Adult Sep 2024 Nursing Slides PDF

‫‪9/17/2024‬‬ ‫الدورة التحضيرية للخريجين الجدد الجتياز االمتحانات‬ ‫العامة للتمريض و امتحانات دول الخليج‬ ‫‪Sep. 2024‬‬ ‫عبدالرحمن ديباجة‬ ‫تحتوي هذه الشرائح على رؤوس اقالم و ال تفي‬ ‫‪.0786207997‬‬ ‫بالغرض بدون حضور المحاضرة و الشرح‬...

‫‪9/17/2024‬‬ ‫الدورة التحضيرية للخريجين الجدد الجتياز االمتحانات‬ ‫العامة للتمريض و امتحانات دول الخليج‬ ‫‪Sep. 2024‬‬ ‫عبدالرحمن ديباجة‬ ‫تحتوي هذه الشرائح على رؤوس اقالم و ال تفي‬ ‫‪.0786207997‬‬ ‫بالغرض بدون حضور المحاضرة و الشرح‬ ‫‪1‬‬  9/17/2024 Cardiovascular Key Terms ‫الد‬ 2 9/17/2024 3  9/17/2024 CRUSHING ADD A FOOTER 8 4  9/17/2024 ADD A FOOTER 9 ADD A FOOTER 10 5  9/17/2024 ADD A FOOTER 11 ADD A FOOTER 12 6  9/17/2024 ADD A FOOTER 13  Cardiac enzymes and isoenzymes. CPK-MB (isoenzyme in cardiac muscle): Elevates within 4–8 hr, peaks in 12–20 hr, returns to normal in 48–72 hr. . Troponin I (cTnI) Levels are elevated at 4–6 hr, peak at 14–18 hr, and return to baseline over 6–7 days. These enzymes have increased specificity for necrosis and are therefore useful in diagnosing postoperative MI when MB-CPK may be elevated related to skeletal trauma.  Myoglobin. A heme protein of small molecular weight that is more rapidly released from damaged muscle tissue with elevation within 2 hr after an acute MI, and peak levels occurring in 3–15 hr. 7  9/17/2024  Relieve pain, anxiety. MOROHIN Nursing  Reduce myocardial workload. Priorities  Prevent/detect and assist in treatment of life-threatening dysrhythmias or complications.  Promote cardiac health, self-care. 8  9/17/2024 Nursing interventions should be anchored on the goals in the nursing care plan.  Administer oxygen along with medication therapy to assist with relief of symptoms.  Encourage bed rest with the back rest elevated to help decrease Nursing chest discomfort and dyspnea. Interventions  Encourage changing of positions frequently to help keep fluid from pooling in the bases of the lungs.  Check skin temperature and peripheral pulses frequently to monitor tissue perfusion.  Provide information in an honest and supportive manner.  Monitor the patient closely for changes in cardiac rate and rhythm, heart sounds, blood pressure, chest pain, respiratory status, urinary output, changes in skin color, and laboratory values.  1. Which of the following is the most common symptom of myocardial infarction (MI)?  A Chest pain  B. Dyspnea  C. Edema  D. Palpitations  2. An intravenous analgesic frequently administered to relieve chest pain associated with MI is:  A. Meperidine hydrochloride  B. Hydromorphone hydrochloride  C Morphine sulfate  D. Codeine sulfate 9  9/17/2024  3. The classic ECG changes that occur with an MI include all of the following except:  A. An absent P wave  B. An abnormal Q wave  C. T-wave inversion  D. ST segment elevation  4. Which of the following statements about myocardial infarction pain is incorrect?  A. It is relieved by rest and inactivity.  B. It is substernal in location.  C. It is sudden in onset and prolonged in duration.  D. It is viselike and radiates to the shoulders and arms. 10  9/17/2024 Hypertension 11  9/17/2024 ADD A FOOTER 23 ADD A FOOTER 24 12  9/17/2024 ADD A FOOTER 25 ADD A FOOTER 26 13  ‫‪9/17/2024‬‬ ‫الدورة التحضيرية للخريجين الجدد الجتياز االمتحانات العامة‬ ‫للتمريض و امتحانات دول الخليج‬ ‫‪feb. 2024‬‬ ‫‪14‬‬  9/17/2024 Causes L–LEFT sided HF R–RIGHT sided HF (weak heart = weak pump) Left sided HF can cause Right HF MI (heart attack) Pulmonary HTN Ischemic Heart Disease Fibrotic Lungs “stiff lungs” (CAD, ACS) Treatment Priority KEY WORDS: new, sudden, worsening, rapid = Pulmonary Edema CRISIS (Lung Fluid!) #1 Furosemide “Body Dried” (drain fluid) H–HOB 45 degrees + (semi fowlers, high fowlers, orthopneic position) O–Oxygen P–Push Furosemide + Morphine, Positive inotropes( DIGOXIN) E–End sodium & fluids (Sodium Swells) NO drinking fluids + STOP IV fluids 15  9/17/2024 DR. BEDS D–Diet: Low SCC (Sodium, Calories, Cholesterol) Low Sodium & Fluid (2L + 2g or LESS/day) NO OTC meds (Cough or Flu, Antacids or NSAIDS NO Canned or packaged foods (chips, sauces, meats, cheeses, wine) R–Risk for Falls! (Change positions slowly!) B–Blood Pressure & BNP (shoud NOT be increasing) E–Elevate HOB & Legs (with pillows) high fowlers D–Daily Weights and Is and Os (0ver 3 lbs/day or 5 lbs in 7 days) = Worsening! S–Stairs (No sex until able to climb 2 flights of stairswithout dyspnea) S–Stocking (TED hose) (decreases blood pooling, remove daily) NEVER massage calves (CHF patients) DIGOXIN (Inotropic) Digs for a DEEP contraction Increased contractility Apical Pulse x 1 minute < 60 PBM HOLD Toxicity (over 2.0) Vision changes, N/V Potassium 3.5 or less (higher r/f toxicity) 16 9/17/2024 17  9/17/2024 ‫الدورة التحضيرية للخريجين الجدد الجتياز‬ ‫االمتحانات العامة للتمريض و امتحانات دول الخليج‬ feb. 2024 Deadly PRIORITY medical emergency! PE is a blood clot that obstructs a pulmonary vessel (blood vessel inside the lung), typically the pulmonary artery. This blockage prevents blood flow to the Alveoli where gas exchange is supposed to happen, eventually leading to DEADLY hypoxemia (deadly low oxygen). Highest Priority : impaired gas exchange r/t imbalance of ventilation & perfusion Causes: Typically caused from a DVT blood clot that loosens from another part of the body (typically the leg) & gets sucked into lungs - causing a blockage 18  9/17/2024 Risk Factors Smoking, Obesity, Immobility, & even cardiac issues like Atrial Fibrillation or valve disorders.. Estrogen birth control “oral contraceptives” MOST TESTED leads to increased risk for blood clots Signs & Symptoms #1 Sign = Hypoxemia 1. Restless 2. Agitation 3. Mental status change Chest pain Dyspnea & SOB Tachypnea Tachycardia Anxiety Diagnostics: High D dimer - High risk for blood clots in the body Indications for pulmonary embolism Memory trick: include... ?? Positive D-Dimer D - Dimer (Positive) Normal range 68- 494 ng/dL) D - Dime sized clot in body Treatments Surgery. Embolectomy: surgical removal of the clot. Vena Cava filter: acts like a net to catch any new clots 19  9/17/2024 Anticoagulent ( heparin and warfarine ) 20 9/17/2024 21  9/17/2024 Digoxin 22 9/17/2024 23  9/17/2024 Atropine Adenosine 24  9/17/2024 Beta Blockers “Propranolol” 25  ‫‪9/17/2024‬‬ ‫الدورة التحضيرية للخريجين الجدد‬ ‫الجتياز االمتحانات العامة للتمريض‬ ‫‪2023‬‬ ‫‪26‬‬  9/17/2024 Anemia is where the body lacks enough RBCs (Red Blood Cells) to carry oxygen around the body to perfuse the tissues. Clients present tired, fatigued & pale skin, with shortness of breath and dizziness, as the body lacks oxygen Anemia Causes Blood loss: surgery, trauma, excessive menstruation ect. Chemotherapy & Immunosuppressants: which suppress the bone marrow where the RBCs are made..Lack of iron, B12 & other building blocks: like with iron def. anemia & pernicious anemia When assessing the patent’s Signs & Symptoms integumentary system, which Dyspnea dermatologic manifeson may indicate anemia? Pallor “pale skin” Pallor Tachycardia 27  9/17/2024 The nurse counsels a client diagnosed with iron deficiency anemia. The nurse determines teaching is effective if the client selects which menu? Flank steak & green leafy vegetables Liver & onions, spinach A nurse is educating a patient with iron deficiency on foods high in iron. Which meal, if chosen by the patient, demonstrates an understanding of iron-rich foods? Grilled chicken thigh, sautéed spinach, and wholegrain bread A patient with iron deficiency anemia is to be discharged home with iron replacement therapy. Which instruction would be most important to maximize iron absorption? Glass of orange juice 28  9/17/2024 ‫الدورة التحضيرية للخريجين الجدد الجتياز االمتحانات العامة للتمريض‬ 2023 The RBCs have a distorted shape, transforming from a nice round plumb shape to a skinny sucked in sickle shape. These misshaped RBCs die quicker than normal RBCs, carry less oxygen to the body & get clogged in tiny blood vessels - blocking or occluding the blood supply causing ischemia (low oxygen) to the organs. A vaso-occlusive crisis or sickle cell crisis. can occur, causing extreme pain from the lack of oxygen! Signs & Symptoms Complication Splenic sequestration crisis One-sided arm weakness Swelling of the feet and hands Rapidly enlarging spleen New-onset paralysis of extremities Low blood pressure Sudden inability to be aroused 29  ‫‪9/17/2024‬‬ ‫الدورة التحضيرية للخريجين الجدد‬ ‫الجتياز االمتحانات العامة للتمريض‬ ‫‪2023‬‬ ‫‪30‬‬  9/17/2024 The body can not absorb B12, which is a vital building block to create RBCs. Clients lack intrinsic factor in the GI tract, which helps the body take in B12. Which factor results from pernicious anemia? The absence of intrinsic factor secreted by the gastric mucosa 31  9/17/2024 formation RBC is called Erythropoiesis 32  ‫‪9/17/2024‬‬ ‫الدورة التحضيرية للخريجين الجدد الجتياز االمتحانات‬ ‫العامة للتمريض و امتحانات دول الخليج‬ ‫‪feb. 2024‬‬ ‫عبدالرحمن ديباجة‬ ‫تحتوي هذه الشرائح على رؤوس اقالم و ال تفي‬ ‫‪.0786207997‬‬ ‫بالغرض بدون حضور المحاضرة و الشرح‬ ‫‪33‬‬ 9/17/2024 34  9/17/2024 bacteria Symptoms HIGHT Fever and chills Cough Rapid breathing or difficulty breathing Chest pain. 35 9/17/2024 36  ‫‪9/17/2024‬‬ ‫الدورة التحضيرية للخريجين الجدد‬ ‫الجتياز االمتحانات العامة للتمريض‬ ‫‪2023‬‬ ‫‪37‬‬  9/17/2024 When the capillaries (little blood vessels in the alveoli) can not adequately exchange CO2 for Oxygen. Causes Infection causes these alveoli to become swollen, inflamed, & filled with mucus or fluid which blocks gas exchange! Clients can present with a common FLU which can progress into pneumonia & eventually into DEADLY A.R.D.S. - Acute Respiratory Distress Syndrome The alveoli become hard due to the capillaries around Causes the Alveoli becoming inflamed & fluid filled, creating a Sepsis - bloodborne infection that inflames leaky barrier, which eventually fills up the little alveoli the entire body sac like a sinking ship! THIS makes it impossible to get. Respiratory inflammation - pneumonia, oxygen in & to get CO2 OUT! inhaled toxin, or even aspiration. Eventually clients DIE frARDS = HARD Alveoli. Acute pancreatitis = HIGH risk for Priority Diagnosis developing ARDS ARDS = HARD Alveoli accidental release of active pancreatic enzymes & cytokines into the bloodstream -. Impaired gas exchang which get sucked into the lungs causing inflammation. 38 9/17/2024 39  9/17/2024 A patient with a history of sleep apnea is experiencing difficulty maintaining an airway during conscious sedation. What should the nurse do to assist this patient? 1. Prepare to administer a reversal agent. 2. Begin artificial ventilations. 3. Measure oxygen saturation. 4. Apply prescribed oxygen via face mask. 40  9/17/2024 Pulmonary Embolism ADD A FOOTER 81 ADD A FOOTER 82 41  9/17/2024 ADD A FOOTER 83 ADD A FOOTER 84 42  9/17/2024 ADD A FOOTER 85 43 9/17/2024 44 9/17/2024 45  9/17/2024 ADD A FOOTER 91 ADD A FOOTER 92 46  ‫‪9/17/2024‬‬ ‫الدورة التحضيرية للخريجين الجدد‬ ‫الجتياز االمتحانات العامة للتمريض‬ ‫‪2023‬‬ ‫‪ADD A FOOTER‬‬ ‫‪94‬‬ ‫‪47‬‬  9/17/2024 Cerebral Vascular Accident (CVA) happens when the brain lacks oxygen resulting in long-term permanent damage. Typically resulting from a blood clot, narrowed blood vessels (arteriosclerosis) or a ruptured blood vessel (aneurysm). TIA - Transient Ischemic Attack - tiny lack of oxygen. Transient: short time frame. Ischemic: Low oxygen. Attack: Happens suddenly...TIA’s come & go often resolving. CVA - Cerebral vascular accident - no oxygen causing long-term damage!. Ischemic CVA - Clot = Low O2 (called embolic or thrombotic stroke). Hemorrhagic CVA - Bleed = HIGH ICP (from an aneurysm) 48 9/17/2024 49 9/17/2024 50  9/17/2024 Head trauma 51 9/17/2024 52  9/17/2024 Severe, GCS < 8–9 Moderate, GCS 8 or 9–12 Minor, GCS ≥ 13. 53  9/17/2024 Increased Intracranial Pressure ICP What is increased intracranial pressure? What is a normal ICP: 5-15 mmHg (>20 mmHg…needs treatment) 54  ‫‪9/17/2024‬‬ ‫لفهم سبب زيادة الضغط داخل الجمجمة ‪ ،‬يجب أن تفهم فرضية مونرو كيلي‪.‬إنه يتعامل مع كيفية تأثر ‪ ICP‬بـ ‪CSF‬ودم المخ‬ ‫واألنسجة وكيف تعمل هذه الهياكل للحفاظ على ضغط التروية الدماغي (‪CPP).‬‬ ‫باختصار ‪ ،‬تقول هذه الفرضية أنه إذا زاد حجم أحد هذه الهياكل ‪ ،‬فيجب على اآلخرين تقليل حجمها للمساعدة في تخفيف‬ ‫الضغط‪.‬عندما يكون هناك زيادة في الضغط داخل الجمجمة ‪ ،‬يمكن للجسم تعويضه مؤقتًا عن طريق تحويل السائل النخاعي‬ ‫إلى مناطق أخرى من الدماغ أو النخاع الشوكي (أو تقليل إنتاجه) ‪ ،‬وتغيير حجم الدم المتجه إلى الدماغ من خالل تضيق‬ ‫األوعية ‪ ،‬ولكن إذا كان الضغط مستمر ال يستطيع التعويض‬ ‫‪55‬‬ 9/17/2024 56  9/17/2024 Nursing Interventions for Increased Intracranial Pressure Focus on preventing further increase ICP and monitoring ICP (if monitoring device inserted) “PRESSURE” Position head of bed: 30 to 45 degree (helps blood return to heart), Respiratory: Prevent HYPOXIA and HYPERCAPNIA! When blood oxygen levels drop or carbon dioxide levels increase, vasodilation occurs and this increases intracranial pressure. Elevated temperature PREVENT this! Systems to monitor: Glasgow Coma Scale Straining activities AVOIDED: vomiting, coughing, sneezing, Valsalva, agitation (keep environment calm), avoiding restraints as necessary Unconscious patient care Rx: Barbiturates: to help decrease brain metabolism and BP which in turn decreases ICP, Vasopressors/IV fluids or antihypertensive to maintain SBP greater than 90 but less than 150, anticonvulsants meds, hyperosmotic drugs MANETOL(leads to the next point of edema management)……. Edema management mechanical ventilation to keep PaCO2 low 30-35 WHY? Vasoconstriction to help decrease ICP by decreasing blood flow….keep the PEEP low…increases intrathoracic pressure 57 9/17/2024 58  9/17/2024 open airwaY IN CPR You're providing education to a group of nursing students about ICP. You explain that when cerebral perfusion pressure falls too low the brain is not properly perfused and brain tissue dies. A student asks, "What is a normal cerebral perfusion pressure level?" Your response is:* A. 5-15 mmHg. B. 60-100 mmHg C. 30-45 mmHg D. >160 mmHg 59  9/17/2024 A patient is being treated for increased intracranial pressure. Which activitie below should the patient avoid performing? A. eating A. Coughing. C. Talking F. Keeping the head of the bed between 60 -75 degrees. A patient with increased ICP has the following vital signs: blood pressure 110-72, HR 65, Temperature 38.8 c, respirations 14, oxygen saturation of 95%. ICP reading is 21 mmHg. Based on these findings you would? A. Administered extra dose of a vasopressor B. Administer 2 L of oxygen C. Remove extra blankets and give the patient a cool bath. D. Perform suctioning 60  9/17/2024 Which of the following is contraindicated in a patient with increased ICP? A. Lumbar puncture. B. Midline position of the head C. Hyperosmotic diuretics D. Barbiturates medications You’re collecting vital signs on a patient with ICP. The patient has a Glascoma Scale rating of 4. How will you assess the patient’s temperature? A. Rectal. B. Oral C. Axillary 61  9/17/2024 A patient who experienced a cerebral hemorrhage is at risk for developing increased ICP. Which sign and symptom below is the EARLIEST indicator the patient is having this complication? A. Bradycardia B. Decerebrate posturing C. Restlessness. D. Unequal pupil size Mental status changes are the earliest indicator a patient is experiencing increased ICP. All the other signs and symptoms listed happen later. While positioning a patient in bed with increased ICP, it important to avoid? A. Midline positioning of the head B. Placing the HOB at 30-35 degrees C. Preventing flexion of the neck D. Flexion of the hips. Avoid flexing the hips because this can increase intra-abdominal/thoracic pressure, which will increase ICP. 62  9/17/2024 What assessment finding requires immediate intervention if found while a patient is receiving Mannitol? A. An ICP of 10 mmHg B. Crackles throughout lung fields. C. BP 110/72 D. Patient complains of dry mouth and thirst FVOL Seizures (Epilepsy( 63  9/17/2024 Seizures (Epilepsy) Seizures occur when abnormal electrical signals are being rapidly fired for neurons in the brain. This can happen throughout the brain affecting both sides (generalized seizure) or being located in a specific area of the brain (partial or focal seizure). 64 9/17/2024 65 9/17/2024 66  9/17/2024 What to do when your patient has a seizure? Protect patient if they are standing-up or sitting down by: gently lying the patient down and turning them onto their side. WHY? This helps prevent the tongue from covering the airway and helps saliva and blood drain from the mouth. DO NOT restrain patient or try to hold the patient down Protect their head and extremities (pillow and bed pads will help with this) DO NOT put anything in the patient’s mouth Remove anything that can impede breathing or break (eye glasses, tight clothing etc. ) 13. You’re patient is scheduled for an EEG (electroencephalogram). As the nurse you will: A. Keep the patient nothing by mouth b. Allow the patient to have coffee, milk, and juice only c. Wash the patient’s hair prior to the test. d. Administer a sedative prior to the test 67  9/17/2024 Cerebrovascular Accident (CVA) Stroke 68  9/17/2024 CVA 69  9/17/2024  Monitor vital signs and neuro status:  airway (difficulty swallowing….at risk for aspiration HOB 30’ with suction at bedside) Nursing  especially blood pressure (notify MD is hypertensive)  turn every 2 hours with proper alignment and watch for Interventions for increased ICP (intracranial pressure) during acute Stroke stage  headache, nausea and vomiting, increased blood pressure and decreased HR and decreased RR, decrease in mental status from baseline, pupils don’t respond . Priority Decision: The patient was in a traffic collision and is experiencing loss of function below C4. Which effect must the nurse be aware of to provide priority care for the patient?  a. Respiratory diaphragmatic breathing  b. Loss of all respiratory muscle function  c. Decreased response of the sympathetic nervous system  d. GI hypomotility with paralytic ileus and gastric distention 70  9/17/2024 ADD A FOOTER 141 ADD A FOOTER 142 71  9/17/2024 BURNS Burns III - ADD A FOOTER 144 72  9/17/2024 ASSESS FOR THE BURN LOCATION.  Head, Neck, and Chest. Respiratory  Face. Corneal ulceration  Perineum. Contaminated with urine and feces  Circumferential Burns of Extremities. Compromise circulation ADD A FOOTER 146 73  9/17/2024 ADD A FOOTER 147 ADD A FOOTER 148 74  9/17/2024 ADD A FOOTER 149 ADD A FOOTER 150 75  9/17/2024 ADD A FOOTER 151  Monitor urine output. A urine output of 0.5 to 1 mL/kg/h is used as an indication of ADEUET resuscitation in thermal and chemical injuries. In electrical injuries, a urine output of 75 to 100 mL/h is the goal.  which clinical manifetation indacate that fluied resustationis adequate Fluid Resuscitation  A urine output of 0.5 mL/kg/h , normal pulse and BP 76  9/17/2024 AIRWAY MANAGEMENT  Airway Management is vital to maintain the airway and provide supplemental oxygen in patients with major burns. Airway management is crucial for types of burns related to inhalation injury. Oxygenation: CO2 poisoning. 100% of oxygen is delivered via a tight-fitting non- rebreather mask until carbon monoxide falls to 15%. Mechanical ventilator as indicated. Endotracheal suctioning. Head of the bed is elevated to facilitate maximum expansion of the lungs. FLUID RESUSCITATION  Fluid Resuscitation refers to replacing fluids in burn patients to prevent hypovolemia and hypoperfusion that can result from the body’s systemic response to burn injury.  Initiate fluid administration. Peripheral IV access may initially be used though in larger and more severe cases of burns, a central venous access is recommended as a large volume of fluid is required.  guidelines for fluid resuscitation. The formula for the total fluid requirement in 24 hours is as follows: 4ml x TBSA (%) x body weight (kg). [Example: Patient weighs 80 kg with TSBA of 20% = 4mL x 80 kg = 320 x 20 = 6,400 mL]  First half of the solution is given in the first 8 hours (3,200 mL)  One quarter of the solution is given in the second 8 hours (1,600 mL)  Another quarter of the solution is given in the third 8 hours (1,600 mL) 77  9/17/2024 RULE OF NINES FOR BURNS It’s a calculation used to calculate the total body surface area burned for burns partial-thickness or greater. The percentage will determine treatment like fluid replacement and if the patient meets the criteria for a burn unit. 78  9/17/2024  You receive a patient who has experienced a burn on the right leg. You note the burn contains small blisters and is extremely pinkish red and shiny/moist. The patient reports severe pain. You document this burn as:  A. 1st Degree (superficial)  B. 2nd Degree (partial-thickness).  C. 3rd Degree (full-thickness)  D. 4th Degree (deep full-thickness)  A 30 year old female patient has deep partial thickness burns on the 58.5 % TBS ,The patient weighs 63 kg. : What is the flow rate during the FIRST 8 hours (mL/hr) based on the total you calculated?  A. 921 mL/hr.  B. 938 mL/hr  C. 158 mL/hr  D. 789 mL/hr  4 x 58.5 x 63 = 14,742 mL……Remember during the FIRST 8 hours 1/2 of the solution is infused, which will be 14,742 divided by 2 = 7371 mL……Hourly Rate: 7371 divide by 8 equals 921 mL/hr 79  ‫‪9/17/2024‬‬ ‫‪ What are some patient priorities during the emergent phase of burn‬‬ ‫?‪management‬‬ ‫‪ A. Fluid volume and Respiratory status.‬‬ ‫‪ B. Psychosocial‬‬ ‫‪ C. Wound closure‬‬ ‫‪ D. Nutrition‬‬ ‫الدورة التحضيرية للخريجين الجدد الجتياز االمتحانات‬ ‫العامة للتمريض و امتحانات دول الخليج‬ ‫‪feb. 2024‬‬ ‫عبدالرحمن ديباجة‬ ‫تحتوي هذه الشرائح على رؤوس اقالم و ال تفي‬ ‫‪.0786207997‬‬ ‫بالغرض بدون حضور المحاضرة و الشرح‬ ‫‪80‬‬  9/17/2024 Chronic Kidney Disease 81  9/17/2024 Renal Failure 82 9/17/2024 83 9/17/2024 84  9/17/2024 Hyperkalemia (>5.1 mEq/L): (normal level 3.5 – 5.3 mEq/L) at risk for significant cardiac event due to the nephrons decreased ability to excrete potassium. Hyperphosphatemia (>4.5 mg/dL): normal level 2.7-4.5 mg/dL Hypocalcemia (2.6 mg/dL): normal 1.6-2.6 mg/Dl normal creatinine result is 0.7 to 1.3 mg/dL (61.9 to 114.9 µmol/L) Which patient below is NOT at risk for developing chronic kidney disease?* A. A 58 year old female with uncontrolled hypertension B. A 69 year old male with diabetes mellitus C. A 45 year old female with polycystic ovarian disease. D. A 78 year old female with an intrarenal injury 85  9/17/2024 6. Your patient with chronic kidney disease is scheduled for dialysis in the morning. While examining the patient’s ECG strip, you note tall peaked T-waves. You notify the physician who orders a STAT basic metabolic panel (BMP). What result from the BMP confirms the EKG abnormality? A. Phosphate 3.2 mg/dL B. Calcium 9.3 mg/dL C. Magnesium 2.2 mg/dL D. Potassium 7.1 mEq/L. While assessing morning labs on your patient with CKD. You note the patient’s phosphate level is 6.2 mg/dL. As the nurse, you expect to find the calcium level to be? A. Elevated B. Low C. Normal D. Same as the phosphate level 86  9/17/2024 While assessing morning labs on your patient with CKD. You note the patient’s phosphate level is 6.2 mg/dL. As the nurse, you expect to find the calcium level to be? A. Elevated B. Low. C. Normal D. Same as the phosphate level When hyperphosphatemia presents the calcium level DECREASES Urinary Tract Infection (UTI) 87  9/17/2024 ADD A FOOTER 175 ADD A FOOTER 176 88  9/17/2024 ADD A FOOTER 177 Nursing Interventions for Urinary Tract Infection Maintain fluid status (intake and output) and monitor that urinary output is at least 30 cc/hr Control pain with nonpharmacological and pharmacology methods: Monitor for complications (sepsis, renal failure) administer antibiotic medications per MD order… If antibiotics are ordered for treatment along with urine culture…COLLECT URINE CULTURE BEFORE starting the first dose of antibiotics 89  9/17/2024 Kidney Stones (Renal Calculi) Hard insoluble crystallized minerals and salts that have formed out of the filtrate produced by the nephron. Where can kidneys stones be located? Inside the kidney Ureters (top, middle, or bottom of ureter before entering bladder) Bladder 90  9/17/2024 Signs and Symptoms of Renal Calculi Pain Nausea and vomiting (due to the intense pain) Signs and symptoms of infection: fever, cloudy, odorous urine Urinary retention: especially if stone is stuck in neck of bladder Nursing Interventions for Renal Calculi Control pain (very, very painful) Maintain oral fluids (3-4 L per day) unless contraindicated Closely monitor I/Os (intake and output) and UTI Nephrotic Syndrome A set of symptoms experienced by a patient with damage to the filtering structure of the kidneys (glomerulus), which is causing massive amounts of proteins to leak into the urine. Note: this is not a disease but a group of symptoms that occurs with a disease ‫ وهذا يسمح لكميات هائلة من البروتينات‬، ‫هناك ضرر يلحق بكبيبة النيفرون‬ :)‫ جرامات في اليوم‬3 ‫بالتسرب إلى البول (أكثر من‬ 91  9/17/2024 Signs and Symptoms of Nephrotic Syndrome Proteinuria (massive): this will cause the urine to be foamy/frothy Hypoalbuminemia…which leads to:Edema (extremities…legs, ankles, hands, ascites Fatigued, anorexia, loss of appetite (tired, won’t feel like eating due to swelling but gaining weight) Hyperlipidemia Nursing Interventions for Nephrotic Syndrome Performing daily weights: use same scale every day…standing scale is the best and compare current weight to previous daily weights. Monitor Intake and Output: patient may be on fluid restriction and diuretics along with IV albumin which will help remove extra fluid. The nurse will need to make sure urine output is normal (1 mL/kg/hr for peds and 30 cc/hr for adults), Assess swelling in extremities and measure abdominal girth Implement diet for Nephrotic Syndrome: Sodium restriction along with fluid restriction if edema present and low fat (due to hyperlipidemia) per MD order A 6 year old male is diagnosed with nephrotic syndrome. In your nursing care plan you will include which of the following as a nursing diagnosis for this patient? A. Risk for infection. B. Deficient fluid volume C. Constipation D. Overflow urinary incontinence A patient with nephrotic syndrome is at risk for infection due to the potential loss of proteins (immunoglobulins) in the urine that help fight infection 92  9/17/2024 You’re collecting a urine sample on a patient who is experiencing proteinuria due to nephrotic syndrome. As the nurse, you know the urine will appear: A. Tea-colored B. Orange and frothy C. Dark and foamy. D. Straw-colored You’re providing care to a 6 year old male patient who is receiving treatment for nephrotic syndrome. Which assessment finding below requires you to notify the physician immediately? A. Frothy, dark urine B. Redden area on the patient’s left leg that is swollen and warm. C. Elevated lipid level on morning labs D. Urine test results that shows proteinuria Patients with nephrotic syndrome are at risk for hypercoagulability (blood clot formation) due to the loss of proteins in the urine that prevent blood clot formation. Option B represents a possible deep vein thrombosis, 93  9/17/2024 As the nurse, you know that it is important to implement a low sodium diet for a patient with nephrotic syndrome. However, it is important to implement what other type of diet due to another complication associated with this syndrome? A. Low-phosphate B. Low-fat. C. High-carbohydrate D. Low-potassium The physician orders a 24-hour urine collection on a patient with recurrent kidney stones. As the nurse you know that the specimen should be? A. Kept at room temperature B. Kept on ice or refrigerated. C. Sent to the lab every four hours D. Kept at a temperature between 98.6 ‘F to 99.3’F 94  9/17/2024 GI bleeding 95 9/17/2024 96 9/17/2024 97 9/17/2024 98  9/17/2024 Remember “Appendix” Abdominal pain (will be dull at first with pain at or around the belly button that radiates to the right lower quadrant and it will localize at this spot) Point of McBurney’s will have the most pain (found one-third distance between the belly button and anterior superior iliac spine) Poor appetite Elevated temperature Nausea/vomiting Desire to be in the fetal position to relieve pain (side lying with knees bent) Increased WBC, inability to pass gas or have a bowel movement (constipation..can have diarrhea too) eXperiences rebound tenderness (when pressure is applied to the right lower quadrant it hurts but it HURTS MORE when the pressure is released) and abdominal rigidity on palpation (involuntary stiffening of the abdominal muscle when abdomen palpated). 99  9/17/2024 Signs the appendix may have rupture (perforated) : patient’s pain is suddenly relieved which will be followed by intense abdominal pain Signs of Peritonitis (Increased HR, Increase Respiration, Increased Temperature, and status of abdominal pain (very intense) and abdominal distention/bloating) Diet will start out slow with clears, then fulls, and solids as tolerated. Encourage patient to eat a high fiber diet (decreases straining during bowel movements). 100  9/17/2024 An 18 year old patient is admitted with appendicitis. Which statement by the patient requires immediate nursing intervention?* A. "The pain hurts so much it is making me nauseous." B. "I have no appetite." C "The pain seems to be gone now." D. "If I position myself on my right side, it makes the pain less intense." A patient is recovering after having an appendectomy. The patient is 48 hours post-opt from surgery and is tolerating full liquids. The physician orders for the patient to try solid foods. What types of foods should the patient incorporate in their diet? A Foods high in fiber B. Foods low in fiber C. Foods high in carbohydrates D. Foods low in protein 101  9/17/2024 An older patient, recovering from surgery, is prescribed a soft diet. Which age-related change does this type of diet support? 1. Decline in gastric motility 2. Reduced intestinal absorption 3. Lactose intolerance 4. Gall bladder insufficiency 102 9/17/2024 103 9/17/2024 104 9/17/2024 105 9/17/2024 106  9/17/2024 Lactose Decreased ammonia blood level Decrease in Fetor Hepaticus 107 9/17/2024 108 9/17/2024 109 9/17/2024 110 9/17/2024 111 9/17/2024 112 9/17/2024 113 9/17/2024 114 9/17/2024 115 9/17/2024 116  9/17/2024 Exogenous insulin, or synthetic insulin, can be administered to help regulate glucose levels, and is most often administered by subcutaneous, or SUBQ injection. It’s a commonly used, high-alert medication, meaning there’s an increased risk of patient harm if administered in error. This is because insulin can cause potentially dangerous hypoglycemia, or low blood glucose levels. 117  9/17/2024 a client dx with type. 1 diabetes asks the nurse why "a pill" for diabetes can't be taken. Which best describes the action of oral hypoglycemic agents? A) they stimulate beta cells in the pancreas to release endogenous insulin. B) they supply exogenous insulin, which enhances the transfer of glucose into cell C) they supply exogenous insulin, which restores efficient sugar and fat ultilization D) they stimulate adipose tissue to release endogenous insulin 118 9/17/2024 119 9/17/2024 120 9/17/2024 121 9/17/2024 122 9/17/2024 123 9/17/2024 124 9/17/2024 125 9/17/2024 126 9/17/2024 127  9/17/2024 he nurse is caring for a client receiving chemotherapy who reports anorexia. Which measure does the nurse use to best monitor for cachexia? A Monitor weight B Trend red blood cells and hemoglobin and hematocrit C Monitor platelets D Observe for motor deficits ANS: A Cachexia results in extreme body wasting and malnutrition; severe weight loss is expected. Anemia and bleeding tendencies result from bone marrow suppression secondary to invasion of bone marrow by a cancer or a side effect of chemotherapy. Motor deficits result from spinal cord compression. 128