NCLEX Flash Notes PDF

NCLEX FLASH ™ ® NOTES 77 MUST KNOW NURSING TOPICS TO CRUSH THE NCLEX® Jon Haws, Bsn, Rn, CCRn alumnus KRisten PoniCHteRa, DnP, Rn, CCRn aBigail Rose, Bsn, Rn © 2023 NURSING.com All rights reserved. No part of this book may be used or reproduced in any manner whatsoever without the express written permission of the copyright holder except in the case of brief quotations embodied in critical articles and reviews. NCLEX®, NCLEX®-RN® are registered trademarks of the National Council of State Boards of Nursing, INC. and hold no affiliation or support of this product nor affiliation with NURSING.com or the author. All photos are original photos taken or created by the author or rights purchased at Fotolia.com. All rights to appear in this book have been secured. 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NURSING.com Products are intended solely ANY LIABILITY OR RESPONSIBILITY FOR THE as a guide and for educational purposes and are not intended CONSEQUENCES OF ANY ACTION TAKEN IN to be used for actual medical treatment or as a statement of RELIANCE ON THESE STATEMENTS OR OPINIONS. iii Your journey is UNIQUE and that is why you will be a great nurse You CAN do this and you are NOT alone. HAPPY NURSING! iv Our ®Mission DREADING THE NCLEX & LOOKING FOR A LIFELINE? Future nurses are offered a free, no-ﬂuff study resource that is exceptionally clear, concise, and designed WE’VE GOT YOUR BACK! to assist them in passing the NCLEX® exam and improving their nursing school grades. MEET NURSING.COM Why TAKE NURSING.com A FREE 15 QUESTION SIMCLEX® The United States is facing an expected workforce shortage of 569,700 nurses by 2024.®Efforts SIMCLEX is thetobest solve predictive this shortage are disjointed NCLEX ® and have practice done little to reduce the problem. 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NCLEX® Study Plans Mobile App 2, 4, 6, and 12 week pre-made NCLEX® study plans developed by the NURSING. com nursing mobile app. Listen to lectures, watch videos, and team that guide you day-by-day as you prepare. Happy Nursing! vi About the Authors Jon Haws, BSN, BS, RN, CCRN Alumnus After graduating nursing school in 2013, Jon Haws began work in a large met- ropolitan Neuro-ICU, where he served as a bedside nurse, charge nurse, SWAT (rapid response) nurse, and preceptor. He found that through his own experi- ence and working with others that nursing education must change. In 2015, he founded NURSING.com, which transformed into the online nursing education platform known as NURSING.com. Abby Rose, BSN, RN Abby has a BS in Nursing from Westminster College. Her nursing educa- tion was aided by NURSING.com, and now she is proud to be part of the team! Her nursing career comprises experience from Med-Surg at Salt Lake City’s VA Medical Center, Critical Care Nursing in the University of Utah’s Cardiovascular ICU, and Huntsman Cancer Hospital’s ICU and Chemotherapy Infusion Clinic. In her free time, she spends time with family and friends, explores new recipes, works as a medical aesthetician, stays active and enjoys meeting new dogs. Kristen Ponichtera, DNP, RN, CCRN Kristen’s nearly 15-year nursing background is multifarious, as it spans from the back of a helicopter to the back of a classroom. Born and raised in inten- sive care units and emergency departments, Kristen shaped her early experi- ence to become a flight nurse. After serving several years in air medical, she directed her sights towards education, becoming a clinical content/item writer and editor and academic clinician. She currently serves as nursing faculty at Duke University Health System and Curriculum Manager at NURSING.com vii Contributors Nichole Weaver, Marie Clark, RN, MNHP, C-MSRN MSN/Ed, RN, CCRN Jason Coco Sandra Haws, RD Fara Ajani, MSN-Ed, RN Alitha D. Jones, Texas Women’s University MSN/Ed, APRN, AGACNP-BC, Parkland Hospital FNP-BC, CCRN-K, CEN, FCCS, LNC Parkland Hospital Jan Ivey MSN, RN, CCRN Bon Secours Memorial College of Nursing Teri Tench, MSN, RN, CNE Bon Secours Memorial College of Nursing Crystal Caddell, MSN/Ed, RN Western Governors University Leslie Buck, MSN, RN CPN Bon Secours Memorial College of Nursing Lara Ratliff, MSN, RN, WHNP-BC Bon Secours Memorial College of Nursing Debra Ann Culter, MS, RN, CCRN, CNML, CMSRN Paige Canaar, MSN, MHA, RN Drexel University Genesis Health System Amy Martinez, MSN, RN, CPN, CNE Lindsey Longstreet, BSN, RN Bryant & Stratton College Medical City Healthcare Meg Highley, MSN, RN, OCN Kara Tarr, MSN, RN The James Cancer Hospital and Duquesne University Solove Research Institute Shawntelle Winslow, MSN, BA, RN Ashley Powell, MSN, RN, CPN State of Delaware Division of Services for Aging Sunderland Royal Hospital, United Kingdom and Adults with Physical Disabilities Maria Stewart, BSN, RN, CCRN, CMSRN Todd Hennig Christus Trinity Mother Frances Louis Content Director, NURSING.com Peaches Owen Heart Hospital viii Table of Contents Med-Surg | Cardiac Sickle Cell Anemia............................................. 47 Angina................................................................. 12 Disseminated Intravascular Coagulation............ 48 Heart Failure....................................................... 13 Anaphylaxis........................................................ 49 Coronary Artery Disease..................................... 15 Leukemia............................................................ 50 Hypertension....................................................... 16 Thrombocytopenia.............................................. 51 Cardiogenic Shock.............................................. 17 Lymphoma.......................................................... 53 Myocardial Infarction......................................... 18 Med-Surg | Integumentary Distributive Shock.............................................. 20 Burn Injuries....................................................... 55 Cardiomyopathy................................................. 21 Herpes Zoster - Shingles..................................... 58 Atrial Fibrillation................................................ 22 Pressure Ulcers................................................... 59 Thrombophlebitis................................................ 23 Hypovolemic Shock............................................ 24 Med-Surg | Metabolic / Endocrine Addison’s Disease............................................... 61 Sinus Tachycardia............................................... 25 Cushing’s Syndrome........................................... 63 Med-Surg | Ears, Eyes, Nose, Throat (EENT) Diabetic Ketoacidosis......................................... 64 Cataracts............................................................. 26 Diabetes Insipidus............................................... 66 Med-Surg | Gastrointestinal Diabetes Mellitus................................................ 67 Cirrhosis.............................................................. 27 Hyperglycemic Hyperosmolar Nonketotic Peptic Ulcer Disease........................................... 29 Syndrome (HHNS)............................................. 69 Cholecystitis....................................................... 30 Hyperthyroidism................................................. 70 Inflammatory Bowel Disease.............................. 31 Hypothyroidism.................................................. 71 Ulcerative Colitis................................................ 31 SIADH (Syndrome of Inappropriate Antidiuretic Appendicitis........................................................ 34 Hormone)............................................................ 72 Pancreatitis.......................................................... 35 Med-Surg | Musculoskeletal Hepatitis.............................................................. 36 Fractures............................................................. 73 Osteoporosis....................................................... 75 Med-Surg | Genitourinary................................37 Urinary Tract Infection....................................... 37 Med-Surg | Neuro Acute Kidney Injury........................................... 38 Parkinson’s Disease............................................ 76 Chronic Kidney Disease..................................... 39 Ischemic Stroke.................................................. 77 Pelvic Inflammatory Disease.............................. 40 Multiple Sclerosis............................................... 78 Dialysis & Other Renal Points............................ 41 Hemorrhagic Stroke............................................ 79 Menopause.......................................................... 44 Meningitis........................................................... 80 Seizure................................................................ 81 Med-Surg | Hematology / Oncology / Immunology Blood Transfusions............................................. 45 Intracranial Pressure ICP.................................... 83 Acquired Immune Deficiency Syndrome........... 46 Routine Neuro Assessments............................... 84 ix Med-Surg | Respiratory Post-Traumatic Stress Disorder (PTSD)........... 100 Alveoli & Atelectasis.......................................... 87 Anxiety............................................................. 101 Chronic Obstructive Pulmonary Disease - Pediatrics COPD.................................................................. 88 Hemophilia....................................................... 102 Asthma................................................................ 89 Congenital Heart Defects.................................. 103 Artificial Airways................................................ 90 Tuberculosis........................................................ 92 (OB) Maternal Newborn Pneumonia.......................................................... 93 Gestational Diabetes......................................... 106 Influenza............................................................. 94 Preeclampsia..................................................... 107 Infections in Pregnancy.................................... 108 Mental Health Newborn Physical Exam................................... 109 Cognitive Impairment Disorders........................ 95 Mood Disorders.................................................. 97 Maternal Nursing Depression.......................................................... 98 Chorioamnionitis.............................................. 112 Suicidal Behavior................................................ 99 Cheatsheet Right vs Left Heart Failure................................. 14 CV Intervention - Nursing Care.......................... 19 Cirrhosis Nursing Care....................................... 28 Colostomy Care.................................................. 32 Ulcerative Colitis vs. Crohn’s Disease.................................................. 33 Types of Dialysis................................................ 43 Blood Compatibility Chart................................. 52 Cancer Quick Tips.............................................. 54 Burn Staging....................................................... 57 Pressure Ulcer Staging........................................ 60 Addison’s vs. Cushing’s...................................... 62 DKA vs HHNS................................................... 65 Routine Neuro Assessments............................... 86 Artificial Airways Decision Tree........................ 91 Congenital Heart Defects.................................. 105 Newborn Assessment........................................ 111 x References American Academy of Pediatrics (2012). Breastfeeding and the use of human milk. Retrieved from https://pediatrics.aappublications.org/content/129/3/e827.full#content-block American Heart Association. (2019). Guidelines highlights. Retrieved from https://eccguidelines.heart.org/index.php/guidelines-highlights/ American Psychological Association. (2019). Is willpower a limited resource? Retrieved from https://www.apa.org/helpcenter/willpower-limited-resource.pdf Baadte, C., & Meinhardt, I. B. (2019). The picture superiority effect in associative memory: A developmental study. British Journal of Developmental Psychology, 37(3), 382–395. https://doi-org.wgu.idm.oclc.org/10.1111/bjdp.12280 Google. (2019). Google calendar. Retrieved from https://www.google.com/calendar? Lee, J. S., Keil, M., & Wong, K. F. E. (2018). Does a tired mind help avoid a decision bias? The effect of ego depletion on escalation of commitment. Applied Psychology: An International Review, 67(1), 171–185. https:// doi-org.wgu.idm.oclc.org/10.1111/apps.12109 Lucid Chart. (2019). Lucid chart. Retrieved from https://www.lucidchart.com/pages/home Krathwohl, D. R., & Anderson, L. W. (2010). Merlin C. Wittrock and the Revision of Bloom’s Taxonomy. Educational Psychologist, 45(1), 64–65. https://doi-org.wgu.idm.oclc.org/10.1080/00461520903433562 Matchu. (2019). Strict workflow google extension. Retrieved from https://chrome.google.com/webstore/detail/ strict-workflow/cgmnfnmlficgeijcalkgnnkigkefkbhd?hl=en National Council of State Boards of Nursing. (2019). Eligibility & licensure/registration requirements. Retrieved from https://www.ncsbn.org/2916.htm National Council of State Boards of Nursing. (2019). NCLEX-RN® examination test plan for the national council licensure examination for registered nurses. Retrieved from https://www.ncsbn.org/2019_RN_TestPlan-English.pdf National Council of State Boards of Nursing. (2019). Computerized adaptive testing (CAT). Retrieved from https://www.ncsbn.org/1216.htm National Council of State Boards of Nursing. (2019). Maximum-length exam rule. Retrieved from https://www.ncsbn.org/5910.htm National Council of State Boards of Nursing. (2019). Run-out-of-time (R.O.O.T.) rule. Retrieved from https://www.ncsbn.org/5912.htm Newcombe, N. (2010). Picture this. Retrieved from https://www.aft.org/sites/default/files/periodicals/Newcombe_1.pdf Newport, Cal. (2016). Deep Work. New York, NY:Grand Central Publishing Nugent, P.M., & Vitale, B. A. (2008). Test Success: Test-Taking Techniques for Beginning Nursing Students. Philadelphia, PA: F.A. Davis Momentumdash.com. (2019). Momentum google extension. Retrieved from https://chrome.google.com/webstore/ detail/momentum/laookkfknpbbblfpciffpaejjkokdgca?hl=en Oregon State University. (2017). Time budget sheet. Retrieved from http://success.oregonstate.edu/sites/success. oregonstate.edu/files/LearningCorner/Tools/time_budet_sheet.pdf Oregon State University. (2017). Evaluate your study places. Retrieved from http://success.oregonstate.edu/sites/ success.oregonstate.edu/files/LearningCorner/Tools/evaluate_your_study_places.pdf Transfusion Media. (2019). Stayfocusd Google extension. Retrieved from https://chrome.google.com/webstore/detail/ stayfocusd/laankejkbhbdhmipfmgcngdelahlfoji?hl=en Tzu, Sun. (2019). The Art of War. Bloomsbury China. xi Med-Surg | Cardiac Click to View the Lesson c. Other Angina i. Syncope ii. Pale Overview iii. Diaphoretic Angina is chest pain resulting from inadequate blood Therapeutic Management flow to the heart muscle. If the flow is not restored, it can lead to further damage. 1. Medication Management (anticipated mediations) General a. Thienopyridines (clopidogrel) b. Heparin 1. Most common cause c. Renin-Angiotensin Blockade (ARBS or Ace a. Coronary artery disease (CAD) inhibitors) i. Atherosclerotic plaque ruptures d. Oxygen ii. Clot forms e. Morphine (only if indicated by facility) 2. Other causes f. Beta Blockers a. Anemia g. Nitroglycerine (per facility policy) b. Heart failure 2. EKG→ Rule out STEMI and monitor c. Stress/overexertion arrhythmias d. Abnormal rhythms 3. Monitor Vital Signs (HR, BP, SpO2) for changes 3. Types 4. Cardiac Enzymes→ Determine myocardial a. Stable – With exertion. Relieved by damage nitroglycerin 5. Cardiac Stress Test→ Determine myocardial b. Unstable – At rest. Lasts longer. Unrelieved by stress point nitroglycerin. 6. Cluster Care – Rest to decrease myocardial O2 c. Variant – Unpredictable. demands 4. Desired Outcome Image 6.16 Angina Pectoris a. Restore blood flow, decrease chest pain, and improve activity tolerance. Assessment 1. Subjective Data a. Chest Pain b. Dyspnea on Exertion 2. Objective Data a. Blood Pressure i. Hypotension – ↓ cardiac output ii. Hypertension – ↑ stress on the heart b. Arrhythmias i. Bradycardias -↓ cardiac output ii. Supraventricular Tachycardia -↑ stress on By Ian Furst - Own work derivative of File:Aorta scheme.jpg and the heart File:Gray1220.png, CC BY-SA 3.0, https://commons.wikimedia.org/w/ index.php?curid=30655972 iii. Atrial Fibrillation – ↑ stress on the heart Click to Take the Quiz NURSING.com NCLEX Flash Notes ® 12 Med-Surg | Cardiac Click to View the Lesson 2. Left-Sided Heart Failure Heart Failure a. Decreased Systemic Perfusion i. Skin pale or dusky Overview ii. ↓ PERIPHERAL PULSES The heart is a pump, it circulates blood throughout iii. Slow capillary refill the body. Heart failure = pump failure. Heart failure iv. ↓ renal perfusion occurs when the heart cannot pump enough blood to 1. ↓ urine output supply the body’s needs. 2. Kidney Injury / Failure General b. Increased Pulmonary Congestion i. Pulmonary edema 1. Pump Failure→ Decreased perfusion forwards 1. COUGH and Increased congestion backward 2. Causes 2. PINK/FROTHY SPUTUM a. Myocardial Infarction→ Dead muscle can’t pump 3. Crackles b. Hypertension→ ↑ afterload = ↑ stress on the 4. Wheezes heart muscle 5. Tachypnea c. Valve Disorders=Inefficient pump→ Blood not moving in the right direction 6. SOB on Exertion 3. Diagnostics ii. Anxiety/restlessness a. BNP (Brain Natriuretic Peptide) → a hormone secreted by cardiomyocytes in response to Therapeutic Management stretching of the ventricles 1. The goal is to decrease the workload on the b. Echocardiogram to detect ejection fraction and heart while still increasing cardiac output. can diagnose valve disorder a. Decrease Preload c. Chest X-Ray to detect cardiomegaly and pulmonary edema b. Decrease Afterload 4. Complications c. Increase Contractility a. Volume Overload Image 6.19 Heart Failure X-Ray b. Decreased Perfusion Assessment 1. Right-Sided Heart Failure a. Decreased Pulmonary Perfusion i. ↓ oxygenation ii. ↓ activity tolerance b. Increased Systemic Congestion i. PERIPHERAL EDEMA By Mikael Häggström - Own work, CC0, https://commons.wikimedia. org/w/index.php?curid=61595288 ii. ↑ Jugular Venous Distention (JVD) iii. ↑ Preload iv. Weight Gain v. Fatigue vi. Liver / GI Congestion Click to Take the Quiz NURSING.com NCLEX Flash Notes ® 13 Med-Surg | Cardiac Cheatsheet 6.6 Right vs Left Heart Failure R v L HEART FAILURE Left Ventricle is unable to Right Ventricle is unable to pump blood into the systemic pump blood into the pulmonary circulation causing a “back-up” circulation causing a “back-up” into the pulmonary circulation. into venous circulation. Lungs Pulmonary Circulation Left Heart Right Heart systemic Circulation Organs and tissues of the body Symptoms: Symptoms: Shortness of Breath Jugular venous Distention Dyspnea on Exertion Fatigue Crackles Ascites Pink-Frothy Sputum Anorexia Cyanosis GI distress Fatigue Weight Gain Orthopnea Dependent Edema Tachycardia Venous Stasis Confusion Restlessness NURSING.com NCLEX® Flash Notes 14 Med-Surg | Cardiac Click to View the Lesson 2. Healthcare provider orders Coronary Artery Disease a. Electrocardiogram (EKG) b. Cholesterol levels Overview c. CT scan→ visualize vessel occlusion and stenosis d. Angiogram→ view inside vessels Coronary artery disease occurs with the buildup of e. Stress test→ view blood flow plaque in the main vessels. The primary causes are high blood pressure and cholesterol. The main symptom is chest pain. Therapeutic Management 1. Medications General a. Cholesterol medications→ Statins to decrease plaque in blood 1. Major vessels b. Anticoagulants→ avoid blood clotting a. Inner walls are damaged c. Beta-blockers→ Decrease the workload of the b. Inflammation occurs→ Plaque sticks to walls heart and clots form d. Calcium channel blockers→ Relax vessels, c. Blockage → loss of blood supply to the heart allow blood through 2. Risk factors e. Nitroglycerin→ Open arteries, allow blood a. Smoking through–>decrease chest pain b. High blood pressure 2. Procedures c. Obesity a. Angioplasty–>go in through vein to open vessels d. Diabetes b. Stent placement–>keep the vessel open e. Hyperlipidemia c. Coronary artery bypass surgery→ new vessel f. Family history pathway around the blockage 3. Complications Image 6.18 Coronary Artery Disease a. Acute coronary syndrome→ plaque breaks off and occludes a coronary artery i. STEMI (ST-segment elevation myocardial infarction) → ”widowmaker”- Near or complete blockage ii. NSTEMI (non-ST-Segment elevation myocardial infarction) → Partial blockage iii. Unstable angina iv. Concerned for → cardiac arrest Assessment By BruceBlaus. When using this image in external sources it can be cited 1. Presentation as:Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014”. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002- a. Chest pain 4436. - Own work, CC BY 3.0, https://commons.wikimedia.org/w/index. php?curid=29140355 b. Arrhythmia c. Shortness of breath d. Elevated blood pressure Click to Take the Quiz NURSING.com NCLEX Flash Notes ® 15 Med-Surg | Cardiac Click to View the Lesson Hypertension Assessment 1. Assessment a. Risk Factors b. “Silent Killer” → Asymptomatic until end- organ damage occurs 1. Stroke 2. MI 3. Renal Failure 4. Heart Failure c. Later signs→ Vision changes, frequent headaches, dizziness, and chest pain/angina Therapeutic Management 1. Therapeutic Management a. Medication therapy→ ACE Inhibitors, Beta- Blockers, calcium channel blockers, diuretics b. Diet & Lifestyle modifications 2. Nursing Priorities a. Perfusion i. Administer BP meds→ CHECK BP/HR FIRST ii. Assess for end-organ damage → renal and neuro status iii. Strict I&O iv. Assess for CV changes Click to Take the Quiz NURSING.com NCLEX Flash Notes ® 16 Med-Surg | Cardiac Click to View the Lesson Therapeutic Management Cardiogenic Shock 1. Treat Cause of the pump failure Overview a. Revascularization for MI (Percutaneous Coronary Intervention, Coronary Artery Bypass Complete pump failure (heart) causing loss of oxygen- Graft) ated blood flow to the body. b. Thrombolytics or surgical removal for PE c. Pericardiocentesis for cardiac tamponade General 2. Improve Contractility a. Dopamine – may ↑ HR 1. Causes b. Dobutamine a. Myocardial infarction (MI) 3. Decrease Afterload b. End-stage cardiomyopathy a. Dobutamine c. Papillary muscle or valve rupture 4. Diuretics d. Cardiac tamponade a. Furosemide – for Pulmonary edema e. Pulmonary embolism (PE) b. Caution – may ↓ BP Assessment 1. Sudden, severe, extreme heart failure 2. Decreased Perfusion a. ↓ CO, ↓ BP b. ↑ HR (compensation) c. ↑ SVR (compensation) d. Weak, thready pulses (pump isn’t pumping effectively and strong) e. Cool, diaphoretic skin f. Pale, dusky, cyanotic, or mottled skin g. ↓ urine output h. ↓ LOC, anxiety 3. Volume Overload (volume backs up because the pump can’t pump) a. ↑ CVP b. JVD c. Pulmonary Edema→ Crackles, pink, frothy sputum, sudden, severe SOB Click to Take the Quiz NURSING.com NCLEX Flash Notes ® 17 Med-Surg | Cardiac Click to View the Lesson a. 12-Lead EKG Myocardial Infarction b. Cardiac Enzymes q3h x 4 c. Thrombolytics unless contraindicated Overview d. Percutaneous Transluminal Coronary Angioplasty (PTCA)--> opens clogged arteries Sudden restriction of blood supply to a portion of the heart causing ischemia and death to the muscle tissue Image 6.17 Myocardial Infarction General 1. Causes a. Coronary Artery Disease and thrombosis Assessment 1. Subjective Data a. Chest pain unrelieved by rest b. Skin pale, diaphoretic, mottled, nausea, anxiety, SOB, and palpitations that worsen with activity 2. Objective Data a. Might be hypotensive/bradycardic b. ST-elevation on 12-Lead (STEMI) c. Elevated Troponins (most sensitive), elevated CK-MB & CK Therapeutic Management 1. Medication Management (anticipated mediations) a. Thienopyridines (clopidogrel) b. Heparin c. Renin-Angiotensin Blockade (ARBS or Ace inhibitors) d. Oxygen e. Morphine (only if indicated by facility) f. Beta Blockers g. Nitroglycerine (per facility policy) 2. Monitor EKG 3. Rest – decrease O2 demands of the heart 4. Anticipate Provider Orders Click to Take the Quiz NURSING.com NCLEX Flash Notes ® 18 Med-Surg | Cardiac Cheatsheet 6.5 CV Intervention - Nursing Care CV INTERVENTION - NURSING CARE By BruceBlaus - Own work, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=30634272 Percutaneous Coronary Coronary Artery Bypass Graft Intervention (PCI) (CABG) PERFUSION CLOTTING PATIENT EDUCATION Pulse Checks Give Anticoagulant Incentive Spirometer Vital Signs Monitor Access Site Diet & Lifestyle Changes Pain Assessment Monitor for Bleeding Medication Instructions Skin Assessment Check Coag Studies Activity Restrictions Give BP Meds Check CBC (H/H) Bleeding Precautions Leg Positioning Assess for DVT When to notify HCP NURSING.com NCLEX® Flash Notes 19 Med-Surg | Cardiac Click to View the Lesson b. Neurogenic Distributive Shock 1. Symptoms a. Spinal cord injury in the last 24 hours Overview b. Warm flushed lower extremities Distributive Shocks – caused by an immune or inflam- c. ↓ BP matory response that interferes with vascular tone, d. ↓ HR (occasional) leading to massive peripheral vasodilation. e. Priapism (due to vasodilation) General 2. Treatment a. Therapeutic hypothermia = 1. Types neuroprotective a. Anaphylactic c. Septic i. Allergic reaction 1. Symptoms ii. Inflammatory cytokines a. ↓ LOC b. Neurogenic b. ↓ BP i. Spinal cord injury c. ↑ HR ii. Loss of SNS activity c. Septic d. Warm, flushed skin i. Systemic infection e. ↑ Temperature ii. Inflammatory cytokines f. s/s infection 2. Treatment Assessment a. IV antibiotics (blood cultures first) 1. Types b. IV fluids to ↑ preload a. Anaphylactic c. Corticosteroids only if vasopressors ineffective i. Symptoms d. Decompensated Shock 1. Hives, rash, swelling of arms, trunk, or 1. Symptoms face/mouth a. Refractory low BP 2. Exposure to allergen b. ↓ LOC 3. ↓ SpO2 c. ↓ SpO2 4. ↓ BP d. ↓ HR 5. ↑ HR 2. Treatment 6. ↑ RR, wheezes a. Vasopressors 7. Warm, flushed skin b. Intubation for airway protection ii. Treatment 1. Epinephrine – relaxes airway muscles 2. Corticosteroids – ↓ inflammation 3. Bronchodilators – protect the airway Click to Take the Quiz NURSING.com NCLEX Flash Notes ® 20 Med-Surg | Cardiac Click to View the Lesson Assessment Cardiomyopathy 1. S/S Heart Failure a. Fatigue Overview b. SOB Abnormality of the heart muscle leads to functional c. Dysrhythmias changes d. Extra heart sounds (S3/S4) e. Poor perfusion General f. Volume overload (JVD and pulmonary edema) 1. Types 2. Echocardiogram or Chest X-ray a. Dilated a. Heart is visibly enlarged or thickened i. 4 chambers enlarged ii. Walls thin, less force Therapeutic Management iii. ↓ contractility, ↓ CO 1. No cure, only supportive b. Hypertrophic 2. Encourage frequent rest i. Thick ventricle muscle 3. Minimize Stress ii. Stiff contraction 4. Manage HTN iii. Less space to fill a. DASH diet iv. ↓ Preload, ↓ CO b. ACE-Inhibitors (Angiotensin-converting c. Restrictive enzyme) i. Ventricles rigid c. ARB’s (Angiotensin receptor blockers) ii. Can’t stretch to fill d. Beta-Blockers iii. ↓ SV, ↓ CO i. ↓ force of contraction ii. ↓ workload Image 6.21 Cardiomyopathy iii. ↓ O2 demands 5. Ventricular Assist Devices a. Help eject blood from LV to the aorta 2. Causes a. Prolonged untreated hypertension b. Congestive Heart Failure c. Congenital disorders Click to Take the Quiz NURSING.com NCLEX Flash Notes ® 21 Med-Surg | Cardiac Click to View the Lesson Assessment Atrial Fibrillation 1. Client Presentation Overview a. Palpitations, fatigue, lightheaded/Syncope 2. Acute or chronic 1. Atrial fibrillation a. If chronic→ Monitor rate/meds a. Multiple, disorganized cells produce additional b. If acute→ Convert to NSR electrical impulse in atria 3. Atrial and ventricular rates→ RVR i. Causes atria to quiver at a fast rate >300 4. Decreased Cardiac Output→ Syncope, bpm→ The heart is unable to effectively hypotension contract which causes pooling of blood in the atria and HIGH risk for stroke 5. PT/INR- If taking Coumadin ii. AV node blocks some of the electrical Therapeutic Management impulses from reaching the ventricles→ Rapid, irregular ventricular contractions 1. Nursing Interventions Image 6.12 Atrial Fibrillation a. Acute or chronic, 12 Lead EKG, Restore NSR, Assess for s/s of stroke 2. Control ventricular rate a. Medications i. Antiarrhythmics ii. Beta-blockers iii. Calcium Channel Blockers b. Transesophageal echocardiography/ Cardioversion By J. Heuser - Own work, CC BY-SA 3.0, https://commons.wikimedia. c. Ablations org/w/index.php?curid=465397 3. Decrease the risk for stroke a. Anticoagulants→ Coumadin (Warfarin), General Xarelto (Rivaroxaban), Eliquis (Apixaban) 1. Characteristics of Atrial fibrillation a. Rhythm→ Irregular b. Rate→ Atrial rate >300 bpm, Wavy baseline i. Ventricular rate→ 60-100 bpm, >100 bpm→ “Rapid Ventricular Rate” (RVR) c. P: QRS ratio→ No obvious P waves d. A wavy baseline that is not measurable e. PR interval→ Not measurable f. QRS complex→ 0.06-0.12 seconds Click to Take the Quiz NURSING.com NCLEX Flash Notes ® 22 Med-Surg | Cardiac Click to View the Lesson Image 6.22 Thrombophlebitis Symptoms Thrombophlebitis Overview Thrombus (clot) formation with associated inflamma- tion in extremity. General 1. Risk Factors a. Virchow’s Triad i. Venous stasis ii. Damage to the inner lining of the vessel iii. Hypercoagulability of blood b. Medical History i. History of thrombophlebitis By James Heilman, MD - Own work, CC BY-SA 3.0, https://commons. ii. Pelvic surgery wikimedia.org/w/index.php?curid=9444797 iii. Obesity iv. Heart failure, MI Therapeutic Management v. A-fib 1. If the client has confirmed DVT: vi. Immobility a. NO SCD/TED, NO massage, Bedrest-->Could vii. Pregnancy dislodge the clot 2. Initiate anticoagulant therapy Assessment a. Heparin→ Monitor PTT q6h 1. Unilateral findings on the affected side b. Coumadin (warfarin)--> Monitor PT/INR a. Pain 3. IVC filter b. Warm skin a. Sits in Inferior Vena Cava c. Redness b. Collects clots before they reach the heart/lungs d. Tenderness c. Monitor for s/s Emboli e. Febrile state d. Heart – MI→ Chest Pain 2. Confirm clinical picture with diagnostics: e. Lungs – Pulmonary Embolism→ Anxiety, SOB, a. Ultrasound to visualize ↑ HR, ↑ RR, chest pain b. D-Dimer→ product of fibrin degradation f. Brain – Stroke→ Facial droop, arm weakness, present in the blood after a blood clot is speech Difficulty degraded by fibrinolysis (positive=clot) g. Monitor distal pulses h. Clotting Prevention/Monitoring i. Monitor circumference of limb BID ii. SCD/TED + enoxaparin sodium (anti-coagulant), if ordered by provider iii. Passive ROM iv. Early ambulation Click to Take the Quiz NURSING.com NCLEX Flash Notes ® 23 Med-Surg | Cardiac Click to View the Lesson Therapeutic Management Hypovolemic Shock 1. Treat Cause Overview a. OR for repair b. Meds for vomiting/diarrhea 1. Hypovolemic Shock – loss of blood volume leading 2. Replace Volume to decreased oxygenation of vital organs a. Crystalloid – LR, NS 2. The body’s compensatory mechanisms fail and b. Colloid – Blood Products organs begin to shut down. c. Rapid Infuser Assessment 3. Support Perfusion a. Hemodynamic Monitoring 1. Symptoms b. Vasopressors a. Worsening hypotension→ low volume 4. Life Support b. Tachycardia→ Body is working hard to pump a. Decreased LOC = may need airway protection the volume that is there & ventilation c. Weakness d. Tachypnea e. Decreased LOC f. Inadequate urinary output→ low volume=low output g. Weak pulse h. The body tries to compensate and if ti can’t organ failure occurs 2. Identify Cause. a. Some causes are vomiting/diarrhea x days, severe burns, traumatic injury, hemorrhage (surgical, obstetric) Click to Take the Quiz NURSING.com NCLEX Flash Notes ® 24 Med-Surg | Cardiac Click to View the Lesson Therapeutic Management Sinus Tachycardia 1. Find and treat the cause Overview 2. Stable a. Vagal Maneuvers, medications (Beta-Blockers, 1. Characteristics of sinus tachycardia Calcium Channel Blockers, Adenosine) a. Rhythm→ Regular 3. Unstable b. Heart rate→ >100 a. Synchronized cardioversion c. P: QRS ratio→ 1:1 d. PR interval→ 0.12-0.20 seconds e. QRS complex→ 0.06-0.12 seconds Image 6.11 Sinus Tachycardia By User:MoodyGroove - en.wikipedia.org, CC BY-SA 3.0, https://commons. wikimedia.org/w/index.php?curid=3961884 General 1. Client Presentation a. Stable b. Unstable→ Rapid heartbeat, palpitations, lightheaded, decreased cardiac output 2. Cause a. Fever, dehydration, hypotension, anemia, anxiety/fear, pain 3. Nursing Interventions a. Determine if stable or unstable and treat the cause of tachycardia Click to Take the Quiz NURSING.com NCLEX Flash Notes ® 25 Med-Surg | Ears, Eyes, Nose, Throat (EENT) Click to View the Lesson Cataracts Therapeutic Management 1. Surgery Overview a. Only curative method 2. Care post-surgery A cataract is a clouding of the lens in the eye which leads to a decrease in vision. If left untreated can lead a. Eye drops several times a day for 2-4 weeks to blindness. b. Mild itching and slight swelling is normal c. Pain control General d. Prevent increases in intraocular pressure 3. Side effects and complications 1. Cataract a. Significant swelling a. The lens has lost transparency and distorts image projected onto the retina b. Bruising 2. Diagnosis c. Infection a. Visual acuity testing→ will show a decreased d. Pain visual acuity e. Bleeding or increased discharge b. Eye exam→ Will show a cloudy lens f. Bloodshot sclera g. Decreased vision Assessment h. Flashes of light or floating shapes 1. Early findings a. Slightly blurred vision, decreased color perception 2. Later findings a. Blurred vision, double vision, difficulty with ADLs 3. Vision loss is gradual 4. Pupil appears white Image 6.88 Congenital Cataracts Click to Take the Quiz NURSING.com NCLEX Flash Notes ® 26 Med-Surg | Gastrointestinal Click to View the Lesson 5. Inflammation Cirrhosis a. Pain in RUQ b. Hepatomegaly Overview c. Splenomegaly d. Portal hypertension 1. Chronic, irreversible liver disease i. Hemorrhoids 2. Inflammation and fibrosis of liver cells ii. Varicose Veins (hepatocytes) leads to the formation of scar tissue iii. Esophageal varices that can cause a within the liver, this causes obstruction of hepatic massive GI bleed and vomiting blood blood flow and impedes proper liver function 6. Impaired Coagulation General a. Anemia b. Bleeding 1. Impaired Liver Function c. Bruising easily a. Liver is sick so it is not functioning properly i. Impaired protein metabolism Therapeutic Management ii. Increased drug toxicity because the liver cannot metabolize 1. Medications iii. ↓ Coagulation factors, ↑ Ammonia levels, ↑ a. Analgesics Bilirubin levels b. Vitamin K for clotting factors iv. ↑ LFT’s (ALT, AST, ALP) c. Antacids to ↓ irritation on the esophagus v. Impaired blood sugar regulation d. Lactulose to decrease ammonia levels 2. Complications e. Blood products if bleeding a. Hepatic Encephalopathy→ ↑ Ammonia causes f. Diuretics to remove fluid edema in cerebral tissue 2. Paracentesis to drain abdominal fluid b. Bleeding Risk→ ↓ Clotting factors 3. Dietary Restrictions→ Fluid restriction, ↓ c. Portal Hypertension→ Obstruction of blood Protein intake, ↓ Na intake flow increases pressure in the portal vein and it 4. Esophageal Varices backs up into GI circulation a. Endoscopy → cauterize, clip, or band varices d. Esophageal Varices→ Dilated, thin veins in the to prevent bleeding esophagus due to portal hypertension that can b. Sengstaken-Blakemore OR Minnesota tube rupture and bleed→ Life-threatening emergency – balloon inflated in the esophagus to put pressure on bleeding varices Assessment 1. Malaise & general fatigue 2. Anorexia 3. ↑ Bilirubin levels a. Jaundice with scleral icterus, dark urine, and clay-colored stools 4. Impaired protein metabolism a. Causes edema, ascites, and increased ammonia → Hepatic encephalopathy which will present with disorientation, altered LOC, and asterixis (flapping hand tremor) Click to Take the Quiz NURSING.com NCLEX Flash Notes ® 27 Med-Surg | Gastrointestinal Cheatsheet 6.14 Cirrhosis Nursing Care CIRRHOSIS NURSING CARE CHRONIC, PROGRESSIVE DISEASE OF THE LIVER RESULTING IN LIVER CELL DESTRUCTION AND SCARRING. COMPLICATIONS o Ascites o Hepatic Encephalopathy - Fluid accumulation in the peritoneal cavity. - Accumulation of ammonia due to liver failure o Portal Hypertension can lead to neurologic decline. - Elevated pressure in the portal vein because o Hepatorenal Syndrome of blood ﬂow obstruction through the liver. - Renal failure associated with hepatic failure. o Esophageal Variceal Bleeding o Coagulation Defects - Blood ﬂow shunts to the weaker veins in the - Liver is unable to synthesize coagulation factors esophagus. These fragile veins can rupture. making the client prone to bleeding. MAJOR ASSESSMENT FINDINGS Neurological Encephalopathy Cardiopulmonary Asterixis Fatigue Spider Angioma Edema Portal Hypertension GI Dyspnea Ascites Hypoxemia Esophageal Varices Hyperventilation GI Bleeding Hepatomegaly Integumentary Pain Jaundice Nausea/Vomiting Spider Angiomas Malnutrition Ecchymosis/Petechia Hematologic Fluid and Electrolyte Anemia Ascites DIC Hypokalemia Splenomegaly Water Retention Thrombocytopenia Edema NURSING CARE Administer Monitor Prepare Other Supplemental Vitamins Edema Patient for Paracentesis Restrict Na Enteral Feedings I&O, Weight Patient for Shunting Elevate HOB Diuretics Level of Consciousness Gastric Intubation if Indicated Blood Products Bleeding Avoid Hepatotoxic Medications Lactulose Coagulation Times Abdominal Girth NURSING.com NCLEX® Flash Notes 28 Med-Surg | Gastrointestinal Click to View the Lesson Therapeutic Management Peptic Ulcer Disease 1. Avoid aspirin and NSAIDs because they increase bleeding risk General 2. Monitor H&H and assess for bleeding 1. Causes 3. Medications→ H2 receptor antagonists, proton pump inhibitors, antacids, and sucralfate (Carafate) a. Helicobacter pylori, frequent use of NSAIDs, → take 30-60 minutes before meals smoking, and alcohol use 4. Surgical options 2. Diagnosis is done with an upper GI Series x-rays or EGD (Esophagogastroduodenoscopy) a. Vagotomy→ Cut Vagus nerves, ↓ Parasympathetic response= ↓ gastric acid Image 6.44 Peptic Ulcer Disease secretion b. Gastric resection / Gastrectomy→ Remove all or part of the stomach to remove ulcerated tissue c. Billroth I, Billroth II→ Remove a portion of the stomach and reattach to the duodenum (I) or jejunum (II) d. Post-Op: i. HOB 45° ii. Clear Liquids x 3-7 days iii. Assess Bowel sounds iv. To help the risk for Dumping Syndrome (rapid influx of gastric contents into the small intestine) avoid sugar or fatty foods, eat smaller meals, and do not consume fluids with meals Assessment 1. Nausea/Vomiting 2. Abdominal Pain a. Usually upper abdominal pain b. Often burning or sharp pain c. Gastric Ulcer→ Gnawing, sharp 30-60 minutes after a meal d. Duodenal Ulcer→ 1.5 to 3 hours after eating, pain may also be relieved by eating 3. Hematemesis (gastric) a. Vomiting of blood 4. Melena (duodenal) a. Dark black tarry feces Click to Take the Quiz NURSING.com NCLEX Flash Notes ® 29 Med-Surg | Gastrointestinal Click to View the Lesson Therapeutic Management Cholecystitis 1. Decrease gallbladder stimulation→ NPO, nasogastric decompression, avoid gas-forming Overview foods 2. Antiemetics, analgesics 1. Acute or chronic inflammation of the gallbladder. 3. Cholecystectomy a. It is caused by cholelithiasis (gallstones), duct a. Removal of gallbladder obstruction, and infection b. Abdominal splinting when coughing 2. Gallbladder stores and secretes bile into the c. Clear liquids post-op, advance as tolerated/ duodenum to aid in digestion of fats ordered 3. Uncorrected can lead to liver damage d. T-tube drainage a. Assessment i. Maintain patency of the duct b. N/V ii. High Fowler’s position c. RUQ pain→ Occurs 2-4 hours after high fat iii. Report drainage >500mL meals and lasts 1-3 hours d. Murphy’s Sign i. Pain with expiration while examiners hand is placed below the costal margin on right side at midclavicular line. ii. The client then asked to inspire and if the client is unable to inspire due to pain, the test is positive. e. Rebound tenderness over RUQ Image 6.47 Cholecystitis By James Heilman, MD - Own work, CC BY-SA 3.0, https://commons. wikimedia.org/w/index.php?curid=15996764 Click to Take the Quiz NURSING.com NCLEX Flash Notes ® 30 Med-Surg | Gastrointestinal Click to View the Lesson Therapeutic Management Inflammatory Bowel 1. Major medication classes Disease a. Corticosteroids→ ie. Methylprednisolone i. Decreases inflammation Overview ii. The risk for Cushing’s Syndrome with chronic use Autoimmune inflammatory conditions affecting the GI b. Salicylates→ i.e. Sulfasalazine tract, periods of remissions and exacerbations occur i. Inhibits pro-inflammatory chemicals (prostaglandins, interleukin-I, Tumor General Necrosis Factor) 1. Ulcerative Colitis c. Immunomodulators→ i.e. Azathioprine or Methotrexate a. Affects colon and rectum i. Decreases immune and inflammatory b. Poor absorption of nutrients response c. Edema + Lesions + Ulcers ii. Helps decrease the need for corticosteroids d. 10-20 Stools/day→ Blood & mucus d. Antidiarrheals→ i.e. Loperamide e. Avoid foods that may exacerbate symptoms i. Decrease loss of fluid and electrolytes i. Raw vegetables and fruits, nuts, popcorn, 2. Surgical options whole-grains, cereals, and spicy foods a. Bowel resection or Colectomy 2. Crohn’s i. Ulcerative Colitis – curative a. Affects entire GI tract ii. Crohn’s – palliative b. May affect other body systems (especially skin and lymphatic system) b. Surgical removal of abscesses c. Thickening + scarring + abscesses d. 5-6 Stools/day→ Pus & mucus Image 6.46 Comparison of Inflammatory Bowel Diseases By Own work - google search: “crohn Colitis ulcerosa”, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=39701853 Click to Take the Quiz NURSING.com NCLEX Flash Notes ® 31 Med-Surg | Gastrointestinal Cheatsheet 6.12 Colostomy Care COLOSTOMY CARE Stoma Locations Patient Care Patient Care Assess stoma apperance. Normal color is Special attention needs to be paid to client diet: pink to red. Report stoma that is pale, dark, purple or brown. Foods that increase gas: beer, broccoli, brussel sprouts, cabbage, Stoma appliance (bag) should be cut carbonated drinks, beans, dairy, spinach 1/16 - 1/8 in larger than the stoma. Foods that thicken stool: Cleanse stomal area and keep dry. applesauce, banana, bread, cheese, yogurt, rice, pasta Apply skin barrier before applying appliance. A small needle sized hole can be made in the Empty appliance frequently to avoid pouch to allow ﬂatus to escape. Seal with a complications. Generally when 1/3 full. bandaid. Wikiversity Journal of Medicine. DOI:10.15347/wjm/2014.010. ISSN 20018762. - Own work, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=33041231 NURSING.com NCLEX® Flash Notes 32 Med-Surg | Gastrointestinal Cheatsheet 6.13 Ulcerative Colitis vs. Crohn’s Disease ULCERATIVE COLITIS VS. CROHN'S DISEASE By Own work - google search: "crohn Colitis ulcerosa", CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=39701853 CROHN’S DISEASE: ULCERATIVE COLITIS: Progressive from rectum to cecum Especially skin & lymphatic system Poor absorption of nutrients Thickening + Scarring + Abscesses Edema + Lesions + Ulcers 5-6 Stools/day 10-20 Stools/day Pus & mucus Blood & mucus NURSING.com NCLEX® Flash Notes 33 Med-Surg | Gastrointestinal Click to View the Lesson Therapeutic Management Appendicitis 1. Avoid heat application which can lead to rupture 2. Avoid stimulation of peristalsis so keep NPO General 3. May require Appendectomy--? Keep NPO a. NG tube for decompression 1. Unknown exact cause b. Post-Op Care → Monitor VS, assess for 2. Major risk is rupture → pus and possibly fecal abdominal distention, and clear Liquids, matter spill into peritoneum causing peritonitis, and advance diet as tolerated sepsis Assessment 1. Abdominal pain at McBurney’s point 2. Pain descends to RLQ 3. rebound tenderness 4. ↑ WBC, fever 5. Fever 6. Abdominal guarding 7. SUDDEN RELIEF OF PAIN SIGNIFIES A RUPTURE→ Medical emergency and requires surgical intervention immediately Image 6.45 McBurney’s Point - Appendicitis Click to Take the Quiz NURSING.com NCLEX Flash Notes ® 34 Med-Surg | Gastrointestinal Click to View the Lesson Image 6.43 Cullens Sign in Pancreatitis Pancreatitis Overview 1. Inflammation of the pancreas 2. Autodigestion of pancreas results from long-term damage General 1. Causes a. Alcohol abuse, gallbladder disease, obstruction By Herbert L. Fred, MD and Hendrik A. van Dijk - http://cnx.org/content/ of the ducts, hyperlipidemia, peptic ulcer m14904/latest/, CC BY 2.0, https://commons.wikimedia.org/w/index. php?curid=5038484 disease (PUD) 2. Types a. Acute – occurs suddenly with most clients Therapeutic Management recovering fully 1. Suppress Pancreatic secretions through NPO diet b. Chronic – usually due to long-standing alcohol and NG tube insertion to decompress the stomach abuse with loss of pancreatic function 2. IV hydration 3. TPN for prolonged exacerbations to provide Assessment adequate nutrition 1. Abdominal pain with sudden onset, located in the 4. Endoscopic Retrograde Cholangiopancreatography mid epigastric and left upper quadrant (ERCP) to remove gallstones→ Camera inserted to 2. N/V visualize common bile duct 3. Weight loss (malabsorption) 5. Surgery 4. Abdominal tenderness a. Whipple – remove a portion of pancreas (for mass or tumor) 5. Abnormal Labs=↑ WBC, bilirubin, ALP, amylase, lipase b. Pancreatectomy – remove the pancreas, which will require Insulin, glucagon, and pancreatic 6. Cullen’s sign→ Bruising and edema around the enzyme supplementation umbilicus c. Cholecystectomy – if the source is gallbladder 7. Turner’s sign→ Flank bruising- Indicative of disease pancreatic autodigestion or retroperitoneal hemorrhage 6. Medications for pain and to control symptoms→ Analgesics, H2 blockers, proton pump inhibitors, 8. Steatorrhea – fatty, foul-smelling stools insulin, and anticholinergics Click to Take the Quiz NURSING.com NCLEX Flash Notes ® 35 Med-Surg | Gastrointestinal Click to View the Lesson Image 6.48 Ascites in Liver Failure Hepatitis General 1. Hepatitis A (HAV) a. Health care workers at risk b. Transmission is fecal-oral, person-to-person, and poorly washed hands/utensils c. Most contagious 10-14 days prior to the onset of symptoms and is self-limiting d. Prevention→ strict hand washing, Standard precautions, and Hepatitis A vaccine 2. Hepatitis B (HBV) a. Transmission by blood or body fluids through IV drug use, sexual contact, or needle Stick b. Prevention→ Standard Precautions, hand washing, blood screening, Hepatitis B vaccine, needle precautions, safe sex practices By James Heilman, MD - Own work, CC BY-SA 3.0, https://commons. 3. Hepatitis C (HCV) wikimedia.org/w/index.php?curid=15335623 a. Transmission→ Blood-borne, IV drug users, needle Stick Image 6.49 Jaundiced Eyes b. Prevention→ Standard precautions, needle safety, blood screening, NO Vaccine available 4. Hepatitis D (HDV) a. Opportunistic infection associated with Hepatitis B Virus (HBV) 5. Hepatitis E (HEV) a. Fecal/Oral route of transmission, common in underdeveloped countries Assessment 1. Preicteric Stage→ Flu-like symptoms, pain, and low-grade fever 2. Icteric Stage a. ↑ Bilirubin→ causes jaundiced skin & eyes, Therapeutic Management dark urine, and pruritus b. Clay-colored stool (lack of bile secretion) 1. Supportive therapy to address symptoms c. Elevated liver function tests (LFT’s) → AST, a. Lactulose for ↑ Ammonia levels ALT, ALP, and Ammonia b. Antiemetics 3. Posticteric Stage→ Recovery phase, laboratory c. Antihistamines→ can help treat hep C virus values return to normal, pain relief, increased 2. Antiviral therapy energy Click to Take the Quiz NURSING.com NCLEX Flash Notes ® 36 Med-Surg | Genitourinary Click to View the Lesson Image 6.52 Cloudy Urine in UTI Urinary Tract Infection Overview 1. Infection anywhere within the urinary tract (Kidneys → Ureters → Bladder → Urethra) leading to inflammation 2. Pathogens gain entrance via perineal area or via the bloodstream a. Indwelling catheters – Catheter-Associated UTI (CAUTI) b. Older males are more prone due to urinary stasis caused by an enlarged prostate Assessment 1. Urine will be cloudy, strong odor (pyuria), burning with urination, and urinary frequency and will increase 2. Confusion (altered mental status) and lethargy, especially in the elderly By James Heilman, MD - Own work, CC BY-SA 3.0, https://commons. 3. ↑ Temp, ↑ WBCs wikimedia.org/w/index.php?curid=17978816 4. Urine cultures reveal bacteria Therapeutic Management 1. Urine and Blood cultures BEFORE antimicrobials 2. Antimicrobials 3. Antispasmodic for bladder pain→ Oxybutynin 4. Analgesics→ Pyridium specifically provides relief of pain and burning with urination Click to Take the Quiz NURSING.com NCLEX Flash Notes ® 37 Med-Surg | Genitourinary Click to View the Lesson 2. Phases Acute Kidney Injury a. Onset→ Note a decrease in baseline urine output Overview b. Oliguric→ Decreased urine output 0.3 2. Blood pressures a. 140/90 or more for two occurrences i. 4 hours apart b. Or a systolic 160 mmHg or more c. Or a diastolic of 90 mmHg or more i. 140/90 & 160/90 are both classified as preeclamptic hypertension Assessment 1. So what does this client look like? a. A sudden increase in edema i. Displayed in hands and face b. Sudden weight gain i. Occurs in excess fluid retention c. Complaints of headache, epigastric, or RUQ pain d. Vision changes i. A serious symptom of preeclampsia ii. From swelling and irritation of the brain and the CNS e. Proteinuria→ MUST be present to be preeclampsia 2. Fetal assessment a. Intrauterine growth restriction (IUGR) i. Placental blood flow is not at its best Click to Take the Quiz NURSING.com NCLEX Flash Notes ® 107 (OB) Maternal Newborn Click to View the Lesson c. Syphilis Infections in Pregnancy i. Woman given penicillin and fetus receives penicillin after delivery 3. Rubella Overview a. Transmitted via placenta 1. Specific infections during pregnancy are more b. Most dangerous/serious if mother acquires this concerning due potential transmission to the fetus infection in 1st trimester (via placenta or during delivery), which can have c. Brain damage, hearing loss, miscarriage, detrimental effects on the newborn stillbirth, and various congenital defects may 2. TORCH result a. T - Toxoplasmosis d. Assess the mother’s immunity by drawing b. O - Other titer. If her titer is non-immune, then vaccinate immediately after delivery because it is a live i. ie: Group B strep (GBS), HIV, Syphilis vaccine. c. R - Rubella i. The vaccine will protect for future d. C - Cytomegalovirus pregnancies e. H - Herpes simplex 4. Cytomegalovirus (CMV) a. A very common, asymptomatic virus General transmitted through bodily fluids 1. Toxoplasmosis b. Transmitted via placenta or during delivery a. Parasitic disease transmitted to mother while and can cause intrauterine growth restriction, handling cat litter, undercooked or raw meat, or seizures, blindness, hepatomegaly, gardening; transmitted to fetus via the placenta splenomegaly, jaundice, hearing loss, microcephaly, and/or death b. Mother is typically asymptomatic but may have a rash or flu-like symptoms for anywhere from 5. Herpes Simplex a few weeks to months a. Transmitted during birth, if active lesions c. Fetal death, spontaneous abortion, and neuro present. A c-section should be done if active complications may result lesion to prevent transmission d. Educate the mother to never change cat litter b. Acyclovir may be given around 36 weeks to prevent an outbreak during labor and delivery 2. Other c. Serious neonatal complications (death, a. Group-B Strep neurologic issues, etc.) i. All women screened for this during the prenatal period by a vaginal swab 35-37 weeks ii. All women have the bacteria but the results will depend on the amount that is colonized iii. Prophylactic antibiotics (penicillin or ampicillin) given during labor to women who screen positive iv. Main cause

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