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
Showing posts with label N002. Show all posts
Showing posts with label N002. Show all posts
Tuesday, December 16, 2008
Monday, December 15, 2008
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.
*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.
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.
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.
Tuesday, November 18, 2008
study guide #2 (brief)
1. Discuss the legal implications of death and dying. (End-of-Life Lecture)
-Dying Person’s Bill of Rights
-Advanced Directives
-DNR Status
-Durable Power of Attorney/Living Will
2. Discuss therapeutic communication when caring for the dying patient. (End-of-Life Lecture)
-be direct and avoid false reassurances
-Hospice says, “Do you know you are dying?”
3. Discuss the types of grief and grief responses. (P/P: Ch. 30, pp. 463, 465-467)
-normal grief
-complicated grief: prolonged and difficult time moving forward
-anticipatory grief: “letting go” before death even occurs
-disenfranchised grief: unsupported grief which is not openly acknowledged
*grief responses vary depending on:
-developmental stage
-personal relationship
-nature of loss
-coping strategies
-socioeconomic status
-culture/ethnicity
-spiritual/religious beliefs
-hope
4. Discuss the concerns of the dying patient. (End-of-Life Lecture)
-arrange a variety of affairs
-cope with loss of loved ones and own death
-future medical needs
-plan for future
5. Discuss the interventions needed to assist the patients to die with dignity. (P/P, Ch. 30, pg. 475)
-treat patient as a whole being rather than a patient will an illness
-encourage conversation about patient’s life experience
-maintain personal hygiene and appearance
-be respectful: address by title
6. Explain the purpose of Hospice care. (P/P: Ch. 30, pp. 478-479)
-provides end-of-life support for patient and familiy
-priority to managing pain and symptoms, comfort, quality of life, and other needs for the patient with less than 6 months to live
7. Discuss the concepts of pain and pain management. (Pain Lecture)
-follow assessment principles
-patient centered
-drug and non-drug therapies
-collaborative care
8. Discuss ethical considerations for the terminal patient. (End-of-Life Lecture)
-Euthanasia/Assissted Suicide
-Organ Donations
9. Discuss the nursing interventions for the patient receiving chemotherapy or radiation treatment. (Cancer Lecture)
-adequate moisturizing
-ambulate/turn
-cough/deep breathe or incentive spirometer
-alternate resting and active periods
-make sure antiemetics are ordered
-therapeutic communication
-protective isolation: avoid crowds
-be aware of food preferences
10. Discuss the relevant assessment data needed for the terminal patient on pain medication. (P/P: Ch. 30, pp. 1078, 1080)
-monitor breakthrough pain
11. Differentiate between the assessment needed for the patient in acute and chronic pain. (Pain Management Lecture)
-based on cause, course, manifestation, and treatment
12. Describe the different types of pain. (P/P: Ch. 43, pp. 1055-1056)
-acute/transient pain: can identify cause, short term, limited tissue damage and emotional response
-chronic/persistent pain: lasts longer than anticipated, not always an identifiable cause, great personal suffering
-chronic episodic pain: sporadic pain over an extended period of time
-cancer pain: usually related to tumor progression or treatment of cancer
-pain by inferred pathological process: musculoskeletal, internal organ, or neuropathic pain
-idiopathic pain: no identifiable physical or psychological cause for chronic pain
13. Discuss the education needed for the patient on opioid medication. (Pain Management Lecture)
-low risk of addiction when treating pain
14. Discuss the nursing diagnoses relevant to grief. (P/P, Ch. 30, pg. 470)
-death anxiety
-compromised family coping
-ineffective denial
-complicated grieving
-hopelessness
-spiritual distress
15. Discuss goals/outcomes for patients in chronic pain. (Pain Management Lecture)
-sometimes the best thing is to decrease pain level
-describe experience in order to treat
-identify goal for therapy and resources for self-management
-prevent pain whenever possible
-will require only oral analgesics for pain
-reports pain of <3 on a scale of 1-10 after PCA use
16. Discuss the safety precaution education needed for patients receiving chemotherapy. (Cancer Lecture)
-radiation source being used
-method of administration
-start of treatment
-length of treatment
-prescribed nursing precautions: protective gear and isolation
-avoid crowds
-do not allow small children to sit on lap
-cough and deep breathe
-moisturize
-ambulate/turn
-alternate resting and active periods
17. Discuss the use of the pain diary in pain management. (Pain Management Lecture)
-helps both nurse and patient identify pain patterns and causative factors
18. Discuss titration in pain management. (Pain Management Lecture)
*adjusting dose or using the smallest dose possible:
-based on assessment of analgesic effect
-to provide effective pain control
-working with patient to decide the optimal analgesic dosage required
**to minimize side effects
19. Discuss the nursing care for the patient using PCA or continuous opioid analgesia. (P/P: Ch. 30, pg. 1076)
-monitor dosing and dosage rate
-teach patient how to use PCA and instruct visitors not to tamper with it
-monitor vital signs
20. Discuss nursing diagnoses relevant for patients with terminal disease. (P/P: Ch. 30, pg. 470)
-death anxiety
-caregiver role strain
-compromised family coping
-readiness for enhanced comfort
-disturbed personal identity
-ineffective denial
-fear
-hopelessness
-spiritual distress
-readiness for enhanced spiritual well-being
21. Discuss risk factors for cancer and the education needed. (Cancer Lecture)
-diet, health history
-ethnicity
-lifestyle
-genetics
-environment
*encourage diet high in fiber, low in fat
*note and report (as they may be early signs of cancer):
C-changes in bowels or bladder
A-a lesion that does not heal
U-unusual bleeding or discharge
I-indigestion or difficulty swallowing
O-obvious changes in wart of mole
N-nagging cough or persistant hoarseness
22. Dosage and Calculations:
-microdrops: 60 gtt/ml
-macrodrops: 10, 15, or 20 gtt/ml
-Dying Person’s Bill of Rights
-Advanced Directives
-DNR Status
-Durable Power of Attorney/Living Will
2. Discuss therapeutic communication when caring for the dying patient. (End-of-Life Lecture)
-be direct and avoid false reassurances
-Hospice says, “Do you know you are dying?”
3. Discuss the types of grief and grief responses. (P/P: Ch. 30, pp. 463, 465-467)
-normal grief
-complicated grief: prolonged and difficult time moving forward
-anticipatory grief: “letting go” before death even occurs
-disenfranchised grief: unsupported grief which is not openly acknowledged
*grief responses vary depending on:
-developmental stage
-personal relationship
-nature of loss
-coping strategies
-socioeconomic status
-culture/ethnicity
-spiritual/religious beliefs
-hope
4. Discuss the concerns of the dying patient. (End-of-Life Lecture)
-arrange a variety of affairs
-cope with loss of loved ones and own death
-future medical needs
-plan for future
5. Discuss the interventions needed to assist the patients to die with dignity. (P/P, Ch. 30, pg. 475)
-treat patient as a whole being rather than a patient will an illness
-encourage conversation about patient’s life experience
-maintain personal hygiene and appearance
-be respectful: address by title
6. Explain the purpose of Hospice care. (P/P: Ch. 30, pp. 478-479)
-provides end-of-life support for patient and familiy
-priority to managing pain and symptoms, comfort, quality of life, and other needs for the patient with less than 6 months to live
7. Discuss the concepts of pain and pain management. (Pain Lecture)
-follow assessment principles
-patient centered
-drug and non-drug therapies
-collaborative care
8. Discuss ethical considerations for the terminal patient. (End-of-Life Lecture)
-Euthanasia/Assissted Suicide
-Organ Donations
9. Discuss the nursing interventions for the patient receiving chemotherapy or radiation treatment. (Cancer Lecture)
-adequate moisturizing
-ambulate/turn
-cough/deep breathe or incentive spirometer
-alternate resting and active periods
-make sure antiemetics are ordered
-therapeutic communication
-protective isolation: avoid crowds
-be aware of food preferences
10. Discuss the relevant assessment data needed for the terminal patient on pain medication. (P/P: Ch. 30, pp. 1078, 1080)
-monitor breakthrough pain
11. Differentiate between the assessment needed for the patient in acute and chronic pain. (Pain Management Lecture)
-based on cause, course, manifestation, and treatment
12. Describe the different types of pain. (P/P: Ch. 43, pp. 1055-1056)
-acute/transient pain: can identify cause, short term, limited tissue damage and emotional response
-chronic/persistent pain: lasts longer than anticipated, not always an identifiable cause, great personal suffering
-chronic episodic pain: sporadic pain over an extended period of time
-cancer pain: usually related to tumor progression or treatment of cancer
-pain by inferred pathological process: musculoskeletal, internal organ, or neuropathic pain
-idiopathic pain: no identifiable physical or psychological cause for chronic pain
13. Discuss the education needed for the patient on opioid medication. (Pain Management Lecture)
-low risk of addiction when treating pain
14. Discuss the nursing diagnoses relevant to grief. (P/P, Ch. 30, pg. 470)
-death anxiety
-compromised family coping
-ineffective denial
-complicated grieving
-hopelessness
-spiritual distress
15. Discuss goals/outcomes for patients in chronic pain. (Pain Management Lecture)
-sometimes the best thing is to decrease pain level
-describe experience in order to treat
-identify goal for therapy and resources for self-management
-prevent pain whenever possible
-will require only oral analgesics for pain
-reports pain of <3 on a scale of 1-10 after PCA use
16. Discuss the safety precaution education needed for patients receiving chemotherapy. (Cancer Lecture)
-radiation source being used
-method of administration
-start of treatment
-length of treatment
-prescribed nursing precautions: protective gear and isolation
-avoid crowds
-do not allow small children to sit on lap
-cough and deep breathe
-moisturize
-ambulate/turn
-alternate resting and active periods
17. Discuss the use of the pain diary in pain management. (Pain Management Lecture)
-helps both nurse and patient identify pain patterns and causative factors
18. Discuss titration in pain management. (Pain Management Lecture)
*adjusting dose or using the smallest dose possible:
-based on assessment of analgesic effect
-to provide effective pain control
-working with patient to decide the optimal analgesic dosage required
**to minimize side effects
19. Discuss the nursing care for the patient using PCA or continuous opioid analgesia. (P/P: Ch. 30, pg. 1076)
-monitor dosing and dosage rate
-teach patient how to use PCA and instruct visitors not to tamper with it
-monitor vital signs
20. Discuss nursing diagnoses relevant for patients with terminal disease. (P/P: Ch. 30, pg. 470)
-death anxiety
-caregiver role strain
-compromised family coping
-readiness for enhanced comfort
-disturbed personal identity
-ineffective denial
-fear
-hopelessness
-spiritual distress
-readiness for enhanced spiritual well-being
21. Discuss risk factors for cancer and the education needed. (Cancer Lecture)
-diet, health history
-ethnicity
-lifestyle
-genetics
-environment
*encourage diet high in fiber, low in fat
*note and report (as they may be early signs of cancer):
C-changes in bowels or bladder
A-a lesion that does not heal
U-unusual bleeding or discharge
I-indigestion or difficulty swallowing
O-obvious changes in wart of mole
N-nagging cough or persistant hoarseness
22. Dosage and Calculations:
-microdrops: 60 gtt/ml
-macrodrops: 10, 15, or 20 gtt/ml
Tuesday, November 4, 2008
study guide exam #1 (brief)
1. Explain the components of a teaching plan: Cognitive domain, Psychomotor domain, and Affective domain. Include in your explanation how the presenter would evaluate each. (P/P: Ch. 25, pp. 365-366 and Lecture: Introduction to Patient Education 10/23)
--cognitive (understanding):
-knowledge-recalling new facts or information
-comprehension-understand meaning of new facts
-application-applying new ideas in a given situation
-analysis-break down facts in an organized manner
-synthesis-apply new ideas and create a whole new one
-evaluation-be critical about new information for a specific purpose
*patient states name and purpose of medication
--psychomotor (motor skills):
-perception: awareness of objects
-set: mental, physical, or emotional readiness to take action
-guided response: imitation of an act under guidance
-mechanism: higher level of guided response with gained confidence
-complex overt response: smooth and accurate performance of a skill
-adaptation: ability to change skill when unexpected problems arise
-origination: use existing skills to create new movement patterns
*patient gives self-injection
--affective (attitudes):
-receiving: willing to attend to another’s word
-responding: active participation by listening and reacting
-valuing: attaching worth to object or behavior
-organizing: utilizing personal value system to resolve conflicts
-characterizing: acting with a consistent value system
*patient accepts he/she has chronic illness
2. Describe the elements of a community assessment. (P/P: Ch. 3, pg. 41)
-structure: observe layout, location of services, and common meeting places
-population: demographics according to statistics
-social system: learn about social services such as school and health care
3. Discuss the factors to consider when providing health education. (P/P: Ch. 25, pp. 366-369 and Lecture: Introduction to Patient Education 10/23)
-motivation to learn: physiological and psychological factors
-ability to learn: sociocultural and capability factors
-learning environment: is it ideal?
4. Describe the physiological, cognitive and psychosocial changes of the aged. Include pharmacological aspects and multiple health problems. (Geriatric Concept Map, 10/30)
-physiological: decreased muscle mass, increased joint stiffness and bone loss, and overall decreased function
-cognitive: impaired memory and sensation
-psychosocial: decreased support and socialization, increased isolation and loss of identity and self-worth
-decreased liver function: decreased drug metabolism
-decreased kidney function: increased drug retention
-decreased GI function: decreased drug absorption
-polypharmacy: multiple medications can cause cascade effects to other problems
5. Discuss the assessment needed for the elderly patient. (Geriatric Concept Map, 10/30)
-standardized assessement tool to determine how limitations impair or affect ADLs
6. Discuss the nursing diagnoses appropriate for the elderly patient. (Geriatric Concept Map, 10/30)
-impaired gas exchange and ineffective tissue perfusion related to decreased cardiac ouput aeb activity intolerance
-risk for injury related to altered sensory perception, decreased muscle mass, or multiple medications
7. Discuss the roles of the community health nurse. (P/P: Ch. 3, pp. 38-41)
-caregiver: primary role; build safe community to achieve higher quality of life and function using nursing process
-case manager: establish plan of care for community using available resources and breakthrough obstacles
-collaborator: work with all persons involved with health care of a patient to develop and achieve goals
-educator: teach community skills and knowledge needed to care for themselves
-counselor: identify and clarify problems and guide through courses of action to solve problem
-client advocate: provide community with information to make informed decisions regarding healthcare services
-change agent: identify and implement more effective solutions to problems
-epidemiologist: protect community level health by surveying community risk factors for illnesses
8. Discuss the principles of appropriate delegation. (P/P: Ch. 21, Box 21-6)
-right task
-right circumstance
-right person
-right direction/communication
-right supervision
9. Discuss the attributes of a nurse manager. (Lecture: Leadership, Management, Delegation 10/23)
-effective communicator
-assertive
-accurate
-honest
10. Discuss the interventions for the elderly patient with visual impairment; hearing impairment. (Geriatric Concept Map, 10/30)
-visual: large print, bright colors, glasses, lit hallways
-hearing: low tones, speaking slowly, face patient, eliminate distractions
11. Discuss the home safety strategies for the aged. (Geriatric Concept Map, 10/30)
-assistive devices: adequate lighting, canes, and safety bars
-clearing pathways
12. Discuss the strategies to enhance and maintain long term memory. (Geriatric Concept Map, 10/30)
-stimulate thinking process: crosswords, crafts, engaging in conversations
--cognitive (understanding):
-knowledge-recalling new facts or information
-comprehension-understand meaning of new facts
-application-applying new ideas in a given situation
-analysis-break down facts in an organized manner
-synthesis-apply new ideas and create a whole new one
-evaluation-be critical about new information for a specific purpose
*patient states name and purpose of medication
--psychomotor (motor skills):
-perception: awareness of objects
-set: mental, physical, or emotional readiness to take action
-guided response: imitation of an act under guidance
-mechanism: higher level of guided response with gained confidence
-complex overt response: smooth and accurate performance of a skill
-adaptation: ability to change skill when unexpected problems arise
-origination: use existing skills to create new movement patterns
*patient gives self-injection
--affective (attitudes):
-receiving: willing to attend to another’s word
-responding: active participation by listening and reacting
-valuing: attaching worth to object or behavior
-organizing: utilizing personal value system to resolve conflicts
-characterizing: acting with a consistent value system
*patient accepts he/she has chronic illness
2. Describe the elements of a community assessment. (P/P: Ch. 3, pg. 41)
-structure: observe layout, location of services, and common meeting places
-population: demographics according to statistics
-social system: learn about social services such as school and health care
3. Discuss the factors to consider when providing health education. (P/P: Ch. 25, pp. 366-369 and Lecture: Introduction to Patient Education 10/23)
-motivation to learn: physiological and psychological factors
-ability to learn: sociocultural and capability factors
-learning environment: is it ideal?
4. Describe the physiological, cognitive and psychosocial changes of the aged. Include pharmacological aspects and multiple health problems. (Geriatric Concept Map, 10/30)
-physiological: decreased muscle mass, increased joint stiffness and bone loss, and overall decreased function
-cognitive: impaired memory and sensation
-psychosocial: decreased support and socialization, increased isolation and loss of identity and self-worth
-decreased liver function: decreased drug metabolism
-decreased kidney function: increased drug retention
-decreased GI function: decreased drug absorption
-polypharmacy: multiple medications can cause cascade effects to other problems
5. Discuss the assessment needed for the elderly patient. (Geriatric Concept Map, 10/30)
-standardized assessement tool to determine how limitations impair or affect ADLs
6. Discuss the nursing diagnoses appropriate for the elderly patient. (Geriatric Concept Map, 10/30)
-impaired gas exchange and ineffective tissue perfusion related to decreased cardiac ouput aeb activity intolerance
-risk for injury related to altered sensory perception, decreased muscle mass, or multiple medications
7. Discuss the roles of the community health nurse. (P/P: Ch. 3, pp. 38-41)
-caregiver: primary role; build safe community to achieve higher quality of life and function using nursing process
-case manager: establish plan of care for community using available resources and breakthrough obstacles
-collaborator: work with all persons involved with health care of a patient to develop and achieve goals
-educator: teach community skills and knowledge needed to care for themselves
-counselor: identify and clarify problems and guide through courses of action to solve problem
-client advocate: provide community with information to make informed decisions regarding healthcare services
-change agent: identify and implement more effective solutions to problems
-epidemiologist: protect community level health by surveying community risk factors for illnesses
8. Discuss the principles of appropriate delegation. (P/P: Ch. 21, Box 21-6)
-right task
-right circumstance
-right person
-right direction/communication
-right supervision
9. Discuss the attributes of a nurse manager. (Lecture: Leadership, Management, Delegation 10/23)
-effective communicator
-assertive
-accurate
-honest
10. Discuss the interventions for the elderly patient with visual impairment; hearing impairment. (Geriatric Concept Map, 10/30)
-visual: large print, bright colors, glasses, lit hallways
-hearing: low tones, speaking slowly, face patient, eliminate distractions
11. Discuss the home safety strategies for the aged. (Geriatric Concept Map, 10/30)
-assistive devices: adequate lighting, canes, and safety bars
-clearing pathways
12. Discuss the strategies to enhance and maintain long term memory. (Geriatric Concept Map, 10/30)
-stimulate thinking process: crosswords, crafts, engaging in conversations
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