NUR 343 Exam One Study Guide PDF

NUR 343 PEDs & Psych-Mental Health Exam One Study Guide Nutrition Failure to Thrive (FTT) Iron Deficienc...

NUR 343 PEDs & Psych-Mental Health Exam One Study Guide Nutrition Failure to Thrive (FTT) Iron Deficiency Anemia (IDA) The inability to obtain and use calories for growth; infants & children A reduction in red blood cell mass or hemoglobin concentration. The who do not grow as expected based on growth standards for age production of hemoglobin requires iron, and if there is low iron in Typically a combination of medical, psychosocial economic, and the body, there is decreased hemoglobin which causes anemia. policy factors Risk Factors Types of Failure to Thrive Pregnancy Inadequate Caloric Intake: oral aversion to food, neglect, dilution Prematurity of formula, poor feeding education Infancy/Toddlerhood Inadequate Absorption: celiac disease, crohn’s disease Adolescence Increased Metabolism: congenital heart defects, hyperthyroidism Menstruation Defective Utilization: genetic anomalies (trisomy 21, FASD, Socioeconomic conditions gastroschisis, palatal anomalies, turner syndrome) Signs and Symptoms Consequences of Failure to Thrive Pallor Sob-optimal growth & development Weakness/Fatigue Diminished immune response Shortness of breath Long term cognitive developmental delays, academic Tachycardia performance delays, and social delays Headache, Lightheadedness, Dizziness Malabsorption or excessive loss of nutrients (chronic PICA intussusception, GERD, lactose intolerance, SBS) Growth delays (severe cases) Interventions Management Nutritional catch up: increase caloric intake by 2-3 times (150-180 Iron supplements: take with orange juice or on an empty kcal/kg) stomach, cause green/black stools Supplemental iron, multivitamin, high calorie beverages Iron fortified formula or foods Continue until the appropriate HEIGHT is achieved May need to decrease milk intake in young children so they eat other foods rich in iron instead Necrotizing Enterocolitis (NEC) Short Bowel Syndrome (SBS) An inflammatory disease of the GI mucosa caused by ischemia or When a patient has had at least ½ of their small intestine removed hypoxia. Ischemia leads to necrotic patches that interfere with and sometimes all or part of their large intestine removed digestion. Significant damage of the small intestine causes poor motility Risks: prematurity, RDS, intrauterine growth restriction, enteral Mild to severe absorption issues due to decreased surface area feedings, asphyxia Patients can not absorb enough water, vitamins, minerals, Expected findings: abdominal distention, feeding intolerance, protein, fat, calories, and other nutrients bloody stool, apnea, lethargy, hypotension, decreased urinary Treatment: TPN in combination with oral/enteral feeds, small & output frequent meals, avoid high sugar/fiber/fat  Diagnostic procedures: abdominal x-rays show sausage shaped Surgery: bowel lengthening, transplants (liver, small bowel, dilation of intestine and air bubbles in intestinal wall pancreas) Nursing Concerns: growth and strict I&Os Celiac Disease Total Parenteral Nutrition (TPN) Immune reaction to gluten (wheat, barley, rye) Fluids, electrolytes, liquid vitamins, and minerals IV through a Continued exposure to gluten leads to damage to the intestinal central line lining, which can prevent absorption of nutrients Only used in patients with a non-intact GI tract ○ Short bowel syndrome, NEC, etc. Clinical Manifestations Diarrhea Side Effects to Monitor Bloating Dehydration & electrolyte imbalances Pain Thrombosis Asymptomatic Hyperglycemia/Hypoglycemia Infection (TPN is sticky & sweet so bacteria love it) Diagnostics: blood test looking for transglutaminase antibodies (if Liver failure (long term TPN use) present, endoscopy & biopsy is performed to confirm diagnosis) Vitamin and mineral deficiencies Fetal Alcohol Spectrum Disorder Cleft Lip and Cleft Palate A group of conditions that can occur in someone who was exposed to Cleft Lip: results from the incomplete fusion of the oral cavity during alcohol before birth intrauterine life. Physical Features: low birth weight, small head, slow physical Cleft Palate: results from the incomplete fusion of the alates during growth, difficulty bottle feeding, cognitive & motor delays, bony intrauterine life. deformities, virion & hearing problems, heart defects, flat midface, short nose, thin upper lip, low nasal bridge, minor ear abnormalities Risks: genetic syndromes, family history, maternal and environmental factors, exposure to alcohol, cigarette smoke, Behavioral Issues: irritability in infancy, learning disabilities, anxiety, anticonvulsants, retinoids, or steroids during pregnancy, folate depression, rapid changing moods deficiency during pregnancy No Treatment: providing symptomatic care is important Complications: ear infections and hearing loss related to altered structure ○ Feed infant in upright position and monitor temperature Hyperlipidemia Metabolic Syndrome (Syndrome X) The elevation of serum lipids (significant risk for cardiovascular Insulin resistance syndrome disease) 25% of americans have metabolic syndrome HDL: good cholesterol Common in +60 years LDL: bad cholesterol, causes arterial narrowing Increased risk of heart disease, stroke, and diabetes Cluster of health problems Risk Factors: Genetic predisposition, High dietary fat intake ○ Hypertension, hyperglycemia, body fat around waist, high cholesterol Treatment Treatment Healthy diet (limit red meat) Diet Physical activity Exercise Medications (Statins) to decrease cholesterol levels Weight loss Smoking cessation Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Obesity Disease (GERD) Excessive amount of adipose tissue Gastroesophageal Reflux (GER): occurs when gastric contents reflux Primary obesity: caloric intake exceeds energy spent (most back up into the esophagus, making esophageal mucosa vulnerable common) to injury from gastric acid. Secondary obesity: result of congenital & metabolic anomalies Risks for GER: prematurity, bronchopulmonary dysplasia, and medications (long term corticosteroid use, antipsychotics) neurologic impairments, asthma, cystic fibrosis, cerebral palsy, BMI correlated with clinical risk factors for hyperlipidemia, scoliosis hyperglycemia, and hypertension Overweight children are more likely to experience health Gastroesophageal Reflux Disease (GERD): tissue damage from GER. problems as adults Risks for GERD: neurologic impairments, hiatal hernia, morbid obesity Risks: women 40-59, men over 60, environmental access, Complications: poor weight gain, esophageal stricture, dysphagia, psychological factors, lack of nutritional knowledge, using food as non-cardiac chest pain, reflux induced asthma, pulmonary rewards, sedentary lifestyle aspiration, chronic cough/throat clearing, laryngitis Labs/Diagnostics: thyroid studies, lipid profile, liver function, blood Assessment sugar Symptom history: heartburn, regurgitation, dysphagia, laryngitis, chronic cough Expected Outcomes: slow the rate of weight gain, lifestyle changes, Diagnostic studies: barium swallow, esophagoscopy, pH increase physical activity monitoring, medication trials Guidelines: Treatment Children: do NOT put children on a diet, do not force to clean their Antisecretory medications: H2 blockers, proton pump inhibitors plate, educate about calorie nutritious snacks and portion size Metoclopramide: promotility agent ○ Medication: Orlistat for +12 years Surgery (severe cases) Adults: no “off days”. Combine healthy foods, portion sizes, and ○ Infants: don't typically require medications, just hold upright exercise, accountability when feeding ○ Medication: ozempic, metformin, bariatric surgery ○ Adults: reduce water intake during meals, but increase intake between means  Elimination Intestinal Obstruction/Ileus Hirshprung’s Disease Mechanical Obstruction: physical obstruction usually in the small The absence of ganglionic cells in part or all of the intestine (surgical adhesions, cancer, intussusception) large intestine which causes a lack of peristalsis, causing obstruction of the colon and accumulation Non-Mechanical Obstruction: reduced or absent peristalsis, paralytic of gas and feces, causing enlargement of colon ileus (anesthesia) Nursing Assessment: baby who can not pass stool Clinical Manifestations after birth, constipation, bloating, flatulence, Abdominal pain vomiting, failure to thrive, pain, at risk for perforation! Nausea/vomiting Distention Diagnostics: history, physical exam, abdominal x-ray, biopsy of colon Constipation tissue looking for ganglionic cells Diagnostics Management: Pull through surgery, Ostomy surgery History and physical Abdominal x-ray Post-Op Nursing Interventions CT Assessment (is patient passing stool?) Contrast enema Look for complications (diarrhea, constipation, fecal incontinence Colonoscopy in adults, delays in toilet training, enterocolitis is risk for first year CBC (elevated WBC may be indicative of perforation) post-op) ○ Fever, hypotensive, possible sepsis Patient Education Management Monitor for signs of enterocolitis (bleeding from rectum, diarrhea, NPO until obstruction is removed fever, abdominal distention, vomiting) IV fluids High fiber diet NG to suction for decompression Increase fluid intake IV antiemetics & antibiotics Encourage physical activity IV pain medication ○ Create healthy bowel patterns! TPN may be needed for bowel rest Irritable Bowel Syndrome (IBS) Benign Prostatic Hyperplasia (BPH) Functional GI disorder (nothing physically wrong with the body) The enlargement of the prostate gland, commonly observed in older men Signs & Symptoms If left untreated, it can obstruct urine flow and lead to urinary Alternating diarrhea & constipation retention Bloating & flatulence Decreased levels of testosterone and increased levels of estrogen Feeling of abdominal distention BPH develops in the inner part of the prostate (Cancer is mostly Lower abdominal pain on the outside of the prostate!) Urgency to defecate Feeling of incomplete evacuation of bowels Management Risks: aging, obesity, lack of physical activity, alcohol consumption, Regular bowel habits erectile dysfunction, smoking, diabetes, family history Weak evidence for medication Increase fiber intake and use stress management techniques! Clinical Manifestations: gradual onset, increased frequency of urination & nocturnal urination, difficulty starting urine flow, weak Nursing Interventions urine stream Family support and education Irritative (storage) symptoms: nocturia, urinary frequency, Referral to dietitian urgency, dysuria, bladder pain, incontinence Elimination diet and slowly reintroduce foods to identify triggers Obstructive (voiding) symptoms: decrease in the force of stream, difficulty initiating voiding, dribbling at the end of urination Renal Calculi (Kidney Stones) Crystals in urine form when there are too many minerals and not enough liquid, calculi form when the crystals stick together Urolithiasis: the presence of stones within the urinary tract Nephrolithiasis: the presence of stones in the kidney Ureterolithiasis: the presence of stones in the ureters ○ Most common types are made out of calcium Risk Factors: warm climate, high sodium intake, high caffeine intake, genetic factors, lifestyle Warm climate causes more fluid loss (decreased urine amount but increased urine concentration) Manifestations: spasm-like pain in the flank/back/abdomen, nausea, vomiting, hematuria, impaired kidney function related to obstruction Nursing Assessment Subjective: diet, family history, voiding patterns, past health history (recent or chronic UTI, prolonged immobility, BPH, gout, kidney disease), medications (allopurinol) Objective: vital signs, assess pain, measure I&Os, assess for infection Diagnostics: abdominal x-ray of kidney/ureter/bladder, CT scan or ultrasound, urinary analysis, 24 hour urinary measurement for stones Labs: serum calcium, sodium, potassium, BUN, creatinine Care Management Acute attack: treat pain, hydration, treat/prevent infection, A1 blockers (tamsulosin), prevent reoccurance, use urine strainer, collect and analyze stones to determine preventative strategies Procedures: occur when calculi are too large to pass (>7mm), bacteria present, obstruction to urinary function, uncontrolled pain, or underlying renal conditions ○ Flexible ureteroscopes and extracorporeal shock-wave lithotripsy (ESWL) are the two most common Post Procedural Care: vital signs, pain management, bleeding, antibiotics, I&O, strain urine to catch stone Complications: hemorrhage, retained fragments, infection, obstruction Patient Education: report persistent hematuria, signs of infection (pain with urination, CVA tenderness, fever), modify diet and lifestyle, encourage 3 liters of fluids per day, normal or low sodium diet Hormone Regulation Pathophysiology Review of Diabetes Pre-Diabetes Exocrine Function: enzyme secretion to aid in digestion Asymptomatic but long term damage already occurring Endocrine Function: produces hormones to aid in metabolism Patient teaching is essential Alpha Cells: responsible for secreting glucagon ○ Undergo screenings, manage risk factors, monitor symptoms, Beta Cells: responsible for secreting insulin maintain healthy weight, diet, exercise Type I Diabetes Type II Diabetes Pathophysiology: autoimmune disorder, viral or environmental Pathophysiology: four metabolic abnormalities (insulin resistance, trigger, production of antibodies and T cells, destruction of fatigued pancreas, inappropriate glucose production by the liver, pancreatic beta cells, inability to regulate blood glucose altered production of hormones and cytokines) Risk Factors: family history, environmental/viral trigger Risk Factors: obesity, +45 years, family history, history of GDM Clinical Manifestations: polyuria, polyphagia, polydipsia (three Ps), Clinical Manifestations: asymptomatic, may have three Ps, pruritus, ketonuria, unexplained weight loss, fatigue delayed wound healing, frequent UTIs, unexplained weight loss, fatigue Management: glucose monitoring, insulin, regular exercise, healthy diet, carry medical alert ID Management: glucose monitoring, weight loss, regular exercise, healthy diet, oral medication/insulin, carry medical alert ID Diagnostics Complications 1. Hgb A1C of 6.5% or greater Acute: hyperglycemia, diabetic ketoacidosis (DKA), hyperosmolar 2. Fasting glucose of 126 mg/dL or higher hyperglycemic syndrome (HHS), hypoglycemia 3. 2 hour glucose of 200 mg/dL or higher Chronic: skin conditions, depression 4. A random glucose of 200 mg/dL or higher with classic symptoms ○ Microvascular: neuropathy, nephropathy, retinopathy 5. Islet cell autoantibody testing to distinguish between type I and ○ Macrovascular: cardiovascular diseases, strokes type II Insulins: rapid-acting, short-acting, intermediate-acting, long-acting Lifestyle Modifications: weight control, smoking cessations, alcohol use goal, stress management, maintain appropriate BP, exercise (150 Oral Medications: Biguanides (Metformin), Sulfonylureas (Glipizide, minutes moderate exercise/week) Glimepriride), Alpha-Glucosidase Inhibitors, DPP-4 Inhibitors Dietary Principles: well balanced diet, limit salt, include carbs from Sick Day Management fruit/vegetables, limit alcohol intake Take usual medicine/insulin dose, may need more insulin Check blood glucose and urine ketones Hypoglycemia: confusion, irritability, diaphoresis, hunger, tremors, Drunk 8 - 12 oz of calorie free fluids/hour visual disturbances, headache If decreased appetite, drink regular liquids in replacement of Treatment: check blood glucose, ingest 10-15 grams of carbs meals  (juice, soda, milk, candy), repeat blood glucose every 15 minutes If vomiting, sip 4 oz of juice/soda per hour ○ If symptoms worsen, subQ/IM glucagon Patients with hypoglycemia unawareness: elderly, patients taking Foot Care: inspect feet daily for dryness, signs of fungal infections, beta blockers calluses, open areas, protect feet with socks and shoes, annual foot exam, follow policy on footcare Hyperglycemia: polyuria, polydipsia, polyphagia, headache, fatigue, trouble concentrating Recommended Follow Up: quarterly HbA1C, annual eye exam, daily foot inspection, BP monitoring, annual lipid profile/urine protein, Lipodystrophy: hypertrophy of subQ tissue dietitian consult, diabetes educator consult, routine immunizations, Seen with frequent use of same administration sites, educate on smoking cessation counseling rotation of sites Patient Outcomes: maintain healthy weight, normal BP, glycemic control, remain free of other diseases (DKA, HHS, amputation) Diabetic Ketoacidosis (DKA) Hyperosmolar Hyperglycemic Syndrome (HHS) Profound deficiency of insulin Life threatening Medical emergency Produce enough insulin to prevent DKA, usually Type 2, common Usually undiagnosed Type 1 or Type 1 with infection in +60 years with illness/infection Hyperglycemia (300 - 900 mg/dL) Hyperglycemia (+400 mg/dL) Ketonuria Increased serum osmolality Metabolic acidosis Neurological manifestations Polyuria & dehydration Clinical Presentation: somnolence, coma, seizures, hemiparesis, Clinical Presentation: Lethargy, weakness, sunken eyeballs, aphasia, mental depression abdominal pain, vomiting, kussmaul respirations, fruity breath Treatment: IV fluids (No dextrose if blood glucose +250 mg/dL) Treatment: IV fluids (No dextrose if blood glucose +250 mg/dL) Regular insulin IV, monitor potassium, cardiac monitoring Regular insulin IV, monitor blood glucose, potassium, ABG, serum bicarb, ketones in urine/blood Mood and Affect Bipolar Disorder Major Depressive Disorder Bipolar One: current manic episode, or history of 1+ manic episode, Depressed mood or loss of interest/pleasure in usual activities, with possible depressive episodes impaired social/occupational functioning existing for at least 2 weeks, no manic behaviors, not attributed to substances or general medical Bipolar Two: recurrent boots of major depression with episodes of conditions hypomania Patho-deficient neurotransmitters Unknown pathophysiology, may be related to genetics or Lack of pleasure/joy, and motivation to care for self environmental triggers Issues with keeping up with ADLs Expected Findings: labile mood, irritability, restlessness, Three A’s hyperverbal, increased psychomotor activity, flight of ideas, impaired Avolition: significant lack of motivation social/occupational functioning decreased sleep, Anhedonia: lack of pleasure/interest in life and experiences Anergia: lack of energy Before Treatment: basic physiological needs MUST be met before treatment can be successful Depression Screening: MUST rule out medical diagnoses first Medications PHQ9 (most common) Lithium Hamilton ○ Contraindicated: St. John’s Wort Beck Screening ○ Do not need to limit salt or fluid intake ○ At risk for dehydration (diarrhea) Medications ○ Lithium Therapeutic Range: 0.6 to 1.2 SSRIs: be careful about too much of an elevated mood because Lithium toxicity: tremors, polyuria, increased deep tendon patients may choose to take action on their suicidal thoughts reflexes, seizures (threshold is altered) Electroconvulsive Therapy (ECT): in addition to meds and Anticonvulsants: lamotrigine or valproic acid therapy, induces a seizure to rewire the brain so medications can work better Hypomania Mainly seen in bipolar two Symptoms not significant enough to need hospitalization or interrupt social life Catatonia Flat affect, awake coma No response to stimuli, but response to painful stimuli (sternal rub) Rigidity & fixed posturing: stuck in a position Mania Serotonin low, excessive norepinephrine and glutamate Mood stabilizer: carbamazepine Delusion: “Somebody is out to get me” Suicide risk and ideation Borderline Personality Disorder (Pages 663-672) Suicide Borderline Personality Disorder (663-672) Suicidal Ideation Depression and or bipolar disorder are common comorbid Geriatric patients have a high incidence of suicide due to diagnoses watching loved ones die, financials, everything is behind them, Additional symptoms: splitting, clinging, distancing, self regret and remorse on life, etc. destructive behaviors, impulsivity (substance abuse) Borderline between neurosis and psychosis, mental condition not Risk for Suicide caused by organic disease (they do NOT lose touch with reality) Family history of suicide Previous personal attempts Medications Antidepressants, mood stabilizers, antipsychotics (2nd Generation) Psychotherapy Dialectical behavioral therapy (DBT): teaches skills and coping mechanisms, more conversational than CBT Interpersonal Communication and Group Dynamics Therapeutic Community Goal: patient will learn adaptive coping, interaction, and relationship skills Milieu: environment Patients gain positive things from the setting: goals, boundaries, socialization, etc Patient Group Dynamics Can be short term or long term Goal oriented Diverse patient groups Benefits: knowledge on social skills, coping skills, acceptance, reassurance, support, hope, power, exploring new behaviors, ability to share feelings/problems/ideas, safe and structured environment, self esteem, self worth Types of Groups: inpatient, outpatient, psychoeducational, maintenance, activity, cognitive behavioral therapy, self-help, medication, relapse prevention, goal setting, coping skills, substance abuse Decreases hospitalization rates Group Leadership Skills: stating the purpose of the group, staying on task, summarizing the session, being positive, knowing how to manage group therapeutically Leading dominant patients, distracting patients, hostile patients, uninvolved patients Therapeutic Management: giving information, seeking clarification, encouraging exploration, focusing, making observations, giving recognition, accepting Violence Suicide Self Directed Self Harm The act of taking one’s life Deliberate or direct attempt to cause harm not resulting in death This is a behavior, not a diagnosis Cutting, carving, burning, scraping, scratching Warning Signs: verbal statements that “nothing matters/ I won't be a Intention: to punish self, connect with others, escape or avoid problem anymore”, giving away possessions, planning funeral, situations, experience sensation or pain sudden cheerfulness after long period of sadness, increased drug or alcohol use, unexpected anger, rage, increase in impulsivity Risk Factors: depression, previous suicide attempts, recent losses, Warning Signs: headache, stomach ache, nausea, vomiting, shortness frequent thoughts about death, substance use, financial stressors, of breath, heart palpitations, chest pain, weight loss/gain, fatigue, unemployment, divorced, separated, widowed, trauma, chronic trouble sleeping illness, mental health diagnoses Behavior Changes: loss of interest, drop in performance, changes in relationships, social withdrawal, poor concentration, delinquent behavior, hopelessness, increased moodiness, low self-esteem Risk Assessments: use therapeutic communication skills, motivational interviewing, observations, affirmations, reflection, summarize Identify ideas, plans, or attempts for suicide Nursing Interventions for Acute Suicidal Crisis Suicide precautions 1:1 observation when appropriate Ensure environmental safety Remove belongings that could be harmful Assess and monitor medications (SSRIs, Benzodiazepines, Mood stabilizers, 2nd Gen Antipsychotics) Electroconvulsive therapy (creates seizures in the brain) Refer to psychotherapy Teach coping skills Professionalism False Imprisonment Physical & Chemical Restraint False Imprisonment: The unlawful confinement of a patient against Chemical Restraint: a drug or medication when it is used as a the patient’s will restriction to manage the person's behavior or restrict the person’s freedom of movement and is not a standard treatment or dosage for Medical Nonviolent Non-Self Destructive Behaviors: interventions to the person's condition keep patient from pulling at tubes, drains, or lines or to prevent patient from ambulating when it unsafe to do so Physical Restraint: any manual method or mechanical device, Dementia, UTI material, or equipment that immobilizes or reduces the ability of a person to move their arms, legs, body, or head freely Psychiatric Mental Health: violent or self destructive behavior, must be imminent danger! Seclusion: involuntary confinement of a person alone in a room or an area where the person is physically prevented from leaving Only allowed for the management of violent or self destructive behavior