Vargas Survey #2 PDF

Zofran - Treat N/V - but pts. Might have headache - Sublingual route Lisinopril - treat hypertension - complications of hyperkalemia (elevated level of potassium) and angioedema (are of swelling) **Blood** = high alert, 2RNs verify etc. Hemolytic rx to receiving blood: headache, low back pain, de...

Zofran - Treat N/V - but pts. Might have headache - Sublingual route Lisinopril - treat hypertension - complications of hyperkalemia (elevated level of potassium) and angioedema (are of swelling) **Blood** = high alert, 2RNs verify etc. Hemolytic rx to receiving blood: headache, low back pain, decrease BP, increased HR, dark urine (can administer tylenol or benadryl) 4 hours max infusion - bacteria growth Consent form needed Hgb : Male 14-18g/dL Hct : 39%-54%\ Female 12-16gdL Hct : 36%-48% Signs of transfusion reaction : tachycardia, itching/skin rash/urticaria, wheezing/dyspnea/tachypnea, anxiety, flushing/fever, back pain - - - **Platelets** - 150,000-450,000/uL Platelets help clot blood. *Platelet aggregation*-when clumping forms a plug at injury site. *Thrombocytopenia*- \450,000 certain cancers & infections **Sodium (N+)** 135-145 m E q/L- major electrolyte. Essential for acid-base, fluid balance, active & passive transport mechanism, irritability and conduction of nerve muscle tissue. * Hyponatremia* \< 135 m E q/L- think of "salt loss" Stupor/coma, Anorexia, Lethargy, Tachycardia, Limp muscles, Orthostatic hypotension, Seizures/headache, Stomach cramping -Increased sodium excretion= 4 D's (diaphoresis,diarrhea, drains, diuretics) * Hypernatremia*\> 145 m E q/L- big & bloated. Think of "fried salt" Flushed, Restlessness, Increased BP & fluid retention, Edema, Decreased urine output, Skin flushed & dry, Agitation, Low-grade fever, Thirst **Potassium (K+)** Imbalance 3.5-5 m E q/L- plays a vital role in *metabolism*, & *transition* of nerve impulses, the functioning of cardiac, lung, muscle tissues, & acid-base balance. -*Hypokalemia* \< 3.5 m E q/L- not enough contraction=weak. S&S: \"7 L\'s (low)\" Lethargic Low, shallow respirations\...failure Lethal cardiac dysrhythmias/ *ECG changes (ST depression, shallow or inverted T wave, prominent U wave)* Lots of urine (freq. & large volume) Leg cramps Limp muscles Low blood pressure -*Hyperkalemia* \>5 m E q/L-muscles contract for too long=tight & contracted. S&S: \"Murder\" Muscle weakness Urine output little or none (renal failure) Respiratory failure (due to muscle weakness) Decreased cardiac contractility (weak pulse/low HR) Early: muscle twitches/cramps/ *ECG changes (tall peaked T waves, Flat P waves, widened QRS complexes, prolonged PR intervals)* Rhythm changes: Tall peaked T waves, prolonged PR interval -*Potassium imbalance can cause cardiac dysrhythmias that can be life threatening.* Potassium & Sodium= Opposites ( ↑Na+ = ↓K+) **Anticoagulants** **Warfarin/Coumadin** - interferes with vitamin K Long-term therapy = PO DO NOT USE DURING PREGNANCY \*\*\*\ Antidote for warfarin/coumadin = Vitamin K (kale, spinach, green vegetables) 10 letters - COUMADIN-PT - Labs = PT (prothrombin time) 10-20 sec 20-34 therapeutic value (based on the Pt condition) Can't take NSAIDs **Heparin** - inhibits formation of fibrin clots Short term therapy - IVs usually or subq Safe during pregnancy yes! Antidote = protamine sulfate Labs = PTT 10 letters - HEPARIN-a(activator) PTT 30-40 sec Can't take NSAIDs Pyridium/Phenazopyridine - used to relieve urinary urgency, pain, and discomfort after removal of urinary catheterization - complications bright-orange urine\*\*\* Diphenhydramine/Benadryl - Relieve allergic symptoms - Think of Martha - drowsiness/drymouth Acetaminophen/Tylenol - antipyretic/non-opioid analgesic - complications of N/V - Do not exceed 3g daily Meloxicam/Mobic - NSAID - relief of pain from arthritis - complications of GI Bleeding\*\* NSAID - take food with NSAID to decrease stomach upset Antihyperlipidemic drugs - STATINS\*\*\* - monitor for signs of Rhabdomyolysis (rare condition where muscle breaks down and releases into bloodstream AVOID grapefruit juice HLD Nitroglycerin - antianginals to treat angina (chest pain) - HEADACHE Give q5 minutes up to 3 doses Sublingual or buccal Monitor BP, because it decreases BP and dilates vessels 4 G's to be mindful when pts are getting anticoagulants - eat green leafy vegetables Garlic, Ginger. Ginseng, Ginkgo biloba Blood Pressure Too wide = low reading Too small = high reading Neurovascular assessment Dorsalis Pedis pulse Radial pulse Apical pulse - 5th intercostal, midclavicular line left side Popliteal - behind knee Medication administration Absorption Distribution Metabolism Excretion Routes of Medication Administration Oral PO Transdermal Sublingual (SL) 25 gauge Rectal suppository Intravenous (IV) Buccal Inhalation Intramuscular (IM) Subcutaneous **DNR ( DO NOT RESUSCITATE)** Doctors cannot override a valid advance directive like a DNR order made by a mentally competent patient. However, there are some instances where a DNR can potentially be disregarded: In an emergency situation where the patient\'s DNR status is unknown and they require immediate life-saving resuscitation. In an emergency situation where the patient\'s DNR status is unknown and they require immediate life-saving resuscitation. For pregnant patients, as some states require resuscitation to potentially save the fetus. If the DNR order does not comply with the facility\'s policies or the doctor has reason to question its validity. In such cases, doctors may temporarily disregard the DNR and provide resuscitation until the patient\'s wishes can be clarified or a court intervenes. But generally, a properly executed DNR from a competent patient must be honored. **Foot drop** Foot drop is a condition where the foot is permanently fixed in plantar flexion, making it difficult for the patient to dorsiflex the foot and lift the toes off the ground while walking. This increases the risk of stumbling. Patients with nerve injuries, paralysis, or disorders affecting the muscles, nerves, brain, or spinal cord (e.g., compression of the peroneal nerve after hip/knee surgery, stroke, multiple sclerosis) are at risk for developing foot drop. **Continuous Sleep Apnea(CPAP)** CPAP stands for Continuous Positive Airway Pressure. It is a treatment that uses a machine to blow air into the airways at a prescribed pressure to keep them open during sleep. CPAP is primarily used to treat obstructive sleep apnea, a condition where the airways become blocked repeatedly during sleep, causing breathing to stop and start. By providing a constant flow of air, CPAP prevents the airways from collapsing and allows for normal breathing. It can significantly improve sleep quality, reduce daytime sleepiness, and lower risks associated with untreated sleep apnea like heart disease and stroke. Patients diagnosed with sleep apnea are often prescribed CPAP to use nightly while sleeping. **Sequential Compression Device (SCD)** It is an intermittent pneumatic compression device used to promote blood flow in the legs and prevent venous stasis and blood clots, especially in immobile patients. The textbook mentions that increasing numbers of SCD devices allow patients to ambulate while wearing them. This helps prevent the device from being removed or turned off during ambulation, reducing the risk of venous thromboembolism when the patient is up and walking around. **Obstructive Sleep Apnea (OSA)** Is a chronic sleep disorder where the upper airway becomes blocked repeatedly during sleep, causing breathing to stop and start. It occurs when the muscles in the throat relax during sleep, allowing the soft tissues to collapse and obstruct the airway. This results in pauses in breathing (apneas) lasting at least 10 seconds. The lack of airflow leads to oxygen desaturation and arousals from sleep as the body tries to resume breathing. OSA is associated with loud snoring, excessive daytime sleepiness, morning headaches, and increased risk of hypertension, heart disease, and stroke if left untreated. Common treatments include continuous positive airway pressure (CPAP) devices, oral appliances, weight loss, and surgery in some cases. **"OLD CARTS"** Onset: When and how the complaint began Location: Where the pain is, including which body part(s) are affected Duration: How long or how often the complaint occurs Characteristic: What type of pain the patient is experiencing Aggravating factors: What makes the pain worse Relieving factors: What makes the pain better Radiation: If the pain spreads to other parts of the body Treatment: What treatment the patient has tried Significance: The importance of the complaint**\ ** **. Oxygen Delivery Devices** a\. Nasal Cannula: 1- 6 L of O2 b\. Simple Face Mask: 5 to 10 L O2 c\. Non Rebreather Mask: 10 to 15 L O2 **Incentive Spirometry** a\. Decreases the risks of developing atelectasis b\. Have px inhale into the IS like you would with a straw. c\. Have px hold their breath for at least 5 seconds [Pressure Injuries-] remember this "AVOIDS PRESS" **A**ging skin **V**ascular disorders **O**besity **I**mmobility & incontinence **D**iabetes **S**kin friction **P**oor nutrition **R**educed RBC's(anemia) **E**dema **S**ensory deficits **S**edation \*Skin hygiene \* Repositioning every 2 hrs [Antihyperlipidemic Drugs] Nursing considerations: - - - Rhabdomyolysis - - - -creatine kinase levels (elevated) -dark urine color (tea or coccoa like urine **[When Pt is in anticoagulants don't eat]** - These foods can reduce the effectiveness of anticoagulants. Examples include leafy green vegetables like spinach, kale, broccoli, and Brussels sprouts, as well as chickpeas, liver, egg yolks, and avocado