Nursing Study Guide

# Nursing Study Guide ## Sodium Diet Restrictions - <2400 mg/day, 1500 mg day preferred - No added salt - Fresh better than canned → Drain, wash, cook in tap water ## Therapeutic Communication ## Prioritization ## Delegation ## Liver Location RUQ of the abdomen, under the diaphragm ## Pa...

# Nursing Study Guide ## Sodium Diet Restrictions - <2400 mg/day, 1500 mg day preferred - No added salt - Fresh better than canned → Drain, wash, cook in tap water ## Therapeutic Communication ## Prioritization ## Delegation ## Liver Location RUQ of the abdomen, under the diaphragm ## Passive Immunity Hepatitis A & B Immunoglobulin (IG) : 6-8 weeks of passive immunity, deactivates virus, within two weeks of being exposed ## Waste Products of Diabetes Too much glucose present = Glucose leaks into urine → Leakage of glucose, ketones, Na, K+, and chloride ## Diabetic Neuropathy Nerve damage → Paresthesia, numbness→ More likely to have foot amputated r/t loss of pain sensation ## Diabetic Resources Glucose monitors, insulin teaching, meal planning resources ## Diabetic Treatment Glycemic control, exercise, stress reduction, self-monitoring ## Insulin Pumps Risk for infection is the same as Subcutaneous, continuous monitoring, better glycemic Control, less insulin, rapid acting insulin, risk for hypoglycemia at peak times ## Peaks of Insulin - Rapid acting "log” → 30 min - 1 hr - Short acting “R” → 2-3 hr - Intermediate acting “N”→ 4-12 hr - Long acting “ glargine & detemir”→ No peak ## Choose My Plate Recommendations - Fruits: 1-2 cups daily - Vegetables: 2-3 cups daily - Grains : 5-8 oz daily - Protein : 5-6.5 daily - Dairy : 3 cups daily - Oils : 5-7 tsp daily ## Important Liver Labs ALT, AST, GGT, Albumin, & PT ## Biliary Tumor S&S Bile duct tumors → Jaundice, itching, abdominal pain, weight loss ## Liver Transplant Treats life threatening end stage liver disease Depends on successful immunosuppression. Immunosuppressant drugs → Infection risk ## Acute Pancreatitis Reversible, NPO, Isolated For both pancreatitis: Systemic inflammatory response, grey turner's sign (flank) Cullen's sign (umbilicus) systemic inflammatory response ( sepsis, organ failure) necrotizing pancreas ## Chronic Pancreatitis Not reversible, progressive destruction of pancreas, healthy cells replaced by Scar tissue, decrease in ability to release enzymes, ( lipase, amylase, trypsin )most common use : alcohol and smoking. Long term glucose intolerance, insulin deficiency, pancreatic insufficiency, & malabsorption & malnutrition ## Pernicious Anemia B 12 insufficiency, must be treated with injections ( monthly for life) intrinsic factor ## Polycythemia Vera Too much RBC, red, ruddy complexion, therapeutic phlebotomy & aspirin ## CHF/ Fluid Overload Priority & Interventions Rest, small frequent meals, high fowlers with pillow tucked under arms, increase tissue perfusion, TED hose ## Professionalism in The Clinical Setting ## Acute Coronary Syndrome Labs - Unstable angina: pt. Has pain by EKG is normal - STEMI : ST elevated = significant damage to heart - NSTEMI : non STEMI elevation, high cardiac biomarkers but EKG is normal ## CHF Medications & Interactions with Electrolytes Digoxin : increases force of Contractility and slows HR : assess apical pulse and K+. Hyperkalemia = digoxin toxicity ## Medications and Their Side Effects - **ACE inhibitors :** “Pril" : cough - **ARBSS:** "sartan" : give if pt. Can't takes Ade - **Diuretics:** lose electrolytes, Sprinolactone: potassium sparing - **Beta blockers** - **Vasodilators** - **Calcium channel blocker :** “dipine” : slows contraction, contraindicated in systolic HF - **Morphine:** vasodilator ## GERD Lifestyle Teaching Low fat meals, no fat, sleep with HOB elevated, no tight clothing, don't eat or drink 2-3 hrs, before bed, don't lie supine 2-3 hours after eating, no bending or lifting heavy objects, no stimulants ## Dosage Calculation ## Peptic Ulcer Disease PCs & Interventions - Hemorrhage: stabilization of shock, progressive NPO, NGT, - Perforation: erosion of the ulcer into peritoneal cavity - Penetration: erosion of ulcer into adjacent cavities - IVF, NGT, ABX, surgical closure - Pyloric obstruction: edema or scarred tissue around ulcer near pylorus - NGT to low suction, IVF, clear progressive diet, antacids, plyloroplasty or andarectomy ## Hip Replacement Post-Op 6 P's, abduction pillow, avoid turning to affected side, avoid clots, avoid pulmonary complications, avoid skin breakdown ## Angina Prevention Limited physical exertion, no strong emotions, small meals, avoid temperature extremes No smoking, limited sexual activity ## Nitroglycerin Vasodilator, I tablet every five minutes (up to three), sublingual, take before any activity, SL SE: headache, hypotension, skin flushing ## Hyperlipidemia Medications - Statins: lower cholesterol - Bile acid sequestrants. : “chole” - 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 = lung, right = peripheral ## Ulcerative Colitis Priority Perforation: rigid board like abdomen Diet: low residue, high calorie, high protein, vitamin supplements I&O Daily weights Meds: anti diarrheals, antibiotics, corticosteroids, bulk agents ## Aminoglycoside Nursing Implications “Micin” Ototoxic, nephrotoxic, & neurotoxic- monitor peaks & troughs ## Post Op Amputation No ACE wrap, elevate with foot of bed, not pillows, tourniquet at bedside Report to health department, positive sputum culture, night sweats ## TB Reporting & transmission Airborne precautions immediately, aerolized droplet transmission Report to health department, positive sputum culture, night sweats ## Percutaneous Transluminal Coronary Angioplasty Done in cath lab Catheter inserted in femoral artery, threaded to place of plaque. Ballon tipped catheter is put in place & inflated.cracks the artheroma, may be done several times ## IBS Diet Modifications Restrict irritating foods & gradually reintroduce Dietary fibers and bulk forme'rs, chew food well, avoid fluids with meals, food diary to identify problem ## Blood Administration Protocol 18- gauge, baseline VS, informed consent, start within 30 min. Of Retrieving blood from bank, complete within 4 hrs, uninterrupted double check at bedside, stay with patient the first 15 min, retake VS after first 15 min, take hourly during the duration after, ## Assessing Fluid Status Daily weights : 2.2 kg = 1 lb, I &Os ## Surgery Classification ## Opioid Administration Implications Frequent pain assessment, monitor VS before during & after Assess LOC & GI, Assess for overdose : cold, clammy, confusion, pinpoint pupils, decreased HR, RR, & BP ## OA Living Modifications Symptoms resolve with rest & worsen at the end of the day ## Bronchitis Assessment Findings “Blue bloaters” Cyanotic, dusky, productive cough, use of accessory muscles (tripod), clubbing, weight gain enlarged heart ## Osteoporosis Risk Factors Small frame, post menopausal, lack of weight barring exercise, prolonged immobility, long term steroid use, no Ca & vitamin D, smoking ## Heparin Precautions pTT: 21-35 seconds, check vital signs and labs, observe for signs of bleeding, bleeding precautions, avoid aspirin & green leafy veggies ## PAOD Interventions and Lifestyle Modifications Anti platelets, statins, vasodilators, smoking cessation, exercise, controlling diabetes, angioplasty, or bypass ## Pneumonia Priority Treatment & Assessment Findings Fever, Tachypnea, dyspnea, tachycardia Wheezing, rhonchi, pleuritic chest pain Bronchodilators, oxygen, rest, high fluid intake, rest, pulmonary hygiene ## Surgical Time Out ## Proper Documentation ## Air Embolism Interventions Left side tredenlenburg & apply oxygen ## Bowel Revision Surgeries - Total protocolectomy w/ permanent illeostomy : liquid, PC: skin irritation - Total protocolectomy w/ continent illeostomy : pouch under skin, self-cath - Illeostomy & ascending PC: dehydration & skin irritation - Transverse and sigmoid PC: constipation ## Emphysema Interventions Pursed lip breathing to eliminate 02, bronchodilators (short acting : albuterol), supplemental oxygen, HOB, Breathing techniques, pulmonary hygiene, pace activities, allow rest, cooler room temp,small frequent meals, flu & pneumonia vaccines, reduce respiratory infections ## TURP Complications and Nursing Interventions PC: urethral stricture, bleeding, clots r/t obstruction of catheter flow Interventions: bladder irrigation, assess for bleeding & clots, antispasmodics, teach perineal exercises, stool softeners, fluid intake, educate client to monitor for bleeding up to two weeks after ## Addison's Lab Monitoring Low cortisol, Na, & BG. High K+ Insulin with dextrose = gets rid of K+ & Kayexalte ## CVA Prevention Healthy lifestyle, smoking cessation ## Urinary Diversion Complications Infection, dehiscence, urinary leakage, ureteral obstruction, Small bowel obstruction, stomal gangrene, not normal to see stool in drainage ## Nephrolithiasis Interventions Allow stone to pass by itself ( first line), narcotics, NSAIDs, Antiemetics, surgical treatment (required of stone does not pass within 6-8 weeks ) Surgical procedures: ureteroscopy, Percutaneous neprolithotomy, extracorporeal shock wave lithotripsy ## Pyelonephritis Signs and Symptoms - Acute : flank pain, CVA tenderness, dysuria, malaise, pus, bacteria, and WBCs in urine - Chronic : vague flank pain, fatigue, headache, occasional fever, bacteriuria ## Hemorrhagic CVA Treatment Optimize cerebral perfusion, decrease ICP ## Thyroidectomy Nursing Implications - Pre-op: antithyroid med until s&s have disappeared, Beta blockers, stop blood thinner 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 incision site, monitor respiratory status, semi fowlers with head supported for comfort, IVFs, instruct to limit speech, over bed table, OOB asap, high calorie diet, monitor for tetany ## Hyperthyroidism Priority Treatment Radioactive iodine therapy, antithyroid agents, iodides, Thyroidectomy Monitor for potential complications: thyroid storm - form of severe hyperthyroidism, untreated if fatal S&S: high fever, tachycardia same as hyperthyroidism, treat it ## Parkinson's Medications Anticholinergics: reduce tremors, dopamine receptor agonists : first line Treatments, levadopa : leave dopamine in the brain ## HTN Complications Damages blood vessels throughout body especially target organs Typical outcomes include: MI, chronic kidney disease, CVA, and impaired vision ## Bladder Cancer Risk Factors Smoking, chemicals, chronic UTIs, high urinary pH, high cholesterol intake, pelvic radiation therapy, metastasis ## Addison's Medication, Treatment, and Goals Meds: add a "sone” Treatment : fluid balance, monitor for fluid volume deficit, prevent hypoglycemia, frequent vital signs, daily weight & I&Os, hormone replacement therapy Goals: prevent Addison crisis & hypoglycemia management ## ACE Inhibitors "Pril” acts in lungs to inhibit conversion of angiotensin Powerful constrictor and stimulator of aldosterone release, results in slight increase of K+ Pancytopenia, angioedema, cough, hypotension Contraindicated with hyperkalemia and impaired renal function Take on empty stomach ## Prevention of Ischemic Stroke Reduce clots ## Identification of Cardiac Rhythms on an ECG Strip ## Correlate EKG with Physiological Events of the Heart Refer to Roger's study guide