study guide for final exam (brief)

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

My D&C answers:
1. 21 gtt/min
2. 15 gtt/min
3. 25 gtt/min
4.
5. 60 min; 0715
6. 7 hr 48 min; 2351
7. 5 hr; 2340
8. 4 hr 42 min; 1256
9. 0.2 ml/hr
10. 300 ml/hr
11. 63 ml/hr
12. 47 ml/hr
13.
14. 10-20 ml/hr
15. a) 217-434 mcg/min
b) 65-130 ml/hr
c)

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.