Copy of Blueprint Final Exam Fall 2023.docx

NUR 326 Final Exam Blueprint Fall 2023 80 questions total This blueprint is intended to help you focus your studies. You are encouraged to review course resources including those listed at the bottom of the Blueprint: Depression/Suicide Provide appropriate nursing and collaborative interventions t...

NUR 326 Final Exam Blueprint Fall 2023 80 questions total This blueprint is intended to help you focus your studies. You are encouraged to review course resources including those listed at the bottom of the Blueprint: Depression/Suicide Provide appropriate nursing and collaborative interventions to minimize the impact of depression. Provide small snacks: high protein/calorie, provide rest after activities, encourage relaxation Anhedonia, weight loss, psychomotor retardation, insomnia, fatigue In adolescents: Anergia, anhedonia, appetite changes, irritability Recognize clinical manifestations of depression. Appetite changes, low energy, poor self esteem, hopelessness, difficulty thinking Identify priority assessments to identify whether a client is at risk for suicide. Presence of a plan, previous attempt, hx of mental disorder, impulsiveness/aggression Demonstrate ability to prioritize clients at risk for suicide by assessing risk and protective factors. Suddenly going from sad to happy, giving away prized possessions Intervention: Provide safe environment, document patients activity, suicide precautions, written contract for no suicide, encourage talking about ones feelings Bipolar Disorders Recognize when a client is experiencing mania. Grandiosity, decreased need for sleep, more talkative, flight of ideas Identify appropriate nursing interventions for clients experiencing mania. Sleep is important, avoid drugs/caffeine, provide coping strategies, exercise, establish routine, Therapies Provide appropriate nursing interventions to ensure a therapeutic milieu, including management of bed assignments. Communication Client centered, purposeful, planned, goal directed Express empathy Open-ended questions, restate, reflect, Identify which conditions may be treated with electroconvulsive therapy. Treats severe bipolar, depression, schizophrenia when all else failed Identify expected and unexpected side effects of electroconvulsive therapy. Expected side effects of ECT include confusion, disorientation, retrograde amnesia Unexpected side effects of ECT include long lasting memory problems, permanent memory loss Psychosis Recognize when an individual is experiencing psychosis, including positive and negative symptoms. Negative symptoms: Alogia, avolition, asociality, anhedonia, blunted affect Positive symptoms: Hallucinations, delusions, thought disturbances Delusions of reference, control, grandeur, and persecutory Tactile (sensation of being touched) and auditory hallucination Provide earphones and music Identify various cognitive, behavioral, emotional, and social effects of schizophrenia and other psychotic disorders. Behavior: social withdrawal, impulsivity, catatonia Cognitive: impaired concentration, memory difficulty Emotional: flat affect, heightened anxiety, mood swings, depression Social: social isolation, stigmatization, work/educational challenges Demonstrate ability to assess for adverse side effects of antipsychotic medications. AIMS: Rating of 2 or higher indicates tardive dyskinesia Identify nursing interventions to increase medication adherence among clients with psychotic disorders. Provide safe environment, limit setting, promote self-care, med education Decrease stimuli, remove unsafe objects, eliminate agitating factors Interpersonal Violence Identify cues of potential aggressive behavior. History of violence, poor impulses, behavioral cues (hyperactivity, easily offended, intense eye contact), verbal cues (threats of harm, loud & rapid talking, abrupt silence, sarcastic remarks) Provide appropriate nursing and collaborative interventions for preventing and managing aggressive behavior among patients, and interventions for patients who have experienced interpersonal violence. Treat the underlying injury, refer victim to “safe house”, minimize personal risk, respond quickly, maintain eye contact, give client space Personality Disorders Identify common behaviors of clients with borderline and antisocial personality disorder. Borderline personality: Anxiousness, emotionally labile, depression, antagonism Antisocial: Manipulation, deceitfulness, callousness, hostility, irresponsibility, impulsive Provide appropriate nursing interventions for managing these behaviors. Assist with impulse control, Dialectical behavioral therapy, coping mechanisms Eating Disorders Demonstrate ability to assess a client for meeting criteria for admission to acute care treatment. 10% body fat loss, HR<50, Tempeture <96.8, electrolyte issues, instable mental health (suicide, psychosis) Refeeding syndrome: rapid initiation of refeeding after period of undernutrition, possibly fatal Small meals are better than large meals, high fiber, low sodium, no caffeine, no fatty foods Offer rewards for eating, monitor bathroom usage after meals (q60min) Anxiety Peplau's Four Levels of Anxiety Mild Anxiety: Sharp senses, increased motivation, heightened awareness, enhanced learning Moderate Anxiety: Narrowed perceptual field, less alert, decreased concentration, muscle tension Severe Anxiety: Severe impairment of attention & cognition, concentration progressively narrowed Panic Anxiety: Complete lack of focus, tendency to misperceive environment, change in baseline behavior Provide appropriate nursing and collaborative interventions to minimize the impact of anxiety. Rule out medical cause, side effects of meds, substances Provide calm environment, remain with patient, suicide risk assessment No teaching during panic attack, no false reassurance “What evidence do you have that could happen?” Addiction Differentiate assessments and clinical manifestations of alcohol and opiate withdrawal. Alcohol withdrawal: nausea, vomiting, tremors, sweats, anxiety, headache Risk for seizures! Opioid withdrawal: High HR, sweating, restlessness, bone/joint aches, runny nose Identify common signs and symptoms of Wernicke’s encephalopathy and Korsakoff’s syndrome. Wernicke's encephalopathy: Acute lack of thiamine → confusion, vision problems, hypothermia, ataxia Daily thiamine given with withdrawal to prevent Wernickes Korsakoff Syndrome → May lead to Wernickes if left untreated → Chronic thiamine deficiency Permanent memory loss, unable to form new memories, memory loss Demonstrate ability to prioritize safety in clients experiencing alcohol and opiate withdrawal. Seizure precautions, have side rails padded, O2, suction, give benzos & thiamine Sleep Identify psychological and physiological consequences of sleep deprivation. Psychological: Cognitive decline, dementia, short term memory loss, paranoia Physiological: Hormonal imbalances, high blood pressure, obesity, heart disease Recognize when an individual is experiencing a disturbance in normal sleep. Extreme fatigue makes it hard to get up in the morning, go to work, do your usual activities and make it through your day. Fatigue feels like you have an overwhelming urge to sleep, but you may not feel refreshed after you rest or sleep. Fatigue Provide appropriate nursing education to prevent and minimize the impact of fatigue. Adults need 8 hours of sleep, adolescents need 10 hours of sleep No screens before bed, establish a sleep routine, create a dark and quiet environment, avoid caffeine, avoid large meals and alcohol before bed, exercise Provide appropriate nursing and collaborative interventions to minimize the impact of insomnia, sleep apnea, and fatigue Sleep inducing medication, cognitive behavioral therapy for insomnia Sleep apnea: Sleep on your side rather than your back, weight loss program, exercise, avoid alcohol Fatigue: Consistent sleep schedule, healthy eating, minimize environmental stimuli Fluid and Electrolytes: Heart Failure Describe the assessment, clinical manifestations, education, and nursing care of the client with heart failure. Reduced cardiac output, reduced ejection fraction, progressive syndrome Assessment Subjective data Healthy history Functional health patterns Medications Objective data Physical examination Priority focus Clinical Manifestations Left sided heart failure – left ventricular dysfunction Sx are due to blood backing up in the lungs Pulmonary congestion Pulmonary edema SOB, crackles in the lungs Right sided heart failure – from left sided HF Back up of blood into right atrium Sx Jugular venous distention – put at 45 degree angle to assess Hepatomegaly, splenomegaly Portal HTN Vascular congestion of GI tract – no appetite Peripheral edema Acute decompensated HF An increase in sx from HF suddenly – lungs are full of fluid Sx Lung crackles, decreased urine output, edema in lungs Sx from both left and right sided HF Fatigue Persistent cough Restlessness, confusion, decreased memory Chest pain Atrial fibrillation All due to decreased perfusion Education Early detection of worsening HF may prevent future hospitalizations Medications Furosemide and digoxin (under medications) Diet Dash and sodium restrictions Exercise Daily weights Cardiac rehabilitation Food logs Nursing Care Monitor daily weight and I&O Assess for SOB, dyspnea, manifestations of medication toxicity (digoxin toxicity) Administer oxygen and ventilatory support as prescribed Monitor VS, hemodynamic pressure, diagnostic results, decrease intravascular volume Position client in high fowlers – maximizes ventilation Encourage bed rest and energy conservation Nutritional therapy Diet and weight reduction: individualize recommendations and consider cultural background DASH diet Vegetables, fruits, fat free or low fat dairy, fish, beans, etc Sodium restricted to 2.5 g per day Fluid restriction not generally required Daily weights are important !! Weight gain of – report to provider 3lb over 1-2 days 3-5 lbs over a week Tissue Integrity Provide appropriate nursing and collaborative interventions to promote optimal tissue integrity and promote wound healing. Nursing Interventions for skin integrity Primary Intention Wounds margins well approximated Most rapid healing Secondary Intention Wound margins not well approximated Large wound area requires formation of granulation tissue to fill up Tertiary Intention Wound healing delayed and occurs when wound previously open in now closed Usually associated with large infected/contaminated wounds Implement interventions to prevent surgical and post-operative complications. Prevention Inspect skin daily Minimize pressure Frequent position changes, at least Q 2hrs Protect skin during turning and repositioning - lift devices, draw sheets Manage moisture Incontinence care Bathing-soaps, warm water Lotion and massage – do NOT massage over bony prominences Cleansing and irrigation Cleaning is performed for the removal of debris and exudate Normal saline solution is used; harsh solutions avoided Dressings Gauze, non-adherent dressings, occlusive, semi occlusive, hydrocolloid, hydrogel, and alginate are applied Vacuum assisted systems are used Nutritional support Protein, vitamin A, and Vitamin C are critical Post-op complications Turning every 2 hrs and checking skin every 2 hrs Early ambulation Describe the clinical manifestations, collaborative care, nursing management of clients with peripheral arterial disease and chronic venous insufficiency of the lower extremities. Peripheral Arterial Disease Progressive narrowing and degeneration of arteries of upper and lower extremities Clinical manifestations Paresthesia – numbness or tingling in the toes or feet Produce loss of pressure and pain sensations Thiny, shiny, taut skin Loss of hair on the lower legs Diminished or absent pedal, popliteal, or femoral pulses Intermittent claudication – pain when you walk Stops when you rest Pallor of foot with leg elevation Ulcers Can lead to amputation Tips of toes, foot, or lateral malleolus Rounded, smooth, looks “punched out” Minimal drainage Black eschar or pale pink granulation Collaborative care Cessation of risk factors Diet modifications/Dash diet Smoking – nicotine causes vasoconstriction Weight management Hygiene Medication management BP control, BG regulation, Coagulation, cardiovascular pulmonary support Surgical/radiographic interventions Debridement, angioplasty, bypass Diagnostic needs Monitoring labs, U/S, cultures, ankle brachial index Ulcer care Teach about daily foot check and foot care Extremities in down position Venous Insufficiency Fluid is leaking out Clinical manifestations Edema present: unilateral or bilateral Hemosiderin staining – pigmentation colors Due to blood pooling and RBC lyse iron inside and expels out Thick hardened skin, leathery appearance Wounds “weep” – fluids exit out of body Skin becomes friable Ulcers Near medial malleolus Irregularly shaped Moderate to large amount of drainage Yellow slough or dark red “ruddy” granulation Collaborative care Compression Moist environment dressings High protein diet Elevation of extremity Hyperbaric support; angiogenesis Room; air is under pressure; pushing O2 when breathing Underlying medical management Drug therapy; anticoagulants Elevate legs Hormonal Regulation Identify hyper and hypothyroid risk factors, clinical manifestations, and collaborative care of each. Hypothyroidism: Iodine deficiency, atrophy of gland Fatigue, depression, cold intolerance, constipation, decreased cardiac output, cold/dry skin, brittle hair T3 & T4 is low, TSH is high in hypothyroidism High calorie diet (4,000 - 5,000 cal/day) Hyperthyroidism: Tiger from Winnie the Pooh Tachycardia, lack of concentration, weight loss, heat intolerance, angina, seizures, agitations, abdominal pain, delirium/coma, shock, vomiting, diarrhea T3 & T4 is elevated, TSH is low in hyperthyroidism Myxedema Coma: Cardiac monitoring, respiratory support, IV thyroid hormone, monitor core temp. Inflammation Provide appropriate nursing and collaborative interventions to control or eliminate inflammation. Smoking cessation, exercise, modify activities to decrease flare-ups Describe the clinical manifestations, collaborative care, laboratory values, nursing management of osteoarthritis and rheumatoid arthritis. Osteoarthritis: slow progressive non-inflammatory disorder of the joints Clinical manifestations: Localized joint pain that occurs after periods of rest Worsen with joint use Early stages – rest relieves pain Late stages – pain w/rest and sleep Early morning stiffness, usually resolves after 30 min Rheumatoid arthritis: Autoimmune response Clinical Manifestations: Raynaud's Phenomenon Peripheral neuropathy & edema Joint pain: Symptoms occur symmetrically Morning stiffness last 1 hr to several hours Joint pain increases with motion Labs RF positive in 70-90% patients ANA positive in 20-30% of patients Positive anti-CCP in more than 80% of patients Elevated ESR, CRP indicative of active inflammation Collaborative care w/ OA and RA Rest and Joint pain Protection Patient must understand importance of balancing rest and activity Maintain good body alignment during rest Encourage positions of extension, avoid positions of flexion Modify activities to put less stress on joints During periods of acute inflammation affected joint should be: Rested Maintained in a functional position With splints or braces if necessary Heat and cold applications May help reduce pain and stiffness Heat is used more often than ice – for stiffness Ice appropriate for acute inflammation/swelling Hot packs, whirlpool baths Describe the clinical manifestations, collaborative care, and nursing management of a client with Cirrhosis. Clinical Manifestations Early Signs – GI disturbances Anorexia or weight loss Dyspepsia flatulence/abdominal pain N/V Changes in bowel habits Fever Enlarged liver or spleen Collaborative Care Health promotion Treat alcoholism – ABSTAIN Identify hepatitis early and treat Nutritional therapy High in calories (3,000 cal/day) Increase in carbohydrate Moderate to low fat Soft diet Small frequent meals Adequate protein and low sodium Acute intervention Rest, oral hygiene, medication therapy, monitor for fluid and electrolyte disturbances and bleeding disorders Management of Inflammation Primary Prevention Reduce risk for injury and infection Helmets, seat belts, safety equipment Maintain good hygiene Properly use safety equipment Properly store and prepare food RICE – Rest, Ice, Compression, Elevation Most helpful after sprain, strain, or trauma Most beneficial for first 24-48 hrs Immunity Compare and contrast the inflammatory bowel diseases of ulcerative colitis and Crohn's disease, including clinical manifestations, collaborative care, nursing management. Crohn's Disease – chronic, non-specific inflammatory bowel disorder Clinical Manifestations Inflammation involves all layers of the bowel wall Can occur anywhere in the GI tract Skip lesions Segments of normal bowel occurring between diseased portions Ulcerations are deep and longitudinal Ulcerations have a cobblestone appearance Abscesses or fistulous tracts that communicate with other loops of bowel, skin, bladder, rectum, or vagina Diarrhea, fever, weight loss, colicky abdominal pain, bleeding can occur, but more common in UC Complications Bowel obstruction Peritonitis Fistulas fluid/electrolyte imbalance Ulcerative Colitis Clinical Manifestations Beings at the rectum and spreads up the colon in a continuous pattern Inflammation and ulcerations occur in mucosa and submucosal layers Destroy the mucosal epithelium Bleeding, diarrhea, fluid and electrolyte losses, protein loss (due to absorption) Tenesmus – feeling you constantly need to pass stool Weight loss, fever, fatigue Pseudopolyps develop – masses of scar tissues that develops after hea;ing from repeated ulcerations GI complications Hemorrhage Strictures – narrowing of bowel Perforation – bowel ruptures/opens up Toxic megacolon Dilation and paralysis of the colon associated with perforation Nursing care for both UC and Crohns Goals Rest the bowel Control inflammation Combat infection Correct malnutrition Manage hygiene until diarrhea is controlled Tend to odor control and prevent skin breakdown Weigh daily and monitor I&O Nutritional therapy High calorie – due to weight loss High protein Low fiber White bread, white rice, eggs Vitamin and iron supplements Lactose free Elemental diet – smoothie Drug therapy 5-ASA Target gut/bowel Antimicrobial Infection Corticosteroids swelling/inflammation Immunosuppressants Suppress immune due to exacerbation of immune system Surgical therapy Crohn's – surgery produces remission, but high recurrence rate UC – total proctocolectomy Infection Define the common causes and risk factors for urinary tract infections. Risk Factors Predisposing factors Increase urinary stasis BPH, tumors, neurogenic bladder, urethral stricture Foreign bodies Catheters, calculi, and instrumentation Compromising immune response Age – older adults HIV Diabetes Functional disorders Constipation – full bowel, block urine Neurogenic bladder Describe the clinical manifestations, collaborative care, and nursing management of the client with a urinary tract infection. Clinical Manifestations Urinary frequency, urgency incontinence, incontinence, nocturia, nocturnal enuresis, weak stream, hesitancy, intermittency, post void dribbling, urinary retention Dysuria – painful or difficult urination Hematuria – blood in urine Darker, cloudy, odor, cramping Older adults Sx are often absent Experience non-localized abdominal discomfort May have cognitive impairment and confusion Less likely to have a fever Nursing care Pain management Tylenol OTC Antibiotics Under medications Wash hands Wear gloves for care of urinary system Routine and through perineal care for all hospitalized patients Avoid catheters Patient education Empty bladder regularly and completely Regular voiding (every 3-4 hours) Wiping from front to back Void and clean after intercourse Monitor urine for color and clarity Glucose Regulation Recognize the criteria for metabolic syndrome. Abdominal obesity BMI over 25 Hypertriglyceridemia >150 Low HDL; Men <40, Women <50 High BP 130/85 High fasting glucose >110 Define the criteria for obesity BMI 30 or higher Waist circumference: >40 Men, >35 Women Intracranial Regulation Notice factors that place individuals at risk for seizures and strokes. Impaired perfusion, compromised neurotransmission, glucose regulation, pathological states (trauma, tumors, seizures) Discuss primary prevention measures to decrease incidence of problems with intracranial regulation. Anti-seizure medication, assess gag reflex, eating utensils, coping with loss Describe the clinical manifestations, collaborative care, and nursing management of clients with seizures, stroke, and Parkinson’s Disease. Stroke: Headache, dizziness, confusion, decreased LOC, slurred speech Parkinson's Disease: tremors, slowed movement, rigid muscles Seizures: Staring spell, complete loss of consciousness Cardiac Glycosides/Inotropic-digoxin Therapeutic use: Heart failure Adverse Drug Reactions: Nausea, vomiting, headache, dizziness, vision changes Digoxin toxicity can vary and might include nausea, vomiting, vision changes, confusion, dizziness, and potentially dangerous heart rhythm disturbances. Interventions: Regularly monitor the patient's heart rate, blood pressure, and electrolyte levels (especially potassium). Assess for signs and symptoms of toxicity or adverse reactions. Monitor intake and output closely. Educate the patient about the importance of compliance with dosing and regular monitoring. Medication for treatment of infections: Antibacterials Penicillin-amoxicillin or Penicillin Therapeutic use: Treat bacterial infections Allergic reaction! Vancomycin-vancomycin Therapeutic use: Used to treat serious bacterial infections such as MRSA Adverse Drug Reactions: Regularly assess kidney function through monitoring of creatinine levels and urine output. Evaluate for hearing changes or symptoms of red man syndrome. Interventions: Administer the medication slowly to reduce the risk of red man syndrome. Medications for thyroid disorders Thyroid Replacements-Prototype Medication-levothyroxine Therapeutic use: Levothyroxine is a synthetic form of the thyroid hormone thyroxine (T4). Adverse Drug Reactions: symptoms of hyperthyroidism Nursing implications Interventions: Monitor the patient's thyroid hormone levels regularly through blood tests to ensure the dosage is appropriate. Assess for signs and symptoms of hyperthyroidism or thyroid storm (a severe form of hyperthyroidism). Antithyroid Drugs-Prototype Medication-propylthiouracil Therapeutic use: Treats Graves disease and hyperthyroidism Adverse Drug Reactions: Adverse reactions can include rash, itching, liver toxicity Interventions: Monitor for signs and symptoms of liver toxicity, including jaundice and abdominal pain. Perform regular blood tests to monitor liver function and white blood cell count. Medications for adrenal disorders Glucocorticoids-Prototype Medication-hydrocortisone Therapeutic use: Used for inflammation, allergic reactions Adverse Drug Reactions: Increased risk of infections Gastrointestinal disturbances (such as stomach upset or ulcers) Medication categories used in the treatment of Depression SSRIs- examples: fluoxetine (Prozac), citalopram (Celexa) Therapeutic use: Bulimia, depression, OCD pharmacology treatment Interventions: Monitor for mania, serum sodium levels (hyponatremia), increased bruising Administration: Avoid NSAIDS, do not abruptly discontinue Client Teaching: Takes 4-6 weeks to start working Adverse Effects: nausea, GI upset, insomnia, sedation, low libido, weird dreams Serotonin syndrome: Confusion, poor focus, fever, agitation, anxiety, sweating, tremors, dilated pupils Hold serotonin meds, give ativan for anxiety, IV fluids, oxygen, monitor VS Tricyclics- example: amitriptyline (Elavil) Therapeutic use: Relieve of symptoms of depression Adverse Drug Reactions: THINK CARDIAC:; dysrhythmias, seizures, V-fib, sedation Block box warning for suicide, tachycardia, anticholinergic effects (dry mouth, blurry vision, UR) Administration: Taken daily, DO NOT stop abruptly Client Teaching: Ritalin increases TCA level, do not take with MAOIs Contraindications: Seizure hx, recent MI, concurrent use of MAOIs MAOIs- example: phenelzine (Nardil) Therapeutic use: Induces CNS stimulation Adverse Drug Reactions: Tyramine foods = HTN Crisis Avoid fermented foods, hot dogs, corned beef, avocados, kimchi, bananas, CAFFEINE, beer Client Teaching: Do not abruptly discontinue Contraindications: Use of alcohol, drug use hx, mania SNRIs - example: venlafaxine (Effexor) Therapeutic use: Used for depression, GAD, SAD Adverse Drug Reactions: Jittery, low appetite, HTN, insomnia, nervousness, nausea, GI upset Nursing implications Interventions: Monitor BP due to cardiac concerns with hypertension Client Teaching: Do not stop abruptly, blackbox warning for suicide Medications used as mood stabilizers for bipolar disorder and aggression Lithium - lithium carbonate (Lithobid) Therapeutic use: Treatment for bipolar disorder Adverse Drug Reactions: fatigue, confusion, memory issues, polyuria, GI upset Interventions: Monitor lithium levels, thyroid, kidney, low heart rate, tremors, sodium levels Administration: Requires blood levels of 0.6-1.2, >1.2 indicates toxicity Symptoms of lithium toxicity: hyper irritability of muscles, blurred vision, hypotension, seizures, death, EKG changes Client Teaching: Avoid with pregnancy, 2-3L of fluid/day, high sodium diet to prevent toxicity Contraindications: ACE inhibitors, diuretics, pregnancy (all can cause toxicity) Mood stabilizers- carbamazepine (Tegretol) Therapeutic use: Bipolar disorder, trigeminal neuralgia Adverse Drug Reactions: ataxia, blurry vision, headache, fluid retention, SJS, photosensitivity Client should report rash to prevent further spread of steven johnson syndrome Client Teaching: Report fever, sore throat, bruising (BMS), asians at high risk, protect from sun exposure. Report decreased UO, edema, SOB - cardiac concerns Contraindications: Bone marrow suppression -> monitor WBC, pregnancy Medications used in the treatment of psychosis Conventional/Traditional-haloperidol (Haldol) Therapeutic use: Suppresses positive symptoms of schizophrenia Adverse Drug Reactions: Anticholinergic, NMS, sexual dysfunction EPS: Acute dystonia (facial grimacing, involuntary eye movement) , tardive dyskinesia (rolling of tongue), akathisia (restlessness, paces floor), pseudoparkinsonism (stooped posture, shuffling gait) Neuroleptic Malignant Syndrome: Mental status change, sweating, can't bend limbs, high fever Give cooling blanket, aspirin, hydration, IV med Administration: Give with food, lay on L/R lateral side for 30 min Contraindications: Alcohol withdrawal, pregnancy, valproic acid Atypical antipsychotic-risperidone (Risperdal) - Second Generation Therapeutic use: Treat schizophrenia, bipolar disorder Adverse Drug Reactions: EPS, weight gain, diabetes, drowsiness, insomnia Administration: Mix with juice Contraindications: glaucoma, tardive dyskinesia, GI obstruction