A nurse is teaching a group of college students about breast self-examination. A student asks for the best time to perform the monthly self-exam. What is the best reply by the nurse?
1. The first of every month, because it is easiest to remember 2. Right after the period ends, when your breasts are less tender 3. Do the exam at the same day and time every month 4. Ovulation, or mid-cycle is the best time to detect changes
Monday, October 26, 2009
Some questions...
Can I calculate MAP? -What does MAP indicate? -What drugs can be used to manipulate MAP? -What range should MAP be in a head injury pt. and why? -What are the complications when ICP=MAP?
Do I understand stress response and the summary points listed on pg. 33 of the red book? -What drugs can a nurse give to manipulate each listed change by the stress response system? -What objective and subjective assessment findings should a nurse anticipate related to the overall stress response by the body? ie: dependent edema r/t water retention
Do I understand how pressure gradients affect fluid movement? -What is the appropriate fluid therapy for a pt.? ie: a pt. who is third spacing or has a head injury
Do I know what a sedation vacation is? -What drugs can a nurse expect to give when a pt. is on a ventilator?
What does the Glascow Coma Score tell me about a pt.? -What are the usual assessment findings for a pt. with a head injury or a spinal cord injury? -How does injury to different areas of the spinal cord affect recovery? -How will these findings change as the pt. improves or decompensates? -What are the nursing interventions for a pt. who is decompensating?
Do I know the indications, side effects, and nursing precautions of the medications above? -How can the nurse assess the therapeutic effect of the drug administered?
A nurse is caring for a client with active tuberculosis and has a history of noncompliance. Which of these actions by the nurse would represent appropriate care for this client?
1. Instruct the client to wear a high efficiency particulate air mask in public places. 2. Ask a family member to supervise daily compliance 3. Schedule weekly clinic visits for the client 4. Ask the health care provider to change the regimen to fewer medications
A pregnant client who is at 34 weeks gestation is diagnosed with a pulmonary embolism (PE). Which of these medications should a nurse anticipate the health care provider will order?
1. Oral Coumadin therapy every other day 2. Heparin 5000 units subcutaneously BID 3. Heparin infusion to maintain the PTT at 1.5 to 2.5 times the control value 4. Laxatives containing magnesium salts
The Nursing Faculty would like to invite any students interested in hearing about and giving constructive advise about the new ADN Curriculum to attend the open forums! When: Monday October 26th Time: 1:00pm to 2:30pm Where: Locke-314
Please come and join us for some fun after your final exams. Bring your nursing class and this flyer to CPK to enjoy great food and to socialize! This is also a wonderful time to exchange books and notes with the other half of your class! We hope to see you all there.
CPK is open from 11:00 am to 9:00 pm SNA will receive 20% of all purchases (includes food, drinks, alcohol, dine-in & take out)
SNA Officers
Debbie, Angela, Sherri & Phil
new postings available in ms. antaran's docushare with topics including:
-multi-system failure -cardio -neuro -pulmonary
Monday, October 5, 2009
The ATI testing date for N007 has been moved from Tuesday to Wednesday according to Ms. Antaran.
A nurse is caring for a client who is diagnosed with asthma and has developed gastroesophageal reflux disease (GERD). Which of these medications prescribed for the client may aggravate GERD?
Hey everyone. I got an e-mail from Debbie O'Sullivan, the President of the Student Nurses' Association that the faculty at Delta College is investigating changing the nursing curriculum. They've already made some proposals and they're looking for student input. They should be having a meeting in the near future, but I don't have a date at the moment. Here are some of the proposed changes in brief, because I didn't want to print out the entire e-mail here. The proposed course list changes can't affect us, but the changes will impact the teaching future nursing students at Delta receive. If you would like a copy, feel free to e-mail me or give my your e-mail in class and I can forward them to you. There are 4 different documents that outline changes. Here's the summary:
Proposed Course List: First Semester: ADN 001 Fundamentals of Nursing ADN 002 Introduction to Medical Surgical Nursing ADN 003a Pharmacology for Nursing A
Second Semester: ADN 004 Reproductive, Maternal and Newborn Nursing ADN 005 Infancy to Young Adult Nursing ADN 003b Pharmacology for Nursing B
Third Semester: ADN 006 Neuro-Psychiatric Nursing ADN 007 Intermediate Medical Surgical Nursing ADN 003c Pharmacology for Nursing C
Fourth Semester: ADN 008 Advanced Medical Surgical Nursing ADN 009 Transition to Practice
Explanation of Proposed Changes to Philosophy and Course Conceptual Model:
Mission statement is elaborated in proposed curriculum to be more aligned with the college mission statement in order to meet NLN and BRN criteria. Updated verbiage includes references to 21st century and outcomes-based education.
The statement regarding Person is shorter in that the need to explain the former Open Systems philosophy no longer exists in proposed curriculum.
Environment is added in philosophy because it constitutes part of the Conceptual Model of the Organizing Framework. Also, Environment is added in response to CCR1426 (a) " ...It shall also take into consideration concepts of nursing and man in terms of nursing activities, the environment, the health-illness continuum, and relevant knowledge from related disciplines."
Philosophy statement regarding nursing is updated to include ANA references
Nursing Education statement modified to describe the Client Needs model and note that the curriculum is outcomes-based in nature.
Health/Illness Continuum added in response to CCR1426 (a) " ...It shall also take into consideration concepts of nursing and man in terms of nursing activities, the environment, the health-illness continuum, and relevant knowledge from related disciplines."
Come to the next SNA Meeting Monday September 21st 1:00pm to 2:30pm in Locke-118 Shari Garabaldi, an attorney, in Stockton will be our guest speaker about the legal paperwork within a patient's medical records...such as power of attorney, advance directives and more. In addition, Debbie and Angela will be answering all of your burning PDA questions. Remember that lunch is served so please come and join all the fun!
Delirium tremors could best be described as what types of observations?
1. "Disorganized thinking, feelings of terror and non-purposeful behavior." 2. "A generalized shaking of the body accompanied by repetitive thoughts expressed verbally." 3. "An excited state accompanied by disorientation, hallucinations and tachycardia." 4. "Single or multiple jerks caused by rapid contracting muscles with alternating relaxation."
SNA's Rush Week Table will be in the quad on September 4th We need some volunteers to help out at the SNA table on September 4th from 8am until 11am. If you are interested in having a great time with some of your fellow nursing students, please contact Angela Aistrup at aaistrup@sbcglobal.net or Debbie O'Sullivan at dopta@comcast.net!
Did you know that S.J. Delta College Nursing Students receive a 25% discount on Skyscape Software? This is a great deal for those of you that are purchasing PDA software. To receive this special discount, please use Delta's Portal at Skyscape. www.skyscape.com/sjdc
We hope that this new information helps to make your student nursing career a little easier!
A nurse is performing CPR on an adult who had a cardiopulmonary arrest. Another nurse enters the room in response to the call for help. After checking the client’s pulse and respirations, what should be the function of the second nurse?
1. "Relieve the nurse performing CPR." 2. "Go get the code cart." 3. "Participate with the compressions or breathing." 4. "Validate the client's advanced directive."
Thursday, August 13, 2009
The CPK Fundraiser was a great success! A big thanks to all of you that participated and supported the SNA by showing up to CPK. This event was a great way to begin a semester. Old friends reunited and a lot of new friends made! Our largest turn out was from the incoming Spring 2011 Class.
Debbie, Sherri, Phil and I appreciate everyone's suuport. Thanks again!
Hey everyone, I got an e-mail from Debbie, the SNA president, that had a list of the meetings this semester with what will be discussed. There's a lot of stuff going on this semester with the SNA, including a state convention in Sac in October. So be sure to check this and the SNA blog through a link to the column on the right. Good luck this semester!
August 31 Meet Board Members, up and coming events, Interclub Council reps committees to sign up for, and NSNA National Convention this October in Sacramento. Guest Speakers: Robin Shum from Student Success Office, Ginger Manss R.N., MSN, AOCN From St. Joseph’s Hospital, Ginger is our Regional Director for the National Student Nurses Association. She will discuss the NSNA, Our National Convention this October in Sacramento. Errisa Santiago and AG Arriola on class blogs.
September 21- Committee Members, current events, Bocce Tournament Guest Speakers Bonnie Boss on her Blog as a tutorial for NCLEX and N-1 thru 10 study info. Passing the NCLEX and Critical Care Specialist Certification she just passed. Trina Eagle on NCLEX Reviews, study tips she took to pass her boards with only 75qts. Interview questions she was given during her interviews. Angela Aistrup and Debbie O’Sullivan on Palms and Software for them.
October 19- Come and learn how to write a resume for future employers. Learn how to answer and conduct yourself in an interview. Handouts will be given on possible interview questions for future employment and student nurse extern positions. Guest speaker TBA
November 16th Elections for Spring Officers, Award nominations, Family Ties X-mas Fundraiser, Current Events, Guest Speaker from Stanislaus State University on their BSN and MSN programs. Hurst and ATI Reviews
December 7th Final Meeting. Announce new club officers, Family Ties X-mas, Current Events, Guest Speakers from Dameron Hospital Roberta Boshears Director of their Versant Program. Lori Hines Educational Director, and Erin Shelby R.N. Graduate of SJSU 2008 and recent graduate of Dameron Hospital Versant program.
A client with pneumococcal pneumonia was started on antibiotics 16 hours ago. During a nurse’s initial evening rounds the nurse notices a foul smell in the room. The client makes all of these statements during their conversation. Which one would alert the nurse to a complication of the therapy?
1. "I have a sharp pain in my chest when I take a breath." 2. "I have been coughing up foul-tasting, brown, thick sputum." 3. "I have been sweating all day all over my body" 4. "I feel hot off and on especially when I lie in bed."
Monday, August 10, 2009
Student Nurses' Association would like to invite you to our CPK Fundraiser!
When: Thursday August 13th 2009 Time: Beginning at 10am and lasting all day Where: California Pizza Kitchen in Stockton (located across the street from the college) *Please bring the attached flyer and present it to your server when ordering and the NSNA will receive 20% of your bill!
California Pizza Kitchen has graciously opened their restaurant to us 1 hour before they open to the public. This will give us time to order our food, catch up with each other/get to know new students, exchange books, buy uniform patches or learn some important information from more seasoned students. At this fundraiser the SNA will be selling uniform patches (3 patches for $15), SNA hooded sweatshirts $35, zipped sweatshirts $40 and fleece jackets $45. In addition, the SNA has been fortunate to have “Scrubs” (a uniform store located in Stockton) donate several items that we will be raffling off as door prizes at 11:00am for those student that are present at that time. We hope to see most of you there because events such as these is a great way to network with students in other semesters but also with some of your fellow classmates. Most returning students will tell you...”You need to have some friends in this program that will help you out when you need it the most!”
We look forward to see you all the there! Thank you!
A nurse is providing instructions for a client with pneumonia. What is the most important information to convey to the client?
1. "Take at least two weeks off from work." 2. "You will need another chest x-ray in six weeks." 3. "Take your temperature every day." 4. "Complete all of the antibiotic even if your findings decrease."
The nurse manager overhears a health care provider loudly criticize one of the staff nurses within the hearing range of others. The nurse manager's next action should be to take what approach?
1. Walk up to the health care provider and quietly state: "Stop this unacceptable behavior. 2. Allow the staff nurse to handle this situation without interference 3. Notify the other administrative branch of a breach of professional conduct 4. Request an immediate private meeting with the health care provider and staff nurse
A client on telemetry begins to have premature ventricular beats (PVBs) at 12 per minute. A nurse reviews the most recent laboratory results. Which lab test would require immediate action by the nurse?
A client is to receive three doses of potassium chloride 10 mEq in 100 mL of 0.9% normal saline to infuse over 30 minutes each. Which action is a priority assessment to perform before a nurse gives this medication?
A client calls the evening health clinic to state “I know I have a severely low sugar since the Lantus insulin was given three hours ago and it peaks in two hours.” What should be the nurse’s initial response to the client?
1. "What else do you know about this type of insulin?" 2. "What are you feeling at this moment?" 3. "Have you eaten anything today?" 4. "Are you taking any other insulin or medication?"
Prior to administration of Alteplase (TPA) to a client admitted with a diagnosis of a cerebral vascular accident (CVA), what serum lab value should a nurse check?
1. "Arterial blood gases and complete blood count" 2. "Potassium and magnesium" 3. "Blood urea nitrogen and creatinine" 4. "Prothrombin time and partial thromboplastin time"
Monday, June 15, 2009
if you are enrolled in the summer sociology 1B online course, don't forget to check your delta email for helpful information...the "first day of class" is today!
A 72 year-old client is scheduled to have a cardioversion. A nurse reviews the client’s medication administration record. The nurse should notify the health care provider if the client received which medication during the preceding 24 hours?
A nurse is caring for a client with end stage renal disease. What action should the nurse take to assess for patency in a fistula used for hemodialysis?
1. "Observe for edema proximal to the site" 2. "Irrigate with five mL of 0.9% Normal Saline" 3. "Palpate for a thrill over the fistula" 4. "Check color and warmth in the extremity"
On July 9th - 12th, Hurst Review Services will be conducting a NCLEX Live Review at Delta College. We need everyone who is interested to please go to their web site and sign up ASAP! The 4 day in-service is normally $350 but for new 4th semester nursing students we will only pay $250. The Nursing Success Program will be paying the other $100. Thanks so much Kim. To hold your spot please pay the $50 deposit. Hurst's web site is www.hurstreview.com. At the top of their web page you can click on "Review Schedule". Then scroll down to July 9th and click on the Delta College Review Session for more information or to sign up. If you have any additional questions or concerns, please call or email Angela Aistrup or Debbie O'Sullivan.
Angela Aistrup: 209-477-6686 or aaistrup@sbcglobal.net Debbie O'Sullivan: 209-451-4781 or dopta@comcast.net
An older adult client with tuberculosis has difficulty coughing up secretions for a sputum specimen. Which nursing action is appropriate?
1. "Spray the oropharynx with saline" 2. "Ask the client to drink a warm liquid" 3. "Force fluids for the next eight hours" 4. "Raise the head of the bed to at least 45 degrees"
Wednesday, May 20, 2009
the bridge we trek
is the road we take to our next destination.
it is nothing but a mere dash or hyphen stuck between point A and B. oh yet, how this bridge intimidated us. it was wooden and it was wobbly. unsteady to the touch, uneasy on the eyes. it made us second guess ourselves, and caused our anxiety to erupt as it has never done before. with the crowd of travelers beside us and the glorious reward just the end of the way, how could we possibly think about turning around?
winds of worry, waves of tears, earthquakes of nervous tremors, and typhoons of complications, life tried to destroy this bridge, so it appeared, a thousand times over.
but we did not fret, not enough to jump off at least. for the crowds of travelers surrounding us soon became friends. a new support system flourished. sturdy beams of friendship, arches of comic relief, and caring ears smoothed the path over. there were even bright lights, in ever changing forms, which illuminated the way, making the bridge we trek not so unbearable after all.
we have made it through one year friends.
you could say the worst part is over, or the hard part is only beginning, but halfway home sounds much better.
congratulations on completing one year of nursing school!
A nurse admits a client transferred from the emergency room (ER). The client, diagnosed with a myocardial infarction, is complaining of substernal chest pain, diaphoresis and nausea. What should be the first action taken by the nurse?
1. "Get the PRN 12 lead EKG taken" 2. "Administer morphine sulfate as ordered" 3. "Flexion of the legs with rebound tenderness" 4. "Hyperflexion of the neck with rebound flexion of the legs"
Saturday, May 16, 2009
finals schedule for N005:
Monday, May 18, 2009 starting at 0800 -75 questions worth 75 points
ATI will be on May 20, 2009 (Wednesday) in computer lab. Don't forget your ATI passcodes!
Which of these clients, all of whom have the findings of a board-like abdomen, would the nurse suggest that the health care provider examine first?
1. "An older adult client who stated, "My awful pain in my right side suddenly stopped about three hours ago." 2. "A pregnant woman of eight weeks newly diagnosed with an ectopic pregnancy." 3. "A middle-aged client admitted with diverticulitis and has taken only clear liquids for the past week." 4. "A teenager with a history of falling off a bicycle without hitting the handle bars."
A client comes into the community health center upset and crying stating “I will die of cancer now that I have this disease.” And then the client hands a nurse a paper with one word written on it: "Pheochromocytoma." Which response should the nurse state initially?
1. "Pheochromocytomas usually aren't cancerous (malignant). But they may be associated with cancerous tumors in other endocrine glands such as the thyroid (medullary carcinoma of the thyroid)" 2. “This problem is diagnosed by blood and urine tests that reveal elevated levels of adrenaline and noradrenaline” 3. "Computerized tomography (CT) or magnetic resonance imaging (MRI) are used to detect an adrenal tumor" 4. "You probably have had episodes of sweating, heart pounding and headaches"
A health care provider has ordered daily high doses of aspirin for a client with rheumatoid arthritis. A nurse instructs the client to discontinue the medication and contact the provider if which of these symptoms occur?
1. Infection of the gums 2. Diarrhea for more than one day 3. Numbness in the lower extremities 4. Ringing in the ears
A nurse is discussing with a new mother the proper techniques for breast feeding an infant. The nurse would identify an incorrect understanding and the need for additional instruction if the mother made which statement?
1. "I should position my baby completely facing me with my baby's mouth in front of my nipple." 2. "The baby should latch onto the nipple and areola areas." 3. "There may be times that I will need to manually express milk." 4. "I will give the baby a pacifier in between nursing."
It used to be easier, dealing with death. Oh, occasionally a particularly devastating case would get to me, but I worked codes with professional detachment and took care of the surviving family members with compassion and professionalism. It used to be easy. It’s not so easy anymore. ***** I knew you for a little over an hour, and the minute I saw you I knew you were dying. War had been raging inside your body for over three years; you met every battle with determination. The enemy was pernicious. Malevolent. This particular enemy always is. Silent until its damage is irreparable, it was now ready to end its rampage. I knew it. And so did you. In the few words we exchanged, you told me you were ready to “turn the page”; you were so exhausted. Bone weary. Exhaustion so deep that you didn’t have the energy to even want to fight anymore. I gave you my hand. You gave it a squeeze. Peace was at hand. Twenty minutes later you were gone. ***** As I watched your monitor slowly dissolve into that undulating line of asystole, my throat tightened and my eyes burned. I made sure your family members were comfortable and I went to the nurses station to do the required paperwork. That infernal, damned paperwork. You had just died, but God forbid that I do anything but the required paperwork. It was the most important aspect of the night. Not the fact that I was ready to cry. I made it to the bathroom, but that made it worse so I swallowed hard, came back out and talked to your doctor, the coroner and the donor network, finished your chart and sent you to our “refrigeration unit”. That’s what the transplant coordinator called it. Guess “morgue” is no longer PC. I didn’t even know you. But two hours later I was crying for you on my way home from work. ***** Why is dealing with death becoming so much harder? As a young nurse, it was what I did. It was also something that happened to other people. Is it my age that makes me more aware of my own mortality, making death that much harder to deal with? Is it that I have now buried my parents-in-law, my father, three grandparents, an uncle, an aunt and two brothers-in-law, the last four within the last 18 months? Is it because I know the feeling of the shock that sets in immediately following the split second of disbelief or the depth of the sadness that precedes the seemingly endless, painful ache? ***** I’m not sure what it is, but the more I experience death, the more it affects me and the harder it is to control my emotions. I wondered if maybe it was time for me to get out of this line of nursing, that maybe I had lost the ability to detach enough to remain the impartial professional. Then I realized, after all these years I should be thankful that I can still feel for my patients and grieve their loss. When I stop feeling for my patients, that would be the time I would need to explore another avenue of nursing. As for now, I’ll stay right where I am. From Kim an Emergency and Critical Care Nurse in the Bay Area
A nurse has been assigned to a group of clients who are receiving IV infusion potassium replacement. Which finding indicates that the nurse needs to advise the registered nurse (RN) to evaluate the client’s potassium replacement?
1. pain radiating down the outer part of the client's arm 2. complaints of belly pain and cramping 3. repeated dysrhythmia alarms on the monitor 4. abnormal 12 lead ECG report
A nurse enters a client's room to discover that the client has no pulse or respirations. After calling for help, what is the first action the nurse should take?
1. Start a peripheral IV 2. Initiate closed-chest massage 3. Establish an airway 4. Obtain the crash cart
The most effective nursing intervention to prevent atelectasis from development in a postoperative client who had a laporotomy is which of these actions?
1. Maintain adequate hydration 2. assist the client to slowly deep breathe, and cough 3. Ambulate client within 12 hours postop 4. Splint the incision with movement
Here's a joke told by a patient in Suite A at CMH to Dr. Zia, his case manager, and to the three of us doing rounds:
A mushroom wanted to make some people laugh. He starts dancing around and making faces but they are not amused. So, the mushroom leaves and comes back in a clown suit. They still don't think it's funny. The mushrrom gets frustrated and says, "Oh, come on! I'm a fun guy!"
I just wanted to say thank you to Ann and all of you now in Nursing 5 for posting the study guides on here to share. It is soooo helpful and very thoughtful of you all. I am glad to know that we all are willing to help each other out! Thanks again! P.S. ONE MORE YEAR!!
A nurse is caring for a client diagnosed with a distal tibia and mid-femur fracture. The client has had a closed reduction and application of a long leg plaster cast. Thirty-six hours after surgery, the client suddenly becomes confused, short of breath and spikes a temperature of 103 degrees Fahrenheit. What should be the first action by the nurse with a focus to collect data?
1. check the orientation to time, place, and person 2. obtain the pulse oximetry reading 3. check the distal circulation of the casted extremity 4. take the blood pressure lying and sitting in a Fowler's position
"...I am happy it is only a two year program too because oh my god this is stressful, and when the dean said in the beginning “You won’t have a life.” I now know she wasn’t kidding."...
A nurse, during reinforcement of information to parents about situations of accidental poisoning in children, should discuss which information?
1. Start treatment before calling the Poison Control Center 2. Empty the child's mouth in any case of possible poisoning 3. Do not move the child if a toxic substance was inhaled 4. Induce vomiting if the poison is a petroleum product
Isabel Romena- -powerpoint presentations are directly from the book, DIRECTLY, but it is a good idea to read over them anyway, particularly the NP >not all information from the ppt will be tested -listen during lecture, paying special attention to scenarios she brings up, many of these show up on the test >"So your neighbor complains to you about symptoms she has been experiencing..." >"What would you do if a patient is exhibiting these symptoms..." >there are also personal experiences she brings up to incorporate into lecture -do the study guides -read the chapters, but not the whole thing, there is too much! instead take the questions from the study guide and read the section corresponding to it. >ie: the study guide question is asking about types of fractures, read that entire section because small details show up on the tests at times >if you cannot read, read the related charts at minimum -know your diagnostic tests and labs, not necessarily the ranges, but diagnostic tests/labs which can diagnose a patient's problem or determine if a treatment is working effectively -know your "at risk" patients for each disease studied -and no...the Lewis study worksheets were not THAT helpful
Caralee Bromme- -a majority of test questions come from the lecture -points which are emphasized during lecture are generally tested -know your diagnostic tests and ranges for labs -answer the study guide questions from the lecture first, particulary the NP questions -understand pathology of the disease process -make certain you understand the concept of fluids and electrolytes
*continue to perfect your testing skills using ATI practice tests, test banks, and the program in the nursing computer lab...
Which intervention would a nurse find most effective to promote healing in a client diagnosed with a venous stasis ulcer?
1. Apply the dressing using sterile technique 2. Improve the client's nutrition status 3. Initiate automatic compression therapy of the limb 4. Begin the ordered proteolytic debridement
Ch. 62-Nursing Assessment: Musculoskeletal System 1. Explain the effects of aging on the MS system. -joint and muscle discomfort -loss of bone density -decreased tendon flexibility and muscle strength -vertebral disc compression causing loss of height
2. Explain the different diagnostic tests of the musculoskeletal system and related nursing care. *standard x-ray: determines bone density -avoid unnecessary exposure and ensure patient is not pregnant *diskogram: contrast dye x-ray to determine intevertebral disk abnormalities -assess for allergy *CT scan: identifies soft tissue and bony abnormalities and musculoskeletal trauma -painless, assess for allergy *myelogram: sensitive test able to pick up nerve impingement and subtle lesions and injuries -risk for spinal headache which should resolve in 1-2 days with rest and fluids *MRI: used to diagnose avascular necrosis, disk disease, tumors, osteomyelitis, ligament tears, and cartilage tears -check for contraindications such as metal on clothing or metal implants like pacemakers *DEXA: diagnose metabolic bone disease and monitor treatment progress -painless *QUS: measures bone density, elasticity, and strength of patella and calcaneous with ultrasound -painless *bone scan: radioisotope injection uptake by bone is monitored -explain procedure *arthroscopy: visualization of joint structure and contents using an arthroscope -performed with strict asepsis, cover wound with sterile dressing *mineral metabolism/serologic studies: studies of minerals and antibodies in the body -obtain blood samples and observe for bleeding/hematoma *arthrocentesis: puncture into joint capsule to obtain synovial fluid -apply compression dressing and observe for leakage; send samples for examination *electromyogram (EMG): evaluation of skeletal muscle contraction by insertion of small needles -avoid stimulants and inform patient of discomfort with needle insertion *duplex venous doppler: ultrasound to detect blood flow abnormalities -painless *thermography: infrared detection of heat radiation on skin surface -painless *plethysmography: records variations of volume and pressure of blood through tissues -painless *somatosensory evoked potential (SSEP): similar to EMG with electrodes placed to the skin -no needles involved
Ch. 63-Nursing Management: Musculoskeletal Trauma and Orthopedic Surgery 1. Identify patients at risk for musculoskeletal injury. -young, elderly, women, occupations with high risks, history of injury
2. Explain the assessment findings and interventions for acute soft tissue injury. *assessment -edema -ecchymosis/contusion -pain/tenderness -decreased sensation -decreased pulse, coolness, and cap refill of >2 seconds -decreased movement -pallor -shortening or rotation of extremity -inability to bear weight if injury to lower extremity -limited function if injury to upper extremity -muscle spasms
*interventions -ensure ABCs -assess neurovascular status of affected limb -RICE -anticipate x-rays -pain relief -give tetanus or diptheria prophylaxis if skin integrity is broken -give antibiotic prohylaxis for open fractures -monitor neurovascular status -monitor for compartment syndrome -monitor for infection/sepsis
3. Explain the different stages of fracture healing and nursing implications. -fracture hematoma: semisolid clots of blood surrounding ends of fragments 72 hours after injury -granulation tissue: hematoma converts to granulation tissue which is the basis of new bone formation 3-14 days after injury -callus formation: cartilage, osteoblasts, calcium, and phosphorus woven about the fracture parts and can be verified by x-ray 2 weeks after injury >assist with ADLs if necessary -ossification: ossification of callus prevents movement of fracture 3 weeks to 6 months after injury >cast may be removed and limited mobility is allowed -consolidation: distance between fracture eventually closes >x-ray determines radiologic union of fracture -remodeling: excess bone tissue is resorbed and bone gradually returns to preinjury shape and strength >introduce exercise, then weight bearing activities
4. Describe the different fracture reduction techniques. -closed reduction: non-surgical, manual realignment of bone fragments, followed by immobilization of alignment until healing occurs >skin/skeletal traction -open reduction: invasive correction of bone alignment using pins and wires -traction: pulling and counteraction forces (weights) applied to affected part to prevent or reduce muscle spasm, immobilize affected part, reduce fracture or dislocation, and treat pathological joint condition
5. Use the NP to provide care to a patient with mandibular wiring, post-hip replacement, and post-lower limb amputation. *mandibular wiring -maintain patent airway, oral hygiene, communication, and nutrition -position with wire side up -keep wire cutters at bedside in case of respiratory or cardiac emergency -keep tracheostomy tray at bedside -frequently rinse mouth -use communication boards -provide appetizing liquid choices for diet -check for GI functioning -address concerns with body image *post-hip replacement -general nursing care of post-operative patient -assess for CSMPT -use pillows for log rolling -avoid extreme flexion or rotation at hip until soft tissue has healed -avoid turning on affected side -keep abductor pillow between legs -apply CPM as ordered -teach patient on correct positioning and risky activities *post-lower limb amputation -general post-operative nursing care -monitor VS and dressing -sterile technique dressing changes -avoid prolonged sitting or pillow under extremity to avoid contractures -correct bandaging to foster correct shape -ROM exercises
6. List and explain the problems/outcomes of fractures and related nursing care. -muscle atrophy: decreased muscle mass following a period of disuse or loss of nerve innervation >implement passive exercises within the confines of mobilization device to prevent muscle atrophy -contracture: flexion and fixation of joint caused by shortened muscles, loss of skin elasticity, and atrophy >progressive stretching, passive ROM exercises, repositioning, and correct body alignment -footdrop: shortened Achilles tendon caused by disuse >apply foam boots and other preventative measures -pain: associated with injury >correct any underlying problems such as repositioning the patient or loosening dressings before medicating -muscle spasms: involuntary muscle contracture which could lead to pain >thermotherapy, especially heat
7. List and explain the complications resulting from fractures. -infection: open fractures are vulnerable to contamination with bacteria -compartment syndrome: compromised tissue integrity and confined myofascial space cause increased compartment pressure >causes pressure pain, may cause loss of function if not addressed -venous thrombosis: lower extremity thrombus formation is common with injury and can travel up after periods of immobility -fat embolism syndrome: free fat droplets are released from injured bone or at the time of trauma and can cause an embolism
8. Use the NP to provide care to a patient with these complications. *infection -assess for signs and symptoms of infection -implement aggressive surgical debridement -administer antibiotics -maintain clean technique when dealing with wound *compartment syndrome -recognize signs and symptoms of compartment syndrome -extremity should not be elevated above heart level -ice should not be used -loosen or remove bandages, bivalve casts, or reduce traction weight -surgical fasciotomy my be necessary *venous thrombosis -TED hose/SCDs -ROM exercises -administer anticoagulant drugs as ordered *fat embolism syndrome -CDB -immobilize long bone fractures -manage symptoms with fluid replacement and maintain airway/breathing
Ch. 64-Nursing Management: Musculoskeletal Problems 1. Explain the pathophysiology of osteomyelitis and osteoporosis. -osteomyelitis: severe infection of bone, bone marrow, and surrounding soft tissue causing increased pressure and vascular compromise of periosteum -osteoporosis: bone resorption is greater than bone deposition causing weakened bone prone to fractures, both spontaneous and secondary to minor trauma
2. Use the NP to provide care for a patient with osteoporosis and osteomyelitis. **osteoporosis *assessment -subjective: age, family history, genetics, early menopause, sedentary lifestyle, anorexia, oophorectomy, history of smoking, alcohol use -objective: weight/height, low calcium intake, low testosterone levels -dx: serum calcium, bone mineral densitometry, x-ray
*diagnoses -risk for injury
*planning -nutritional therapy -calcium supplementation -exercise -prevention of fractures -drug therapy: estrogen replacement and increase bone resorption
*implementation -diet high in calcium or supplement calcium/vitamin D -weight bearing exercises -quit smoking and decrease alcohol consumption -estrogen therapy
**osteomyelitis *assessment -subjective: bone trauma, infection, bone surgery, IV drug abuse, chills, weight loss, weakness, muscle spasms, local tenderness, irritability, withdrawal, anger -objective: restlessness, night sweats, edema, diaphoresis, restricted movement, wound drainage -dx: bone or soft tissue biopsy, CBC, ESR, bone scan, CT, MRI
*planning -pain and fever control -no secondary complications -follow treatment plan -maintain positive outlook
*implementation -immobilization to decrease pain -drug therapy -relaxation techniques -drainage dressing changes in sterile technique -repositioning for patients on bedrest -monitor for adverse side effects of drug therapy
3. Use the NP to provide care after spinal surgery. -maintain proper body alignment: log roll, use pillows or wedges, one or more staff members to move -pain control -fluid replacement -assess for CSF drainage -monitor neurological signs -monitor GI/GU system for functionality -patient teaching: avoid long periods of standing or sitting, mentally think through an activity to avoid injury and pain
Ch. 65-Nursing Management: Arthritis and Connective Tissue Diseases 1. Explain the pathophysiology of osteoarthritis, rheumatoid arthritis, gout and SLE. *osteoarthritis: damage to cartilage triggers metabolic response -body attempts to repair weakened cartilage leading to fissuring and erosion at joint surfaces -pain caused by bone contact after cartilage is destroyed *rheumatoid arthritis: pannus, or high vascular granulation tissue, forms within joint covering and eroding cartilage -inflammatory cytokine production also contributes to destruction of cartilage -causes tendon and ligament scarring and shortening *gout: marked by hyperuricemia; deposits of sodium urate crystals cause sudden swelling and pain in articular, periarticular, and subcutaneous tissues *SLE: production of antibodies against nucleic acids, particularly directed against the make-up of the cell nucleus -can deposit basement membrane of capillaries in a variety of locations in the body triggering an aggressive inflammatory response by the complement system
2. Use the NP to provide care to client with osteoarthritis, rheumatoid arthritis, gout and SLE. **osteoarthritis *assessment -subjective: type, location, severity, frequency, and duration of joint pain; effects on ADLs, pain relief measures -objective: tenderness, swelling, ROM, crepitation, and comparison of affected joints -dx: CT, MRI, x-ray, and synovial fluid analysis
*diagnoses -acute and chronic pain -insomnia -impaired physical mobility -self-care deficit -imbalance nutrition: more than body requirements -chronic low self-esteem
*planning -maintain/improve joint function with periods of rest and activity -provide joint protection measures to improve activity tolerance -optimize ADLs -manage pain using drug therapy and non-pharmacologic strategies
*implementation -drug therapy -heat/ice packs -relaxation techniques -highly individualized depending on patient’s progression of disease
**rheumatoid arthritis *assessment -subjective: infection, joint surgery, medications, family history, anorexia, weight loss, swelling or weakness of joints, numbness and tingling to hands and feet, pain and aching of joints with activity -objective: fever, peripheral edema, skin ulcers, shiny/taut skin over joints, symmetric pallor and cyanosis of fingers (Raynaud’s phenomenon), chronic bronchitis, Felty syndrome, joint deformity -dx: positive rheumatoid factor, synovial fluid analysis
*planning -pain relief -minimize loss of affected joint functioning -plan and carry out therapeutic regimen -maintain positive self-image -maximize self-care
*implementation -drug therapy -heat/ice packs -relaxation techniques -highly individualized depending on patient’s progression of disease
*implementation -drug therapy -patient education: avoid overindulgence and excessive caloric intake of foods containing purines and other precipitating factors
**SLE *assessment -subjective: depression, withdrawal, irregular menstrual periods, visual disturbances, headache, diarrhea, dyspnea, fatigue, weight loss, dysphasia, frequent infections, photosensitivity with rash -objective: proteinuria, arthritis, facial weakness, hallucinations, disorientation, dysrhythmias, symmetric pallor and cyanosis of fingers, murmurs, decreased breath sounds, alopecia, butterfly rash, leg ulcers, fever, edema -dx: presence of assorted antibodies in the body (anti-Smith and anti-DNA)
*planning -pain relief -comply with therapeutic regimen -awareness of activities which could cause exacerbation -optimal functioning and self-image
*implementation -individualized periods of activity and rest -drug therapy and relaxation techniques -monitor skin for breakdown -educate on signs and symptoms of exacerbations
3. Explain the mode of action and resulting nursing care of the different drug categories used in the management of these conditions. *osteoarthritis: -acetaminophen: for mild to moderate joint pain >should not exceed 4 grams daily -topical creams: works to stop transmission of pain impulses -NSAIDS: for moderate to severe pain, working by blocking prostaglandins >risk for bleeding with warfarin and GI side effects -antibiotics: decreases loss of cartilage with OA of the knee >monitor treatment effectiveness -hyaluronic acid (HA): supplements substances found in normal joint fluid and articular cartilage
*rheumatoid arthritis: -disease-modifying antirheumatic drugs (DMARDS): lessen permanent effects of RA >potential for bone marrow intoxication and hepatotoxicity -NSAIDS: anti-inflammatory effects >may be used when patient is intolerant of high aspirin doses -biologic/targeted drug therapies: slows disease progression >follow schedule of injections; anakinra and abatacept should not be used in combination with TNF inhibitors -corticosteroids: temporarily relieves pain and inflammation symptoms experienced during flare-ups >can be used until DMARDS effects can be seen, but should not be a long-term therapy
*gout: -colchicine: anti-inflammatory with no analgesic effect >monitor effectiveness as it may add to evidence to diagnose gout -NSAIDS: pain management >used in combination with colchicine -allopurinols: blocks production of uric acid >patients who cannot tolerate side effects can be switched to oxypurinol -selective xanthine oxidase inhibitor: reduces serum uric acid
*SLE -NSAIDS: pain management >monitor GI effects -antimalarial agents: used in combination with NSAIDS to treat fatigue, and moderate skin/joint problems >monitor for retinopathy; may be switched to anti-leprosy drugs if not tolerated -corticosteroids: used sparingly to control polyarthritis exacerbations >monitor for toxicity and side effects
Next Thursday, the Student Nursing Association will be holding a fundraiser at California Pizza Kitchen. Just show up to California Pizza Kitchen and buy something to eat or drink and hand them a flyer and 20% of the bill will go to the Student Nursing Association. The fundraiser was scheduled between the two classes so that it gives everyone a time to relax and talk to other nursing students there about what to expect for the rest of the semester. It will be a great time to find out about the Nursing 4 and 5 classes and encourage the Nursing 2 students. I tried to add a copy of the flyer at the bottom of this post. You should be able to click it to open it so you can print one yourself. If you can't print one feel free to email me and I can send you a copy of it. If you have any questions just ask!
The counseling office recommends getting transcript evaluations before graduation. This way, the student knows which classes still need to be completed before receiving a degree. Right now is a good time to do so because it takes some time for them to evaluate the transcript. All you need is an official transcript of all schools attended and an evaluation form from the counseling office. Once the paper is filled out, turn it into Admissions and Records. Find out what classes you need because the summer is a perfect time to complete these classes!
Ch. 17-Fluid and Electrolytes 1. Review calcium regulation. -present in the body as free or ionized, bound to proteins like albumin, and complexed with phosphate, citrate, or carbonate -serum calcium levels reflect all three forms *plasma acidosis: decreases albumin bound calcium, thus increasing ionized calcium *plasma alkalosis: increases albumin bound calcium, thus decreasing ionized calcium *calcium balance controlled by parathyroid hormone (PTH), calcitonin, and vitamin D -PTH: produced by parathyroid gland and stimulated by low serum calcium >increases movement of calcium out of bones, GI absorption of calcium, and renal tubule reabsorption of calcium -calcitonin: produced by thyroid gland and stimulated by high serum calcium >opposes PTH action—decreases GI absorption, increases calcium deposition into bone, and promote renal excretion -vitamin D: formed through UV rays in precursors found in skin or diet >aids in absorption of calcium in GI
2. Identify clients at risk for calcium imbalance. *hypercalcemia -hyperparathyroidism -malignancies: cause bone destruction from tumor invasion or secrete a parathyroid-like protein to stimulate calcium release from bones -vitamin D overdose -prolonged immobility: bone mineral loss and increased plasma calcium concentration -rarely occurs from increased calcium intake *hypocalcemia -removal or injury of parathyroid gland -acute pancreatitis: causes lipolysis which produces fatty acids that combine with calcium ions -multiple blood transfusions: citrate used as anticoagulant binds to calcium -low calcium diet or decreased absorption from laxative abuse or other syndromes
3. Recognize the signs and symptoms of hypercalcemia and hypocalcemia. *hypercalcemia -reduced excitability of muscles and nerves: decrease in memory, confusion, disorientation, fatigue, muscle weakness, constipation, cardiac dysrhythmias, and renal calculi *hypocalcemia -increased excitability of muscles and nerves: tetany, manifested by Chvostek’s sign and Trousseau’s sign, laryngeal stridor, dysphasia, numbness and tingling around the mouth or in extremities, and ventricular tachycardia from decreased cardiac contractility
4. Use the NP to provide care to a client with a calcium imbalance. *assessment -subjective: ALOC, confusion, memory loss, fatigue, muscle weakness, numbness and tingling around mouth and extremities -objective: disorientation, constipation, cardiac dysrhythmias, renal calculi, tetany, dysphasia, laryngeal stridor -dx: serum calcium levels, ionized calcium levels
*diagnoses -risk for injury
**planning/implementation *hypercalcemia -promote excretion of calcium in urine: loop diuretics, hydrate with isotonic saline solutions, 3000-4000 ml fluid intake (also to decrease kidney stone formation) -lower serum calcium levels: synthetic calcitonin, low calcium diet -enhance bone mineralization: mobilization with weight-bearing activity -Aredia: hypercalcemia associated with malignancy; inhibits osteoclast action which breaks down bone and releases calcium as a result -Mithracin: cytotoxic antibiotic; inhibits bone resorption to lower serum calcium levels *hypocalcemia: treat the underlying cause -oral or IV calcium, but not IM -high calcium diet with vitamin D supplements or calcium supplements for low tolerance of dairy products -treat pain and anxiety to prevent respiratory alkalosis induced hypocalcemia
Ch. 48-Nursing Assessment: Endocrine System 1. Review the normal regulation of hormonal secretion. -stimulate or inhibit hormone synthesis or secretion using: *simple feedback: based on blood levels of a particular substance -negative feedback: increase or decrease of secretion depending >calcium regulation: low serum calcium stimulates PTH to increase calcium levels, once achieved the increased calcium levels inhibit further PTH release -positive feedback: increases target organ action beyond normal >pressure receptors in the vagina during birth stimulate more oxytocin secretion to make stronger uterine contractions *complex feedback: hormone stimulation or inhibition involving multiple glands *nervous system control: hormone secretion directly affected by nervous system actvity like pain, emotion, sexual excitement, and stress *physiologic rhythms: secretions by rhythms originating in the brain structure like the circadian rhythm related to sleep-wake or dark-light cycles
2. Review the actions of the different hormones and their sources. **hypothalamus: secretes releasing and inhibiting hormones to the anterior pituitary gland to stimulate or inhibit release of hormones *releasing hormone: -corticotropin-releasing hormone (CRH) -thyrotropin-releasing hormone (TRH) -growth hormone-releasing factor or somatotropin-releasing hormone -gonadotropin-releasing hormone (GnRH) -prolactin-releasing hormone *inhibiting hormone -somatostatin: inhibits growth hormone release -prolactin-inhibiting hormone **anterior pituitary *tropic hormone: precursor hormones with control the secretion of hormones by other glands >thyroid stimulating hormone (TSH), adrenocortiocotropic hormone (ACTH), follicle stimulating hormone (FSH), and luteinizing hormone *growth hormone: affects growth and development of skeletal muscle and long bones *prolactin: stimulates breast development for lactation after childbirth **posterior pituitary: hormones actually produced in hypothalamus, but stored here until release is triggered *antidiuretic hormone (ADH): regulates fluid volume by stimulating reabsorption of water in renal tubules, making concentrated urine; also a potent vasoconstrictor *oxytocin: stimulates ejection of milk into mammary glands and contraction of uterine smooth muscle **thyroid gland: regulated by TSH from anterior pituitary *thyroxine (T4) and triiodothyronine (T3): affect metabolic rate, caloric requirements, oxygen consumption, carbohydrate and lipid metabolism, growth and development, brain functions, and other nervous system activities *calcitonin: lowers serum calcium levels by inhibiting calcium resorption from bone, increasing calcium storage in bones, and increasing kidney excretion of calcium and phosphorus **parathyroid glands *parathyroid hormone (PTH): regulate blood level of calcium -stimulates bone resorption and inhibits bone formation -increases calcuim reabsorption and phosphate excretion -stimulates conversion of vitamin D in most active form to enhance intestinal absorption of calcium **adrenal glands *adrenal medulla -catecholamines: stress response neurotransmitters *adrenal cortex: any hormones secreted are referred to as corticosteroids except androgens -cortisol: glucocorticoid; regulates blood glucose concentration by stimulating hepatic conversion of amino acids to glucose; necessary to maintain life >antiinflammatory action, maintains vascular integrity and fluid volume -aldosterone: mineralocorticoid; maintain extracellular fluid volume by promoting reabsorption of sodium and excretion of potassium and hydrogen ions -adrenal androgens: stimulates pubic and axillary hair growth and sexual drive in females in the form of estrogen >negligible amounts in men **pancreas (islets of Langerhans) *glucagon: increases blood glucose through stimulation of glycogenolysis, gluconeogenesis, and ketogenesis *insulin: facilitates glucose transport into cell membrane
3. Effects of the sympathetic and parasympathetic system. -insulin secreted by both systems
Ch. 49-Nursing Management: Diabetes Mellitus 1. Differentiate the pathophysiology of the different types of DM. -Type 1 DM: destruction of islets by immune system, therefore there is a little to no insulin production -Type 2 DM: pancreas can produce insulin, but is insufficient and/or poorly utilized by the body -Gestational: high blood glucose during pregnancy and high risk of developing type 2 diabetes -Pre-Diabetic: not enough to be diagnosed, but high risk of type 2 diabetes if not treated >Fasting glucose and OGTT higher than normal -Secondary Diabetes: result of another medical condition or treatment which causes high glucose levels
2. Differentiate normal, pre-diabetic, and diabetic blood-glucose levels. -normal: 70-120 mg/dl -pre-diabetic: >100 -<126>140-<200 mg/dl casual -diabetic: >126 mg/dl when fasting or >200 mg/dl casual
3. Use the NP to provide care to a pre-diabetic patient and a diabetic patient. *assessment -subjective: obesity, family history, history of viral infections, surgery, or medical conditions, thirst, hunger, poor healing -objective: Kussmaul respirations (rapid, deep breathing with fruity odor), weight loss -dx: Hb A1c, FSBG, IGT, IFG
*diagnoses -ineffective theraupeutic regimen management -risk for injury -risk for infection -powerlessness -imbalanced nutrition: more than body requirements
*planning -active patient participation -few or no episodes of acute hyperglycemic emergencies or hypoglycemia -maintain blood glucose within normal range -prevent/delay chronic conditions -maintain ADLs with minimal stress
*implementation -identify those at risk -teach how to monitor blood glucose regularly -teach insulin therapy -emphasize personal hygiene and foot care -medical alert bracelet and ID
4. Know the action of the oral hypoglycemic agents. *not insulin, works to improve mechanisms which insulin and glucose are produced and used *three main actions: increases insulin production from pancreas, decreases glucose production from liver, and/or improves insulin use by body -sulfonylureas (Glucotrol, Amaryl): increases insulin production from pancreas -meglitinides (Prandin, Starlix): increases insulin production from pancreas -biguanides (Glucophage): decreases glucose production from liver, improves insulin use by body -alpha-glucosidase inhibitors (Precose): slows absorption of carbohydrates in small intestine -thiazolidinediones (Actos, Avandia): greatly improves insulin use by body
5. Know the onset, peak action, and duration of the different types of insulin. *rapid-acting (Humalog, Novolog, Apidra, Exubera): peaks 60-90 minutes -onset: 15 minutes -duration: 3-4 hours *short-acting (regular): peaks 2-3 hours -onset: 30-60 minutes -duration: 3-6 hours *intermediate-acting (NPH): peaks 4-10 hours -onset: 2-4 hours -duration: 10-16 hours *long-acting (Lantus, Levemir): no peak -onset: 1-2 hours -duration: 24+ hours
6. Explain the information needed to teach a diabetic patient about exercise and the management of their diabetes. -teach patient it is essential to diabetes management because it increases insulin receptor sites, lowers blood glucose, and contributes to weight loss -individualized exercise plan: done after medical clearance with a gradual progression -monitor blood glucose before, during, and after -exercise after meals with small carbohydrate snacks every 30 minutes
7. Explain the pathophysiology of DKA, HHS, hypoglycemia and hyperglycemia. *DKA: profound deficiency of insulin causes breakdown of fat with ketones as a byproduct -lowers pH causing metabolic acidosis -ketones are excreted in the urine and electrolytes become depleted *HHS: inadequate hydration paired with polyuria cause blood glucose to be >400 mg/dl and high serum osmolality *hypoglycemia: too much insulin in proportion to glucose in the blood *hyperglycemia: too much glucose in proportion to insulin in the blood
8. Use the NP to provide care for a patient with DKA, HHS, and hypoglycemia **DKA *assessment: -subjective: type 1 diabetes, illness or infection, poor self management, neglect, lethargy, weakness, nausea, vomiting -objective: inadequate insulin dosage, dehydration, abdominal pain, Kausmall respirations (rapid, deep rhythm), fruity smelling breath -dx: blood glucose >300 mg/dl, ABG pH <7.3,>add D5 to prevent hypoglycemia when blood glucose levels approach 250 mg/dl >replace potassium >sodium bicarbonate, if pH <7>400 mg/dl, increased serum osmolality, and little to no ketone bodies in blood or urine (unlike DKA because of circulating insulin)
*diagnoses: -risk for injury
*planning (like DKA): -maintain patent airway -correct fluid/electrolyte imbalance, more than DKA -insulin therapy (after fluids have begun)
*implementation: -administer oxygen -1/2 NS or NS to restore urine output and blood pressure >add D5 to prevent hypoglycemia when blood glucose levels approach 250 mg/dl >replace potassium >sodium bicarbonate, if pH <7>70 mg/dl, investigate further; begin treatment if <70 mg/dl --alert patients should be given 15-20 g of a simple carbohydrate like orange juice --avoid fatty foods as they decrease absorption of sugar --continue to monitor BG and give scheduled snacks -if after 2-3 doses of simple carbohydrates do not work or the patient is not alert --administer 1 mg of glucagon IM or SQ --give complex carbohydrate after recovery --20-30 ml D50 IVP in acute care setting
9. List and explain the chronic complications resulting from diabetes. *microvascular angiopathy: thickening of capillary and arteriole vessel membranes particularly in the eyes, kidneys and skin -retinopathy: --proliferative: most severe; occlusion of small blood vessels involving retina and vitreous --non-proliferative: most common; partial occlusion of small blood vessels in retina -neuropathy: damage of vessels which supply blood to glomeruli of kidneys; nerve damage caused by metabolic complications of diabetes --sensory: abnormal sensation of hands and/or feet bilaterally --autonomic: can affect nearly all body systems -integumentary problems: infection and necrosis caused by a combination of loss of nerve sensation and poor blood circulation
10. Use the NP to provide care to a patient specific to each of these complications. *angiopathy: *retinopathy: treat early with annual dilated eye exams -photocoagulation -cryotherapy -vitrectomy *neuropathy: tight glucose control, BP management, yearly screening of microalbuminuria in urine and serum creatinine, drug therapy *integumentary problems: treat infections quickly and vigorously
Ch. 50-Nursing Management: Endocrine Problems (incomplete) 2. Differentiate between the signs and symptoms of Addison's disease and Cushing's disease. -Addison's disease: lack of corticosteroids; progressive weakness, fatigue, weight loss, skin hyperpigmentation, anorexia, confusion -Cushing's disease: excess corticosteroids; weight gain (moon face, trunk weight, water retention), secondary diabetes, purple-red straie, slow wound healing,
A client has been admitted with complaints of lower abdominal pain, difficulty swallowing, nausea, dizziness, headache and fatigue. During the initial observation the client exhibits agitation, fearfulness, and tachycardia. The client remarks, "I am too sick to return to work." The client is diagnosed as having somatoform disorder. During a team discussion of the plan of care, a nurse should consider that the behavior is?
1. controlled by the subconscious mind 2. manipulative to avoid work responsibilities 3. usually responsive to a variety of strategies 4. modifiable through reality therapy
A client is admitted with the diagnosis of infective endocarditis (IE). History of which finding is most important for the nurse to report to the registered nurse (RN)?
1. tiredness and drowsiness 2. a rash that appeared suddenly 3. fever for the past 24 hours 4. clubbing of the nails
Sunday, February 8, 2009
Student Nurses Association Meeting Agenda February 23, 2009 1:00pm in Locke-229
I. Call Meeting to Order II. Welcome III. Approval of January 26, 2009 SNA Meeting Minutes IV. Old Business V. New Business
CPK fundraiser for March
Easter Toy Drive for Family Ties (Easter April 12th)
Reimbursements
Reorder needed items
SNA Leadership Award
VI. PDA Party with Mr. Meza VII. Raffle of T-shirts and Unbound Nursing Software IX. Adjournment
Ch. 56-Nursing Assessment: Nervous System 1. Review the functions of the cerebral lobes. *frontal: higher cognitive function, memory retention, voluntary motor movement, voluntary eye movement, expressive speech *temporal: receptive speech, integration of somatic, visual, and auditory data *parietal: sensory cortex, control and interpret spatial information *occipital: sight processing
2. Describe the effects of aging on the nervous system. *CNS -loss of neurons in certain areas of brainstem, cerebellum, and cerebral cortex >enlargement of ventricles >decreased brain weight >decreased blood flow >decreased CSF production -glycosylated hemoglobin (Hb A1C): risk factor for accelerated cerebral atrophy *PNS -changes to anterior horn cells, peripheral nerves, and target organ muscle -deteriorated myelin sheath, therefore decreased nerve conduction -decreased neuromuscular activity >slower BP response to position change and body temperature *additional relevent changes -decreased memory, vision, hearing, taste, smell, vibration/position sense, muscle strength, and reaction time >decreased dietary intake >increased perceptual confusion >fall/fracture risk
3. Differentiate the effects of the sympathetic and parasympathetic nervous system. *both are part of the autonomic nervous system which governs involuntary functions of cardiac muscle, smooth (involuntary) muscle, and glands -sympathetic nervous system (T1-L2): “fight or flight” response >release of norepinepherine and acetylcholine >occurs throughout body >imagine what the body would do if a bear was attacking you -parasympathetic nervous system (S2-S4): conserves and restores energy stores of the body >releases acetylcholine >acts in localized and discrete regions of the body >imagine what the body would do after thanksgiving dinner
4. Explain common neurological assessment abnormalities. *mental status -ALOC: unable to speak, obey commands, or open eyes appropriately with verbal or painful stimulus -anosognosia: unable to recognize bodily defect or disease *speech -aphasia: loss of language faculty -dysphasia: difficulty with use of language -dysarthria: lack of coordination in articulating speech *eyes -aniscoria: unequal pupil size -diplopia: double vision -homonymous hemianopsia: loss of vision in one eye *cranial nerves -dysphasia: difficulty swallowing -ophthalmoplegia: paralysis of eye muscles -papilledema: “choked disc”; swelling of optic nerve head *motor system -apraxia: inability to perform learned movements -ataxia: lack of coordination in movement -dyskinesia: fragmentary movements due to impairment of power -hemiplegia: one-sided paralysis -nystagmus: jerking of eyes while tracking objects -opisthotonus: arching of back with head retraction *sensory system -analgesia: loss of pain sensation -anesthesia: absence of sensation >hyperesthesia/hypoesthesia: increase/decreased in sensation -astereognosis: inability to recognize object form by touch *reflexes -Babinski’s sign: upgoing toes with plantar stimulation -Brudzinski’s sign: neck lesion results in neck pain and reflex flexion of hip and knee -Kernig’s sign: reflex contraction and pain when in supine position and hips are flexed 90 degrees *spinal cord -bladder dysfunction >atonic: no muscle tone/contractility >hypotonic: decreased muscle tone/contractility >hypertonic: increased muscle tone, but decreased capacity -paraplegia: paralysis of lower extremities -quadriplegia: paralysis of all extremities
5. Explain different types of diagnostic studies of the neurological system and appropriate nursing responsibilities. *cerebral angiography: catheter inserted into femoral artery, when vascular lesions or tumors are suspected, then x-rayed -observe for bleeding -apply pressure dressing and ice to promote hemostasis and prevent swelling *electroencephalography (EEG): monitors electrical activity of surface cortical neurons of the brain -withhold stimulants -inform patient it is similar to an ECG, no pain involved *electromyography (EMG): records electrical activity associated with innervation of skeletal muscles -inform patient of slight discomfort with needle insertion *lumbar puncture (LP): CSF aspiration at L3-L4 or L4-L5 interspace to assess CNS disease -monitor neurologic system and vital signs -encourage fluids -label specimen -maintain strict asepsis -patient should be flat lying after procedure -assure there is no tumor which could be herniated with procedure *computed tomography scan (CT): computer assisted x-ray on several thin cross sections of body parts -elicit allergies to contrast media -remain calm during procedure and explain scanner -non-invasive if no dye is used *magnetic resonance imaging (MRI): imaging using magnetic energy with greater contrast than CT scan -screen body for metal parts -be aware of contraindications -the patient will need to lie still for about an hour -administer sedatives if necessary *myelography: detects spinal lesions by x-ray of spinal cord and vertebral column with contrast media -pre-procedure sedation -empty bladder -table will move during test -patient should lie flat for a few hours after procedure -encourage fluids -monitor neurological system and vital signs -headache and n/v may occur *positron emission tomography (PET): assess cell death or damage by using radioactive material to measure metabolic activity -explain procedure and that there will be 2 IV lines required -no sedatives or tranquilizers involved -empty bladder pre-procedure -different activities may need to be performed during test -glucose monitoring is necessary due to injected venous scan material *carotid duplex studies: combined ultrasound and doppler technology to evaluate stenosis of carotid and vertebral arteries -explain procedure to patient
Ch. 57-Nursing Management: Acute Intracranial Problems 1. Explain factors that affect intracranial pressure and cerebral blood flow. *ICP -arterial pressure, venous pressure, intraabdominal/intrathoracic pressure, posture, temperature, and ABGs, particularly CO2 *CBF -carbon dioxide, oxygen, hydrogen ion >low CO2: relaxes smooth muscle, dilates cerebral vessels, decreased cerebrovascular resistance, and increased CBF >high CO2: constricts cerebral vessels, increased cerebrovascular resistance, increases CBF, and increased O2 tension >low O2 tension: causes lactic acid which leads to vasodilation and the accumulation of hydrogen ions --acidosis: autoregulation is lost and CBF would then be directly influenced by systemic BP, hypoxia, and catecholamines
2. Use the NP to provide are to a patient with IICP. *assessment -subjective: obtain from family/friend familiar with patient -objective: LOC, deviations from normal bodily functions, neurological assessment -dx: CT or MRI
*planning -maintain patent airway -have ICP within normal limits -demonstrate normal fluid and electrolyte balance -no complications secondatry to immobility or decreased LOC
*implementation -suction airway -reposition from side to side -elevate HOB -NG tube for gastric distention unless contraindicated -decrease environmental stimuli and hazards -assess ABGs, F&E, and pain -minimize actions which promote ICP
3. Use the NP to provide care for a patient with an acute head injury. *assessment -subjective: how injury was inflicted, anticoagulant usage, use of alcohol or drugs, risky behaviors, headache, mood changes, impaired judgement, fear, denial, anger, agression -objective: ALOC, type of laceration and bruising, patency of airway, fluid leakage, Cushing’s triad, vomiting, incontinence, uninhibitied sexual expression, pupil dysfunction, neurological function, muscle strength -dx: CT, MRI, PET
*planning -adequate cerebral oxygenation and perfusion -remain normothermic -control pain and discomfort -free from infection -maximal cognitive, motor, and sensory function
*implementation -protective gear education -safe driving education -explain need for frequent neurological checks -check for CSF leaks -care for the immobile patient -surgery consent from family if needed
4. Explain the types of head injuries and related complications. *scalp lacerations -external head trauma -excessive blood loss -risk for infection *skull fractures -linear, depressed, simple, comminuted, compound >intracranial infection, hematoma, meningeal, and brain tissue damage *minor head trauma -concussion: sudden transient mechanical head injury >repeated minor head trauma could lead to a more progressive, serious problem *major head trauma -contusion: bruising of brain tissue -laceration: bleeding of brain tissue >brain hemorrhage *epidural hematoma -bleeding between dura and inner brain surface *subdural hematoma -bleeding between dura mater and arachnoid layer *intracerebral hematoma -bleeding within the brain
5. Explain the indications for and types of cranial surgery *stereotactic -uses precision apparatus to drill Burr hole -removes small brain tumors and abscesses, drains hematomas, ablative procedures for extrapyramidal diseases, and repair of arteriovenous malformations -reduces surrounding tissue damage -also ionizing radiation procedure *craniotomy -removal of brain part by sawing Burr hole
6. Use the NP to provide care to a patient post-cranial surgery *assessment -subjective: how injury was inflicted, anticoagulant usage, use of alcohol or drugs, risky behaviors, headache, mood changes, impaired judgement, fear, denial, anger, agression -objective: ALOC, type of laceration and bruising, patency of airway, fluid leakage, Cushing’s triad, vomiting, incontinence, uninhibitied sexual expression, pupil dysfunction, neurological function, muscle strength -dx: CT, MRI, PET
*planning -return to normal consciousness -control pain and discomfort -maximize neuromuscular functioning -rehabilitate to maximal ability
*implementation -therapeutic communication -explain procedure -prevent ICP -suction airway -reposition from side to side -elevate HOB -NG tube for gastric distention unless contraindicated -decrease environmental stimuli and hazards -assess ABGs, F&E, and pain -minimize actions which promote ICP
7. Use the NP to provide care to a patient with bacterial meningitis. *assessment -subjective: how injury was inflicted, anticoagulant usage, use of alcohol or drugs, risky behaviors, headache, mood changes, impaired judgement, fear, denial, anger, agression -objective: ALOC, type of laceration and bruising, patency of airway, fluid leakage, Cushing’s triad, vomiting, incontinence, uninhibitied sexual expression, pupil dysfunction, neurological function, muscle strength -dx: CT, MRI, PET
*planning -maximize return of neurologic function -resolve infection -control pain and discomfort
*implementation -darken room and cool towel for photophobia -manage fever -assess for dehydration -respiratory isolation -therapeutic communication
Ch. 58-Nursing Management: Stroke 1. Differentiate the pathophysiology of each type of stroke. *anatomy of cerebral circulation -internal carotid arteries: anterior circulation -vertebral arteries: posterior circulation *regulation of cerebral blood flow -cerebral autoregulation: changes to vessel diameter to compensate for systemic BP changes -systemic BP, CO, and blood viscosity all affect brain blood flow -collateral circulation: compensation for decreased cerebral blood flow -ICP *artherosclerosis: hardening and thickening of arteries can lead to thrombus formation and contribute to emboli *ischemic stroke: inadequate blood flow to brain from partial or complete artery occlusion -thromobotic stroke: injury to vessel wall and blood clot fomration >narrowing of vessel by plaque -embolic stroke: clot blocks blood flow *hemorrhagic stroke: bleeding into brain tissue itself or into subarachnoid space or ventricles -intracerebral hemorrhage: bleeding within the brain by a ruptured vessel >hypertension -subarachnoid hemorrhage: bleeding into CSF-filled space between arachnoid and pia mater on brain surface
2. Using a system’s approach, identify the complications resulting from an acute stroke. *motor function -impairment of mobility, respiration, swallowing/speech, gag reflex, and ADLS *communication -aphasia, dysphasia, dysarthria *affect -uncontrolled exaggerated emotional responses related to loss of functions *intellectual function -impaired memory and judgement >right brain stroke: impulsive decisions and memory problems related to language >left brain stroke: cautious decisions -difficulty making generalizations; difficulty learning *spatial-perceptual alterations -right side stroke: decreased perception of self and illness, decreased sensory input form affected side, decreased object recognition by sight, touch, sound and decreased ability to carry out learned sequential movements on demand *elimination -initial and temporary >secondary result
3. Use the NP to provide care to a patient with stroke. *assessment -subjective: description of current illness, hisotyr of similar symptoms, current medications, risk factors such as HTN and family history -objective: LOC, cognition, motor ability, cranial nerve function, deep tendon reflexes (all should be monitored continuously) -dx: non-contrast CT scan for confirmation and cause
*planning -maintain or improve LOC -attain maximum physical functioning -maximum self-care abilities and skills -stable body functions -maximal communication skills -adequate nutrition -avoid further complications -effective coping
*implementation -focused prevention on risk factors -respiratory patency and function >positioning, suctioning, oxygenation, gag reflex -monitor neurological signs -monitor cardiac rhythm and vital signs -monitor IV and I&O -monitor lung sounds and heart sounds -ROM exercises -observe lower extremity edema >TEDs and SCDs -elevation to avoid dependent edema -hygiene care -bladder training or foley care -mouth care -therapeutic communication -monitor possible changes to senses and perceptions -familial support -patient education regarding home care
Ch. 59-Nursing Management: Chronic Neurologic Problems 1. Explain the pathophysiology and types of seizures *abnormal neurons spontaneously fire *generalized seizures: involve both sides of the brain -tonic-clonic: loss of consciousness, stiffening of body, then subsequent jerking -typical absence seizure: staring spell may be resulting from hyperventilation or flashing lights >children -atypical absence seizures: staring spells accompanied by peculiar behavior or confusion *partial seizures: begin at one side of brain and can evolve to both -simple partial seizure: no loss of consciousness and short lasting -complex partial seizures: ALOC, longer than one minute, involves emotional, behavioral, cognitive, and affective function followed by confusion
2. Use the NP to provide care to the patient with seizure disorder, multiple sclerosis, myasthenia gravis and Parkinson’s disease **seizure disorder *assessment -subjective: history of seizures, current compliance with medications, family history of seizures, changes before seizure, anxiety, depression, changes in sexual drive -objective: bitten tongue, soft tissue damage, abnormal RR or breath sounds, HTN, tachycardia, bradycardia, GI/GU incontinence, type of seizure, weakness, paralysis -dx: toxiclology screen, serum levels, LP
*planning -free of injury during seizure -optimal mental/physical health while taking anti-seizure drugs -satisfactory psychosocial functioning
*implementation -identify precipitating events -promote safety measures -good general health habits -record details of seizure -maintain airway and safety -therapeutic communication -medic alert bracelet
**multiple sclerosis *assessment -subjective: past infections or vaccines, use/compliance to current medications, family history, malaise, weight-loss, dysphagia, decreased GI/GU function, generalized muscle weakness, numbness, tingling, muscle spasms, blurred/lost vision, anger, depression, euphoria -objective: apathy, inattentiveness, pressure ulcers, scanning speech, impaired hearing, muscular weakness -dx: CSF analysis, MRI
*diagnoses -impaired physical mobility -impaired verbal communication -deficient diversional activity -imbalanced nutrition: less than body requirements
*planning -maximal neurological function -maintain ADLS as long as possible
**myasthenia gravis *assessment -subjective: fatigue level, affected body parts, severity, coping abilities -objective: RR and depth, SpO2, and muscle strength -dx: ABGs, pulmonary function tests *diagnoses -ineffective breathing pattern -ineffective airway clearance -impaired verbal communication -imbalanced nutrition: less than body requirements -disturbed sensory perception (visual) -activity intolerance -disturbed body image
*planning -return of muscle endurance -manage fatigue -avoid secondary complications -maintain quality of life
*implementation -adequate ventilation -drug therapy and monitor side effects (drug-drug interactions) -daily planning -balanced diet
Ch. 60-Nursing Management: Alzheimer’s Disease and Dementia 1. Explain the pathophysiology of dementia and Alzheimer’s disease *dementia: neurodegeneration and vascular disorders *Alzheimer’s Disease: plaque of the brain, abnormal protein threads inside nerve cells and loss of neuron connections
2. Use the NP to provide care for a patient with dementia and Alzheimer’s Disease. *assessment -subjective: repeated head trauma, family history, malnutrition, incontinence, poor personal hygiene, disturbed sleep pattern, impaired coping, forgetfulness -objective: disheveled appearance, loss of recent memory, disorientation, agitation, confusion, inability to do simple tasks -dx: diagnoses by exclusion
*diagnoses -disturbed thought process -self-care deficit -risk for injury -wandering
*planning -maintain functional ability as long as possible -safe environment and minimal injuries -meet personal care needs -maintain dignity
*implementation -assess for depression and suicide ideation -work with caregiver to monitor ongoing changes -consistency to reduce anxiety or disruptive behavior
3. Explain the general categories of drug therapy for Alzheimer’s Disease. *drugs for… -decreased memory and cognition: block cholinesterase to improve functional abilities -depression: improve cognitive ability -behavioral problems: atypical anti-psychotics with uncertain side effects -sleep disturbances
4. List general nursing care instructions for the caregiver. -provide a safe environment -stop potentially dangerous behavior early -reinforce routine and continue communication -monitor diet -reduce stress triggers -know when caring for the patient is too much
A nurse enters a client's room to discover that the client has no pulse or respirations. After calling for help and giving two breaths, what is the next action the nurse should take?
1. continue to oxygenate with a pocket mask 2. check for a carotid pulse 3. initiate closed-chest massage at a rate of 100 bpm 4. obtain the crash cart from the hallway
*What is the overall pH? *Is it respiratory or metabolic? *Is there compensation? -zero compensation -partial compensation -total compensation
2. Review the processes of acid-base regulation. *buffer system -fastest acting, primary system -change strong acids into weaker acids or neutralize acid
*respiratory system -excrete by-products of cellular metabolism, CO2 and water
*renal system -reabsorb and conserve bicarbonate -eliminate excess H ions
3. Recognize clients at risk for acid-base imbalances. -patients with diabetes mellitus, chronic obstructive pulmonary disease, kidney disease, vomiting, diarrhea, older patients, or patients with serious illnesses
4. Use the NP to provide nursing care to a client with an acid-base imbalance. *assessment -subjective: past medical history, medications, diet, lifestyle, health perception, tingling, numbness, n/v/d, light-headedness -objective: irregular breathing, low BP, irregular heartrate, confusion, lethargy -dx: serum electrolyte values, ABGs, serum glucose, BUN, creatinine
*diagnoses -ineffective breathing pattern -risk for injury -acid/base imbalance
*planning -replacement of electrolyte and oral/intravenous fluids
*implementation -treat underlying cause
5. Given lab values, identify the acid-base imbalance and the resulting nursing care. *respiratory acidosis, hypoventilation -7.3, 50, 30 -deep breath
*metabolic acidosis, severe diarrhea -7.3, 30, 20 -Lactated Ringer’s
*metabolic alkalosis, severe vomiting or excess gastric suctioning -7.5, 50, 30 -anti-enemics, monitor suctioning
Ch. 26-Nursing Assessment of the Respiratory System 1. Review the factors that control respiration. *chemoreceptors: responds to change of chemical composition of the fluid surrounding it -central, peripheral -changes respiratory rate
*mechanical receptors: stimulated by physiologic factors like irritants, muscle stretching, and alveolar wall distortion -located in lungs, upper airways, chest walls, and diaphragm
2. Explain the pulmonary changes associated with aging. (Table 26-4) *alterations in: -structure: decreased elasticity and compliance -defense mechanisms: less forceful cough, less functional cilia, and dry mucous membranes -respiratory control: decreased response to changes in blood gases
3. Explain the different diagnostic tests. (Table 26-11) *blood studies: assesses Hb, Hct, and ABGs
*oximetry: assesses oxygen saturation
*sputum studies: tests infecting microorganism
*skin tests: tests for allergic responses
*radiologic studies: screens lungs for lesions, areas of inadequate airflow, and evaluates change
*endoscopic examinations: uses scopes to inspect the lungs and collect specimen
*lung biopsy: obtain tissue, cells, or secretions for evaluation
*thoracentesis: locally anesthesized, fluid collected from pleural space
*pulmonary function tests: measure lung volumes and air-flow to diangose pulmonary disease, monitor disease progression, and evaluate disability /response to bronchodilators
*exercise testing: determines exercise capacity for disability evaluation
4. Use the NP to provide care to the patient pre- and post- thoracentesis/ bronchoscopy. (Table 26-11) *thoracentesis: -explain and obtain signed permission for procedure -position patient upright with elbows on overbed table with feet supported -instruct patient not to cough or talk during procedure -observe signs of hypoxia and pneumothorax -monitor lung sounds in all fields after procedure -encourage deep breathing for lung expansion -send specimen to lab
*bronchoscopy -NPO 6-12 hours prior -obtain signed permission -administer ordered sedative before procedure -continue NPO status until gag reflex returns after procedure -monitor laryngeal gag reflex -monitor recovery from sedative -monitor for hemorrhage and pneumothorax -blood tinged mucus is not abnormal
Ch. 27- Nursing Management: Upper Respiratory Problems 1. Use the NP in care of a client with influenza and OSA **Influenza *assessment -subjective: abrupt onset of symptoms (cough, fever, myalgia), headache, sore throat, weakness, patient health history -objective: dyspnea, crackles, purulent sputum -dx: influenza in the community
*diagnoses -risk for infection -ineffective airway clearance -ineffective breathing
*planning -symptom relief -prevention of secondary infection
*implemenation -drug therapy: antivirals to relieve symptoms and prevent spread
*evaluation -does the patient have difficulty in breathing? -is the patient free of secondary infection?
**OSA *assessment -subjective: frequent awakenings at night, insomnia, daytime sleepiness, witnessed apneic episodes, snoring, morning headaches, personality changes, irritability, inability to concentrate, impaired memory… -objective: hypertension, dysrhythmias -dx: polysomnography (more than 10 episodes of oxygen desaturation of below 90%)
*planning -patient will understand methods to treat mild-severe OSA
*implementation -avoid sedatives and alcohol 3-4 hours before sleep -referral to weight loss programs for OSA r/t excessive weight -oral appliance to prevent airflow obstruction -CPAP, BiPAP, or uvulopalatoplasty -monitor SpO2, HR, BP...
*evaluation -does the patient demonstrate understanding of the treatment methods?
Ch. 28-Nursing Management: Lower Respiratory Problems 1. Explain the pathophysiology of pneumonia, HAP, CAP, tuberculosis, pulmonary edema, pulmonary hypertension, cor pulmonale, lung cancer, pulmonary embolus, and atelectasis. -pneumonia: congestion (fluid fills alveoli), red hepatization (dilation of capillaries, making the lung appear red and granular), gray hepatization (decreased blood flow and consolidation of affected part of lung), resolution (exudate lysed by macrophages and gas-exchange returns to normal) -HAP: same as above, acquired in hospital -CAP: same as above, acquired in community -tuberculosis: active bacteria that multiply and cause clinically active disease -pulmonary edema: increased hydrostatic pressure or decreased colloidal oncotic pressure pulls fluids into interstitial space -pulmonary hypertension: deficient release of vasodilators to pulmonary epithelium causing increased pulmonary pressure -cor pulmonale: enlargement of right ventricle secondary to diseases of the lung, thorax, or pulmonary circulation -lung cancer: hypersecretion of mucus, desquamation of cells, cancerous cells of upper lobes -pulmonary embolus: thrombus, fat or air embolus, or tumor tissue blocking pulmonary arteries obstructing perfusion -atelectasis: collapsed, airless alveoli commonly caused by airway obstruction from retained exudate and secretions observed in post-operative patients
2. Identify clinical situations and patient populations at risk for developing the listed pulmonary conditions. -pneumonia: decreased defense mechanisms-age, air pollution, ALOC, immune suppression, prolonged immobility, chronic diseases, debilitating illiness, inhalation of noxious substances, tube feeding, malnutrition, smoking, upper respiratory tract infection, intubation… -HAP: VAP and HCAP -CAP: smokers -tuberculosis: immunocompromised, exposure to infected individuals -pulmonary edema: most commom cause is left-sided HF -pulmonary hypertension: use of Fen-Phen, more women than men -cor pulmonale: patients with disease of lung, thorax, or pulmonary circulation -lung cancer: smokers or exposure to second-hand smoke -pulmonary embolus: post-surgery or childbirth-immobilization, stroke, history of DVT, and malignancy -atelectasis: post-operative patients
3. Use the NP to care for clients with pneumonia, HAP, CAP, pulmonary edema, pulmonary hypertension, cor pulmonale, lung cancer, pulmonary embolus, and atelectasis. **pneumonia, HAP, CAP *assessment -subjective: chest pain, confusion, fatigue, headache, sore throat, nausea, -objective: sudden onset of fever, shaking chills, SOB, productive cough, rust-colored sputum, crackles, bronchial breath sounds, vomiting, diarrhea -dx: chest x-ray, CBC, blood stain, sputum test
*planning -clear breath sounds -normal breathing patterns -no signs of hypoxia -normal chest x-ray -no complications related to pneumonia
*implementation -teaching: hygiene, rest, exercise, and good health habits -position to minimize risk of aspiration, repositioning every 2 hours -“good lung down” -elevate HOB for tube feedings and VAP patients -infection control -CDB/IS -medication routine
*diagnoses -ineffective breathing pattern -imbalanced nutrition: less than body requirements -noncompliance -activity intolerance -ineffective health maintenance
*planning -comply with therapeutic regimen -no recurrence of disease -normal pulmonary function -prevention of disease spread
*implementation -isolation -appropriate drug therapy -stage disease -teach patient to prevent spreading disease -follow-up care
*planning -maximize breathing -monitor VS -limit progression and recurrence
*implementation -position in semi-fowlers -therapeutic communication -teaching regarding long term anti-coagulation
**pulmonary hypertension -treat underlying cause
**pulmonary edema -monitor cardiac and respiratory function -fluid therapy
**atelectasis: CDB, IS
**cor pulmonale: -chronic management, resulting from COPD: continuous low-flow O2 during sleep, exercise, and small, frequent meals to feel better and be more active
4. Nursing care of a post lung/chest surgery patient. (Table 28-2) -monitory respiration -reposition -oxygen therapy -monitor bubbling and tidaling in water-seal chamber -prevent air leaks and keep drainage container below chest -pain management -IS
Ch. 29-Nursing Management: Obstructive Pulmonary Disease 1. Recognize the clinical profile of a patient with COPD. -exposure to noxious particles and gases: smoker, occupational chemical and dusts, urban air pollution -prone to infection -AAT deficiency: hereditary risk factor -aging: change to lung structure, thoracic cage, and respiratory muscles
2. Explain the measure needed to teach patients to prevent COPD. -quit or do not begin smoking -avoid exposure to occupational and environmental pollutants -IS: shows how much function has been lost, but can be regained
3. Explain the pathophysiology of asthma, emphysema and bronchitis. -asthma: chronic inflammation causing acute airflow limitation, hyperresponsiveness occurs with exposure to allergens or irritants -emphysema: abnormal permanently enlarged air spaces with destructed walls and no obvious fibrosis -bronchitis: chronic productive cough for 3 months in each of the last 2 consecutive years with not other cause
4. Explain information needed to teach patients on the correct use of MDI’s and PDI’s. -when it is appropriate to use -does it need to be shaken? -duration of inspiration -cleaning and storage of inhaler
5. Use the NP to provide care to a client with asthma, emphysema and bronchitis **asthma *assessment -subjective: past medical history, medications, family history, lifestyle, sleep pattern, stress -objective: body positioning, sweating, eczema, cyanosis, wheezing, crackles, nasal drainage, use of accessory muscles, tachycardia, low SpO2 -dx: ABGs, allergy skins tests, peak expiratory flow rate
*diagnoses -ineffective airway clearance -inadequate gas exchange -inadequate tissue perfusion
*planning -maintain >80% of personal best PEFR or FEV1 -have minimal symptoms during day and night -maintain acceptable activity levels -have no or decrease incidence of asthma attacks -have knowledge to carry out management
*implementation -educate to identify personal triggers and how to avoid or reduce risk of attack -educate on medications which can inhibit bronchodilation or immunity -monitor lung sounds and cardiac functions for red flags -deep breath
**emphysema and bronchitis *assessment -subjective: exposure to smoke or irritants, weight loss/gain, past medical history, family history, lifestyle, PND, headache, soreness, anxiety, constipation, gas, bloating -objective: cyanosis, poor skin turgor, shallow breathing, tachycardia, ascites, barrel chest, accessory muscle use, wheezing, crackles -dx: ABGs, chest x-ray, pulmonary function tests
*planning -prevent disease progression -improve activity tolerance -symptom relief -no COPD related complications -improve quatity of life -ability to implement long-term treatment
*implementation -breathing techniques -monitor respiratory and cardiac function -position techniques to maximize breathing -oxygen therapy
6. Methods of oxygen administration and related nursing care. (Table 29-22) -nasal cannula: pad ears to avoid pressure points -simple face mask: clean, check for pressure points on ears, and keep at 5 L/min -partial rebreathing mask: check for occlusion -non-rebreathing mask: snug fit with the bag adequately inflated at inspiration and expiration -oxygen-conserving cannula: check for pressure points on ears, for long-term use -transtracheal catheter: not appropriate for patients with excessive mucus -face tent: maintain aerosol at body temperature -tracheostomy collar: clean to prevent aspiration and infection -tracheostomy T-bar: should be removed when suctioning, and emptied as necessary -venturi mask: check for occlusion
7. Explain the mode of action of the different drug categories used in the management of these conditions and resulting nursing care. (Table 29-7) *anti-inflammatory agents: decreases inflammatory response -administer in AM with milk -discontinue gradually over time -observe for epigastric distress -long-term corticosteroid therapy should be paired with vitamin D and calcium
*mast cell stabilizers: inhibit release of mast cells to suppress other inflammatory cells -educate patient on correct use
*anti-cholinergics: blocks bronchoconstriction -may cause blurred vision if contact with eyes -cautious use for narrow-angle glaucoma or prostatic enlargement patients
*leukotriene modifiers: reverse bronchospasms of acute asthma attacks -monitor liver enzymes -effects metabolism of erythromycin, warfarin, and theophylline -take 1 hour before or 2 hours after meals
*B2-adrenergic agonists: prevent bronchoconstriction and increase mucociliary function -cautious use patients with diabetes, hypertension, angina, or cardiac disorders -overuse may cause rebound bronchospasm
*methylxanthines: bronchodilator -monitor cardiac function
Chapter 13 - Inflammation and Wound Healing 1. Explain the inflammatory response **cellular injury **vascular response: release of histamines, kinins, and prostaglandins increases blood flow to tissue causing edema and swelling, WBCs adhere to thickened blood **cellular response: movement of WBCs for phagocytosis **healing: by primary, secondary, and tertiary healing
2. Explain the cellular response, types of WBC’s and their normal values **cellular response -chemotaxis (migration of WBCs) to injury site, margination (movement of neutrophils and monocytes to capillary wall), and diapedesis (movement of neutrophils and monocytes throught capillary wall) to injury site for phagocytosis -migration of lymphocytes, eosinophils, and basophils for more specialized role in response -phagocytosis results in cellular exudate at injury site
**types of WBCs and normal values -eosinophils: 3% of WBC count, associated with parasitic infections -basophils: normally lacking in circulation, associated with allergic reactions from mild to severe -lymphocytes (T and B cells): 20-40% of WBC count, elevated count indicates “shift to right”, viral infection -granulocytes (neutrophils): 55-70% of WBC count, elevated count plus elevated bands indicate “shift to left”, bacterial infection -agranulocytes (monocytes): 2-8% of WBC count, macrophage
3. List and explain the chemical mediators and their effects on homeostasis (Table 13-1) *complement system: increases inflammatory response by enhancing phagocytosis, vascular permeability, chemotaxis, and cellular lysis -kills bacterial cells
*prostaglandins and leukotrienes: causes vasodilation and stimulates chemotaxis, respectively -allows increased local blood flow for immune response
*histamine: causes vasodilation and increased vascular permeability -allows increased local blood flow for immune response
*serotonin: causes vasodilation and increased vascular permeability -allows increased local blood flow for immune response
*kinins: contraction of smooth muscle and dilation of blood vessels to stimulate pain -sends body message of injury
*cytokines: increase pulse, respiration, and metabolism to increase body temperature -increases immune response
4. Use the NP to explain the nursing management of a patient with an inflammatory response. **assessment -subjective: pain, loss of function, diet, past medical history, age, lifestyle, medications, surgery, altered elimination pattern -objective: swelling, redness, drainage, color, heat, fever, high BP and P, malaise, nausea, and anorexia -dx: CBC, WBC, wound culture
**diagnoses: -acute pain r/t inflammation process -hyperthermia r/t inflammation process -risk of FVD r/t increased metabolic rate -risk for imbalanced nutrition: less than body requirements r/t decreased intake of essential nutrients
**planning: -drug therapy: fever, inflammation, nutrients -nutritional therapy: promote healing and nutrients/fluids to meet energy demands
**implementation: -RICE: rest, ice/heat, compression/immobilization, elevation -anti-pyretics for fevers greater than 104 degrees F -anti-enemics for nausea -vitamins to promote healing process -continue observations of swelling and wound, if present -adequate nutritional/fluid intake and output
**evaluation -is the patient running a harmful, high-grade fever? -is the patient in pain? -is the patient nutritional needs getting met?
Chapter 14 - Genetics, Altered Immune Responses and Transplantation 1. Differentiate the different types of Immunity *natural: immunity exists prior to contact with antigen
*passive: receives antigen, rather than synthesizing it -artificial: injections from immune animal or human -natural: mother to child
*active: invasion of foreign substances resulting in development of antibodies and lymphocytes -artificial: immunization with antigen -natural: getting over a flu
2. Differentiate between cell-mediated immunity from humoral immunity (Table 14-7) *cell-mediated: involves T lymphocytes and macrophages which produce sensitize T cells and cytokines against fungus, intracellular viruses, and chronic infectious agents
*humoral: involves B lymphocytes which produce antigens against bacteria, extracellular viruses, and respiratory and GI pathogens
3. Explain the effects of aging on the immune system (pg. 224) *decline in cell-mediated immunity specifically from decreased size and activity of thymus gland
4. Explain and differentiate between the different types of hypersensitivity reactions. Give examples of conditions under each type. *Type 1 Reaction: allergens cause allergic reactions immediately causing smooth muscle contraction, increased vascular permeability, vasodilation, hypotension, increased mucus secretion and itching -asthma
*Type 2 Reaction: destruction of erythrocytes, platelets, and leukocytes resulting in rapid tissue damage -transfusion reaction
*Type 3 Reaction: local or systemic reactions on self-cells resulting in tissue damage -rheumatoid arthritis
*Type 4 Reaction: a delayed allergic reaction which could cause itching, redness, and scaly skin -contact dermatitis to poison ivy
5. Using the NP, explain the care of a patient with an allergic disorder. *assessment -subjective: past health history, medications, family history, diet, lifestyle, cramps, diarrhea, fatigue, cough, itching, burning, stinging, tightness of chest -objective: rashes, wheals and flares, dryness, scratches, watery eyes, lung sounds, sputum, swelling, sneezing… -dx: skin tests
*diagnoses -ineffective airway clearance -fatigue -risk for infection -ineffective tissure perfusion -readiness to learn -knowledge deficit
*planning -reduce exposure to allergen -treat symptoms -immunotherapy, if necessary
*implementation: **drug therapy/ immunotherapy: -anti-histamine: swelling and itching -sympathomimetics/decongestants: epinepherine for anaphylactic reactions and minor decongestants for allergic rhinitis -corticosteroids: relieves allergic rhinitis -anti-pruritic drugs: itch relief -mast-cell stabilizers: asthma management -leukotriene receptor antagonists: blocks leukotriene, a major inflammatory mediator **patient education: administer epi-pen, self tourniquet, avoid allergen sources, sleep in air-conditioned room, hypoallergenic products, medic-alert bracelet
*evaluation: -does the patient understand the information presented?
6. List and explain the cardinal principles in the therapeutic management of anaphlaxis. (pg. 230) 1. recognizing signs and symptoms of a reaction 2. maintaining a patent airway 3. using a tourniquet to prevent the spread of the allergen 4. drug administration 5. treatment for shock: -patent airway -remove substance, ie: bee sting -Epinepherine 1:1000: 0.2-0.5 ml SQ, repeating 10-15 min -Epinepherine 1:10,000: 0.5 ml, 5-10 min -O2 per NRB on high flow -recumbent elevate leg -Benadryl IM/IV -Histamine H2 blocker -maintain BP -corticosteroids
7. Describe the different mediators of the allergic response and resulting clinical outcomes. (Table 14-10) *histamine: increases vascular permeability, constricts smooth muscle, and stimulates irritant receptors -edema of airway, constriction of bronchial, swelling, itching, n/v/d, shock
*prostaglandins: stimulates vastodilation and constricts smooth muscle -wheal and flare reaction, hypotension, and bronchospasm
*platelet-activating factor: stimulates vasodilation and aggregates platelets -increases pulmonary artery pressure and causes systemic hypotension
*kinins: stimulates slow, sustained smooth muscle contractions, increases vascular permeability, stimulates secretion of mucus, and pain receptors -angioedema with painful swelling, bronchial constriction
*serotonin: increases vascular permeabiliyy and stimulates smooth muscle contraction -mucosal edem and bronchial constriction
*anaphylatoxins: stimulates histamine release
8. Briefly explain autoimmunity and the different treatment methods and related nursing care. **immune response against self *corticosteroids: suppress immune response *aphresis: term meaning “separate”, separation of a plasma component thought to be the cause of the disease -watch for complications of hypotension and citrate (anticoagulant) toxicity
9. Differentiate primary from secondary immunodeficiency disorders and related nursing care. *immunodeficiency involves deficiency of one or more: phagocytosis, humoral response, cell-mediated response, complement system, or combined humoral and cell-mediated response -primary: caused by irregular or absent immune cells -secondary: caused by immunosuppression by illness or treatment, primarily drug-induced **drug therapy and patient education: avoid crowds, report symptoms of infection, avoid animals and plants, avoid sick people…
Chapter 17 – Fluid, Electrolytes, and Acid-Base Imbalances 1. Review fluid movement in capillaries. (pg. 318) *capillary hydrostatic pressure: moves water out of capillaries *intersitial oncotic pressure: moves water out of capillaries
*interstitial hydrostatic pressure: moves water into capillaries *plasma oncotic pressure: moves water into capillaries
*capillary hydrostatic pressure vs. plasma oncotic pressure -capillary hydrostatic pressure greater at arterial end-fluid moves out of capillary plasma oncotic pressure greater at venous end-fluid draws back into capillary
**fluids get pulled by proteins, oncotic pressure is due to proteins
2. Explain the different types of crystalloids and their uses. *hypotonic -D5W: replaces water, does not expand ECF
*isotonic -NaCl (.9% NS): for ECF deficits -Lactated Ringers (LR): for ECF deficits resulting from bleedings and dehydration from loss of bile
*hypertonic -Lactated Ringers with D5W: for ECF deficits -D5.9NS: for ECF deficits with metabolic acidosis -D5.45NS: maintainence fluid -D5.2NS: maintainence fluid
3. Give examples of patient conditions or situations with abnormal fluid dynamics and the pathophysiology. -hyperglycemia -hypernatremia
4. Use the NP to provide nursing care of a client with sodium imbalance and water imbalances. **sodium imbalance *assessment -subjective: past medical history, medications, diet, elimination pattern, numbness, tingling, twitching, weakness of muscles -objective: cold, clammy skin; flushed, dry skin; rapid, weak, thready pulse; hypotension; decreased LOC; restlessness; indifference; confusion and irritability -dx: serum electrolytes and arterial/venous blood gases
*diagnoses -risk for injury secondary to abnormal CNS function
*planning -correct underlying cause and fluid/sodium imbalance
*implementation -monitor neurological changes, ie: LOC, pupillary response, voluntary movement of extremities… -monitor cardiovascular changes, ie: JVD, BP, pulse force
*evaluation -is the underlying cause corrected?
**water imbalance *assessment -subjective: past medical history, medications, diet, elimination pattern, numbness, tingling, twitching, weakness of muscles -objective: poor skin turgor; pitting edema; bounding pulse; rapid, weak, thready pulse; hypo/hypertension; SOB; moist crackles; indifference; restlessness; confusion and irritability; ALOC -dx: serum electrolytes and arterial/venous blood gases
*diagnoses -FVE/FVD -impaired gas exchange -decreased cardiac output -risk for impaired skin integrity -disturbed body image
*planning -correct underlying cause of deficit/excess -replace/remove fluids
*implementation -input and output -monitor cardiovascular changes, ie: JVD, BP, pulse force -monitor respiratory changes, ie: SOB, cough, crackles, increased RR -monitor neurological changes, ie: LOC, pupillary response, voluntary movement of extremities… -daily weights -skin care -monitor IV fluids
*evaluation -is underlying problem of the imbalance corrected?
Chapter 15 – Infection and HIV Infection (Lecture and Ch. 15)
1. Explain the pathophysiology of HIV/AIDS. (Lewis Study Guide) *virus binds to CD4 and chemokine receptors and enters cell *virus splices itself into DNA of cell and reverse transcriptase assists to make viral DNA *all replicated cells from that point on are infected **greatly reduces the immunity
2. Use the NP to explain the nursing care of a patient with HIV/AIDS. **assessment: -subjective: lifestyle (high risk behavior), past medical history (STDs, family history, blood transfusions, clotting factors), flu-like symptoms (fatigue, nightsweats, fever), weight loss -objective: thrush, oral hairy leukoplakia, localized infections, wasting syndrome, dementia, opportunistic diseases (AIDS diagnoses if one or more of the following criteria are met for a person with HIV: CD4 count under 200 cell per microliter, development of one opportunistic infection or cancer, wasting syndrome, or AIDS dementia) -dx: EIA, WB, IFA, rapid tests, CD4 tests
**diagnoses: -prevention stage: prevent or detect early HIV infection -ongoing infection stage: promote health and disability and manage problems caused by infection -dying stage: maximize quality of life and resolve end-of-life issues
**planning: -keep viral load low -maintain immune function: prevent opportunistic disease and new infections -improve quality of life -reduce disability: coping **interventions: -adhere to drug regimen -promote healthy lifestyle: prevent transmission, have supportive relationships, maintain productive activity, explore spirituality -cope with disease, symptoms, and treatments
**implementation: -holistic and individualized approach -health prevention promotion: safe lifestyle practices, appropriate medication for pregnant women -therapeutic communication: coping with stress and social stigma -antiviral therapy: are they ready? >schedule fitting of lifestyle? >lifestyle changes to promote healthy immunity >side effects: depression, N/V/D, fatigue, pain, peripheral neuropathy
**evaluation: -how is the patient adhering to the medication? -does the patient understand the importance of lifestyle changes? -is the patient abstain from high risk behaviors? -is the patient coping?
3. Identify complications of HIV/AIDS and resulting nursing care. *treat each patient in an individual and holistic approach *opportunistic diseases: prevent infections and treat each disease and its side effects respectively *coping: counseling and therapeutic communication *transmission: patient education on high risk behavior and correlation with transmission to others
4. Explain diagnostic studies, criteria and collaborative care for patients with HIV/AIDS. *Rapid tests: tests for antibodies yielding quick results, but need to be confirmed by WB and IFA if positive test *EIA, WB, IFA: test for antigens -risk assessment before the test and patient education after the test should be initiated *collaborative care: -get baseline and monitor CD4 and viral load of patient over a period of time -prevent and detect opportunistic infections and complications of drug therapy -maintain ongoing health assessement -patient education regarding disease process and prevention
5. Explain the different opportunistic diseases associated with AIDS and general nursing management. *pneumocystis jiroveci infection: pneumonia with dry, nonproductive cough *herpes simplex 1 infection: cold sores of mouth and lips -patient teaching: avoid kissing and oral sex *kaposi sarcoma: hyperpigmented lesions of skin, lungs, and GI tract *cytomegalovirus infection: retinitis, esophagitis, gastritis, colitis, stomatitis -hydration for diarrhea, assess airway, daily weights *varicella-zoster virus infection: shingles with maculopapular, pruritic rash -medication for itching and redness *candida albicans: yeast infection of mouth, esophogus, GI tract
6. Explain the indications for the initiation of antiretroviral therapy of the HIV patient. *should be started when immune suppression is greatest to avoid burnout and nonadherence *must be ready to initiate therapy to ensure better adherence to the regimen *patient should understand the importance of taking medication on schedule and the side effects of the medication like pain, fatigue, N/V/D, depression and peripheral neuropathy
7. Explain the different drug categories of antiretroviral agents used in HIV infection. (Table 15-14) *NNRTIs and NRTIs: inhibition of HIV to make a DNA copy in early replication *NtRTIs: inhibit action of reverse transcriptase *PIs: stops budding activity to occur on cell membrane *Fusion or entry inhibitors: stops HIV from binding to cell receptors
from learningext.com, the website mrs. bromme was talking about...
for the week of 01.12.09
A client has just returned to the medical-surgical unit after a segmental lung resection. What should be the first nursing action upon entering the room?
1.administer pain medication 2.suction excessive tracheobronchial secretions 3.assist client to turn, cough and deep breathe 4.check oxygen saturation by pulse oximeter
there was a huge volume of photos received and not all made it to the slideshow. if you would like to see the photos, a photobucket account has been set up. the username is futurenurses2010 and the password is pinned2010. these photos are unedited. feel free to upload more photos to the corresponding albums. this is a good way to keep pictures stored in one place for all to browse and keep a collection for the slideshow on that great day in spring 2010.
*after logging in, click on my albums on the top left and there are links to albums on the left hand side
TEA spring 2009 went off without a hitch. the actresses of the three little pigs skit, the nurse rappers, a personalized song by rich, and a mini stand-up piece by phil made the event very entertaining. many thanks to those who showed up to support to the incoming class by setting/cleaning up, your presence provided moral support. if you couldnt make it, you missed out! the ravioli and sandwiches were deLISH, thank you amy and misty. prizes elicited from local businesses, special baskets and giftbags were also a plus for the raffle, thank you to those who contributed. a special thanks to heidi for the hours she put into this event, we cant thank you enough!
just a reminder the TEA will be held on January 9, 2009 in upper danner hall. please arrive at 11 am in scrubs to begin set up if you can, otherwise the TEA starts at 1:30. if you have not given heidi your group basket, bring it!!! donations of $5-10 per person is also suggested for TEA expenses. heidi has been working very hard to put this together, if you can volunteer some of your time, please contact her. her email is hloehrer704@students.deltacollege.edu.
Ok so this is what I got, some of it I got from a. ha. and some of it I went into way too much detail. But anyways here is my contribution to our blog:
STUDY GUIDE – FINAL EXAM 1. Discuss the stages of hypertension. (L Pg. 765 TAB 33-2 & Notes)
Normal: <120/<80>160/>100 Stage I and stage II : Asymptomatic Stage III: blurred vision, headache, ALOC, SOB, dizziness…May be asymptomatic too
2.List appropriate nursing diagnoses for the patient with hypertension. (L Pg. 778, TAB 33-12)
Ineffective health maintenance RT lack of knowledge of pathology, complications, and management of hypertension Anxiety RT complexity of management regimen, possible complications, and lifestyle changes associated with hypertension Sexual dysfunction RT side effects of antihypertensive medication Disturbed body image RT diagnosis of hypertension Ineffective therapeutic regimen management RT lack of knowledge Ineffective tissue perfusion RT complications of hypertension
3. Discuss the risk factors for hypertension. (L Pg. 766 TAB 33-3)
Age : SBP rises progressively with increasing age Alcohol Smoking Diabetes Mellitus: More common in diabetics Elevated serum lipids: Elevated levels of cholesterol and triglycerides are primary risk factors in atherosclerosis, hyperlipidemia is more common in people with hypertension Excess dietary sodium Gender : More prevalent in men Family history Obesity Ethnicity: Twice as high in African Americans Sedentary lifestyle Socioeconomic status: More prevalent among less educated Stress
4.Explain referred pain. (P Pg. 1064 TAB 43-5)
Perception of pain is in unaffected areas Myocardial infarction, which causes referred pain to the jaw, left arm, and left shoulder Kidney stones, which refer pain to groin.
5. Discuss the assessment needed for the patient with GI dysfunction. (L Pg. 1057 TAB43-22)
Subjective data: Past medical history: infection, autoimmune disorders Medications: Use of antidiarrheal meds Functional Health Patterns · Health management: family history of ulcerative colitis, fatigue, malise · Nutrition: Nausea, vomiting, anorexia, weight loss · Elimination: Diarrhea, blood, mucus or pus in stools · Cognitive-perceptual: Lower abdominal pain (worse before defecation, cramping, tenesmus)
7. Discuss the education needed for the cancer patient after treatment. (notes)
· Improve lifestyle · avoid crowds of people or microbe carrying vectors · avoid extreme temperatures · understand symptoms of infection · allow rest between periods of activity
8. Discuss the education needed for dietary modification to decrease CAD. (L Pg. 792 & notes)
Low fat, high fiber, low salt, increased water intake
9. Discuss therapeutic communication for the cancer patient. (L Pg. 310)
be direct and avoid false reassurances acknowledge feelings Be available Exhibit a caring attitude Listen actively to fears and concerns Provide relief from distressing symptoms Provide essential information regarding cancer and cancer care Maintain a relationship based on trust and confidence Use touch to exhibit caring Maintain hope
10. Discuss the psychosocial manifestations of approaching death. (P Pg. 463-465)
Denial – Anger – Bargaining – Depression – acceptance normal grief complicated grief: prolonged and difficult time moving forward anticipatory grief: “letting go” before death even occurs disenfranchised grief: unsupported grief which is not openly acknowledged
11. Discuss the assessment needed for the patient with heart failure. (a.ha)
Key s/s: Dyspnea on Exertion (DOE) Paroxysmal Nocturnal Dyspnea (PND) : occurs when patient is asleep. Orthopnea (how many pillows?)
12. Discuss the pathophysiology of orthopnea. (L. 825 & notes) - Difficult or painful breathing except in an erect sitting or standing position. - increased ease in breathing with increased elevation by pillows
13. Discuss the assessment needed for the unconscious patient with GERD. (a.ha)
- mouth: signs of lesions in mouth and dental decay
14. Discuss the assessment needed for the patient with cancer. (L Pg. 282)
- diethealth history - Ethnicity - Lifestyle - Genetics - Enviroment note and report (as they may be early signs of cancer): C-hanges in bowels or bladder A- lesion that does not heal U-nusual bleeding or discharge T- hickening or a lump in the breast or elsewhere I-ndigestion or difficulty swallowing O-bvious changes in wart of mole N-agging cough or persistant hoarseness
15. Discuss the education needed for the patient with Hepatitis B. (a.ha)
No real treatment; requires rest and adjusted diet Certain lifestyle choices (like alcohol consumption) may lead to lifelong infection Can be transmitted through blood, semen, and saliva
16. Discuss the nutritional education for the patient with liver disease. (Notes & L Pg. 1094 TAB 44-6)
low salt, low protein diet restricted fluids avoid or restrict alcohol
Book says: High calorie, High protein? high carb, Low fat & vitamin supplements
17. Discuss the pain management of the patient with a terminal disease. (L Pg. 161 TAB 11-8 & notes)
Comfort care Drug titration: adjust dose or use the smallest dose possible-based on assessment of analgesic effect Work with patient to decide the optimal analgesic dosage required**minimize side effects Administer medications around the clock in a timely manner and on a regular basis to provide constant relief rather than waiting until the pain is unbearable Evaluate effectiveness of pain relief measures frequently to ensure that the patient is on a correct and adequate drug regimen
18. Discuss the purpose and safety issues of the use of an NG tube in a patient with GI dysfunction. (L. Pg. 992 & 996) Purpose: decompression for distended patients or patients experiencing nausea and vomiting Lavage: elevates patient’s need to vomit Safety issue: check for correct placement
19. Discuss the nursing care of the patient with Inflammatory Bowel Disease. (a.ha)
modified diet: to prevent constipation and increase stool bulk non-opiod pain management: bedrest monitor signs of any further complications
20. Discuss the complications of Pancreatitis.(L Pg. 1119)
Pancreatic fistula: abnomal tunneling which can ultimately erode abdominal wall Pancreatic pseudocyst: A cavity continuous with or surrounding the outside of the pancreas Pancreatic abcess: a lrg fluid containing cavity within the pancreas, resulting from necrosis
21. Discuss the purpose of the diagnostic test, Holter Monitor and provide the education needed. (L Pg. 753)
PURPOSE: Recording of ECG rhythm for 24-28 hrs and then correlating rhythm changes with symptoms recorded in diary Normal patient activity is encouraged to stimulate conditions that produce symptoms. Electrodes are placed on chest and a recorder is used to store information, print it, and analyze it for any rhythm disturbance. It can be performed on an in patient or outpatient basis.
EDUCATION: Explain importance of keeping accurate diary of activities and symptoms. Tell the patient that no bath or shower can be taken during monitoring. Skin irritation may develop from electrodes.
22. Discuss the age-related changes of hypertension in the elderly. (a.ha)
Decreased vessel elasticity · Increased build-up on vessel · BP increases · Overall decreased functioning of bodily systems
23. List the nursing diagnoses appropriate for the patient with heart failure. (L Pg. 836-837 & notes)
Activity intolerance RT fatigue secondary to cardiac insufficiency and pulmonary congestion aeb dyspnea, SOB, weakness, increase in heart rate on exertion, and patient’s statement “I feel to weak to do anything.”
Excess Fluid volume RT cardiac failure aeb edema, dyspnea on exertion, increased weight gain, and patient’s statement “I’m short of breath and my ankles are so big and puffy?”
Impaired gas exchange RT increased preload, mechanical failure, or immobility aeb increased respiratory rate, SOB, dyspnea on exertion, and patient’s statement, “I just can seem to catch my breath.”
Anxiety RT dyspnea or perceived threat of death aeb restlessness, irritability, expression of feelings of life threat, and patient’s statement, “Don’t leave me alone, I’m afraid I might die.”
Altered tissue perfusion
Ineffective breathing r/t fluid accumulation aeb DOE, PND, SOB
24. Discuss the concept of ageism. (L Pg.67 & P Pg. 193)
A negative attitude based on age, it leads to discrimination and disparities in the care given to the older adult because others consider the knowledge and experience of older adults too outdated to have any current value.
28. Explain the purpose of a needle biopsy. (L. Pg. 283)
Used to obtain cells and tissue fragments through a large-bore needle that is guided into the tissue in question (e.g. bone marrow aspiration; core biopsy of prostate gland, breast, liver, and kidney tissues). Cytological analysis is then performed to determine the presence of a tumor.
29. Discuss the principles of pain management. (L Pg. 134)
Follow the principals of the pain assessment – Pain is subjective, the patient is the best judge of his or her won pain, but also is the expert on the effectiveness of each pain treatment.
Every patient deserves adequate pain management – Be aware of your own biases and treat all patients equally with respect.
Base the treatment plan on the patient’s goals
Use both drug & non-drug therapies
Address the pain using muilti displinary approach – including clinical psychology, physical and occupational therapy, spiritual care, etc.
Elvalutae the effectivness of the therapies to ensure that they are meeting the patient’s goals
Prevent and/or manage medication side effects
26. Discuss the pathophysiology of PUD. (L. 1015)
Peptic Ulcer Disease: A condition characterized by erosion of the GI mucosa resulting from the digestive action of HCL acid and pepsin. Any portion of the GI tract that comes into contact with gastric secretions is susceptible to ulcer development, including the lower esophagus, stomach, and duodenum. H. Pylori infects stomach lining
27. Discuss the education needed for the patient with GI bleeding when diagnostic tests are ordered, (a.ha)
Educate patient on ordered procedure No smoking Clear liquid or light meal at night NPO after midnight
28. Discuss the nursing care of the elderly to ensure compliance with treatment. (a.ha)
Maintain and educate patient on safety issues Allow adequate time for patient to complete activities Treat patient with dignity Speak in a low voice face to face with patient
29. Discuss the discharge planning of the elderly to ensure compliance with treatment. (a.ha)
Can the patient achieve ADL’s, which were able to be completed before admission? Frequently reassess if patient can achieve these goals
Monday, December 15, 2008
ati scores are up at atitesting.com, under my results and the first test listed.
1. Discuss the stages of hypertension. (HTN Lecture) *Stage I and II: asymptomatic *Stage III: blurred vision, headache, ALOC, SOB, dizziness…sometimes asymptomatic too
2. List appropriate nursing diagnoses for the patient with hypertension. (Lewis: Ch. 33, Table 33-12) *ineffective tissue perfusion, disturbed body image, ineffective therapeutic regimen management, sexual dysfunction, anxiety, ineffective health maintenance
3. Discuss the risk factors for hypertension. (HTN Lecture) *lifestyle, diet, stress, smoking, age, gender, ethnicity, past medical history
4. Explain referred pain. (P/P: Ch. 43, pg. 1064) *perception of pain is in unaffected areas -ie: pain in arm from heart attack
5. Discuss the assessment needed for the patient with GI dysfunction. (GI Dysfunction Lecture) -past medical history, diet, heartburn, dysphasia, lifestyle
6. Discuss the education needed for the cancer patient after treatment. (Cancer Lecture) -avoid crowds of people or microbe carrying vectors -avoid extreme temperatures -understand symptoms of infection -allow rest between periods of activity
7. Discuss the education needed for dietary modification to decrease CAD. (CAD Lecture) *low fat, high fiber, low salt, increased water intake
8. Discuss therapeutic communication for the cancer patient. (Cancer Lecture) -be direct and avoid false reassurances -acknowledge feelings
9. Discuss the psychosocial manifestations of approaching death. (P/P: Ch. 30, pp. 463, 465-467) -normal grief -complicated grief: prolonged and difficult time moving forward -anticipatory grief: “letting go” before death even occurs -disenfranchised grief: unsupported grief which is not openly
10. Discuss the assessment needed for the patient with heart failure. (HF Lecture) *Key s/s: Dyspnea on Exertion (DOE), Paroxysmal Nocturnal Dyspnea (PND), orthopnea (how many pillows?)
11. Discuss the pathophysiology of orthopnea. -increased ease in breathing with increased elevation by pillows, etc.
12. Discuss the assessment needed for the unconscious patient with GERD. -mouth: signs of lesions in mouth and dental decay
13. Discuss the assessment needed for the patient with cancer. (Cancer Lecture)-diet -health history-ethnicity-lifestyle-genetics-environment*note and report (as they may be early signs of cancer):C-changes in bowels or bladderA-a lesion that does not healU-unusual bleeding or dischargeI-indigestion or difficulty swallowingO-obvious changes in wart of moleN-nagging cough or persistant hoarseness
14. Discuss the education needed for the patient with Hepatitis B. (GI Dysfunction II Lecture) -no real treatment; requires rest and adjusted diet -certain lifestyle choices (like alcohol consumption) may lead to lifelong infection -can be transmitted through blood, semen, and saliva
15. Discuss the nutritional education for the patient with liver disease. (GI Dysfunction II Lecture) -low salt, low protein diet -restricted fluids -avoid or restrict alcohol
16. Discuss the pain management of the patient with a terminal disease. (Pain Management Lecture) *comfort care *drug titration: adjust dose or use the smallest dose possible-based on assessment of analgesic effect-provide effective pain control-work with patient to decide the optimal analgesic dosage required**minimize side effects
17. Discuss the purpose and safety issues of the use of an NG tube in a patient with GI dysfunction. (GI Dysfunction Lecture) -purpose: decompression for distended patients or patients experiencing nausea and vomiting -safety issue: check for correct placement
18. Discuss the nursing care of the patient with Inflammatory Bowel Disease. (GI Dysfunction Lecture) -modified diet: to prevent constipation and increase stool bulk -non-opiod pain management: bedrest -monitor signs of any further complications
19. Discuss the complications of Pancreatitis. (GI Dysfunction II Lecture) -pancreatic fistula: abnomal tunneling which can ultimately erode abdominal wall
20. Discuss the purpose of the diagnostic test, Holter Monitor and provide the education needed.
21. Discuss the age-related changes of hypertension in the elderly. (Geriatric Lecture) -decreased vessel elasticity -increased build-up on vessel -overall decreased functioning of bodily systems
22. List the nursing diagnoses appropriate for the patient with heart failure. (HF Lecture) -impaired gas exchange, activity intolerance, altered tissue perfusion, fluid volume excess, ineffective breathing r/t fluid accumulation aeb DOE, PND, SOB
23. Discuss the concept of ageism. (P/P: Ch. 14, pg. 193) *discrimination against people because of increasing age -“outdated” knowledge, “worthless” after leaving workforce
24. Explain the purpose of a needle biopsy. (GI Dysfunction II Lecture) -samples cells in an area of the body, like the liver to determine liver dysfunction
25. Discuss the principles of pain management. (Pain Management Lecture) *follow assessment principles*patient centered*drug and non-drug therapies*collaborative care
26. Discuss the pathophysiology of PUD. (GI Dysfunction Lecture) -H. Pylori infects stomach lining -increased gastric acid in stomach causes erosion or ulcers
27. Discuss the education needed for the patient with GI bleeding when diagnostic tests are ordered. (GI Dysfunction Lecture) -educate patient on ordered procedure -no smoking -clear liquid or light meal at night -NPO after midnight
28. Discuss the nursing care of the elderly to ensure compliance with treatment. (Geriatric Lecture) -maintain and educate patient on safety issues -allow adequate time for patient to complete activities -treat patient with dignity
29. Discuss the discharge planning of the elderly to ensure compliance with treatment. (Geriatric Lecture) -can the patient achieve ADLs which were able to be completed before admission? -frequently reassess if patient can achieve these goals
DOSAGE AND CALCULATIONS Can you calculate? Flow rates Infusion times Dosage rates Titration dosages Safe and therapeutic dosage ranges
CASE SCENARIO – The Nursing Care of the patient with heart failure using the nursing process. (HF Lecture)
A: Key S/S: dyspnea on exertion (DOE), paroxysmal nocturnal dyspnea (PND), orthopnea (how many pillows?) Subjective: fatigue, disturbed sleep pattern, past medical history, breathing pattern, lifestyle… Objective: altered level of consciousness, irregular heart sounds (displaced PMI, gallops, murmurs), cold/clammy skin, tachycardia, crackles in lung sounds…
D: impaired gas exchange, activity intolerance, altered tissue perfusion, fluid volume excess, ineffective breathing r/t fluid accumulation aeb DOE, PND, or SOB
P: maximize cardiac output, provide treatment, preserve target organ function
I: meds: oxygen, diuretics, inotropes, ACE inhibitors, nitrates Check: K levels (nausea and vomiting are S/S of dig toxicity) , apical HR, and BP Patient education: nutrition, exercise, avoid cold, medication regimen, S/S of angina, stress management…
E: are goals met? If not, reassess.
Saturday, December 6, 2008
Mrs. Semillo gave me this information about our ATI test. Thought others might be interested.
The Proficiency Level Reference Table for Fundamentals says:
Level I = 60%
Level II = 68.3%
Level III = 81.7%
ATI tells us that "an Individual score meeting the criterion established for Proficiency Level II is:-Fairly certain to meet the NCLEX standards in this content area.-Demonstrates a level of knowledge in this content area that more than adequately supports academic readiness for subsequent curricular content.-Exceeds the minimum expectations for performance in this content area.-Demonstrates achievement of a satisfactory level of competence needed for professional nursing practice in this area.
For those who were not aware, like me, APA formatted references are actually available on CINAHL for your articles of choice. Just go to the icon on the upper right corner that says "citation" and different formats of citations are available to copy and paste!
Author, A., Author, B., & Author, C. (Date). Article title. Periodical Title, volume(issue), pages.* Retrieved , from database. (other information needed to trace the article should be in parenthesis, such as specific File Name, item number--if applicable)
*Since some online articles do not indicate page numbers, you will not always be able to include them in your citation.
Examples with author:
Carter, W. (1998, August 10). Collective effort. Telephony, 235(6), 66-67. Retrieved January 8, 2001, from ABI/Inform Global database.
Hayes, M. (1998, December 21). Thin clients offer savings—advances promise lower ownership costs, but Microsoft prices remain high. Information Week. Retrieved January 8, 2001, from Lexis-Nexis Academic Universe database.
Intext citation: (Hayes, 1998)
Example with no author:
Mobile telephones: Wireless war. (2001, January 8). The Economist. Retrieved January 8, 2001, from Factiva database. (Retrieval Item: ECON99008000049)
1. What are gram negative infections more difficult to treat than gram positive? a. their cells walls are more complex making it more difficult to penetrate
2. What is empiric therapy? a. a broad spectrum antibiotic known to treat symptoms the patient is experiencing without identifying the specific specimen
3. Why should culture specimens be drawn before antibiotic therapy is begun? a. it yields the most accurate specimen in the infection
4. What is prophylactic antibiotic therapy? a. infection prevention in circumstances where infections are likely to occur
5. Under what circumstances do superinfections occur? a. when antibiotics reduce or completely eliminate normal flora
6. What are the causes of strains of bacteria that are resistant to antibiotics? a. over or inappropriate antibiotic prescribing and patients not finishing their antibiotic regimen
7. What does it mean for an antibiotic to be bacteriostatic? a. inhibits bacterial growth
8. Why are antibiotics given using the “around the clock” method? a. maintain therapeutic levels
9. What are the common manifestations to a hypersensitive reaction of an antibiotic? a. wheezing, shortness of breath, swelling of face, tongue or hands, itching, or rash
Chapter 38
10. What is the benefit of once-daily aminoglycoside dosing? a. reduces nursing care time and allows for outpatient or home-based therapy
11. Why are trough levels drawn on aminoglycosides? a. ensure adequate renal clearance and avoid toxicity
12. When should aminoglycoside trough levels be drawn? a. at least 18 hours after completion of the dose
13. What is the therapeutic goal for trough concentration of aminoglycosides? a. at or below 1 mcg/mL
14. What is the risk when trough levels are above 2 mcg / mL? a. toxicity to the ears and toxicity to the kidneys
15. How often are aminoglycoside trough levels monitored? a. once every 3 days
Chapter 39
16. Viruses are particles that do what inside a cell? a. replicate
17. How do antiviral drugs work? a. destory virions or inhibit replication
18. How do the current antiviral drugs that are synthetic compounds work? a. inhibit viral replication
19. Where must antiviral drugs go to disrupt viral replication? a. enter the cells the same way the virion does
20. What are antiretroviral drugs specifically used for? a. treatment of infections caused by HIV
21. What is the mechanism of action of non-retroviral antiviral drugs? a. block activity of polymerase enzyme, impairing viral replication
Chapter 41
22. What is an infection cause by a fungus called? a. mycosis
23. Generally, who is affected by systemic fungal infections? a. hosts with compromised immune defenses
24. Why is it so difficult to produce systemic antifungals for human use? a. drug concentrations cannot be tolerated by human beings
25. What are the side effects that nearly all patients who receive amphotericin B intravenously experience? a. fever, chills, hypotension, tachycardia, malaise, muscle and joint pain, anorexia, nausea and vomiting, and headache
26. What drug classes are given to decrease the severity of reaction to amphotericin B? a. anti-pyretics, anti-histamines, and anti-emetics
citation machine is a free web service. there are links provided to purchase materials for APA style formatting, but citation machine is free to use. the link to the APA style format is on the left hand side. there will be a drop down menu and since we are using online journals, that is the link you would want to select. it will format the reference, but will not check for spelling, punctuation, and capitalization mistakes that has been input by the user. it is also not required to register to use the service.
Tuesday, November 25, 2008
pharm grades for exam #4 are posted on turnitin.com!
Monday, November 24, 2008
GRMs for week #13 are available with answers on Mr. Scott's docushare!
*Can sustained release capsules be crushed for administration?
*A patient is concerned about damage to her liver because of the 81 mg dose of aspirin she is getting. What can you tell this patient about the mechanism of action and why it is safe for her to get this daily dose?
*What is a safety issue for a Parkinson’s Disease patient?
*What are typical treatments for EPSs?
*Describe oxyhemoglobin-dissociation and factors affecting it.
*A patient on a statin is complaining of muscle pain and hemutria. What is the nurse’s concern?
*What tames heparin?
*Is it safe for a patient to be on coumadin and heparin IV?
*What is the treatment for status asthmaticus?
*How does Lopid lower LDLs?
*What else is Serevent useful in treating
*In what way is heparin and insulin similar, regarding medication administration?
*What is the normal range for PaO2 and PaCO2?
*What are the benefits of Clariton?
*What is the correct procedure for using Advair?
*What are the five things that can be done for a hypoxemic patient?
*What labs should be monitored for patients on lithium? Why?
*What is the relation between Sinemet and B6?
*A patient is receiving Plavix and is scheduled for surgery in a week and the nurse calls the physician to discontinue the medication. What does the physician tell the nurse?
*Is it okay for a patient to be receiving 18-21% FIO2?
*What is warfarin’s mechanism of action?
*What is the nursing care of a patient on Plavix after coming back from surgery?
*How does adrenergics work as a decongestant?
*How can you test if a rescue inhaler is empty?
*Why should a patient on Albuterol or Serevent avoid caffeine?
*What labs should be checked for a patient on Lipitor or Zocor?
*What can result in pleural effusion and can it be solved?
*What is ordered for a person undergoing a percutaneous coronary intervention and what is the route of administration?
*What should a nurse always watch for when a patient is taking Tegretol and Depakote?
*What are the signs of a hypoxemic patient?
*How are mucolytics useful?
*What is another anti-hyperlipidemic drug that is best combined with Lipitor or Zocor?
*What are the two types of lung disorders and how do they differ?
*Why is warfarin’s therapeutic range for a prosthetic valve patient different from a patient without a prosthetic valve?
*In general, how does an anti-hyperlipidemic work?
*What does a PaO2 less than 80 mm Hg indicate and what can it lead to?
*What labs should a nurse know about a patient before administering heparin?
*A patient is about to receive a tissue plasminogen activator to prevent clots. Is this correct?
*What type of lung disorder is pulmonary tuberculosis? Why?
*What are the routes of administration of heparin?
*What is the significance of high CYP3A4 enzyme levels of a patient on Lipitor or Zocor?
*What is the significance of monitoring the baseline platelet count?
*What is the right procedure for using a rescue inhaler? A MDI?
*What is the therapeutic range for theophylline?
*What are 4 types of respiratory units?
*What is the most common treatment of Parkinson’s Disease?
*Describe safety precautions for a patient prone to hypoxia of the brain.
*Compare and contrast Intal and Singulair.
*How should Dilantin be administered orally? IV?
*How are opiods and Robitussin DM similar?
*What can consolidation be a result of?
*What is the difference between a lipoprotein high in lipids and a lipoprotein low in lipids?
*What labs should be taken for a person on Rifampin?
*What is the mechanism of action of Atrovert?
*What is the patient suffering from acidemia prone to? Why?
*What is Zetia’s mechanism of action?
*A newly admitted patient has a platelet count of 650,000. What is this referred to as and should the nurse be concerned about the count?
*What is the significance of PaCO2 that is out of normal range?
*What fluids can Dilantin IV be mixed with?
*How is tuberculosis spread?
*For every liter of O2, ___ increases by __%.
*What is the significance of administering heparin SubQ and administering heparin IV?
*What actions should be taken for a patient experiencing status epilepticus?
*Why is Benadryl discouraged in the elderly?
*What specific questions should a nurse ask a patient on Isoniazid?
*What is normal range for a platelet count?
*What are the three routes of administration of corticosteriods and an example of each?
*Why do anemic patients have a decreased circulation of gas?
*What should a patient know before beginning to take MAOIs?
*What are the adverse effects of lipoprotein removal drugs?
*What is the biochemical reason for mental illnesses?
*What is safe administration for a dose of heparin to prevent a clot?
*What drug class is aminophylline?
*What is the relation between carbon monoxide poisoning and oxygen affinity?
*What are the adverse effects of beta-2 agonists?
*What is offered to treat neurological symptoms of a patient on Isoniazid?
*What are examples of SSRIs and what do they improve?
*Describe three problems associated with corticosteroids.
*What are the side effects of niacin?
*What are specific signs and symptoms of bleeding?
*How does Sinemet work?
*A patient on warfarin is exhibiting unexplained swelling, chest pain, and weak pulses. What is the nurse’s interpretation of these symptoms and what can be done?
*What is the duration of drug therapy for the schizophrenic patient?
*What is a side effect of Atrovert?
*What is patient education needed for a patient on drugs altering the clotting mechanism?
*What are the adverse effects of TCAs and MAOIs?
*What should a nurse expect to see after administering a methylxanthine and what might be a side effect?
*What should a patient on TB treatment avoid?
*What is Robitussin useful for?
*What is the mechanism of action of unfractionated heparin?
*Can heparin be used on an emergency patient experiencing a stroke?
1. Discuss the legal implications of death and dying. (End-of-Life Lecture) -Dying Person’s Bill of Rights -Advanced Directives -DNR Status -Durable Power of Attorney/Living Will
2. Discuss therapeutic communication when caring for the dying patient. (End-of-Life Lecture) -be direct and avoid false reassurances -Hospice says, “Do you know you are dying?”
3. Discuss the types of grief and grief responses. (P/P: Ch. 30, pp. 463, 465-467) -normal grief -complicated grief: prolonged and difficult time moving forward -anticipatory grief: “letting go” before death even occurs -disenfranchised grief: unsupported grief which is not openly acknowledged *grief responses vary depending on: -developmental stage -personal relationship -nature of loss -coping strategies -socioeconomic status -culture/ethnicity -spiritual/religious beliefs -hope
4. Discuss the concerns of the dying patient. (End-of-Life Lecture) -arrange a variety of affairs -cope with loss of loved ones and own death -future medical needs -plan for future
5. Discuss the interventions needed to assist the patients to die with dignity. (P/P, Ch. 30, pg. 475) -treat patient as a whole being rather than a patient will an illness -encourage conversation about patient’s life experience -maintain personal hygiene and appearance -be respectful: address by title
6. Explain the purpose of Hospice care. (P/P: Ch. 30, pp. 478-479) -provides end-of-life support for patient and familiy -priority to managing pain and symptoms, comfort, quality of life, and other needs for the patient with less than 6 months to live
7. Discuss the concepts of pain and pain management. (Pain Lecture) -follow assessment principles -patient centered -drug and non-drug therapies -collaborative care
8. Discuss ethical considerations for the terminal patient. (End-of-Life Lecture) -Euthanasia/Assissted Suicide -Organ Donations
9. Discuss the nursing interventions for the patient receiving chemotherapy or radiation treatment. (Cancer Lecture) -adequate moisturizing -ambulate/turn -cough/deep breathe or incentive spirometer -alternate resting and active periods -make sure antiemetics are ordered -therapeutic communication -protective isolation: avoid crowds -be aware of food preferences
10. Discuss the relevant assessment data needed for the terminal patient on pain medication. (P/P: Ch. 30, pp. 1078, 1080) -monitor breakthrough pain
11. Differentiate between the assessment needed for the patient in acute and chronic pain. (Pain Management Lecture) -based on cause, course, manifestation, and treatment
12. Describe the different types of pain. (P/P: Ch. 43, pp. 1055-1056) -acute/transient pain: can identify cause, short term, limited tissue damage and emotional response -chronic/persistent pain: lasts longer than anticipated, not always an identifiable cause, great personal suffering -chronic episodic pain: sporadic pain over an extended period of time -cancer pain: usually related to tumor progression or treatment of cancer -pain by inferred pathological process: musculoskeletal, internal organ, or neuropathic pain -idiopathic pain: no identifiable physical or psychological cause for chronic pain
13. Discuss the education needed for the patient on opioid medication. (Pain Management Lecture) -low risk of addiction when treating pain
14. Discuss the nursing diagnoses relevant to grief. (P/P, Ch. 30, pg. 470) -death anxiety -compromised family coping -ineffective denial -complicated grieving -hopelessness -spiritual distress
15. Discuss goals/outcomes for patients in chronic pain. (Pain Management Lecture) -sometimes the best thing is to decrease pain level -describe experience in order to treat -identify goal for therapy and resources for self-management -prevent pain whenever possible -will require only oral analgesics for pain -reports pain of <3 on a scale of 1-10 after PCA use
16. Discuss the safety precaution education needed for patients receiving chemotherapy. (Cancer Lecture) -radiation source being used -method of administration -start of treatment -length of treatment -prescribed nursing precautions: protective gear and isolation -avoid crowds -do not allow small children to sit on lap -cough and deep breathe -moisturize -ambulate/turn -alternate resting and active periods
17. Discuss the use of the pain diary in pain management. (Pain Management Lecture) -helps both nurse and patient identify pain patterns and causative factors
18. Discuss titration in pain management. (Pain Management Lecture) *adjusting dose or using the smallest dose possible: -based on assessment of analgesic effect -to provide effective pain control -working with patient to decide the optimal analgesic dosage required **to minimize side effects
19. Discuss the nursing care for the patient using PCA or continuous opioid analgesia. (P/P: Ch. 30, pg. 1076) -monitor dosing and dosage rate -teach patient how to use PCA and instruct visitors not to tamper with it -monitor vital signs
20. Discuss nursing diagnoses relevant for patients with terminal disease. (P/P: Ch. 30, pg. 470) -death anxiety -caregiver role strain -compromised family coping -readiness for enhanced comfort -disturbed personal identity -ineffective denial -fear -hopelessness -spiritual distress -readiness for enhanced spiritual well-being
21. Discuss risk factors for cancer and the education needed. (Cancer Lecture) -diet, health history -ethnicity -lifestyle -genetics -environment *encourage diet high in fiber, low in fat *note and report (as they may be early signs of cancer): C-changes in bowels or bladder A-a lesion that does not heal U-unusual bleeding or discharge I-indigestion or difficulty swallowing O-obvious changes in wart of mole N-nagging cough or persistant hoarseness
22. Dosage and Calculations: -microdrops: 60 gtt/ml -macrodrops: 10, 15, or 20 gtt/ml
Friday, November 7, 2008
noo2 exam #1 grades are posted on docushare!
Thursday, November 6, 2008
Hey everyone. Mr. Meza had given this documentation paper to his clinical group. He thought it would be helpful for Semillo's group, but I think it might be useful to everyone. It's kinda lengthy, but very informative. Hope it helps.
Keys To Documentation Course # 111 2 contact hours Written By: Monica Oram, RN, BSN
Upon completion of this course the reader will be able to achieve the following objectives: 1. Define documentation and identify its importance 2. Describe four forms commonly used in documentation 3. Describe legal aspects of documentation 4. List five reasons for careful documentation 5. List ten guidelines for documentation
What Is Documentation?
Documentation means “to give written information that is proof or support of something that has been done or observed.” Documentation is the written account of observations, the information the client, resident or family relates or states, the data you collect during care, and the care that you provide.
A medical record is a collection of information about the person you are caring for. It is a legal and confidential record with pertinent information related to the care provided.
We have heard it said over and over again, “ If you did not document it, it was not done”. We have heard this a thousand times. Lets look at what all this means………….
Simply put, a medical record is the record of all care that is provided. If it is not recorded, it did not happen. If it is recorded incorrectly, it happened incorrectly. This is why it is so important to be accurate when documenting.
Four most commonly used forms with particular importance are: 1. Nurse’s progress notes 2. Graphic sheet for vital signs 3. Care plans 4. Activities of daily living sheets by CNA’s
These are the forms where the most pertinent data is collected. There is little room for error on these documents. This is not to say that the rest of the chart is not equally as important, as the whole record is essential. These forms are particularly important because the content they contain sum up what was done ( or not done ) for the patient.
Legal Implications
Documentation provides crucial legal protection. Admissible in court, the patient’s medical record must be documented in an accurate, complete, systematic, logical, concise, and timely manner. Courts will view the documentation in the medical record as proof and verification to patient care. By showing that the individual under your care received quality, adequate care, a well documented record can, and will most likely protect you legally.
The medical record is a legal document. It is also regarded as highly confidential, especially in light of the new HIPAA regulations. In the event of a medical malpractice case, the medical record may be used to provide the court with evidence about a person’s condition and treatments. In a malpractice case, the jurors usually view the medical record as the best evidence of what really happened. For this reason, all documentation should be neatly written and legible. Illegible handwriting is handwriting that cannot be read or understood by others. This would account for sloppy writing, and often misspelled words and poor grammar. Illegible or poorly written documentation makes you look careless and distracted. Take the time to write neatly and clearly. Avoid words that are unnecessary or very long. When you abbreviate, make sure it is a standard abbreviation with no possibility of having more than one meaning.
DO NOT cover up anything in a chart with white out. Draw one line through it and indicate “error”, and be certain you initial it.
NOTE: if you didn’t chart it, you didn’t do it… has another meaning, if you did not do it, don’t have someone else chart you did what you did not. Also, do not document care provided by someone else. If there is a problem, you will be held liable.
Do’s to good charting
1. Check to be sure you have the correct chart before you begin writing 2. Make sure your documentation reflects the nursing process and your professional capabilities. 3. Write LEGIBLY 4. Use a permanent black ink pen ( other colors do not Xerox well) 5. Chart completely 6. Be concise and accurate 7. Chart time for each entry 8. Document PRN medications and exceptional things in the record. 9. Chart precautions or preventative measures, ( Such as use of side rails) 10. Include the following for procedures: what was done, when it was done, who did it, how it was done, how the client tolerated it, adverse reactions, if any. Paint a clear picture of what happens. 11. Record each phone call to or from a physician, including exact time, message, and response. 12. Chart when a doctor makes a visit, and if there are any new orders. 13. Chart as soon as possible after providing care. 14. Chart a client’s refusal of treatment or medications. 15. Chart client’s subjective data.. ( what he says and how he says it) use quotations if necessary. 16. If you remember something important after you have completed your documentation, write “ late entry” and make the note. 17. If information on a flow sheet does not pertain to your patient, write N/A for not applicable, leaving it blank appears that it was not addressed or an oversight. 18. Make sure that each page has the patients name on it. Just last name is not acceptable, as it could become misplaced, and posted on the wrong chart of someone else with the same last name.
These good rules of charting is a good start to successful documentation.
The do not’s of charting are very important also:
1. Don’t chart a symptom such as “c/o Pain” without also writing what you did about it. 2. Don’t alter a chart….this is a criminal offense. 3. Don’t add information at a later date without indicating that you did so. 4. Don’t date the entry so that it appears to have been written at an earlier time. 5. Don’t use shorthand or abbreviations that are not standard. 6. Don’t write vague descriptions such as “ large amount of drainage” 7. Don’t make excuses, such as “meds not given because not available.” 8. Don’t chart what someone else says unless you use quotations and state who said it. 9. Don’t chart an opinion. 10. Don’t use words that suggest a negative attitude, such as “weird” or “nasty” 11. Don’t chart ahead of time. If something happens it will look bad to go back and make that correction. 12. Misspelled words and bad grammar are as bad as illegible handwriting. 13. Don’t record staffing problems. 14. Don’t document that an incident report was completed. 15. Don’t record staff conflicts.
Charting care that was not given is fraud. It is punishable by the Board Of Nursing and can land you in court, or put your license in jeopardy.
Also… if you make a mistake, draw a line through the error, and indicate it as an error, and then initial it. Do not write “oops” or “sorry” or draw a happy or sad face in the margin, or any where on the document. This is unprofessional and inappropriate. Don’t leave any blank spaces. Never save a space for a colleague who forgot to chart.
To avoid litigation, healthcare professionals must document according to State and Federal Legislation. Remember it is the law.
Nurses are also mandated by their state’s nurse practice act to document appropriately.
Avoid block charting, such as 0700-1500, this makes it very difficult to pin point a time that anything was done on the shift.
Types of charting
Regardless of the system of charting you use, it must include the nursing process as a guideline. 1. Assessment 2. Planning 3. Implementation 4. Evaluation
Assessment includes observing the patient for signs and symptoms that may indicate actual or potential problems.
Planning includes developing a plan of care directed at preventing, or resolving identified client problems or issues.
Implementation (or intervention) of the plan that has been developed includes the specific action that the nurse needs to take to accomplish the plan.
Evaluation determines whether or not the goal was met in identifying if the plan of care was effective in preventing, or resolving the problem.
Narrative charting
The nurse documents in chronological order the events that took place throughout the shift. Narrative charting is time consuming, so make certain your notes are legible and clear to understand by all who reads them. A note should be made at least every two hours.
SOAP Notes
This method is preferred by many nurses. It stands for Subjective data, Objective data, Assessment, and Plan. Sometimes it can be referred to as SOAPIE or SOAPIER, in which the “I” indicates implementation and “E” indicated Evaluation. When an “R” is included, this indicates Revision.
APIE
More commonly known as “Pie Charting” Assessment, Plan, Intervention (or implementation), and Evaluation. It is more concise in the aspect that the nurse will indicate subjective and objective data in the assessment section, what will be done in the plan, the intervention and the outcome. As it follows through in A, P, I, E format.
Flow Sheets
Also known as graphic sheets, or graphic records. These are a quick way to document. They need to be used CAREFULLY, as some areas do not apply to all patients. Avoid leaving any boxes unmarked, and individualize it to meet your patients needs. Focus Charting
The term focus was developed to encourage the nurse to view the client’s status from a positive perspective rather than a negative perspective. The system uses three columns to indicate date/time, focus, and progress note. The progress note portion includes DAR( date, time, response)
Date/time focus progress note
Date: Action: Response:
Charting by exception
Also known as CBE. A system of charting in which only significant information, findings, or exceptions are documented.
No matter which method you prefer, or your facility uses, make sure that the content is addressing the proper do’s and don’ts for charting.
Care Plans
Most care plan formats have three columns. One for the nursing diagnosis, one for the interventions, and one for the expected outcome. The nurse must develop a care plan for each client usually within a specified period of time after the client arrives to the facility. They are generally initiated upon admission.
Standardized care plans are preprinted care plans to help save time for the nurse. They must be individualized to fit the needs of each patients separately and individually.
Critical pathways or health care maps are usually preprinted care plans. They include nursing actions for a client with a specific medical diagnosis. The specify care that should be given on a daily basis including, but not limited to diet, medications, activity, treatments, ect. Pathways are popular with managed care becoming about more and more.
Kardexes
Kardexes are useful, but need to be maintained and up to date to be of any value. The card system is readily available to all staff who need information at a glance to what is pertinent with the patient. The cards are written in pencil so they can be updated appropriately and easily.
Things To Remember
We have learned a lot about proper documentation. Here are a few other things to consider:
The following mistakes can cause legal problems:
Ÿ Documentation not accurate Ÿ Documentation not complete Ÿ Failure to record prevention efforts Ÿ Particularly falls, side rails, call bells in reach, restraints( if used), smoking and any other potential for injury Ÿ Failure to record treatments and care Ÿ Failure to record refusal of care Ÿ Failure to record families refusal to accept care provided to patient Ÿ Incomplete incident reports (do not note incident reports in a chart) Ÿ Tampering with a medical record Ÿ Failure to record client’s failure to follow orders, noncompliance
Reimbursement
Another very important aspect of charting is related to reimbursement. In health care, sometimes private insurance and Medicare will deny payment if documentation is not satisfactory or is not done at all. This means that Insurance Companies, Medicare, and Medicaid pay the facility in reimbursement for care provided, which in turn pays salaries and supply costs. Payment can be denied if documentation is missing or incomplete from the chart. The importance of good documentation, charting vital information, and patient status is essential for reimbursement in many cases.
Reasons For Careful Documentation
1. Documentation gives written evidence of care given, the patient’s response, and the effect of the care. 2. Documentation plans for the future care and changes in plan of care so all members can be kept current. 3. Documentation serves as a communication tool. When you document, remember that you alone are responsible for noting what was done, and observed. 4. Documentation is legal, and reimbursement is often dependant on the notes that are written. 5. Documentation allows for continuity of care and focuses on clients needs and goals from all those involved in their care. 6. If the chart goes to court, you will most likely go to court too.
Summary
In closing, it is important to remember the basics for good documentation to protect yourself legally and to be able to provide good care to your patients. Cover all your bases, and think about legal aspects everyday as you go about your daily routines. Remember that what you write today, can save you and your license in the future, should the record end up in a court room. Keep in mind, whether your facility uses narrative charting or the more modern documentation systems on a computer, you need to document your actions expertly. By following these tips and guidelines, you will be well on your way to protecting yourself legally and provide the best possible care to your patients.
And we will say it one more time…… “ If you didn’t chart it, it wasn’t done.”
1. Explain the components of a teaching plan: Cognitive domain, Psychomotor domain, and Affective domain. Include in your explanation how the presenter would evaluate each. (P/P: Ch. 25, pp. 365-366 and Lecture: Introduction to Patient Education 10/23) --cognitive (understanding): -knowledge-recalling new facts or information -comprehension-understand meaning of new facts -application-applying new ideas in a given situation -analysis-break down facts in an organized manner -synthesis-apply new ideas and create a whole new one -evaluation-be critical about new information for a specific purpose *patient states name and purpose of medication
--psychomotor (motor skills): -perception: awareness of objects -set: mental, physical, or emotional readiness to take action -guided response: imitation of an act under guidance -mechanism: higher level of guided response with gained confidence -complex overt response: smooth and accurate performance of a skill -adaptation: ability to change skill when unexpected problems arise -origination: use existing skills to create new movement patterns *patient gives self-injection
--affective (attitudes): -receiving: willing to attend to another’s word -responding: active participation by listening and reacting -valuing: attaching worth to object or behavior -organizing: utilizing personal value system to resolve conflicts -characterizing: acting with a consistent value system *patient accepts he/she has chronic illness
2. Describe the elements of a community assessment. (P/P: Ch. 3, pg. 41) -structure: observe layout, location of services, and common meeting places -population: demographics according to statistics -social system: learn about social services such as school and health care
3. Discuss the factors to consider when providing health education. (P/P: Ch. 25, pp. 366-369 and Lecture: Introduction to Patient Education 10/23) -motivation to learn: physiological and psychological factors -ability to learn: sociocultural and capability factors -learning environment: is it ideal?
4. Describe the physiological, cognitive and psychosocial changes of the aged. Include pharmacological aspects and multiple health problems. (Geriatric Concept Map, 10/30) -physiological: decreased muscle mass, increased joint stiffness and bone loss, and overall decreased function -cognitive: impaired memory and sensation -psychosocial: decreased support and socialization, increased isolation and loss of identity and self-worth -decreased liver function: decreased drug metabolism -decreased kidney function: increased drug retention -decreased GI function: decreased drug absorption -polypharmacy: multiple medications can cause cascade effects to other problems
5. Discuss the assessment needed for the elderly patient. (Geriatric Concept Map, 10/30) -standardized assessement tool to determine how limitations impair or affect ADLs
6. Discuss the nursing diagnoses appropriate for the elderly patient. (Geriatric Concept Map, 10/30) -impaired gas exchange and ineffective tissue perfusion related to decreased cardiac ouput aeb activity intolerance -risk for injury related to altered sensory perception, decreased muscle mass, or multiple medications
7. Discuss the roles of the community health nurse. (P/P: Ch. 3, pp. 38-41) -caregiver: primary role; build safe community to achieve higher quality of life and function using nursing process -case manager: establish plan of care for community using available resources and breakthrough obstacles -collaborator: work with all persons involved with health care of a patient to develop and achieve goals -educator: teach community skills and knowledge needed to care for themselves -counselor: identify and clarify problems and guide through courses of action to solve problem -client advocate: provide community with information to make informed decisions regarding healthcare services -change agent: identify and implement more effective solutions to problems -epidemiologist: protect community level health by surveying community risk factors for illnesses
8. Discuss the principles of appropriate delegation. (P/P: Ch. 21, Box 21-6) -right task -right circumstance -right person -right direction/communication -right supervision
9. Discuss the attributes of a nurse manager. (Lecture: Leadership, Management, Delegation 10/23) -effective communicator -assertive -accurate -honest
10. Discuss the interventions for the elderly patient with visual impairment; hearing impairment. (Geriatric Concept Map, 10/30) -visual: large print, bright colors, glasses, lit hallways -hearing: low tones, speaking slowly, face patient, eliminate distractions
11. Discuss the home safety strategies for the aged. (Geriatric Concept Map, 10/30) -assistive devices: adequate lighting, canes, and safety bars -clearing pathways
12. Discuss the strategies to enhance and maintain long term memory. (Geriatric Concept Map, 10/30) -stimulate thinking process: crosswords, crafts, engaging in conversations
Hey everyone. I got an e-mail from the National Student Nurses' Association about their Midyear Conference in Reno. The convention is from November 13 to the 16th at the Nugget. They will have panels on nursing specialties, workshops on topics like pharmacology and nursing exams, and an exhibit hall with employers schools and other groups of interest to nursing students. The above link will take you to the National Student Nurses' Association web site for the conference which has a lot more information about specific presentations and activities.
For students from California, they are offering registration for the conference at $30 per day as long as we get 15 people interested in going. I've already got some people, but we are looking for more. This will be a good chance to talk to hospitals about what they look for when hiring new graduates as well as learning what you can do to score better in class. This is a national convention and I think we really need to take advantage of the fact that its so close. If you're interested in going, please e-mail me with your name, and which day(s) you would like to go. I've already got people who are interested in car pooling and going for Saturday only, but if you would like to stay up there for longer you're more than welcome. The following is the text of the e-mail I received about the event:
Attention Nursing Students and Pre-Nursing Students in California
We don’t want you to miss the upcoming Career Planning Conference sponsored by the National Student Nurses’ Association.We know that students are impacted by the current economic crisis so we have created a sale just for you!
Groups of 15 or more nursing students and/or pre-nursing students from the same school may register to attend the MidYear Conference for just $30 per day for Friday and Saturday.This special daily registration fee includes the Keynote Speaker on Thursday, 5:00 – 6:30 pm.See the complete program description and schedule to see which day works best for you.The Career Fair with 100 exhibitors takes place on Friday and Saturday.Nursing Career Specialty Panels take place on Saturday.
Here’s what you need to do to take advantage of this offer—use the attached form to:
Collect the names of at least 15 nursing students and/or pre-nursing students who will attend the Conference;
Indicate the name of the school of nursing and contact information;
Include the day(s) that the students will be attending.
Have a faculty member at your school sign and date the form;
Submit the form by Wednesday, November 5.
This offer is for both NSNA members and non-members. Our hope is that non-members will join when they learn about NSNA and experience what the organization offers to members.
Once we receive the list, we will prepare badges which can be picked up at the Pre-Registered conference desk. You may pay by cash, credit card, or check.You will need to show your student ID when you register.Note that walk-in daily registration is also available so that those who do not make it onto the list can also attend at the special rate.
If you have any questions, please call (718) 210-0705 or e-mail nsna@nsna.org
We look forward to seeing you!
Sincerely, Jenna Sanders, NSNA President
PSSee more information about the conference below.
Career Fair–Friday and Saturday. Find your first RN position, summer internships, and residencies.There are over 100 exhibits—bring plenty of business cards and your resume!
Nursing Specialty Showcase—Saturday November 15
Hear from 12 nursing leaders in a variety of nursing specialty careers—ask questions and get the answers you need to help guide your career decisions
"Conquering Your Own Everest: Do You Have What It Takes?"
Patrick Hickey, DrPH, MSN, RN, CNOR, is the Keynote Speaker at the National Student Nurses’ Association (NSNA) MidYear Conference in Reno, NV, November 13-16-2008. Dr. Hickey became the first registered nurse to have climbed all Seven Summits when he reached the top of Mt. Everest on May 24, 2007.Known as a humorous and engaging speaker, Dr. Hickey’s keynote speech, promises to deliver a rousing kick-off to NSNA’s MidYear Conference. And be the first to view NSNA’s new Career Advancement Video!
Major General Patricia Horoho presents the Midyear Leadership Address You will not want to miss this important event and an opportunity to meet the Chief Nurse of the US Army Nurse Corps, Major General Patricia D. Horoho.The Leadership Address takes place on Saturday, November 15, immediately following the Leadership Breakfast sponsored by the US Army Nurse Corps Recruiting Command.
Nursing’s Future:Opportunities and Challenges—Friday, November 14
Hear from five top nursing leaders—ask the panel participants questions and discuss the issues that concern your future as a Registered Nurse.
Special event with karaoke, networking, dancing, pizza, cup-cake decorating contest, raffles, and prizes.Event takes place on Friday at 7:00 pm.Admission:$5.00.Join us and help raise funds for the Foundation of the NSNA Disaster Fund.
1. How is the effectiveness of a psychotropic drug therapy often measured? a. verbal reports from patients regarding improvements in social and occupational functioning
2. What factors constitute ideal mental health? a. emotional, psychosocial, and spiritual factors
3. What is psychosis and what is its hallmark? a. severe emotional disorder impairing mental functioning impairing ADLs; hallmark is loss of contact with reality
4. What is another name for affective disorders? a. mood disorders
5. What is the biochemical concept of mental illness? a. abnormal levels of neurotransmitters
6. Which neurotransmitters play a role in maintaining mental health? a. dopamine, norepinepherine, serotonine, and histamine
7. What advantages do newer antidepressants have over TCAs and MAOIs? a. fewer and less severe systemic adverse effects and less drug-drug and drug-food interactions
8. How long does it typically take antidepressants to reach their maximum clinical effectiveness? a. 4-6 weeks
9. How do TCAs work? a. block reuptake of neurotransmitters to correct imbalance of concentrations
10. In general, how do antipsychotics work? a. produce state of transquility and work on abnormally functioning nerves
11. What are the positive symptoms of schizophrenia? a. hallucinations, delusions, and conceptual disorganizations
12. What are the negative symptoms of schizophrenia? a. apathy, social withdrawal, blunted effect, poverty of speech, and catatonia
1. What causes the excessive mucus production in a URI? a. inflammatory response by viral invasion
2. What causes nasal congestion in URI? a. irritation of nasal mucosa resulting in dilated small blood vessels of the nasal sinuses
3. What 4 classes of drugs are used to treat URI? a. antihistamines, decongestants, antitussives, and expectorants
4. What do histamine-1 receptors mediate? a. smooth muscle contraction and dilatio of capillaries
5. What do histamine-2 receptors mediate? a. acceleration of heart rate and gastric acid secretion
6. How does excessive histamine release cause a drop in blood pressure and edema? a. vasodilation and increased capillary permeability, moving fluids from blood vessels into tissues
7. How do antihistamines work? a. directly compete with histamine for specific receptor sites
8. What is the other term for antihistamines? a. histamine antagonists or blockers
9. Which specific smooth muscle are histamine-1 antagonist particularly focused on? a. smooth muscles surrounding blood vessels and bronchioles
10. What are the primary anticholinergic effects of antihistamines? a. secretions of lacrimal, salivary, and respiratory mucosal glands
11. How does histamine cause pruritis? a. stimulates nerve endings
12. What are the two main cells that release histamine? a. basophils and mast cells
13. What do antihistamines do to smooth muscle in the bronchial tree? a. cause extravascular muscle to contrict
14. Why is it most beneficial to give antihistamines early in a histamine-mediated reaction? a. compete with histamine to occupy the unoccupied receptors
15. What are the consequences of histamine binding? a. prevent consequences like vasodilation, increased secretions, and edema
16. What is the chief adverse effect of antihistamines? a. drowsiness
17. How do the non-sedating antihistamines avoid causing drowsiness? a. work peripherally without affecting the CNS
18. What is another name for non-sedating antihistamines? a. peripherally acting antihistamines
19. What class of drug is loratadine (Claritin)? a. non-sedating antihistamine
20. What class of drug is diphenhydramine? a. antihistamine
21. Why is the use of diphenhydramine discouraged in the elderly? a. hangover effect and increased risk of fall
22. What are the three classes of drugs used as decongestants? a. adrenergics (sympathomimetics), anticholinergics (parasympatholytics), and corticosteroids
23. How do sympathomimetics produce decongestion? a. constrict blood vessels to better drain nasal secretions
24. How do opioids reduce coughing? a. suppress cough reflex
25. What are the two mechanisms of action for expectorants? a. loosening and thinning of RT secretions and direct stimulation of secretory glands
Week 11-Chapter 36
26. Where does the oxygen-carbon dioxide exchange take place? a. alveoli
27. What is the common feature of asthma, emphysema and chronic bronchitis? a. obstruction of airflow through the airways
28. What is it that narrows bronchioles in asthma? a. bronchospasm, inflammation, and edema of bronchial mucosa
29. What is the collective term for such substances as the histamines and leukotrienes? a. inflammatory mediators
30. In asthma, what antibody sensitizes the patient to the offending allergen? a. immunoglobulin E
31. How do bronchodilators work? a. relax bronchial smooth muscle to dilate bronchi and bronchioles
32. What are the three classes of bronchodilators? a. Beta-agonists, anticholinergics, and xanthine derivatives
33. How do each of the subtype beta adrenergic agonists work? a. non-selective adrenergic drugs: stimulate alpha 1, beta 1, and beta 2 receptors b. non-selective beta adrenergic drugs: stimulate beta 1 and beta 2 receptors c. selective beta 2 drugs: stimulate beta 2 receptors
34. When a nonselective adrenergic agonist is given, what are the cardiovascular adverse effects? a. increased HR, contractility, and BP
35. How are beta 2 agonists useful in treating hyperkalemia? a. shifts potassium from blood stream to cells temporarily
36. List the adverse effects of alpha-beta agonists. a. insomnia, restlessness, anorexia, cardiac stimulation, hyperglycemia, tremor, and vascular headache
37. How does the parasympathetic autonomic nervous system bring about bronchoconstriction? a. releases Ach which binds to bronchial trees to constrict airways
38. How do anticholinergic drugs indirectly cause airway dilation? a. blocks Ach which causes constriction
39. What is the therapeutic range for theophylline? a. below 20 mcg/ml
40. What do leukotrienes cause in asthmatics? a. inflammation, bronchoconstriction, and mucus production
41. How do antileukotriene drugs work? a. prevent leukotrienes from attaching to receptors on circulating and local immune cells
42. How are inhaled corticosteroids used? a. control inflammatory response believed to cause bronchospastic disorders
43. How is fluticasone administered? a. intranasally
44. Is it safe to crush a sustained-release capsule for administration? a. no
45. What is the relationship of caffeine and beta agonist drugs? a. increase in adverse effects like tachycardia, hypertension, headaches, nervousness, and tremors
Week 11-Chapter 40
46. Describe MTB. a. a rod shaped bacterium thriving in highly oxygenated sites like the lungs
47. How is TB spread? a. inhaled droplets from infected hosts to new host
48. Why is MTB more difficult to treat than most bacterial infections? a. slow growing organism
49. Why are slow growing microorganisms difficult to kill? a. cells are not as metabolically active compared to faster growing organisms
50. What is the most widely used antitubercular drug? a. isoniazid (INH)
51. What it the major effect of drug therapy with antitubercular drugs? a. reduction of cough, and therefore infectiousness
1. What are seizures, convulsions and epilepsy? a. seizures: brief episodes of abnormal electrical activity in the nerve cells of the brain b. convulsions: involuntary spasmodic contractions of any or all voluntary muscles throughout the body, including skeletal and facial muscles c. epilepsy: chronic, recurrent pattern of seizures
2. What is accurate diagnosis of seizure disorder based upon? a. electroencephalogram (EEG)
3. What is an AED? a. antiepileptic drugs
4. What other types of illnesses are AEDs used for besides seizures? a. psychiatric disorders, migraine headaches, and neuropathic pain syndromes
5. Under what circumstances should an AED be abruptly stopped? a. a severe adverse effect occurs
6. Under what circumstances would a patient with a seizure disorder be maintained on a subtherapeutic drug level? a. decreases the risk for medication-induced adverse effects and interactions
7. What are the three pharmacologic effects of AEDs? a. make it difficult for a nerve to be excited or reduce the nerves response to incoming electrical or chemical stimulation b. limit the spread of seizure discharge from its origin c. decrease the speed of nerve impulse conduction within a given neuron
8. At what time of day are AEDs typically given? a. >?
9. Why should carbamazepine not be given with grapefruit? a. >?
10. Why does IV phenytoin have to be given with normal saline? a. avoid local venous irritation
11. Why does phenytoin IV have to be given slowly? a. possible cardiovascular/respiratory collapse
12. What is the most common adverse effect of AEDs? a. sedation, confusion, CNS depression
Week 10-Chapter 14
13. What does PD result from? a. imbalance of dopamine and acetylcholine
14. What do dopamine and acetylcholine regulate? a. proper regulation of posture, muscle tone, and voluntary movement
15. What are the classic PD symptoms? a. slowness of movement (bradykinesia), rigidity, tremor, and danger of falling
16. What is the primary role of MAOs? a. breakdown of catecholamines
17. What does selegiline do? a. decrease amount of levodopa needed
18. What does levodopa do? a. precursor for dopamine synthesis by the brain
19. How does amantadine (Symmetrel) exert its antiparkinsonian effect? a. elicits release of dopamine from nerve endings
20. In PD, what are anticholinergic drugs useful in? a. treat the muscle remors and muscle rigidity
21. What is the relationship of pyridoxine and levodopa? a. B6: promotes levodopa breakdown and possibly reverse effects
22. Explain the concept of a drug holiday. a. obtain more therapeutic effectiveness; allow patient to respond to lower doses of drug
1. What are anticoagulants? a. inhibits the action or formation of clotting factors thus preventing clots from forming
2. What are antiplatelet drugs? a. prevent platelet plugs from forming by inhibiting platelet aggregation which is beneficial for preventing heart attacks and strokes
3. What do thrombolytic drugs do? a. break down clots which have already formed
4. Why is frequent monitoring not necessary with LMWH? a. low molecular weight heparins have a predictable anticoagulant response
5. How does warfarin work? a. inhibits the four vitamin K-dependent clotting factors to prevent clot formation
Week 9-Chapter 28
1. How is cholesterol used in the body? a. used to make steroid hormones, cell membranes, and bile acids
2. How doe statins lower serum cholesterol levels? a. decrease rate of cholesterol production
3. What is rhabdomyolysis? a. breakdown of muscle protein leading to myoglobinuria (urinary elimination of the muscle protein myoglobin
4. When assessing liver enzymes, which are it most important to assess when a patient is on statins? a. activity of CYP3A4 in the liver to metabolize statins
citing sources is probably the most time consuming and annoying part of papers. there is a wonderful link to a site called citation machine on the right side of the blog that will help you out so much if you feel the same way. all you have to do is input the info like article title, author, etc. and it will automatically format in apa or mla format...whichever you chose to do. its such a time saver!!
I thought some of you might like a little distraction after the final and I saw this interesting article online. The American Heart Association recommends a rate of 100 compressions per minute while performing CPR. The authors of a recent study practiced CPR while listening to different songs on ipods, and they found out that "Stayin Alive" by the Bee Gees has a beat of 103 per minute. 5 weeks later they practiced CPR again and were told to think of the song while giving compressions and it improved their compression rates.
while we are busy studying for the final, dont forget N001 is coming to an end tomorrow, too. remember the first 3 weeks we were driving ourselves crazy wondering how we were going to make it through anything at all? well, we have accomplished something huge, even if its only 9 weeks in. we plowed through these weeks like hot, garlic, mashed potatoes.
take the time to recognize the bumpy road you took to get here because being proud of your accomplishment is the most rewarding thing you can do for yourself. have a good dinner tonight and rest up...a half hour of sleep will do more good than 30 extra minutes of study time!
Hey everyone. My desk is covered with Nursing 1 Study Notes and I am trying to get prepared for the final on Thursday. But I started thinking about Nursing 3 (my mind sometimes wonders). Anyways, I was just thinking about how I study for Pharmacology. On Test #2, I did all the reading and guided modules and studied for many hours but still made a poor grade. I was wondering how everyone went about studying for the test and class? Any suggestions would be greatly appreciated. Good luck on the final. Nursing 1 is almost under our belt.
1. Discuss the risk factors for complications of the patient undergoing surgery. (Ch. 50, pp. 1369-1375) -age, nutrition, obesity, obstructive sleep apnea, immunocompromise, F&E imbalance, pregnancy, medical history, lifestyle choices, and socioeconomic factors
2. Discuss the signs and symptoms of the patient experiencing dyspnea. (Ch. 40, pg. 920) -clinical sign of poor tissue perfusion marked by shortness of breath *exaggerated respiratory effort, increased depth and RR, and activity intolerance
3. Discuss the nurse’s responsibility to safe medication administration. (Ch. 35, pg. 687) -evaluate the effects of medications on health status -teach patients about medications and side effects -ensuring adherence with medication regimen -evaluate client’s ability to self-administer
4. Discuss the responsibility of the nurse when a medication error has occurred. (Ch. 35, pg. 705) -prepare written occurrence report or incident report to be filed within 24 hours -feel comfortable and fear no repercussions; safety of the patient first
5. Discuss the nursing actions that will maintain dignity and respect to patients. -good communication skills -following through -knowledgeable
6. Discuss the nursing interventions to promote communication with a patient with aphasia. (Ch. 24, Table 24-10) -be patient and attentive -ask simple questions, allowing time to answer -encourage conversation -do no speak loudly -use communication aids and collaborate with speech therapists -let patient know if you do not understand
7. Discuss the purpose of the implementation phase of the nursing process. (Ch. 19, pg. 279) -achieve goals and expected outcomes to support or improve the patient’s health status
8. Discuss the purpose of open-ended questions when obtaining subjective data. Provide examples. (Ch. 16, pg. 239) -technique leads to the patient actively describe their health status and strenghthen the nurse-client relationship *tell me how you are feeling *your discomfort affects your ability to get around in what way *describe how your wife has been helping you *give me an example of how you get relief from your pain at home
9. Discuss the nursing interventions to prevent vascular complications for an immobile patient. (Ch. 47, pg. 1247) -mobilize the patient as soon as their physical condition allows for them to do so -teach client to breathe out while repositioning themselves in bed -lower extremity exercises, frequent fluids, and position changes
10. Differentiate between evaluation and assessment. (Ch. 20, pg. 291). -evaluation is ongoing and whenever there is contact with the patient -to compare the status before the assessment stage and after a nursing intervention to redirect nursing care if necessary
11. Explain autonomy. Provide examples. (Ch. 24, pg. 348 and Ch. 22, pg. 314) -self-direction of nurses to make choices and accept outcomes of action like owning medication errors if they occur -inclusion of patients in all aspects of care like signing consent forms before surgery
12. Discuss the nursing responsibilities for the patient while in the PACU. (Ch. 50, pg. 1394) -focuses on monitoring and maintaining airway, respiratory, circulatory, and neurological status and on managing pain
13. Discuss strategies to ensure safe administration of medication. (Ch. 35, pp. 705-709) -standards: right medication, right dose, right client, right route, right time, right documentation -medical reconciliation: verify client’s current list of medications, clarify the list is accurate with as many people as necessary, reconcile discrepancies between new medication orders and current medications, and transmit updated and verified list to caregives and client
14. Discuss the assessment needed for the patient with fluid imbalance. (Ch. 41, pp. 978-984) -age -medical history including present medication -lifestyle -socioeconomic factors -daily weights and I&Os
15. List the criteria for writing a correct outcome or goal. (Ch. 18, pg. 265-267) -client centered and is specific and measureable reflecting wellness and independence -realistic -mutually set by nurse and patient
16. Discuss the criteria needed for writing an accurate nursing diagnosis. (Ch. 17, pg. 252) -client centered problem based on validated objective and subjective data -within nursing scope of practice -includes diagnostic label, related factor (related to…), and etiology (as evidenced by…)
17. Discuss strategies that promote effective communication. (Ch. 24, pp. 348-355) -use therapeutic communication techniques -use active listening -use professional communication -provide comfortable and safe environment with favorable conditions
18. Discuss the role of the health care team when developing an initial plan of care. (Ch. 18, pp. 268-269) -which interventions will be dependent nursing interventions -communicate nursing care priorities to other health care professionals
19. Compare and contrast legal decision making and ethical and moral principles. (Ch. 22, pp. 314- and Ch. 23, pp. 328-332) -legal decision making: advance directives, standards of care, informed consent, mental health parity act -ethical and moral principles: autonomy, benefiecience, maleficience, justice and fidelity; code of ethics including advocacy, responsibility, accountability, and confidentiality
20. Discuss the nursing care of the patient with a urinary catheter. (Ch. 45, Table 45-3) -prevent bacterial growth -promote comfort, check for displacement -assess purpose and need for catheter
21. Discuss the patient education needed for the patient scheduled for surgery. (Ch. 50, pp. 1379-1380, 1386) -understand pre-op instructions and exercises -state the time of surgery -understand to post-op location and where family will be able to wait during and after surgery -understand the post-op monitoring and therapy -understand surgical procedures and post-op treatment -understand post-op activity resumption -understand pain-relief measures -can openly express feelings about surgery
22. Discuss the nursing care of the patient who is confused. (Ch. 41, pp. 973-974) -may be evidence of electrolyte imbalance *monitor I&Os, daily weights, vital signs… *per physician order: correct imbalance by administering diuretic or IV fluid electrolytes
23. Discuss the complications of general anesthesia. (Ch. 50, pg. 1392) -side effects of anesthetic agents like cardiovascular depression or irritability, respiratory depression, and liver/kidney damage
24. Discuss the nursing interventions to prevent thrombophlebitis in the post-operative patient. (Ch. 50, pp. 1401-1403) -leg exercises unless contraindicated -apply stocking or devices to prevent circulatory stasis -encourage ambulation as soon as possible after monitoring vital signs and safety measures -reposition effectively -anticoagulant drugs as ordered -adequate hydration
25. Discuss the risk factors of the elderly patient undergoing surgery. (Ch. 50, Table 50-4) -reduced cardiac function, skin integrity, respiratory function, renal function, metabolic function and sensory loss -good vs. harm of patient going to surgery
26. Discuss the assessment needed for the patient with diarrhea. (Ch. 46, pp. 1185-1188) -assess frequency, volume, and consistency -inspect mouth and abdomen -assess usual elimination patterns of patient
27. Discuss the nursing interventions for the patient with impaired skin integrity. (Ch. 48, pp. 1301-1305) -maintain skin care, reposition to improve circulation and use devices if necessary to avoid further impairing skin integritry and educate the patient
28. Discuss causes of bradycardia. (Ch. 40, pp. 918-922) -age, lifestyle choices, and socioeconomic factors may cause decreased elasticity of heart muscle, thicker and stiffer heart valves, and calcification of vessels
29. Discuss the assessment needed for the patient with the diagnosis of Activity Intolerance. (Ch. 47, pg. 1240) -extent of ROM, ability to perform ADLs, varying degrees of pain perception/tolerance before and during activity
30. Discuss the signs and symptoms of severe hypoxia/hypoxemia. (Ch. 40, pg. 917) -cyanosis, declined RR, low SpO2 as a result of respiratory fatigue
31. Discuss the nursing interventions needed to promote oxygenation of the post-operative patient. (Ch. 50, pg. 1401) -breathing exercises: diaphragmatic breathing, coughing exercises, and incentive spirometer -use respiratory devices when/if patient uses them at home or oxygen if ordered -promote comfort: assist in turning and oral hygiene -remove secretions
32. Discuss the preparation needed to safely transfer the patient to the operating room. (Ch. 50, pp. 1389-1391) -use stretcher -double checks for identification -standards to prevent falls; rails up after medication administration -void before surgery
33. Discuss the nursing interventions needed to promote ambulation. (Ch. 47, pp. 1246-1275) -maintain circulation and muscle use to prevent ambulation complications *ROM exercises, repositioning, breathing exercises, devices designed to improve circulation
34. Discuss the assessment needed for the patient who has been on bed rest and has an order to begin ambulation. (Ch. 47, pg. 1230-1237) -assess mobility of the patient including range of motion, gait, exercise/activity tolerance, and body alignment -ask or observe -assess to protect patient safety: orthostatic hypotension
35. Discuss the purpose of bed rest. (Ch. 47, pg. 1225) -reduce physical activity and oxygen needs of the body -reduce pain -allow ill or debilitated patients to rest -allow exhausted patients uninterrupted rest
36. Discuss the correct procedure for administering a subcutaneous medication. (Ch. 35, pp. 744-750) -use the rights of medication administration before giving injection and assess purpose and need for medication *draw up syringe, cleanse proper injection site, pinch site and inject at 45-90 degree angle *DO NOT RUB HEPARIN
37. Discuss the nursing care for the post-operative patient who had a nasogastric tube. (Ch. 50, 1404-1405) -for decompression, not feeding, because stomach becomes paralyzed after surgery -listen to BS, look BM, distension -safely remove stomach contents to provide comfort for patient
38. Discuss the purpose of using an assistive device when moving patients. (Ch. 47, pg. 1224) -reduce number of work-related injuries -avoid unnecessary injury to nurse and patient
39. Discuss the correct procedure for suctioning a patient. (Ch. 40, pp. 934-941) -suction to clear secretions a patient is unable to produce or clear
40. Discuss the physiological effects of prolonged bed rest. (Ch. 47, pg. 1239) -poor circulation and muscle weakness *slow wound healing, slowed or impaired GI/GU activity, activity intolerance, impaired respiration, lack of ROM, and muscle/fat loss
41. Discuss dependent nursing interventions for the patient experiencing nausea. (Ch. 41, pg. 975) -may be evidence of fluid volume deficit or excess *per physician order: diuretics, administering IV fluids, blood transfusions, laboratory tests…
42. Dosage and Calculations (Ch. 35, pp. 696- 698) Can you calculate pills/tablets/injections? -(dose ordered)/(dose on hand) x amount on hand = amount to administer Can you calculate safe dosage ranges? Can you safely administer medication (using the correct equipment)?
43. Can you utilize the nursing process given a specific case scenario?
Hey everyone, here's my portion of the questions I answered from the study guide. Feel free to add in your two cents... and Don't be shy to SHAARREEE!!!
1. Discuss the risk factors for complications of the patient undergoing surgery. (pp. 1369-1372) Age- anesthesia can cause vasodilation and heat loss in underdeveloped young pts. -Less physical capacity due to deterioration of body functions in older adults. Nutrition- malnourished pts more prone to poor tolerance to anesthesia, negative nitrogen balance from lack of protein, delayed blood-clotting, infection, poor wound healing, and potential for multiple organ failure. Obesity- reduced ventilation and cardiac function can lead to sleep apnea, hypertension, coronary artery disease, DM, and CHF à embolisms, atelectasis, and pneumonia. Obstructive sleep apnea (OSA)- often results in sleep-associated oxygen desaturation. Immunocompromise- increase risk for infection due to suppressed immune system. F & E Imbalance- body responds to surgery as trauma, therefore the body retains sodium and water and loses potassium within the first 2-5 days post-surgery. Pregnancy- all major system of the body affected during pregnancy due to increased metabolic rate and body’s response to trauma. Surgery only done on emergent or urgent basis.
2. Discuss the signs and symptoms of the patient experiencing dyspnea. (p. 920)- shortness of breath; clinical sign of hypoxia. Exaggerated respiratory effort Use of the accessory muscles of respiration Nasal flaring Marked increases in the rate and depth of respirations Orthopnea
3. Discuss the nurse’s responsibility to safe medication administration. (p. 696) –To safely administer medications to pts, nurses need to know how to calculate medication doses ACCURATELY. They also need to understand the different roles that members of the health care team play in the prescribing and administering of meds. Prior to administration (NOTES) -therapeutic effect -side effects -drug toxicity -drug allergies -cumulative effects -drug interactions
4. Discuss the responsibility of the nurse when a medication error has occurred. (p.705)*When an error occurs, the client’s safety and well-being being are TOP PRIORITY. -assess and examine the client’s condition and notify the physician or prescriber of the incident as soon as possible. -once client is stable, report incident to appropriate person in institution -nurse is responsible for preparing written occurrence or incident report that usually needs to filed within 24 hours of the error. (includes client id info; location and time of incident; accurate, factual description of what occurred and what was done; nurse signature) ** Report all MEs, including those that do not cause obvious or immediate harm or near misses.
5. Discuss the nursing actions that will maintain dignity and respect to patients. (pp. 100-103) -promoting caring nurse-patient relationship/therapeutic communication -nurses need to learn culturally specific behavior -providing presence and active listening -using the comforting approach such as touch -providing privacy as well as advocacy -providing client-centered care -active listening -getting to know your patient -spiritually caring -involving family and loved ones upon client’s request or consent
6. Discuss the nursing interventions to promote communication with a patient with aphasia. (pp.1358-1359) **aphasia- unable to speak Listen to the client, and wait for the client to communicate. Do not shout or speak loudly. Use simple, short questions and facial gesture to give additional clues. Speak of things familiar and of interest to the client. Simple yes or no answers. Offer pictures or communication board so client can point. Be calm and patient; do not pressure or tire the client. Avoid patronizing and childish phrases.
7. Discuss the purpose of the implementation phase of the nursing process. (pp. 279) The nurse initiates interventions that are most likely to achieve the goals and expected outcomes needed to support or improve the client’s health status. Designed to improve patient’s level of health.
8. Discuss the purpose of open-ended questions when obtaining subjective data. Provide examples. (p. 239) Open-ended questions prompts clients to describe a situation in more than one or two words. This leads to a discussion in which clients actively describe their health status. Open-ended questions strengthen your relationship with your pts because it shows you want to hear their thoughts and feelings. **encourage and let client tell the story all the way through **use good eye contact and listening skills ** back-channeling (“uh-huh,” “go on,” “all right”) EXAMPLES: Tell me how you are feeling. Your discomfort affect your ability to get around in what way? Describe how your wife has been helping you. Give me an example of how you get relief from your pain at home. Tell me about the problems you are having. What might be causing this problem? ***Probe until exhaustion.
9. Discuss the nursing interventions to prevent vascular complications for an immobile patient. (pp. 1247-1248 & NOTES) ***Clients who are immobile often experience orthostatic hypotension, increased cardiac workload, thrombus formation, deep edema, venous vasodilation and stasis, diminished cardiac reserve. For a pt with orthostatic hypotension, mobilize pt as soon as they physical condition allows, even if it’s only dangling at the bedside or moving to a chairàmaintains muscle tone and venous return. Discourage use of Valsalva Maneuver (baring down) as this decreases venous return and cardiac output. In prevention of thrombus formation, interventions include: elevate lower extremities; leg, foot, and ankle exercises such as ankle pumps, foot circles, and knee flexions; regularly providing fluids; position changes; flexing and extending of feet; medications, Tedhose, SCDs require doctor’s orders. ROM exercises reduce the risk of contractures and aid in preventing thrombi.
10. Differentiate between evaluation and assessment. Assessment encompasses gathering information about the client’s condition both subjectively and objectively, as well as analyzing and clustering the data as a basis for developing nursing diagnoses, identifying collaborative problems, and developing a plan of individualized care. Evaluation is a determinant of whether goals are met and outcomes are achieved. The key is to determine if you met your expected OUTCOMES, not if nursing interventions were completed.
11. Explain autonomy. Provide examples. (p. 314) In regards to Professional Standards in nursing practice, autonomy refers to the commitment to include clients in decisions about all aspects of care. Obtaining a signed consent after explaining potential procedures. Involving client in end-of-life decisions. Advance Directives: Living Wills & Durable Power of Attorney
a patient has a tracheal artificial airway and is having non-productive coughs. upon ascultation of the lungs on the back, the student nurse hears coarse crackles and wheezing. when the student ascultates for the heart sounds, she cannot hear any because the crackles and wheezing sounds make it difficult for her to do so.
what should the student nurse do?
since the patient is having non-productive coughs, the sputum is ineffectively clearing from the patient's airway. the student can say so because there is lack of sputum present when the patient coughs, and crackles indicates this as well. the student should deep suction the artificial airway as necessary to remove the sputum effectively. the sputum removed should be observed for quantity and quality. to ensure the student nurse performed efficient suctioning, she should ascultate the lung sounds again to check for improvement.
1. What do inotropic drugs do a. change the force of myocardial contraction
2. What do positive chronotropic drugs do? a. increase the rate at which the heart beats
3. What are the two main classes of positive inotropic drugs? a. cardiac glycosides and phosphodiesterase inhibitors
4. What is the definition of heart failure? a. abnormal condition in which cardiac pumping is impaired as a result of myocardial infarction
5. What is ejection fraction and what is the normal value? a. amount of blood ejected with each contraction, normally 65% of the blood volume in the ventricle
6. When a person is in heart failure, which of their organs are the last to be deprived of blood? a. those most dependent on blood, the brain and heart
7. What is the relationship of sodium and potassium to heart function? a. depolarize the heart
8. Define systolic dysfunction and diastolic dysfunction. a. systolic dysfunction: inadequate ventricular contractions during pumping of the heart b. diastolic dysfunction: inadequate ventricular filling during ventricular relaxation
9. How does a cardiac glycoside improve myocardial contractility? a. inhibits the ATPase pump, increasing calcium concentration
10. What are the inotropic, chronotropic, dromotropic and other cardiac effects of digoxin? a. positive inotropic effect: increase in force and velocity of contractions without increasing oxygen consumption b. negative chronotropic effect: lowers HR c. negative dromotropic effect: decreases automaticity at SA node, decreases AV node conduction, reduces conductivity at the bundle of His, and prolongs the atrial and ventricular refractory periods d. other cardiac effects: increase in stroke volume, reduction in heart size during diastole, decrease in venous BP and engorgement, and increase in coronary circulation
11. What are the primary indications for cardiac glycosides? a. heart failure and supraventricular dysrhythmias
12. What is the normal therapeutic drug level for digoxin? a. 0.5-2 ng/ml
13. How do low serum potassium levels affect digoxin therapy? a. increase potential for toxicity
14. What are the common adverse effects of cardiac glycosides? a. dysrhythmias, headache, fatigue, malaise, confusion, convulsions, colored vision, halo vision, flickering lights, anorexia, nausea, vomiting, and diarrhea
15. What is the step-by-step management of digoxin toxicity? a. discontinue administration of the drug b. begin continuous ECG monitoring for cardiac dysrhythmias, administering appropriate drugs as ordered c. determine serum digoxin and electrolyte levels d. administer potassium supplements for hypokalemia if indicated, as ordered e. institute supportive therapy for GI symptoms like nausea, vomiting, or diarrhea f. administer digoxin antidote if indicated, as ordered
16. How does digoxin immune Fab (Digibind) work? a. binds to unbound digoxin to reverse effects and symptoms of toxicity
17. What are the results of inhibition of phosphodiesterase? a. positive inotrophic response and vasodilation
18. What is an inodilator? a. a drug producing positive inotrophic response and vasodilation
19. What is the effect of inhibition of phosphodiesterase on the availability of calcium, systemic and pulmonary vessels and cardiac workload? a. increases availability of calcium for heart to use for muscle contraction, dilates systemic and pulmonary vessels which decreases cardiac workload
20. How do PDI’s reduce afterload? a. dilate blood vessels
21. What are the two most common PDI’s? a. inamrinone and milrinone
22. What serum lab values should the nurse investigate before giving a cardiac glycoside? a. serum potassium
23. What heart rates in the adult should cause the nurse to withholding a cardiac glycoside? >?
24. What is the relationship between bran and digoxin? a. bran in large amounts may decrease the absorption of digoxin
25. What is the safe infusion rate for IV digoxin? a. usual digitalizing dose: 1-1.5mg/day b. usual maintenance dose: 0.125-0.5 mg/day
Week 9-Chapter 23
26. How is the heart’s oxygen supply met? a. delivered by coronary arteries
27. What is angina pectoris? a. chest pain
28. Define coronary artery disease, myocardial infarction, chronic stable angina, unstable angina, and vasospastic angina. a. coronary artery disease: supply of oxygen and energy-rich nutrients needed for the heart to meet its demands is decreased due to atherosclerosis b. myocardial infarction: heart attack; blood flow through the coronary arteries to the myocardium is completely blocked so that part of the heart cannot receive oxygen from blood-borne nutrients c. chronic stable angina: triggered by exertion or stress causing intense pain for 15 minutes and usually subsides d. unstable angina: pain episodes increase in severity and frequency e. vasospastic angina: spasms of the smooth muscle surrounding atherosclerotic coronary arteries often happening during rest
29. Which are two example classes of drugs that aim to correct the imbalance between myocardial oxygen supply and demand and how do they do it? a. nitrates and nitrites: dilate all blood vessels b. beta blockers: slow heart rate and reduce blood pressure
30. Explain the process that results in angina. a. oxygen deprivation of the myocardium under ischemic conditions cause the heart to work anaerobically producing lactic acid and stimulating pain receptors surrounding the heart
31. What is it that actually causes the heart pain called angina? a. lactic acid causes pain receptors to be stimulated
32. How do nitrates and nitrites vasodilate? a. relaxes the smooth muscle cells of venous and arterial wall structure
33. What does dilation of coronary arteries by nitrates result in? a. reverses or prevent exercise induced spasms, encouraging healthy physical activity in patients 34. Explain the way in which nitrates/nitrites reduce preload. a. cause venous dilation and reduces venous return
35. Why are nitrates/nitrites contraindicated in persons with severe anemia, closed-angle glaucoma, hypotension and severe head injury? a. conditions can be worsened
36. Why specifically is it risky to give nitrates/nitrites to a person with severe anemia? a. cause drug-induced hypotensive episode
37. What is reflex tachycardia? a. cardiovascular overcompensation marked by increased heart rate
38. What is the purpose of the regimen of removing transdermal patches at night for 8 hours and then applying a new patch in the morning? a. prevent tolerance to nitrates
39. How do beta blockers improve the chances of survival in patients following an MI? a. block harmful effects of the high levels of circulating catecholamines from irritating the heart
40. How do calcium channel blockers work? a. promotes muscle relaxation causing coronary artery dilation increasing blood flow and oxygen supply
41. What is the primary beneficial antianginal effect of amlodipine and nifedipine? a. indicated for angina and hypertension
42. What is the onset time for sublingual nitroglycerine? a. 2-3 minutes
43. What systolic BP should be reported before giving a nitrate? a. less than 60 mm Hg
44. Why is it unsafe to take nitrates when taking erectile dysfunction drugs? a. worsens hypotensive response, paradoxical bradycardia, and increased angina with risk of cardiac or cerebrovascular complications from decreased perfusion
45. When receiving a nitrate, what position should the person be in? a. seated to avoid falls
46. Where should nitroglycerine ointment be placed? a. upper arms or body
47. Should nitroglycerine ointment be rubbed in and what is done with it when the dose is changed? a. it should not be rubbed in and should be cleaned with soap and water and patted dry before applying the changing the dose
Week 8-Chapter 22 1. What is it that results in disturbances in cardiac rhythm? a. abnormally functioning cardiac cells
2. What is the term for spontaneous electrical excitability found in cardiac cells? a. automaticity 3. What are the three main ions involved that move across the cell membrane causing cardiac electrical activity? a. calcium, sodium, and potassium 4. What mechanism maintains the polarized distribution of ions in the myocardium? a. sodium-potassium adenosine triphosphatase (ATPase) pump 5. How are antidysrhythmic drugs categorized? a. Class 1, 1a, 1b, 1c, class II, class III, class IV 6. In general, how do antidysrhythmic drugs work? a. affect the resting membrane potential (RMP) and sodium channels, in turn influencing the rate of impulse conduction 7. Be able to recognize from the pictures on pages 335 – 337 and defined on page 338, the following dysrhythmias: a. atrial fibrillation: supraventricular dysrhythmia characterized by rapid atrial contractions that only incompletely pump blood into the ventricles
-rapid, ineffective atrial contractions: QRS complex separated by squiggly lines
b. ventricular tachycardia: rapid heartbeat from impulses originating in ventricles
-photo of sustained VT: uniform mounds
c. ventricular fibrillation: worsened ventricular tachycardia which can be fatal if not reversed
8. What are the therapeutic responses to antidysrhythmic drugs that the nurse should see in the patient? a. improved cardiac output, decreased chest discomfort, decreased fatigue, improved vital signs, skin color, and urinary output
Week 8-Chapter 24 1. List all of the drug categories that are used to lower the blood pressure in those with hypertension. a. Loop diuretics, potassium sparing diuretics, beta blockers, ACE inhibitors, alpha 1 antagonists, ARBs, CCBs and vasodilators
2. In Figure 24-1 on page 369, be familiar with the values that represent normal as well as the different classifications of hypertension. Know columns 1, 2 & 3 of the table. BP Classification: SBP (mm Hg) / DBP (mm Hg) a. normal: less than 120/less than 80 b. prehypertension: 120-139/80-89 c. stage 1 hypertension: 140-159/90-99 d. stage 2 hypertension: 160 or higher/100 or higher 3. Know Figure 24-3 on page 372 you need to know only the classes of antihypertensives, not the drugs that represent each class. Essentially, what I want you to know is where each anti-hypertensive class works in the body. a. centrally-acting alpha 2-receptor agonists: vasomotor center b. centrally and peripherally acting allergenic neuron blocker: vasomotor center and sympathetic ganglion --> blood vessel c. peripherally acting alpha 1-receptor antagonists: blood vessel d. direct-acting arteriolar dilators: blood vessel e. direct-acting arteriolar and venous dilator: blood vessel f. diuretics: kidney g. angiotensin II receptor blockers (ARBs): angiotensin II h. angiotensin-converting enzyme (ACE) inhibitors: angiotensin-converting enzyme i: beta-adrenergic blocking drugs: heart
Week 8-Chapter 25 1. What do diuretics remove from the body? a. sodium and water 2. What are the mechanisms that make diuretics hypotensive drugs? a. direct arteriolar dilation which decreases peripheral vascular resistance b. reduce extracellular fluid volume, plasma volume, and cardiac output 3. What is the main problem with diuretic use? a. excessive fluid and electrolyte loss
4. How are diuretics classified? a. carbonic anhydrase inhibitors, loop diuretics, osmotic diuretics, potassium-sparing diuretics, and thiazide and thiazide-like diuretics 5. List the diuretic subclasses according to their potency in the order of most potent to least potent. a. loop diuretics, osmotic, thiazide-like diuretics, thiazides, and potassium sparing 6. Fill in the blanks. The more sodium and water diuretics inhibit from resorption, the greater the amount of diuresis.
7. What are the beneficial hemodynamic effects of loop diuretics? a. reduction of preload and central venous pressures 8. What are the cardiovascular effects of loop diuretics? a. reduces blood pressure, pulumonary vascular resistance, systemic vascular resistance, central venous pressure, and left ventricular end-diastolic pressure 9. What are the electrolyte losses associated with diuretic administration? a. loss of sodium, potassium and some calcium 10. How do osmotic diuretics work? a. produces osmotic pressure in the glomerular filtrate which pulls fluid (mostly water) into renal tubules from surrounding tissue b. inhibits tubular resorption of water and solutes producing rapid diuresis 11. How does spironolactone lead to diuresis? a. competitively binds to aldosterone receptors thus blocking the resorption of sodium and water induced by aldosterone secretion 12. How do thiazide diuretics work? a. inhibit resorption of sodium, potassium, and chloride resulting in osmotic loss
updated exam #3 grades are up if you have not yet checked docushare and the study guide for the final is also posted. dont be shy to post your study guide here too if youd like to share it...but of course dont feel obligated to!!
and just in case you didnt notice there is a link to docushare on the right column for your convenience :)
Opps! I think I spelled your name wrong, sorry about that.
Thank you Ann for taking the time to organize this blog, and thanks for inviting me. This really is a more user friendly website, it's cool. Oh and I just want to shout out that I hope everyone did well on the third exam, and good luck on the Pharm exam everyone!
I know I have been buggin you guys about the TEA. It will be here before you know it!! I know alot of you have already secured donations. However we need more donations, now is the time to get them, the holiday season is approaching and people are too busy to give!!.
Ideas on the theme for the TEA would be great! Mandy suggested a Fiesta, if you have any additional ideas please share.
Ann volunteered to do the video presentation. If you have any pictures or ideas please give them to Ann (the brilliant person who created this blog).
Please get ahold of me If you would like to help out with the TEA. I am not in charge I am just getting it going! I will help to do what I can, so if you feel so inclined to head up this endeavor speak up!!
thanks a. ha for taking the time to incorporate Nurses 2010 blog in with the previous years blogs. I was thinking about investing in a PDA. Does anyone have any suggestions on the model that is most beneficial in buying for our purposes? How much memory would be adequate? And the programs that you like so far? Good luck on the test #3 to everyone.
For those of you who don't routinely check your student emails, here's the latest from Mr. Scott....
Dear HS 3, N 3 Students:Beginning now, I will posting grades in the turnitin.com website rather than DocuShare. Each student’s grade will be anonymous and the gradebook will retain all of your scores. It is an improved way of record keeping for me as well as a better way of you tracking your performance in the class.In order for you to get your grades in this course, you will need to go to the turnitin.com website and open an account. Below are the instructions to do this.Go to the turnitin.com home page.In the upper right corner, you will see, “New Users.” Click on that.On the page that appears, click on “Student.”Under class ID, enter 2441659Under class enrollment password, enter pharmacologyComplete the remaining portion of the form and click on I agree—create profileOnce you are enrolled, you will be able to access the course, HS 3, N 3 Administration of Medication.I will not be developing the gradebook until students have enrolled. Please be patient, this may take some time. I hope to place your Exam II scores in the turnitin gradebook.Thanks for participating.Bruce Scott
The final is scheduled for october 16 at EMSTI from 0800-1200. It is comprehensive and worth 100 pts of the grade.
*50 pts-multiple choice (like what we usually have) *25 pts-dosage calculations (application type calculations, not like pharm) *25 pts-short answer response to case scenario
There will be a study guide available on Mrs. Semillo's DocuShare when it is ready.
1. What are the functions of HCl, bicarbonate, pepsinogen, intrinsic factor, mucus and prostaglandins in the stomach? a. HCl: aids in digestion and barrier to infection, b. bicarbonate: natural mechanism to prevent hyperactivity c. pepsinogen: precursor to pepsin which digests protein d. intrinsic factor: facilitates absorption of B12, e. mucus: protection from HCl and digestive enzymes f. prostaglandins: antiinflammatory and protective functions
2. Which cells produce HCl? a. parietal cells
3. What usually causes hyperacidity in the stomach? a. food, caffeine, chocolate, alcohol or emotional stress
4. What is the typical pH of the stomach? a. 1-4
5. What is the primary target of the drugs that treat acid-related disorders? a. parietal cells
6. What are the three types of receptors on the parietal cells? a. acetylcholine (Ach), histamine, and gastrin
7. What is the name of the mechanism which transports HCl from the parietal cells to the stomach? a. proton pump
8. How do anticholinergics reduce HCl production? a. block Ach receptors which also decrease hydrogen ion secretion from parietal cells
9. Why do aluminum and calcium based antacids also contain magnesium? a. contributes to acid-neutralizing capacity and conteracts constipating effects of calcium and aluminum
10. To what degree do antacid dosages raise the gastric pH? a. 0.3 points, reducing it by 50% b. 1 point, reducing it by 90%
11. How do H2 receptor blockers raise the gastric pH? a. competitively block H2 receptor of acid-producing parietal cells and reduces responsiveness to histamin and stimulation of Ach and gastrin
12. How do PPI’s raise the gastric pH? a. bind to proton pump preventing movement of hydrogen ions and blocks gastric acid secretion
13. When both antacids and H2 blockers are given, what is the proper practice? a. Do not administer simultaneously.
14. Why are antacids to be given with water? a. enhance absorption in stomach
15. In relation to other medications, how should antacids be given? a. 1-2 hours before other medications are taken
16. What may happen if ranitidine is given rapidly IV? a. hypotension
Week 7-Chapter 52
17. What is the definition of diarrhea? a. abnormal passage of stools with increased frequency, fluidity, weight, or with increased stool water excretion
18. How do adsorbents work in treating diarrhea? a. coat the wall of the GI tract, binding to causative bacteria or toxin to their surface to be eliminated from the body through stool
19. How do anticholinergic drugs reduce diarrhea? a. slow peristalsis by reducing the rhythmic contractions and smooth muscle tone of the GI tract
20. How do opioids treat diarrhea? a. reduce bowel motility
21. How do opiods affect absorption? a. increases the absorption of water, electrolytes, and nutrients
22. Why might someone who takes oral anticoagulants with absorbants be at higher risk for bleeding? a. may bind to vitamin K which is needed for clotting
23. Why does Lomotil contain atropine? a. discourages recreational opiate use
24. What is the definition of constipation? a. abnormally infrequent and difficult passage of feces through the lower GI tract
25. What problems can chronic laxative use cause? a. laxative dependence, damage to bowel or intestinal problems
26. What are the three ways in which laxatives work? a. affecting fecal consistency, increasing fecal movement through colon and facilitate defecation through the rectum
27. Describe the way in which the 5 categories of laxatives work. Know drug examples from each laxative category. Table 52-4 Laxatives: Drug Effects *Bulk: Psyllium Increase peristalsis, causes increased secretion of water and electrolytes in small bowel, inhibits absorption of water in small bowel, increases water in fecal mass, softens fecal mass
*Emollient: Mineral oil Increase peristalsis, causes increased secretion of water and electrolytes in small bowel, inhibits absorption of water in small bowel, increases wall permeability in small bowel, increases water in fecal mass, softens fecal mass
*Hyperosmatic: Glycerin Increase peristalsis, acts only in large bowel, increases water in fecal mass, softens fecal mass
*Saline: Magnesium hydroxide Increase peristalsis, causes increased secretion of water and electrolytes in small bowel, inhibits absorption of water in small bowel, increases water in fecal mass, softens fecal mass
*Stimulant: Senna Increase peristalsis, causes increased secretion of water and electrolytes in small bowel, inhibits absorption of water in small bowel, increases wall permeability in small bowel, increases water in fecal mass, softens fecal mass
28. How does lactulose reduce serum ammonia levels in patients with hepatic encephalopathy? a. converts ammonia to ammonium which cannot be reabsorbed in the small intestine
29. How long does it take polyethylene glycol 3350 to cleanse the bowel if it is taken properly? a. 4 hours
30. What color does bismuth subsalicylate turn the stool? a. black or grey
1. What are the three main body fluid compartments? a. intracellular fluid, interstitial fluid, and plasma volume
2. Know the terms extracellular fluid, extravascular fluid, interstitial fluid, intracellular fluid and intravascular fluid. a. extracellular fluid: fluid outside the cells b. extravascular fluid: fluid outside blood vessels c. interstitial fluid: fluid between cells d. intracellular fluid: fluid within a cell e. intravascular fluid: fluid within blood vessels
3. What does isotonic mean? a. equal concentration of solutes across a membrane
4. There are two forces within the capillaries that bring about the movement of water. Hydrostatic pressure pushes water out of the capillaries and oncotic or colloidal oncotic pressure pulls or retains water within the vessels. The arterial blood pressure is what provides for the hydrostatic pressure. It is a person’s arterial blood pressure that promotes the movement of fluid from within the capillaries to outside the capillaries (tissues and cells). Serum protein (albumin) is what causes a person to have oncotic pressure so it is actually the albumin that pulls water into the capillaries. So, hydrostatic pushes and oncotic pulls.
5. What is the principle extracellular electrolyte? a. albumin
6. What are the three categories of agents used to replace lost fluids? a. crystalloids, colloids, and blood products
7. What are the constituents of crystalloids? a. fluids and electrolytes normally found in the body
8. How do colloids move fluid from the interstitial
Student Nurses' Association would like to invite you to our CPK Fundraiser!
*photos from learntheecg.com