N2 Study Guide for the Final

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)

Objective data
· General: Intermittent fever, emaciated appearance, fatigue
· Integumentary: pale skin with poor turgor, dry mucous membranes, skin lesions, anorectal irritation, skin tags, cutaneous fistulas
· Gastrointestinal: Abdominal distension, hyperactive bowel sounds, abdominal cramps
· Cardiovascular: Tachycardia, hypotension
· Possiable findings: Anemia; leukocytosis; electrolyte imbalance; hypoalbuminemia; vitamin and tarce mmineral deficiencies; guaiac-positive stool; abnormal sigmoidoscopic; colonoscopic, and/or barium enema findings
· (GI Dysfunction Lecture)-past medical history, diet, heartburn, dysphasia, lifestyle

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