final exam Flashcards
Chronic Illness: Addressing symptom complaints
- decreased mobility
chronic pain - fatigue and depression (don’t kno which but could be both)
- cognitive issues
any suffer from social isolation - hearing and vision problem
- frequent infections at time
- abuse (many form, physical emotional)
- issues with medications
ALOT OF PATIENTS WITH CHRONIC ILLNESS REPORT THAT
- they’re weak
- no energy
- not eating well
- losing weight
WHEN THEY REPORT TO YOU AS A NURSE
- try to identify when this episodes of things are happening
- KEEP A JOURNAL of what they’re eating, drinking, when they have pain
Home care: Nursing diagnoses-intervention
a lot are related to medical diagnoses they may have
- impaired physical mobility
- altered nutrition (USUALLY LESS THAN)
- decreased cardiac output
- high risk for injury ( infections and falls )
- altered urinary elimination
- chronic pain
- social isolation
- non compliance
- POWERLESS = FEELS LIKE THEY DONT HAVE NO CONTROL
WANNA MAKE SURE WE TELL PARENTS TO PARTICIPATE IN SELF CARE ACTIVITIES TO THEIR OPTIMAL LEVEL = give more control
- also want them to have choices
Dying patient: Responsiveness-intervention
WHAT WE SEE IN DYING PATIENTS
- we see grief
- sorrow
- sadness
- suffering
UNIVERSAL FINDINGS OF A PERSON WHOS DYING = HYPOXIA!!
- malnutrition
- hepatic and renal failure
- fluid and electronic imbalance
- BECOMES RESTLESS AND AGITATED
- experience dyspnea
- problem swallowing
- REMEMBER WITHDRAWAL CAN BE A NORMAL RESPONSE in the process of dying
Central line dressing change intervention
- DO NOT
- APPLY CLEANSING AGENT WHILES STILL WET
- do not put supplies on the bed ( put on sterile field )
HAVE
- have a mask on as a nurse and even on the patient
- put mask on patient and have patient turn their head BECAUSE WE DONT WANT THEM BREATHING ON THE AREA OF THE CENTRAL LINE
- hand hygiene before donning gloves
- OFTEN CLEAN THE CENTRAL LINE WITH CHLORHEXIDEN SWABS using STERILE GLOVES
Kidney transplant rejection: Interventions
- we administer immunosuppressant drugs and they on for a lifetime
IF YOU MISS A DOSE - inform a doctor right away
CALL DOC
- chest pain
- SOB
- hemoptysis
- fever
- pain
- bleeding
- CHECK ALL MEDS THEY TAKING WITH DOCS EVEN OTC
- anti rejection meds are for life
- KNOW TO MONITOR BLOOD PRESSURE, WEIGHT AND FINGERSTICK
- be careful of their diet, make sure they exercise for what they can tolerate
TALK TO DOC ABOUT WHAT VACCINES THEY CAN AND CANNOT TAKE AFTER A KIDNEY TRANS
Viral hepatitis: Interventions
- easy to transmit
- high morbidity
- prolong work of time from work and school ( if a person has hepatitis, they’re usually out for 3 or 6 months from school )
PREVENTION
- assess for signs and symptoms
- maintain blood and fluid precautions
- we wanna observe skin ( JAUNDICE ON THEIR SKIN AND SCLERA
- observe their stools
- watch for mental changes, pneumonia, dehydrations, vascular problems, pressure ulcers
MAIN INTERVENTION TO WATCH FOR = THAT THEY GETTING ENOUGH FLUIDS AND THAT THEY DONT HAVE ANY ELECTROLYTE IMBALANCE
Hepatitis with ascites: Interventions
- make sure their diet is high in calories and carbs
- daily weight
- check abdominal birth ( when you take a tape measure at level of umbilicas (NOT ABOVE OR BELOW)
DO WHAT? = do a paracentesis to take fluid out and ascites go down
- ASK IF YOU USE ANY OTC MEDICATIONS, WORRY ABOUT TYLENOL (ACETAMINOPHEN) cus we know that can cause LIVER DAMAGE
Cirrhosis patient with paracentesis: Outcomes
paracentesis = tap to drain fluid
- worry about hypovolemic shock cus it can take out large fluids
- WORRY ABOUT RESPIRATORY, ARE THEY NOW BREATHING BETTER?? are they less short of breath? cus you taking the fluid out and the fluid is no more pressing on their lungs
Adrenal insufficiency: Labs related to treatments
insufficiency = ADDISON
- monitor electrolytes ( HYPONATREMIA ) = give salt, iv or mouth
- hyperkalemia
- HYPOGLYCEMIA = give some sugar but not too much either
Addisonian crisis: Teaching
- monitor vital signs for HYPOTENSION
- watch for volume depletion
- sign of shocks
THEY NEED TO KNOW WHEN TO TAKE THE CORTICOSTEROIDS AS SCHEULEDcus addison is low levels or cortisol
- inform the doctor if they’re stress, sick because then they may need increase in their corticosteroids
Cushings: Clinical manifestations/Body image
- truncal obesity
- hirtuism
- buffalo hump
- moon face
- weight gain
- petechiae
- thinning of the hair
- purple streaks on the abdomen (striae)
- HIGH LEVEL OF CORTISOL
- these ppl tend to worry about body image
IF THEY HAVE SURGERY TO REMOVE ADRENAL GLANDS OR THE PITUITARY, THEN THE SYMPTOMS WILL REDUCE because it removes the source of corticosteroids
Lupus: Medication teaching/Labs
connective tissue disorder so it affects many systems so WORRY ABOUT KIDNEY (MAIN CONCERN)
- needs to be on steroids
- prednisone will be tapered done you DONT STOP THEM RIGHT AWAY
- teach them about side effects of meds ordered for them
- WEAR MEDIC ALERT BRACELET SO PPL KNO THEY HAVE LUPUS
Clinical manifestations
- malar rash, discoid rash
- butterfly rash
LABS
- WORRY about kidney damage and can end up on dialysis
- REPORT ABNORMAL LABS SUCH AS
ABNORMAL URINE CONTAINING PROTEIN
ELEVATED BUN
ELEVATED CREATININE
Acute Kidney Injury: Clinical manifestations
- can lead to CHRONIC RENAL FAILURE
- check urine output
- know GFR rate
- may have METABOLIC ACIDOSIS
- rapid and deep respirations
DEPEND ON PHASE,
OLIGURIC - they’ll have some urine but it’ll be decreased urine output
fluid retention
- neck vein distension
- bounding pulse
- edema
- HYPERTENSION (kidney)
- FATIGUE
- SEIZURES
- EKG CHANGES
DIURETIC PHASE: dehydration
Chronic Renal Failure: Nursing Diagnosis based on findings/Meds to avoid/assessment based on stage/cause of clinical manifestations
NURSING DIAGNOSIS
- fluid volume EXCESS ( we worry about this cus the kidneys are unable to excrete the fluids so they holding unto the fluids)
- LOOK AT LUNGS, CRACKLES
- ELEVATED BLOOD PRESSURE? GAINING WEIGHT? CLOTHES, SHOES GETTING TIGHTER??
TEACH PATIENT
- important that the doctor checks the fluid and electrolytes
MED TO AVOID = magnesium and aluminum hydroxide (THEY BOTH ANTACID AND GONNA CAUSE MORE PROBLEMS FOR THE KIDNEYS)
- are they any other antacids they can take tho? YESSS BUT NOT THOSE
EARLY STAGE
- may not have no urinary change output BUT REMEMBER SOME PATIENTS MAY ALSO BE DIABETIC (POLYURIA which is not from the kidneys but the diabetes)
- AS IT PROGRESSES = WATCH FOR URINARY RETENTION, lethargy, fatigue, headaches, nausea and vomiting
- DIFF SYSTEMS MAY BE AFFECTED WITH DIFF PATIENTS WITH CHRONIC RENAL FAILURE
- may have pruritus
- UREMIC FROST, UREMIC BREATH
- some of the clinical manifestaction the patient has such as N/V is cus they can’t get rid of the waste product.
you gonna have lethargy
Continuous Ambulatory Peritoneal Dialysis: Monitoring
peritoneal dialysis
- make sure the drainage is flowing
- no foul odor
- doesn’t look cloudy
- if it’s not draining = make sure they’re no kinks in the urine
- there’s no blood clots in the tubing
check site for
- infection
- don’t want them to develop peritonitis
- hernia
- low back pain
- could have bleeding
- pulmonary complications
- protein lost
