Copy of Final Exam Review_ NUR 337.docx

WEEK 9-10: Ashley Tsoie (WK 36) HTN Disorders in pregnancy gHTN: Development of HTN after 20 weeks of pregnancy without proteinuria or other systemic findings cHTN: HTN in pregnant woman present before pregnancy Superimposed preeclampsia: Chronic HTN associated with preeclampsia Preeclampsia: deve...

WEEK 9-10: Ashley Tsoie (WK 36) HTN Disorders in pregnancy gHTN: Development of HTN after 20 weeks of pregnancy without proteinuria or other systemic findings cHTN: HTN in pregnant woman present before pregnancy Superimposed preeclampsia: Chronic HTN associated with preeclampsia Preeclampsia: development of HTN and proteinuria after 20 week gestation S/SX Thrombocytopenia Renal insufficiency Impaired liver function Pulmonary edema Cerebral or visual sx Pathophysiology Increase in BP - Vasospasm → decreased placental perfusion → endothelial cell activation → vasoconstriction, activation of coagulation cascade, intravascular fluid redistribution → all lead to decreased organ perfusion Management Accurate measurement of BP Assessment of edema DTR, Clonus Proteinuria Activity restriction Diet Eclampsia: development of seizures Seizure precautions Patent airway Bed rails covered HELLP Syndrome H: Hemolysis Look at hemoglobin levels, N: 12-16 In HELLP syndrome levels will decrease Look at hematocrit levels, N: 37-47 In HELLP syndrome levels will decrease EL: elevated Liver enzymes ALT: 3-21 AST:4-20 LDH:45-90 In HELLP syndrome levels will increase LP: Low platelets PLT: 150,000-400,000 Anything less than 100,000 Abnormal Placentation: Less maternal blood flow to placenta causes placental: Hypoperfusion, hypoxemia, ischemia Medications for HTN disordered Hydralazine: Vasodilator Adverse effects HA, tachycardia, flushing Labetalol: beta blocker Adverse effects Flushing, tremor Nifedipine: calcium channel blockers Adverse effects H/A, flushing Methyldopa: alpha 2 agonist adverse effects Postural HTN Verapamil: calcium channel blockers adverse effects Dizziness, lightheadedness Magnesium Sulfate: Used for preeclampsia to prevent seizures Prevent seizures Slows everything down LOC changes, decreased reflexes (DTR, clonus), output, Mag levels Too much can cause hypermagnesemia Lethargy, N/V, impaired reflexes, muscle paralysis, respiratory and cardiac arrest Used calcium gluconate to reverse effects Use with Lactated ringer's solution Isotonic Similar in compositions to plasma except contains no mag WEEK 9-10: Jackie Daniels Dx: fracture of left ankle CIWA Alcohol withdrawal scale N/V Tremor Paroxysmal Sweats Anxiety Tactile/auditory/visual disturbances Headache; fullness in head Agitation Orientation and clouding of sensorium CAGE Alcoholism screening C: Have you ever felt you should cut down on your drinking A: Have people annoyed you by criticizing your drinking G: Have you ever felt guilty about your drinking E: Have you ever had a drink first thing in the morning to steady your nerves (eye opener) RASS Richmond Agitation & Sedation Score +4 combative → violent immediate danger to staff -5 unrousable → no response to voice or agitation ASU Alcohol withdrawal protocol w/hold Lorazepm if below -1 CIWA assessment Greater than 15 → Q1 hr assessment, give lorazepam 2mg every 1 hr 8-15 → Q2 hr assessment, lorazepam 1 mg every 2 hrs Less than 8 → Qh hr assessment, when 3 consecutives scores less than 8, may discontinue CIWA RASS assessment Standard Drink 12.8 oz of regular beer (5% ETOH)= 8-9 fl oz of malt liquor (7% alcohol) = 5 fl oz of table wine (12% alcohol) = 1.5 fl oz of distilled spirits (gin, run, tequila; 40% alcohol ) Ceftriaxone (cephalosporins) Therapeutic use: Treats infections caused gram positive cocci Adverse effects GI sx, D/N, rare cause of C.diff, thrombophlebitis, disulfiram like reaction if clients take alcohol Nursing interventions: Monitor and report bloody stools, thrombophlebitis, prothrombin Infuse slowly Morphine sulfate Therapeutic use: treats severe pain Adverse effects Confusion, drowsiness, dyspnea, fever, hypoxia, infections, nausea, urinary retention, vomiting, abd. Pain Nursing interventions Ensure naloxone and O2 delivery is available Monitor for excessive and persistent sedation, and VS WEEK 9-10: IVP/IVPB IVP: IV push back Way to give medication through IV For any medication look at drug book Look at compatibility and time to push Pushing too fast can cause side effects Alway look at IV sites for redness, swelling, patency, etc. IVPB: IV piggyback Smaller bag goes up higher than regular bag Small bag will finish then it will go straight to the regular bag Look for compatibility and be careful of sterility WEEK 11-14: Marliee Sweetwater Dx: DM for 22 years, many ulcers on left foot, R BKA PCA pump Interactive method of pain management that permits patients to manage their pain by self administering Patients push the pump to receive medication, but it only comes in doses Only patient could push the pump Process of administration Physician → determines whether the patient is a candidate RN → assesses patients cognitive function, teaches the patient about participation in the pain assessment Pharmacist validates appropriate PCA orders Assessment Elevate patient's mental status, LOC, and development status Initiate only when Willingness to use PCA Understanding relationship between pain, pressing the PCA button, and pain relief Understanding of dosing interval A return demonstration of self administration a PCA dose After medication administration Pain – establish a standard measurement scale to assess the patients level of pain Sedation – establish a standard scale the ramsay scale Rasmasy scale Anxious and agitated or restless or both Co-operative, oriented, and calm Responsive to commands only Exhibiting brisk response to light or loud stimulus Exhibiting sluggish response to stimulus Unresponsive Respiratory – rate, quality, O2 saturation How often – baseline and every 15 mins for one hour with any change in dose, then every one hour for 4 hours, and finally every 2-4 hrs Warning Education must include family members to Avoid administering concomitant opiates Have oxygen and naloxone readily available Morphine Sulfate Treats severe pain Adverse effects Respiratory depression, sedation, dizziness, constipation, N/V, urinary retention, Nursing interventions Monitor VS Encourage to urinate every 4 hrs Auscultate lungs regularly Have suction available Inform it is short term Naloxone Reversal of opioid effects Adverse effects Ventricular arrhythmias Increase in RR, BP, and HR Abstinence syndrome ( hypertension, vomiting, cramping) Nursing interventions Monitor VS, Heart rhythm Have O2 and resuscitation available Educate on adverse effects and drug purpose Post-OP policy Assessments Temperature Pulse RR BP O2 saturation Pain procedures/requirements Completely assess within 10 minutes of admission Close observation during first three hours 1st hours: VS every 15 miniatures 2nd & 3rd hour: VS every hour Every 4 hrs for the next 24 hrs Other observations LOC, cardiovascular and respiratory assessment, conditions of dressings/wounds, drains/tubes, IV solution and site, urinary output Nursing interventions Turn, cough, and deep breaths Medicate for pain and N/V Assure call light is within reach assure bed is in low position WEEK 11-14: Cecilia Proctor Dx: small cell carcinoma of the lung Loperamide Helps with diarrhea Adverse effects Anticholinergic Blurred vision Dry mouth Constipation Cardiac arrest, QT interval prolongation, torsades de pointes, ventricular arrhythmias, syncope Allergic reaction Nursing interventions Monitor clients when ambulating, anticholinergic effects, urinary elimination Recommend lowest dose Fentanyl Treats severe pain Adverse effects Constipation, hypokalemia, vomiting, abdominal pain, agitation, anxiety, anorexia, ascites, back pain, blurred vision, bone fractures and bone pain. Nursing interventions Monitor VS, bowel function, BP, and I&O RR under 12, withhold Auscultate lung regularly Have suction available TPN TPN is total parenteral nutrition nutrition that is given through the central line due to patient not being able to eat for many reasons Intravenous for clients who are unable to use their esophagus Mixtures of Dextrose, water, vitmains, amino acids, lipids, electrolytes, traced elements TPN is hypertonic Ways to reduce adverse effects/ make client feel more comfortable Make sure central line is patent prior to administering TPN, with confirmation of device placement Needs a second nurse change Expect solution for cracking, do not administer if there is a crack Either infuse immediately or put in refrigerator Let out for 1 hr before given if refrigerated If there is a delay give 10-20% dextrose with water Do not speed up rate Are at risk for electrolyte imbalances Monitor clients daily weight, I&O, and watch electrolytes levels Hyperglycemia due to dextrose Infections assess site, change IV tubing 24 hrs, and dressing every 48-72 hrs ASU TPN orders TPN Monitoring Guidelines CMP – Day 1,2, &3, then every Mon. and Thur. Prealbumin – prior to initiation on Day 1, then every Mon. & thurs Triglyceride – Prior to initiation on Day 1, then every Mon. & thurs 24 hr BUN – Every Sunday BG – every 6 hrs Palliative care Maintain highest quality of life, while alleviating pain or in chronic pain WEEK 11-14: Central Line Dressing Change Giving TPN or anything else in central line give in trendelenburg's position (head down) Alway wear gloves since it is very sterile. Make sure all caps are closed or it can cause an air embolism Pull sticker towards catheter site Side effects to look out for SOB Muscle stiffness Bleeding, redness, swelling at catheter site Fever or chills WEEK 11-14: Straight Catheterization Used to quickly empty bladder, does not stay in. Have the patient bear down when inserting a catheter. WEEK 11-14: Nutrition Provide 4 examples of each type of diet. Clear liquid Water Tea or coffee without milk Gelatin without fruit Honey or sugar Full liquid Strained creamy soups Jell-o Ice cream Pudding Bland Cooked, canned, or frozen vegetables Eggs Potatoes Low fat or fat free milk and other dairy products Soft Salad greens Soft cereals Rice Tofu Regular Fruits Vegetables Nuts fish Low sodium Low sodium peanut butter Dry peas and beans Yogurt Dried fruits If a provider orders "Advance diet as tolerated", what does that mean in terms of nursing care? Answer in a minimum of 5 sentences. Usually this is for patients after surgery. First they are only given liquids then once their GI tract can take it they advance depending on what the professional team decides. As a nurse one of the things to do is assess the patient. You want to assess their bowel sounds, if they are able to swallow, and if they are ready to advance their diet. As well as checking on them when their diet advances and make sure they don’t aspirate. Out of Seat: Roise chester Palliative care Out of seat: Transgender Trans 101 Module Who are transgender patients Experience significant health disparities Sex is assigned at birth Solely based on external genitalia Gender identity – personal internal, personal sense of being a man or a woman, or outside that gender binary Gender expression – everything we do that communicates our internal sense of our gender to others. Can be expressed through our clothing, hairstyles, mannerisms, way of speaking, roles in interactions, etc. Sexual orientation – a person's physical, romantic and/or emotional attractions Trnasgener is not a sexual orientation it is a gender identity Nursing care Ask for pronouns Be respectful and correct any mistakes