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lOMoARcPSD|23524095 Milestone Exam 2 Milestone 2 (Herzing University) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Tierra Earl ([email protected]) ...

lOMoARcPSD|23524095 Milestone Exam 2 Milestone 2 (Herzing University) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Tierra Earl ([email protected])  lOMoARcPSD|23524095 Mental Health Schizophrenia: chronic disorder that affects a person’s ability to think, feel, and behave clearly. Caused by a combination of genetic, environmental, and chemical factors. Positive Symptoms include hallucinations, delusions, and disorganized speech/thoughts. Negative symptoms include anhedonia, avolition, and blunted effect. Cognitive symptoms include memory issues, impaired sensory perception, and inability to process social cues. The nurse should reorient the client to reality, ensure medication adherence, and educate about early signs and symptoms of relapse. Promote safety, assess if patient can function within society. Antipsychotics: Typical (Haloperidol, Chlorpromazine) have movement related S/E such as tremors and dystonia, anticholinergic symptoms, and photosensitivity; long-term use may cause Tardive Dyskinesia. Atypical (Risperidone, Quetiapine, Aripiprazole) increases risk of DM and high cholesterol. Atypical antipsychotics may also cause kidney or bladder problems. Use Bleuler’s four As to remember the characteristics of schizophrenia. Autism; loss of connection to reality, odd thoughts. Affects; flat or blunted, lack of emotional expression. Associations; loose, rapidly changing. Ambivalence; simultaneously having two opposing attitudes toward a topic/situation. Establish trust, provide safe environment, and use clear concise terms when talking to the patient. Avoid arguing and agreeing with inaccurate communications, set limits on inappropriate behaviors, and praise acceptable social behaviors. Avoid fostering a dependent relationship, encourage the patient to identify positive self attributes. Approach the patient in a nonthreatening manner and avoid making demands or being authoritative. Promote the safety of the patient, nurse, and others in the environment. If a patient demonstrates escalating behavior the nurse should:  Administer medications.  Move the patient to a quiet environment.  Temporarily use seclusion or restraints in severe cases. Grief: a natural response to a loss. Mourning is the outwardly expression of grief (crying, memorials, funeral services). There are five stages of grief, remember DABDA: Denial- avoidance, confusion, elation, shock, fear. Anger- frustration, irritation, anxiety. Downloaded by Tierra Earl ([email protected])  lOMoARcPSD|23524095 Bargaining- struggles to find meaning, reaching out to others. Depression- overwhelmed, helplessness, hostility, flight. Acceptance- exploring options, new plan in place, moving on. Offer a supportive presence to the patient, practice active listening, refer patient to grief counseling or support groups. Encourage patient to express their feelings and to socialize with family and peers. Encourage activities that promote the use of coping strategies. Responses to grief include:  Anger, sadness, anxiety  Feeling numb  Questioning and trying to make sense of the loss.  Guilt, resentment, sorrow, loneliness, depression, apathy, despair  Loss of appetite. Alzheimer’s Disease: a progressive disease that destroys memory and other important cognitive functions serious enough to interfere with daily life. Aphasia (inability to express speech), Apraxia (inability to perform certain gestures/movements), Agnosia (inability to interpret information from 5 senses). Hallucinations develop in the middle to late stages of the disease. Have the patient close to the nurses’ station, reorient patient to themselves and surroundings, and promote safety. Provide a safe and consistent environment, maintain nutrition and hygiene, assist with ADLs, provide routine daily activities, and provide support to patient and family. Patient is tasked with re-defining themselves in relation to change in role (Erikson). Donepezil (Aricept): treats dementia related to Alzheimer’s disease. Enzyme blocker that restores balance of neurotransmitters (ACh) in the brain. S/E: N/V, diarrhea, weight loss, dizziness/drowsiness, tremors. Cautious use in patients with pulmonary diseases, GI diseases, and urinary diseases. QT Prolongation. Delirium: the abrupt onset of reduced orientation to the environment in contrast to dementia that has a slow onset. Delirium may be caused by infection, certain medications, intoxication, or drug withdrawal. Address the underlying cause, promote safety, and monitor patient vital signs. Keep the patient oriented to surroundings as often as possible, reduce environmental stimuli, explain all procedures, and respond quickly to calls for assistance. Downloaded by Tierra Earl ([email protected])  lOMoARcPSD|23524095 Alcohol Withdrawal: occurs when a patient stops drinking or significantly decreases their alcohol intake after long-term dependence. Develops as early as 4 to 6 hours after stopping drinking and peaks at 48 to 72 hours; symptoms decrease within 4 to 5 days. S/S: elevated vital signs (sudden or gradual), delirium tremens (12-36 hrs), tachypnea, diaphoresis, insomnia, transient visual, auditory, and tactile hallucinations/illusions. CIWA Score is used to determine if interventions are necessary. A score between 8 and 10 indicates minimal to mild withdrawal and does not require pharmacological treatment. A score between 10 and 15 indicated moderate withdrawal and a score above 15 indicated severe withdrawal. Promote safety, ensure medical supervision is continuous. Limit caffeine intake, reduce environmental stimuli, prevent aspiration, implement seizure precautions, provide vitamin supplementation (B), Provide emotional support (suicide watch). Administer Benzodiazepines: Lorazepam (Ativan), Diazepam (Valium), Chlordiazepoxide (Librium): slow down the activity in the brain and nervous system. S/S: sedation, weakness, dizziness, blurred vision, aggression. Risk for physical dependence, avoid hazardous activities if sedation occurs, and monitor vital signs for Respiratory Depression. Methadone: used to treat opioid addiction/withdrawal. Used as a replacement for opioids, dose is titrating over 2 weeks. Reduces symptoms to mild case of the flu. S/S of OD include: Decreased LOC, respiratory depression, and constricted pupils. Administer Naloxone for opioid overdose only. Intimate Partner Violence/Domestic Violence: criminal act of physical, emotional, economic, or sexual abuse between an assailant and a victim who most commonly are or were in an intimate relationship (married or dating). Assess patient for low self-esteem, depression/suicidal ideations, abrasions, cuts, bruises in different stages of healing, anxiety, delay in seeking treatment, use of alcohol or drugs, and looks to abuser when answering questions. The nurse should aim to establish trust in a nonjudgmental manner. Treat physical injuries and interview patient while abuser is not present, document objective data, and determine the potential for reoccurring violence. Aggression Response: hostile or violent behavior or attitudes toward another; readiness to attack or confront. Downloaded by Tierra Earl ([email protected])  lOMoARcPSD|23524095 Assess verbal and non-verbal cues for escalating behavior. Have the patient talk about what is triggering them and use seclusion or have others leave the room/area. Avoid asking ‘why’, teach patient how to redirect anger in safe alternative ways and implement behavior modification therapy. 4 to 6 trained staff members are needed to restrain an aggressive patient safely. Patient is informed of what is happening and order from provider is received for restraints. PRN or IM medication may be given. Nurse should observe and document patient actions while in restraints. Adverse Effects of Medications: Extrapyramidal Effects (tremors, muscle stiffness, parkinsonism, tardive dyskinesia), Photosensitivity (sensitivity to sunlight), Neuroleptic Malignant Syndrome (high fever, diaphoresis, unstable BP, muscle rigidity), Serotonin Syndrome (agitation, confusion, shivering), Anticholinergic Effects (dry mouth, urinary retention, blurred vision). EPS: administer anticholinergics (IM during emergency), Benadryl, Ativan. Inderal is used to treat akathisia and Vitamin E is used to treat tardive dyskinesia. Rule out anxiety and teach patient and family when to report symptoms. Photosensitivity: teach patient to stay out of direct sunlight, wear protective clothing and sunglasses. NMS: early recognition is important. Patient should be transported to hospital for nutritional support, renal failure, and respiratory failure. Anticholinergic Effects: encourage sips of water, chew sugar free gum/candy, increase fiber intake, change positions slowly, report urinary retention, and tolerance to side effects usually occur. Maslow’s Hierarchy of Needs: theory that states that five categories of human needs dictate an individual’s behavior. Physiological: air, water, food, shelter Safety: personal security, employment, resources, health, property Love & Belonging: friendship, intimacy, family, sense of connection. Esteem: respect, self-esteem, status, recognition, strength, freedom Self-Actualization: desire to become the most that one can be Downloaded by Tierra Earl ([email protected])  lOMoARcPSD|23524095 Elder Abuse: the mistreatment of older adults may be done by family members, strangers, healthcare providers, caregivers or friends. The nurse should assess for physical manifestations of abuse, the safety of the patient, and the legal responsibilities as a nurse. Psychosocial abuse occurs when the assailant keeps the victim isolated; the elder may abruptly stop doing things that were once fun to them. Material abuse involves the control of money or resources the older adult may need. Self-neglect may be attributed to hoarding. Physical abuse and neglect are also forms of elder abuse. Attention Deficit Hyperactivity Disorder (ADHD): neurodevelopmental disorder of childhood that causes attention difficulty, hyperactivity, and impulsiveness. Causes and risk factors are unknown; suggests genetic factors. Dextroamphetamine (Adderall): Assess the child for failure to listen and follow instructions, difficulty playing quietly and sitting still, disruptive, impulsive behavior, excessive talking, underachievement in school performance, and easily distracted. Monitor growth and development due to loss of appetite. The provider may prescribe a ‘drug holiday’ that encourages the discontinuation of stimulants when the child is not in school. This may aid in decreasing weight loss and growth suppression. Obsessive Compulsive Disorder (OCD): recurrent, persistent, intrusive, and unwanted thoughts, images, or impulses that cause marked anxiety and interfere with interpersonal, social, or occupational functioning. Patients may exhibit repression, isolation, or undoing, have difficult interpersonal relationships, and safety concerns. The nurse should actively listen to the patient, avoid being judgmental, and assist the patient in learning new ways of dealing with stress or anxiety. Administer prescribed antianxiety medications (Lorazepam), tricyclic antidepressants (Clomipramine), or SSRIs (Paxil, Prozac). Cognitive behavioral therapy (CBT). Lorazepam: enhances the inhibitory effects of GABA (promotes calming effects). Side effects include dizziness, sedation, headache, fatigue, sexual dysfunction, and anti-cholinergic effects (dry mouth, constipation etc.) Avoid other CNS depressants (alcohol, antihistamines). Avoid caffeine and hazardous activities when sedation occurs. Monitor for orthostatic hypotension and take only as prescribed. Encourage the use of sugar-free gum and increase fluids for dry mouth. Downloaded by Tierra Earl ([email protected])  lOMoARcPSD|23524095 Fluoxetine: inhibits the reuptake of serotonin making the neurotransmitter more readily available. Side effects include nausea, vomiting, diarrhea, sexual dysfunction, anxiety, nervousness, and insomnia. Assess for history of suicide and suicidal ideations. Remind patients that effects of medication take 2-3 weeks to develop and 6-8 weeks to maximize. Monitor for serotonin syndrome (rigidity, hyperreflexia, hypotension, tachycardia, fever, sweating, agitation). Avoid taking MAOIs while taking SSRIs. Missed doses may be taken with 8 hours. Suicide Precautions: suicide is the leading cause of death in the U.S. Suicide precautions are implemented for a wide variety of patients including victims of abuse, patients with schizophrenia, and patients who are grieving. The nurse should obtain a health history. The most significant risk factor is a previous suicide attempt. Other risk factors include those with/predisposed to depression, substance abuse, organic brain disorders, and other medical conditions. Patients who have family members that have committed suicide are at a higher risk. Be aware of the major warning signs of an approaching suicide attempt. The patient may begin giving away personal items. Extreme happiness in a previously depressed person may also be planning a suicide attempt. Evaluate the intent of the patient. Ask the patient if they intended to harm themselves. Identify chosen method and determine if the method is readily available to the patient. Anorexia: an eating disorder that is characterized by an abnormally low body weight, intense fear of gaining weight, and a distorted perception of weight. Patients with anorexia place a high value on controlling their weight and shape, using extreme efforts such as diet aids, laxatives, enemas, diuretics, and extreme exercise. Self-induced vomiting may also occur. Patients with anorexia will have a skeletal appearance, distorted body image, low self- esteem, hair loss, dry skin, irregular heartbeat, decreased pulse and BP, and delayed sexual development. Pt will have lanugo, acrocyanosis, and dry, cracking skin. Electrolyte imbalances, erosion of dental enamel (perimyolysis/dental caries), osteoporosis, hypometabolism, amenorrhea, and anemia. Monitor weight, vital signs, and electrolyte levels (K+, Thyroid hormones, Calcium, Phosphorus). Provide a structured and supportive environment during mealtimes.ee Monitor food and fluid intake; monitor for 1 hour after meals to avoid vomiting. Downloaded by Tierra Earl ([email protected])  lOMoARcPSD|23524095 Administer prescribed antidepressants, encourage family therapy, and monitor activity level of patient assessing for weakness or fatigue. Downloaded by Tierra Earl ([email protected])  lOMoARcPSD|23524095 Family Nursing Sickle Cell Disease: sickle shaped red blood cells block blood flow to organs and deprive them of blood and oxygen. Blood is chronically low in oxygen and may be fatal. It is a recessive disease; if one parent has the disease all children will be carriers. Vaso-occlusive crisis occurs when the circulation of sickled RBC agglutinate (clump together) in blood vessels causing an obstruction. This results in ischemic injury to tissues and organs and severe pain. Crisis may be caused by blood loss, trauma, illness, exposure to high altitudes, dehydration, fever, or stress. S/S: fever, severe abdominal pain, hand-foot syndrome in infants, painful edematous feet, and arthralgia. Treat with pain management (Morphine, Toradol) and IV fluids typically D5W in ½ Normal Saline or D5W in Normal Saline. Administer oxygen and antibiotics to prevent infection. Promote bedrest and elevate the affected extremities. Administer Folic Acid to help promote RBC production and Hydroxyurea to help decrease sickled shape of RBCs by promoting Hgb F. Encourage adequate fluid intake, infection prevention, and stress reduction. Duchenne Muscular Dystrophy: congenital disease that is characterized by progressive muscle degeneration and weakness due to alterations of Dystrophin, a protein that keeps muscle cells intact. It is an X-linked recessive disease that mostly affects males (mother is carrier, sons may develop disease). Symptoms develop in early childhood ages 3-5. By ages 9-11 the child loses the ability to walk independently. Life expectancy is usually in the 3rd decade. S/S: enlarged thigh/calf muscles, waddling gait, frequent falls, walking on toes and ball of feet, muscle weakness at trunk then limbs. Pt will have positive Gower’s sign. Provide supportive care, provide active and passive exercise, and prevent exposure to respiratory infections. Encourage a balanced diet, support patient and family in grieving process, and their participation in the Muscular Dystrophy Association. Coordinate care with PT, OT, nutrition, neuro, ortho, and genetics. Corticosteroids may be used to slow the progression of the disease. Calcium and Vitamin D supplements are prescribed to decrease osteoporosis associated with long term steroid use. ACE inhibitors and Beta Blockers may be prescribed to decrease cardiac workload. Downloaded by Tierra Earl ([email protected])  lOMoARcPSD|23524095 Encourage minimal weight bearing in a standing position to improve circulation. Perform passive strengthening exercising as per PT. Provide assistive devices such as braces or wheelchairs. Educate the patient on positioning and use of adaptive equipment. X-Linked recessive diseases usually affect male offspring, as in Duchenne MD. With each pregnancy of a woman who is a carrier, there is a 25% chance of having a child with Duchenne MS. If the child is male, he has a 50% chance of having Duchenne MD. If the child is female, she has a 50% chance of being a carrier. Congenital Heart Defects: most common type of birth defect. These birth defects are present at birth and result from abnormalities in the structure of the heart. These structural defects affect how the heart functions. Manifestations include murmurs, cyanosis, digit clubbing (age 2+), poor feeding, poor weight gain, frequent regurgitation, frequent respiratory infections, activity intolerance, and fatigue. First sign of a congenital heart disease is feeding difficulty. The nurse should assess the heart rate and rhythm, respiratory status, pulses, blood pressure and blood pressure. Tetralogy of Fallot is the result of ventricular septal defect, overriding aorta, pulmonary stenosis, and right ventricular hypertrophy. S/S include tachypnea during feeding, decreased O2 saturation, heart murmur, and cyanosis. Tet spells may occur which are hypoxic events that may be relieved by squatting or a knee-chest position. Tet spells may cause cyanosis of the lips, nails, and skin and may occur during feeding or when agitated. Complications associated with Tetralogy are blood clots (stroke), endocarditis, arrythmias, heart failure, and death. Respiratory Syncytial Virus (RSV): a common respiratory virus that is spread through contact. Assess for history of upper respiratory infection, irritability and distress, paroxysmal coughing, poor eating, nasal congestion, nasal flaring, prolonged expirations, wheezing/rales, and deteriorating conditions (respiratory distress). Rhinorrhea is one of the first symptoms of RSV. Implement contact precautions and promote isolation of infected child. Avoid assigning pt to nurse with small children. Monitor respiratory status and identify early signs of hypoxia. Use bulb syringe to clear airway secretions. Use mist tent to provide care and administer oxygen as prescribed. Maintain adequate hydration and evaluate the child’s response to respiratory therapy treatments. Downloaded by Tierra Earl ([email protected])  lOMoARcPSD|23524095 Palivizumab: provides passive immunity against high-risk children (180/110 and no organ damage. Hypertensive Emergency occurs within hours to days and is manifested by a BP >220/140 with organ damage including MI, intracranial hemorrhage, renal failure, and left ventricular failure. Both may be caused by the abrupt discontinuation of antihypertensives or the poor management of the disease. During hypertensive crisis administer antihypertensives via IV Sodium Nitroprusside and monitor the patient’s BP. Identify and manage any complications. Goal is to decrease BP by 25% in first hour and to 160/100 within 2-6 hours. Promote smoking cessation, reducing alcohol intake, and avoiding sedentary lifestyle. Promote exercise and weight control. Encourage low sodium, low-fat diet and increased intake of fruits and vegetables (DASH diet). Encourage increased potassium intake and decreased alcohol intake. Hypothyroidism: low levels of T4 with elevated levels of TSH. Treatment is to increase metabolic rate with synthetic T4 Levothyroxine (Synthroid). Primary is caused by thyroid gland disorder, Secondary is caused by pituitary or hypothalamus gland disorder. May be caused by iodine deficiency, drugs such as Amiodarone (anti-arrhythmic) and Lithium (mood stabilizer); damage to the thyroid gland, or from treatment of hypothyroidism (thyroidectomy, radioactive iodine therapy). Risk factors include pregnancy, postpartum, surgery/radiation to the head or neck, type 1 DM, adrenal insufficiency, celiac disease, pernicious anemia, and multiple sclerosis. S/S: lethargy, fatigue, weakness, muscle aches, paresthesia, intolerance to cold, brittle nails, dry skin, tingling and numbness in fingers. Hypo- natremia, glycemia, ventilation, tension, thermia, and bradycardia. Downloaded by Tierra Earl ([email protected])  lOMoARcPSD|23524095 Levothyroxine should be administered in the morning before meals. Monitor serum hormone levels throughout pharmacologic treatment. Complete daily weight, monitor BP and pulse regularly. Avoid iodine and use caution in patients with cardiovascular disease. Levothyroxine Toxicity: tachycardia, chest pain, restlessness, nervousness, and insomnia. Common side effects include increased appetite, weight loss, heat sensitivity and excessive sweating. Myxedema Coma is a medical emergency caused by prolonged untreated hypothyroidism. S/S include hypothermia, respiratory depression, hypoglycemia, and coma. Avoid sedating these patients and do not hold Synthroid prior to surgery. Diverticulosis and Diverticulitis: bulging or inflammation of the pouches in the GI wall (diverticula). Diverticulosis causes mucosa lining to push through surrounding muscles. Diverticulitis may cause obstruction, infection, or hemorrhage. S/S: LLQ pain (sigmoid colon), increased flatulence, rectal bleeding, N/V, crampy pain, palpable tender rectal masses, constipation, low-grace fever, and abdominal distention. S/S of bowel obstruction include constipation alternating with diarrhea, abdominal distension, anorexia, and low-grade fever. Barium enema used during non-acute phase and Colonoscopy may be used to diagnose diverticular disease. Abdominal radiograph is used to diagnose obstruction, ileus, or perforation of bowels. Provide well-balanced, high fiber (non-acute phase) foods. During acute phase maintain NPO and follow up with fluids, then low-residual bland foods. Encourage 3L fluid intake per day. Monitor I&O, bowel elimination, and observe for complications (peritonitis, hemorrhage). In the recovery phase avoid fiber and foods that irritate the bowels. During maintenance phase encourage high fiber foods with bulk forming laxatives to avoid food pooling in diverticula. Gout: form of arthritis that occurs when urate crystals accumulate in a joint, usually the big toe. Gout causes inflammation and intense pain. Foods such as red meat, organ meat, beer, fructose, and shellfish should be avoided for their high purine content. Primary gout is caused by an inherited inability to excrete adequate uric acid. It is most common in middle-older ages men and post-menopausal women. Secondary gout is caused by excessive uric acid in the blood from renal insufficiency, or diuretic therapy. Downloaded by Tierra Earl ([email protected])  lOMoARcPSD|23524095 Patient may have swollen inflamed joints (big toe) with the joint being too painful to move. Medications such as Aspirin and Diuretics may precipitate gouty attacks. Diagnosed using ESR, serum uric acid levels, and synovial joint aspiration. Administer Allopurinol which inhibits the conversion of purines to uric acid and is absorbed in the GI tract and processed in the kidneys. Use caution in patients with CKD, onset is 24-48 hours. Should be taken daily with meals. Risk for liver dysfunction and bone marrow suppression. S/E: diarrhea, vertigo, N/V, abdominal pain, indigestion, headache, and drowsiness. Dose should be administered after meals to ensure absorption. May cause rash if used with antibiotics. Avoid alcohol and anticoagulant use. Diabetes Mellitus: impaired ability to respond to insulin resulting in abnormal metabolism or carbohydrates and elevated blood and urine glucose levels. A blood glucose 125 (fasting) or 180 is considered hyperglycemic. 1 unit of regular insulin lowers blood sugar by about 30mg/dL. S/S: polyuria, polydipsia, polyphagia, irritability, fatigue, changes in weight, abdominal complaints such as N/V. Integumentary changes: poor wound healing, skin infections, acanthosis (hyperpigmentation). Oral: candidiasis, and periodontal disease. Eyes: cataracts and retinopathy may cause permanent vision changes or blindness. Peripheral: poor perfusion and hair loss on extremities. Kidney changes: edema of the face, hands and feet, UTI symptoms, nephropathy. Cardiopulmonary: angina, dyspnea, HTN, cardiomyopathy, CAD. Neuro: neuropathy. GI: malabsorption (gastroparesis) and nighttime diarrhea. Reproductive: impotence in males, dryness, frequent infections, and menstrual irregularities in women. Non-compliance to treatment plan may lead to target organ damage, coma, amputation, and death. Monitor BG before, during, and after exercising. Monitor K+ levels during DKA ( BG means K+) Heart Failure: occurs when the heart cannot pump enough oxygen rich blood to meet the body’s needs. Blood flow is decreased, and organs may not work well as a result. BNP is used to diagnose HF, BNP is normally 2. Monitor I&O, weight, EKG, and electrolyte levels. GI and CNS symptoms indicate adverse effects. ACE Inhibitors and Loop diuretics are also prescribed for HF. ACE inhibitors decrease arteriolar and venous resistance (vasodilation) causing decreased cardiac workload. Loop diuretics are used to reduce edema in patients with HF. Encourage a low sodium diet 65, smoking, prolonged bedrest, malnutrition, living in long-term care settings, abdominal or thoracic surgery, and exposure to pollutants and animals. Assess sputum for volume, color, consistency, clarity, and distinct odors. Provide increased fluids to aid in breaking down respiratory secretions. Assess lung sounds before and after coughing. Encourage productive coughing by:  Deep breathing every 2 hours (may use incentive spirometer)  Using humidity to loosen secretions  Suctioning airways if necessary  Chest physiotherapy Downloaded by Tierra Earl ([email protected])  lOMoARcPSD|23524095 Administer Antibiotics (Penicillin, Macrolides), Bronchodilators (Albuterol, Metaproterenol), and Mucolytics (Acetylcysteine). Promote pneumonia prevention through vaccinations, hand-hygiene, and avoiding large crowds during flu season. COPD: preventable and treatable slowly progressive respiratory disease involving the airways, pulmonary parenchyma, or both. Two types include Emphysema (pink puffers) and Chronic Bronchitis (blue bloaters). Emphysema is characterized by impaired oxygen and carbon dioxide exchange caused by overdistended alveolar. Primary cause is chronic smoking. Chronic Bronchitis is the presence of productive cough for at least 3 months over 2 consecutive years; caused by respiratory irritants. S/S: fatigue, weight loss, productive cough (bronchitis), barrel chest (emphysema), cyanosis (bronchitis), tripod positioning, dyspnea, tachypnea, crackles, wheezing, rhonchi, abdominal retractions. Patients with COPD function with low levels of oxygen (retain lots of carbon dioxide, respiratory acidosis). Administer oxygen at 1-2 L per nasal cannula, do not exceed 3L. Teach the patient pursed lip breathing to promote excretion of CO2. Encourage diaphragmatic breathing. Pace activities to conserve energy and maintain adequate nutrition through small frequent meals, dietary supplements, and increases calorie and protein amounts. Encourage smoking cessation and increased fluid intake 3L per day (between meals). Albuterol: bronchodilator that works to open up airways. Ipratropium: anti-cholinergic and bronchodilator. Prednisone, Hydrocortisone: decreases inflammation. Acute Respiratory Distress Syndrome (ARDS): the exchange of oxygen for carbon dioxide in the lungs is inadequate for oxygen consumption and carbon dioxide production within the body’s cells. Caused by a diffused lung injury or critical illness and leads to extravascular lung fluid in the alveolar capillaries. S/S: hypoxemia non-responsive to oxygen, decreased pulmonary compliance, dyspnea, non-cardiogenic bilateral pulmonary edema, dense pulmonary infiltrates on radiography. Pt will have respiratory acidosis due to the inability to excrete carbon dioxide. Downloaded by Tierra Earl ([email protected])  lOMoARcPSD|23524095 Pt will not have abnormal lung sounds upon auscultation because edema occurs in interstitial spaces first. Dyspnea, hypercapnia, crackles/rales, and wheezing or decreased breath sounds may be heard. Intercostal retractions, cyanosis, pallor, mottled skin, and hypoxemia will be present. The patient will have diminished breath sounds that continue to decrease. Pt may complain of anxiety, restlessness, confusion, and agitation. The nurse should position the patient for maximal lung expansion. Prepare the patient for mechanical ventilation and intubation using PEEP. For patients on mechanical ventilation, it is important to assist with daily awakening, comprehensive oral hygiene program, and comprehensive mobility program. Intravenous (IV) Fluids: liquids that are passed through veins in order to prevent dehydration and electrolyte imbalances. IV solutions may be isotonic, hypotonic, or hypertonic. Isotonic solutions include normal saline (0.9% NS), LR (Lactated Ringers), and 5% Dextrose in water (D5W). Solute concentration and water concentration are the same as concentration found within the body. Hypotonic solutions include ½ NS, ¼ NS, and 1/3 NS. Solution has a lower solute concentration than the cells. This causes water to move from intravascular spaces into the cell causing the cell to swell. Hypertonic solutions include 3%, 7%, and 10% NS. Solution has a higher solute concentration than within the cells. Water moves out of the cell and into interstitial spaces. Hypertonic IV solutions are used to treat intravascular dehydrations such as  Surgery  Blood loss  Ascites  Third-Space Fluid Shifting (burn victims) Rheumatoid Arthritis (RA): systemic autoimmune disorder where the body attacks joints causing major inflammation and deformities mostly in the hands. Diagnosed with synovial fluid aspiration and arthroscopy. Blood tests for rheumatoid factor, ESR and C-Reactive protein. S/S: morning joint stiffness more than 30 mins, bilateral joint swelling, low grade fever. Pt will also have Rh factor and Anti-citrullinated peptide antibody (APCA). Downloaded by Tierra Earl ([email protected])  lOMoARcPSD|23524095 Administer prescribed medications: NSAIDs, Methotrexate, Prednisone. Encourage warm, moist heat compress to alleviate pain, whirlpool baths, and a hot shower in the morning. Use diversionary activities such as imaging, distraction, self-hypnosis, and biofeedback. Pts experience pain at rest that is relieved by activity. Methotrexate: blocks the formation of folate within the body. Disease modifying anti-rheumatic drug that slows disease progression. May cause hepatotoxicity and immunosuppression (leukopenia), most commonly causes GI upset. Avoid use during pregnancy. Prednisone: Corticosteroid that decreases inflammation by suppressing the immune system. May cause increased appetite, weight gain, mood changes, insomnia, susceptibility to fungal infections (thrush). Peptic Ulcer Disease (PUD): ulceration in the mucosal wall of the pylorus, stomach duodenum, or esophagus (upper GI tract). Ulcer may be referred to as gastric, duodenal, or esophageal. PUD is the leading cause of bowel obstructions. Primarily caused by H. Pylori or extensive NSAID use. Gastric ulcers are exhibited by pain with eating, hematemesis, and anorexia. Duodenal ulcers produce no pain with eating, bloody stools, wake up with pain, bloating, waking up with burning pain. During surgery and post-op period stomach contents are drained via NG tube. Monitor fluid and electrolyte balance and assess for infection or peritonitis. Administer antibiotics if caused by H. Pylori. Administer bismuth to provide gastric coating. Monitor patient for complications such as peritonitis (referred shoulder pain), bowel obstruction, and hemorrhage. Omeprazole (Prilosec), Pantoprazole (Protonix): proton pump inhibitors, decrease stomach acid and help protect the stomach lining. The use of PPIs may cause GI upset (constipation, N/V, diarrhea) and headache. Avoid taking with food. Famotidine (Pepcid), Ranitidine (Zantac): block histamine receptors caused decreased gastric secretions. Use of H2 receptor blockers may cause GI upset and headache. Avoid giving H2 blockers with antacids. Downloaded by Tierra Earl ([email protected])  lOMoARcPSD|23524095 Sucralfate (Carafate): lines the stomach and adheres to the ulcer site, protecting it from acids and enzymes. May cause GI upset and headache. Carafate should be taken on an empty stomach. Avoid administering with H2 blockers. Magnesium Hydroxide, Calcium Carbonate, Aluminum Hydroxide: antacids that neutralize stomach acid. Use of antacids may interfere with the absorption of PO medications. Benign Prostatic Hyperplasia (BPH): enlargement or hypertrophy of the prostate. Usually occurs in men over 40 years old. Interventions are implemented when symptoms of obstruction occur. Assess for increased urinary frequency, nocturia, urinary hesitancy, terminal dribbling, decrease in size and force of stream, acute urinary retention, bladder distention, and recurrent UTIs. Implement active surveillance or watchful waiting of symptoms. Pts may be prescribed Finasteride decreases size of prostate or Tamsulosin, relaxes muscles of prostate. Most common surgery is Transurethral Resection of the Prostate (TURP) where the prostate is removed via endoscopy, this allows for a shorter hospital stay. Pt may still feel urge to void after surgery. Encourage 2 L of fluid per day, avoid alcohol and caffeine. Tamsulosin (Flomax): blocks smooth muscle receptors of the bladder and urethra to improve urine flow. Use of Flomax can cause orthostatic hypotension and should not be combined with BP lowering drugs. Finasteride (Proscar): blocks the action of the enzyme 5-alpha-reductase which decreased the production of testosterone and slows prostate growth. The use of Proscar may cause chills, cold sweats, and bloating. Irritable Bowel Disease (IBD): two forms, Ulcerative Colitis and Crohn’s Disease. Ulcerative Colitis is characterized by inflammation and ulcers of the superficial lining of the large intestines. Inflammation and ulceration began at the rectum and ascend to other parts of the bowel (Ulcers move Up). S/S include anorexia, weight loss, abdominal tenderness and cramping, severe bloody/mucus diarrhea (15-20x/day), fatigue, anemia, intermittent tenesmus, rebound tenderness. Maintain NPO during acute phase, administer fluids and electrolytes. Monitor bowel sounds, avoid gas forming foods, milk, whole grains, nuts, raw veggies, Downloaded by Tierra Earl ([email protected])  lOMoARcPSD|23524095 caffeine and alcohol. Following acute phase initiate clear liquid diet and low fiber foods. Chron’s Disease is characterized by skin lesions throughout the GI tract. Administer Immunosuppressants, Corticosteroids, Salicylates, and Anti-diarrheals. Asthma: bronchial spasms causing difficulty breathing. May be caused by allergies. Triggers of asthma include:  Infections (encourage flu vaccine)  Pollen, mold, dander, dust  Cockroaches  Air pollutants such as smog or smoke  Exercise  Changes in weather  GERD  Strong emotions (anger, sadness, stress) Administer Bronchodilators and Montelukast. Arterial Insufficiency: any condition that stops the flow of blood through arteries. May be caused by Diabetes Mellitus (poor tissue perfusion). Skin: smooth, shiny, hairless, dry, thin skin, and thickened nails. Color: pallor on elevation and rubor when dependent. Cool temperature with decreased or absent pulses. Pt will experience sharp pain that increases with activity or elevation. Intermittent claudication that is relieved by rest. Ulcers may develop on lower legs, toes, or heels. Ulcers will have demarcated edges, circular shape, necrosis, and non-edematous. Ulcers are small but deep and are usually very painful. Encourage patient to dangle legs. Monitor extremities (temp, color, sensation). Encourage smoking cessation. Avoid crossing legs and constrictive clothing. Do not confuse with Venous Insufficiency which causes dull aching pain, present pulses, reddish/blue skin coloration, superficial ulcers, and edema. GERD: occurs when stomach acid repeatedly flows back into the esophagus. S/S: heartburn, regurgitation, dysphagia, hoarseness, sore throat, vomiting. Downloaded by Tierra Earl ([email protected])  lOMoARcPSD|23524095 Eat small, frequent meals (low-fat, high fiber), eliminate foods that aggravate symptoms, encourage the patient to sit upright while eating. Stop eating 3 hours prior to bed. Elevate the head of the bed. Avoid fried foods, alcohol, caffeine, strawberries, chocolate, and NSAIDs. Administer H2 antagonist Famotidine and Antacids. Seizures: a sudden, uncontrolled burst of electrical activity in the brain. Patient may or may not become unconscious during or after a seizure. If the patient is unconscious: Maintain patent airways, turn patient on side to aid in ventilation. Do not restrain the patient. Protect from injury and support patient’s head. Document seizure activity, characteristics, and length. Maintain seizure precautions (reduce stimuli, padded rails, suction and O2 nearby). Administer Anticonvulsants and monitor therapeutic drug levels. Avoid the use of a tongue blade, this may cause trauma to oral cavity. The most common causes in children are fever, infection, head trauma, hypoxia, and cardiac arrest. Perform these actions if a patient is having an active seizure:  Remain calm.  If the patient is standing ease them to the ground if possible  Time the seizure episode  Loosen tight clothing or jewelry from around the patient’s neck.  Place patient on one side and open airways  Do not restrain the patient.  Remove hazards in the area.  Do not forcible open jaw with a tongue blade or fingers.  Document length of seizure and movements noted including cyanosis, loss of bladder control or loss of bowel control.  Remain with the patient until they regain consciousness. Urolithiasis Lithotripsy: a procedure used to breakdown kidney stones. Performed under topical anesthesia. Percutaneous nephrostomy is in place to ensure ureter is not obstructed by blood or edema. Common complications include hemorrhage, infection, and urinary extravasation. General Anesthesia: produces a state of controlled unconsciousness. The post-operative assessment on a pt who received general anesthesia should include: Downloaded by Tierra Earl ([email protected])  lOMoARcPSD|23524095  Assess pain.  Prioritize ABCs  Maintaining surgical site integrity  Manage N/V  Assess neurological status.  Monitoring for complications  Encouraging patient independence Chronic Kidney Disease: characterized by gradual loss of kidney function over time. It is the progressive, irreversible damage to the nephrons, glomeruli, and causes uremia. Patients who have developed End Stage Kidney Disease (ESKD) or are actively undergoing dialysis are at risk of developing metabolic acidosis. Because the kidneys are unable to excrete adequate acid (uric acid) and reabsorb bicarb (sodium bicarbonate). Monitor serum electrolyte levels, daily weight, and I&O ratios. Assess patient for JVD, peripheral and pulmonary edema. Encourage low protein, low sodium, low potassium, and low phosphate diet. HTN indicates fluid volume overload and indicated need for emergency dialysis. Acute Renal Failure: abrupt deterioration of the renal system, may be reversible. Occurs when metabolites accumulate in the body and urinary output changes. S/S: alterations in urinary output, edema, weight gain, hematuria, changes in mental status, dry mucus membranes, drowsiness, headache, muscle twitching, seizures. Pts will also have elevated BUN and potassium levels. Monitor I&O ratios and maintain fluid restriction during the oliguric phase. Monitor weigh daily and report any changes in fluid volume status. Encourage adequate protein intake of 0.6-2g/kg/day. Monitor lab serum and urine values for electrolyte imbalances. Monitor for hyperkalemia (peaked T-waves). Encourage low-potassium diet, no kiwis, potatoes, or oranges. Restrict sodium intake. Assess LOC and prevent infection. Administer Sodium Polystyrene (Kayexalate) if K+ is too high. Arterial Blood Gases: if the pH is normal it is compensated. If one component (respiratory/metabolic) is normal while the other is abnormal it is uncompensated. If the pH, PaCO2, and HCO3 are all abnormal it is partially compensated. Downloaded by Tierra Earl ([email protected])  lOMoARcPSD|23524095 If both the pH and the Bicarb are in the same direction it is metabolic. If the pH is alkaline the pt will have hypokalemia. If the patient is acidotic the pt will have hyperkalemia. Acidotic states slow the body (bradycardia, lethargy, decreased GI motility, respiratory arrest, coma). If the patient is alkaline body systems are working harder (irritability, hyperreflexia, tachycardia, seizure) Severe respiratory acidosis may cause increased ICP causing papilledema and dilated conjunctival blood vessels. S/S of increased ICP include bradycardia, irregular respirations, and increased differenced in systolic BP and diastolic BP (Cushing’s Triad). Pts may also have altered LOC, vomiting, and headache. Pulmonary Edema: occurs when too much fluid accumulates within the lungs. Primarily caused by CHF when blood backs up into pulmonary blood vessels. As pressure increases in the blood vessels fluid is pushed into the alveoli. S/S: dyspnea, orthopnea, paroxysmal nocturnal dyspnea. Coughing up frothy, blood- tinged sputum. Palpitations, cold, clammy skin, shortness of breath, wheezing. Crackles may be heard upon auscultation. The nurse should sit the patient up with their legs dangling over the side of the bed. Apply oxygen via a nonrebreather mask. Assess patient’s oxygen saturation. Assess patient for hypervolemia prior to administering IV fluids. Normal Sinus Rhythm: rhythm that originates in the Sinus Node of the heart.  Ventricular and Atrial rate: 60 to 100 BPM  Ventricular and Atrial rhythm: regular   QRS shape and duration: usually normal, 22mmHg and decreased accommodation or inability to focus. Downloaded by Tierra Earl ([email protected])  lOMoARcPSD|23524095 Open Angle: meshwork that aqueous humor flows through becomes clogged allowing fluid to accumulate and compress on optic nerve. S/S occur suddenly without pain and include tunnel vision and optic disc cupping. Closed Angle: meshwork is open, angle is decreased. Emergency; may be caused by anatomical defect or certain medications. S/S include severe eye pain, N/V, vision changes such as halos and blurring, red eyes, and edema cornea. Guillain Barre Syndrome: an autoimmune condition that affects the peripheral and cranial nerves. Usually preceded by a viral infection 1-4 weeks prior to developing symptoms. S/S: paresthesia, muscle weakness of the legs ascending to upper extremities, trunk, and face, paralysis of ocular, facial, and oropharyngeal muscles (difficulty talking, chewing, swallowing), increased pulse rate, transient HTN, pain in the back of calves, weakness or paralysis of the intercostal and diaphragm muscles may develop quickly. Assess for breathlessness while talking, shallow/irregular breathing, use of accessory muscles to breath, change in respiratory status, and paradoxical inward movement of the upper abdominal wall while in a supine position. These indicate poor respiratory conditions. Cerebrovascular Accident (CVA/Stroke): sudden loss of brain function resulting from a disruption in the blood supply to a part of the brain. May be classified as thrombotic or hemorrhagic. Diagnosed with cranial CT scan, MRI, Doppler flow studies, and Ultrasound imaging. Presenting symptoms relate the specific are of the brain that has been damaged. If the left side of the brain is damaged, symptoms will occur on the right side of the body. Expressive aphasia usually indicates a left hemisphere CVA which is in the frontal lobe. Expressive aphasia is the difficulty expressing themselves through speech but may understand things being said to them. Broca’s area is responsible for forming words and comprehending language. A stroke in this area will cause aphasia (expressive or receptive). Patients with aphasia may become frustrated while attempting to speak. Cardiomyopathy: disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body. Main types include dilates, restrictive, and hypertrophic and may lead to heart failure. Downloaded by Tierra Earl ([email protected])  lOMoARcPSD|23524095 Monitor the patient’s CV status and vital signs. Assess oxygen saturation and administer O2 as needed. Administer antihypertensives (Beta Blockers, CCBs, ACE inhibitors, Diuretics) Encourage rest and minimize stress. Educate the patient about a low sodium (DASH) diet. Monitor for symptoms of poor perfusion such as weakness, pale, clammy skin, and diaphoresis. Also monitor for SOB, pink frothy sputum, and pulmonary edema. Compartment Syndrome: occurs when pressure rises in and around muscles. This restricts blood flow and causes pain to the affected extremity. Compartment syndrome is a complication of fracture treatments. Fasciotomy should be completed immediately to prevent permanent nerve and vasculature damage that would lead to amputation. With this procedure, the fascia is cut to relieve pressure in the muscles. S/S include pain, paresthesia, pallor, pulselessness, paralysis, and poikilothermia (thermoregulation failure) of the affected extremity. Acute Pancreatitis: nonbacterial inflammation of the pancreas where there is digestion of the pancreas by its own enzymes primarily Trypsin. Alcohol ingestion and biliary tract disease (gallstones) are the major causes of acute pancreatitis. Digestive enzymes remain in pancreas and leak into surrounding organs/tissues. S/S: severe mid-epigastric/upper abdominal pain radiating to the back, abdominal guarding with a rigid, hypoactive bowel sounds, board-like abdomen, ascites, N/V, fever, tachycardia & hypotension (shock), bluish discoloration of flank (Grey Turner’s sign), bluish coloration of periumbilical area (Cullen’s Sign). Pain may be exacerbated by fatty meals, alcohol, and lying down. Pt will have elevated amylase and lipase, and blood glucose levels (symptoms of DM). Pt will have hypocalcemia, elevated bilirubin, and elevated WBC count > 10,000 due to inflammation. Administer IV fluids and manage pain usually with Hydromorphone (no Morphine). Pt will have third space fluid shift. Pt will have dull, persistent pain in the upper abdomen. Administer Antacids, PPIs, H2 receptor blockers, and Anticholinergics. Maintain NPO status and use NG tube for nutrition (TPN). Assist the patient in maintaining a comfortable position and maintain bedrest. Avoid alcohol, caffeine, spicy, Downloaded by Tierra Earl ([email protected])  lOMoARcPSD|23524095 and fatty foods. Assess for s/s of hypocalcemia and hyperglycemia. Encourage pt to do deep breathing and instruct about incentive spirometer use. May cause Acute Respiratory Distress Syndrome (ARDS) due to the secretion of inflammatory chemicals into the blood stream. Pt may develop Acute Kidney Injury, DIC, or Myocardial Depression. Cirrhosis: the degeneration of liver tissue resulting in the enlargement, fibrosis, and scarring of the liver. It may be causes by chronic alcohol ingestion or viral hepatitis. Pts can develop hepatitis secondary to cirrhosis. Hepatomegaly occurs first then the liver becomes hard and nodular. Pts will have weakness, malaise, anorexia, palpable liver (RUQ), increased abdominal girth, jaundice, and fruity or musty smelling breath (Fetor hepaticus). Pt may also have asterixis (hand-flapping), mental changes, bruising, dry skin, gynecomastia, ascites, hematemesis, palmar erythema. Pts will have hyponatremia due to water retention and hemodilution. Administer Albumin (restores fluid to intravascular spaces, decreasing ascites) via IV and Lactulose to excrete excess ammonia (livers inability to convert ammonia to urea). Pt is at risk for hypokalemia. Administer vitamin supplements, assess mental status frequently, and observe for signs of bleeding. Encourage low-sodium, low-fat diet. Encourage lean protein intake and avoid raw seafood and alcohol. Implement fluid restriction. Complications associated with cirrhosis include hemorrhage, ascites, portal HTN, esophageal varices, encephalopathy (asterixis, coma, fetor hepaticus), respiratory distress, splenomegaly, and coagulation defects. Addison’s Disease: insufficient secretion of adrenal hormones (Cortisol, Aldosterone). Pts with this disease are lethargic, fatigued, have muscle weakness, weight loss, hypoglycemia, hyponatremia, bronzed skin, hypercalcemia, and hyperkalemia. Addison’s Crisis is brought on by the sudden withdrawal of steroids, a stressful event, exposure to cold, overexertion, or decreased salt intake. It is a medical emergency that causes vascular collapse and hypoglycemia. During crisis the patient will be hypotensive and tachycardic. Administer IV fluids at a rapid rate until vital signs stabilize. Administer fluids to restore electrolyte imbalances. Administer IV glucose to correct hypoglycemia. Downloaded by Tierra Earl ([email protected])  lOMoARcPSD|23524095 Administer parenteral Hydrocortisone or Prednisone to reverse crisis. Administer Fludrocortisone Acetate orally with simultaneous administration of sodium if the patient is hyponatremic. Educate the patient about lifelong steroid use and about increasing dosage during times of stress. S/S of crisis include severe headache, abdominal, leg, and lower back pain, generalized weakness, irritability, and confusion. Crisis may lead to shock and severe hypotension. Cushing Syndrome: hypersecretion of adrenal hormones. Usually caused by the chronic use of corticosteroids. May also be caused by adrenal, hypothalamus, or pituitary tumors. S/S: moon face, truncal obesity, buffalo hump, stretch marks, muscle atrophy, thinning of the skin, hirsutism in females, hyperpigmentation, amenorrhea, edema, poor wound healing, impotence bruises easily, HTN, osteoporosis, peptic ulcer formation, susceptibility to infections, false positive or false negative test results. The patient will have elevated blood glucose and sodium levels. Also, decreased levels of potassium, eosinophils, and lymphocytes. The patient will have increased plasma cortisol levels and urinary 17 hydroxy-corticoids. Educate the patient about hand hygiene and how to prevent infections. Promote safety. Educate about low-sodium diet and encourage the consumption of vitamin D and Calcium rich foods. Discuss weaning of steroid use, do not wean too quickly or Addison’s disease will occur. Monitor the patient’s I&O ratios. Provide peptic ulcer prophylaxis. Chemotherapy: drug treatment that uses powerful chemicals to kill fast growing cells within the body. It is most commonly used to treat different forms of cancer. S/E: bone marrow depression, N/V, diarrhea, abdominal pain, alopecia, fatigue, headache, blood glucose issues, seizures, dermatitis, toxicity to the heart, lungs, kidneys and skin. Multiple Sclerosis: demyelinating disease resulting in destruction of CNS myelin and consequent disruption in the transmission of nerve impulses. Downloaded by Tierra Earl ([email protected])  lOMoARcPSD|23524095 S/S: optic neuritis, visual and swallowing difficulties, gait disturbances, tremors, unusual fatigue, weakness, and clumsiness. Numbness on one side of the face, impaired bladder and bowel control, speech disturbances, scotomas (white spots in visual field), dipoplia. Orient the client to surroundings and encourage self-care and rest periods. Teach stretch- hold-relax exercises. Promote safety to prevent falls. Encourage adequate fluid intake, high fiber diet. Administer ACTH, Corticosteroids, and Immunosuppressants, Cyclophosphamide. Symptoms involving motor function usually begin in the upper extremities with weakness that progresses to spastic paralysis. Bladder dysfunction is more common in women and occurs in about 90% of cases. Educate the patient about self-catheterization if urinary incontinence worsens. Women may use a foley catheter and a male may use a condom catheter. Meningitis: inflammatory disorder of the meninges that cover the brain and spinal cord. Diagnosed using a CT scan and then lumbar puncture that shows increased WBC, protein, and ICP along with decreased glucose and a positive culture. S/S: altered LOC, positive Brudzinski and Kernig sign. Headache, nuchal rigidity, elevated temperature. Implement droplet precautions first (surgical mask, gloves). Administer antibiotics and antipyretics as prescribed. Isolate the patient for a minimum of 24 hours and monitor vital signs and neurological status. Keep the environment quiet and darkened to prevent overstimulation. Implement seizure precautions and position the patient for comfort. Measure the patient’s head daily in infants to determine intracranial pressure. Monitor I&O ratios. Monitor hydration status and IV therapy carefully. Pts may have inappropriate ADH secretion causing fluid retention (cerebral edema) and dilutional hyponatremia. Valve Replacement: surgery to replace damages or diseases heart valves that do not function as they should. Monitor the client for thrombus formation. Educate the patient about prophylactic antibiotic therapy prior to invasive procedures such as dental work. Prepare the patient for surgery. Downloaded by Tierra Earl ([email protected])  lOMoARcPSD|23524095 Educate the patient about lifelong anticoagulant therapy for mechanical valve replacement to prevent thrombus formation. Tissue or biological valves do not require lifelong anticoagulant therapy. End of Life Treatment: focuses on managing symptoms. Provide pain management, alleviate dyspnea, provide emotional support to the patient. Manage GI symptoms such as N/V, gastritis, constipation, or diarrhea. Support the family and caregivers of the patient. Encourage and educate the family about bereavement support. Recognize and attend to the spiritual needs of the patient. Implement palliative sedation if symptoms or intractable. Hypovolemia: also known as fluid volume deficit characterized by inadequate fluid in the blood and extracellular spaces. Loss of fluids may be through vomiting, loss of water, diarrhea, fistulas, GI suctioning, DI, and third space fluid shifts. S/S: acute weight loss, decreased skin turgor, oliguria, concentrated urine, prolonged capillary refill time, decreased BP (hypotension), cool, clammy, pale skin. Pt will have elevated Hgb, and Hct. Pt will have weak pulse and increased respirations. Pt will have increased urine sodium levels (hypernatremia), elevated BUN levels. Increased urine and serum specific gravity and osmolarity (concentrated urine). Isotonic solutions are first line in hypotensive patients, because they expand plasma volume (0.9% NS or LR). Once the patient is normotensive hypotonic IV solutions are used (0.45% NS) to provide electrolytes and water to promote renal waste excretion. Hypervolemia: results from the expansion of the ECF. Most common in conditions that stimulate ADH production (cirrhosis, heart failure, nephrotic syndrome). S/S: edema, JVD, crackles upon auscultation. Peripheral edema, weight gain, SOB, increased BP, bounding pulse, increased urine output. Pt will have decreased Hgb and Hct, decreased serum and urine osmolality and specific gravity. Pt will have decreased sodium levels, decreased serum and urine osmolality and specific gravity due to dilution of body fluids. Downloaded by Tierra Earl ([email protected])  lOMoARcPSD|23524095 Administer Diuretics as prescribed. Monitor for electrolyte imbalances. If renal function is impaired dialysis may be initiated. Encourage sodium and fluid restriction (2,000 mg/day). Downloaded by Tierra Earl ([email protected])