looky looky we got our very own countdown!

question of the week

Question of the week for 12.21.09

A client develops volume overload from an IV that has infused too rapidly. What assessment should a nurse expect to find?

1. S3 heart sound
2. Thready pulse
3. Flattened neck veins
4. Hypoventilation

now you can breathe!

congratulations, we are all done with 3rd semester...

LAST semester, here we come!

=D

question of the week

Question of the week for 12.14.09

A client is unconscious following a tonic-clonic seizure. What should a nurse do first?

1. Check the pulse
2. Administer the ordered Ativan
3. Place the client in a side-lying position
4. Place a tongue blade in the mouth

Countdown

Hey, just curious, can we put up one of those countdown things on here?! I don't know how but could someone do it?! I think it's time!!!

question of the week

Question of the week for 12.07.09

A nurse is caring for a client in the coronary care unit. The display on the cardiac monitor indicates ventricular fibrillation. What should the nurse do first?

1. Perform defibrillation
2. Administer epinephrine as ordered
3. Assess for presence of pulse
4. Institute CPR

RE: yearbook CD

Sounds like a good idea to me! I think we should send a mass email to our entire class through Julie in the nrsg office and I also think we should bring this idea up on our first day of N10 when ALL of us are in the same room, ya know? Since I know not everyone checks this blog very often. Just a suggestion! :)

A little birdie wants to tell you:

Carin has brought up the idea of capturing our memories as a graduation gift for those of us who will be pinned Spring 2010 (fingers crossed). At first, a yearbook was suggested, however, factors such as cost and quality made that a poor choice. So, in lieu of a bound paper yearbook, a CD yearbook appears to be a better choice. It would be a double sided disc with one side being photos of our class and the other side being a compilation of songs. In no way is this set in stone, it is only an idea and not yet put into motion. It sounds a bit early to even being thinking about something like this, but a project like this takes long hours and a lot of effort. Since photos from the pinning ceremony itself would be included, this CD would not be available until after graduation, sometime into the summer. The following is a list of some things (not limited to) which would be necessary for this graduation gift to be produced:

1. Consensus from our class :)
2. Photos of our nursing class (social and academic) dating back to first semester
3. Funds to purchase 80 double sided writable CDs
4. Team willing to volunteer their time to compile photos and songs to the CD

That's about the bulk of it. The idea is to start putting together semester 1-3 now, so when 4th semester comes around there won't be much else to it. Like always, photos can be uploaded to photobucket.com. The username is futurenurses2010 and the password is pinned2010. If you do not know how to go about uploading your photos, please ask! You can also submit hard copies if that's easier for you.

PLEASE COMMENT WITH IDEAS AND SUGGESTIONS!!! YOUR INPUT IS NEEDED!

question of the week

Question of the week for 11.30.09

A client admits to benzodiazepine dependence for over the past several years. The client is now in an outpatient detoxification program. The nurse should understand that a priority during withdrawal from any substance is which of these actions by the client?

1. Avoid alcohol use during this time
2. Rise slowly from a lying to standing position
3. Discontinue the drug by weaning
4. Expect mild physical symptoms

N006 Exam #2 scores are posted :)

Happy happy thanksgiving!

question of the week

Question of the week for 11.23.09

A pregnant woman is hospitalized for treatment of pregnancy induced hypertension (PIH) in the third trimester. She is receiving magnesium sulfate intravenously. A nurse understands that this medication is used mainly for what purpose?

1. Maintain normal blood pressure
2. Prevent convulsive seizures
3. Decrease the respiratory rate
4. Increase uterine blood flow

question of the week

Question of the week for 11.16.09

A nurse is beginning nutritional counseling/teaching with a pregnant woman. What is the initial step in this interaction?

1. Teach her how to meet the needs of self and her family.
2. Explain the changes in diet necessary for pregnant women.
3. Question her understanding and use of the food pyramid.
4. Conduct a diet history to determine her normal eating routines.

question of the week

Question of the week for 11.09.09

A client telephones the community clinic to ask about a home pregnancy test she used this morning. A nurse should understand that the presence of which hormone strongly suggests that a woman is pregnant?

1. Estrogen
2. Human chorionic gonadotropin
3. Alpha-fetoprotein
4. Progesterone

question of the week

Question of the week for 11.02.09

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

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?

question of the week

Question of the week for 10.26.09

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

question of the week

Question of the week for 10.19.09

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

please share

your photos that is-

upload onto this photobucket account:

user id: futurenurses2010
password: pinned 2010

insert sigh of relief here

ladies and (scattered) gentlemen...

one more down, and just a few to go!

Bocce Ball Fundraiser

SNA Bocce Ball Tournament Sign-up!

question of the week

Question of the week for 10.12.09

A nurse is teaching a client about precautions with Coumadin therapy. The client should be instructed to avoid which over-the-counter medication?

1. Non-steroidal anti-inflammatory drugs (NSAIDs)
2. Cough medicines with guaifenesin
3. Histamine blockers
4. Laxatives containing magnesium salts

Open Curriculum Forum

Open Curriculum Forum

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

CPK Fundraiser

End of the rotation CPK Fundraiser

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

The ATI testing date for N007 has been moved from Tuesday to Wednesday according to Ms. Antaran.

question of the week

Question of the week for 10.05.09

A nurse is caring for a client with a deep vein thrombosis. Which finding would require the nurse's immediate attention?

1. Temperature of 102 degrees Fahrenheit
2. Pulse rate of 98 beats per minute
3. Respiratory rate of 32r
4. Blood pressure of 90/50

question of the week

Question of the week for 09.28.09

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?

1. Anticholinergic
2. Corticosteroid
3. Histamine blocker
4. Antibiotic

Curriculum Changes

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."

question of the week

for the week of 09.21.09

A nurse is providing instructions for a client with asthma. Which of these factors should the client monitor on a daily basis as a priority?

1. "Respiratory rate"
2. "Peak air flow volumes"
3. "Pulse oximetry"
4. "Respiratory effort"

Next SNA Meeting

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!

Fall 2009 SNA Board

question of the week

for the week of 09.14.09

A nurse is caring for a client with heart failure. Which finding requires the nurse's immediate attention?

1. "Pulse oximetry of 85%"
2. "Nocturia"
3. "Crackles in lungs"
4. "Diaphoresis"

question of the week

for the week of 09.08.09

A client is diagnosed with methicillin resistant staphylococcus aureus pneumonia (MRSA). What type of isolation is appropriate for this client?

1. "Reverse"
2. "Airborne"
3. "Standard precautions"
4. "Contact"

very useful information in Mr. Scott's docushare:

-EKG review powerpoint
-interview #2 with Ms. Antaran

question of the week

for the week of 08.31.09

What is the feeling called after a cocaine high where the user commonly experiences an extremely unpleasant feeling?

1. "Craving"
2. "Crashing"
3. "Outward bound"
4. "Nodding out"

SNA Meeting - August 31st 2009

SNA Meeting
Monday - August 31st 2009
1:00pm in Locke-229

Our meeting will include club news, club committees and Errisa & AJ will talk about the class blogs. In addition we will have 2 great guest speakers.

• Robin Shum from Student Success
• Ginger Manss from St. Joseph's Hospital on the NSNA
  

Please come and join the fun! We will have pizza for lunch!

question of the week

for the week of 08.24.09

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."

Rush Week Volunteers

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!

New Skyscape Information

Skyscape Discount

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!

SNA - Fall 2009

question of the week

welcome back to school!

for the week of 08.17.09

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."

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!

SNA this Semester

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.

question of the week

for the week of 08.10.09

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."

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!

Angela Aistrup - Vice-President (Fall 2009)

question of the week

for the week of 08.03.09

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."

question of the week

for the week of 07.27.09

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

question of the week

for the week of 07.13.09

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?

1. "Calcium 9 mg/dL"
2. "Magnesium 2.5 mg/dL"
3. "Potassium 2.5 mEq/L"
4. "Partial thromboplastin time 70 seconds"

question of the week

for the week of 07.06.09

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?

1. "Oral fluid intake"
2. "Bowel sounds"
3. "Grip strength"
4. "Urine output"

question of the week

for the week of 06.29.09

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?"

question of the week

for the week of 06.22.09

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"

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!

question of the week

for the week of 06.15.09

A nurse should instruct a client who is taking digitalis to report which of these side effects?

1. "Nausea, vomiting, fatigue"
2. "Rash, dyspnea, edema"
3. "Polyuria, thirst, dry skin"
4. "Hunger, dizziness, diaphoresis"

question of the week

for the week of 06.08.09

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?

1. "Digoxin (Lanoxin)"
2. "Diltiazem (Cardizem)"
3. "Nitroglycerin ointment"
4. "Metoprolol (Toprol XL)"

question of the week

for the week of 06.01.09

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"

Hurst Review this Summer!

Please join us for the
Hurst Review Session

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

We are looking forward to see you there!

question of the week

for the week of 05.26.09

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"

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!

question of the week

for the week of 05.18.09

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"

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!

0745 – CMH Tue/Wed
0915 – BHC Tue/Wed
1030 – CMH Thu/Fri
1145 - BHC Thu/Fri & DSPS students

almost there!!

question of the week

for the week of 05.11.09

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."

question of the week

for the week of 05.04.09

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"

question of the week

for the week of 04.27.09

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

mini-vacation

there is no class to be held on April 27, 2009 for nursing 5! :)

-mid-term grades are posted on turnitin.com!

-peer review of process recording papers is now worth 50 pts!

-only three more weeks of school!

question of the week

for the week of 04.20.09

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 Don't Come Easy

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

question of the week

for the week of 04.13.09

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

AA websites

http://www.aadelta.org/

http://aasacramento.org/meeting_schedules/meeting_map.htm

students are not allowed at closed meetings!!

question of the week

for the week of 04.06.09

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

Spring Break! Yay! Enjoy!

question of the week

for the week of 03.30.09

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

"Hey I'm a fun guy!"

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!"

Ha Ha...get it? fun guy...fungi...

Janice

Thank You!

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!!

question of the week

for the week of 03.23.09

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

sorry, Jessica, this was just too good

"...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."...

-Jessica Salcido

question of the week

for the week of 03.16.09

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

Grades for n004 are posted on online transcripts!

Learn your ABG lab values...

just a few tips for nursing 4 that seems to help:

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...

Don't forget to take care of yourself!!!

did we just finish another nine weeks?

question of the week

for the week of 03.09.09

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

Exam #6: Ch. 62-65 (Musculoskeletal System)

KEEP ON TRUCKIN...FINAL FOR N004!!!

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

*diagnoses
-acute pain
-ineffective therapeutic regimen management
-impaired physical mobility

*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

*diagnoses
-chronic pain
-impaired physical mobility
-disturbed body image
-ineffective therapeutic regimen management
-self-care deficit (total)

*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

**gout
*assessment
-subjective: trauma, surgery, sepsis
-objective: dusky, cyanotic joints, extremely tender joints, inflammation of big toe, low grade fever, tophaceous deposits
-dx: elevated uric acid levels

*diagnoses
-acute pain
-activity intolerance
-self care deficit
-disturbed body image

*planning
-avoid unnecessary pain
-joint immobilization
-heat/cold application

*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)

*diagnoses
-fatigue
-acute pain
-impaired skin integrity
-deficient knowledge

*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

California Pizza Kitchen Fundraiser

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!

question of the week

for the week of 03.01.09

Which dinner menu would be best to provide the most iron for a toddler diagnosed with iron deficiency anemia?

1. Fish sticks, French fries, banana, cookies, milk
2. Ground beef patty, lima beans, wheat roll, raisins, milk
3. Chicken nuggets, macaroni, peas, cantaloupe, milk
4. Peanut butter and jelly sandwich, apple slices, milk

Missing Classes?

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!

question of the week

for the week of 02.23.09

A client takes digoxin for heart failure. A nurse should report which side effects to the charge nurse?

1. bradycardia, hypotension

2. blurred vision, yellow vision

3. anorexia, vomiting

4. fatigue, headache

Exam #4: Ch. 17, 48-50 (Endocrine System)

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,

question of the week

for the week of 02.16.09

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

Question of the Week

for the week of 02.09.09

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