Final Study Guide PDF

Week 4 – Chapters 28 (1 question), CH. 29 – (2 questions) Blood transfusions - Make sure consent is obtained before - Follow protocol - Assessment of patient is on the nurse o Check allergies o Assess vitals o Assess lung...

Week 4 – Chapters 28 (1 question), CH. 29 – (2 questions) Blood transfusions - Make sure consent is obtained before - Follow protocol - Assessment of patient is on the nurse o Check allergies o Assess vitals o Assess lung sounds ▪ Assess for fluid overload ▪ If happens you may hear crackles -> give diuretic - 22 or high gauge for giving blood - Only with IV normal saline, no dextrose Sickle Cell - Shape of cell causes occlusion -> blood not flowing the way it should - Jump to get blood culture o See sensitivity of the pathogen - Make sure patient knows to avoid high altitude areas - Address pain - Hydration Week 5 – Chapters 14, (3 questions) 15 (2 questions) & 16 – (5 questions) Operating Room - Ask information from patient before surgery o Ask about pain management o Allergies are so important o Smoking history o Spiritual history ▪ Does anything calm them down? - Objective assessment o Vital signs o Have patient open mouth -> loose teeth ▪ Can aspirate o Consent is signed - Think about population taken to the OR - OR is very cold o Monitor older patients o Hypothermia o Give warm IV fluids - Have blood ready- typed and crossed - PTSD o Keep conversations professional - Monitor Neuro Status o Patients can become confused  - Prevent complications o Push for incentive spirometer & deep coughing ▪ Prevent pneumonia and atelectasis o Encourage early ambulation - Skin breakdown -> protect pressure areas - Have a ride home if same day o Give them the drs number to call if they have problems Week 7 – Chapters 19 (10 questions) & 20 (3 questions) Review clinical manifestations for COPD, bronchitis and emphysema Pneumonia - Lethargic - Tachycardia/tachypnea - Increased tactile fremitus - Fatigued - Chest PT to move the mucus o Important nursing technique o Stop it they are in pain - Monitor for atelectasis o Increased heart rate o Increased breathing Emphysema - Poor elasticity - Air floating around alveoli - Hyper resonance - Tachypnic - Cachexic -> look sick - Barrel chested - Pursed lip breathing Bronchitis - Inflamed bronchi & mucus - Bloated/gain weight - Steroids o Check blood sugar ▪ Raises blood sugar ▪ Masks signs of hyperglycemia Asthma - Restrictive airway - Patient is wheezing - Inhaler -> albuterol o Bronchodilator - Know when to go to the ER  - Peak flow o Asses how much air they can breath o Patient needs to stand cant be laying down - Caution with Chinese food due to additives - Wash clothes with hot water not warm -> kills bacteria Tuberculosis - PPD is positive -> larger than 10mm o Simply telling you the patient has exposure to mycobacteria o Next step is Chest X-ray ▪ If negative -> latent Isoniozide 6-9 months Vitamin B6 for tingling in the fingers o neuropathy ▪ Positive -> active Negative pressure room Treatment Airborne precautions Week 8 – Chapter 31 (2 questions) 33 – 0 Passive Immunity - From vaccines - From Birth Active - Formed immunity in the body - You fought an illness Lymphocytes - Recognition o Find the pathogen - Proliferation o Lymphocytes go back to lymphoid to tell them something wrong - Response o B cells form plasma cells & antibodies o Killer T cells go after bad guy - Effector o Fell better Week 9 – Chapters 21 (0 questions), & CH. 27 (8 questions) Hypertension - Know about untreated long term effects - Chronic Kidney Disease - Risk factors o Obesity o Smoking  - Target BP of 120/80 - Control obesity and diabetes - Encourage exercise daily - Advise about beta-blockers o Slow rise after rest o May take time for effects to be seen o Don’t stop just like that need to ween o Don’t give when HR is lower than 60 - Hypertensive Emergency o BP > 180/120 ▪ Must be lowered immediately to prevent further organ damage o No more than 25% in first hour o Reduce to 160/100 within 2-6 hours o Gradual reduction to normal within 24-48 hours o Exceptions = ischemic stroke & aortic dissection o Medications: ▪ IV vasodilators Sodium nitroprusside Nitroglycerin - Hypertensive Urgency o BP > 180/120 o No evidence of immediate target of organ damage o Oral agents within 24-48 hrs to normalize BP ▪ Fast acting: Beta-blockers: labetalol ACE inhibitor: captopril Week 10 – Chapters 23 (5 questions) & 25 (5 questions) Angina - Ask patient what activity they were doing / precipitating factors - Gerontological considerations o Diminished pain with aging o Teach to recognize “chest pain like” symptoms -> weakness o Stress testing / cardiac catheterization - Stable o Happens during activity -> stops during rest o Predictable o Lasts short time < 5 minutes - Unstable (medical emergency) o Occurs during rest o Severe / lasts > 20 minutes o If doesn’t improve -> heart attack  - Treatments: o Reduce myocardial oxygen demand & increase oxygen supply o Oxygen therapy o Reperfusion therapy -> thrombolytic drugs - Planning & Goals: o Awareness of disease process o Understanding of care plan and importance of adherence o Absence of complications - Nursing: o Treat angina ▪ Semi fowlers ▪ Assessment of patient: vitals, respiratory distress, assessment of pain, ECG ▪ Admin medications: nitro -> up to 3 doses ▪ Oxygen -> 2 L/min nasal cannula o Reduce anxiety o Prevent pain ▪ Plan activities Alternate rest / active o Education ▪ Avoid exercise in cold temps ▪ Diet low in fat/high in fiber ▪ Carry nitro! Follow up with provider Venous Leg ulcers - Due to potential cardiac insufficiency - Pay close attention to them - Diet o High calorie o They don’t normally eat as much -> helps metabolism o High protein Circulation - Address ineffective tissue perfusion Metabolic Issues - 3/5 risk factors o Waist circumference > 35.4 inches o HTN w/ systolic > 130 o Fasting glucose > 100 o Elevated triglycerides o Decrease in HDL CAD - Arteriosclerosis = blood vessels become thick & stiff & harden  - Atherosclerosis = build up of fats/cholesterol/etc. on artery walls -> causes plaque o Endothelium changes & stopes making antithrombotic & vasodilating agents o Inflammation attracts inflammatory cells like macrophages o Macrophages ingest lips -> become foam cells -> transport lipids to artery wall = fatty streak - Stable & Unstable Plaque o Thick cap = stable -> resist blood flow/vessel movement o Thin cap -> leads to rupture -> attracts platelets/trhombus formation -> blocks blood flow -> MI - Encourage patient to express feelings Heart Failure - Structural or functional disorder that impairs ventricle ability to fill or eject blood o Unable to pump enough blood to meet body’s demands - Compensated o Initial stage o Structural & functional changes compensate for reduction of CO - Decompensated o End stage o No longer capable of compensating for reduced CO - Pathophysiology o Heart Damage -> decreased ventricular contraction o Tachycardia -> myocardial hyper trophy o Decreased CO -> decreased renal perfusion -> increased sodium retention -> increased osmotic pressure o Increased ADH -> water reabsorption -> edema -> fluid overload - Left Sided: Drowning heart o Left ventricles can’t pump blood effectively ▪ Backs up to lungs ▪ Pulmonary congestion Cyanosis/hypoxia/COE/fatigue ▪ Pulmonary Edema Restlessness/anxiety Cough with pink frothy sputum Paroxysmal nocturnal dyspnea Crackles ▪ Decrease CO Extra heart sounds S3 - Right Sided: o Cant eject blood effectively o Blood backs up or rest of the body – congestion of peripheral tissues ▪ Jugular Vein Distention ▪ Ascites -> increased abdominal girth/weight gain ▪ Pitting edema  ▪ Liver congestion/hepatomegly -> nausea / vomit ▪ GI distress -> RUQ – liver pain - Diagnostic Tests: o Labs: ▪ BNP > 100 = HF ▪ Electrolytes ▪ CBC o EKG/ECG/CXR o Transesophageal echocardiography-TEE ▪ Noninvasive ultrasound ▪ Evaluated structural & functional changes Valve performance & shape of Heart & ejection fraction ▪ NPO 6 hours before! ▪ Bed rest post OP ▪ HOB elevated 45 degrees - Medications: o Diuretics -> decrease fluid volume ▪ Watch electrolytes ▪ Take in AM (avoid sleep interferences with peeing) ▪ Dailey weights for input & output o ACE inhibitors -> lowers BP ▪ Watch hypotension ▪ Cough ▪ Angioedema o Beta Blocker -> lowers HR -> lowers BP ▪ Prescribed with ACE ▪ Weeks before effects o Digitalis -> improves contractility ▪ Hypokalemia K+ & digoxin bind to same receptor -> low K+ increases digoxin ▪ Toxicity N/V -> anorexia Yellow/blue haze / halo vision - Decompensated IV Medications: o Immediate medical treatment o Dopamine: increase BP / myocardial contractility o Dobutamine: increase contractility ▪ Left ventricular dysfunction o Vasodilator: enhance symptom relief ▪ Nitro/nitropruisside  - Gerontological o Atypical signs -> fatigue / weakness/ somnolence (drowsiness) o Decreased renal function -> resistant to diuretics o Fall risk - Nursing – Hospital setting o Bed rest for acute exacerbations o Vitals -> O2 therapy ▪ HOB elevated o Manage Fluid ▪ Assess weights o Psychological support - Nursing – Home setting o Encourage regular activity -> build up to 30 min daily ▪ Pace/modify activities to conserve energy ▪ Avoid extreme temperatures o Promote home & community care o Daily weight / I & O - Education: o Diet: Low sodium / fluid restriction o How & when to contact health care provider o Include family! - Pericardial Effusion -> fluid in pericardial sac o Cardiac Tamponade -> restriction of heart function because of fluid ▪ Decrease venous return ▪ Decreased CO o Manifestations: ▪ Falling systolic BP ▪ Narrowing pulse pressure Week 11 – Chapters 38 (3 questions) & 39 – (3 questions) -> GI Digestive & GI Health - Assessment o Health History: medical/surgical/social/family o Pain: characteristics/patterns/location/time o Stool habits/ characteristics ▪ Color: Bleeding from upper GI = tarry-black/foul odor (Melena) o Enzymes breaking down blood through GI tract o Peptic ulcers / NSAID overuse Bleeding from lower GI = bright or dark red - Diagnostic Tests o Guaiac-based fecal occult blood testing (gFOBT) ▪ Detects blood  ▪ Avoid red meat/ aspirin/ NSAIDS & Vit C 72 hrs before test (false positive results) ▪ Mail paper slide to PCP/Lab ▪ Every year o FIT-fecal DNA ▪ Detects DNA from cancer or polyps ▪ Mail to PCP/Lab ▪ Every 3 years o Breath Test ▪ H pylori lives in mucus lining in stomach -> cause peptic ulcer disease ▪ Patient ingest carbon-labeled urea H. Pylori metabolized urea rapidly -> carbon absorbed quick Measured as CO2 in the expired breath ▪ Breath sample obtained 10-20 min later o Colonoscopy: ▪ Examines entire colon ▪ Every 10 years ▪ Sigmoidoscopy Examines lower colon Every 5 years ▪ Nursing: Pre procedure diet Meds to take (laxatives) Meds NOT to take (Coumadin/aspirin) -> bleeding Patient position -> left lateral Discharge plans -> ride o Endoscopy: ▪ Examines upper digestive system ▪ Nursing: NPO 8 hours before Assess gag reflex post OP - Gastroesophageal reflux Disease (GERD) o Backflow of gastric contents into esophagus o Management: ▪ Avoid eating or drinking 2 hours before bedtime ▪ Elevate HOB by at least 30 degrees - Cancer of Esophagus o Adenocarcinoma and Squamous cell carcinoma o Risk Factors: ▪ Chronic alcohol/tobacco ▪ GERD – esophagus irritation o Prevention: early diagnosis & treatment of GERD o Symptoms: Dysphagia / lump in throat feeling / regurgitation  - Tube Feedings o Parenteral -> through a vein ▪ Bypasses entire digestive tract ▪ Used if GI not functioning or rest from disorder or surgery o Enteral -> tube to the stomach of small intestine ▪ Tube through nose of abdomen o Gastronomy tube -> directly through the stomach wall o Jejunostomy tube -> directly through intestine wall o Nursing: ▪ Confirm tube placement -> hospital policy ▪ Admin @ prescribed rate/ method / patient tolerance ▪ Flush before & after each medication / feeding ▪ Can’t hang longer than 4-8 hours ▪ hydration/weights/skin integrity ▪ Patient education Week 13 – Chapter 47 (3 questions), CH. 49 (13 questions), CH 62 (11 questions) Kidney & Urinary Systems - Regulates fluid & electrolytes - Kidneys regulate: o Fluid & electrolyte balance o Acid-base balance (ABG) o Blood pressure - Gerontological Considerations o More susceptible to kidney injury due to structural and functional changes ▪ Decreased blood flow ▪ Fluid volume deficit – encourage drinking frequently ▪ Decreased drug clearance = increased drug-drug interactions - Assessment Findings: o History of renal or urinary test, surgery, procedures, UTI o Hesitancy/ straining to pee/ frequency o Urinary incontinence: ▪ Stress: involuntary leaking during activities that increase abdominal pressure (sneezing/couging) Pelvic floor therapy ▪ Urge: sudden/intense urge -> leak before reach bathroom ▪ Overflow: frequent dribbling due to incomplete emptying ▪ Functional: physical or cognitive impairments prevent access to toilet ▪ Patient Education: Management takes time -> give support & encouragement Use voiding log / diary - Tests:  o Urinalysis/ urine culture o Creating clearance test: ▪ Compares amount of creatinine in blood to amount in urine ▪ 24 hours urine collection - Urinary Tract Infection - (UTI) o Risk Factors: ▪ Bacteria in urinary tract ▪ Urine backflow from bladder ▪ Shorter urethra in women o Prevention: ▪ Lots of water ▪ Hygiene ▪ Empty bladder before & after sex o Assessment: ▪ Pain/burning when peeing ▪ Nocturia/ incontinence/ hematuria o Gerontological considerations ▪ Delirium -> low grade fever o Nursing: ▪ Relieve pain Phenazopyridine -> change color of urine to reddish orange / stain contact lenses Heat to perineum ▪ Give antibiotics Provide fluconazole prophylactic if prone to yeast infections ▪ Increase fluid -> frequent voiding - Urolithiasis (kidney stone) / Nephrolithiasis (urinary tract stone) o Causes: ▪ Build up of calcium and hard deposits ▪ Diet ▪ Excess body weight o Symptoms: ▪ Depends on: Location size of stone Presence of obstruction or infection ▪ Pain ▪ Hematuria o Diagnosis: ▪ CT / blood chemistry ▪ 24 urine collection Strain all urine & save stones o Nursing:  ▪ Hydration! -> can help pass o Patient Education: ▪ Diet to reduce change of kidney stones Rhubarb/beets/spinach/sweet potatoes/nuts - Urinary Tract Cancers o Bladder cancer = leading cause of death ▪ Smoking increases risk by 50% o Symptoms: ▪ Visible/ painless hematuria ▪ Pelvic/ back pain o Diagnosis: ▪ Ureteroscopy / CT / MRI Stroke - Blood clot blocks artery -> blood supply to brain is interrupted - Risk Factors: o Atrial Fibrillation -> blood pools in atrium o Arteriosclerosis o TIA – transient ischemic stroke o Diabetes / smoking / obesity / oral contraceptives o Uncontrolled HTN - Pathophysiology o The brain cant store O2 / glucose / nutrients o Arterial blood flow brings O2 to brain o Venous blood takes CO2 & lactic acid away o If blood supply is interrupted more than a few minutes-> cerebral tissue dies -> infarction o CO2 cant leave brain & O2 cant get to the brain = cell death ▪ High CO2 -> cerebral vasodilation -> edema ▪ Low O2 -> cerebral vasodilation -> edema o Edema -> increase intracranial pressure (ICP) - Diagnostics: o CT / MRI / PET / EEG / 12 lead EKG - Ischemic o Disruption of blood caused by obstruction o Thrombotic ▪ Takes time ▪ Don’t see symptoms right away ▪ Atherosclerotic blood vessels -> clot occludes vessel ▪ Symptoms worsen over 72 hours due to increased cerebral edema Observe neurological changes o Embolic ▪ Sudden onset Maximum deficit at onset  ▪ Usually emboli from heart ▪ Rapid neuro changes ▪ Middle cerebral artery mostly affected ▪ Give TPA to dissolve the clot o Manifestations: ▪ Speech / visual problems ▪ Confusion / change in mental status ▪ Facial droop ▪ Difficult walking ▪ Numbness / weakness of face/ leg / arm -> especially on one side o Management: ▪ Prompt diagnosis and treatment ▪ Thrombolytic therapy (tPA) Assess criteria & eligibility Must be given within 3-4.5 hours after first stroke symptoms Side effects: potential bleeding - Transient Ischemic Attack o Temporary stoke / lack of blood flow to part of brain o “Warning of impending stroke” o Symptoms last few minutes to less than 1 hour ▪ Could damage brain with repeated insults ▪ Depends on affected part of the brain o Prevention / Treatment ▪ Antiplatlet therapy ▪ Statins -> reduce LDL levels ▪ Surgical: carotid endarterectomy Remove plaque build up in artery - Hemorrhage o Bleeding into brain tissue / ventricles / or subarachnoid space o Causes: ▪ Spontaneous rupture of small vessels -> hypertension ▪ Subarachnoid hemorrhage-> ruptured aneurysm ▪ Intracerebral hemorrhage Arterial venous malformations Intracranial aneurism ▪ Anticoagulants o Brain metabolism disrupted -> exposure to blood o Increased ICP caused by blood in subarachnoid space o Intracerebral: ▪ Bleed into brain ▪ Sudden onset ▪ Symptoms rapid -> poor prognosis  ▪ HTN / brain tumors / anti-coagulants o Intracranial (cerebral aneurysm) ▪ Dilation of cerebral arterial wall due to weakness ▪ Cause = unknown Predisposing factors: o HTN / congenital defect / trauma ▪ Blood supply decreases distal to the bleed o Manifestations: ▪ Worst headache of my life ▪ Altered LOC -> early sign of ICP ▪ Photophobia ▪ Stiff neck ▪ Nausea / vomiting ▪ Fixed dilated pupils o Thrombolytic therapy is contraindicated - Nursing For Stroke: o Maintain airway & ventilation ▪ Raise HOB unless contraindicated ▪ Oxygen therapy o Improving mobility / preventing joint deformities ▪ Approach patient from unaffected side ▪ Establish exercise program Help out of bed ASAP Remove clutter Seizure precautions o Bowel & Bladder control ▪ Prevent constipation-> stool softeners/ fiber/ fluid / toilet schedule o Simple Communication o Family Education o Nutrition ▪ Consult with speech therapy or nutrition services ▪ Have patient sit upright ▪ Thickened liquids or puréed diet ▪ Chin tuck -> double swallow method - Right Hemisphere CVA / Stroke o Impulsiveness / lack of awareness about deficits o Paralysis / weakness on left side ▪ Left visual deficit o Lack of inhibition / humor o Agnosia: ▪ Loss of ability to recognize objects through particular sensory system Visual / auditory / tactile  o Worry about safety - Left Hemisphere CVA / Stroke o Aphasia o Paralysis or weakness on right side of body ▪ Right visual deficit o Slow / cautious behavior o Quick to anger / frustration ▪ Changes in function and communication - Home Care / Education o Prevention / signs & symptoms of complications o Medication education -> anti hypertensive o Safety measures ▪ Use of assistive devices for ADLS o Nutrition: ▪ Diet ▪ Swallow techniques ▪ Tube feeding o Elimination: ▪ Bowel & bladder programs ▪ Catheter use o Social support - Encourage deep breathing o Helps prevent atelecteis/ pneumonia Week 14 - Chapter 45 – 21 questions Endocrine System - Hormones Regulate: o Growth / development o Homeostasis o Metabolism o Reproduction - Negative Feedback Mechanisms - Thyroid o T3 – active o T4 – inactive o Calcitonin ▪ Secreted in response to high calcium levels ▪ Increases calcium deposit into bone o Function: ▪ Metabolism -> increase oxygen consumption / respiration rate / and body temperature o Negative Feedback ▪ Hypothalamus detects change in serum levels -> releases Thyrotoropin-releasing hormone (TRH) ▪ Stimulates anterior pituitary to release Thyroid Stimulating hormone (TSH)  ▪ Stimulates Thyroid to release Thyroid hormones (T3 & T4) o Diagnostic Tests: ▪ TSH -> most sensitive test ▪ T3 / T4 / Thyroid antibodies ▪ Radioactive iodine uptake - Hypothyroidism o Primary: most common ▪ Autoimmune thyroiditis -> Hashimoto disease ▪ Loss of thyroid gland -> removal o Secondary: ▪ Anterior pituitary malfunction -> TSH o Tertiary (central): ▪ Hypothalamus malfunction (TRH) o Pathophysiology: ▪ Iodine necessary for thyroid to synthesize / secrete hormones ▪ Insufficient iodine / suppressed TH / increased TSH -> gland hypertrophy Goiter ▪ Deceased TH leads to slowed metabolism o Manifestations: ▪ Neurological: lethargy ▪ Weight: weight gain ▪ Environment: cold intolerance ▪ Skin: dry ▪ Hair & Nails: coarse hair/ tendency to break/ dry nails ▪ GI: constipation ▪ Menstrual: menorrhagia (heaving bleeding) ▪ Reflexes: hyporeflexia ▪ Cardiac: Bradycardia ▪ Labs: Increase TSH Decrease T3 & T4 o Medications: ▪ Synthroid Take first thing in the morning -> don’t eat before Cardiac Assessment o Increased BP / HR Diet: o Low Calorie o Increased Fiber / Water / iodized salt  - Hyperthyroidism o Graves’ disease -> autoimmune: most common form o Thyrotoxicosis: excessive output of thyroid hormone ▪ Thyroid storm o Circulating antibodies (TSH-R Ab) bumps TSH from role o Hyper metabolic -> leads to burnout o Progress to hypothyroidism overtime o Decrease TSH o Increase T3 & T4 o Manifestations: OPPOSITE OF HYPOTHYROIDISM ▪ Neurological: nervous / tremors ▪ Weight: weight loss ▪ Environment: heat intolerance ▪ Skin: warm / moist ▪ Hair / Nails: fine hair & thin nails ▪ GI: loose stools / increased appetite ▪ Cardiac: elevated systolic BP / tachycardia / dysrhytmias o PTU ▪ Safe for pregnancy o Therpazol - Post Thyroid surgery o Need suction o Oxygen o Trach kit o Know the trach size Total – 100 Select all that apply: 16 NGN - 3