Ok so this is what I got, some of it I got from a. ha. and some of it I went into way too much detail. But anyways here is my contribution to our blog:
STUDY GUIDE – FINAL EXAM 1. Discuss the stages of hypertension. (L Pg. 765 TAB 33-2 & Notes)
Normal: <120/<80>160/>100 Stage I and stage II : Asymptomatic Stage III: blurred vision, headache, ALOC, SOB, dizziness…May be asymptomatic too
2.List appropriate nursing diagnoses for the patient with hypertension. (L Pg. 778, TAB 33-12)
Ineffective health maintenance RT lack of knowledge of pathology, complications, and management of hypertension Anxiety RT complexity of management regimen, possible complications, and lifestyle changes associated with hypertension Sexual dysfunction RT side effects of antihypertensive medication Disturbed body image RT diagnosis of hypertension Ineffective therapeutic regimen management RT lack of knowledge Ineffective tissue perfusion RT complications of hypertension
3. Discuss the risk factors for hypertension. (L Pg. 766 TAB 33-3)
Age : SBP rises progressively with increasing age Alcohol Smoking Diabetes Mellitus: More common in diabetics Elevated serum lipids: Elevated levels of cholesterol and triglycerides are primary risk factors in atherosclerosis, hyperlipidemia is more common in people with hypertension Excess dietary sodium Gender : More prevalent in men Family history Obesity Ethnicity: Twice as high in African Americans Sedentary lifestyle Socioeconomic status: More prevalent among less educated Stress
4.Explain referred pain. (P Pg. 1064 TAB 43-5)
Perception of pain is in unaffected areas Myocardial infarction, which causes referred pain to the jaw, left arm, and left shoulder Kidney stones, which refer pain to groin.
5. Discuss the assessment needed for the patient with GI dysfunction. (L Pg. 1057 TAB43-22)
Subjective data: Past medical history: infection, autoimmune disorders Medications: Use of antidiarrheal meds Functional Health Patterns · Health management: family history of ulcerative colitis, fatigue, malise · Nutrition: Nausea, vomiting, anorexia, weight loss · Elimination: Diarrhea, blood, mucus or pus in stools · Cognitive-perceptual: Lower abdominal pain (worse before defecation, cramping, tenesmus)
7. Discuss the education needed for the cancer patient after treatment. (notes)
· Improve lifestyle · avoid crowds of people or microbe carrying vectors · avoid extreme temperatures · understand symptoms of infection · allow rest between periods of activity
8. Discuss the education needed for dietary modification to decrease CAD. (L Pg. 792 & notes)
Low fat, high fiber, low salt, increased water intake
9. Discuss therapeutic communication for the cancer patient. (L Pg. 310)
be direct and avoid false reassurances acknowledge feelings Be available Exhibit a caring attitude Listen actively to fears and concerns Provide relief from distressing symptoms Provide essential information regarding cancer and cancer care Maintain a relationship based on trust and confidence Use touch to exhibit caring Maintain hope
10. Discuss the psychosocial manifestations of approaching death. (P Pg. 463-465)
Denial – Anger – Bargaining – Depression – acceptance normal grief complicated grief: prolonged and difficult time moving forward anticipatory grief: “letting go” before death even occurs disenfranchised grief: unsupported grief which is not openly acknowledged
11. Discuss the assessment needed for the patient with heart failure. (a.ha)
Key s/s: Dyspnea on Exertion (DOE) Paroxysmal Nocturnal Dyspnea (PND) : occurs when patient is asleep. Orthopnea (how many pillows?)
12. Discuss the pathophysiology of orthopnea. (L. 825 & notes) - Difficult or painful breathing except in an erect sitting or standing position. - increased ease in breathing with increased elevation by pillows
13. Discuss the assessment needed for the unconscious patient with GERD. (a.ha)
- mouth: signs of lesions in mouth and dental decay
14. Discuss the assessment needed for the patient with cancer. (L Pg. 282)
- diethealth history - Ethnicity - Lifestyle - Genetics - Enviroment note and report (as they may be early signs of cancer): C-hanges in bowels or bladder A- lesion that does not heal U-nusual bleeding or discharge T- hickening or a lump in the breast or elsewhere I-ndigestion or difficulty swallowing O-bvious changes in wart of mole N-agging cough or persistant hoarseness
15. Discuss the education needed for the patient with Hepatitis B. (a.ha)
No real treatment; requires rest and adjusted diet Certain lifestyle choices (like alcohol consumption) may lead to lifelong infection Can be transmitted through blood, semen, and saliva
16. Discuss the nutritional education for the patient with liver disease. (Notes & L Pg. 1094 TAB 44-6)
low salt, low protein diet restricted fluids avoid or restrict alcohol
Book says: High calorie, High protein? high carb, Low fat & vitamin supplements
17. Discuss the pain management of the patient with a terminal disease. (L Pg. 161 TAB 11-8 & notes)
Comfort care Drug titration: adjust dose or use the smallest dose possible-based on assessment of analgesic effect Work with patient to decide the optimal analgesic dosage required**minimize side effects Administer medications around the clock in a timely manner and on a regular basis to provide constant relief rather than waiting until the pain is unbearable Evaluate effectiveness of pain relief measures frequently to ensure that the patient is on a correct and adequate drug regimen
18. Discuss the purpose and safety issues of the use of an NG tube in a patient with GI dysfunction. (L. Pg. 992 & 996) Purpose: decompression for distended patients or patients experiencing nausea and vomiting Lavage: elevates patient’s need to vomit Safety issue: check for correct placement
19. Discuss the nursing care of the patient with Inflammatory Bowel Disease. (a.ha)
modified diet: to prevent constipation and increase stool bulk non-opiod pain management: bedrest monitor signs of any further complications
20. Discuss the complications of Pancreatitis.(L Pg. 1119)
Pancreatic fistula: abnomal tunneling which can ultimately erode abdominal wall Pancreatic pseudocyst: A cavity continuous with or surrounding the outside of the pancreas Pancreatic abcess: a lrg fluid containing cavity within the pancreas, resulting from necrosis
21. Discuss the purpose of the diagnostic test, Holter Monitor and provide the education needed. (L Pg. 753)
PURPOSE: Recording of ECG rhythm for 24-28 hrs and then correlating rhythm changes with symptoms recorded in diary Normal patient activity is encouraged to stimulate conditions that produce symptoms. Electrodes are placed on chest and a recorder is used to store information, print it, and analyze it for any rhythm disturbance. It can be performed on an in patient or outpatient basis.
EDUCATION: Explain importance of keeping accurate diary of activities and symptoms. Tell the patient that no bath or shower can be taken during monitoring. Skin irritation may develop from electrodes.
22. Discuss the age-related changes of hypertension in the elderly. (a.ha)
Decreased vessel elasticity · Increased build-up on vessel · BP increases · Overall decreased functioning of bodily systems
23. List the nursing diagnoses appropriate for the patient with heart failure. (L Pg. 836-837 & notes)
Activity intolerance RT fatigue secondary to cardiac insufficiency and pulmonary congestion aeb dyspnea, SOB, weakness, increase in heart rate on exertion, and patient’s statement “I feel to weak to do anything.”
Excess Fluid volume RT cardiac failure aeb edema, dyspnea on exertion, increased weight gain, and patient’s statement “I’m short of breath and my ankles are so big and puffy?”
Impaired gas exchange RT increased preload, mechanical failure, or immobility aeb increased respiratory rate, SOB, dyspnea on exertion, and patient’s statement, “I just can seem to catch my breath.”
Anxiety RT dyspnea or perceived threat of death aeb restlessness, irritability, expression of feelings of life threat, and patient’s statement, “Don’t leave me alone, I’m afraid I might die.”
Altered tissue perfusion
Ineffective breathing r/t fluid accumulation aeb DOE, PND, SOB
24. Discuss the concept of ageism. (L Pg.67 & P Pg. 193)
A negative attitude based on age, it leads to discrimination and disparities in the care given to the older adult because others consider the knowledge and experience of older adults too outdated to have any current value.
28. Explain the purpose of a needle biopsy. (L. Pg. 283)
Used to obtain cells and tissue fragments through a large-bore needle that is guided into the tissue in question (e.g. bone marrow aspiration; core biopsy of prostate gland, breast, liver, and kidney tissues). Cytological analysis is then performed to determine the presence of a tumor.
29. Discuss the principles of pain management. (L Pg. 134)
Follow the principals of the pain assessment – Pain is subjective, the patient is the best judge of his or her won pain, but also is the expert on the effectiveness of each pain treatment.
Every patient deserves adequate pain management – Be aware of your own biases and treat all patients equally with respect.
Base the treatment plan on the patient’s goals
Use both drug & non-drug therapies
Address the pain using muilti displinary approach – including clinical psychology, physical and occupational therapy, spiritual care, etc.
Elvalutae the effectivness of the therapies to ensure that they are meeting the patient’s goals
Prevent and/or manage medication side effects
26. Discuss the pathophysiology of PUD. (L. 1015)
Peptic Ulcer Disease: A condition characterized by erosion of the GI mucosa resulting from the digestive action of HCL acid and pepsin. Any portion of the GI tract that comes into contact with gastric secretions is susceptible to ulcer development, including the lower esophagus, stomach, and duodenum. H. Pylori infects stomach lining
27. Discuss the education needed for the patient with GI bleeding when diagnostic tests are ordered, (a.ha)
Educate patient on ordered procedure No smoking Clear liquid or light meal at night NPO after midnight
28. Discuss the nursing care of the elderly to ensure compliance with treatment. (a.ha)
Maintain and educate patient on safety issues Allow adequate time for patient to complete activities Treat patient with dignity Speak in a low voice face to face with patient
29. Discuss the discharge planning of the elderly to ensure compliance with treatment. (a.ha)
Can the patient achieve ADL’s, which were able to be completed before admission? Frequently reassess if patient can achieve these goals
Monday, December 15, 2008
ati scores are up at atitesting.com, under my results and the first test listed.
1. Discuss the stages of hypertension. (HTN Lecture) *Stage I and II: asymptomatic *Stage III: blurred vision, headache, ALOC, SOB, dizziness…sometimes asymptomatic too
2. List appropriate nursing diagnoses for the patient with hypertension. (Lewis: Ch. 33, Table 33-12) *ineffective tissue perfusion, disturbed body image, ineffective therapeutic regimen management, sexual dysfunction, anxiety, ineffective health maintenance
3. Discuss the risk factors for hypertension. (HTN Lecture) *lifestyle, diet, stress, smoking, age, gender, ethnicity, past medical history
4. Explain referred pain. (P/P: Ch. 43, pg. 1064) *perception of pain is in unaffected areas -ie: pain in arm from heart attack
5. Discuss the assessment needed for the patient with GI dysfunction. (GI Dysfunction Lecture) -past medical history, diet, heartburn, dysphasia, lifestyle
6. Discuss the education needed for the cancer patient after treatment. (Cancer Lecture) -avoid crowds of people or microbe carrying vectors -avoid extreme temperatures -understand symptoms of infection -allow rest between periods of activity
7. Discuss the education needed for dietary modification to decrease CAD. (CAD Lecture) *low fat, high fiber, low salt, increased water intake
8. Discuss therapeutic communication for the cancer patient. (Cancer Lecture) -be direct and avoid false reassurances -acknowledge feelings
9. Discuss the psychosocial manifestations of approaching death. (P/P: Ch. 30, pp. 463, 465-467) -normal grief -complicated grief: prolonged and difficult time moving forward -anticipatory grief: “letting go” before death even occurs -disenfranchised grief: unsupported grief which is not openly
10. Discuss the assessment needed for the patient with heart failure. (HF Lecture) *Key s/s: Dyspnea on Exertion (DOE), Paroxysmal Nocturnal Dyspnea (PND), orthopnea (how many pillows?)
11. Discuss the pathophysiology of orthopnea. -increased ease in breathing with increased elevation by pillows, etc.
12. Discuss the assessment needed for the unconscious patient with GERD. -mouth: signs of lesions in mouth and dental decay
13. Discuss the assessment needed for the patient with cancer. (Cancer Lecture)-diet -health history-ethnicity-lifestyle-genetics-environment*note and report (as they may be early signs of cancer):C-changes in bowels or bladderA-a lesion that does not healU-unusual bleeding or dischargeI-indigestion or difficulty swallowingO-obvious changes in wart of moleN-nagging cough or persistant hoarseness
14. Discuss the education needed for the patient with Hepatitis B. (GI Dysfunction II Lecture) -no real treatment; requires rest and adjusted diet -certain lifestyle choices (like alcohol consumption) may lead to lifelong infection -can be transmitted through blood, semen, and saliva
15. Discuss the nutritional education for the patient with liver disease. (GI Dysfunction II Lecture) -low salt, low protein diet -restricted fluids -avoid or restrict alcohol
16. Discuss the pain management of the patient with a terminal disease. (Pain Management Lecture) *comfort care *drug titration: adjust dose or use the smallest dose possible-based on assessment of analgesic effect-provide effective pain control-work with patient to decide the optimal analgesic dosage required**minimize side effects
17. Discuss the purpose and safety issues of the use of an NG tube in a patient with GI dysfunction. (GI Dysfunction Lecture) -purpose: decompression for distended patients or patients experiencing nausea and vomiting -safety issue: check for correct placement
18. Discuss the nursing care of the patient with Inflammatory Bowel Disease. (GI Dysfunction Lecture) -modified diet: to prevent constipation and increase stool bulk -non-opiod pain management: bedrest -monitor signs of any further complications
19. Discuss the complications of Pancreatitis. (GI Dysfunction II Lecture) -pancreatic fistula: abnomal tunneling which can ultimately erode abdominal wall
20. Discuss the purpose of the diagnostic test, Holter Monitor and provide the education needed.
21. Discuss the age-related changes of hypertension in the elderly. (Geriatric Lecture) -decreased vessel elasticity -increased build-up on vessel -overall decreased functioning of bodily systems
22. List the nursing diagnoses appropriate for the patient with heart failure. (HF Lecture) -impaired gas exchange, activity intolerance, altered tissue perfusion, fluid volume excess, ineffective breathing r/t fluid accumulation aeb DOE, PND, SOB
23. Discuss the concept of ageism. (P/P: Ch. 14, pg. 193) *discrimination against people because of increasing age -“outdated” knowledge, “worthless” after leaving workforce
24. Explain the purpose of a needle biopsy. (GI Dysfunction II Lecture) -samples cells in an area of the body, like the liver to determine liver dysfunction
25. Discuss the principles of pain management. (Pain Management Lecture) *follow assessment principles*patient centered*drug and non-drug therapies*collaborative care
26. Discuss the pathophysiology of PUD. (GI Dysfunction Lecture) -H. Pylori infects stomach lining -increased gastric acid in stomach causes erosion or ulcers
27. Discuss the education needed for the patient with GI bleeding when diagnostic tests are ordered. (GI Dysfunction Lecture) -educate patient on ordered procedure -no smoking -clear liquid or light meal at night -NPO after midnight
28. Discuss the nursing care of the elderly to ensure compliance with treatment. (Geriatric Lecture) -maintain and educate patient on safety issues -allow adequate time for patient to complete activities -treat patient with dignity
29. Discuss the discharge planning of the elderly to ensure compliance with treatment. (Geriatric Lecture) -can the patient achieve ADLs which were able to be completed before admission? -frequently reassess if patient can achieve these goals
DOSAGE AND CALCULATIONS Can you calculate? Flow rates Infusion times Dosage rates Titration dosages Safe and therapeutic dosage ranges
CASE SCENARIO – The Nursing Care of the patient with heart failure using the nursing process. (HF Lecture)
A: Key S/S: dyspnea on exertion (DOE), paroxysmal nocturnal dyspnea (PND), orthopnea (how many pillows?) Subjective: fatigue, disturbed sleep pattern, past medical history, breathing pattern, lifestyle… Objective: altered level of consciousness, irregular heart sounds (displaced PMI, gallops, murmurs), cold/clammy skin, tachycardia, crackles in lung sounds…
D: impaired gas exchange, activity intolerance, altered tissue perfusion, fluid volume excess, ineffective breathing r/t fluid accumulation aeb DOE, PND, or SOB
P: maximize cardiac output, provide treatment, preserve target organ function
I: meds: oxygen, diuretics, inotropes, ACE inhibitors, nitrates Check: K levels (nausea and vomiting are S/S of dig toxicity) , apical HR, and BP Patient education: nutrition, exercise, avoid cold, medication regimen, S/S of angina, stress management…
E: are goals met? If not, reassess.
Saturday, December 6, 2008
Mrs. Semillo gave me this information about our ATI test. Thought others might be interested.
The Proficiency Level Reference Table for Fundamentals says:
Level I = 60%
Level II = 68.3%
Level III = 81.7%
ATI tells us that "an Individual score meeting the criterion established for Proficiency Level II is:-Fairly certain to meet the NCLEX standards in this content area.-Demonstrates a level of knowledge in this content area that more than adequately supports academic readiness for subsequent curricular content.-Exceeds the minimum expectations for performance in this content area.-Demonstrates achievement of a satisfactory level of competence needed for professional nursing practice in this area.
For those who were not aware, like me, APA formatted references are actually available on CINAHL for your articles of choice. Just go to the icon on the upper right corner that says "citation" and different formats of citations are available to copy and paste!
Author, A., Author, B., & Author, C. (Date). Article title. Periodical Title, volume(issue), pages.* Retrieved , from database. (other information needed to trace the article should be in parenthesis, such as specific File Name, item number--if applicable)
*Since some online articles do not indicate page numbers, you will not always be able to include them in your citation.
Examples with author:
Carter, W. (1998, August 10). Collective effort. Telephony, 235(6), 66-67. Retrieved January 8, 2001, from ABI/Inform Global database.
Hayes, M. (1998, December 21). Thin clients offer savings—advances promise lower ownership costs, but Microsoft prices remain high. Information Week. Retrieved January 8, 2001, from Lexis-Nexis Academic Universe database.
Intext citation: (Hayes, 1998)
Example with no author:
Mobile telephones: Wireless war. (2001, January 8). The Economist. Retrieved January 8, 2001, from Factiva database. (Retrieval Item: ECON99008000049)
1. What are gram negative infections more difficult to treat than gram positive? a. their cells walls are more complex making it more difficult to penetrate
2. What is empiric therapy? a. a broad spectrum antibiotic known to treat symptoms the patient is experiencing without identifying the specific specimen
3. Why should culture specimens be drawn before antibiotic therapy is begun? a. it yields the most accurate specimen in the infection
4. What is prophylactic antibiotic therapy? a. infection prevention in circumstances where infections are likely to occur
5. Under what circumstances do superinfections occur? a. when antibiotics reduce or completely eliminate normal flora
6. What are the causes of strains of bacteria that are resistant to antibiotics? a. over or inappropriate antibiotic prescribing and patients not finishing their antibiotic regimen
7. What does it mean for an antibiotic to be bacteriostatic? a. inhibits bacterial growth
8. Why are antibiotics given using the “around the clock” method? a. maintain therapeutic levels
9. What are the common manifestations to a hypersensitive reaction of an antibiotic? a. wheezing, shortness of breath, swelling of face, tongue or hands, itching, or rash
Chapter 38
10. What is the benefit of once-daily aminoglycoside dosing? a. reduces nursing care time and allows for outpatient or home-based therapy
11. Why are trough levels drawn on aminoglycosides? a. ensure adequate renal clearance and avoid toxicity
12. When should aminoglycoside trough levels be drawn? a. at least 18 hours after completion of the dose
13. What is the therapeutic goal for trough concentration of aminoglycosides? a. at or below 1 mcg/mL
14. What is the risk when trough levels are above 2 mcg / mL? a. toxicity to the ears and toxicity to the kidneys
15. How often are aminoglycoside trough levels monitored? a. once every 3 days
Chapter 39
16. Viruses are particles that do what inside a cell? a. replicate
17. How do antiviral drugs work? a. destory virions or inhibit replication
18. How do the current antiviral drugs that are synthetic compounds work? a. inhibit viral replication
19. Where must antiviral drugs go to disrupt viral replication? a. enter the cells the same way the virion does
20. What are antiretroviral drugs specifically used for? a. treatment of infections caused by HIV
21. What is the mechanism of action of non-retroviral antiviral drugs? a. block activity of polymerase enzyme, impairing viral replication
Chapter 41
22. What is an infection cause by a fungus called? a. mycosis
23. Generally, who is affected by systemic fungal infections? a. hosts with compromised immune defenses
24. Why is it so difficult to produce systemic antifungals for human use? a. drug concentrations cannot be tolerated by human beings
25. What are the side effects that nearly all patients who receive amphotericin B intravenously experience? a. fever, chills, hypotension, tachycardia, malaise, muscle and joint pain, anorexia, nausea and vomiting, and headache
26. What drug classes are given to decrease the severity of reaction to amphotericin B? a. anti-pyretics, anti-histamines, and anti-emetics
citation machine is a free web service. there are links provided to purchase materials for APA style formatting, but citation machine is free to use. the link to the APA style format is on the left hand side. there will be a drop down menu and since we are using online journals, that is the link you would want to select. it will format the reference, but will not check for spelling, punctuation, and capitalization mistakes that has been input by the user. it is also not required to register to use the service.
Tuesday, November 25, 2008
pharm grades for exam #4 are posted on turnitin.com!
Monday, November 24, 2008
GRMs for week #13 are available with answers on Mr. Scott's docushare!
*Can sustained release capsules be crushed for administration?
*A patient is concerned about damage to her liver because of the 81 mg dose of aspirin she is getting. What can you tell this patient about the mechanism of action and why it is safe for her to get this daily dose?
*What is a safety issue for a Parkinson’s Disease patient?
*What are typical treatments for EPSs?
*Describe oxyhemoglobin-dissociation and factors affecting it.
*A patient on a statin is complaining of muscle pain and hemutria. What is the nurse’s concern?
*What tames heparin?
*Is it safe for a patient to be on coumadin and heparin IV?
*What is the treatment for status asthmaticus?
*How does Lopid lower LDLs?
*What else is Serevent useful in treating
*In what way is heparin and insulin similar, regarding medication administration?
*What is the normal range for PaO2 and PaCO2?
*What are the benefits of Clariton?
*What is the correct procedure for using Advair?
*What are the five things that can be done for a hypoxemic patient?
*What labs should be monitored for patients on lithium? Why?
*What is the relation between Sinemet and B6?
*A patient is receiving Plavix and is scheduled for surgery in a week and the nurse calls the physician to discontinue the medication. What does the physician tell the nurse?
*Is it okay for a patient to be receiving 18-21% FIO2?
*What is warfarin’s mechanism of action?
*What is the nursing care of a patient on Plavix after coming back from surgery?
*How does adrenergics work as a decongestant?
*How can you test if a rescue inhaler is empty?
*Why should a patient on Albuterol or Serevent avoid caffeine?
*What labs should be checked for a patient on Lipitor or Zocor?
*What can result in pleural effusion and can it be solved?
*What is ordered for a person undergoing a percutaneous coronary intervention and what is the route of administration?
*What should a nurse always watch for when a patient is taking Tegretol and Depakote?
*What are the signs of a hypoxemic patient?
*How are mucolytics useful?
*What is another anti-hyperlipidemic drug that is best combined with Lipitor or Zocor?
*What are the two types of lung disorders and how do they differ?
*Why is warfarin’s therapeutic range for a prosthetic valve patient different from a patient without a prosthetic valve?
*In general, how does an anti-hyperlipidemic work?
*What does a PaO2 less than 80 mm Hg indicate and what can it lead to?
*What labs should a nurse know about a patient before administering heparin?
*A patient is about to receive a tissue plasminogen activator to prevent clots. Is this correct?
*What type of lung disorder is pulmonary tuberculosis? Why?
*What are the routes of administration of heparin?
*What is the significance of high CYP3A4 enzyme levels of a patient on Lipitor or Zocor?
*What is the significance of monitoring the baseline platelet count?
*What is the right procedure for using a rescue inhaler? A MDI?
*What is the therapeutic range for theophylline?
*What are 4 types of respiratory units?
*What is the most common treatment of Parkinson’s Disease?
*Describe safety precautions for a patient prone to hypoxia of the brain.
*Compare and contrast Intal and Singulair.
*How should Dilantin be administered orally? IV?
*How are opiods and Robitussin DM similar?
*What can consolidation be a result of?
*What is the difference between a lipoprotein high in lipids and a lipoprotein low in lipids?
*What labs should be taken for a person on Rifampin?
*What is the mechanism of action of Atrovert?
*What is the patient suffering from acidemia prone to? Why?
*What is Zetia’s mechanism of action?
*A newly admitted patient has a platelet count of 650,000. What is this referred to as and should the nurse be concerned about the count?
*What is the significance of PaCO2 that is out of normal range?
*What fluids can Dilantin IV be mixed with?
*How is tuberculosis spread?
*For every liter of O2, ___ increases by __%.
*What is the significance of administering heparin SubQ and administering heparin IV?
*What actions should be taken for a patient experiencing status epilepticus?
*Why is Benadryl discouraged in the elderly?
*What specific questions should a nurse ask a patient on Isoniazid?
*What is normal range for a platelet count?
*What are the three routes of administration of corticosteriods and an example of each?
*Why do anemic patients have a decreased circulation of gas?
*What should a patient know before beginning to take MAOIs?
*What are the adverse effects of lipoprotein removal drugs?
*What is the biochemical reason for mental illnesses?
*What is safe administration for a dose of heparin to prevent a clot?
*What drug class is aminophylline?
*What is the relation between carbon monoxide poisoning and oxygen affinity?
*What are the adverse effects of beta-2 agonists?
*What is offered to treat neurological symptoms of a patient on Isoniazid?
*What are examples of SSRIs and what do they improve?
*Describe three problems associated with corticosteroids.
*What are the side effects of niacin?
*What are specific signs and symptoms of bleeding?
*How does Sinemet work?
*A patient on warfarin is exhibiting unexplained swelling, chest pain, and weak pulses. What is the nurse’s interpretation of these symptoms and what can be done?
*What is the duration of drug therapy for the schizophrenic patient?
*What is a side effect of Atrovert?
*What is patient education needed for a patient on drugs altering the clotting mechanism?
*What are the adverse effects of TCAs and MAOIs?
*What should a nurse expect to see after administering a methylxanthine and what might be a side effect?
*What should a patient on TB treatment avoid?
*What is Robitussin useful for?
*What is the mechanism of action of unfractionated heparin?
*Can heparin be used on an emergency patient experiencing a stroke?
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
Friday, November 7, 2008
noo2 exam #1 grades are posted on docushare!
Thursday, November 6, 2008
Hey everyone. Mr. Meza had given this documentation paper to his clinical group. He thought it would be helpful for Semillo's group, but I think it might be useful to everyone. It's kinda lengthy, but very informative. Hope it helps.
Keys To Documentation Course # 111 2 contact hours Written By: Monica Oram, RN, BSN
Upon completion of this course the reader will be able to achieve the following objectives: 1. Define documentation and identify its importance 2. Describe four forms commonly used in documentation 3. Describe legal aspects of documentation 4. List five reasons for careful documentation 5. List ten guidelines for documentation
What Is Documentation?
Documentation means “to give written information that is proof or support of something that has been done or observed.” Documentation is the written account of observations, the information the client, resident or family relates or states, the data you collect during care, and the care that you provide.
A medical record is a collection of information about the person you are caring for. It is a legal and confidential record with pertinent information related to the care provided.
We have heard it said over and over again, “ If you did not document it, it was not done”. We have heard this a thousand times. Lets look at what all this means………….
Simply put, a medical record is the record of all care that is provided. If it is not recorded, it did not happen. If it is recorded incorrectly, it happened incorrectly. This is why it is so important to be accurate when documenting.
Four most commonly used forms with particular importance are: 1. Nurse’s progress notes 2. Graphic sheet for vital signs 3. Care plans 4. Activities of daily living sheets by CNA’s
These are the forms where the most pertinent data is collected. There is little room for error on these documents. This is not to say that the rest of the chart is not equally as important, as the whole record is essential. These forms are particularly important because the content they contain sum up what was done ( or not done ) for the patient.
Legal Implications
Documentation provides crucial legal protection. Admissible in court, the patient’s medical record must be documented in an accurate, complete, systematic, logical, concise, and timely manner. Courts will view the documentation in the medical record as proof and verification to patient care. By showing that the individual under your care received quality, adequate care, a well documented record can, and will most likely protect you legally.
The medical record is a legal document. It is also regarded as highly confidential, especially in light of the new HIPAA regulations. In the event of a medical malpractice case, the medical record may be used to provide the court with evidence about a person’s condition and treatments. In a malpractice case, the jurors usually view the medical record as the best evidence of what really happened. For this reason, all documentation should be neatly written and legible. Illegible handwriting is handwriting that cannot be read or understood by others. This would account for sloppy writing, and often misspelled words and poor grammar. Illegible or poorly written documentation makes you look careless and distracted. Take the time to write neatly and clearly. Avoid words that are unnecessary or very long. When you abbreviate, make sure it is a standard abbreviation with no possibility of having more than one meaning.
DO NOT cover up anything in a chart with white out. Draw one line through it and indicate “error”, and be certain you initial it.
NOTE: if you didn’t chart it, you didn’t do it… has another meaning, if you did not do it, don’t have someone else chart you did what you did not. Also, do not document care provided by someone else. If there is a problem, you will be held liable.
Do’s to good charting
1. Check to be sure you have the correct chart before you begin writing 2. Make sure your documentation reflects the nursing process and your professional capabilities. 3. Write LEGIBLY 4. Use a permanent black ink pen ( other colors do not Xerox well) 5. Chart completely 6. Be concise and accurate 7. Chart time for each entry 8. Document PRN medications and exceptional things in the record. 9. Chart precautions or preventative measures, ( Such as use of side rails) 10. Include the following for procedures: what was done, when it was done, who did it, how it was done, how the client tolerated it, adverse reactions, if any. Paint a clear picture of what happens. 11. Record each phone call to or from a physician, including exact time, message, and response. 12. Chart when a doctor makes a visit, and if there are any new orders. 13. Chart as soon as possible after providing care. 14. Chart a client’s refusal of treatment or medications. 15. Chart client’s subjective data.. ( what he says and how he says it) use quotations if necessary. 16. If you remember something important after you have completed your documentation, write “ late entry” and make the note. 17. If information on a flow sheet does not pertain to your patient, write N/A for not applicable, leaving it blank appears that it was not addressed or an oversight. 18. Make sure that each page has the patients name on it. Just last name is not acceptable, as it could become misplaced, and posted on the wrong chart of someone else with the same last name.
These good rules of charting is a good start to successful documentation.
The do not’s of charting are very important also:
1. Don’t chart a symptom such as “c/o Pain” without also writing what you did about it. 2. Don’t alter a chart….this is a criminal offense. 3. Don’t add information at a later date without indicating that you did so. 4. Don’t date the entry so that it appears to have been written at an earlier time. 5. Don’t use shorthand or abbreviations that are not standard. 6. Don’t write vague descriptions such as “ large amount of drainage” 7. Don’t make excuses, such as “meds not given because not available.” 8. Don’t chart what someone else says unless you use quotations and state who said it. 9. Don’t chart an opinion. 10. Don’t use words that suggest a negative attitude, such as “weird” or “nasty” 11. Don’t chart ahead of time. If something happens it will look bad to go back and make that correction. 12. Misspelled words and bad grammar are as bad as illegible handwriting. 13. Don’t record staffing problems. 14. Don’t document that an incident report was completed. 15. Don’t record staff conflicts.
Charting care that was not given is fraud. It is punishable by the Board Of Nursing and can land you in court, or put your license in jeopardy.
Also… if you make a mistake, draw a line through the error, and indicate it as an error, and then initial it. Do not write “oops” or “sorry” or draw a happy or sad face in the margin, or any where on the document. This is unprofessional and inappropriate. Don’t leave any blank spaces. Never save a space for a colleague who forgot to chart.
To avoid litigation, healthcare professionals must document according to State and Federal Legislation. Remember it is the law.
Nurses are also mandated by their state’s nurse practice act to document appropriately.
Avoid block charting, such as 0700-1500, this makes it very difficult to pin point a time that anything was done on the shift.
Types of charting
Regardless of the system of charting you use, it must include the nursing process as a guideline. 1. Assessment 2. Planning 3. Implementation 4. Evaluation
Assessment includes observing the patient for signs and symptoms that may indicate actual or potential problems.
Planning includes developing a plan of care directed at preventing, or resolving identified client problems or issues.
Implementation (or intervention) of the plan that has been developed includes the specific action that the nurse needs to take to accomplish the plan.
Evaluation determines whether or not the goal was met in identifying if the plan of care was effective in preventing, or resolving the problem.
Narrative charting
The nurse documents in chronological order the events that took place throughout the shift. Narrative charting is time consuming, so make certain your notes are legible and clear to understand by all who reads them. A note should be made at least every two hours.
SOAP Notes
This method is preferred by many nurses. It stands for Subjective data, Objective data, Assessment, and Plan. Sometimes it can be referred to as SOAPIE or SOAPIER, in which the “I” indicates implementation and “E” indicated Evaluation. When an “R” is included, this indicates Revision.
APIE
More commonly known as “Pie Charting” Assessment, Plan, Intervention (or implementation), and Evaluation. It is more concise in the aspect that the nurse will indicate subjective and objective data in the assessment section, what will be done in the plan, the intervention and the outcome. As it follows through in A, P, I, E format.
Flow Sheets
Also known as graphic sheets, or graphic records. These are a quick way to document. They need to be used CAREFULLY, as some areas do not apply to all patients. Avoid leaving any boxes unmarked, and individualize it to meet your patients needs. Focus Charting
The term focus was developed to encourage the nurse to view the client’s status from a positive perspective rather than a negative perspective. The system uses three columns to indicate date/time, focus, and progress note. The progress note portion includes DAR( date, time, response)
Date/time focus progress note
Date: Action: Response:
Charting by exception
Also known as CBE. A system of charting in which only significant information, findings, or exceptions are documented.
No matter which method you prefer, or your facility uses, make sure that the content is addressing the proper do’s and don’ts for charting.
Care Plans
Most care plan formats have three columns. One for the nursing diagnosis, one for the interventions, and one for the expected outcome. The nurse must develop a care plan for each client usually within a specified period of time after the client arrives to the facility. They are generally initiated upon admission.
Standardized care plans are preprinted care plans to help save time for the nurse. They must be individualized to fit the needs of each patients separately and individually.
Critical pathways or health care maps are usually preprinted care plans. They include nursing actions for a client with a specific medical diagnosis. The specify care that should be given on a daily basis including, but not limited to diet, medications, activity, treatments, ect. Pathways are popular with managed care becoming about more and more.
Kardexes
Kardexes are useful, but need to be maintained and up to date to be of any value. The card system is readily available to all staff who need information at a glance to what is pertinent with the patient. The cards are written in pencil so they can be updated appropriately and easily.
Things To Remember
We have learned a lot about proper documentation. Here are a few other things to consider:
The following mistakes can cause legal problems:
Ÿ Documentation not accurate Ÿ Documentation not complete Ÿ Failure to record prevention efforts Ÿ Particularly falls, side rails, call bells in reach, restraints( if used), smoking and any other potential for injury Ÿ Failure to record treatments and care Ÿ Failure to record refusal of care Ÿ Failure to record families refusal to accept care provided to patient Ÿ Incomplete incident reports (do not note incident reports in a chart) Ÿ Tampering with a medical record Ÿ Failure to record client’s failure to follow orders, noncompliance
Reimbursement
Another very important aspect of charting is related to reimbursement. In health care, sometimes private insurance and Medicare will deny payment if documentation is not satisfactory or is not done at all. This means that Insurance Companies, Medicare, and Medicaid pay the facility in reimbursement for care provided, which in turn pays salaries and supply costs. Payment can be denied if documentation is missing or incomplete from the chart. The importance of good documentation, charting vital information, and patient status is essential for reimbursement in many cases.
Reasons For Careful Documentation
1. Documentation gives written evidence of care given, the patient’s response, and the effect of the care. 2. Documentation plans for the future care and changes in plan of care so all members can be kept current. 3. Documentation serves as a communication tool. When you document, remember that you alone are responsible for noting what was done, and observed. 4. Documentation is legal, and reimbursement is often dependant on the notes that are written. 5. Documentation allows for continuity of care and focuses on clients needs and goals from all those involved in their care. 6. If the chart goes to court, you will most likely go to court too.
Summary
In closing, it is important to remember the basics for good documentation to protect yourself legally and to be able to provide good care to your patients. Cover all your bases, and think about legal aspects everyday as you go about your daily routines. Remember that what you write today, can save you and your license in the future, should the record end up in a court room. Keep in mind, whether your facility uses narrative charting or the more modern documentation systems on a computer, you need to document your actions expertly. By following these tips and guidelines, you will be well on your way to protecting yourself legally and provide the best possible care to your patients.
And we will say it one more time…… “ If you didn’t chart it, it wasn’t done.”
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
Hey everyone. I got an e-mail from the National Student Nurses' Association about their Midyear Conference in Reno. The convention is from November 13 to the 16th at the Nugget. They will have panels on nursing specialties, workshops on topics like pharmacology and nursing exams, and an exhibit hall with employers schools and other groups of interest to nursing students. The above link will take you to the National Student Nurses' Association web site for the conference which has a lot more information about specific presentations and activities.
For students from California, they are offering registration for the conference at $30 per day as long as we get 15 people interested in going. I've already got some people, but we are looking for more. This will be a good chance to talk to hospitals about what they look for when hiring new graduates as well as learning what you can do to score better in class. This is a national convention and I think we really need to take advantage of the fact that its so close. If you're interested in going, please e-mail me with your name, and which day(s) you would like to go. I've already got people who are interested in car pooling and going for Saturday only, but if you would like to stay up there for longer you're more than welcome. The following is the text of the e-mail I received about the event:
Attention Nursing Students and Pre-Nursing Students in California
We don’t want you to miss the upcoming Career Planning Conference sponsored by the National Student Nurses’ Association.We know that students are impacted by the current economic crisis so we have created a sale just for you!
Groups of 15 or more nursing students and/or pre-nursing students from the same school may register to attend the MidYear Conference for just $30 per day for Friday and Saturday.This special daily registration fee includes the Keynote Speaker on Thursday, 5:00 – 6:30 pm.See the complete program description and schedule to see which day works best for you.The Career Fair with 100 exhibitors takes place on Friday and Saturday.Nursing Career Specialty Panels take place on Saturday.
Here’s what you need to do to take advantage of this offer—use the attached form to:
Collect the names of at least 15 nursing students and/or pre-nursing students who will attend the Conference;
Indicate the name of the school of nursing and contact information;
Include the day(s) that the students will be attending.
Have a faculty member at your school sign and date the form;
Submit the form by Wednesday, November 5.
This offer is for both NSNA members and non-members. Our hope is that non-members will join when they learn about NSNA and experience what the organization offers to members.
Once we receive the list, we will prepare badges which can be picked up at the Pre-Registered conference desk. You may pay by cash, credit card, or check.You will need to show your student ID when you register.Note that walk-in daily registration is also available so that those who do not make it onto the list can also attend at the special rate.
If you have any questions, please call (718) 210-0705 or e-mail nsna@nsna.org
We look forward to seeing you!
Sincerely, Jenna Sanders, NSNA President
PSSee more information about the conference below.
Career Fair–Friday and Saturday. Find your first RN position, summer internships, and residencies.There are over 100 exhibits—bring plenty of business cards and your resume!
Nursing Specialty Showcase—Saturday November 15
Hear from 12 nursing leaders in a variety of nursing specialty careers—ask questions and get the answers you need to help guide your career decisions
"Conquering Your Own Everest: Do You Have What It Takes?"
Patrick Hickey, DrPH, MSN, RN, CNOR, is the Keynote Speaker at the National Student Nurses’ Association (NSNA) MidYear Conference in Reno, NV, November 13-16-2008. Dr. Hickey became the first registered nurse to have climbed all Seven Summits when he reached the top of Mt. Everest on May 24, 2007.Known as a humorous and engaging speaker, Dr. Hickey’s keynote speech, promises to deliver a rousing kick-off to NSNA’s MidYear Conference. And be the first to view NSNA’s new Career Advancement Video!
Major General Patricia Horoho presents the Midyear Leadership Address You will not want to miss this important event and an opportunity to meet the Chief Nurse of the US Army Nurse Corps, Major General Patricia D. Horoho.The Leadership Address takes place on Saturday, November 15, immediately following the Leadership Breakfast sponsored by the US Army Nurse Corps Recruiting Command.
Nursing’s Future:Opportunities and Challenges—Friday, November 14
Hear from five top nursing leaders—ask the panel participants questions and discuss the issues that concern your future as a Registered Nurse.
Special event with karaoke, networking, dancing, pizza, cup-cake decorating contest, raffles, and prizes.Event takes place on Friday at 7:00 pm.Admission:$5.00.Join us and help raise funds for the Foundation of the NSNA Disaster Fund.
1. How is the effectiveness of a psychotropic drug therapy often measured? a. verbal reports from patients regarding improvements in social and occupational functioning
2. What factors constitute ideal mental health? a. emotional, psychosocial, and spiritual factors
3. What is psychosis and what is its hallmark? a. severe emotional disorder impairing mental functioning impairing ADLs; hallmark is loss of contact with reality
4. What is another name for affective disorders? a. mood disorders
5. What is the biochemical concept of mental illness? a. abnormal levels of neurotransmitters
6. Which neurotransmitters play a role in maintaining mental health? a. dopamine, norepinepherine, serotonine, and histamine
7. What advantages do newer antidepressants have over TCAs and MAOIs? a. fewer and less severe systemic adverse effects and less drug-drug and drug-food interactions
8. How long does it typically take antidepressants to reach their maximum clinical effectiveness? a. 4-6 weeks
9. How do TCAs work? a. block reuptake of neurotransmitters to correct imbalance of concentrations
10. In general, how do antipsychotics work? a. produce state of transquility and work on abnormally functioning nerves
11. What are the positive symptoms of schizophrenia? a. hallucinations, delusions, and conceptual disorganizations
12. What are the negative symptoms of schizophrenia? a. apathy, social withdrawal, blunted effect, poverty of speech, and catatonia
1. What causes the excessive mucus production in a URI? a. inflammatory response by viral invasion
2. What causes nasal congestion in URI? a. irritation of nasal mucosa resulting in dilated small blood vessels of the nasal sinuses
3. What 4 classes of drugs are used to treat URI? a. antihistamines, decongestants, antitussives, and expectorants
4. What do histamine-1 receptors mediate? a. smooth muscle contraction and dilatio of capillaries
5. What do histamine-2 receptors mediate? a. acceleration of heart rate and gastric acid secretion
6. How does excessive histamine release cause a drop in blood pressure and edema? a. vasodilation and increased capillary permeability, moving fluids from blood vessels into tissues
7. How do antihistamines work? a. directly compete with histamine for specific receptor sites
8. What is the other term for antihistamines? a. histamine antagonists or blockers
9. Which specific smooth muscle are histamine-1 antagonist particularly focused on? a. smooth muscles surrounding blood vessels and bronchioles
10. What are the primary anticholinergic effects of antihistamines? a. secretions of lacrimal, salivary, and respiratory mucosal glands
11. How does histamine cause pruritis? a. stimulates nerve endings
12. What are the two main cells that release histamine? a. basophils and mast cells
13. What do antihistamines do to smooth muscle in the bronchial tree? a. cause extravascular muscle to contrict
14. Why is it most beneficial to give antihistamines early in a histamine-mediated reaction? a. compete with histamine to occupy the unoccupied receptors
15. What are the consequences of histamine binding? a. prevent consequences like vasodilation, increased secretions, and edema
16. What is the chief adverse effect of antihistamines? a. drowsiness
17. How do the non-sedating antihistamines avoid causing drowsiness? a. work peripherally without affecting the CNS
18. What is another name for non-sedating antihistamines? a. peripherally acting antihistamines
19. What class of drug is loratadine (Claritin)? a. non-sedating antihistamine
20. What class of drug is diphenhydramine? a. antihistamine
21. Why is the use of diphenhydramine discouraged in the elderly? a. hangover effect and increased risk of fall
22. What are the three classes of drugs used as decongestants? a. adrenergics (sympathomimetics), anticholinergics (parasympatholytics), and corticosteroids
23. How do sympathomimetics produce decongestion? a. constrict blood vessels to better drain nasal secretions
24. How do opioids reduce coughing? a. suppress cough reflex
25. What are the two mechanisms of action for expectorants? a. loosening and thinning of RT secretions and direct stimulation of secretory glands
Week 11-Chapter 36
26. Where does the oxygen-carbon dioxide exchange take place? a. alveoli
27. What is the common feature of asthma, emphysema and chronic bronchitis? a. obstruction of airflow through the airways
28. What is it that narrows bronchioles in asthma? a. bronchospasm, inflammation, and edema of bronchial mucosa
29. What is the collective term for such substances as the histamines and leukotrienes? a. inflammatory mediators
30. In asthma, what antibody sensitizes the patient to the offending allergen? a. immunoglobulin E
31. How do bronchodilators work? a. relax bronchial smooth muscle to dilate bronchi and bronchioles
32. What are the three classes of bronchodilators? a. Beta-agonists, anticholinergics, and xanthine derivatives
33. How do each of the subtype beta adrenergic agonists work? a. non-selective adrenergic drugs: stimulate alpha 1, beta 1, and beta 2 receptors b. non-selective beta adrenergic drugs: stimulate beta 1 and beta 2 receptors c. selective beta 2 drugs: stimulate beta 2 receptors
34. When a nonselective adrenergic agonist is given, what are the cardiovascular adverse effects? a. increased HR, contractility, and BP
35. How are beta 2 agonists useful in treating hyperkalemia? a. shifts potassium from blood stream to cells temporarily
36. List the adverse effects of alpha-beta agonists. a. insomnia, restlessness, anorexia, cardiac stimulation, hyperglycemia, tremor, and vascular headache
37. How does the parasympathetic autonomic nervous system bring about bronchoconstriction? a. releases Ach which binds to bronchial trees to constrict airways
38. How do anticholinergic drugs indirectly cause airway dilation? a. blocks Ach which causes constriction
39. What is the therapeutic range for theophylline? a. below 20 mcg/ml
40. What do leukotrienes cause in asthmatics? a. inflammation, bronchoconstriction, and mucus production
41. How do antileukotriene drugs work? a. prevent leukotrienes from attaching to receptors on circulating and local immune cells
42. How are inhaled corticosteroids used? a. control inflammatory response believed to cause bronchospastic disorders
43. How is fluticasone administered? a. intranasally
44. Is it safe to crush a sustained-release capsule for administration? a. no
45. What is the relationship of caffeine and beta agonist drugs? a. increase in adverse effects like tachycardia, hypertension, headaches, nervousness, and tremors
Week 11-Chapter 40
46. Describe MTB. a. a rod shaped bacterium thriving in highly oxygenated sites like the lungs
47. How is TB spread? a. inhaled droplets from infected hosts to new host
48. Why is MTB more difficult to treat than most bacterial infections? a. slow growing organism
49. Why are slow growing microorganisms difficult to kill? a. cells are not as metabolically active compared to faster growing organisms
50. What is the most widely used antitubercular drug? a. isoniazid (INH)
51. What it the major effect of drug therapy with antitubercular drugs? a. reduction of cough, and therefore infectiousness
1. What are seizures, convulsions and epilepsy? a. seizures: brief episodes of abnormal electrical activity in the nerve cells of the brain b. convulsions: involuntary spasmodic contractions of any or all voluntary muscles throughout the body, including skeletal and facial muscles c. epilepsy: chronic, recurrent pattern of seizures
2. What is accurate diagnosis of seizure disorder based upon? a. electroencephalogram (EEG)
3. What is an AED? a. antiepileptic drugs
4. What other types of illnesses are AEDs used for besides seizures? a. psychiatric disorders, migraine headaches, and neuropathic pain syndromes
5. Under what circumstances should an AED be abruptly stopped? a. a severe adverse effect occurs
6. Under what circumstances would a patient with a seizure disorder be maintained on a subtherapeutic drug level? a. decreases the risk for medication-induced adverse effects and interactions
7. What are the three pharmacologic effects of AEDs? a. make it difficult for a nerve to be excited or reduce the nerves response to incoming electrical or chemical stimulation b. limit the spread of seizure discharge from its origin c. decrease the speed of nerve impulse conduction within a given neuron
8. At what time of day are AEDs typically given? a. >?
9. Why should carbamazepine not be given with grapefruit? a. >?
10. Why does IV phenytoin have to be given with normal saline? a. avoid local venous irritation
11. Why does phenytoin IV have to be given slowly? a. possible cardiovascular/respiratory collapse
12. What is the most common adverse effect of AEDs? a. sedation, confusion, CNS depression
Week 10-Chapter 14
13. What does PD result from? a. imbalance of dopamine and acetylcholine
14. What do dopamine and acetylcholine regulate? a. proper regulation of posture, muscle tone, and voluntary movement
15. What are the classic PD symptoms? a. slowness of movement (bradykinesia), rigidity, tremor, and danger of falling
16. What is the primary role of MAOs? a. breakdown of catecholamines
17. What does selegiline do? a. decrease amount of levodopa needed
18. What does levodopa do? a. precursor for dopamine synthesis by the brain
19. How does amantadine (Symmetrel) exert its antiparkinsonian effect? a. elicits release of dopamine from nerve endings
20. In PD, what are anticholinergic drugs useful in? a. treat the muscle remors and muscle rigidity
21. What is the relationship of pyridoxine and levodopa? a. B6: promotes levodopa breakdown and possibly reverse effects
22. Explain the concept of a drug holiday. a. obtain more therapeutic effectiveness; allow patient to respond to lower doses of drug
1. What are anticoagulants? a. inhibits the action or formation of clotting factors thus preventing clots from forming
2. What are antiplatelet drugs? a. prevent platelet plugs from forming by inhibiting platelet aggregation which is beneficial for preventing heart attacks and strokes
3. What do thrombolytic drugs do? a. break down clots which have already formed
4. Why is frequent monitoring not necessary with LMWH? a. low molecular weight heparins have a predictable anticoagulant response
5. How does warfarin work? a. inhibits the four vitamin K-dependent clotting factors to prevent clot formation
Week 9-Chapter 28
1. How is cholesterol used in the body? a. used to make steroid hormones, cell membranes, and bile acids
2. How doe statins lower serum cholesterol levels? a. decrease rate of cholesterol production
3. What is rhabdomyolysis? a. breakdown of muscle protein leading to myoglobinuria (urinary elimination of the muscle protein myoglobin
4. When assessing liver enzymes, which are it most important to assess when a patient is on statins? a. activity of CYP3A4 in the liver to metabolize statins
citing sources is probably the most time consuming and annoying part of papers. there is a wonderful link to a site called citation machine on the right side of the blog that will help you out so much if you feel the same way. all you have to do is input the info like article title, author, etc. and it will automatically format in apa or mla format...whichever you chose to do. its such a time saver!!
I thought some of you might like a little distraction after the final and I saw this interesting article online. The American Heart Association recommends a rate of 100 compressions per minute while performing CPR. The authors of a recent study practiced CPR while listening to different songs on ipods, and they found out that "Stayin Alive" by the Bee Gees has a beat of 103 per minute. 5 weeks later they practiced CPR again and were told to think of the song while giving compressions and it improved their compression rates.
while we are busy studying for the final, dont forget N001 is coming to an end tomorrow, too. remember the first 3 weeks we were driving ourselves crazy wondering how we were going to make it through anything at all? well, we have accomplished something huge, even if its only 9 weeks in. we plowed through these weeks like hot, garlic, mashed potatoes.
take the time to recognize the bumpy road you took to get here because being proud of your accomplishment is the most rewarding thing you can do for yourself. have a good dinner tonight and rest up...a half hour of sleep will do more good than 30 extra minutes of study time!
Hey everyone. My desk is covered with Nursing 1 Study Notes and I am trying to get prepared for the final on Thursday. But I started thinking about Nursing 3 (my mind sometimes wonders). Anyways, I was just thinking about how I study for Pharmacology. On Test #2, I did all the reading and guided modules and studied for many hours but still made a poor grade. I was wondering how everyone went about studying for the test and class? Any suggestions would be greatly appreciated. Good luck on the final. Nursing 1 is almost under our belt.
1. Discuss the risk factors for complications of the patient undergoing surgery. (Ch. 50, pp. 1369-1375) -age, nutrition, obesity, obstructive sleep apnea, immunocompromise, F&E imbalance, pregnancy, medical history, lifestyle choices, and socioeconomic factors
2. Discuss the signs and symptoms of the patient experiencing dyspnea. (Ch. 40, pg. 920) -clinical sign of poor tissue perfusion marked by shortness of breath *exaggerated respiratory effort, increased depth and RR, and activity intolerance
3. Discuss the nurse’s responsibility to safe medication administration. (Ch. 35, pg. 687) -evaluate the effects of medications on health status -teach patients about medications and side effects -ensuring adherence with medication regimen -evaluate client’s ability to self-administer
4. Discuss the responsibility of the nurse when a medication error has occurred. (Ch. 35, pg. 705) -prepare written occurrence report or incident report to be filed within 24 hours -feel comfortable and fear no repercussions; safety of the patient first
5. Discuss the nursing actions that will maintain dignity and respect to patients. -good communication skills -following through -knowledgeable
6. Discuss the nursing interventions to promote communication with a patient with aphasia. (Ch. 24, Table 24-10) -be patient and attentive -ask simple questions, allowing time to answer -encourage conversation -do no speak loudly -use communication aids and collaborate with speech therapists -let patient know if you do not understand
7. Discuss the purpose of the implementation phase of the nursing process. (Ch. 19, pg. 279) -achieve goals and expected outcomes to support or improve the patient’s health status
8. Discuss the purpose of open-ended questions when obtaining subjective data. Provide examples. (Ch. 16, pg. 239) -technique leads to the patient actively describe their health status and strenghthen the nurse-client relationship *tell me how you are feeling *your discomfort affects your ability to get around in what way *describe how your wife has been helping you *give me an example of how you get relief from your pain at home
9. Discuss the nursing interventions to prevent vascular complications for an immobile patient. (Ch. 47, pg. 1247) -mobilize the patient as soon as their physical condition allows for them to do so -teach client to breathe out while repositioning themselves in bed -lower extremity exercises, frequent fluids, and position changes
10. Differentiate between evaluation and assessment. (Ch. 20, pg. 291). -evaluation is ongoing and whenever there is contact with the patient -to compare the status before the assessment stage and after a nursing intervention to redirect nursing care if necessary
11. Explain autonomy. Provide examples. (Ch. 24, pg. 348 and Ch. 22, pg. 314) -self-direction of nurses to make choices and accept outcomes of action like owning medication errors if they occur -inclusion of patients in all aspects of care like signing consent forms before surgery
12. Discuss the nursing responsibilities for the patient while in the PACU. (Ch. 50, pg. 1394) -focuses on monitoring and maintaining airway, respiratory, circulatory, and neurological status and on managing pain
13. Discuss strategies to ensure safe administration of medication. (Ch. 35, pp. 705-709) -standards: right medication, right dose, right client, right route, right time, right documentation -medical reconciliation: verify client’s current list of medications, clarify the list is accurate with as many people as necessary, reconcile discrepancies between new medication orders and current medications, and transmit updated and verified list to caregives and client
14. Discuss the assessment needed for the patient with fluid imbalance. (Ch. 41, pp. 978-984) -age -medical history including present medication -lifestyle -socioeconomic factors -daily weights and I&Os
15. List the criteria for writing a correct outcome or goal. (Ch. 18, pg. 265-267) -client centered and is specific and measureable reflecting wellness and independence -realistic -mutually set by nurse and patient
16. Discuss the criteria needed for writing an accurate nursing diagnosis. (Ch. 17, pg. 252) -client centered problem based on validated objective and subjective data -within nursing scope of practice -includes diagnostic label, related factor (related to…), and etiology (as evidenced by…)
17. Discuss strategies that promote effective communication. (Ch. 24, pp. 348-355) -use therapeutic communication techniques -use active listening -use professional communication -provide comfortable and safe environment with favorable conditions
18. Discuss the role of the health care team when developing an initial plan of care. (Ch. 18, pp. 268-269) -which interventions will be dependent nursing interventions -communicate nursing care priorities to other health care professionals
19. Compare and contrast legal decision making and ethical and moral principles. (Ch. 22, pp. 314- and Ch. 23, pp. 328-332) -legal decision making: advance directives, standards of care, informed consent, mental health parity act -ethical and moral principles: autonomy, benefiecience, maleficience, justice and fidelity; code of ethics including advocacy, responsibility, accountability, and confidentiality
20. Discuss the nursing care of the patient with a urinary catheter. (Ch. 45, Table 45-3) -prevent bacterial growth -promote comfort, check for displacement -assess purpose and need for catheter
21. Discuss the patient education needed for the patient scheduled for surgery. (Ch. 50, pp. 1379-1380, 1386) -understand pre-op instructions and exercises -state the time of surgery -understand to post-op location and where family will be able to wait during and after surgery -understand the post-op monitoring and therapy -understand surgical procedures and post-op treatment -understand post-op activity resumption -understand pain-relief measures -can openly express feelings about surgery
22. Discuss the nursing care of the patient who is confused. (Ch. 41, pp. 973-974) -may be evidence of electrolyte imbalance *monitor I&Os, daily weights, vital signs… *per physician order: correct imbalance by administering diuretic or IV fluid electrolytes
23. Discuss the complications of general anesthesia. (Ch. 50, pg. 1392) -side effects of anesthetic agents like cardiovascular depression or irritability, respiratory depression, and liver/kidney damage
24. Discuss the nursing interventions to prevent thrombophlebitis in the post-operative patient. (Ch. 50, pp. 1401-1403) -leg exercises unless contraindicated -apply stocking or devices to prevent circulatory stasis -encourage ambulation as soon as possible after monitoring vital signs and safety measures -reposition effectively -anticoagulant drugs as ordered -adequate hydration
25. Discuss the risk factors of the elderly patient undergoing surgery. (Ch. 50, Table 50-4) -reduced cardiac function, skin integrity, respiratory function, renal function, metabolic function and sensory loss -good vs. harm of patient going to surgery
26. Discuss the assessment needed for the patient with diarrhea. (Ch. 46, pp. 1185-1188) -assess frequency, volume, and consistency -inspect mouth and abdomen -assess usual elimination patterns of patient
27. Discuss the nursing interventions for the patient with impaired skin integrity. (Ch. 48, pp. 1301-1305) -maintain skin care, reposition to improve circulation and use devices if necessary to avoid further impairing skin integritry and educate the patient
28. Discuss causes of bradycardia. (Ch. 40, pp. 918-922) -age, lifestyle choices, and socioeconomic factors may cause decreased elasticity of heart muscle, thicker and stiffer heart valves, and calcification of vessels
29. Discuss the assessment needed for the patient with the diagnosis of Activity Intolerance. (Ch. 47, pg. 1240) -extent of ROM, ability to perform ADLs, varying degrees of pain perception/tolerance before and during activity
30. Discuss the signs and symptoms of severe hypoxia/hypoxemia. (Ch. 40, pg. 917) -cyanosis, declined RR, low SpO2 as a result of respiratory fatigue
31. Discuss the nursing interventions needed to promote oxygenation of the post-operative patient. (Ch. 50, pg. 1401) -breathing exercises: diaphragmatic breathing, coughing exercises, and incentive spirometer -use respiratory devices when/if patient uses them at home or oxygen if ordered -promote comfort: assist in turning and oral hygiene -remove secretions
32. Discuss the preparation needed to safely transfer the patient to the operating room. (Ch. 50, pp. 1389-1391) -use stretcher -double checks for identification -standards to prevent falls; rails up after medication administration -void before surgery
33. Discuss the nursing interventions needed to promote ambulation. (Ch. 47, pp. 1246-1275) -maintain circulation and muscle use to prevent ambulation complications *ROM exercises, repositioning, breathing exercises, devices designed to improve circulation
34. Discuss the assessment needed for the patient who has been on bed rest and has an order to begin ambulation. (Ch. 47, pg. 1230-1237) -assess mobility of the patient including range of motion, gait, exercise/activity tolerance, and body alignment -ask or observe -assess to protect patient safety: orthostatic hypotension
35. Discuss the purpose of bed rest. (Ch. 47, pg. 1225) -reduce physical activity and oxygen needs of the body -reduce pain -allow ill or debilitated patients to rest -allow exhausted patients uninterrupted rest
36. Discuss the correct procedure for administering a subcutaneous medication. (Ch. 35, pp. 744-750) -use the rights of medication administration before giving injection and assess purpose and need for medication *draw up syringe, cleanse proper injection site, pinch site and inject at 45-90 degree angle *DO NOT RUB HEPARIN
37. Discuss the nursing care for the post-operative patient who had a nasogastric tube. (Ch. 50, 1404-1405) -for decompression, not feeding, because stomach becomes paralyzed after surgery -listen to BS, look BM, distension -safely remove stomach contents to provide comfort for patient
38. Discuss the purpose of using an assistive device when moving patients. (Ch. 47, pg. 1224) -reduce number of work-related injuries -avoid unnecessary injury to nurse and patient
39. Discuss the correct procedure for suctioning a patient. (Ch. 40, pp. 934-941) -suction to clear secretions a patient is unable to produce or clear
40. Discuss the physiological effects of prolonged bed rest. (Ch. 47, pg. 1239) -poor circulation and muscle weakness *slow wound healing, slowed or impaired GI/GU activity, activity intolerance, impaired respiration, lack of ROM, and muscle/fat loss
41. Discuss dependent nursing interventions for the patient experiencing nausea. (Ch. 41, pg. 975) -may be evidence of fluid volume deficit or excess *per physician order: diuretics, administering IV fluids, blood transfusions, laboratory tests…
42. Dosage and Calculations (Ch. 35, pp. 696- 698) Can you calculate pills/tablets/injections? -(dose ordered)/(dose on hand) x amount on hand = amount to administer Can you calculate safe dosage ranges? Can you safely administer medication (using the correct equipment)?
43. Can you utilize the nursing process given a specific case scenario?
