2 less than 90%), tachypnea, hypotension, fever, pulmonary edema → crackles in lung - **NA:** **maintain airway**, oxygen, intubation, fluid support - **Prevention:** limit frequency and amount transfused, use blood products from men, screen donor for antibodies **[Bacterial contamination]** - most common w/ platelets b/c stored at room temp - **Onset:** during or several hours after transfusion - **Cause:** improper storage or processing of product, organisms on donors skin - **S/S:** fever, chills, hypotension, sepsis - **NA:** **[STOP]** transfusion, monitor VS, administer antibiotics, admin IV NS, **send blood cultures to lab** - **Prevention:** proper procurement and processing of product, correct administration times → PRBCs and whole blood **complete** in 4 hours **Recognize most common causes and expected findings with different electrolyte imbalances.** **[Potassium:]** 3.5-5.0 mEq/L [Hypokalemia] [Causes:] - GI loss: vomiting, suctioning, ileostomy, tumor - Medications: thiazide and loop diuretics, corticosteroids, sodium penicillin, amphotericin B, **[insulin]** - pushes K back into cells - Other: poor diet, hyperaldosteronism - pushes K into renal tubules then K is urinated out [Expected findings:] **EKG changes, dysrhythmias**, dilute urine, fatigue, anorexia, muscle weakness, decreased bowel motility, paresthesia [Hyperkalemia] [Causes:] - Medications: KCL, heparin, ACE inhibitors, NSAIDs, beta-blockers, cyclosporine, potassium-sparing diuretics, tacrolimus - Body functions: hypoaldosteronism, acidosis, decreased renal excretion of K - Other: chemotherapy, tissue trauma [Expected findings:] **cardiac changes and dysrhythmias,** muscle weakness, paresthesia, anxiety, GI: nausea, cramps, abdominal distention **Interpret arterial blood gasses (ABGs) and identify possible causes** +-----------------------+-----------------------+-----------------------+ | ABG | Ranges | Interpretation | +-----------------------+-----------------------+-----------------------+ | pH | 7.35-7.45 | **[Metabolic | | | | acidosis:]{.underline | | | | }** | | | | low pH, low bicarb, | | | | commonly b/c kidney | | | | injury, monitor for | | | | hyperkalemia and | | | | hypocalcemia | | | | | | | | **[Metabolic | | | | alkalosis:]{.underlin | | | | e}** | | | | high pH, high bicarb, | | | | commonly b/c emesis | | | | or gastric suctioning | | | | or long term diuretic | | | | usage | | | | | | | | **[Respiratory | | | | acidosis:]{.underline | | | | }** | | | | low pH, high PaCO2, | | | | respiratory disorder | | | | leading to low CO2 | | | | excretion | | | | | | | | **[Respiratory | | | | alkalosis:]{.underlin | | | | e}** | | | | high pH, low PaCO2, | | | | b/c hyperventilation | +-----------------------+-----------------------+-----------------------+ | PaCO2 (carbonic | 35-45 mm Hg | | | **ACID** in water) | | | +-----------------------+-----------------------+-----------------------+ | HCO3 (bicarbonate = | 22-26 mEq/L | | | basic) | | | +-----------------------+-----------------------+-----------------------+ | PaO2 | 80-100 mm Hg | | +-----------------------+-----------------------+-----------------------+ | O2 saturation | \>94% | | +-----------------------+-----------------------+-----------------------+ \*Remember ROME: Respiratory Opposite Metabolic Equal\* **Perioperative Nursing** (3 questions) **Identify appropriate interventions to prevent postoperative complications.** - Baseline assessment of VS Q15 min for first hour, Q30 min for the next 3 hours, Q4H is stable - Assess of surgical: drainage, hemorrhage, tubes/drains - Pain and anxiety assessment - IV fluids and meds - **Maintain patent airway** - HOB at 15-30 degrees unless contraindicated - Control N&V - Determine readiness for discharge - **Maintaining cardiovascular stability** - **Hypotension = blood loss** (\>500 mL), hypoventilation, position changes, pooling of blood in extremities, side effects of medication and anesthesia - **Shock = hypovolemic** most common b/c hemorrhage from surgical site - HTN secondary to SNS stimulation from hypoxia, pain or bladder distention - Dysrhythmias secondary to electrolyte imbalances, altered respiratory function, pain, hypothermia, stress, and anesthetic agents **Differentiate roles in obtaining informed consent for operative procedures.** - **Surgeon**- provides informed consent for surgery - Voluntary and written consent from the patient - Provide a clear understanding of the procedure - Benefits vs Alternatives - Risks and complications - Disfigurements and disability - Removal of body parts - Expectations in the postoperative phase. - **Nurse** - May ask the patient to sign the consent form after the surgeon's explanations - May witness the informed consent - Advocate for the patient - Ensure the patient understands the information - Surgeon may need to answer patient's questions prior to surgery **Identify risk factors in a client for malignant hyperthermia.** - Strong, bulky muscles, history of leg cramps or muscle weakness, unexplained temperature elevation, unexplained death of a family member during surgery Oncology (2 questions) **Identify appropriate interventions to prevent various cancers such as:** [Skin cancer prevention] - Minimize sun exposure - Avoid the sun between 10am to 4pm - Wear protective clothing - Wear sunglasses when outdoors - Use sunscreen SPF of 15 or higher, apply 20 minutes prior to sun exposure and reapply every 2 hours - Avoid UV sources - Check your skin regularly - Self examination monthly - Examination by provider early year **Identify clients at risk for neutropenia and implement appropriate nursing interventions.** Patients who receive chemotherapy are at risk for neutropenia and at an increased risk for infection. - Check vital signs every 4 hours and monitor WBCs daily - Inspect sites that may serve as a point of entry for infection - Report fever and obtain cultures before initiating antibiotic therapy - Place client in a private room if WBC count falls below 1,000 - Educate clients and visitors about not visiting if recently ill - Instruct good hand hygiene - Avoid rectal and vaginal procedures - Instruct patient to use electric razors - Avoid fresh fruit, raw meats, fish, and vegetables if count falls below 1,000 Respiratory Disorders (4 questions) **Identify risk factors and nursing interventions for clients at risk of aspiration.** - [Risk factors]: seizure activity, brain injury, decreased LOC, positioning, stroke, swallowing disorder, pain meds, endotracheal intubation → **every patient population is at risk for aspiration** - [Nursing interventions] - Assess tube placement if pt is on tube feedings - Identify delayed stomach emptying - HOB 30-45 degrees for continuous feedings or after bolus feeds - Check for residuals Q4H → **want \20 cm H2O to prevent secretions going into lower resp tract - Prolonged intubation can depress laryngeal and glottic reflexes **Identify clients at risk for pneumonia.** - [Risk factors]: **older than 65**, exposure to viral/bacterial influenza, tobacco/substance use, chronic lung disease, dysphagia, mechanical ventilation, inactivity or mobility, inability to clear secretions **Identify appropriate nursing interventions for clients in airborne vs. droplet precautions.** - [Airborne]: N95 mask or HEPA respirator, gown, gloves, goggles/eyewear, room by self, negative pressure room, closed room door, pt wears mask outside of room - [Droplet]: wash your hands before entering the room, put on a mask, gloves, gown, before entering and take them off before leaving, mask when pt leaving room, 6 ft away when possible **Identify appropriate nursing interventions and prioritization of care for clients with hypoxemia.** - Nasal cannula - Assess patency of the nares - Ensure prongs are properly positioned - Place client in semi fowlers or fowlers - Provide oxygen therapy at the lowest rate that will correct hypoxemia - Monitor pulse oximetry - Discontinue oxygen therapy gradually **Medication education related to TB medications.** - **Medication compliance** for full 6-12 months - Contact social services for assistance with obtaining meds - Failure to comply could lead to resistant strain of TB - Follow up care for full year of treatment - Sputum samples Q2-4 weeks → no longer infectious after **three** negative cultures Hypertension and Circulatory Disorders (4 questions) **Identify normal vs. abnormal laboratory values related to a lipid panel.** +-----------------------+-----------------------+-----------------------+ | Lipid Panel | | | +-----------------------+-----------------------+-----------------------+ | Cholesterol (total) | Less than 200 mg/dL | Screening for heart | | | | disease | +-----------------------+-----------------------+-----------------------+ | LDL (bad) | Less than 130 mg/dL | Transport cholesterol | | | | to cells from the | | | | liver | +-----------------------+-----------------------+-----------------------+ | HDL (good) | F: greater than 55 | Protects coronary | | | mg/dL | arteries from heart | | | | disease | | | M: greater than 45 | | | | mg/dL | | +-----------------------+-----------------------+-----------------------+ | Triglycerides | F: 35-135 mg/dL | Evaluates risk for | | | | heart disease | | | M: 40-160 mg/dL | | +-----------------------+-----------------------+-----------------------+ **Blood pressure classifications.** ------------------- --------------------- ----- --------------------- BP classification Systolic BP (mmHg) Diastolic BP (mmHg) Normal \