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.
