N343 Midterm Exam Test Map Fall 2024 PDF

N343 Midterm Exam Test Map Fall 2024 This exam will be 50 points consisting of multiple choice, matching, select all that apply, and ordering questions. This test map is a guideline to what will be covered on the midterm exam. You will have 90 minutes to complete. TOPIC...

N343 Midterm Exam Test Map Fall 2024 This exam will be 50 points consisting of multiple choice, matching, select all that apply, and ordering questions. This test map is a guideline to what will be covered on the midterm exam. You will have 90 minutes to complete. TOPIC APPROXIMATE # OF QUESTIONS PERIOPERATIVE NURSING 15 NURSING PROCESS 10 NUTRITION & OBESITY 10 SLEEP 5 PAIN MANAGEMENT 10 Topics and items to review Perioperative Nursing o Patient education/patient teaching – who to involve, when to start patient education -Involve patient, family members, and care team -Start patient education as early as possible Baseline Data: vital signs, assessment, health history, medications: home meds, pre meds, herbal supplements, anesthesia assessment, discharge o Preop assessment – findings that need to be communicated to surgical team (I.e. medications, illness, abnormal lab values, medical history including tobacco use); physical assessment, if have fever do not go to surgery Subjective Data: things a patient says (SAY) (SUBJECTIVE) Objective Data: things you notice about a patient o Post-op concerns and priorities -Prioritize ABCS, pain, and complications o Interpreting assessment data and orders to determine the appropriate treatments -Interpret findings (vital signs, lab results, assessments) to perform appropriate interventions such as oxygen administration and medication adjustments  Nursing Process o Diagnosis structure = correct vs incorrect Problem related to (etiology) as evidence by (symptoms or signs) o Prioritizing interventions Use ABCs (airway, breathing, circulation) and hierarchy to prioritize care AIDET: acknowledge, introduce, duration, explanation, thank ADPIE: assessment, diagnosis, planning, implementation, evaluation o Appropriately formatting outcomes Outcomes should be SMART: specific, measurable, attainable, realistic, and timed Ex: pt will report pain below a 3/10 within 1 hr of medication administration o Evaluating effectiveness of interventions/outcomes Assess whether the interventions achieved the desired outcomes and adjust as needed Pain Management o Pain management related to post operative patients Use a combination of non pharma logical and pharma logical interventions such as hot cold therapy, relaxation techniques, can help mild to moderate pain levels o When are non-pharmacological vs pharmacological interventions appropriate Pharmacological: Non-opioids Great starting point for all patients! Good for mild to moderate pain Consider side effects Avoid NSAIDs in renal failure or bleeding disorders Avoid Tylenol in liver failure Dosage adjustments may be needed based on comorbidities Opioids Useful for acute and chronic pain More effective for nociceptive pain but can be used for neuropathic on occasion side effects:  Decreased HR, decreased BP, decreased RR N/V Sedation Constipation Adjuvant therapies Neuropathic pain Anesthetics – lidocaine, bupivocaine Antidepressants – bupropion (Wellbutrin), duloxetine (Cymbalta) Antiseizure – pregabalin (Lyrica), gabapentin (Neurontin) Cannabinoids Somatic pain Benzodiazepine – diazepam (Valium) Muscle relaxants – cyclobenzaprine (Flexeril) Non Pharmalogical: Non-Pharmacological vs. Pharmacological Interventions: Non-pharmacological interventions (e.g., heat/cold therapy, relaxation techniques) can be appropriate for mild to moderate pain. Pharmacological interventions are needed for more severe pain or when non- pharmacological approaches are ineffective. Pharmacological Pain Management: Non-opioids: Good for mild to moderate pain (e.g., acetaminophen, NSAIDs). Opioids: Reserved for moderate to severe pain but come with side effects like respiratory depression, nausea, sedation, and constipation.  Adjuvant Therapies: Used for neuropathic pain, including antidepressants (e.g., duloxetine), antiseizure meds (e.g., gabapentin), or anesthetics (e.g., lidocaine). o Patient education for medications Patient Education: Educate patients about their pain management plan, potential side effects, and proper medication usage. Educate patient on medications – timing, side effects, expectations Obesity/Nutrition o Metabolism syndrome- diagnosis criteria and patient education o -Cluster of symptoms/diseases that increase risk of coronary artery disease o -1:3 people get this o -More common in men over 60 o -Hispanic is most affected o -21.3% of adults 20-39 yrs had metabolic syndrome, increasing prevalence in younger adults A cluster of conditions (high blood pressure, high glucose, high lipid profile, large waistline, low HDL) that increase the risk of heart disease. More common in men over 60 and the Hispanic population. Nurses should educate patients on lifestyle changes to manage the syndrome. o -high blood pressure, high glucose, high lipid profile, large waist line, low HDL levels Key Points -Dietary approaches can assist in weight loss -Obesity can be related to genetics, environmental contributors, psychosocial responses to stress -Obesity can lead to chronic conditions -Nurses play significant role in obesity prevention and obesity reduction -Each type of special diet has its own nutritional benefits and drawbacks  Special Diets: Vegan ◦ Lack of cobalamin(vitaminB12) common ◦ Vegetarian ◦ Need well planned diet to avoid vitamin and protein deficiencies ◦ Gluten free (CeliacDisease) ◦ Watch for vitamin and nutrient deficiencies as many whole-grain breads and other products are natural or enriched sources such as fiber and thiamin ◦ Lacto-ovo-vegetarians ◦ Watch for vitamin and mineral deficiencies ◦ Iron deficiency For which patients is it MOST important for the nurse to refer to a dietitian for a complete nutritional assessment? 1. A 38-yr-old with hypertension who is undergoing laser eye surgery 2. A 55-yr-old with a diabetes and history of alcohol use disorder who is hospitalized with a fractured femur from a fall 3. A 24-yr-old who has been taking short term course of corticosteroids for 1 week for treatment of an asthma exacerbation 4. A 45-yr-old hospitalized with nausea and abdominal pain who has had no oral intake andonlyIVfluidsofD51⁄2NSfor2days o Functional Health Patterns- Metabolic and Nutrition Assessment Questions -What are you concerns about baseline health -What diet education would you include in a patient with: metabolic syndrome, or special diets?  o Nursing Implications – Enteral & Parenteral Feeds Nutritional Support Types: Enteral (Oral): Tube feeds administered via tubes directly into the stomach or intestine. Special formulas available for chronic conditions like diabetes, lung disease, liver disease, or kidney disease. May be given via continuous or bolus infusions. Parenteral (IV): Nutritional formulas delivered directly to the bloodstream via peripheral IVs or, more commonly, central lines. Solutions are carefully customized to the patient on daily basis. Electrolytes, proteins, calories and vitamins/minerals adjusted regularly. Given to maintain/improve nutritional status – won’t result in weight gain in underweight patients Given via IV pump at a calculated rate. Solution is only good for 24 hours. Enteral Feed Routes: Short Term: Orogastric (OG) Nasogastric (NG) Nasoduodenal (ND) Nasojejunal (NJ) Long Term: Gastrostomy tube (GT) Jejunostomy tube (JT) Enteral and Parenteral Nutrition: Enteral: Administered via feeding tubes for patients unable to eat. Nurses monitor for complications like aspiration. Parenteral: Given via IV for patients who cannot use their GI tract. Nurses must monitor for complications like infection and electrolyte imbalances. Enteral (oral) Tube feeds administered via tubes directly into the stomach or intestine. Special formulas available for chronic conditions like diabetes, lung disease, liver disease, or kidney disease. May be given via continuous or bolus infusions. Parenteral (IV) Nutritional formulas delivered directly to the bloodstream via peripheral IVs or, more commonly, central lines. Solutions are carefully customized to the patient on daily basis. Electrolytes, proteins, calories and vitamins/minerals adjusted regularly. Given to maintain/improve nutritional status – won’t result in weight gain in underweight patients Given via IV pump at a calculated rate. Solution is only good for 24 hours. Nutrition Planning: Goals should be to: Achieve appropriate weight (either gaining or losing) Consume specified calories per day based on individualized diet No adverse consequences related to nutrition Enteral Feeds: Implications Big problems: aspiration, tube dislodgement Preventing aspiration: HOB > 30 Preventing tube dislodgement: measure/mark tube to visualize placement regularly, make sure tube is securely attached to the nare or the skin, advise patients to avoid touching/pulling at tube Verify placement/location via x-ray May check gastric volume residuals (GVR) when starting feeds or if patient is complaining of feeling “full” or nauseated Site care: assess skin around tube for redness, skin breakdown May use dressings around G/J tubes until healed Rotate G/J tube daily Tube patency – flush with warm water before/after medications Routinely flush to keep open if not using regularly Parenteral Feeds: Implications Preparing: check orders to what your bag contents are; ensure they are “fresh” (expire after 24 hours) Maintaining: aseptic technique to reduce infection Use filtered tubing Change tubing at 24 hours Administering: use IV pump Typically given continuously for 24 hours but can be given for shorter periods of time Monitoring: Watch for signs of infection/infiltration Take vital signs regularly with daily weights  Continue to check electrolytes daily, CBC and liver labs frequently at the start Monitor blood glucose levels every 4-6h If solution is unexpectedly stopped, MUST run dextrose solution in the interim to prevent hypoglycemia Keep strict intake/output documentation Complications of Parenteral Nutrition: Metabolic Problems: o Altered renal function o Essential fatty acid defieicnecy o Hyperglycemia, hypoglycemia o Thrombosis of vein o Complications of Refeeding Syndrome Complications of Refeeding Syndrome: Occurs in malnourished patients receiving nutrition too quickly. Monitor electrolyte levels closely. Caused by mineral/electrolyte shifts after starting nutritional support Characteristics: fluid retention, electrolyte imbalances o Hypophosphatemia is biggest sign o Low K+ and low mag also common Risk factors: chronic alcohol use, chemotherapy, major surgeries, chronic undernutrition Adverse outcomes: dysrhythmias, respiratory arrest, neurological changes  o Types of Malnutrition- apply types to the nursing process (ADPIE) 1. Anorexia Nervosa: - Restricted caloric intake and types of foods Intense fears of gaining weight Assessment findings: extremely skinny, low body temps, weak Leads to severe weight loss and electrolyte imbalances (e.g., low potassium), which can cause muscle weakness and heart issues. Low K+ typically leads to muscle weakness, dysrhythmias, renal failure Electrolyte abnormalities: hypoglycemia, hyponatremia, hypomagnesemia, hypophosphatemia Bulimia Nervosa: Characterized by binge eating and purging. Monitor for metabolic alkalosis and electrolyte imbalances like hypokalemia. Episodes of binge eating followed by behaviors such as vomiting, excessive laxative use, or overexercising to avoid gaining weight o Conceal their abnormal eating habits so difficult to identify sometimes Assessment findings: normal weight and height o Some electrolyte abnormalities related to vomiting such as hypokalemia & metabolic alkalosis Differences between Bulimia Nervosa vs Anorexia Nervosa: BULIMIA: o Broken blood vessels o Salivary gland enlargement o Enamel erosion (from vomiting) o Esophagitis o Dysrhythmias o Diarrhea o Callus o Edema ANOREXIA: o Dizziness, confusion o Dry brittle hair, hair loss o Low blood pressure and pulse o Loss of menses o Stool retention o Muscle wasting o Osteoporosis o Dry skin o Edema  Sleep o Non-Pharmacological Sleep Interventions -avoid alcohol, coffee, nicotine 4-6 hrs before bed -limit daytime naps --avoid strenuous exercise 6 hrs before bed -keep a regular schedule -dark quiet cool room -avoid sleeping pills: use sparingly Non-Pharmacological Sleep Interventions: Encourage patients to avoid alcohol, caffeine, and nicotine before bed. Suggest keeping a regular sleep schedule and avoiding napping during the day. Recommend creating a cool, dark, and quiet sleep environment. o Nursing considerations for common OTC sleep aids (ie melatonin, Tylenol PM) Caution with frequent use of OTC sleep aids like melatonin or Tylenol PM as they may have side effects or lead to dependency. o Nursing considerations for patients with OSA Obstructive Sleep Apnea patients may need CPAP therapy post-op and should be monitored for respiratory complications, especially under sedation. Practice EAQs have been created for you on the midterm content areas. These are optional study tools. These EAQs can be found under week 7 additional resources folder. You can also create your own EAQ if you want to use EAQs as a study strategy.