Nursing Exam Notes PDF

• What about if the Client has a question about exercise after Surgery after a procedure? Nurses can educate about Post of Care • How about a Client going for a Partial hysterectomy and want to Know if they Can Still have children with one ovary left. Nurses can't provide Specifics. • How about a Cl...

• What about if the Client has a question about exercise after Surgery after a procedure? Nurses can educate about Post of Care • How about a Client going for a Partial hysterectomy and want to Know if they Can Still have children with one ovary left. Nurses can't provide Specifics. • How about a Client who's anxious about an upcoming Surgery wants to cancel it due to all the risks? Does the nurse educate him? No v Advanced Directives: ➢ Are legal documents that outlines desired medical Care if a client becomes unable to verbalize their wishes. ➢ is a living Will. The signed document that outlines wishes and desired medical care if the Client unable to Communicate. v There are four types: ➢ A full Code is Full resuscitative measures, mean we will do everything to save this Clint life. ➢ A Chemical Code is medications only So no Shocking No CPR, no respiratory help. ➢ ADNI means do not intubate. ➢ DNR means do not resuscitate at all ≪No CPR No resuscitate action≫. 21  Example: • Can a Client with DNR get oxygen Via nasal cannula For a Comfort measure? if it's clearly Stated comfort measures only, Not resuscitative measures. So yes. • Client Came to ER unconscious or has a brain bleed and unable to speak and we can’t find advanced directives. What do you do? Full treating Full life Saving. v Durable Power of Attorney (POA):  Means assigns another Person, called a health Care Proxy or surrogate, to make decisions for the Client if unable to do. ➢ Health Care Proxy, or Surrogate: This Parson will make decisions for the Client, not spouse, not family even the girl friend or Fiancée. ➢ if the sister of the Client is POA and not the wife, then the sister can make the final decision. This Proxy (POA) Can be changed any time. v Refusal of Care and AMA. - The Client has the right to refuse treatment. - Competent adult Can refuse treatment even if the partner does not agree, even Child, Spouse, Mother Mandatory. v AMA: ➢ Leaving against medical advice but, does any Client have the right to leave the hospital for any reason or at one time? ➢ The answer depends on several factors: ➢ Was the Client properly educated as Why they Should Stay in the hospital? Yes 22 ➢ Are they Competent to make their own decision? Yes ➢ Any they mentally stable? If yes So, Cannot Leave because they are on a suicide hold v But in case they are able to make their own decision and Fully conscious and awareness? 1. So, my rule to educate him about the risks of leaving the hospital. 2. Notify the Provider. 3. Remove any IV Catheters and tubes. 4. Sign AMA Consent. 5. Follow principles do not inform the security. vMandatory Reporting. ➢ Assess First, then intervention. ➢ If abuse is Suspected You must Legally report. 1. Protect the Client from that immediate harm. 2. Separately interview the Client. 3. Collect and Prepare evidence. 4. Create a Safety Plan and Provide information like shelters of even houses.  Some examples:  charge nurse delegates beginning CPR: • R.N • Licensed Practical Nurse (LPN). • Certified nurse assistant. • Orderly ≪ Non 11 license hospital assistants ≫ 23 • physical Therapy assistant. v Client ≪ Diabetes type 2 → Metformin ≫Done Cot with Contrast: • Avoid taking Metformin for u 8hr after the procedure o Prevent lactic acidosis. v Case manger's recommendation for disease management what You Know about disease management? • Recommended for Client with lifelong disease Chronic include DM, COPD • Promat Communication, education 24 v Lecture four vAcid, Base imbalances.  What is acid and base imbalances?  Balance between Acid and base of the body kind of like a tug of war the body Loves to keep these in balance. v Measured in blood via PH: Under 7.35 Above 7.45 The body goes Into Acidosis The body goes Into Alkalosis Too Low Two High v The Key Players that keep us in balance: 1. Hco3 → o Bicarbonate Known as bicarb this is our Base that helps to put the body in Alkalosis. Too much Hco3 get body in Alkalosis. 2. Co2 → o Carbon dioxide is our Acid helps to put the body in Acidosis.  Memory Tricks o Too much Co2  get the body in Acidosis. o High Carbon dioxide is high Carbon de acid. 3.H2→Hydrogen ions acidic‫شكل من أشكال الحمضيات‬ o H2 = Hydrogen ions are form of acid. o found in: - The stomach acids and urine. 25  Memory Tricks: - Hydrogen ions is high acid - Too much hydrogen ions equals an Acidotic  So, what makes the body Acidosis? o "H2 " hydrogen ions get High acid. o 𝐂𝐨𝟐 Carbon dioxide Just think Carbon diacid.  What makes the body Alkalosis? - Hco3 Bicarb base  The main organs that Control Acid and base are. - The lungs and the Kidneys.  First the Lungs Control Carbon dioxide 𝐜𝐨𝟐 (Respirators): - we breath in oxygen and breathe out co2 v Hypoventilation: o less breath out co2 means Less co2 out So more co2 retained in the body which makes the body more Acidic that’s mean more Carbon dioxide is more Carbon diacid and occurs for that patient. o Example: o Intoxicated, overdosed, Head injury. v Hyperventilation: o So more co2 out from the body which makes the body more alkalosis. Hyperventilation From an anxiety attack and panic attack. v Second Kidney. (Metabolic). ✓ Hydrogen ions ≪Acid≫ 26 ✓ Bicarbonate Hco3 “Base"  Metabolic alkalosis ✓ Vomiting ✓ NGt Suction  Metabolic acidosis ✓ Diarrhea ✓ Renal failure ✓ DKA ≪ Diabetic keto acidosis≫.  Respiratory Acidosis (Hypoventilation)  Every Condition that's breathing too slow is acidosis for respiratory Acidosis.  Low and slow respiratory rate. ✓ Sleep apnea. ✓ Head trauma. ✓ Post Operative. ✓ Drugs * CNS depressants. NELX TIP o Opioid overdose. o Alcohol in toxication. o Benzodiazepines (Diazepam) o Pneumonia and COPD or Asthma attack  Respiratory alkalosis (Hyperventilation)  Every Condition that's breathing too fast is Alkalosis For respiratory alkalosis. 27 - Fast respiratory rate - Hyperventilation=increase respiratory rate  Example: o Panic attack  Sign and Symptom for Respiratory alkalosis: o Low Paco2. o Low Hco3  Compensation:  Kidney excrete less H2 Base ‫ عشان نحافظ‬reabsorb less Hco3  which client to be in respiratory acidosis? 1. Morphine overdose. 2. CODD. 3. Asthma attack 4. Alcohol. 5. Apnea. v How can I solve the question for PH:  PH: 7.35 TO 7.45  PCO2: 35 TO 45  HCO3: 22 TO 26 v Notes:  Always Look to PH First.  Match PH with Partner.  compensated or uncompensated v how can I know compensated or non?  if PH Normal →Fully Compensated.  PH not normal→uncompensated. 28  partially compensated: ‫اسال نفسك‬ ‫طب‬uncompensated ‫مش طبيعي معني كده انه‬PH ‫ ف حاله ان لقينا ان‬ ‫ عشان نعرف هنشوف الطرف التالت هل هو بيحاول‬partial compensated or not ‫هل هو‬ .‫ زي ما هتشوف ف االمثله‬compensated or not ‫يساعد وال ال يعني يحاول يعمل‬  How does the nurse expect the client to show compensation for the following ABG values? alkalosis ‫ ميكنش ف الطبيعي ويميل الي‬paco2 ‫الزم‬compensation ‫عشان يكون في‬ o PH = 7.20 o Co2=37 o HCO3= 15 - Decreased respiratory rate X - increased respiratory rate ✓ - increased renal retention X - Most Important Objective data when determining if a client is Hypoxia? - Abnormal blood gases “ABG” - Best Diagnostic test to Evaluate patient oxygenation ventilation After a Traumatic brain injury? - Arterial blood gases ABG  Allen’s test: o Done to determine potency the history of the ulnar artery. - client makes a fist the Rt occlude the radial artery. - The palm is opened to reveal a pale palm from the lack blood flow. - Releasing the pressure on the ulcer artery. First the palm should regain its color in about 15 seconds or less. 29  AFTER: o Hold Firm Pressure.  Essential action after ABGs is down: o Apply pressure to puncture Site.  Priority Intervention following ABG Procedure: Examples: - PH= 7.25 Acidosis → uncompensated - Paco2 =55 ACIDOSIS - HCO3=25 Normal  Respiratory Acidosis uncompensated - PH 7,57 ... Alkalosis....uncompensated - Paco2. 25 ...... Alkalosis - Hco3. 22......Normal  Respiratory alkalosis uncompensated - PH 7,21.... Acidosis.... uncompensated - Paco2.... 39....Normal - Hco3.... 19.......Acidosis  Metabolic acidic uncompensated - PH. 7,32.... Acidosis - Pco2...55...... Acidosis - Hco3......42..... Alkalosis  Respiratory acidosis partially compensated. ‫ يعني بيحاول يساعده‬Balance‫ عشان بيحاول يعمل‬Alkalosis ‫ بقى‬Hco3 ‫الن‬ 30