general terms Flashcards

Question

jehovah witness

Answer 1

AVOID = blood products such as - RBC - red cells - white cells - plateless, plasma CAN RECEIVE - saline - **dextran** - lactated ringers - hetastarch **hypertension is a contraindcation in erythropoietin** - administer erythropoetin IV or subcue area not IM

Answer 2

**16 or 18 guage IV catheter** - same for large bore IV access and delivering large IV fluids UAP - can take vital signs before and after the 15 mins period INSTRUCTIONS - **ALWAYS CHECK THEM FIRST AFTER A HAND OFF** - HAVE THEM VOID BEFORE SO THAT INCASE OF A REACTION OCCUR, a fresh urine can be obtained - USE Y TYPE BLOOD ADMINSTRAATING TUBE and should be administered with 0.9 sodium chloride only - **infuse it within 30 minutes of receiving it from the blood bank and must be completed WITHIN 4 HOURS** - not compatible with dextrose **run with normal saline ONLY** - nurse must **REMAIN with client 15 minutes** to monitor for transfusion reactions COMPLICATION - **hypotention is a reaction** BLOOD TRANSFUSION REACTIONS 1. stop the transfusion 2. admister oxygen 3. take vital signs 4. **obtain urine specimen to check for hemolyzed RBCs** TREATMENT OF ALLERGIC REACTIONS TO BLOOD TRANSFUSION - vasopressors - epinephrine - diphenhydramine - corticosteroids **all these drugs increases blood pressure and since hypotension is a complication of blood transfusion, these agents can correct the hypotension by increasing blood oressure** BLOOD GROUP - O- = universal donor - AB+ = universal recipient BLOOD DONATION RULES - can give to whoever has your letter - CANNOT receive if they don’t have your letter

Answer 3

**METABOLIC ACIDOSIS** = SOIDUM CARBONATE - starving - diabetic mellitus - severe diarrhea - burns - renal failure - salicylate toxicity - lactic acidosis **METABOLIC ALKALOSIS** - vomiting - gastric suctioning = losing acid from the stomach = **can lead to paralytic ileus** - over the counter antacids ( tums, alka-seltzer ) = **these meds neutralize acid in the stomach so it makes sense why they cause alkalosis** TIP **if you don’t know the answer… always answer METABOLIC ACIDOS**

Answer 4

- treats hyperthyroidism by partially damaging thyroid glad **has a delayed response** CLIENTS SHOULD FOLLOW THE FOLLOWING PRECAUTIONS - limit close contact and time spent with pregannt women and children - **breastfeeding should be stopped 6 weeks before treatment to prevent agen accumulating in the breasts after treatment** - use separate toilet, flush 2 or 3 times - use disposables utentils **do not share foods** - If the urine is spilled, **they must call the HAZMAT TEAM** = radioactivity is excreted THROUGH URINE - do not sit near others for. a prolonged time (train, flight travel) - **breastfeeding is not resumed with the current child but can be resumed with future pregnacies** BRACHYTHERAPY = internal radiation **RADIATION THERAPY** - causes dryness of mouth so perform oral hygiene often

Answer 5

after the infection, it’s is important to ask the client to follow up in 48-72 hours for results read **RESULTS** - < 5mm i= negative - > 15 = positive **however, a positive response does not indicate the client has TB but has been exposed and developed immune response** **report if client is taking prednisone** = it converts latent TB to active disease USED TO CONFIRM - chest x ray is used to confirm the client has active disease after the positive induration for all skin test, IT IS IMPORTANT TO MAKE SURE THEY COME BACK FOR THE READING OF THE RESULT

Answer 6

**earliest sign = LOC** HEAD OF THE BED SHOULD BED RAISED **CUSHING TRIAD** 1. widened pulse pressure (systolic hypertention) = **seen as late sign** 2. bradycardia 3. irregular respiration **cushing triad = later sign that does not appear until the ICP is increased and can INDICATE BRAIN STEM COMPRESSION** **KIDS** - high pitch cry - irritable and fever MONITOR - decerebrate ( extension ) can indicate worsening - **projectile vomiting** FLUIDS: hypertonic fluid 3% INTERVENTION = HYPERTONIC FLUID 3% / MANNITOL - **IV mannitol to reduce cerebral edema by pulling water from the cerebral cells into the vasculature** - elevate bed 30-40 degrees - dim lights - **administer stool softeners** - do not place on abdomen/prone - **maintain strict bed rest. assist with activities** - reduce exertion - **maintain head in midline position to improve jugular venous return to the heart**

Answer 7

best way in preventing and reducing medication errors **used in health facility to document events that pose unanticipated actual or potential risk to the health or safety of a client, visitor or employee** - if you adminster wrong medication, FIRST THING TO DO IS MAKE SURE CLIENT IS STABLE BEFORE FILING A REPORT **EVENTS THAT REQUIRE REPORTING** 1. **assault and injury** (physical, verbal or sexual in the health care facility) - client falls with or without injury - staff and visitor falls regardless of acceptance or refusal of treatment 2. **Treatment and intervention** - delayed/inadequate diagnosis and monitoring - hospital equipment failure - failure to obtain or intervene requested procedures - anything that deviates from the norm - refusing to wear PPE - tempering with medical devices activating a patients pain controlled analgesia - falls or injuries **most important outcome of interdisciplinary communication among care givers = reduce number of medical errors** WHEN REPORTING AN INCIDENT, YOU DONT DOCUMENT THE OCCURANCE!!!! = DONT DOCUMENT IT IN THE MEDICAL RECORD OR NURSING NOTES **medical errors should be reported to the state department of health** **CRISIS** - unanticipated - rapid - can be brief - can result from actual and perceived threats assault: threats to do bodily harm to another person battery: involves touching the person

Answer 8

**INFILTRATION** - non vesicant in subcue tissue **infiltration intervention** - discontinue - elevate the affected extremities to decrease swelling - cold, warm or moist compress **EXTRAVASATION** - vesicant into the tissue surrounding the vein **extravasation intervention** - stop the infusion and diconnect the IV tubing - **use syringe to aspirate the drug from the catheter and remove the iv catheter while aspirating** - elevate the extremity above the heard to reduce EDEMA - notify HCP to obtain prescription for the **EXTRAVASATION ANTIDOTE = PHENTOLAMINE** - administer it into affected tissues IV access is restablished onto an unaffected extremity or through a central line

Answer 9

- **post op, HOB flat or low fowler position with affected extremity straight** - used to assess and diagnose coronary artery disease - a catheter is inserted through a large artery or vein (femoral) and threaded to the heart **most common complication is bleeding so monitor for hematoma** - metformin should be held for 48 hours **HOW TO PREVENT AND CONTROL BLEEDING** - supine and HOB less than or equal to 30 - **apply pressure above the insertion site to control bleeding** - affected **extremities straight** to prevent bleeding from the catheter insertion site - assess bilateral pulses frequently **radiofrequency catheter abaltion = SVT** - close monitor for a fib Peripheral pulses may be diminished following cardiac catheterization, but the complete absence of a pulse indicates a serious complication. If unable to palpate the patient’s pulse, the nurse’s priority action should be to attempt to locate it with a doppler.

Answer 10

used to support a fracture, dislocation, surgery - **elbow flexed at 90 degrees: prevent swelling, relieve shoulder pressure** - hand slightly above the level of the elbow to prevent venous pooling and edema - bottom of the sling ends in the **middle of the palm with fingers visible** - sling supports the wrist joint

Answer 11

- infertility drug that works by stimulating ovulation **necessary to engage in frequent sexual intercourse 5 days after completing the medication regimen** SIDE EFFECTS - INCREASED RISK OF MULTIPLE GESTATION - may cause mood swings - nausea - **hot flashes and headaches** INFERTILITY - failing to conceive after 12 months (women less than 35) of frequent unprotected sex - **in women of 35 or more, it is after 6 months** - IT IS IMPORTANT TO ASSESS THEM FOR ANXIETY AND DEPRESSION. **use active listening and open ended questions** INFERTILITY RISK FACTORS - age 35 and up - hormonal dysfunction such as lack of ovulation - STI - endometriosis - very low BMI (18-24.9) or very high BMI (24.9 and up) FERTILITY INTERVENTION - TEACH ABOUT TIMING OF SEXUAL INTERCOUURSE NEAR OVULATION (FERTILE WINDOW) = OTC pregnancy ovulation predictor kit detects luteinizing hormone for fertile window - **DO THIS BEFORE SUGGESTING ALTERNATIVES AND BEFORE EDUCATING THEM IT TAKES A YEAR TO GET PREGNANT**

Answer 12

- irritation to the diaphragm from inflammed gallbladder **RUQ pain that refers to the RIGHT shoulder** MANIFESTATIONS - nausea (promethazine suppository is 2nd priority to relief nausea and vomiting to minimize further fluid loss) - vomiting (prirotiy is NPO if actively vomiting) - fever - leukocytosis - NG tube might be prescribed to prodive gastric decomp and alleviate nause and vomiting and promote bowel rest **green vomit** in infants are **red flag** = CAN INDICATE BOWEL OBSTRUCTION SIGNS OF CHOLECYSTECTOMY INFECTION - pneumonia occur when atelectasis (alveolar collapse) prevents clearing of secretions - **surgical site infections = redness, warmth, swelling and purulent drainage** - UTI - **peritonitis = rebound tenderness,GUARDING boardlike abdominal rigidity** POST OP CHOLECYSTECTOMY = **low fat diet** - surgical bandages can be removed day after sugery and the client **MAY SHOWER AT THIS TIME BUT NOT BATH!!** - baths are not permitted aa they may introduce infection into the surgical sites. once incisions are head, baths may be resumed

Answer 13

- overgrowth in intestine when GI flora is destroyed example by **antibiotic use** PHARMALOGICAL TREATMENT - **metronidazole and ORAL vancomycin** **METRONIDAZOLE** - unpleasant metallic taste is expected - dark urine (brown, rust colored) is expected - AVOID ALCOHOL COMPLETELY PRIOR and 3 days after therapy - although rare, stevens johnson syndrome can occur (rash, skin peeling) MANIFESTATIONS - watery diarrhea = hypovolemia and loss of electrolyte imbalance - nausea - leukocytosis - fever - abdominal pain LABS - hyponatremia - hypokalemia - HYPER bun = elevated by dehydration INTERVENTION - **USE SOAP AND WATER not hand sanitizers** - gowna dn gloves at all times - USE DILUTED bleach solutions ( chlorine ) to disinfect contaminated surfaces - **hand based alcohol products are NOT EFFECTIVE**

Answer 14

- CONTINUOS IV INFUSION: can be changed every 72 hours (3 days). this means maximum time it should be left on is 3 days. after that, it needs to be changed INTERMITTENT FLUIDS (hypertonic,TPN, propofol, blood): needs to be changed more frequent *4-24 hours) due to risk of infection

Answer 15

- procedure to look inside the bladder EXPECTED POST OP (48 hours) - pink tinged urine - dysuria and urinary frequency - abdominal disocmfort and bladder spasm = **take acetaminophen/ibuprofen and warm tub/sitz bath** = warm sitz bath can help you to urinate COMPLICATIONS - urinary retention - hemorrhage - infection REPORT - blood clots - bright red blood when urinating - inability to void - fevers - chills or severe pain

Answer 16

tol**TERODINE**, oxybutynin, , soli**FENACIN** (**TOS**), dicyclomine SIDE EFFECT - **dry mouth (XEROSTOMIA) = sugar free hard candy or gum** - sedation = avoid driving or operating heavy machinery - dry mouth = INCREASE FLUID - **heat intolerance** - drowsiness - decreased sweat production = hyperthermia **SO AVOID HOT TEMPERATURE** INTERVENTION - increase fluid intake and bulk forming foods (fruits, veggies) to prevent constipation CONTRAINDICATIONS - **closed angle glaucoma** - urinary retention(BPH) - bower obstruction **SJORGREN SYNDROME** - chronic autoimmune disorder in which moisture producing exocrine glands of the body are attacked by WBC - **most commonly affected are the salivary and lacrimal glands leading to dry eyes and dry mouth** - AVOID DECONGETATANS = further dryness

Answer 17

PURPOSE - used to check and evakauate absorption from last feeding. **FINDINGS** less than 500 is good and feeding should not be stopped **BUT you must verify placement first (x ray or gastric ph) before starting feeding** AVOID BOLUS FEEDING IN RISK OF ASPIRATION PATIENTS + CONTINUAL IS SAFTER **AMOUNT** - **safe amount (<500)** = reinsert and feeding continues - unsafe amount = content is discarded and feeding is held until the GRV decreases **MONITOR FOR** - nausea, vomiting - abdominal distension - constipation - abdominal pain - should be checked first 48 hours of gastric feeding and after that, every six to eight hours **EXPECTED FINDINGS AFTER GASTROSTOMY TUBE IS INSTALLED** - thin, pale, and yellow-green drainage with a sour odor and a small amount of blood - use cotten tipped applicator dipped in sterling saline to clean - **if client coughs during NG tube, pull back on the tube slightly and then pause to give the client time to recover and breathe before advancing the tube** - coughing and gagging occur when the tube coils in the throat or slips into the larynx

Answer 18

- it is a form of AVERSION THERAPY (gut hatred for something, in this case alcohol) - **does not cure alcoholism so they should continue seeing a therapist** - It's used in recovery programs that include **medical supervision and counseling** PREVENT - nausea - vomiting - death **WEAR A BRACELET ALERTING OTHERS OF BEING ON DISULFIRAM THERAPY** **PATIENT TEACHING = avoid all alcohol containing products so AVOID** - mouthwash - alcohol-based hand sanitizers - **aftershaves alcohols** - perfumes/colognes - **sauces, vinegars and flavor extracts** - insect repellents (mosquitos sprays) - **ANY COUGH MEDS AND OTC MEDS THAT ENDS WITH -ELIXER (robitussin)** - uncooked icings (VANILLA EXTRACTS) **takes 2 weeks for drugs to start working and effect of drug can last 2 weeks after the last dose** acamprosate: decreases cravings for alcohol ( common side effect: diarrhea ) **ALCOHOL SCREENING TOOL** - CAGE = **C**UT down alcohol = **A**nnoyed = **G**UILTY= **E**YE OPENER - TWEAKING = **t**olerance, **w**orry, **e**ye **o**peners, **a**mnesia - AUDIT = **a**lcohol **u**se **d**isorder tool drinking during pregancy = microcephaly, cleft palate

Answer 19

4DS: dysphagia, dysphonia (muffled voice), drooling, and distress - should be placed in a tripod position **TREATMENT = ENTRACHEAL INTUBATION** COMMON CAUSE: bacterial infection HIB - sore throat - **abrupt onset** - **absence of spontaneous cough due to severe EDEMA** - not wanting to swallow due to pain - drooling may indicate they’re going into respiratory distress - DO NOT TAKE ORAL TEMP = can lead to airway obstruction and cause SPASM - do not open throat to do visual exams or swab throat = can cause obstruction of airway AIR RAID - Airway inflammation - Increased pulse - Restlessness - Retractions - Anxiousness - Inspiratory stridor - Drooling

Answer 20

**physical therapy** = BELOW THE WAIST - ability to move their body, balance and gait = MOBILITY - walker training **occupational therapy** = ABOVE THE WAIST - use of assistive device to manage activities of daily living ( fine motor coordinations ) - dressing - bathing **speech therapy**: assess and treat patients with swallowing disorders as well as communication and speech problems that occur following a stroke **orthopedics**: dealing with the correction of deformities of bones or muscles

Answer 21

**FACIAL NERVE DISORDER** = unilateral - STROKE IS CAUSED BY BLOOD CLOTS THAT STOPS BLOOD TO THE BRAIN INTERVENTION - **chew on the unaffected side** = prevents food trapping - SOFT DIET PREFERRED - CAREFUL ORAL CARE after every meal to prevent problems from accumulating residual food **DOES NOT AFFECTION VISION, BALANCE, CONCIOUSNESS, EXTREMITY MOTOR FUNCTIONS SO YOU CAN STILL DRIVE** **BELLS P =eye stay open so to prevent dryness, apply eye lubricants in the form of artificial tears** - flattening of the nasolabial folds Blink reflex abnormal Earache/eye rollsl up Lower corner of mouth and eye lid Loss of taste and brow movement **Suddent onset (hours to days)** Paralysis unilateral facial nerve 7 TREATMENT: **steroids (prednisone) and antiviral**

Answer 22

**OPEN FRACTURE** - Assess - Protect (cover the wound with a clean dressing) - Apply ice pack - Elevate **SPRAIN** = RICE - rest: activities and movement should be stopped and limited to promote healing within the first 24 to 48 hours - ice (cryotherapy) - compression (ace wrap, splint) - elevation *analgesia *exercise rehab program **IF A PATIENT FALLS AND YOU SUSPECT A FRACTURE** **FIRST THING**: IMMOBILIZE THE LEG BEFORE MOVING THE PATIENT - this helps minimizes bleeding, edema, pain and prevents further injury to the tissues and structures surrounding the fracture. This also decreases the patient’s risk for the development of other complications such as fat embolism and shock. **monitor ppl with fractures for fat embolism which is a priority** MANIFESTATIONS OF FAT EMBOLISM - PRIORITY IS MINIMIZING MOVEMENT OF THE INJURED EXTREMITY - **repiratory distress** - **mental status changes** -**petechaie on chest** - parestheisa and pressure in extremity is compartment syndrome - petechiae is small pinpoint red/purple spots on mucus membrane or skin **HIP FRACTURE** - extremities externally rotated - muscle spsm - shortening of the extremity - ecchymosis

Answer 23

NORMAL GFR RATE: 120 ml per minute fluid retention - **HIGH BLOOD PRESSURE = HIGHEST PRIORITY** MANIFESTATIONS - **tea/pink or cola colored urine** - **headaches can indicate encelopathy and should be taken serious** - periorbital and facial/generalized edema - hematuria INTERVENTION - avoid salt in the diet - conserve energy ACUTE PYELONEPHRITIS - dull, constant and maximal at the costovertebral angle area - severe bacterial infection - **requires aggressive IV fluids and IV antibiotic to stop progression of infection and kidney scarring SO PATENT IV IS THE PRIORITY** - even though administering IV antibiotic is the priority, BLOOD AND URINE CULTURES MUST BE OBTAINED BEFORE INITIATING ANTIBIOTIC THERAPY WHENEVER POSSIBLE

Answer 24

- epstein-barr virus CAUSES - sharing drinks - kissing or other exposure to saliva MANIFESTATIONS - fatigue - fever - sore throat - splenomegaly - swollen lymph nodes - **MONITOR FOR RUPTURED SPLEEN** REPORT - sudden onset **severe abdominal pain*** in the left upper quadrant - airway obstruction = stridor, difficulty breathing INTERVENTION = **hydration, rest, pain control and reducing fever as necessary** - SORE THROAT IS TREATED WITH SALINE GARGLES or ANESTHETIC TROCHES - avoid contact sports like soccer to prevent injury to the spleen or liver - **its a viral infection so antibiotic is inappropriate** = TAKING IT CAN CAUSE A RASH

Answer 25

- **INCREASED RISK WIH PACIFER AND DRINKING FROM BOTTLE WHILES LYING DOWN** - blocked eustachian tube which leads to buildup of purulent fluid and inflamation in the ear - infant are at more risk due to horizontal, shorter and narrower MANIFESTATIONS - **refusal to eat** - red, bulging tympanic membrane, inner ear pressure - **pulling of ear indicates ear infection** - nausea vomiting - rhinorrhea **OTITS EXTERNA** - retracted tympanic membrane - severe pain with pressure on the tragus **AVOID DECONGESTANTS** ASSESSMENT - in toddlers (1-3), wait until end of the assessment to perform otoscopic exams especially when pain is present = can lead to distress - **examine traumatic procedures ears, eyes and mouth near the end of assessment** - insert speculum only as **far as the outer cartilage** not into the bony interior - inspect tympanic membrane for infection RECOMMEND - flu and pneumococcal conjugate vaccine **TREATMENT: AMOXICILLIN** - PRIORITY = administer acetaminphone espcially if febrile and pulling ears - antibiotic eardrops not effective. **systematic like amoxicillin** may be used - heat and cold packs may be used - side lying may be used to drain fluid from ear but its not a priority - **if symptoms do not improve by 48-72 hours of amoxillin therapy = return for further assessment**

Answer 26

- NSAIDS and BETA BLOCKERS CAUSES MORE PROBLEMS IN ASTHMA PATIENTS - begins early in life - **symptoms worse at night** - usually occur in **obese ppl** - hypersensitivity - swimming is s good exercise or aerobic exercises MANIFESTATIONS - tachycardia (120 or up) - tachpnea (30 per minute) - saturation less than 90 - use of accessory muscles - **elevated eosinophils is associated with allergy** administer oxygen followed by albuterol by nebulizer - bronchodilator should be given before chest physiotherapy **RESCUE EMERGENCY DRUGS: albuterol, ipratropium nebulizer every 20 minutes** **acetylcysteine does not work with airway clerance and can cause or worsen bronchospasm** ALBUTEROL SIDE EFFECTS - diffculty sleeping - palpitations - tremors - nausea/vomint **TRAFFIC SIGNAL COLORS/PEAK FLOW** (rate <50 of personal best needs emergency medical care) - GOAL OF FLOW METER USAGE IS TO EXHALE AS QUICKLY AND FORCIBLY AS POSSIBLE - green zone (**peak flow of 80 and above**: asthma under control ( no worsening symptoms) - yellow zone: means caution. **even on a return to the green zone after rescue meds, further medication or change is still needed** - RED ZONE: medical alert. NEED FOR IMMEDIATE TREATMENT **IF levels does not return to yellow immediately after taking recue meds* - **best reading is attained over a 2 week period when asthma is in control** - peak flow meter is used after a short acting bronchodilator rescue not after corticosteroids LONG TERM - montelukast - salmeterol - BECLOMETHASONE: long term, first line drug to control **chronic airway inflammation**. taken on a regualr schedule. **should not be omitted if SABA is effective** - rinse mouth to prevent candida infection (thrush) **when using both, take the SABA albuterol first to open airways** - wash only the mouthpiece with warm water 1-2 times a week cus deposits can prevent full dose of medication from being dispended RELIEVES - wheezing, breathlessness, chest tightnness associated with asthma - sleep High or semi-Fowler's position INTERVENTION - deteremine the severeity of clients condition before impleneting intervention **teach to avoid triggers but if the patient is present with symptoms, ASSESS PEAK EXPIRATORY FLOW FIRST!!*** or assess respiratory rate and lung sounds WORSENS ASTHMA SYMPTOMS - problems with the perception of the disease - **frequent visits to the hospital** - recent withdrawal from corticosteroids

Answer 27

**0.6-1.5** = above 2 is toxicity INDICATION - **anti-mania drug for bipolar** = TAKES ABOUT 3 WEEKS TO START WORKING - stabililizes nerve cell membranes SALT LEVELS - **low sodium** = makes lithium MORE TOXIC - **high sodium** = makes lithium ineffective - **SODIUM level must be NORMAL for LITHIUM TO WORK** **EXPECTED SIDE EFFECTS** - weight gain - dry mouth - drowsiness INTERVENTION **if pt is sweating/manic - do NOT give them water; give Gatorade/POWERADE** MANIFESTATIONS = **3Ps** - **PEEing** - **POOPing** - **Paresthesia** (numbness & tingling) because that’s the early sign of ALL electrolyte imbalance **YOU can still GIVE lithium with these S/S; just tell the DOC when they come in** - hyperactivity and audiotry hallucinations are still expected when lithium therapy starts because it may take 3 weeks to become effective **TOXIC EFFECTS** = hold dose and call doctor - tremors - **metallic taste** & severe diarrhea **CAUSES OF LITHIUM TOXICITY = dehydration from stomach flu or diarrhea** - hyponatremia - severe renal dysfunction = lithium is cleared renally - thiazide diuretics - NSAIDS (**acetaminophen will be betteer for pain relief** - ACE inhibitors **blood levels should be monitored frequently for therapeutic lithium levels and toxicity** **about half of the patients on long term lithium therapy will develop HYPOTHYROIDISM** - can cause leukocytosis

Answer 28

- lead system placed in the endocardium via subclavian vein - cannot sense or treat pulselessness so CPR is needed if there’s no pulse EXPECTED MANIFESTATIONS - firing of the ICD may be painful - clients describe it as a blow to the chest **clients should take ICD identification card and list of medications while travelling** POST OP TEACHINGS - **refrain from lifting the affected arm above shoulder including brushing hair, doing hair**

Answer 29

**clients with respiratory failure has repiratory acidosis** - paCO2 ≥ 45 = hypercapnia - paO2 ≤ 60 - paradoxical breathing = use of respira muscles - mental status change - **absence of wheezing and silent chest** - single word dyspnea = inability to speak 1 word before pausing to breathe - MARKED DECREASE OR INCREASED WORK OF BREATHING **PEDIATRICS** - nasal flaring - head bobbing - GRUNTING = mostly in c section babies NORMAL RESPIRATION IN PEDS - **30-60 with less than 20 periodic pauses** **in neonates, rectal temp of >100.4 or less than 96.8** is a RED FLAG**

Answer 30

- surgical procedure that removes atherosclerotic plaque from carotid artery WATCH OUT FOR **there are at increased risk for TIA and stroke** BECAUSE BLOOD CAN LEAK INTO THE BRAIN MONITOR - monitor blood pressure during the first 24 hours -**hypertension may strain the surgical site and trigger hematoma formation = leading to hemorrhage or airway obstruction** - neurological fucntion = **STROKE** INTERVENTION -**ensure systolic blood pressure is MAINTAINED 100-150 to ensures adequate cerebral perfusion and avoidance of hemorrahe. or stain***

Answer 31

disorder in the ear (excessive fluid in ears) leading to **vertigo, tinnitus and sensorurineural hearing loss** - FALL RISK ASSESSMENTS SHOULD BE DONE WITHIN 2 HOURS OF ADMISSION - FEELING LIKE YOU ARE SPINNING = initiate fall risk measures **reduce stimulation by not watching televison and not to look at flickering light** MANAGEMENTS - **REDUCE DIETARY SODIUM, CAFFEINE INTAKE = reduces attacks** - they should use earphones - initiate fall risk measures by raising side rails **BUT NOT ALL SIDE RAILS BECAUSE THAT IS CONSIDERED A RESTRAIN** HOW TO MINIMIZE VERTIGO - quiet, dark room impaired hearing = speak at normal volume **SEVERE MENIERE = nausea and vomiting** TREATMNET: diuretics, antiemetics, low sodium and antihistamines

Answer 32

HIGHLY CONTAGIOUS life threatening medical emergency so initially priority is IV antibiotics **COMPLICATION TO MONITOR = hydrocephalus** - assess for bulging and tense fontanels - access for increasing head cicumference - access icp MANIFESTATIONS - fever - neck stiffness(nuchal rigidity) - photophobia = so avoid pupillary light response - **altered mental status** - nausea - vomiting **suspected meningitis, priroity is placing on droplet precaution** INTERVENTIONS - head of bed 10-30 degrees to increase blood perfusion from the brain and reduce ICP - if menigitis is suspected, diagnostic testing (**Lumbar punch** and immediate antibiotic therapy are critical and need - FLUID RESUSCITATION IS PRIORITY - NURSE SHOULD PERFRIM GALSGOW COMA SCALE AND - **TAKE ORAL TEMPERATURE** - precautions can be discontinued 24 hours after beginning antibiotic therapy - **KERNIG SIGN**= positive sign is when client complains of pain when his knee is extended with hip flexed - **Brudzinski's sign** positive when severe neck stiffness occurs after the neck is flexed towards the chest, causing the patient’s hips and knees to flex.

Answer 33

high priority problem because clot can disloge and cause life threatening complicatipn pulmonary embolism **RISK FACTORS** - RECENT SURGERY - priority - pregnancy - birthcontrol use - long travel - age **DIAGNOSTIC TEST = HOMANS SIGN** - positive homan sign = pain in the calf when the leg is flexed (dorsiflexion) and the knee is kept extended **homan sign is unreliable so as a nurse, assess the calf for pain, swelling and warmness before concluding on DVT** **INTERVENTION** - elevate legs, **dorsiflex the feet** - limit alcohol and caffeine - resume exercise program **client do not need to avoid travelling but should use preventive measure like wearing compression socks, walk every hour** ** don’t cross legs, stop smokin** PREVENTION - anticoagulant therapy **not aspirin**

Answer 34

- tooth separated from the mouth of a permanent tooth. its an emergency **PRIORITY: rinse the tooth with sterile water and reinsert the tooth into the gingival socket and hold it in place until stabilized by a dentist** - reimplantation within 15 minutes reestablishes blood supply increasing probability of tooth survival **if reimplantation is not possible, the tooth should be placed in commercialy prepared solution, cold milk or sterile water** DONT - place fallen tooth in water = will lyse the cells killing the tooth - sterilize gauze = will dry out teeth **NYSTATIN = ORAL CANDIAL INFECTIONS** - assists clients who weat dentures to remove and soak in nysatatin susoension = DENTURES OFTEN BECOMES A RESEVOIR FOR INFECTION - swish the suspension in the mouth for several minutes **and then swallow the medication to allow treatment of esophageal candida** - avoid missing dose and shake well

Answer 35

- ACE inhibitors (-**pril**) **for clients that cannot tolerate ACE, use ARBS that ends in -SARTAN** - **measure potassium levels prior to ACE inhibtors** AVOID POTASSIUM AND SALT SUBSTITUTES **docusate sodium can be precribed to reduce straining which increases workload of the heart** - straining can also cause bradycardia due to vagal resoonse **SIDE EFFECT** - ortho hypotension - dry hacking cough = this cough **will not** be relieved by cough suppressants - **temporary increase in serum creatinine** - **REPORT ANGIOEDEMA** ANGIOEDEMA - most common in african american - swelling of face, lips and aireaysetc **ACE INHIBITORS AND ARBS ARE BOTH CONTADINCATED IN PREGANCY** - nitroprusside is indicated for hypertension in heart failure. can lead to severe hypotension so priroity is checking blood pressure **DRUGS TO AVOID IN HEART FAILURE** - NSAID cus they contribute to sodium retention and therefore leading to fluid retention

Answer 36

continuos pumps of insulin - delivers more accurately than injections so client will experience fewer swings in blood glucose levels and hypoglycemic episodes - **a bolus might still be adminstered manually at mealtime to cover carbohydrate intake** - still check glucose 4 times a day **SHORT ACTING (LAG) peak 30 minutes-3 hrs** - **l**ispro - **a**spart - **g**lulisine - used with sliding scale - take 30 mins before meals **REGULAR peak 2-3 hrs** - best IV use (DKA) - RAPID short acting - used with sliding scale - take 30 minutes before meal - only insulin that can be given IV **INTERMEDIATE ACTING (NPH) = PEAK 12-18 hrs** - TWICE DAILY morning and evening - peak 12-18 hours - when taking at night, eat bedtime snacks containing complex carbs and protein (cereal with milk, crackers with peanuts) AVOID RAPID AND SHORT ACTING INSULINS BEFORE SURGERIES because they’re supposed to be given with meals and if person is NPO = will cause hypoglycemia LONG ACTING (DDG) - **d**etermir - **d**egludec - **g**largine - **ONCE DAILY**

Answer 37

CAST CARE - avoid exposure to water - if exposed to water, DRY THOROUGHLY IMMEDIATELY or with hair dryer - plastic wrap is not complety occlusive to prevent water into the cast area - dont insert any foreign object under cast - AVOID HEAT APPLICATIONS= cause vasodilation and swelling ITCHY CAST?? = **apply a cool air under the cast with blow dryer** cast on leg = elevate the leg on pillows continuosly cast on arm = elevate arm above shoulder **COMPARTMENT SYNDROME** numbness and tingling for hours or days after a cast is applied. **don’t remove cast without a physicians order** - Pain with passive motion and loss of sensation are early signs of compartment syndrome 7 Ps - paresthesia = earliest sign = tingling, numbness, burning - pain - pallor - pulseless - pressure - poikkilothermy = cool skin temp - paralysis = late sign **itching is not alarming due to heat and sweat under the cast = can be relieved by blowing hair under the cast with blow dryer** - INABILITY TO EXTEND FINGERS IS A HIGH PRIROTY = CAN INDICATE VOLKMANN CONTRACTURES

Answer 38

- **overeating followed by means to avoid weight gain such as purging, laxative abuse, exercisive exercise, prolonged fasting** - THEY OVEREAT AS A COPPING MECHANISM BUT THEY DONT WANNA GAIN WEIGHT - sit with client for like an hour to prevent self induced vomiting as a way to prevent weight gain - they often has a healthy body weight but has concerns about personal appearance and others perception of them and their desire to be in control of their bodies **PRIORITY: ASSESS FOR DEPRESSION** NURSING INTERVENTIONS - readiness to change maladaptive behaviors such as purging - monitor client during and after meals atleast an hour to prevent = **after eating is more important** - enocurage journal about feelings associated with food - initiate structured meal schedule - document the amount of food consumed on a calorie count form for the dietician to evaluate - monitor for electrolyte imbalances

Answer 39

REFEEDING SYNDROME = DECLINE in **PPM** (**p**otassium, **p**hosphorus, **m**agnesium) - fatal complication of nutritional rehabilitation in chronically malnourished clients (anorexia nervosa, chronic alcoholism) **monitor potassium, PHOSPHATE and MAGNESSIUM** during the first few days of nutrional replenishment **MANIFESTATIONS OF ANOREXIA NERVOSA** - cold intolerance - **they are still allowed to refuse food** - WEIGHT 25% BELOW NORMAL WEIGHT - disturbed body image and may see themselves as being fat or overweight DESPITE being severely underweight **strive for perfection exhibiting obedience** Many of these patients see someone in the mirror who weighs more than their desired weight. Despite being too thin, this client will not eat in hopes of getting the perfect body. **PHSYSIOLOGICAL ANOREXIA** - when high metabolic demands of an infancy slows down - **toddlers become very picky and eat small amount of food** - decreased appetite **INTERVENTION OF PHYSIOLOGICAL ANOREXIA** - small feedings - **offer the child 2 or 3 choices of food** - INTRODUCE THEM TO NEW FOODS overtime - schedule for meals and snacks - avoid distractions like watching tv when eating INTERVENTION - assist the client to reflect triggers of disordered eating = encourage discussion about dysfuntional - **maintain strict documentation of dietary and calorie intake** - remain with client for the duration of each meal - weight client each morning prior to any oral intake - **limit exercise** FINDINGS - hypothermia cus of lack of subcue fat - hypotension why? dehydration - continuous dieting - altered electrolyte imbalance

Answer 40

MANIFESTATIONS - bronze HYPERpigmented (tanned) - insufficient sodium so HHYPONATREMIA - salt craving - **cant tolerate stress** = purpose of stress response is to raise glucose and blood pressure. - vitiligo **since these ppl do not have the adrenal cortex to carry out the stress response, when they undergo stress, they go into SHOCK = MAY NEED MORE STEROIDS DURING STRESS** - DOESNT TAKE MUCH TO PUT THEM INTO SHOCK Anything from a tooth filling at the dentist or a minor fender bender can cause these.. people to stress out & die.. TICKING TIME BOMB! LABS - D sodium - I = Potassium - D glucose TREATMENT = **ADDisson = ADD A SONE** = prednisone, dexamethasone & hydrocortisone - **prednisone should not be taken with nsaid = GI BLEEDING** - ORAL CORTICOSTEROIDS SHOULD BE TAKEN WITH FOOD TO LESSN THE LIKELIHOOD OF GASTRIC IRRITATION - side effect: WEIGHT GAIN - **LONG TERM CORTICOSTEROIDS USE CAUSES IMMNUNOSUPRESSION SO REPORT ANY SIGN OF INFECTION** **STEROIDS MAKES BLOOD GLUCOSE GO UP EVEN IF YOU ARE NOT DIABETIC so lookout of people with diabetes

Answer 41

- puffy moon face - hirsutism (facial hair) - trunkal/central obesity (big body) - gynecomastia (female breast on men) - buffalo hump - excess acnes - menstrual irregularities - skinny arm & legs (muscles waste away) - retain sodium & water; losing potassium - striae (stretch marks) - hypertension - bruising -**“I’m mad; I have an infection = grouchy/irritable & immunosuppressed** LAB TESTS - 24 hour urine collection = tested for free cortisol. results 80-120 confirms cushiony syndrome is present TREATMENTS - HYPERsecreting of the adrenocortex so = ADRENALectomy **BUT IF YOU DO A BILATERALECTOMY?? = ADDISON** = so they might need steroids again making them look like CUSHman again = FRAUSTRATING) **24 hour urine is collected and evaluated for cushing**

Answer 42

RISK FOR - hemorrhage - infection - voiding difficulties EXPECTED FINDINGS AFTER PROCEDURE - glans should appear dark red - **after 24 hours, a yellow exudate** = PARENTS SHOULD BE TAUGHT THIS IS A NORMAL HEALING PROCESS CIRCUMCISION CARE - **ONLY WARM WATER (no soap or alcohol based wipes)** - diapers should be changed every 4 hours to keep area clean - **petroleum gauze or ointment should be applied at every diaper change (unless plastibell used) to prevent sticking)** - diapers should be secured loosely to minimize pressure agaisnt the healing circumsicion site - **hypospadias** =urethra underside of the penis - no urine output for 2 hours is a red flag INFECTION - redness - swelling - odor discharge

Answer 43

gastric problem where part of the stomach slide back into the diapgram (**weakening the diaphram**) **may be asymptomatic and commly associated with GERD** everything needs to be (**HI**) FOR (**HI**)ATAL HERNIA except for protein and fats INTERVENTION - elevate head of bed approx 30 degrees - high fluids = - **Avoid lifting or straining** - high carbs - avoid caffeine - small frequent meals **avoid wearing girdle or tight clothes that increases intabadominal pressure** - lifestyle changes such as smoking cessation - AVOID ACTIVITIES THAT PROMOTES STRAINING LIKE WEIGHT LIFTING = INCREASES ABDOMINAL PRESSURE **LOW PROTEIN and FAT** if unrelieved, surgery might be recommended

Answer 44

gastric problem, usually follows gastric injury - gastric contents dump too quickly into the duodenum ( yes they are suppsoed to go into the duodenum but in this case TOO FAST ) - moves in the right direction, but at the wrong rate avoid very hot and cold foods, sugars, soda, cakes, sweets **TREATMENT** we want to s**LOW** everything - Eat with head low & turned to the side - **low fluids with meal** - low carb content in the meals. - **HIGH PROTEIN!! HIGH FAT**

Answer 45

- HIGH BLOOD GLUCOSE ONLY IN TYPE 1 generally due to lack of insulin - another name for type 1 is ketosis thats why. type 2 we know is non ketosis MANIFESTATIONS - dehydration - ketones in blood/ kussmaul breathing (deep and rapid) - K (potassium) up - Acidosis (metabolic)/ acetone breath, anorexia due to nausea **client with DKA may initally develop kyperkalemia despite losing potassium from urinary loss but as DKA is being corrected, it might result in HYPOKALEMIA SO GIVE POTASSIUM** **CAUSES** - too much food - not enough medication - not enough exercise **TREATMENT (DIE)** - diet (least important) - **insulin (most important)** - exercise - **acute illness in clients with type 1 diabetes may trigger release of stress hormones = increased blood glucose AS A RESULT, YOU STILL GIVE INSULIN EVEN IF THEY DO NOT EAT** **KUSSMAUL BREATHING** - deep and labored breathing pattern asscoiated with severe METABOLIC DISORDER particulary DKA but also kidney failure **you can have ketones in your urine and not have DKA but ketones in blood means you have DKA** MONITOR AND REPORT - lethargy - abdominal pain - uirne ketones **MANAGEMENT = HYDRATE** - IV fluids fast 200ml/hr - insulin (**most important**) - **regular insulin normal saline with dextroseD5** whyD5?? = doesn’t stay in veins; goes into the tissues and wont cause hyperglycemia**(D10 and D50 will cause hyperglycemia** NOTE! **hypokalemia often occurs when acidosis is being corrected so you still admnister potassium even if the clinet has normal potassium levels to prevent hypokalemia** **#1 CAUSE OF DKA IN PEDS IS = acute viral upper respiratory infections within the last 2 weeks)** CAUSES FLUID VOLUME DEFICIT = thready pulse, tachypnea and ortho hypo **LONG TERM COMPLICATIONS OF DIABETES** - poor tissue perfusion - peripheral neuropath if they ask you, diabetic has renal failure, what will this be due to?? poor tissue perfusion DKA, HHNK, HYPOGLYCEMIA = theyre are acute

Answer 46

INSTRUCTIONS - use dark jug containing powder to protect urine from light and preserve the urine and adjust its acidity - start time and then empty bladder and discard 1st urine - collect for 24 hours and keep in the fridge or ice chest with secure lid - exactly 24 hours after start time, empty bladder once more into the collection container **USE STERILE TECHNIQUE WHEN COLLECTING A URINE SPECIMEN** REGULAR URINE COLLECTION - discard first sample - collect midline of the urine = less likely to be contaminated - if the bladder is completely drained (anything over 800 mL = spasm) **DO NOT COLLECT FROM CLLECTION BAG** **PERINEAL HYGIENE IS PERFORMED USING SOAP AND WATER ONLY not aseptic**

Answer 47

STI that may cause frothy, maldorous, yellow green vaginal discharge inform partners to be treated to avoid reinfection **MED: metronidazole = dark color urine is expected** metronidazole can cause metallic state MED INSTRUCTION - abstain from sexual intercourse until infection is cleared - avoid alcohol for 3 days = can cause nausea, vomiting and severe abdominal pain

Answer 48

airway anti-spasmodic. **range 10-20** - NOT a bronchodilator - **used when all bronchodilators fails to work** - does not work right away so it should not be used in sudden SOB **MONITOR = seizures and arrhythmias** when a bronchodilator doesn’t work in an acute airway problem, = GIVE THEM AMINOPHYLLINE, then give the bronchodilator - caffeinated products as they increase risk. ofadverse effects SIGNS OF TOXICITY = **avoid cimetidine and ciprofloxacin** ciprofloxacin interactions leads to toxicity and cimetidine decreases absorb option - nausea - vomitting - restlessness - **anorexia and insomnia**

Answer 49

**ELECTROCONVULSIVE THERAPY** - NPO prior - do not drive during the course of ECT - temporary confusion is common immediately after treatment **stop feeding for 1-2 hours before and after adminstering** used for seizures range: 10-20 **toxic levels: 20 and above** MANIFESTATIONS - gum hypertrophy = **but does not indicate toxicity** - increase in body hair - **folic acid depletion** **TOXICITY = CNS** - horizontal nystagmus - gait unsteadiness - ataxia **MONITOR FOR stevens johnson syndrome which starts with flulike symptoms** = discontinue drug use is SJS occurs - clients with seizure should avoid driving INTERVENTIONS - **decreases effectiveness of oral contraceptives and warfarin** - stop feeding for 1-2 hours before and after adminstering it - **products containing calcium, andtacid can decrease absorption** - enteral feeding decreases absorptions too COMMON SIDE EFFECTS - **gum problems = instruct them on proper dental hygiene** - drowsiness that improves OTHER SEIZURE DRUGS - valproate - levetiracetam **REPORT THE FOLLOWING WHEN USING AN ANTICONVULSANT** - new or increased agitation, anxiety and or depression = associated with suicidal ideation - report new rash

Answer 50

**hypoalbuminemia** due to losing alot of protein in urine MANIFESTATIONS - massive proteinuria - edema in abdomen, face and perineum - **HYPERLIPIDEMIA** HOW TO COLLECT URINE FOR URINALYSIS TO MONITOR FOR PROTEINURIA - place cotton balls in dry diaper and later squeeze urine onto a dipstick - avoid urine dipstick in clients diaper CAUTION **loss of immunoglobins = increased susceptibility to infection** = MAKE SURE TO PREVENT ANYTHING THAT CAN LEAD TO THIS **including limiting visitors, playdates** MANAGEMENT - low sodium diet - fluid restriction for severe edema - monitor weight gain and **proteinuria** to detect relapse

Answer 51

causes: **hypotension** = **lack of blood flow to the kidney**, medications and trauma, hyperkalemia symptoms: oliguria **urolithiasis** - kidney stone , the presence of calculi (stones) in the urinary tract. common condition associated = dehydration **KIDNEY STONES/RENAL CALCULI** INTERVENTION - **strain all urine for the prescence of stone** - encourage fluid intake up to 3L/day - administer analgesic at regularly scheduled intervals - frequent ambulation and mobilization facilitate passage of calculi - **do not massage the flank but heat therapy would be acceptable** renal calculi include hematuria (blood in urine), renal colic (unilateral pain spasms in flank), and severe radiating pain, which can cause nausea/vomiting, sweating, and elevated blood pressure

Answer 52

- preventive strategy in which antiretroviral therapy is prescribed for those at high risk of contracting HIV **emtrucutabine/tenofovir is a commonly used combination therapy for high risk individuals** HIGH RISK INDIVIDUALS - IV recreational drug users - sexual partners with HIV - men who have sex with men **hiv can be transmitted through needlestick injury but risk is low, therefore standard precautions are sufficient to prevent HIV transmission in healthcare workers**

Answer 53

- urinary catheter will remain in place - removal of only the enlarged portion of the prostate - blood tinged urine, small clothes are expected - PAINFUL BLADDER SPASMS ARE EXPECTED AFTER TURP AND CATHETER PLACEMENT = tretaed with oxybutynin **MONITOR** - priority = hemorrhage - can have altered urinary elimination too - **monitor post op hematocrit and hemoglobin** - AFTER TURP, continuos bladder irrigation is recommended 24-36 to flush out small clots and prevent obstrcution** - assess the urine in the continuous irrigation drainage bag **REDDISH-PINK DRAINAGE IS EXPECTED IN THE IMMEDIATE POSTOP PERIOD**

Answer 54

**TIMED VOIDING** have them in a time scheduled voiding - **goal is to prolong the time interval** - void every 2 hours - have them wait for 20-30 seconds after voiding and then attempt to void a second time to help empty residual urine FLACCID BLADDER: **perform the crede maneuver or valsalva maneuver (bearing down)** before catherization BECAUSE IT IS NON INVASIVE METHOD - **SELF CATHERIZATION** = intervention for flaccid, spastic or urinary retention - lossing excess weight is good to reduce pressure on the pelvic floor NORMAL RESIDUAL VOLUME: 50-100 **residual urine volume of 100 mL or more on a bladder scan may indicate urinary retention** FECAL INCONTINENCE - provide perianal skin skin care with barrier cream

Answer 55

- **central line is preferred** TPN IS THE SAME AS HYPERALIMENTATION - contains dextrose, amino acids and electrolyes ofc **central lines ONLY** = highest risk of infection SUSPECTED AIR EMBOLISM - clamp catheter - position on left, tredelenburg position - administer oxygen - notify hcp - stay with client AFTER TUBE IS PLACED ** confrim placement with chest xray before starting the infusion** INDICATIONS - indicated for high risk for aspiration patients - indicated for GI track obstruction **have 10% in water IV solution is available to prevent hypoglycemia** APPROPRIATE ACTIONS - attach filter to the IV tubing - **monitorbaseline blood glucose level and fingerstic BG every 6 hours. maintain at 140-180** - incorrect placement of a subclavian central venous catheter can result in pneumothorax or hemothorax **10-mL syringe is preferred for flushing of central venous catheter** =use push-pause method DO NOT - piggyback or add medication to TPN - **do not abruptly stop even if its almost done** = pacrease will continue to secrete increased a ounts of insulin in anticipation = **rapid-onset hypoglycemia** IF TPN ABRUPTLY STOPs - assess for signs of hypoglycemia and **have blood glucose measured IMMEDIATELY!!** COMPLICATIONS - infection - fluid overload - hypo/hyperglycemia **HYPO IF ABRUPTLY STOPPED** - embolism (failure to clamp IV properly) - pneumothorax (accident puncture of the lungs) WHEN PERFORMING DRESSING CHANGE - use sterile technique (central line) - **during injection cap and tubing = hold the breath to prevent air from entering = air embolism** - have client TURN THE HEAD AWAY from picc site to prevent contamination** when removing contaminated dressing = use clean rather than sterile gloves **PARENTAL NUTRITION** - delivers nutrient to the body via bloodstream rather than GI tract - WHERE ABSORPTION IS IMPAIRED

Answer 56

INITIAL POST OP MONITORING - level of alertness - lung sounds - O2 stat - respiratory pattern = cus you just drained alot of fluids from the pleural space which may have been pressing against the lung **most common complication = COLLAPSED LUNGS ( pneumothorax)** LATER MONITORING (after 72 hours) - infection (temperature) **urine output should not be affected by thoracentesis or the drugs administered for the procedure - preferred position procedure: sitting up leaning forward **aucultating fine crackles in base of lung is common 1 day post op and its usually related to atelectasis casued by hypoentilation especially in a client who has not yet ambulated**

Answer 57

- cough suppresants should be avoided cus if cough reflex is suppressed, it can lead to accumulation of secretions - usually develops later in life - they usually run high on the CO2 and low on the O2 **RISK FACTORS** - tobacco smoke active/passive - occupational exposure - air pollution - gentics - **tiotropium is a capsule but it is put in a special inhaler to be inhaled NOT SWALLOWED** - they are not resuce drugs except **ipratropium** - difficulty breathing during sleep = orthopnea which can be as a result of sleeping style, pillow etc - **COPD patients that can’t sleep at night should be asked how many pillows they sleep with** INTERVENTIONS - pursed lips effective when CO2 slightly above normal like the 50s = **inhale for 2 sec through nose and exchale for 4 seconds** - COPD patients should also be allowed to sleep in recliners which can facilitate better breathing **BIPAP THERAPY** - in worse cases where CO2 levels are up the roof like 80 = **BIPAP therapy** is effective to decrease CO2 levels - nebulizer treatment - BIPAP machines are able to deliver nebulizer treatment while providing positive pressurized oxygen - **AVOID INCREASING OXYGEN IN COPD because it can increase CO2 retention causing further respiratory failure** - steroid therapy SEEK MEDICAL HELP FOR - **increased sputum** - fever - worsening dyspnea VACCINES - obtain influenza and pneumococcal vaccines to prevent exacerbations LAB VALUE OF COPD - **plycethemia (increased RBC) so taking iron pills can be harmful** - RBC is produced more to carry out oxygen as a way of compensating for the low oxygen levels MEDICATIONS: **TIOTRAPIUM** inhalers - **tiotropium is a capsule but it is put in a special inhaler to be inhaled NOT SWALLOWED** - they are not resuce drugs except **ipratropium** AVOID MORPHINE AND BENZODIAZEPINES = worsen CO2 retention

Answer 58

- prevent small aveoli or airways from collapsing (keeps them open) - **usually kept at 5cm h20** INDICATION - high levels can be used to manage ARDS - helps reduce **COMPLICATION = barotrauma** - HIGH LEVELS (10-20 CM H20) = can lead to overdistension and rupture of alveoli (**BAROTRAUMA**) BAROTRAUMA - air from ruptured alveoli can escape into the pleural space causing **pneumothorax and emphysema** - causes increased pressure in the throacic leading to **REDUCED venous return and HYPOTENSION** **use of lower FiO2 = reduces the risk for oxygen toxicity**

Answer 59

- closed chest drainage system to collect the blood and drainage and to prevent it from accumulating in the chest - high fowler position - deep coughing and splinting are encouraged during post op period to promote expansion of the lung - lie on affected side so that the drains don’t drain into the good lung **but for pneumonia, lay on the good side to promote proper blood flow**

Answer 60

AVOID - suppositories or enemas - straining **clients who go home with indwelling catheter should learn how to clean around urinary meatus with warm water and soap to prevent infection** INTERVENTION TO PREVENT CONSTIPATION - fluid intake - **at risk of devloping DVT and pulm embolism so AMBULATION IS IMPORTANT and will reduce comnstipation** MASECTOMY POST OP CARE - removal of part of the titty - massage tecqnuique to mobilize fluid (decongestive therapy) - perform isometric exercises - tingling, numbness and itching are common at the surgical site **place client in semi fowler position with the affected side arm on several pillows** = promotes draininage and prevents venous and lymphatic pooling - avoid supine position - **never place client in HIGH FOWLER position immediately after anesthesia = MIGHT DECREASE BLOOD PRESSURE and cause dizziness** **MOST COMMON QUADRANT OF BREAST CANCER** = upper quadrant = BREAST TISSUE THERE ARE THICKER (GLANDULAR TISSUE)

Answer 61

**SPINAL INJURY AT T6 OR HIGHER** - FULL/DISTENTION OF BLADDER OR RECTUM IS COMMON CAUSE (**pressure ulcers** could also be) - **leads to high blood pressure and REDUCED HEART rate** - **sudden headache** = analgesic needed. headache is corrected after blood pressure is solved - **flushed skin above the level of the spinal cord injury (T6 or above)** - piloerection = goosebumps INTERVENTION - elevate head of bed, high fowler - removing tight clothing - correcting cause of bowel or bladder distension **INSERT INDWELLING CATHETER** TO RELIEVE but first palpate the bladder first

Answer 62

- not hormonal so does not raise risk for breast cancer, thromboembolism or cardiovascular disease - they have immediate effect - **REPORT CHANGES IN STRING LENTH = CAN INDICATE DISPLACEMENT** - does not cause bone demineralization (unlike depot shot) - adverse effect: **increased bleeding and cramping within first 6 months** - **menstrual cycles may be more heavier due to cramping** **CERVICAL CAP** - used with sperimicide - remain in place >6 hours after sex BUT SHOULD NOT EXCEED 48 HOURS - alternative should be used during menstruation = can lead to toxic shock syndrome - insert several hours before sex **clients with intrauterine fetal demise are at risk for dissemninated intravascular coagulation (DIC) = obtain baseline lab test for fibrinogen and complete blood count with platelets **VAGINAL RING** - wear for 3 weeks then remove it for 1 week - hormones from the ring are absorbed into the bloodstream through vaginal mucosa - if accidently removed, rsine and place back within 3 hours**

Answer 63

yellowin, bilirubin in the skin - normal: 9.9 and less - elevated levels: 10-20 - toxic level: 20 and above ( GOES INTO KERNICTERUS = bili in brain ) COMPLICATIONS (billi levels around 20) - **kernicterus** = when billirubin is on the blood and occurs when bilirubbin is at highest levels - **Opisthotonus** = the position assumed when there is high bilirubin in blood/brain leading to **HYPEREXTENSION**. place baby on their side PHOTOTHERAPY = treat high bilirubin - low heat setting - babies should. befully exposed except for diaper - **cover eyes with patches to prevent retinal damage** - avoid lotions and ointments = can absorb heat and cause burns - don't interrupt parent feeding child - adequate hydration **kids who undergo phototherapy are prone to DEHYDRATION so promote human milk or infant formula (not water)**

Answer 64

MANAGEMENT IF CLIENT IS NOT BREASTFEEDING - apply ice pack to both breast for 15-20 minutes every 3-4 hours to reduce blood flow and swelling - apply chilled, fresh cabbage leaves on both breast - **avoid manual milk expressin and breast massage cus they stimulate milk production** - maintain firm breast support (supportive bra, breast binder) until milk flow is diminished - take analgesic as directed to reduce pain **BREASTFEEDING** - **if i need to reposition my baby latch, i will use my clean finger to break the suction first in the newborns gum before unlatching** = do same if baby needs to be removed from breast - 15 to 20 minutes oer breast **brest feeding is supply and demand process meaning massaging or manually expressing milk stimulates more milk to be produced** so if client chooses to stick to just fomula, they should avoid such behaviors **BREASTFEEDING POSITIONS** - cradle hold - cross craddle hold - football hold - lying down - tummy to tummy **MASTITIS** INTERVENTION - apply **WARM** compresses to the breast (for engorgement you apply COLD compresses) - increase oral fluid intake - take ibuprofen as needed for pain - massage - **dont discontinue breastfeeding** - antibiotic therapy AVOID - tight fitting bra as much as possible ( do this in breast engorgement care )

Answer 65

POSITION = bear down or exhale, air occlusive dresing - supine trendelenburg position = **this is to prevent air embolism** CARE = **non sterlirle gloves** - should be changed every 7 days - scrub the hub with alcohol or chlorhexideine for 10-15 seconds using friction to the veniouncture site - ** THE LUMEN HUB SHOULD BE CLEANED THOROUGHLY WITH ANTISEPTIC PRIOR TO DRUG ADMINSTRATION** - **distal port largest lumen should be used for cvp monitoring** - **most CVC require IV heparin flushes to maintain patency and prevent clotting 10 units/ml are standard care. dose of 1000-10000 is given for cases of thromboembolism** - in events of catheter occlusion,reposition the patient normal central venous pressure (CVC) = 2-8 - normal pulmonary artery wedge pressure (pawp) = 6-12 - high fowler might worsen respiratory distress

Answer 66

- small herniations in the large bowel = COMMON CAUSE IS LOW FIBER DIETS = 50% of ppl over the age of 65 will have this - adhere to high fiber diet like scrambled eggs, white toast INTERVENTION FOR DIVERTICULITIS - **main goal is allowing the BOWEL TO REST = maintain NPO and bed rest** - IV pain meds and antibiotics - **prevent abdominal pressure** - avoid laxatives - **AVOID RECTAL TUBES** - any procedure or treatment that increases intrabdominal pressure may cause rupture - **in severe cases of abdominal distention, nausea and vomiting, NG suction may be prescribed** **RECTAL TEMPERATURE CONTRAINDICATIONS** - people who are post MI bc it can slow the heart rate by stimulating the vagus - hemorrhage **FOODS TO AVOID AFTER** - red meat - high fat foods

Answer 67

GI tract functions is normal and food goes to your stomach, large and small intestines -**preferred during times like stress ulcers** - LOWER RISK OF INFECTIOUS COMPLICATIONS THAN TPN - **maintains intergrity of the gut, prevent ulcers and help prevent translocation of bacteria into the blood stream** - initoate slowly and advance to a prescribed rate - **OBSTRUCTION/ CLOGGED TUBE DURING FEEDING - flush and aspirate the tube with warm water** - digestive enzyme may help if warm water is not effective

Answer 68

- impairs acetylcholine - impair **facial, eye, chewing, swallowing and respiratory muscles** - skeletal muscles tend to be stronger in the morning and weaken throughout the day MANIFESTATIONS - diplopia - ptosis - **respiratory failure** = have ambu-bag by bedside - facial and oropharyngeal muscle weakness - difficulty swallowing indicate need for immediate intervention MYASTHENIC CRISIS = - infection - undermedication - stress HOW TO PREVENT **MYASTETHENIC CRISIS** - eat semi solid food to prevent choking - get annual flu vaccine - **take acetylcholine inhibitors (pyriodostigmine) before meals so that the peak effects of the medication help the cleint to eat and swallow** TREATMENT: pyridostigmine = increases acetylcholine

Answer 69

- represents P wave CAUSES - overactive thyroid glad (**hyperthyroidsim**) PRIORITY - **keeping ventricular rate under control to less than a 100 to prevent stroke** - CCB, beta blockers (metoprolol) and digoxin is **used for ventricular rate reduction** **TREATMENT** = **AMIODARONE** (also for v tach-stable with a pulse) - ABCD - beta blockers ( -LOL ) (side effects: headache, hypotension) **no asthma** - calcium channel blockers (avoid grapefruit) - digitalis (digoxin same as lanoxin) before administering beta blocker, apical pulse has to be atleast 60 beats per min **SYNCHRONIZED CARDIOVERSION** - used to **convert tachyarrthmias (SVT, v tach) (sometimes a fib with rapid vtach response)** with a pulse to stable cardiac rhythm - SYNCHRO CARDIOVERSIONS ARE LAST RESORT FOR ATRIAL DISORDERS **V TACH** - unstable with pulse = synchronized - stable with pulse = amiodarone - if client becomes pulseless, the synchronize function should be turned off and defib should be started - TURN OFF OXYGEN PRIOR TO DELIVERING!! - **make sure "sync" feature is engaged to prevent delivery of asynchronous shock** (not for v fib) - cardioversion may be done for ATRIAL FIBRILLATION = shock is delivered to client **CARDIOVERSION = there has to be a pulse**

Answer 70

- **HAVE THEM SIT HIGH FOWLER** - draining fluid from the abdomen due to accumulation, ascites - HAVE CLIENT VOID BEFORE - maintain client on BED REST!! worry about hypovolemic shock cus it can take out large fluids. **tachycardia** is a rapid response to hypovemia - 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 **CLIENTS WITH CIRRHOSIS AND ASCITES** - cirrhosis = cholestyramine = take 1 hour before other meds - position in semi fowler or fowler postion why?? we dont want the pressure exerted on abdominal ascites on the diaphrapgn which restricts lung expansion

Answer 71

- **elevated thyroid stimulating hormone** **hypo**metabolism so signs and symptoms reflects name = give them thyroid hormones: **levothyroxine (synthroid)** MANIFESTATIONS - obesity - **cold intolerance (hypo = always cold) - heat tolerance - low BP and pulse - menstrual irregularity **WHEN CARING FOR HYPOTHYROIDISM PATIENTS** - do not sedate them because they are already have slow vitals and - **If the patient is supposed to be NPO** make sure you question that they still get their morning levothyroxine pill!! = they NEED it (might die on the table due to body been too low already from the anesthesia)! MYXEDEMA = **severe form of hypothyroidism** - **hypo**natremia - **hypo**ventilation which causes respiratory acidosis - **HYPO**THERMIA - **HYPO**GLYCEMIA (calcium gluconate available) TREATMENT FOR MYXEDEMA = **levothyroxine and hydrocortisone** LEVOTHYROXINE = **low levo increases TSH, increased levo is needed to lower TSH** - avoid taking in the evening - **AS PREGNANCY ADVANCES, DOSES MAY NEED TO BE INCREASED** - take same time each day **BEFORE BREAKFAST** - follow up to check tsh and t4 levels - **report signs of excess thryoid hormones such as heart palpiations, tachycardia, weight loss and insomnia**

Answer 72

- sores in large abdomen = stools containing blood and mucous **keep a symptom journal** **EXPECTED FINDINGS** - elevated temp - abdominal cramping INTERVENTION - **manage pain** - assess fluid balance - continue SULFSALAZINE even after resolution of symptoms - **take daily vitamins (calcium) and supplements** - increase fluid to 2000 ml per day - **small frequent meals with HIGH CALORIES AND PROTEINS** - AVOID COFFEE and other triggers

Answer 73

- sucralfate should also be taken 1 hour before meals to protect stomach ulceration in the protective layer(mucosa) of the stomach - leads to perforation and bleeding RISK FACTORS - **H pyloris infections** - genetic prediposition - prolonged NSAID use - **stress** - lifestyle choices INTERVENTION - **amoxicillin, clarithromycin and OMEPRAZOLE for 14 days** AVOID - **meals or snacks before sleeping** - taking NSAIDs without prescription - caffeine = cola, tea, coffee - smoking and alcohol - **FIRST LINE MEDICATIONS = PROTON PUMP INHIBITORS**ENDS IN **-PRAZOLE** - SHOULD NOT BE TAKEN WITH FOOD. **TAKE BEFORE MEALS** - may decrease absorption of calcium and promote osteoporosis - **LONG TERM USE: osteoporosis, C. difficile and pneumonia**

Answer 74

MOST COMMON CAUSES - cholelithiasis - alcoholism **MAJOR GOALS** - NPO status - IV fluids - NG tube -**clients often position themselves in knee chest position to alleviate pain** - semi fowler to decrease tension on the abdomen CULLEN SIGN ( C = calcium also) - the discoloration (bruising) of the abdomen and periumbilical area HIGH RISK OF DEVELOPING **ARDS = MOST SEVERE COMPLICATION** MANIFESTATIONS - **severe, continuos, piercing or penetrating pain in the mid epigastric area or left upper quadrant radiating to the back** - steatorrhea - fatty, yellow, foul smelling stool COMPLICATIONS - **increased risk of third spacing, ARDS due to systemic infla response and hypocalcemia**

Answer 75

INTERVENTION FLUID RESUSCITATION IV CRYSTALLOIDS(normal saline, lactated ringers) is priority in appendicitis CAUSE **result of viral or infectious diseases more common in males** - high carbs are risk factors MANIFESTATIONS - **pain from mid epigrastric / left upper that radiates to the back** - if they’re feeling pain and suddenly stops = RED FLAG IT COULD BE A RUPTURED APPENDIX - PAINS - Pain (RLQ) - Anorexia - Increased temperature and WBC - Nausea - **Signs (mcburneys, psoas)**

Answer 76

**C**APUT **S**UCCEEDANEUM - normal edema of soft tissue of the scalp that **C**rosses **S**utures (symmetrical) = look at their initials **CS** - develops due to prolonged pressure of the presenting part against the cervix = resolves in few days - It appears as a lump or a bump on their head. This condition is caused by prolonged pressure from the dilated cervix or vaginal walls during delivery. CEPHALOHEMATOMA = does not cross suture lines - traumatic subperiosteal bleed under the skin **VAGINAL HEMATOMAS** - formed following trauma to the tissues (vaccum or forceps assisted, episiotomy) - severe vaginal pain with fullness but fundus is midline -

Answer 77

- abnormal porstate enlargement normally in clients over 50 - **the prodtate enlarges and comresses the urethra causing voind problmes** MANIFESTATIONS - urinary urgency - urinary frequency - urinary hesitancy - **symptoms are similar to UTI with the exception of burning sesnation and cloudy/foul smelling urine = REPORT THOSE!** - urine dribbling - nocturia **increased risk for UTI because of incomplete bladder emptying and urine retension** INTERVENTION - voiding schedule - avoidance of caffeine an antihistamines **MED = finasteride** - inhibits further grwoth of the prostate - **takes several months of therapy to see appreciable differences in prostate size** - as a result, missing 3 doses will not cause immediate or long term adverse effects saw palmetto is recommended by many urologist to treat bph

Answer 78

**DRAW A TROUGH LEVEL PRIOR TO ADMINISTERING** = about 15-30 minutes - powerful class on antibiotics. BIG GUNS OF ANTIBIOTICS ends in **-mycin** without the "thro" in middle - NOT GIVEN PO (poorly absorbed), PREFFERED ROUTE - ONLY IM OR IV (**central venous catheter preffered** - peripheral IV may be used for short term therapy **PERIPHERAL IV ARE PREFERRED AT THE DORSAL SURFACE OF THE HAND TO REDUCE RISK FOR INFECTION** WHEN ORAL AMINOGLYCOSIDES ARE INDICATED 1. hepatic coma (liver coma) = amonia levels are too high = **lactulose and neomycin** 2. pre op bowel surgery to **sterilize the bowel** = **NEO**MYCIN, and **KAN**MYCIN **GIVE SLOWLY OVER 60 MINUTES** - if given too fast can cause facial flushing but facial flushing is not an indicative of allergic allergic. - wheezing and hives indicates allergic reaction INDICATIONS - life threatening - resistent - gran negative (TB) MONITOR - anaphylaxis (red man syndrome, laryngeal edema, wheezing) - **observe site every 30 mins for pain, redness and swelling** cus they are considered vesicants and can cause thrombophlebitis, extravasation and tissue necrosis - **MONITOR BUN AND CREATININE LEVELS!!** - monitor blood pressure - respiratory status TOXIC EFFECTS - **nephrotoxicity** elevated creatinine levels - ototoxicity (hearing loss, vertigo/balance, tinnitus) - toxic to cranial nerve 8 **administer them every 8 hours too** - MUSCLE CRAMPING IS NORMLA AND DOES NOT REQUIRE INFUSION TO BE STOPPED

Answer 79

canes should equal the distance from the greater trochanter to the floor - **2-3 finger widths below the anterior axillary fold** to a point lateral to and slightly in front of the foot - **hand grip** = elbow flexion should be about 30 degrees - **basic crutch stance** = 6 inches front and side **REPORT HAND AND WRIST WEAKNESS** = CRUTCH PARALYSIS - if any of the answers says AXILLA OR MEAUSURE TO YOUR FOOT (any landmarks on your foot) , THEY ARE WRONG **GOING ON STAIRS** - ASCENDING (up) = lead with stronger leg (weak leg and cane,crutches should move together) - DESCENDING ( down ) = lead with affected leg **crutch might go first but affected leg should follow right after** **2 POINT GAIT CRUTCHES** - two things are moving together - MOVEMENT: 1 crutch/opposite foot.. other crutch/other foot = RIGHT CRUTCH WITH LEFT FOOT. LEFT FOOT WITH RIGHT CRUTCH SIMULTANEOUSLY **3 POINT GAIT CRUTCHES** - MOVEMENT: moving 2 crutches & the bad leg together at the same time - odd leg (1 leg affected) **4 POINT GAIT CRUTCHES** - for severe bilateral weaknesses - MOVEMENT: move everything separately similar to wlaking - weight bearing on both legs **SWING THROUGH CRUTCHES** - NON-weight bearing, amputations - MOVEMENT: plant the crutches & swing through past where the crutches are placed **RESIDUAL LIMB CARE FROM AMPUTATION** - RESIDUAL LIMB SHOULD NOT BE ELEVATED!! - **lie prone several times each day and avoid sitting in a chair for more than an hour** - **phantom pain is a priority** - lying prone will prevent flex flexion contractures - avoid alcohol, lotion, powder - wash with soap and water - perform range of motion exercises to improve muscle strenth and mobility REMEMBER - odd for odd - even for even

Answer 80

immune reaction to eating glutten, a protein found in wheat - need to be on a glutten free diet for the rest of life - **if client does not experience relief after being on a gluten free diet, = ASK THEIR LAST MEAL** MANIFESTATIONS - dirrhea - **foul smelling stools** AVOID = **BROW** = barley, rye oats and wheat **french fires** - wheat - rye GLUTEN FREE OPTIONS - eggs - potatoes - fish - vegetable - corn - rice - milk - red meat - chicken

Answer 81

**insufficient outflow results most often from CONSTIPATION** INTERVENTION FOR INSUFICIENT OUTFLOW - **dialysate bag should be installed using a sterile technique** - assess for abdominal distention and constipation - examine fir kinks and obstructions - place in side lying position **stool softenrs may be prescribed** MONITOR AND REPORT = **they are signs of peritonitis** - cloudy outflow (effluent) = infection - brown outflow = perforation - **respiratory distress AND CRACKLES** - low grade fever - tachcardia avoid beta blockers or anything that brings down pressure prior to dialysis cus one of the complications of dialysis is hypotension

Answer 82

**GLYBURIDE** = LOWERS BLOOD GLUCOSE - bad cross sensitivity with sulfa containing drugs - severe risk and prolonged hypoglycemia in geriatric population - cross sensitivity with diuretics - even foods labeled as diabetic, sugar free or sugarless may still contain carbs such as honey, sugar and corn syrup which all can elevate blood sugar **HYPOGLYCEMIA** 70-110 is normal - not enough food - TOO MUCH INSULIN/MEDS - **too much exercise** **OVER MEDICATION IS THE NUMBER 1 CAUSE OF HYPOGLYCEMIA** - they can all lead to permanent brain damage **SIGN AND SYMPTOMS** - drunk in shock (how drunk ppl behave and they also look like they are in shock) **epinephrine is one major hormone released during hypoglycemic reaction** **HYPOGLYCEMIA MANIFESTATIONS** DRUNK - staggerin’ gait - slurred speech - impaired judgemnt - delayed reactions - labile ( EMOTIONS ALL OVER THE PLACE) - loud/obnoxious **diaphoresis** **trembling** SHOCK - (vasomotor) low BP - tachcardia - tachypnea - pale, cold, clammy, mottled skin **if a client is demonstrating hypoglycemia signs and symptoms, FIRST THING CHECK BLOOD GLUCOSE BEFORE GIVING THE SUGAR** **UNRESPNSIVE CLIENTS OR CLIENTS WITH DYSPHAGIA** - 1 mg of glucagon IM int deltoid muscles

Answer 83

both lethal arrhythmias with no cardiac output (pulse) = no brain perfusion = dead = THEY WILL KILL YOU IN 8 MINUTES OR LESS ASYSTOLE = **NO DEFIB** - always confirm electrodes are placed first **do not take electrode off during shower** - continuous high-quality CPR, oxygenation and epinephrine are priority - lacks QRS **defibrillation is not indicated for asystole because it LACKS electrical activity (flat line)** - atropine can be given too but EPI first - **defib is not effective for pulseless electrical activity either** VENTRICULAR FIBRILLATION (v-fib) - defib, shock with CPR in between - **DEFIB PADS, RIGHT UPPER CHEST AND LEFT LATERAL STERNAL BORDER** = for 8 years and older - less than 8 years = place one pad on chest and the other at back 2. **V FIB** = defib and shock with cpr in between what those two have in common, no cardiac output (pulse) = no brain perfusion = dead = THEY WILL KILL YOU IN 8 MINUTES OR LESS - V FIB responds to defibrillation NOT CARDIOVERSION ATROPINE is also given for bradycardia **ICDS CANNOT SENSE OR TREAT PULSELESSNESS SO CPR SHOULD BE INITATED IN PULSELESS CLIENTS WITH ICD**

Answer 84

- xlinked rexcessive disorder due to lack of protein called DYSTROPHIN - **muscle tissued being replaced by connective tissue** = lower extremities weakness **MANIFESTATIONS** - frequent trips and falls at home - places hands on the thighs to push to stand = GOWER SIGN - walks TIPTOES and has disproportional large calve **respiratory and cardiac problems are the leading causes of mortality** DIET - **whole grains, fruits and vegetables to maintain a bowel fuction to reduce risk for conspitation from IMMOBILITY** INTERVENTION - no effective cure = die by 20-30 years from respiratory failure - **avoid floor clutter, throw rugs and prevent falls/injury** - gentle exercise and swimming to avoid disuse atrophy and social isolation - **most might require a wheelchair due to how they can easily fall** **SCLERODERMA** - overproduction of collagen that causes tighthening and hardening of the skin and connective tissue - **MONITOR FOR RENAL CRISIS THAT CAUSES MALIGNANT HYPERTENSION**

Answer 85

created to provide vascular access for hemodialysis with kidney disease **maturing the fistula requires hand performing hand exercises such SQUEEZING A RUBBER BALL** = increases blood flow to the vein - cerebral arteriovenous malformation is a contraindication in thrombolytic therapy PATENCY Ensure patency of AV fistula = BRUITS (hear) or THRILL (feel) = teach patient how to feel them o Auscultate for bruit/thrill = loud swooshing sound o No BP where fistula is o Not to wear bracelets—may restrict blood flow to arm o Do not carry bags—use shopping cart = NO PRESSURE ON ARM WITH FISTULA o Do not sleep on the affected side **ARTERIOVENOUS MALFROMATION** - tangle of veins and arteries - blood pressure control is prioty - avoid anything that can increase bleeding

Answer 86

hyperthyroidism = hypermetabolism therefore **MANIFESTATIONS** - weightloss but avoid high fiber foods cus they increase GI symptoms - increased appetite - high pulse & BP - **Atrial fibrillation** - irritable **insomnia** - heat intolerance - cold tolerance - exophthalmos (bulging eyes) - lightly tape eyes shut if can’t close at night - raise head of bed - GRAVES disease (running yourself into the grave) - **PRIORITY OUT OF ALL THE MANIFESTATION IS AGITATION AND CONFUSION** **TREATMENT** 1. radioactive iodine = patient needs to be by themself for 24 hours (restriction of visitors) **CLIENTS RECEIVING RADIOACTIVE IMPLANTS** - long handled forceps and lead lined container should be present at bed side - in cases of dislogment = use forceps to place the implant in a lead container to contain radiation exposure 2. Propylthiouracil (PTU) = Puts Thyroid Under - CANCER drug = immunosuppression (**monitor WBC**) 3. thyroidectomy (most common way) = total or subtotal thyroidectomy most important thing before answering a thyroidectomy question is if its a total (complete) or subtotal (partial) HYPERPARATHYROID = elevated calcium TREATED BY FUROSEMIDE - avoid THIAZIDE CUS IT CAUSES CALCIUM LEVELS TO INCREASE MORE

Answer 87

- 1st 12 hours: PRIORITY = airway and hemmorhage (**neck edema**, irregular breathe, prevent swelling) **TOTAL THYROIDECTOMY** = 12-48 hours - **T**otal = **T**etany (TT) = **muscular spasms in larynx: can cut off airway) due to LOW calcium** - RISK FOR LOW CALCIUM **SUBTOTAL THYROIDECTOMY** - **S**ubtotal = **S**torm (SS) - DOES NOT REQUIRE LIFELONG HORMONE REPLACEMENT **but now at risk for thyroid storm** - after 48 hours: INFECTION ( NEVER choose infection as a PRIORITY in the first 72 hours for anything!!! ONLY CHOOSE it after the first 72 hours ) MONITOR AND REPORT THYROTOXICOSIS - **chills** - **fevers** INTERVENTION - HOB 30-45 degrees - have trach kit, suction and oxygen by bedside at all times ASSESS FOR - voice strength and quality to monitor for laryngeal damage REPORT IMMEDIATELY - **report noisy breathing = indicates airway obstruction** - **stridor and difficulty breathing should be reported immediately** - SIGNS OF HYPOCALCEMIA = trousseu and cvostek signs OTHER SIDE EFFECTS TO MONITOR - elevated blood pressure - **low oxygen saturation (common in postoperative clients so its not much of a priority)**

Answer 88

**INCOMPLETE** 1. BROWN-SEQUARD SYNDROME - being stabbed. orshot - damage to ONE SIDE ONLY - cover the wound with petroleum gauze taped on three sides 2. CENTRAL CORD SYNDROME - most common form of incomplete SCI characterized by **HYPEREXTENSION AND HYPERFLEXION** - AFFECTS THE UPPER EXTREMITIES than the lower **COMPLETE SPINAL CORD INJURY (PARAPLEGIA)** - also called leg paralysis - total loss of motor function and sensations below the level of injury BOTH SIDES ARE EQUALLY AFFECTED

Answer 89

- also called **phenothiazines** ALL **ENDS IN AZINES + haloperidol** - Chlorprom**azine** - Haloperidol = can be given to pregnant women - Fluphen**azine** they are considered major TRANQUILIZERS *BIG GUNS!!* **out of them all HALDOL IS THE ONLY ONE THAT CAN BE SAFELY GIVEN TO PREGNANT WOMEN** they do not cure psych diseases, they just reduce the symptoms. targets psotive symtpoms but no effect on negative **IN LARGE DOSES** = they are **ANTIpsychotics** **IN SMALL DOSES** = they are **ANTIemetics** aminoglycocides are to antibiotics, like phenothiazines are to tranquilizers* = they’re both the BIG GUNS! = you pull them out when nothing else is gonna work **HALPERIDOL** - the ONLY MAJOR antipsychotic tranqulizer that CAN be given to pregnant women! - safety CONCERNS related to the side effect - **has a “decanoate” form; LONG acting IM** **BENZTROPINE** - anticholinergic used to treat extrapyramidal symptoms - side effects = **dystonia (abnor muscle movem) and parkinson symptoms** - contraindicated in clients with urinary retention and acute glaucoma **SIDE EFFECTS OF HARIPERIDOL** A = anticholinergic (dry mouth) *Nursing dx: risk for injury* B = blurred vision ***Nursing dx: risk for injury*** C = constipation D = drowsiness E = EPS (extrapyramidal symptoms); like Parkinsons = associated with metocloropramine and treated with **benztropine** F = Fotosensitivity (photosentivity) aG = agranulocytosis (LOW white count; immunosuppressed) **Nursing dx: risk for injury** **DECANOATE DRUGS** - IM DRUGS

Answer 90

USED TO TREAT SEVERE SCHIZOPHRENIA **-zapine** **-idone** **CLOZAPINE** - has an advantage by not having side effects A, B, C, D, E or F BUT **HAS THE SIDE EFFECT OF AGRANULOCYTOSIS = low white count = TRASHES BONE MARROW** - However, aG doesn’t always happen with everyone; so some people can take this drug & some people can’t BEFORE STARTING CLOZAPINE - ** obtain a complete blood count and ANC** - ECG cus they prolong QT interval - blood pressure = orthostatic hypotension is a side effect **agranulocytosis poses more significant danger to the client** REPORT sore throat (flu-like symptoms) because it can indicate infection due to neutropenia - Remember: with any of your ATYPICAL ANTIpsychotics, WHITE count is a BIG DEAL **ZIPRASIDONE** - has a **BLACK BOX WARNING** (FATAL drug situation - it prolongs the QT interval & can cause sudden CARDIAC arrest = **do NOT use with heart problem pt’s**

Answer 91

- first drug or choice FLUOXET**INE** (PROZAC) SERTRALINE (zoloft) - cita**lopram** - escita**lopram** - **INCREASES RISK OF SUICIDE ESPECIALLY IN YOUNG ADULTS 18-24** so a client who reports increased in energy without change in depressive feeling needs to be assessed and monitored DO NOT TAKE WITH ST JOHN WORT side effects A = anticholinergic (dry mouth) B = blurred vision C = constipation D = drowsiness E = euphoria - frequent headaches - weight gain - gastro disturbances - **sexual dysfunction** FLUOXETINE (PROZAC) - ** causes insomnia so give it before noon, DONT GIVE AT BED TIME** - **when CHANGING the DOSE in adolescents/young adults; watch for increased suicidal risk! = wont be a risk of dose are kept the same** SERTALINE - monitor for serotonin syndome - diarrhea and fever - causes insomnia just like fluoxetine (prozac) but **you can give this one at bedtime** - interferes with cytochrome p450 system in the liver which is responsible for breaking down and deactivating the drugs in the liver - **sertraline makes it easier for other drugs to reach TOXICITY** ** MOST CONCERNING SIGN IN SUICIDAL CLIENTS: sudden positive outlook. THE NURSE SHOULD ASK ABOUT THE PLAN** **"risk of suicide" is the nursing diagnosis for people who have attempted suicide are at more risk of suicide** **RISK FOR SUICIDE** - significant life stressor such as unemployment, difficulty finding new job - access to devices firearms - history of substance abuse - feelings of hopelessness

Answer 92

ATYPICAL - Venla**faxine** - Desvenla**faxine** - Dulo**xetine** = has pain reliving effects **SEROTONIN SYNDROME** - upper symptoms - diaphoresis - agitation - tachycardia

Answer 93

**IV catheter = large bole = 14 gauge** - BP go down - rates go up - pale, cold and clammy (**in neurogenic shock, skin is warm and dry**) **decreased central venous pressure** normal: 2-8 **MANIFESTATIONS** - dysonea - lightheadnesses - skin rash hives) - wheezing PLACING SpO2 on FOREHEAD rather than finger gives more accurate readings NEUROLOGICAL SHOCK = heart rate decreases - **bradycardia** - skin is warmed and flushed POSITION: trendelenburg position ( supine with head kinda pointed down ) **as shock progresses, kidneys decrease filtration and increase reabsorption to correct BP** INTERVENTION - FLUID RESUSCITATION = IV boluses of isotonic fluid to increases intravascular volume and perfusion DO NOT DELAY IV - **norepinphrine is a vasopressoror to increase stroke volume. titrated to maintain MAP 65 or up**

Answer 94

- lateral recumbent position or sitting upright - needle is inserted L3/4 or L4/5 **AFTER PROCEDURE** - lie flat with NO PILLOW for atleast 4 hours - increase fluid intake - **INCREASE FLUID IF PATIENT COMPLAINS OF HEADACHE** - headache not a priority - headaches happen as a result of CSF fluid leaked - **ask the client to void prior** - DOES **NOT** REQUIRE **NPO** - dextrose testing is used to test for the presence of leaked CSF but make sure there’s no presence of blood cus it can skew results. why? because blood contains glucose

Answer 95

-WARFARIN is given only PO - takes few days to week to work - **CANNOT BE GIVEN TO PREGNANT WOMEN** - can be given rest of your life - antidote = vitamin K (FRESH FROZEN PLASMA can be used for rapid reversal) **eat the same amount of food high in vitamin K (dark, green, leafy vegetables) when taking warfarin** - avoid aspirin **VITAMIN K RICH FOODS** - brocolli - liver spinach OFTEN USED IN CLIENTS WITH - **atrial fibrillation to prevent clot formation and reduce the risk of stroke** - DVT, pulmonary embolism - **mechanical heart valves to prevent clot formation on valves** MECHANICAL HEART VALVE INR = 0.6-1.2 MONITOR - PT(INR) (coumadin = 8 letters; count on hand; 2 fingers left (PT) - **vitamin K intake should be consitent cus too much vitamin k makes warfarin ineffective and too little increases effectiveness placing client at high risk of bleeding** **DONT DELIVER WARFARIN IF INR OVER 4** AVOID - cranberry and grapefruit - green tea

Answer 96

- atonic = sudden LOSS OF MUSCLE MASS **TONIC CLONIC** - stiffening and contraction of the muscle - normal to wake up confused and then back to sleep for few hours **levetiracetam is used to prevent seizures also** PHASES OF SEIZURE - **prodromal phase** = warning signs that precedes the seizure - **aural phase**: period before the seizure when client may experience visual or sensory changes - **ictal phase**: period of the active seizure activity - **postictal** recovering from the seizure, confusion, headache , syncope **KEY CONCERN OF SEIZURES = have suctioning by bed side** SEIZURE PRECAUTIONS -

Answer 97

- NPO/clear liquids (seizures) - private/near nurses station - restricted bed rest - bed pans/urinals - restrained (VEST or 2 point locked leathers) = 1 arm and opposite legs MAKE SURE IV ACCESS HAS BEEN ESTABLIHSED - oxygen at bed side - suctioning available **CAUSES OF DELIRIUM** - medications (opiods, anticholinergic) - electro imbalance (hyponatremia) - hypoxia - acute infection (fever, **positive culture**) - lack of sleep - dehydration or malnutrition - metabolic disorders (hypoglycemia) **SAFETY IS A HIGH PIRORITY IN DELIRUM CLIENTS = close observation and one on one supervsision** **MED TREATMENT** - antihypertensive pills - TRANQUILIZER - MULTIVITAMIN B1 TO PREVENT WERNICKE-KORSAKOFF SYNDROME - THIS IS BEACUSE SINCE THEY ARE GOING THROUGH WITHDRAWAL, EVERYHTING GOES UP AND THE BP PILL WILL KEEP EVERYTHING DOWN **RESTRAINTS CARE** - not as needed = based on behavior - **release one at a time** - 45 degrees and up - **avoid supine or prone** - **never put 4 rails up because it is considered a restraint**

Answer 98

- raccons eyes (periorbital hematomas) - battle sign (postauricular) **CSF leakage is an indication of this and can be evidenced by conjugated blood surrounded by CSF** CSF TESTING - dextrose testing but only when there is no presence of blood because blood contains glucose also CONTRAINDICATIONS - NG tube should not be used when basically skull fracture is suspected - morphine

Answer 99

chest tube installing : have client raise arm above the head when placing a chest tube **GOOD FINDINGS: continuous and gently bubbling** - amount of suctioning is controlled by water in the chamber **NOT** by the wall suctioning. **BAD FINDINGS**: intermittent bubbles which indicates suctioning is not high enough. go to the dial on the wall and turn it up until bubbling is continuous **turning up wall will cause vigorous bubbling but DOES NOT increase suctioning** = **check water level and add sterile water if necessary to prescribed levels** **COLLECTION CHAMBER** - where the drainage from client accumulate - 50-500ml for the first 24 hours is expected - **REPORT drainage of 100 or more an hour** - assess amount and color of the fluid and record as output

Answer 100

**BUCKS(SKIN)** APPROPRIATE ACTIONS - keep supine or HOB in semi fowler (max 30 degress) - **maintain limb in straight neutral position** - lose the velcro straps if the boot is too tight = **can impair neurovascular status** - provide fracture pan to minimize client movement (they can move to the bathroom but better if in bed) - avoid side to side repositioning of the client - **weights should be free hanging at all times and should never be placed on bed or touch floor** **SKELETAL TRACTION** - used to immbobilize - **NEVER REMOVE WEIGHTS = CAN CAUSE INJURY and unless there is a life threaning situation **NURSING INTERVENTIONS** - Temperature - Ropes hang freely - **NO weigh on bed/floor** - Alignment - Check circulation by nurse - Type and location of fracture - Overhead trapeze to lift self up during bed change etc **overhead trapeze for both and perform assessment of affected extremities in tractions** RN CAN DELEGATE THE FOLLOWING TASK TO UAP - assist with passive ROM - notify the nurse of pain, tingling etc - remind client to use incetive spirometer - maintain proper use of pneumatic compression devices

Answer 101

destroy the nerves of the peripheral nerves MANIFESTATIONS contribute - **numbness and tingling** = diabetic neuropathy - **assending paralysis** paresthesia decreased reflexes **MOST COMMON COMPLICATION** = rate and depth of respiration - at risk of paralytic ileus due to immobility or nerve damage ITS IMPORTANT TO ASK ABOUT RECENT **RESPIRATORY AND GASTRO TRAC INFECTIONS** cus GBS usually start few days or weeks after - have INTUBATION TRAY AT BED SIDE

Answer 102

- part of the stomach is removed and shortened leading to client experiencing **DUMPING SYNDROME MANIFESTTIONS** because they demonstrate dumping syndome, apply same interventions for this!! = **LAY DOWN AFTER EATING TO SLOW GASTRIC EMPTYING** MANIFESTATIONS - **sweating** - **tachycardia** - **hypotension** - abdominal pain, N/V. dizziness

Answer 103

gestational trophoblastic disease that results in abnormal fertilization - **rapid growing of trophoblastic tissues** - MONITOR HCG LEVELS!! **TROPHOBLASTIC CELLS MAY CONTAIN GENETIC MATERIAL THAT EXORESSES THE RH FACTOR THEREFOR RHOGAM IS REQUIRED FOR CLIENTS WITH RH NEGATIVE BLOOD TYPES** AFTER EVACUATION OF MOLAR PREGNANCY - hcg hormone will continue. toincrease - **AVOID PREGANNCY** to allow HCP to closely monitor rising hcg levels which may indicate malignant gestational trophoblastic neoplasia

Answer 104

- polyhydramnios (excess amniotic fluid). **OLIGOHYDRAMNIOS IS NOT ASSOCIATED WITH PPH** - dytocia = prolonged and painful labor **UTERINE ATONY = most common** - preeclampsia and ecampsia - placenta previa = painless = cervix covering cervix - twins - multifetal gestation - macrosomia = infant larger than average/birth weigh 8lbs or more - use of meds like mag sulfate **UTERINE ATONY** = soft boggy uterus - after they gave birth and they’re bleeding, ITS MOST LIKELY DUE TO UTERINE ATONY SO MASSAGE THE FUNDUS!! - inability of the uterine muscle to contract** adequately following birth, leading to vaginal bleeding and/or postpartum hemorrhage = meds: misoprostol - **boggy uterus** - soaked perineal pads - **SOFT FUNDUS**= massage the fundus until its FIRM **NORMAL FINDINGS 24 HOURS POSTPARTUM** - elevated temperature (fever) - elevated WBC (leukocyte) **OPERATIVE VAGINAL BIRTH USING VACCUM EXTRACTOR OR FORCEPS** - never apply fundal pressure = can lead to uterine rupture

Answer 105

- swelling in the arteries througout the body - - **PRIORITY OF TREATMENT AND PRIMARY GOAL IS TO PREVENT HEART DISEASE** **PRIORITY MANIFESTATION** - MONITOR FOR GALLOP AND HEART SOUNDS AND DECREASED URINE OUTPUT **MANIFESTATIONS** - **acute febrile HIGH FEVER** - **administer ASPIRIN or immunoglobin to prevent coronary artery aneurysms** - soft food and clear liquids - irritability is expected and can last up to 12 months - **temp joint pain and other arthritis are expected = ROM exercises and warm baths will help reduce symptoms and minimize discomfort** - skin peeling - lymphadenopathy/ sleep enlargement - **obtain 12 lead electrocardiogram** - this ASPIRIN can lead to reye syndrome **IV IMMUNOGLOBULIN** - since they are receiving a lot of fluid can lead to fluid overload, heart failure, decreased urine cus the fluid is being retended ONCE DISCHARGED - check temp every 6 hours for the first 48 hours - strawberry tongue - bright, red swollen lips - blood shot eyes - red palms and soles of feet

Answer 106

- occurs more often during stressful situations or on waking so sleep should not be interrupted **Place the infant in the knees to chest position** = improves pulm blood flow FOR TOF, REPORT INCREASED RBC **THE CHILD SHOULD BE FIRST PLACED IN KNEE CHEST POSITION** = flexion of the legs relief dyspnea and improve oxygenation **HOW TO REDUSE HYPERCYANOITC SPELLS** - encourage smaller, frequent feedings - offer a pacifier when the infant begins. to cry - promote calm environemnt - swaddle infant during procedures **MEDICATION: MAGNESIUM SULFATE** and **MORPHINE** OTHER INTERVENTION - Administer 100% oxygen - Administer morphine sulfate - Administer an IV fluid bolus - Document the event have oxygen available during infant vax. vaccinations make them cry and crying uses alot of their energy tracheoesophageal fistula = cyanosis **when giving oral medication to kids** - have them in semi reclining position - use oral syringe - direct liquid towards the back and inside of the infants cheek

Answer 107

**some diabetic patients may not feel the ache of a blister or the sting of a cut on their feet due to DECREASED PERFUSION** - wash feet everyday in WARM water - **don't put feet in hot water, don't use heating pads or hot water bottles** - don't try to remove corns, calluses - don't wear tight, elastic, thick bulky socks - **use mild foot powder on perspiring (sweating) feet** - we want to keep the feet clean, dry and free from irrtation - dont walk barefoot - creams or lotion can be applied on the tops and bottoms of feet to keep them from crackling. - **dont cut nails laterally** LOTIONS SHOULD NOT BE APPLIED BETWEEN TOES = between the toes should be kept dry

Answer 108

viral illness caused by **parvovirus** that mainly affects school aged children MANIFESTATIONS - rash on cheek = slapped face - **only communicable prior to onset of symptoms** - spreads via respi secretions - **general malaise and joint pain = well controlled by NSAIDS** - recover in like 7-10 days

Answer 109

- left sided pneumonia should be placed on their OPPOSITE SIDE (right) - good lung down to increase blood flow to the lung most capable of oxygenating blood = blood flow in the lungs are partially influenced by gravity **RISK FACTORS** - advanced age (over 65) - young age (less than 2) - CNS depression - decreased level of conciousness MANIFESTATIONS - fever - chills - fatigue - **crackles** - sputum production - hemoptysis = usually sig amount that is not concerning - lung abscess - bronchiectasis **small amounts of blood tinged sputum are normal after brochoscopy, frank bleedings or clots be reported** INTERVENTION - obtain sputum for gram stain and culture testing because administering med before can skew results - **MED LEVOFLOXACIN** COMPLICATIONS - pleurisy (pleural friction rub) = caused by inflammed parietal and visceral pleurae rubbing together **REPORT = pleural friction rub (pleurisy)** - stabbing pleuristic chest pain that increases on INSPIRATION DISCHARGE TEACHING - avoid the use of oTC cough suppressant - schedlue follow up with HCP and chest xray - keep cool mist humidifer in your bedroom at night = keeps membranes mosit - continue incentive spirometer - infleunza and pneumonia vaccinations

Answer 110

**GOOD FETAL MONITORING PATTERNS** - high fetal heart rate of 110-160 (**if above 160 for 10 or more minutes = fetal tachycardia = concerning findings**) - High baseline variability = when babies heart is always changing - Early deceleration = when heart slows before or at end of contraction **BAD FETAL MONITORING PATTERNS** - Low fetal heart rate (**less than 110**) - Low baseline variability = babies heart stays the same and does not change - Late deceleration = babies heart slows down near end or after contraction = fetal oxygen is compromised = c section - Variable (VERY BAD) deceleration **INTERVENTIONS FOR BAD FETAL MONITORING** - LION but stop oxytocin first if its running - Left side - IV (increase IV) - O2 - Notify doctor amniofusion = used to correct fetal heart rate **VEAL CHOP** - Variable = Cord compression due to loss of amniotic fluid (oligohydramnios) - **Early deceleration** = Head compression - Acceleration (high fetal heart rate = Okay - Late deceleration = Placental Insufficiency - KNEE CHEST FIRST!! then amniofusion is indicated to give room for cord to float **ALWAYS CHECK FETAL HEART RATE = WHEN IN DOUBT, PICK THIS AS THE ANSWER!**

Answer 111

**BNP (brain natriuretic peptide)** = BEST INDICATOR for Congested Heart Failure** - left ventricular presence/severity of heart failure **BNP LAB** - should be under 100 HEART AND NOT HIGH PRIORITY??? = cus it indicated chronic condition and not an acute (acute beats chronic) - should not call the doctor middle of the night just watch them for CHF **LEFT SIDED HEART FAILURE** = congested heart failure/ systolic heart failure - **s3 gallop** = NORMAL IN CHILDREN - any symptom lungs related - inability of the left ventricles to pump blood leading to pulmonary congestion (CRACKLES) - fluid backs up into the lungs making it difficulty to breathe = **patient will cough as a result of that** **RIGHT SIDED HEART FAILURE** = diastolic heart failure - everything is being retained leading to swelling - **elevated central venous pressure can indicate fluid overload** = 2-8 is normal - **s4 gallop is heard** - jugular vein distention - peripheral edema - **oliguria** - weight gain

Answer 112

**LAB = CPK-MB** **VARIANT ANGINA** - occurs at the same time everyday USUALLY AT REST including sleeping **UNSTABLE ANGINA** : myocardial infarction (MI) = shortness of breath and muscle weakness - avoid isometric exercises such as weight lifting because it can increase the workload on the heart **CHRONIC STABLE ANGINA** - DONT EXERCISE ON A FULL STOMACH - preferably, 2 hours after eating** - aerobic exercises such as walking, swimming or cycling are GOOD **STABLE ANGINA** - relieved by rest = RELIEVED BY NITROGLYCERIN TABLETS **NITROGLYCERIN TABLET INSTRUCTIONS** - lie down before taking tablet cus it can cause dizziness from possible orthostatic hypotension - MONITOR FOR HYPOTENSION = **dizziness and lightheadness** = PRIORITY! **PRIORITY ALWAYS MEAN SAFETY** - CAN WEAR NITROGLYCERIN PATCH IN SHOWER - **keep tablests in original container and store way from light and heat sources including body heat and cars** - 1 tablet or spray taken sublingually EVERY 5 MINUTES for a maximum of 3 doses - relieves pain in about 3 minutes and lasts 30-40 minutes **side effect of headaches are expected form the vasodilation and can be treated with acetaminophen** - **if symptoms are unchanged or worse 5 minutes after first dose, call emergency** - they should be made assessible at all time **CONTRAINIDCATIONS OF NITROGLYCERIN** **AVOID: use of erectile dysfunction drugs (ends in -AFIL) when taking nitroglycerin tablets = can lead to severe hypotension** - dont give if blood pressure is already low

Answer 113

**STEMI** - goal is to reduce cardiac workload and improve myocardial oxygenation to prevent mycocardial necrosis - **should undergo an immediate angiography with PCI = IF IMMEDIATE PCI IS NOT AVAILABLE = administer fibronylitics ( ends in PLASE )** - they should NOT have chest pain after PCI **NSTEMI** - perform an angiography with 28-48 hours MONAB Morphine Oxygen Nitroglycerin Aspirin Beta blockers = fatigue is a side effect **ventricular bigeminy following a myocardial infarction is a PRIORITY** = can lead to v fib **CLIENT CAN RESUME SEXUAL ACTIVITITIES AFTER THEY ARE ABLE TO CLIMB 2 FLIGHT OF STAIRS OR WALK 1 BLOCK WITH NO SYMPTOMS**

Answer 114

antidepressants DRUGS (**-ine**) - Tranylcypromine (PARnate) - Isocarboxazid (MARplan) - Phenelzine (NARdil) - Selegiline - **interacts with many drugs such as antidepressants so should be prevented 2 weeks of eachother to prevent adverse reactions** - **AVOID TYRAMINES** - to PREVENT severe acute, sometimes fatal HYPERtensive crisis: - they are allowed all fruits and veggies **except NO, BAR (bananas,avocados,raisins (any dried fruits)** - Grains are fine; cookies, bread, pies :) - NO ORGAN meats; liver, kidney, tripe (sheep’s stomach), etc. - NO PRESERVED meats smoked, dried, cured, pickled* - NO hot dogs or certain processed lunch meats; they contain “other assorted parts” **DAIRY: NO cheeses except cottage cheese & mozzarella** - NO ALCOHOL or CHOCOLATE (caffeine), NO YOGHURT **FOODS TO AVOID** - yogurt - no cheese except cottage and mozzarella - broad beans - beer - red wine - choclate - avocado **Teach the pt’s NOT to take over-the-counter meds when they are on a MAOI** - give in morning with food, ensure adequate fluid **SIDE EFFECTS OF MAOI** A = anticholinergic (dry mouth (XEROSTOMIA) B = blurred vision C = constipation D = drowsiness

Answer 115

**-DAPINE + cardizem (can be IV continuos) and verapimil** = VASODILATORS **CCB** TREATS EVERYTHING WITH "ATRIAL" IN IT NOT VENTRICULAR EXCEPT SUPRAVENTRICULAR TACHYCARDIA AAAS **sure systolic has to be atleast 100 or up** - antihypertension = relaxes your heart so it relaxes blood vessels as well - anti-angina = relaxes your heart by decreasing oxygen demand - anti-atrial-aarhythmia (NOT VENTRICULAR) - Supraventricular Tachycardia SVT IS HEART RATE OF 200-300 **SUPRAVENTRICULAR TACHYCARDIA = TERMINATED WITH ADENOSIDE** but first have them bear down if having a bowel movement/ throw ice bucket on them to slow down HR - give adenosid eover 1-2 seconds followed by 20 ml bolus - ADENOSIDE HAS A SHORT HALF LIFE - SVT is Skinny = NARROW QRS - suPravebtricular = some sort of P waves **DURING SVT ATTACK (200-300/min** - place ice bag on clients face and instruct client to hold their breathe while bearing down - stimulating a vagal response like coughin is appropriate intervention for SVT - DONT USE VALSVA MANEUVER ON ELDERLY ****radiofrequency catheter ablation is indicated for clients with recurrent episodes of SVT** SIDE EFFECTS - **headaches** = vasodilates the brain - **hypotension** = relaxes cardiac and heart vessels **because they cause vasodilation, client may develop peripheral edema = advised to elevate legs when lying down and use stockings** - REPORT MOOD CHANGES!! CONTRAINDICATION - **avoid grapefruit = SEVERE HYPOTENSION** - systolic pressure less than 100 ** negative inotropic, negative chronotropic, negative dromotropic** = CARDIAC DEPRESSANT - its like valium to your heart meaning THEY CALM AND RELAX. CARDIAC DEPRESSANT **positive inotropic, postive chronotropic, positive dromotropic** = THEY STIMULATE THE HEART AND MAKE EVERYTHING GO UP

Answer 116

- characterized by affected blood flow to the **LOWER EXTREMITIES** = fail pinprick test - hairlessness on lower extremities due to no blood flow down - **ULCER AT GREAT TOE** - worsened pain when elevating legs - **avoid heating pad** - pain extremities when walking ( can be relieved by rest = CLAUDICATION ) = expected of PAD so not a priority **can cause tissue necrosis** - keep legs below heart levels - **at risk of developing other vascular disease such as AORTIC ANEURYSM dissection or rupture** - decreased peripheral pulses **DANGLE LEGS WHEN PAIN OCCURS** **CAUSES** - smoking - hypertension - diabetes insipidus - hyperlipidemia MANAGEMENT - lower the extremities when sitting - engage in moderate exercise to promote circulation and distal tissue perfusion - **take prescribed vasodilators and antiplatelets** - skin care, applying lotion to prevent skin breakdown **CONTRAINDICATIONS/AVOID** - elevating legs cus we want blood to come down - **heating pad** = they have decreased sensation on the ectremities and can lead to brun - compression/stocking/ted socks - tight clothings

Answer 117

leg veins don't allow blood to flow back up to your heart = risk of developing pulmonary embolism - **ULCER WOUND USUALLY AT THE ANKLE** = PAD is ulcer at the toe - hyperpigmentation of the legs due to stagnant blood - **warm compresses help reduces edema and are safe with DVT** - **early ambulation such as walking** - portruding veins in the legs - edema in legs = elevate legs - pedal pulses are present - focus on wound care **+1 is normal in pregancy** **MASSAGING IS CONTRAINDICATED = can cause the clot to become disloged and result in life threatening PE** EPHEDRINE are contraindicated

Answer 118

- antianxiety meds considered minor TRANQUILIZERS - have a "ZEP" in name, ALPRAZOLAM INDICATIONS other uses of benzos - **pre op to induce anesthesia** - **muscle relaxant** - alcohol withdrawal (delirium tremors) - seizures ( suctioning ) **clients with seizures should always be assessed first due to high risk of injury, aspiration and airway obstruction** -a patient that fights a ventilator (relaxes them) - they work quickly, but YOU MUST NOT take them longer than 2-4 weeks. **preferred time to take is at night** ANTIDOTE: **flumanezil** CONTRAINDICATED - hepatic encelopathy = **MUSCLE RELAXANTS ARE METABOLIZED BY THE LIVER** - COPD patients

Answer 119

MONITOR - defibrillation = attach on cardiac monitor (PRIORITY) **hypothermia is a medical emergency** = 95F (35C) AVOID - frequent turning = could lead to v fib MANAGEMENT = focus on airway - one of the first goals is to warm the client = warmed fluids, blankets - sometimes they get so cold pulse cannot be detected this is why they say a client is not dead until warm and dead = they might just require prolonged resuscitation - **hypothermia which may lead to organ failure = prone to dysrhytmias so attach to a cardiac monitor** - most client develop acute respiratory distress syndrome - blood transfusion is not indicated unless trauma had occured during the near drowning incident

Answer 120

WEIGHT MONITORING - measure and record daily weights in same clothing before breakfast **BUT after voiding** **DIETS TO AVOID** - cold cuts - canned foods - broth and stocks - LIMIT FLUID INTAKE TO 2L MEDICATION REGIMEN - **examine OTC drugs such as laxative, antacid and other drugs containing sodium** - take own pulse for 1 minute if taking digoxin or beta blocker - know symptoms of orthostatic hypotension ACTIVITY - increase walking or other activities gradually - plan for rest periods - consider cardiac rehab - **avoid extremes of heat and cold** REPORT - weight gain of 3lb in 2 days or 3-5 lbs in a week - frequent dry, hacking cough especially when laying down - swelling of ankles, feet,abdomen or face

Answer 121

amiodarone = CAUSES LUNGS LIVER AND THYROID ISSUES - A FIB HAS IRREGULAR PULSE

Answer 122

venous duplex ultrasonography - noninvasive that assess the flow of blood through veins of the arms and legs

Answer 123

**VITAMIN FOR CHOLESTEROL: B3 NIACIN** - HDL (good cholesterol): <50 - LDL: <100 - triglycerides: <150 **fish oil is good for triglyceride** total is 200 METABOLIC SYNDROME (WBTHG) = presence of 3 or more of the listed below - We Better Think High Glucose - **W**aist cirumference - **B**lood pressure - **T**riglyceride, **H**DL - **G**lucose (>100) D dimer = fibring lingaments **myoglobin is released into the circulation within 2 hours after MI** **BMI** 18.5 to 25 less is underweight 25-30 is overweight obesity is from 30

Answer 124

atrial fibrillation or atrial flutter cardioversion delivers a timed electrical current to reset the heart’s electrical activity - **prior to delivery of electrical shock (cardioversion, defibrillation), OXYGEN SHOULD BE TURNED OFF AND MOVE AWAY** oxygen is flammable

Answer 125

ABCD - Ace inhibitors ( has "PRIL" in name) = **monitor for angioedema (affects areas of the face,lips, tongue)** = mostly occurs in african americans - Beta-blockers ( lol monitor for hypotension) - Calcium channel blockers ( -DAPINE, verapimil, diltiazem ) = **avoid GRAPEFRUIT = severe hypo** - Dieuretics ( hydrochlorothiazide furosemide ) **HYPERTENSION DRUGS SAFE FOR PREGGOS** - Hypertensive Mothers Love Nifideipne - hydralazine - methyldopa - labetalol - nifedipine FUROSEMIDE SHOULD BE GIVEN SLOWLY TO PREVENT OTOTOXICITY **WHEN TAKING CLONIDINE = ADVISE CLIENT NOT TO STOP TAKING ABRUPTLY** = rebound hypertension - **nitroprusside** can also be indicated for hypertensive situations and hypertension in heart failure **CLIENTS WITH HYPERTENSION SHOULD AVOID** - OTC meds including antacid, appetite suppresant, cold and sinus meds = THEY CAN INCREASE BLOOD PRESSURE. HERBAL - hawthron **RISK FACTORS OF HYPERTENSION** - diabetes 1&2 - african american - increasing age CLONIDINE PATCH - upper outer arm or chest once every 7 days - rotate sites - never stop using patch abruptly = rebound hypertension

Answer 126

heart rate multiplied by strove volume CO = HR x SV

Answer 127

it might be acute myocardial infarction (heart attack, CK-MB) so implement the following - obtain electrocardiogram (ecg) - establish IV access - administer nitroglycerin **holter monitor** = used to record ecg for 24-48 hours - keep a diary of activities and any symptoms - DO NOT BATHE R SHOWER during test period - enegage in normal activities

Answer 128

deCorticate = damage to the midbrain - flexing of the arms - arms shaped like a C moving towards the spinal Cord decerebrate = damage to deep brain structures (pons) - extension, example toes pointing straight down, arms and legs straight out, head/neck arched back - INDICATES WORSE, MORE EXTENSIVE DAMAGE DECEREBRATE = ICP

Answer 129

condition of the large intestine (colon) that causes difficulty passing stool MANIFESTATIONS - constipation (they fail to pass meconium so its normal finding) - feeding intolererance - vomiting green bile = indicates bowel obstruction - poor feeding - **ribbon like stools** - abdominal distention does not respond to medications REPORT = enterocolitis - fever - lethargy - explosive, foul smelling diarrhea and rapidly worsening abdominal distension **COLECTOMY/PULL-THROUGH PROCEDURE where the surgeon get rid of that part of the colon and connect the rest of the colon to the anus meconium = should be passed within 24 hours of birth

Answer 130

TONSILITIS = group A strep REPORT - TRISMUS = inability to open mouth due to tonic contraction of the muscles = inidcates serious complication of tonisilitis - deviated uvula EXPECTED MANIFESTATIONS FEW DAYS AFTER SURGERY - severe throat pain - **white scabs will form at surgical site** - a low grade fever - ear pain is expected after adenotonsillectomy due to iritation of the 9th cranial never - fluid filled exudates in the throat with halistosis (foul smelling breath) - ear pain = given acetaminophen MONITOR AND REPORT - FREQUENT SWALLOWING INDICATES HEMORRHAGE AND SHOULD BE REPORTED - **hemorrage may occur up to 14 days after surgery so avoid strenous activity or contact sport** - potential for bleeding is even higher 7-10 days after post op while sloughing is occuring - vomiting bring red blood AVOID NO HOT, ACIDIC OR SPICY FOODS FOODS TO GIVE AFTER - soft foods! - ice chips and applesauce are good - **COOL ICE CHIPS CAN HELP EASE THE THROAT PAIN** - AVOID THE USE OF STRAWS and other pointed objects in mouth - toddlers can be given magic blankets for pain cus they they are mystical thinkers - suction equipment should be available but only for EMERGENCY airway obstruction **RHEUMATIC FEVER** = streptococcal infection - temperature alone is not sufficient because because fever is a symptoms of many illnesses not just RF **treated with group A streptococcal**

Answer 131

**family members may be allowed in the to sit or stand in the area but a staff member should be assigned to stay with them and explain whats going on** - first check level of consciousness - check for pulse for **no longer than 10 second** at the carotid artery - begin chest compression (2inc/5cm deep) - **after 30 high quality compressions, open the airway with the head tilt** - delivery 2 rescue breathes followed by activating rhe emergency response and obtaining automated external defibrillator **if no shock is advised, the nurse should resume chest compressions immediately** **100-120 per minute** - center breast bone (lower half of the sternum **in babies less than 1, BRACHIAL PULSE is the most accessible pulse not carotid** bc it might not be palpable due to fatty issue around infants neck and shorter necks - **NECK SLIGHTLY EXTENDED = SNIFFING POSITION** - ROLL TOWEL OR BLANKET UNDER NEWBORN SHOULDER - single person performing infant CPR should use 30:2 and 15:2 when two rescuers are involved - **RADIAL PULSE** IS USED IN **RESPONSIVE CLIENT** over 1 year

Answer 132

severe adverse reaction caused by certain drugs used for surgery = **IT IS INHERITED** - triggering agents leads to **excessive calcium released into the muscles** **TREATMENT: IV dantrolene** EXPECTED FINDINGS RIGHT AFTER GEN ANESTHE SURGERY - pinpoint - difficult to arrouse - hypo and hyperthermia - muscle rigidity MANIFESTATIONS - hypercapnia (earliest sign) - generalized muscle rigidity (jaw, trunks, extremities) - hyperthermia (later sign to confirm suspision of malignant hyperthermia) **REPORT muscles stiffness/rigidity with elevated temperature** MED: dantrolene = relaxes muscles

Answer 133

MONITOR - URINE SPECIMEN FOR **PROTEINURIA** - **report BUN and creatinine elevation** - KIDNEY FUCNTIONING **LABS** - postive antinuclear antibody (expected) - low WBC and plateless, and anemia - anemia and leukopenia, thrombocytopenia (nurse would report these too but not a priority over abnormal kidney values **MANIFESTATIONS** - butterfly rash (2 wings representing kidneys) - issues with photosensitivity - joint stiffness - **recurrent oral ulcers** - can lead to end stahe kidney disease - **use the LOWEST POSSIBLE DOSES of antiinflammatory drugs** = cus they may cause creatinine elevation - skin biopsy test may be ordered **INTERVENTION** - avoid stressful physical and emotional stress - avoid sun exposure and UV light when posible - **notify hcp when you have fever** - hydrochloroquine can be prescribed to reduce SLE exacerbation but can take several months - monitor for renal and visual disturbances whiles taking chloroquine

Answer 134

**INTERVENTION** - when they are being disruptive, offer deep breathing exercises to help them slow down and relax = blowing a ballon - **isolating them is punitive and not therapeutic but instead, remove them from source of anger** MANIFESTATIONS - inattention = easily distracted - distractibility - hyperactivity can lead to impaired social skills and peer rejecetion = LOW SELF ESTEEM INTERVENTION - should be weighed regularly at home or school - blood pressure and cardiac function - sugars does not reduce childs symptoms - **MED = METHYLPHENIDATE** = CAN CAUSE GROWTH DELAYS - drug is a stimulant - take 30-45 minutes before meals - **MONITOR loss of appetite, weigh loss, increased blood pressure, tachycardia** = upper symptoms cus drug is a stimulant - take med before meals - drug is a stimulant and can interfere with sleep so dont take it after 6pm to prevent sleep disruption **GROWTH HORMONE** - daily injection under the childs skin - not lifetime = therapy is stopped when bone growth begins to cease or when the child, parents and provider make the decision THEY CAN DEVELOP PARANOIA IF THEY TAKE HIGH DOSES OF MED OR MEDICATION MISUSE

Answer 135

when antibodies are formed through previous exposure to an allergen. (**elevated eosinophils are seen in allergy** - wear a medical alert bracelet - anaphylaxis causes increased capillary permeability, leaking intravascular fluid into free spaces - **RISK OF HYPOTENTION = GIVE ISOTONIC FLUID (0.9 SODIUM) **fever is not an expected symptom of anaphylactic reaction** MANAGEMENT OF ANAPHYLACTIC SHOCK WHILES ON IV MEDICATION 1. stop the infusion and call for healp 2. ensure patent airway and administer oxygen 3. given epinephrine intramuscular 4. administer adjunctive therapies (bronchidilators, corticosteroids, antihistamines) **FIRST LINE DRUG: parenteral epinephrine** **EPIPINE** - always be available and DO NOT DELAY - can be given through clothes - **GIVE AT MID OUTER THIGH and hold position for 10 seconds to allow the entire contents to be injected** - still go to the emergency after you give epi to monitor for further complications - **REPEAT DOSES WITH 5-15 MINS ALLOWED IF THERE IS NO IMPROVEMENT FROM THE INTIAL DOSE**

Answer 136

**FINDINDS** - the presence of extra inguinal or thigh folds - laxity of the hip joint on the affected side (barlow and ortolani maneuvers) - affected leg may be shorter than the opposite leg but this is also apparent after age 3 months **Barlow maneuver** - **ADD**uction with posterior pressure on the hip **ortolani maneuver** - **ABD**uction with anterior lifting of the hip TREATMENT: pavlik harness (prevents them from extending legs, kinda put them in a frog position) , proper swaddling **PAVLIK HARNESS INSTRUCTIONS** - should be left on during care activites including diaper change = could be removed for a short bath once a day - dress child in a shirt and knee socks under the straps to protect the skin = same for boston brace for scoliosis - lightly massage the skin under the straps daily = promotes circulation - **place diaper under the straps** - regulary assess skin for redness and breakdown but avoid lotion and powders to prevent irritation and excess mositure **goal is to keep hips flexed/bent up abducted and opened as possible and to promot immobilization of the hip = like a frog legs** **CONTRAINDICATIONS** - ROM contraindicated - DONT SWADDLE THEM WITH HIPS EXTENDED AND ADDUCTED avoid any positioning device, seat or carrier that causes hip extension and knees straight togehter

Answer 137

- degeneration of dopamine-producing neurons - damage to dopamin neurons makes it difficult to control muscles **INTERVENTION** - identify times where clients has more energy to provide teachings - **dont exclude ppl with cognitive impairement from plan of care** MANIFESTATIONS - mask like facial expression - bradykinesia (delay in initation of movement) - increased muscle tone (**RIGIDITY** - **typical parksinson tremors occurs at resting** - shuffling gait MEDICATION: **carbidopa-levodopa** = orthostatic hypotension is an adverse effect = tell them to rise slowly CARBIDOPA-LEVODOPA TEACHINGS - intedneded effect = imporovement in spontaneous activity - it decreses tremors but does not elimintae them - **red, brown, black secretions and discolorations are normal** - fall precautions = change positions slowly - takes several weeks to reach maximum benefit - **dyskinesia (facial/eye lid twitching, tongue protrusion, facial grimacing) may indicate overdose or toxicity** **ORTHOSTATIC HYPOTENSION** - whiles measuring, if any position produces decreases systolic by >/20 , decrease diastolic >/10 or more, **disconitnue assessment, place client in recumbent postion and noticy HCP** - aslo discontinue further position change if pulse increases by 20 in any new position

Answer 138

HEPATITIS A = fecal oral route - undercooked food - FECAL ORAL ROUTE (rotavirus) - contaminated water sign and symptoms - pruritus - abdominal pain - scleral icterus HEPATITIS B = body fluids - blood - semen - vaginal secretions - **can still breastfeed newborn as long as nipple is intact** **HEPATITIS RISK FACTORS** - alcohol - OTC meds - herbal and dietary **HEPATITIS C** - may be asymptomatic - drug abuse especially IV - anything needle associated tattos etc - sexual transmission is RELATIVELY LOW **TREATMENT: no vaccine, antirivals (ribavirin)** OTHER CAUSES Sexual behavior—high risk sexual behavior * Drug abuse, especially IV * Occupation exposure * Dialysis * Peritoneal exposure—dialysis * One peritoneal (peritoneum) and one via blood (hemodialysis)—dialysis * Blood transfusions before 1992 reduction of IV drug use decreases risk of HEPATITIS C

Answer 139

HOW TO CONFIRM DIAGNOSIS - collect early morning sputum sterile specime on 3 consecutive days for an acid-fast bacili (AFB) - **RINSE MOUTH WITH WATER BEFORE OBTAINING SPUTUM SAMPLE** = reduce bacteria in the mouth and prevent specimen contamination by oral flora **report if client is taking prednisone** = it converts latent TB to active disease MANIFESTATIONS - chest pain - **hemoptysis** - low grade fever - **NIGHT SWEATS** - fatigue TREATMENT (4 drug regimen) = **RIPE** **RIFAPENTINE = REDUCES EFFICIACY OF ORAL CONTRACEPTIVES** = **R**ed secretions - pyrazinamide **ISONAZID = interferes with the action of vitamin B6 resulting in peripheral neuropathy** - ethambutol = have eyes checked - **RIFAMPIN** - wear eye glasses instead of contact - red discolration such as urine is expected ISONAZID = monitor liver = **TAKE PYRIODOXINE(VIT B6)** - **only antitubercular drug that does not cause red-orange discoloration of bodily fluids** - **take pyriodoxine(vitamin b6) to prevent neuropathy** - avoid alumninium contaning antacids within 1 hour of taking isoniazid EXPECTED SIDE EFFECTS FROM MEDS - yellow skin = hepatotoxicity - dark colored urine - **hepatotoxicty is not common with ethambutol but clients taking ethambutol must have baseline and periodic eye exam** - amniglycoside antibitoic may be used for drug resistant TB - hepatoxicity may occur from treatments (jaundice,fatigue,weakness, nasuea and **anorexia**) client taking oral contraceptive will need a non hormonal birth control like iud to prevent pregancy during treatment

Answer 140

- drugs ends with STATIN **TAKE AT NIGHT OR DURING FASTING STATE** EXPECTED SIDE EFFECTS - insomnia - abdominal discomfort - morning headache REPORT TO HCP - **muscle aches or weaknesses** = could be an early sign of rhabdomyolysis - cause hepatotoxicity **monitor liver function tests prior to the start of therapy** CONTRAINDICATIONS **AVOID GRAPEFRUIT WHILES TAKING THIS DRUG = MYOPATHY** **rhabdomyolysis = breakdown of muscle tissue that leads to the release of muscle fiber contents into the blood**

Answer 141

- goal is to increase clients CD4&8 cells and to DECREASE VIRAL LOAD **CANNOT BE TRANSMITTED THROUGH** - sweat - urine - saliva PREGNANCY - it reduces the risk of transmitting the disease to the fetus - breastfeeding is contraindicated -**infants born to HIV positive parents should receive antiretroviral therapy for atleast 4-6 weeks after birth** HIV = multiple drug regimen **OPPORTUNISTIC INFECTIONS** - kaposis sarcoma - tuberculosis - toxoplasmosis they take hold once the host immunity declines significantly (immunocompromised) THESE SYMOTOMS ARE ASSOCIATED WITH HIV!!!

Answer 142

- HIV - Hepatitis A - Syphylis = treated with IM penicillin for primary, secondary etc - chlaymydia - gonorreha - ifluenza - rabies - pulm tuberculosis - chicken pox

Answer 143

**TIA** - Transient Ischemic Attack - Ischemic stroke - Acute coronary syndrome **elevated BP in the presence of acute ischemic stroke is an expected findings and may be a protective measure to maintain tissue perfusion** TIA MANIFESTATIONS - expressive aphasia = inability to express spoken words **occurs in the frontal and temporal lobe**

Answer 144

- DO NOT APPLY TOURNIQUETS **why** = impedes arterial blood flow and we don’t want want the poison being concentrated at one spot = it will rapidly destroy cells in that area so allow it to spread to be diluted - DO NOT APPLY ICE PACK - **immobilize the affected extremities to decrease absorption of the venom** - estbalish IV access - collect lab values such as ptt, pt/inr, platelets and CPK

Answer 145

MONITOR - **neurological and cardiac** = HALLMARKS - **artrioventricular heart block** MANIFESTATIONS - neuropathy - red rash - fatigue - bulls eyes - lymphadenopathy - bulls eye rash - **flu like symptoms (headache, malaise, sore throat)** = REPORT - arthritis - myalgias and joint issues **MEDICATION: doxycycline** INTERVENTION - tick should be removed carefully with a tweeezer - dont cover ticks on the skin with a petroleum jell or nail polish

Answer 146

- breathing in bacterial spores - **ingestion of RAW/CONTAMINATED ANIMAL PRODUCTS** - through open wound or scratch on the skin **ANTIDOTE OF ANTHRAX: Ciprofloxacin** IT IS NOT SPREAD PERSON TO PERSON **RADIATION CONTAMINATION (CHEMO)** - oral mucusa ulcerations - gastro (vomiting/nausea) - bone marrow (RBC WBC ETC) -

Answer 147

- also known as genital herpes - lesions are vesicular and painful MED: **acyclovir = shorten duration and severity of active lesions** MANAGEMENT - warm water with mild soap - when applying topical medications to herpes lesions = use gloves to prevent spreadin - keep the lesions clean and dry = hair dryer on a cool setting - **sitz bath and oatmeal baths to provide comfort and relief of itching and burning** - avoid sexual activity when lesions are present. **barrier contraception like condoms are not sufficient during an outbreak** - continue to use condom in the absence of active lesions = transmission is still possible in future sexual encounters

Answer 148

- epistaxis is nose bleed - sit them upright whiles leaning forward and pinching the nose togehter - humidifier or nasal spray to keep the nose moist redcues risk of nosebleeds - client should also be asked about aspirin, bleeding disorders, nasal surgeries/injuries an anticoagu use **in peds, PRIORITY is to keep them calm and quiet = crying can exacerbate the bleed**

Answer 149

- nulliparity (never being preggo) - early menarche - late menopause - family history - overweight or obesity - white women are more likely to develop breast cancer but BLACK PEOPLE ARE MORE LIKELY TO DIE BRCA 1&2 POST MENOPAUSE - consider dietician - **spotting or bleeding after menopause is most common symptoms of endometrial cancer** - cholesterol monitoring - weight bearing exercise regimen - green, leafy veggies and dairy products - support group to cope with any emotional symptoms iron tends to increase with agin so avoid iron pills in old age

Answer 150

WAYS TO PREVENT NAUSEA - serve small meals - provide meals best eaten at room temperature - **BRUSH TEETH IN AFTERNOON rather than in the morning** - when they begin experiencing nausea and vomiting, MOST IMPORTANT THING TO DO = **evaluate the onset, frequency and severity of the nauseas and vomiting** REPORT - low grade fevers in these patients

Answer 151

- HIV - family history - cryptorchidism (undescended testicles) = normal in newborns TESTTICULAR TORSION = priority and can result in testicular ischemia from inadequate blood supply

Answer 152

- packed rbc when needed - offering stool softners to avoid constipation - preventing the use of harb objects and basiclly anything that can cause bleeding - mouth sponge is preferred over toothbrush ALL OF THESE ARE MEASURES TO BE TAKEN FOR PATIENTS WITH CLOTTING DISORDERS if injected, apply pressure on the site for like 30 mins to prevent further bleeding cus these ppl have clotting disorders

Answer 153

- lower back pain - decreased ROM - reduced tendon reflexes - URINARY RETENTION due to inability to contract the bladder NORMAL RESIDUAL VOLUME: 50-100 **residual urine volume of 100 mL or more on a bladder scan may indicate urinary retention**

Answer 154

invasion by a tumor OBSTRUCTS **VENOUS CIRCULATION** or **DRAINAGE OF HEAD,NECK,ARMS AND THORAX** - trouble breathing - puffy neck/face - nasal congestion - raspy voice **SUPINE HYPOTENSION IN PREGNACY/ AORTOCAVAL COMPRESION** - when mom is laying supine, it causes the uterine to fall on the aorta and vena cava - treatment is elevation/tilit and support = moves the uterus to the side

Answer 155

both calcium phosphate and uric acid are deposited into the kidneys causing renal injury **LABS** - HYPERkalemia - **HYPERphosphatemia binds to calcium leading to HYPOcalcemia** - HYPERuricemia - **HYDRATE!!!! hydration prevents TLS** MEDICATION = **allopurinol** - used to decrease hyperurecemia caused by TLS

Answer 156

3.5-5.5 - depleted plasma protein - **blood volume expansion** indicated - thermal burns ( greater than 10% = **priority is assessing for respiratory status** - third spacing

Answer 157

THEY CONTAIN ABUNDANCE OF CLOTTING FACTORS coagulopathy (clotting deficiency) - **deficiency of certain clotting factors** - **TO BE INFUSED OVER 15-30 mins** packed red blood cells TO BE INFUSEd over 2-4 hours may be used for warfarin toxicity along with vitamin K

Answer 158

**PRIMARY** PREVENT THE ONSET OF THE DISEASE EDUCATION AND IMMUNIZATIONS - seatbelts - eliminating alcohol - surveying a home to identify fall risk **SECONDARY** - screening - HEALTH FAIRS - early identification of the disease - makes it possible to treat the disease early and increases chances it will be cured - colonoscopy - pap smears = early detection of cervical cancer PAP SMEARS - 21 years and up only. no adolescent - **21-29 years should be screened every 3 years** - no testing after 65 years **TERTIARY PREVENTION** - already developed the disease - participating in recovery programs - PREVENTION IS NO LONGER AN OPTION - rehab to prevent disease progression - treats the disease and prevent further complications nutritional education for someone with CHF

Answer 159

- repeated episodes of partial or complete airway obstruction during sleep = **CONITINUOS AIRWAY PRESSURE (CPAP)** **MANIFESTATIONS** - excessive daytime sleepiness - morning headachques - snoring - witnessed episodes of apnea AVOID - sedative medications - **eating at bed time** - stimulants - alcohol INTERVENTION = CPAPA - continuos positive airway pressure - increasing exercise and weight loss - KEEPS THE PHARYNX AND TONGUE FROM COLLAPSING BACKWARDS AND OBSTRUCTING THE AIRWAY - **check to see the tightness of the straps and mask** BECAUSE ITS the main cause of sudden drop in O2 levels whiles sleeping

Answer 160

- measures maternal antibodies present on the infant RBC **those antibodies puts the infant at risk for erythroblastosis fetalis** indirect coombs test = test to see of the mother is at risk for Rh immunization

Answer 161

**client that underwent surgery with general anesthesia with low O2 levels should do head tilt to open airways FIRST** = this opens up airway ➢ Return to baseline neurological status ➢ Adequate urinary output (30 mL/hr) ➢ Return of reflexes (cough, gag, swallow) ➢ Bowel sounds present in all four quadrants ➢ Ability to ambulate ➢ Vital signs within normal limits ➢ Ability to tolerate oral fluids ➢ **Minimal nausea and vomiting** = PRIORITY DUE TO ANESTHETIC SIDE EFFECT OF DECREASED GASTROINTESTINAL MOTILITY = **HIGH RISK OF ASPIRATION DUE TO THEIR ALTERED LOC** ➢ Adequate pain control

Answer 162

urine flow is deoendent on gravity so the draining bag should hung below the level of the bladder to maintain gravity flow INDWELLING CATHETER = STERILE - insert int point of bifurcation (two branch on the catheter) - drops of urine may just mean theres urine in the urethra so further put in until theres full urine. after that is when you inflate the ballon **lower abdomen or upper thigh to prevent urethral injury** - they should be minimized during hospitilization = SHOULD BE REMOVED POST OP AS SOON AS CLIENT IS AWAKE AND ALERT **APPROPRIATE USE OF INDWELLING CATHETER** - urinary obstruction or retention - perioperative use - prolonged immobilization - to impove end of life comoft - facilitate healing **INAPPROPRIATE USE OF INDWELLING CATHETER** - convenience or replacment for nursing care (urinary incontinence) - for obtaining urine culture - post op for prolonged periods - should be secured with an adhesive device - the device should be removed gently with an alcohol swab to avoid shearing injury to the skin CONDOM CATHETER - if uncircumscined, DO NOT RETRACT FOREKSIN BEFORE APPLYING CONDOM CATHETER=. can lead to paraphimosis (when foreksin cannot be returned to its orignal postion after being pulled back. can lead to permanent damage) - drainage tube is attached to leg collection bag in a mobile client to enable ambulation, prevent tube kinking and facilitate gravity drainage **leave 1-2 inch(2.5-5cm) space between the tip and end of the condom to prevent irritation and pooling of urine in the condom - if not adhessive, elastic adhessive is used in spiral fashion to secure the device to the penis. adhessive tape may cause irritation/injury and should not be used

Answer 163

- approach client from the good eye - avoid bending down - avoid coughing and deep breathing that can lead to increased ICP - orient cilent to environemnt - obtain prescription for stool softener

Answer 164

- varenicline - buspirone = smoking cessation properties **NICOTINE WITHDRAWAL** headache nervousness poor concentration anger hunter and restless BURPOPION is used in treatment of depressive disorders but MAY BE USED IN MANAGEMENT OF NICOTINE ADDICTION

Answer 165

- immediate post op priority goal for a client with new tracheostomy is to prevent dislogment. = **check the tightness of ties and allowing 1 finger to fit under these ties** disloged tracheostomy = open the airways with a curved hemostat and insert a new tracheotomy with an OBTURATOR - **should be performed only when clinically indicated** **DON'T SUCTION IF ARTERIAL BLOOD GAS IS ORDERED BECAUSE SUCTIONING DEPLETES OXYGEN LEVELS AND WILL GIVE INACCURATE TEST RESULTS** - USE STERILE technique - administer 100% oxygen prior to suctioning - apply suctioning **WHILE WITHDRAWING** catheter from airway **not when inserting** - LIMIT SUCTION TO LESS THAN 10 seconds each suctioning - **SUCTION PRESSURE SHOULD BE SET TO 100-120 for adults and 50-75 for children** AVOID - frequent endotracheal suctioning but provide oral care and ORAL SUCTIONING every 2 hours` - **HUMIDIFICATION IS CRUCIAL = it keeps the secretions thin and reduces formation of mucus plugs so do not remove it if theres too much secretions because that is the intended effect** fenestrated tracheostomy: person can still speak **cleints with tracheostomy should always carry two spare tubes (ONE SAME SIZE, ONE SIZE SMALLER) = to ensure tube can be replaced quickley and effectively** - if tube is meeting resistance = small tube should be used **TRACHEOSTOMY AND FEEDING** - cuff is inflated in clients who are at risk for aspiration - deflate cuff if patient can eat

Answer 166

sudden and painless = **bright flashes of light, hairnet, cobweb, gnats floating dark spots, curtain drawing over eyes** CAUSE - aging, ocular injury - restrict activity - apply eye patch on the affected eyes NEEDS SURGERY **MACULAR DEGENERATION** - CENTRAL BECOMES DARK but peripheral(sides) vision remains intact **TUNNEL VISION** = GLAUCOMA - opposite of macular degeneration - glaucoma **CATARACT** = blury vision/ cloudy appearance if patient calls reporting constipation = PRIROTY cus its gonna lead to increased ICP **INTERVENTION AFTER CATARCT SURGERY** - sleep on opposite side - **sleeping on the affected side increases IOP, swelling and bleeding** - increase fluid and high fiber diets to prevent constipation - **may take 1-2 weeks before visual acuity is improved** THERE SHOULD NOT BE REDUCTION IN VISION AFTER EYE SURGERY. if they experience this after surgery?? = EMERGENCY REPORT TO SURGEON **SNELLEN TEST** used to test for visual acuity **IN PEDS = position child 10 ft instead of 20 as in adults** myopia = near sight, squinting hyperopia = far sight

Answer 167

FIRST: Orient the patient to their room - **when ambulating a blind client, the nurse uses sighted-guide technique by walking SLIGHLY AHEAD (half step ahead) with the cleint holding the nurses elbow** - elbow for guidance - clock face orientation to decribe the location of items

Answer 168

- tilt head back - pull down lower eye lid - administer med in center of lower eyelid - ask patient to close eyes

Answer 169

contains combined doses of estrogen and progesterone that stops ovulation - 99% effective when taken consistently - **increase risk of hypertension and thrombophlebitis** - estrogen:- creates thick endometrium wall to protect implanted fertilized egg - legitimizing hormone(LH): releases of an ovum from the ovary CONTRAINDI - history DVT - **family history of cerebrovascular accidents** - smoking if a woman misses there or more oral contraceptives in a row, they should throw out the rest of the pack and start a new pack **the following sunday**. USE A NEW FORM OF CONTRA FOR THE NEXT 7 days with the new pack **PROGESTIN ONLY PILLS** - oral contraception that works by thickening cervical mucus and thining endometrium to hinder implantation -if pill is takenafter 3 hours, a second barrier method is needed until pill is taken correctly for 2 days - contact HCP if you experience leg pain or swelling - **irregular bleeding and spotting between menses are common side effects of combined OCPS** - breast tenderness is a common side effect too - do not smoke while taking combined contraceptives - seek immediate medical treatment if you experience vision loss

Answer 170

PRE - Proteinuria - Rising BP (140/90) - Edema MED: magnesium sulfate to prevent seizure MANIFESTATIONS - **blurred vision** - **hypertension** - generalized edema - proteinuria CAN LEAD TO PLACENTAL ABRUPTION **AVOID IN PREECLAMPSIA** - bright lights = lights should be minimized to decrease risk for seizures - overstimulations - **HYPERTENSIVE DISORDERS** - HEADACHE AND FACIAL EDEMA **HELLP** form of preeclampsia - **H**emolysis - **E**levated **L**iver enzymes - **L**ow **P**lateless MANIFESTATIONS - hypertension - RUQ pain - nausea/vomiting - possible headache and vision loss

Answer 171

- no protection against STIs - **if recently gotten, another type of birth control should be used until sperm count is 0** - outpatient surgery with low risk - **although reversible, it is often difficult** - ONCE SPERM COUNT IS 0, no need for follow up exams

Answer 172

**basically like colonoscopy but for the vagina** - semi-lithotomy - dyspareunia = painful intercourse = occurs after a colposcopy - used to detect an array of gynecological conditions - **does not require NPO or due** - **VAGINAL INTERCOURSE IS NOT ADVISED 48 hours after colposcopy** = SEX MAY BE **PAINFUL** AND LEAD TO POST PROCEDURE BLEEDING

Answer 173

- clean pin sites using sterile water - **don't adjust pins ONLY DOCTROS CAN DO THIS** - neck exercises such flexion and extension is contraindicated. **USE STRAWS** - place small pillow under the client head when supine to reduce pressure on the device - pin care should be implemented (NO LOSE PINS) - **WRENCH taped to the front of the vest incase it needs to be taken off DURING EMERGENCY like CPR** - avoid driving/bicycle - **when getting out of bed, roll to the side and push on the mattress** - AVOID GRABBING THE DEVICE FRAME WHEN MOVING OR POSITIONING THE CLIENTAS THIS MAY CAUSE SCREWS TO LOOSEN OR ALTER DEVICE ALIGNMENT - wear cotton t shirt under to absorb any mositure - use blow dryer on cool setting to dry the vest when wet

Answer 174

- administer oral sucrose solution. to newborn during circumcision - **during painful procedures like the heel stick, apply WARM (not cold) on the heel to facilitate blood flow** - offering nonnutritive sucking (pacifiers) which can help calm and distract them - swaddling

Answer 175

**preferred way to administer analgesic = oral route** - somatic: noncicpetive = BONE SKIN MUSCLES NEUROPATHIC PAIN - phantom pain **shoulder pain radiating down the arm after an amputation may indicate MYOCARDIAL ISCHEMIA** NEUROPATHIC PAIN MEDS - pregabalin - amitriptyline - duloxetine

Answer 176

- pain is a priority - systematic and BILATERAL - low grade fever - **SLEEP AND REST IN FLAT NEUTRAL POSITION** = elevating legs leads to development of contractures - serum rheumatoid factor (not for osteoarthrtis) - low grade factor (not for osteoarthritis) TREATMENT: prednisone, METHOTREXATE (bone marrow suppression, hepatoxicty, gasto irritation) - take med even if joint not hurting - **prednisone should not be taken with nsaid = GI** NON PHARMALOGICAL INTERVENTIONS - **taking a warm shower/bath or applying heat first thing in morning helps with stiffness and increases flexibility** - ROM exercises are more effective after warm shower - ROM is encourgaed to prevent loss of function **OSTEOARTHRITIS** = TOPICAL CAPSAICIN =apply to hands and wait atleast 30 minutes before washing them - unilateral (herbeden nodels - noninflammatory - nonsystemic disorder - occasional OA inflammation is limited to affected joints DMARDS - methotrexate, hydrochloriquine, leflunomide, sulfasalazine (dehydration, elevated urine gravity due to cystal formation in the kidney) - **methotrexate is also used for psoriasis** - can cause oral candidiasis which is expected - TERATOGENIC = folate antimetabolite - hepatotoxic so avoid alcohol - suppresses the immune system so avoid anything that can lead to infection

Answer 177

**an hour after post op, check for drainage in suction drainage device = blood loss/hemorrhage** PERFORM RANGE OF MOTION!! DISCHARGE TEACHING - **elevated toilet seats** - head of bed greater than or equal to 60 degrees. 90 degrees promotes excessive hip flexion - **DONT PUT PILLOW BEHIND THE KNEE CUS IT CAUSES JOINT FLEXION WHICH INCREASES THE RISK OF CONTRACTURE** - cold packs may be applied to reduce post op swelling and pain - use continual passive motion deice if prescribed - perform leg exercises to strenthen muscles around the hip and **avoid excessive hip flexion when sitting, dressing and toileting** - perfrom isometric quads, gluteal setting, leg raises and ABDUCTION EXERCISES from supine and standing positions - client should **use a toilet riser or bedside commode chair** with arms to prevent excessive hip flexion when getting on and off the toilet seat SLEEP ON BACK WITH PILLOW/ wedge BETWEEN LEGS - no internal or external rotation of hip **USE TROCHANTER ROLL**, AVOID CROSS OF LEG - NO ADDUTION OF HIP (abduction pillow might be used to prevent dislocation of the joint) TOTAL KNEE ARTHROPLASTY - place on continuos passive ROM exerciser for 6-8 hours a day - ROM HELP WITH CONTRACTURES AS WELL - **may increase risk of VTE = TAKE ANTICOAG** - **Maintaining joint flexion is high priority** - DO NOT DANGLE FEET = can cause dislocation

Answer 178

- if they fall, assess for capillary refill and sensation first - weight bearing exercises - increase calcium and vitamin d (sun) - take calcium supplement with food **calcium absorption is impaired if taken in excess of 500 mg or more per dose** MED: **alendronate** = take early morning and before food. DO NOT LAY FOR 30 MINS AFTER TAKING IT - irritate esophagus AVOID - PPI (prazole) = **decrease absorption of calcium** **colles fracture = dinner fork characterisic of the wrist** rotator cuff injury = shoulder pain with arm abduction

Answer 179

- ROM exercises of the extremities help prevent contractures - **too many pillows under head can cause neck flexion contracture** - flexion contrations more common - SPLINTING MIGHT HELP Recognize those who are at risk. These would be individuals recovering from a burn, stroke, or **any neurological impairment inhibiting range of motion**. Collaborate with other disciplines such as physical and occupational therapy. Apply splints to the hands and feet. Reposition the client frequently Avoid positioning the client that has extremities in extreme flexion. **Perform range of motion exercises of all extremities**

Answer 180

- buildup of uric acid deposited in the joints that causes pain and inflammation - abnormal metabolisms of purines(proteins) FOODS TO AVOID - adhere to low purine diets but does not need to avoid protein foods - red meat (liver, kidney, brain , seafood, sardine, shellfish) - beans MEDICATION - **allopurinol is used to prevent gout by preventing uric acid depositis in joints** ALLOPURINOL INSTRUCTIONS - can take several months to become effective (**colchicine is used in gout attacks**) - can be taken with or after food to prevent gastric upset - **take with glass of water and increase fluid intake to prevent kidney stones** = MOST IMPORTANT TEACHING - REPORT any form of rash = stop taking med and CALL HCP - nausea can be prevented by taking medication with food CONTRAINDICATIONS - **ROM can aggravate the pain in gout** - **partial weight** bearing on the affected extremities not FULL - sunlight photosensitivity

Answer 181

- ensure patent airway - **STABILIZE THE CERVICAL SPINE to prevent further damage including applying HARD COLLAR** - place on firm and rigid surface - use log rolling technique as a unit (requires precense of a nurse) **upper back injuries should be treated like spinal injury which means you should stabilize the back on a backboard util the spine is appropriately assessed** **best away to visualize and open airway = jaw-thrust maneuver IN SUPINE POSITION ON A BACKBOARD** ASSESS FOR - abdominal breathing - increased work of breathing may indicate impending loss of airway and require rapid sequence intubation **movement of the neck/upper extremities should be avoided until cervical injury is ruled out with imaging** **JAW THRUST VS HEAD TILT** - jaw thrust = when spinal injury is suspected - head tilt chin lift = open airways of unconscious patient

Answer 182

- disrupts the replacement of old bone tissue with new one - accelerated bone remodeling

Answer 183

burns over 10% = hyperkalemia - vascular dehydration - **HEMATOCRIT and BUN goes up** - hyperglycemia due to the stress - metabolic acidosis - hemoconcentration **FLUID CHOICE FOR BURNED CLIENT = LACTATED RINGERS** because it remains in the intravascular space longer than other solutions - stabilizes blood pressure and avert shock **LABS OF A BURN PATIENT** - epinephrine - aldosterone - anti diuretic LAB VALUES OF BURN INJURIES **MONITOR FOR HYPERKALEMIA** - hemoglobin and hematorcit levels go up - hyponatremia and hypovolemia FLUID CHOICE FOR BURNED CLIENT = LACTATED RINGERS because it remains in the intravascular space longer than other solutions - stabilizes blood pressure and avert shock **TYPES OF BURNS** **daily application of water based lotion is necessary to minimize scar formation and alleviate itching** - **Superficial-partial** - partial burns: blister formation, exudation - **superficial** - redness of the skin, only epidermal - **deep-partial** - wound appear moist and pale white, sluggish cap refill - **full thickness** - deep to muscle, bone **unstageable** - slough or eschar (yellow and black) - slough appears yellow or tan - returned pulses distal to the site. **deep tissue injury** = intact skin - area of dark purple or maroon discolaration - clean with sterile, gentle solution like normal saline and pat dry with gauze - clean wound with hydrophilic(water loving) dressing that absorbs moisture electrical burns = place on electrocardigram STAGE 1: nothing is lost, just reddened **hydrocolloid = protect shallow ulcers** **PHOTOTHERAPY(sunlight) helps with psoriasis** **BURNS CALCULATIONS** PARKLAND FORMULA - 4mL x body weight(kg) x total body surface area burned ( % TBSA) - **first 8-hr fluid administration = 50% total fluid requirement - remaining 16- hr fluid administration = 50% total fluid requirement** **MONITOR FOR HYPERKALEMIA** RULE OF NINES (just anterior) - head: 4.5% x2 - torso: 18% x2 - left arm: 4.5% x2 - right arm: 4.5% x2 - perineal = 1% - left leg = 9% x2 - right leg = 9% x2 **should add up to 100** don't priortize clients with burns 60 or up = expected to die **THERMAL BURN** Assess airway patency Administer supplemental oxygen, as indicated Keep the client NPO Initiate IV line and telemetry monitoring Provide prescribed fluid resuscitation Keep the burns covered with sterile dressings

Answer 184

Decreased epidermal thickness Increased epidermal permeability Decreased dermal blood flow Thinning subcutaneous layer Degeneration of elastic fibers - increased growth of facial hair **PHOTOTHERAPY(sunlight) helps with psoriasis**

Answer 185

- serous = clear watery - sanguineous = BRIGHT RED - seroanguineous = pink mixture of red and clear - purulent = thick yellow, FOUL ODOR **serosanguineous is expected 2 hours after surgery but sanguineous (bright red) indicates excess blood loss = hemorrhage** DURING WOUND CHANGE - contaminated dressing should be placed in impervious plastic/glove or paper bag before disposable into household trash = paper towels are not effective as the dressing content can seep through into other items - unused sterile supplies should be throwed out

Answer 186

**symptoms are often subtle** and condition is often not discovered until advanced stage MANIFESTATIONS - **bloating and pelvic pressure**

Answer 187

event that has reached the patient and caused harm like death or serious physical or psychological injury adverse event: - injury to a client caused by medical management rather than clients underlying condition - no harm event: reaches the patient but no harm is caused - close call/near miss/ good catch: patient safety event that did not reach the patient

Answer 188

- moisturize skin using zinc oxide, good - use emollient and barrier creams on dry surfaces - avoid bed at 90 degrees. 30 degrees or less is fine - avoid donut pillows - do not use hydrogen peroxide and iodine agents - EAT PROTEIN enriched foods - repositions every 2 hours - don’t massage bony prominence

Answer 189

MANIFESTATIONS - **head lag after 6 months is associated with cerebral palsy** - abdnormal brain development often before birth - **spasticity/clonus is an expected finding** - **congenital disorder of movement, muscle tone and posture** = head lag after 6 months - ELEVATE HEAD OF BED AT 60-90 when feeding to prevent aspiration - **ROM is good to prevent contractures** - lowering bed to lowest position is good to decrease risk of injury incase of a fall

Answer 190

EYE OPENING (1-4) - 4 eyes VERBAL RESPONSE (1-5) - jackson 5 MOTOR RESPONSE (1-6) - V6 engine **8 or less = INTUBATE THEM cus its considered a coma** INTUBATION - **drop in oxygen saturation = confirm tube placement by AUSCULTATE LUNG SOUNGDS BILATERALLY** - ausculating lung sounds is necessary to confirm tube placement before suctioning - maintain endotracheal cuff pressure **CAMATOSE CARDIAC ARREST PATIENTS** - perform an induction of therapeutic hypothermia - induction of hypothermia is indicated for camatose patients or clients who do not follow commands after resuscitation - after 24 hours, the client is slowly rewarmed - improves neurologic outcomes

Answer 191

- **macewen sign** = (percuss temporal side. **crack pot or hyperresonant** sound means hydrocep is present) MANIFESTATIONS OF ICP IN CHILDREN - increased head circum - setting sun eyes (sundowning eyes) = **sclera visible above the iros** - bulging fontanels - irritable - high pitched cry TREATMENT = **ventriculoperitoneal shunt** **COMPLICATIONS OF VP SHUNT** - high risk of seizure - stopping seizure activity is first priority during status epilepticus - blockage and infection leading to ICP and cushing triad **MALFUNCTION OCCUR WITH INCREASED ICP** - vomiting - headache - vision changes - chnages in mental status - **early intervention decrease risk to the brain tissue** **SHAKEN BABY SYNDROME** - type of abusive head injury from violent shaking of an infant by the arms, legs or shoulders - external signs are usually absent on physical examination with SBS - causes bleeding with the brain or the eyes **S/S OF SHAKEN BABY SYNDROME** - vomiting - lethargy - irritability - inability to suck or eat - seizures - inconsolable crying

Answer 192

most serious type of spina bifida. BUMP AT THE BACK FILLED WITH FLUID. MANIFESTATIONS OF SPINA BIFIDA - **small tuft of hair at the base of the spine** - hemangioma = bright red birthmark - nevus = mole - dimple along the base of the spine - cover the sac with sterile, moist, non adherent dressing to the sac - can cause constipation

Answer 193

impaired metabolism of an essential amino acid phenylalanine found in PROTEINS - hypopigmentation of hair, skin, irises COMPLICATIONS - **intellectual disability** by intefering with brain growth and development INTERVENTION - **low-pheylanine diet is required before and during pregancy** - **elimination of diary, meat, eggs and any food with protein** - protein substitutes should replace meat eggs etc - **AVOID HIGH PROTEIN** foods** - eat mostly fruits and veggies -**adequate milk intake after birth is important to ensure the screening test for PKU is accurate** - avoid aspartame - restriction of tyrosine might not be necessary - lifetime dietary restrictions are recommended for optimal health - infants should be given special fomrulas - irritability - nausea and vomiting

Answer 194

bedwetting = establish and maintain a voiding diary for the child meds like desmopressing and tricyclic antidepressant (IMIPRAMINE=tofranil) may be prescribed

Answer 195

- dress newbordn in no more than one layer of clothing than adults. **DRESS THEM IN WEARABLE BLANKET, SLEEP SAC** this keeps the newborn warm and prevents head from being covered during sleep - hard mattress is preffered soft can confrom to their face and suffocate them when they're rolling - overheating might be a cause - **BACK-TO-SLEEP IS SAFEST POSITION FOR INFANT** - no stuffed animals = risk of suffocation - kids sleeping with adults contributes to SIDs = **avoid cosleeping with their infants**

Answer 196

- bronchitis = inflammed large airways ( trachea and bronchi which are in the lower part of respi tract) **bronchiolitis** - inflammation of the small airways (bronchioles) - RSV is most likely the cause = **use saline nose drops and suction the nares with bulb syringe prior to feeding** LUNG SOUNGS - laryngotracheobronchitis (croup) = stridor/ seal like cough - pleurisy = granting sound rubbing together - bronchitis = thick secretions causing resembling in moaning or snoring - pneumothroax = diminished or absent

Answer 197

**ASD,VSD** - trisomy 21 - artrioventricular canal - **atrial septal defect (ASD)** - **ventricular septal defect (VSD)** - simian crease = single line inside the palm **floppy muscles** - intellectual disability INTERVENTION - genetic screen and echocardiogram are scheduled - surgery is conducted when neonate grows in size and can tolerate invasive procedure MARFAN SYNDROME = tall and thin = **aortic root disease** - affects connective tissue - **cardiovascular manifestations** = PRIORITY - avoid contact sports = risk of cardiac injury - ocular problems - scoliosis (wear t shirt under the boston brace at all times. remove for bathing and exercise) - overcrowind of teeth - **high risk of maternal mortality = use a reliable form of birth control** **TRISOMY 18 (EDWARDS SYNDROME) - affects multiple organs - many fetuses affected by this condition die in the utero - of the children that survive birth, HALF DIE IN THE FIRST WEEK and most do not make it to their first

Answer 198

- small frequent feedings - feed for a max of 30 mins - increased calorie formula MANIFESTATIONS - tachypnea - tachcardia - **pale cool extremities** - diaphoresis - puffiness around the eyes - **weight gain** - POOR FEEDING/ LOSS OF APPETITE - fatigue - rhonchi on ausculatation is not part late sign - oliguria = reduction in wet diapers - hypoxia

Answer 199

- increases preload in the left ventricle - causes decreased cardiac output - increases left ventricle end diastolic pressure. **MITRAL VALVE REGURGITATION** - may bar asymptomatic and may eventually turn to heart failure so report any sign of fatigue - decrease cardiac output

Answer 200

- **highly contagious** - common bacterial skin infection 2-5 years - usually not systemic - contact precaution - **common around nose, mouth, hand and feet** - lesions **NO LONGER CONTAGIOUS AFTER 24 HOURS OF ANTIBIOTICS** **DECREASE TRANSMISSION** - handwashing - isolate infected person clothing and linens and washing them in hot water - keep fingernials short to prevent bacteria from collecting under them and to deter scraching - **avoid close contact with others for 24-48 hours** MANIFESTATIONS - burning - pruritus

Answer 201

- varicella - airborne and contact precaution - can go back to school after sores are crusted. this happens in about a week - apply diphenhydramine / antihistamines cream to lesions after bathing because the rashes are usally itchy - acetaminophen for pain and fever - **cool oatmeal baths also helps with itching** **vaccine is not indicated for those that has already developed immunity and recovering from it** - keep giving your child acyclovir (antiviral therapy) to fight the virus

Answer 202

- acute from of encelopathy/CEREBRAL EDEMA - increased ICP LAB = elevated ammonia RISK FACTORS - **viral illness like flu and varicella (chicken pox)** - metabolic disorders - **ASPIRIN AND SALICYLATE USE DURING INFLUENZA OR VARICELLA INFECTION** INTERVENTION - acetaminophen is appropriate antipyretic to reduce risk of syndrome **ASPRIN?ACETYLSALICYCLIC OVERDOSE OR TOXICITY** = ACTIVATED CHARCOAL - after the activated charcoal, IV sodium carbonate is an appropriate treatment **PEDS INGESTING SOMETHING** - first assess the clients condition = mental, physical, mental status and behavior - based on the condition, the nurse can provide guidance and instructions

Answer 203

- opening between the stomach and duodenum(small intes) is hardend and almost closed - projectile vomiting without visualized blood especially after feeding - **olive shaped mass** - weight loss NOT anorexia **ESOPHAGEAL ATRESIA AND TRACHEOESOPHAGEAL FISTULA** = ASPIRATION GREATEST RISK - eso phagus and the trachea does not properly separete or develop - **frothy saliva, chocking** - client may also develop apnea and cyanosis **CHOKING INTERVENTION** = HEIMLICH MANEUVER - under 1 year = back blows and chest thrust - over 1 year = abdominal thrust

Answer 204

- voluntary or involuntary fecal incontinence in children over age 4 who were previously trained

Answer 205

part of the intestine slides into an adjacent part of the intestine TREATMENT - can successfully treated without surgery **using hydrostatic (saline) or pneumatic (air) enema** MANIFESTATIONS - sausage shaped stools - **red, currant jelly stools** - **bilious vomiting** - stools mixed with blood and mucus - intermitten pain drawing up of the knees - non projectile vomiting MONITOR FOR = REPORT - **notify HCP if there is a passage of normal stool = indicates reduction of the intussuception** = plans of surgery should be stopped and the plan of care should be modified

Answer 206

- blowing bubbles - giving them a pinwheel to blow = THEY FACILITATE LUNG LUNG EXPANSION AND PREVENT RESPIR PROBLEMS - such activities can serve as incensitvive spiromer

Answer 207

intestines, liver and other organs OUTSIDE of the abdomen IN A SAC - umbilical cord at apex **GASTRISCHISIS** - eviscerated bowel with no covering membrane - umbilical cord to the left of defect **INTERVENTION** - maintain NPO - administer ceftrixone due to the abdominal contents being exposed - d5W - **DO NOT APPLY PETROLEUM JELLY TO THE BOWEL** - cover with nonadherent dressing **plastic bowel bag, sterile, saline soaked gauze covered by loose plastic**

Answer 208

cancer that affects renal cells/kidneys (usually one kidney) MANIFESTATIONS - unusal bulding/contour abdomen on one side of the abdomen - **hypertension due to excess production of renin** - if tumor metastized, **adventitious sounds** may be present INTERVENTION **DONT PALPATE ABDOMEN** should be placed at bedside - palpating can disrupt the tumor and cause dissemination of tumor cells

Answer 209

- if temperature is elevated, **PRIORITY is the establish an IV access** because they are immunocompromised and antibiotics needs to be started right away - **neutropenic and bleeding precautions** LAB VALUES - decreased platlets - decreased neutrophils - increased blast percentage - **decrease in RBC/erythrocytes = anemia**

Answer 210

- both parents gotta have sickle cell to make it a 100% for child to inherit - if one parent has sickle cell and the other is a carrier = 50% - monitor of ischemic stroke = prirotiy INTERVENTION - HYDRATE!! - follow high calorie and high protein diet - **they are at high risk of CVA so if they complian of headache = assess neuro status** - drink extra fluids if going on a plane - avoid extreme cold/hot temps. high latitudes, mountains - SEVERE PAIN IN THESE CLIENTS COULD INDICATE VASOOCLUSION AND TISSUE ISCHEMIA AND NEEDS TO BE ADDRESSED = **may lead to irreversible tissue damage** - daily aerobic exercise is helpful but avoid strenous exercises - they have lower immunity so advise them to take annual influenza vaccine - **continuos PCA is recommended rather than a prn** **males can develop priapism** - priapism is a side effect trazodone **DURING CRISIS, AVOID** - action game = too exciting and can increase oxygen expenditure - avoid activity rooms = too stimulating - **MAINTAIN BED REST DURING CRISIS** - crisis also affects joints so will be hard to use hand dexterity in playing game AVOID

Answer 211

the blood does not clot properly = **administer SUBQUE clotting factors** MEDICATION: desmopressin = stimulates the release of factor VIII **LONG TIME COMPLICATION = JOINT DESTRUCTION (HEMARTHROSIS)** - the most common site of bleeding are the joints especially the knee HOW TO ADMINISTER MEDICATIONS - use smallest guage - vaccines are **adminstered subcutaneously** whenever possible to **prevent IM hematoma** AVOID - NSAIDs (ketorolac, ibuprofen, indomethacin, naproxen) - avoid warm compress to the injection site. **use ice** - avoid massaging **ACETAMINOPHEN IS RECOMMENDED FOR PAIN RELIEF** LAB VALUES - normal PT/INR - abnormal PTT - normal thrombin time

Answer 212

infant (birth to 18 months) - sooth by high pitched voice - **communication is nonverbal through touch, patting etc** - crying as means of communication - separation anxiety - **pincer grasp should be present by age 10 months** - palmar grasp = 10 months

Answer 213

grade school (6-11) solid foods: 4-6 months - requires 9-12 hours of sleep - experience slower growth rates and require decrease hours of sleep - NO ACTIVE PLAYTIME BEFORE BED. quiet and restful activities like coloring and reading prior to bed will promote restful sleep

Answer 214

adolescent (13-18) - peer! SEXUAL MATURATION IN BOYS - **first manifestation is testicular enlargement** - followed by pubic, axillary, facial, body hair and voice changes

Answer 215

young adult (18-40)

Answer 216

middle age adult (40-65)

Answer 217

older adult (65+)

Answer 218

- neonate: 16 to 18 hours of sleep each day - infant: 14 to 15 hours of sleep - pre school: 11 to 13 hours of sleep

Answer 219

- strong genetic components - not liked to old parents age **INTERENTION** - structured routine and consistency - **they will be stimulated if you give them too many choices** - place in private room away from the nurses station ( they may be hyper or hyposensitive to sound, lights, movements, touch, taste, smells - maintain calming environemt - have family bring in patients toys - dim lights in the room - maintain constant care givers - low noise **head lag remaining after 6 months can be associated with autism** vaccines are **NOT** risk factors

Answer 220

- sensorimotor stage (0-2 years) - preoperational stage ( 2 to 7 years) - concrete operational (77 to 11 years) - formal operational (11 to adulthood)

Answer 221

- only effective if the mother HAS NEVER DEVELOPED ANTIBODIES - given IM within 72 hours after birth - **ONLY WHEN MOM IS RH NEGATIVE, BABY IS RH POSTIVE** - prevent sensitization to the RH factor in an Rh negative woman with an infant who is Rh positive - **additional dose might be given if excessive fetomartenal hemorrhage is required**

Answer 222

severe complication by preeclmapsia - dark red bleeding - hypotension - **rigid abdomen** PLACENTA PERVIA MANAGEMENT - placenta covers cervix, **painless** bleed - transvaginal ultrasound to confirm (also confirms ectopic preggo) - **DONT assess cervix for dilation** - blood draw for type and screen - initiate 2 large bore IV catheters - pelvic rest - c section prior to onset of labor **BLOOD DRAW** - after 2 attempts to draw blood and still unsuccessful, dont try again. contact a phleotomist or a different nurse to complete blood draw

Answer 223

- moro/startle reflex: infant startle and strecthes out their extremities in response - **absencne of moro refelx = underdeveloped or damaged brain/spinal cord** - babinski sign: plantar flexion when inside of the feet is stroked. positive is when the toes flexes UP. positive is normal in newborn up to 1 year = DISSAPEARS AT 1 YEAR **in adults positive babinski (toes goin up) = indicates brain or spinal cord lesion** - rooting reflex: the newborn turns his/her head to the side on which the cheek is stroked

Answer 224

- when fertilized ovum implants outside the uterine cavity **MANIFESTATIONS** - unilateral abdominal pain (lower quadrant abdominal pain on one side) - **referred shoulder pain** - hypotension (dizziness, tachycardia) RISK FACTORS - recurrent STIs - IUDs - pelvic pain - vaginal bleeding - positive preggo test NO fever NO dysuria **PELVIC INFLAMMATORY DISEASE** - most common cause is untreated STI - multiple sex partners - history of PID - history of STI - age 15-25 - lack of consitent barrier contraceotion use

Answer 225

ultrasound-guided test used in the detection of fetal abnormalities - may be conducted in patients with high risk - may tell the gender of the baby - will receive IV sedation **Ultrasounds typically require a full bladder as the fluid moves the uterus upward and assists with visualization**

Answer 226

- increased in heart size ( heart shift upwards and to the left - increased BMI - reduced renal threshold for glucose - decrease gastric motility WBC elevates even in the absence of infection AVOID NSAIDS (ibuprofen, indomethacin, naproxen

Answer 227

- glucose in the urine oral glucose challenge test for clients with gestattional diabetes. abnormal is 130 and higher - **causes elevated hematocrit levels in kids**

Answer 228

retension of potassium and phosphurus (restrict them) **fluid restriction** **the kidneys regulate fluid volume and blood pressure** MANIFESTATION - uncontrolled hypertension and hypertensive emergencies MONITOR FOR AND REPORT - **hypertensive encephalopathy = nausea, vomiting and headache** ALLOWED FOODS - apples - pears - grapes - pineapple - black and blue berries plum AVOID NSAIDS - ibuprofen - indomethacin - ketorolac - naproxen **AVOID NSAIDS IN PREGNANCY** ALSO AVOID - salt substitutes - high phosphorus - high fluids (popsicles) - high potassium they retain electrolytes such as potassium and excess potassium often results in dysrhythmias - **avoid high sodium foods such as cured meats, pickeld foods, canned soups, salad dressing** NSAIDs antitiotic statins prazoles

Answer 229

ends in **NATE** - DRINK EXTRA WATER AND SIT UPRIGHT FOR 30 mins after taking them

Answer 230

- high risk of cold stress due to decreased brown adipose tissue - **INABILITY TO GENERATE HEAT BY SHIVERING** - cold stress can lead to hypoglycemia **IMPORTANT PROBLMES OF PRE TERM NEW BORNS** - cold stress and hypoglycemia SIGNS AND SYMPTOMS OF COLD STRESS - decreased temperature - altered mental status - bradycardia - hypoxia - weak cry and suck **in elderly clients, acute altered mental status may indicate infection(urinary tract)**

Answer 231

- first assess for **unintentional weight loss** - after that, contributing factors such as functional status, mood alteration, diet **if a person is not eating, UNINTENTIONAL WEIGHTLOSS IS A PRIORITY OVER DEPRESSION**

Answer 232

- under tuition and inadequate growth in infants = weight less than 80% of ideal for age - **children are not at risk based on birth order or number of siblings** SOCIOECONOMIC CAUSES - poverty - notional isolation - cognitive and mental disorders - lack of nutritional education domestic violence - negative attitude towards food **PRIORITY = OBSERVING CLIENTS FEEDING** PHYSIOLOGIC FACTORS - pre term babies - breastfeeding difficulties - gastroesophagral reflux - cleft palate

Answer 233

- they may have unfinished business that needs to be completed which may motivate the client to become anxious or **INSIST ON DISCHARGE** - **ask them to tell you more about their need to leave the hospital** - end stage organ failure must be motivated and educated on organ transplants rules such as abstaining from alcohol etc PAIN MED AT END OF LIFE - advocate it as a nurse even if the side effects can lead to death **PALLIATIVE VRS HOSPICE** **PALLIATIVE CARE** - **provides relief from symptoms associated with chronic illnesses** - can be provided at any time - **focuses on quality of life on the client and their families** - provided by multidisciplinary team **HOSPICE CARE** - **only started when client decides to do without curative treatment**

Answer 234

- **mother can still cradle baby to encourage bonding and attachment** - place infant in supine. PRONE INCREASES SIDS - **recasting needs to be done ever 5-8 weeks** - monitor for circulation ( make sure toes is pink and warm ) - keep the cast dry to prevent skin irritation or infection

Answer 235

- epidural causing decreased bladder sensation - **urinary retention can cause bladder distention which can lead to displaced or body uterus** **MANAGEMENT**: self limited condition and **INTERMITTENT CAUTERIZATION**

Answer 236

- 4th intercostal space, midway point of the AP diameter of the chest wall **this is where you accurately measure continual arterial and or pulmonary artery pressure** - - lower will make the BP reading too high - upper will make the BP reading too low **AUSCULTATING HEART VALVES** APETM aortic (2nd RIGHT sternal border) pulmonic (2nd LEFT sternal border) erbs point (3rd LEFT sternal border) tricuspid (4th LEFT sternal border) mitral (5th mid clavicular line) *apical pulse!* infant apical pulse is at 4th intercostal space

Answer 237

- gastrointestinal absorption of the neurtoxin produced by C botulism **MAIN CAUSE: imporperly canned or stored foods**. - in infants = **RAW WILD HONEY** - results in muscle paralysis **DESCENDING FLACCID PARALYSIS STARTING FROM THE FACE** dysphagia and constipation (smooth muscle paralysis - **discard canned food with bulging ends** children under one year should not be given honey due to their immature gut system = makes them prone to botulism

Answer 238

**FIRST CHECK THE PRESCRIPTION TO VERIFY THE 6 RIGHT OF MED ADMIN** - this confirms the right patient. - **ONLY TEACH THE PURPOSE OF THE MEDICATION AFTER YOU HAVE VERIFIED IT FROM THE HCP PRESCRIPTION MEDICAL RECORD**

Answer 239

- instruct the caller to have the CHARGE NURSE RECEIVE THE REPORT - if UAP reports to the nurse whiles shes caring. for another patient that a client wants them = tell them to tell the charge nurse the needs of the client critical lab results should be verbally communicated

Answer 240

cardioversion = used to restore FAST beating arrhythmias to normal trans pacing = used to correct SLOW arrhythmias to normal

Answer 241

- wash daily with soap and water and gently pat dry - **itching, tingling and numbess around the site may be present for several weeks due to damage of the local nerves** - avoid tub baths = infection - **dont apply powders or lotions on incisions as they trap bacterials into the incision** - wear supportive elastic hose on the legs, elevate when sitting to decrease swelling - **incisions may take 4-6 weeks to heal**

Answer 242

- **toxic inhalants that enters the blood and bind. to the hemoglobin (carboxyhemoglobin)** - pulse oxi reading often appears normal because such **devices cannot differentiate between CO and oxygen = THIS IS WHY IT IS DEADLY!!** - a serum carboxyhemoglobin is needed to confirm diagnosis. **< 5 in non smokers, < 10 in smokers** **TREATMENT: immediate 100% oxygen to correct hypoxemia and eliminate CO from the blood** = SMOKE INHALATION IS THE LEADING CAUSE OF DEATH IN BURN CLIENTS = KILLS FASTER AND IS ALWAYS A PRIORITY

Answer 243

- withdrawal from opiates due to maternal drug use Manifestations -**neurologic**: irriatability, hypertonia, jittery movements, seizures(rare) = swaddling can be an intervention for those - **gastro**: dirrhea, vomitting, feeding intolerance - **autonomic**: sweating, sneezing, pupillary dilation, nasal congestion, **frequent yawning**, sneezing, tachypnea, sweating **TREATMENT: opiod therapy (methadone and morphine)** - methadone has a long half life itching is an expected side effects of narco';/;tics **FETAL ALCOHOL SYNDROME** - microcephaly - thin upper lips - smooth philtrum - short palpebral fissures flat midface **INTELLECTUAL DISABILITY IN CHILDREN** - down syndrome - hypothyroidism - fetal alcohol syndrome - phenylketonuria **OPIOD OVERDOSE** = NALOXONE - EVERYTHING GO DOWN - slurred speech - respiratory depression - hypotension - drowsiness - constricted pupil **GASTRIC LAVAGE:** = stomach wash - Performed through probate if tube to remove ingested toxins and irrigate stomach - **prepare intubation and suction at the bed side incase of aspiration and respiratory distress** **OPIOID DISORDER DRUGS** - - natrexone - methadone - buprenorphine better if combined with appropriate counseling

Answer 244

- microcephaly - cleft palate **plagiocephaly** = flattening of the skull = when infants spends a lot of time in the same position (supine)

Answer 245

- inflammation of subcue tissues CAUSES - insect bites - abrassion - open wound MANIFESTATIONS - redness - **edema** - pain - fever **daily marking and dating of reddened and edema assist with monitoring improvement** INTERVENTION - **elevate legs** to promote circulation and reduce edema - warm compresses

Answer 246

- infliximab, adalimumab and etanercept - **clients should be tested for TB before** - **no traumatic procedures (initation of IV sites, IM injection) should be performed unless absolutely necessary due to risk of bleeding** - any sign of infection, avoid taking these drugs = because they **suppresses the immune system** - **avoid live vacciness BUT SHOULD RECEIVE INFLUENZA** CONTRAINDICATIONS - **CLIENT WITH CURRENT, RECENT OR CHRONIC INFECTION SHOULD NOT TAKE TNF INHIBITOR** -

Answer 247

- nausea and vomiting are expected MACROLIDES - mycin antibiotics with “thro” in it = they prolong QT interval - ecg should be monitored for any sudden changes CLIENTS THAT SHOULD RECEIVE PROPHYLACTIVE ANTIBIOTICS PRIOR TO DENTAL PROCEDURES (**this is to prevent infective endocarditis** - cardiac transplantation recipients who develop **heart valve disease** - prothestic **heart valve** - previous infective endocarditis - unrepaired cyanotic - **ineffective endocarditis require IV antibiotic for up to 4-6 weeks** - persistent temperature elevature may indicate that the therapy is ineffective or complications have developed **BLOOD CULTURES** - always obtain blood cultures before you administer antibiotics because it can lead to false negative results when patients have fever chills, rash, blood cultures should be done before antibiotics is administered

Answer 248

- amidarone - sotalol - haliperidol - ziprasidone (second gen antidepressan) - clozapine - they can hepatotoxic so monitor for liver function test **it’s priority even if it’s expected cus it can lead to cardiac arrest and other lethal arrhythmias such as TORSADES DE POINTES** TORSADES DES POITES - caused by low magnesium **treated with magnessium sulfate**

Answer 249

- increased risk of complications DURING ENCOUNTER AS A NURSE - discuss emotional response - family/social support systems - nutritonal habits and subtance abuse

Answer 250

- **AVOID** - liver = rich in vit A and can be teratogenic - deli meats, hot dogs - **avoid unpasteurized** milk products - unwashed fruits and veggies - raw fish or fishes high in mercury **EAT** - folic acid (fortified cereals, bread, pasta) - green and leafy veggies

Answer 251

- rare but serious perinatal mood disorder = psychitric emergency - signs appear 2 weeks after birth and include hallucinations, delusions and paranoia **delirium that someone wnna hurt the baby** POSTPARTUM DEPRESSION - assess parent and ask question about depression and feeling of hopelessness

Answer 252

INCLUDE MMR (measles-mumps-rubella), **varicella-zoster, rotavirus** - a child less than 12 months can and should receive MMR when they contract it - **safe for healthy 2-49 years including breastfeeding women** MMR CONTRAINDICATIONS - HIV with CD4 less than 200 - history of guillain baire syndrome - **pregnant women** - immunocompromised (leukemias) - **corticosteroids therapy** - chemotherapy - **AVOID pregancy for atleast 1-3 months after MMR immunization is given** - chicken poxed - less than 2 years - leukemia **best way to administer MMR vaccine to a nonimmune client is postpartum period just prior to discharge** **if a client calls that that they are seeing rash and having mild = ask them what their temperature is. FEVER AFTER MMR CAN LEAD TO FEBRILE SEIZURES** **INACTIVATED VACCINESS RECOMMENDED FOR PREDNACY** - TDAP - tetanus - dipthertia - pertussis **CONTRAINIDICATED VACCINES FOR PREGNANCY** - MMR - HPV - live attenuated influenza - varicella FLU TREATMENTS ( flu last for about a week) - antiviral meds like oselta**mivir** are given to clients with symptoms within the last 48-72 hours = can shorten duration of the illness - annual vaccine - droplet precaution - wear mask when being transported out the room **MISCONCEPTIONS ABOUT IMMUNIZATIONS** - penicllin allergy - mild illness (with or without an elevated temperature) - mild site reactions (swelling, erythema, sorness) - recent infection exposure - current course. ofantibiotics **THESE PEOPLE CAN STILL RECEIVE IMMUNIZATIONS**

Answer 253

- extremly contagious viral disease with high mortality - standard, contact and droplet precautions - placed on single client airborne isolation - **maintain log of everyone in and out the clients room** - keep client door closed at all times client does not require n95 HOWEVER all other individuals entering the room must don approprate ppe - **visitors prohibited unless necessary like parent visiting an infected child** PPE REMOVAL PROCESS - **requires strict monitoring by a trained observer** - outer gloves are first cleaned with disinfectant and removed - inner gloves are wiped between removal

Answer 254

- psychological disorder that develop from stress and disrupt daily life - **unexplained physical symptoms like abdominal pain** NURSING INTERVENTION - **DONT DISPUTE** = disputing the validity of the client symptoms may increase the clients stress level and make everyhting even worse - **clients symptoms are real despite the lack of diagnostic findings** **CONVERSION DISORDER** - diagnosis that acknowleges that your symptoms are real even if there isnt a physical cause

Answer 255

IDICATION - prevent stomach ulcers (can still take nsaid cus that’s the point of the medication, it reduces the effects of nsaids) - can take with food if stomach irritation occurs - **cervical ripening** that occurs before onset of labor - adminster orally or vaginally. **rectal administration during postpartum hemorrhage** CONTRAINDICATIONS - **PREGNANCY CATEGORY X** - avoid taking with antacid - the client receiving another uterotonic like oxytocin simustaneously - abnormal fetal heart rate - **tachystole = more than 5 contractions in 10 mins** - c sections **narcotics during labor should be given slowly DURING THE PEAK of the next contraction** = reduces the amount of narcotic that crosses the placental barrier and affects the fetus

Answer 256

- bleeding into the subdural space- **elderly clients taking anticoagulants are at high risk** - result of blunt force head trauma - surgical evacuation of the hematoma may be necessary to relieve pressure on the brain - **can lead to herniation (midline shift)** - assess for ICP, cushing triad = increased ICP = decreased cerebral perfusion MANIFESTATION OF SUBDURAL HEMATOMA - headache - gait disturbance - memory loss - decreased LOC **EPIDURAL HEMATOMA** = TEMPORAL BONE - accumulation of blood between the skull and dura mater - they lose conciousness at the time of impact then REGAINS consciousness quickly and feel well for some time (lucid interval) AND THEN FOLLOWED BY A QUICK DECLINE IN MENTAL HEALTH that can progress to coma and death. - **emergent diagnosis and treatments are needed to prevent brain stem herniation** **subarachnoid hemorrhage** - often described as worst headache of my life

Answer 257

- **movement disorder often irreversible** - may be **caused by high doses metoclopramide** which is a common antiemetic medication - question the medication if they experience any symptom of tardive dyskinesia

Answer 258

**FEEDING RULES TO ASPIRATION RISK** - position the child supine with an elevated HOB after feedings - burp the infant often cus they swallow large amounts of air during feeding - feed in upright position - **feed slowly over 20-30 minutes every 3-4 months** - use a specialty bottle: squeezable/assisted bottle - **bottle should be pointed down away from the cleft** - cross cut and preemie nipple due to inability to create suction and pull milk from nipple. - elbow restraint is used to prevent the child from disrupting the surgical site **AVOID HARD OBJECTS** - utensils - tongue depressors - pacifiers - starws

Answer 259

- rupture prior to onset of labor at term gestation >37 - does not hurt the baby however, **if labor dont begin after ROM, induction of labor might be necessary to decrease risk of infection** - **green amniotic fluid = child has passed meconium in utero = can cause aspiration**

Answer 260

- **hypotension** and low cardiac output example: heart failure - artificial or dark fingernail polish - peripheral arterial disease - vasoconstriction eg hypothermia, **vasopressor medications** - if they had a **DYE procedure** **ANEMIA** - if the patient is anemic, you should look at other indicators of good oxygenation besides the pO2 cus youd think they are better thna they actually are which is pretty dangerous

Answer 261

- hydroCHLOROTHIAZIDE and CHLOROTHALIDONE CONTRAINDICATIONS - gout cus it increases uric acid - causes hyperglycemia - causes hypo sodium too - sunlight = photosensitivity - **encourage client to use sunscreen and wear protective clothing** INDICATIONS - edema - **hypertension** - USUALLY PRESCRIBED WITH SPIRONOLACTONE TO TREAT HYPERTENSION - spironolactone is a potassium sparing drug so it counterracts the potassium loss from thizide diuretics LABS - **HYPO potassium = muscle cramps (report)** - HYPO sodium = altered mental status and seizure - HYPER uriCEMIA = worsen gout attacks - HYPER glyCEMIA - HYPER calCEMIA considered potassium wasting diuretics - **AVOID LICORICE ROOT** = can lead to hypokalmia since thiazide already puts patient at risk of hypokalemia - diuretics should be taken in the morning cus nighttime will cause nocturia and interrupted sleep - thiazide depletes every other electrolytes THIAZIDE CALCIUM - **reduce urine calcium levels** BUT **increase blood calcium levels**

Answer 262

CAUTION - **C**hnage in bower and bladder habits - **A** sore that do not heal - **U**nusual bleeding or discharge - **T**hickening or lump in breast or elsewhere - **I**ndigestion or difficulty swallowing that does not go away - **O**bvious change in wart or mole - **N**agging cough or hoarseness CANCER MED = methotrexate SIDE EFFECT - causes bone marrow suppression = risk of infection - hepatoxicity (avoid alcohol) - gastrointestinal irritation EXAMINATION OF SKIN CANCER = **ABCDE** A = asymmetry B = boarder irregularities C = color changes and variations D = diameter of 6mm or larger E = evolving (appearance is changing in shape, size and color) **pus or purulent drainage is usually indicative of an infectious disease NOT appearance** - AVOID TANNING BEDS = they emit UV radiation

Answer 263

DOs - assign private room - choose clothing for client - **have them participate in physical exercise one on one interactions rather than group** - high protein, high calories - low lightening - quite calm environemnt - limit number of ppl who come in contact with client DONTS - avoid group stuff and activities - avoid loud areas - dont let them eat in dining room with other ppl = too much stimulating - avoid anything that causes too much stimulation MED: lithium

Answer 264

- sore throat caused by group A strep (pharygitis) - **distinguised by bright red rash** **PHARYNGITIS** - **toothbrush should be replaced 24 hours starting antibiotics (bristles can harbor bacteria and reinfection may occur) - soft diet and cool liquids (**ice chips**) - can lead to renal or cardiac complications if not treated ORDER - rapid streptococcal antigen test to confirm it - throat culture is needed to verify result STREP THROAT- contagious period starts from onset of symptoms and last through first 24 hours of beginning of beginning antibiotic treatment = **they can return to school or daycare after they have completed 24 hours of antibiotics and are afebrile**

Answer 265

- blood vessel ruptures in the brain causing bleeding NURSING INTERVENTION - implement seizure options due to increased ICP - **during acute phase, dysphagia might occur so client must remain NPO until swallow screen functions reveals no deficit** - perform neurological assessments (LOC, pupillary response) - administer stool softners

Answer 266

- temp airway devices used to prevent tongue displacement and trach obstruction in SEDATED or UNCONSCIOUS CLIENTS - as conciousness is gained, client will cough or gag indicating the need to remove it!! - **nurses must enure it is easily removable, so do not tape it!!** **INSTALLATION OF OROPHARYNGEAL AIRWAY** - measure the OPA airway against the cheek and jaw - insert with distal end pointing upward towards roof of mouth - rotate the device tip once it reaches the soft palate towards the esophagus = pushes tongue forward and maintains airway patency - suction secretions prior to prevent asipiration - **never tape** in place because when the client awakes, the device stimulates gag reflex and can cause aspiration

Answer 267

- eliminate sugar containing bevs **including fruit juices** - set relistic goals (losing 1-2 lbs) every week - eat small, frequent meals to decrease hunger and tendency to eat - **adequate sleep 7-9 hours cus sleep deprivation is associated with weight gain and obesity** - dont skip meals - incoporate daily exercise **HEALTHIER BEVERAGES OPTIONS** - flavored or unflavored club soda - fresh veggie juice - unsweetedned tea or coffee - non fat or low fat milk in limited amounts **ORLISTAT** - inteferes with fat soluble vitamin intake so client should take vitamins ADE and K but MUST BE TAKEN 2 HOURS AFTER ORLISTAT - lipase inhibitor that prevents the breakdown and absorption of fats - take with or within 1 hour of meals that contain fat - dose may be skipped if food does not contain fat -

Answer 268

TREATMENT: rewarming is key!! - **depending on the extremity, putting it in warm water immediately is the key!! 104 degrees water** - keep wounds open immediately after water bath before applying loose, nonadherent, sterile dressings **DO NOT MASSAGE BODY PART THAT HAS SUSTAINED COLD INJURY** - face and keys can be rewarmed with warm facecloths - give them something warm to drink but only after putting the place of affect in warm water

Answer 269

- oxygenation should be considered first before med = CHECK PULSE OP - **if the client is speaking, airway is open** - if they're snoring = opening airway is priority

Answer 270

produced by fetal kidneys and serves 2 major purposes - prevent cord compression - promote lung development COMPLICATIONS OF OLIGOHYGRAMNIOS = low - pulmonary hypoplasia = small lungs = have additional neontal personel available for possible resuscitation and evaluation of the newborn - umbilical cord compression = continuos (not intermitten) fetal monitoring should be applied to monitor for variable deceleration **normal amniotic fluid causes extra room for the umbilical cord to float freely, when theres not enough amniotic fluid, the baby body part is likely to press on the cord against the uterus**

Answer 271

- prolonged, painful erection not necessarily related to sexual arousal **requires urgent treatment in the emergency department as it can lead to erectile tissue ischemia (blue discoloation of the penis) and necrosis** MANIFESTATIONS - extreme pain is expected - difficulty voiding - anxiety and embarassment REPORT - blue discoloration of the penis - can manifest in male clients with sickle cell

Answer 272

- stabilizes bone by inserting metal pins through the skin into the bone and attaching them to. ametal rod outside the skin - **promote early mobilization for clients, may begin walking with physcial therapy the day after surgery** ASSESS FOR AND REPORT(indicates infection) - low grade fever - drainage - pain - redness - swelling

Answer 273

- **nonmalefience**: doing no harm - **beneficience**: to do good(implenting measures to promote client well being) = it can involve withholding information at times - **fedelity**: loyal and fulfilling commitments - **justice**: treating all clients fairly without bias - **veracity**: telling the truth - **autonomy**: right to make decisions for self/ allowingthe clients to choose the direction of care - **paternalism**: teating clients as children

Answer 274

- aspirin - clopidogrel = should be discontinued 5-7 days before surgey - prasugrel **dont adminster before procedure** MANIFESTATIONS - prevent thomboembolic events in clients with increased risk of stroke and myocardial infarction SIDE EFFECTS - brusing - monitor for and reports signs of uncontrolled bleeding such as bloody stools - signs of stokes **antiplatelet agents does not affect blood pressure**

Answer 275

- furosem**ide**, bumetan**ide** **GIVE THEM SLOWLY TO PREVENT OTOTOXICTY** - report muscle cramps HOW TO TAKE THEM - take with full glass of water - sit up for like 30 mins after taking = prevent tablet from dislodging in esophagus or reflux from the stomach - **DO NOT TAKE ON AN EMPTY STOMACH** take during meals or immediately after meals to prevent **stomach upset** MONITOR NAD REPORT SIGN OF - hypokalemia = unmanaged hypokalemia can lead to lethal cardiac dysrhtymias - muscle cramps and flushing INTERVENTION - potassium supplement high potassium diet may be required AVOID - licorice SIDE EFFECTS - muscle cramps, weakness - paresthesia **POTASSIUM SPARING** - “SAME” acronym with “one”

Answer 276

CONTRAINDICATION - apical pulse less than 60 SIDE EFFECTS - fatigue **presence of wheezing after taking propranolol may indicate bronchoconstriction or bronchospams is occuring** = assess them for asthma

Answer 277

- **heavy sutures, placed transvaginally or transabdomininally to prevent preterm delivery by keeping the cervical os closed** INDICATED FOR - clients with histories of second trimester loss or premature birth - clients with history of cervical insufficieny CERVICAL INSUFFICINCEICY - painless - premature cervical dialtion - miscarriage or preterm baby **placement occurs at 12-14 weeks gestation and should remain in place unitl 36-37 weeks** DISCHARGE INSTRUCTIONS - activity restriction/ bed rest for a few days - **recognize pre term labor such as low back aches, contractions and pelvic pressure** - recognize ROM - report feeling pressure in pelvic

Answer 278

- inflammation of vein CAUSES - irritating drugs (vancomycin) - **catheter movement within vein (inadequate stabilization** - bacteria due to poor aseptic technique PRIORITY AND REPORT - when redness and inflamation occurs especially with irritating drugs like vancomycin. IMMEDIATE REMOVAL because it can lead to thromboplebitis, eboli or other bloodstream infections

Answer 279

- compression of MEDIAN nerve within the carpal tunnel at the wrist. - **phalen test is used to diagnose carpal tunnel syndrome** **INTERVENTION = WRIST IMMOBILIZATION SPLINTS** - avoid hand exercises cus it leads to more compression of the median nerve MANIFESTATIONS - weakness - pain - **impaired sensation in the median nerve distribution** - numbness

Answer 280

end of drug ends in **-sin** RULES - take at bedtime MONITOR - orthostatic hypotension - avoid erectile dysfunction drugs and any other drugs that increases smooth muscle relaxation

Answer 281

- medical emergency - tear in the characterized by **ripping**/ **tearing** back pain **TREATMENT** = CONTROLLING HYPERTENSION!! - maintain normal blood pressure in the aorta - **administer IV beta blocker** **INTERVENTION** - bed rest and low stimulation environment MANNIFESTATIONS - abrupt - tearing - moving (upper to lower) - back pain - epigrastic pain CAUSE - hypertention

Answer 282

- often in **infants** when formula is diluted. which parents do to save money MANIFESTATION - irritability - lethargy - **hypothermia** - **seizure**

Answer 283

MANIFESTATIONS - **intrusive thoughts** - urges - complusions - **extreme rigidity and inflexibility** - impulses - unwanted thoughts - **punctual to rules and regulations** - teach client how to use the technique of thought stopping MANAGEMENT - recognzing triggers and using relaxation or redirection techniques - use behavioral technique to decfease or eliminate time spent performing the ritualistic behavior

Answer 284

MANIFESTATIONS - **paranoia** **POSITIVE SYMPTOMS OF SCHIZO** INTERVENTIONS - struggling with social interactions = first start with one on one interactions before group activities - during hallucination = reinforce reality and acknowlege how the client may be feeling **i know you are frigthened but i do not see a man in your room**

Answer 285

- injury to the lumbosacral nerve roots (l4-l5) causing motor and sensory deficits MAIN SYMPTOMS - lower back pain - saddle anesthesia: motor weakness/loss of sensation to inner thighs and buttocks - **bowel and bladder incontinence (late sign)**

Answer 286

- ovulation may occur as early as 4 weeks after birth before resumption of menses. - MANY CLIENT RESUME SEXUAL ACTIVITY BEFORE their postpartum check up(4-6 weeks after birth) -**encourage clients to use contraceptive such as condoms to prevent pregnancy**

Answer 287

- slow release - enteric coated - extended release - sustained release these drugs are designed to release at a slowly within a specififc frame ALSO **you would have to crush these drugs to pass through NG tube and crushing these drugs are contraindicated and introduces risk of adverse effects** BUT REG DRUGS NEEDS TO BE CRUSHED FOR NG TUBE **during abdominal surgeries, it is customary to insert a nasogastric tube that is left in place during the immediate post op period. green bile colored drainage is expected but bloody drainage would cause concern**

Answer 288

- assessment and rating of cervical favorability and readiness for induction of labor **higher bishop score indicates likelihood of successful induction that results in vaginal birth** for nulliparous(never gave birth) women, a score of 6-8 indicates induction will be successfull NONSTRESS TEST - reactive: fetus is well oxygenated and establishes fetal well being = **it does not provide information about the likely success or failure of labor induction** - nonreactive: bad!

Answer 289

- abnormal craving for food and substances of no nutritional value during pregnancy **often accompanied by iron deficiency anemia so MONITOR HEMO AND HEMA LEVELS** FOODS TO INCREASE HEMOGLOBIN LEVELS - meat - fish - poultry **iron deficiency anemia is the most common nutritional disorder in children** = mostly due to excessive intake of milk **if a client of 50 or above has new onset of anemia, the nurse should find the etiology first before treatment = SCREENING COLONOSCOPY**

Answer 290

PINWORM - intestinal worm infection from eating from contaminated food, drinks toys **charcterized by anal itching and troubled sleeping** HOOKWORM - blood sucking roundworms from larvae in contaminated soil - **migrate to intestines and causes BLEEDING AND ANEMIA** **eczema and psoriasis is not contagious** **TINEA CORPORIS/RINGWORM** - caused by fungus - **red,scaly, blistered RINGS on the skin or scalp** = easily spread by sharing hair care instruments, towels, hats, clothings etc - contagious fungal infection - direct contact precaution = shared hairbrushes, bedding, towels, hats - **NOT CAUSED BY WORM INFESTATION** **MED: griseofulvin** and 1% selenium sulfide shampoo applied several times each week - **treatment should not be discontinued early even if symotoms subsides. tretament can go from weeks to months** MED (griseofulvin) INSTRUCTION - **absorption occurs best after eating high fat food like ice cream** - avoid prolonged exposure to sunlight = photosensitivity

Answer 291

- purpose is to prevent fluid build up in a closed space (**abdominal and breast reconstruction surgeries**) HOW TO EMPTY - perform hand hygiene = assepsis must be maintained to prevent transmission of microorganisms - pull the plug on the bulb to open the device and pour the drainage into a small calibrated container - **empty device every 4-12 hours unless its 1/2 or 2/3 full because as the capacity bulb of 100mL fills, the amount of negative pressure in the bulb decreases** - compress the empty bulb by squeezing it from side to side with 1 or 2 hands until it is totally collapsed = more effective in establishing the negative pressure needed - clean the spout on the bulb with alcohol and replace the plug **when it is totally collapsed to restore negative pressure**

Answer 292

- **abnormal placental adherence to the MYOmetrium INSTEAD OF THE ENDOMETRIUM** RISK FACTORS - previous c sections COMPLICATIONS - life threatening hemorrhage when an attempt is made to separate it INTERVENTION = **blood transfusion** -**two large bore IV(18 guage) and a blood type and crossmatch**

Answer 293

- diagnosed prior to adulthood - **have limited levels of intellectual functioning and adaptive skills for their chronological age** NURSING INTERVENTION - consistenly assigning the same staff - providing toys that are developmentally appropriate NOT BASED ON AGE - **involve parents but dont exclude patient** - prevent self-injury by reinforcing the parents limit-setting measures - use visual demonstrations to facilitate communication **DISORDERS THAT CAUSES INTELLECTUAL DISABILITY** - hypothyroidism - down syndrome - phenylketonuria -

Answer 294

- done clean gloves and perform hand hygiene before and after - clean the wound bed (form center outward) - monitor site for infection - apply dry sterilze gauze over wound bed - cover the gauze with occlusive sterile dressing to keep gauze in place. COVERING SHOULD BE APPLIED WITHOUT TOUCHING THE WOUND BED

Answer 295

- dabiga**TRAN** - api**xa**ban - rivaro**xa**ban INDICATIONS - used to reduced risk for clots and strokes in clients with A fib - **they are being prescribed more often often over oral anticoag like warfarin DUE TO LOWER RISK OF BLEEDING AND REQUIRES LESS MONITORING** - also used to prevent venous thromboembolism **CONTRAINDICATIONS** - NSAIDS **KEEP CAPSULES IN THEIR ORIGINAL CONTAINER UNTIL USE** INTEERVENTION - implement bleeding. precautions **AVOID ASPIRIN, GARLIC, GINGER** - routine monitoring of clotting times are unnessary for clients with Xa inhibtors

Answer 296

**RED = HIGHEST PRIORITY** - the patient has life-threatening injuries, but a high chance of survival once stabilized **YELLOW** - the victim has injuries that are not immediately life-threatening - can wait up to an hour before receiving treatment **GREEN** - the patient has minor injuries such as cuts or abrasions and can wait several hours before receiving treatment **BLACK = EXPECTED TO DIE** - the patient’s injuries are so severe that there is little to no chance of survival - apnea **SPINAL IMMOBILIZATION** - acronym NSAIDS - **N**euro exam - **S**ignificant traumatic mechanism - **A**lertness - **I**ntoxication - **D**istracting - **S**inal exams

Answer 297

absorbed systmeically so does not need to be applied excatly on site of pain **should be applied on area of flat, intact skin (**upper back, chest**) to prevent accidental removal** - not recommended for acute post op pain, temporary or intermitten pain. ONLY CHRONIC AVOID - heating pad over them = increases absorption - cutting = cutting damages delivery system **DONT SHAVE AND APPLY THERE cus there might be microcuts** DISPOSAL - fold the used patch in half so the edges adhere and immediately discard - remove old patch when applying a new patch every 72 hours (days)

Answer 298

**AVOID WHY AND HOW QUESTIONS**!!!! **first thing to do when a person is experiencing severe anxiety / panic attack** - move them away from the cause of the attack by accompanying to a vacant room - don’t try to talk to client as they are already anxious and cannot recollect themselves **what do you not say to an agitated psych patient** - do not tell them to calm down - Once the client is at risk of harming himself, other clients, or staff, the nurse should call for help and prepare to administer a sedative/tranquilizer to calm him down **a client experiencing psychosis and says anything like “ya trying to kill me** - ask what make you think we are trying to kill you? - pick the answer that keeps them talking

Answer 299

- initial assessment (ADMISSION, POST OP) - assessment and care for unstable patients - administer IV push, blood products, TPN and medications requiring titration and continuous monitoring - monitoring, qualitative data and assessments - access implanted device - interpret and analyze data requiring COMPLEX critical thinking - Care plan development - initiation of client referrals - initial and discharge teaching NURSE SHOULD MONITOR FOR SIDE EFFECTS OF MEDS OR INTERVATIONS **RNs are required to follow up to ensure that the task was completed accurately** **5 rights of delegation** Right Task. Right Circumstances. Right Person. Right Direction/Communication. Right Supervision/Evaluation. = following up to see they did the task just like it should be when language is a barrier, USE INTERPRETER **MANAGEMENT FUNCTIONS** - planning - organizing - staffing - directing - controlling **EFFECTIVE TIME MANAGEMENT** - include the patient in it = asking what is their priory to be accomplished each day - using teamwork can enhance performance also **CRISIS** -

Answer 300

- monitor RN findings ( obtain BP, HR ) - gather data (focused and subsequent) on stable patients - auscultating lung or bowel sounds after intitial assessment by RN - can give most meds except for IV medications - can give subque meds - monitoring behavior chnages - basic client care (CHANGING BANDAGES, INSERTING CATHERS ( **but not central lines/ picc**) NG tube, - WOUND CULTURES DURING DRESSING CHANGES - BLOOD SAMPLES - report client status and concerns to RN/PHCP - care for stable clinicals with PREDICTABLE outcomes (chronic, ready for discharge, consistent lab, expected findings) - reinforce RN education - ostomy - tracheostomy care - stool samples - NO INTRAVENOUS MEDICATIONS!!! CAN ADMINISTER DRUGS (EXCEPT IV PUSH) TO PPL WITH CHRONIC CONDITIONS

Answer 301

- ambulation, ROM, hygiene, ADL - feeding, oral care for **STABLE PATIENTS (NOT IF AT RISK FOR ASPIRATION)** - **they cannot feed a stroke patient until 48 hours have passed** - routine vital signs, intake and output - positioning and linen chnage - **pacing bed alarms to reduce falls** - transfer/transport T/FROM BED, CHAIR, COMMODE, STRETCHER **when transferring, use distal not pivotal** - report concerns to RN/LPN

Answer 302

- continuos IV solution (normal saline) is required to **keep the vein open and flush the PCA medication so it reaches the client** - if doctor says to turn off saline = question it to clarify it **DONT CONVERT IT TO A SALINE LOCK** OTHER IV OPIODS WITH SALINE - convert to a saline lock - SALINE LOCKS KEEPS THE LINE PATENT AND ALLOWS FOR GREATER MOBILITY THAN A CONTINUOS INFUSION

Answer 303

when it’s 8-9 on a scale of 1-10 after a procedure * REMEMBER PAIN IS WHAT THE PATIENT SAYS IT IS!! ASK!! **STAT PAIN MEDS NEEDS TO BE ADMINISTERED ONCE! = need to obtain a new prescription from doc to administer again** nausea, vomiting diaphoresis increased pulse tachypnea increased glucose dilated pupils (mydriasis)

Answer 304

**ALWAYS MAINTAIN A PATENT AIRWAY FIRST** (example is turning them to their side) **BEFORE DELIVERY OXYGEN!!** cannula: 24-44 simple face mask: 40-60 partial rebreather: 60-75 non rebreather: 80-95 = short term use (pulmonary edema) **venturi mask = consitently delivers O2 regardless RR, depth or tidal volume. BEST FOR COPD** CANT USE CANNULA FOR SEIZURE. AMBU BAG IS NEEDED. cannula doesn’t deliver enough oxygen **NASAL CANNULA** - avoid vaseline cus its flammable - use a water soluble lubricant instead - NONREBREATHER MASK - monitor the resevoir bag to assure continual inlfation during inhalation - **if resevoir bag is deflated during inspiration, increased oxygen flow** - valves close on inhalation to prevent entry of room air - valves close on exhalation to prevent reinhalation of exhaled air

Answer 305

- INTENSE PAIN - fixed and mild dilated pupil INTERVENTION - PLACE THEM **SUPINE** this decreases pupillary block and **help keep lens from falling away from the iris** **normal pupils are 3-5 mm in diameter** - MEDS - timolol = used to decrease intraocular pressure - acetazolamide - diuretic

Answer 306

10-20 = timolol used to decrease it - tested with tonometer - lying down increases intraocular pressure AVOID UNNESSARY MOVEMENT. INTRAOCULAR FOREIGN BODIES/PENETRATING SHOULD BE TREATED BY OPTHALMOLOGIST ONLY!! = cover the eyes with a cup and tape it in place and call doctor. this prevent further damage that may be caused by rubbing eye - **do not flush eyes with cool water as it may cause further damage by moving the pathogen** surface foreign bodies can be removed with irrigation and a mositened cotton tipped applicatorSA

Answer 307

MANIFESTATIONS - mental status is altered ask if they know what day it is - asterixis (flapping tremors of the hand) ask them to extend arm MEDS - lactulose = laxative effect to trap and expel ammomnia - lactulose is commonly used to treat asterixis (flapping hand tremors) - neomycin **LACTULOSE INSTRUCTIONS** - desired effect is 2-3 soft stools a day so don’t hold if that occurs - give on empty stomach for rapid effect - mix with fruit or juice for better flavor - assess mental status and orientation CONTRAINDCATION - benzodiazepines **HYPERTENSIVE ENCEPHALOPATHY** - sudden elevation of blood pressure - medical emergency - visual impairment - **epistaxis** - seizures - coma

Answer 308

spasms of the large bowel = diarreha alternating constipation and diarrhea - anticholinergic drugs are CONTRAINDICATED cus they relaxes smooth muscles leading to uirnary retention, bowel ileus, closed angle glacuoma **INTERVENTION** - add probiotic supplement to reduce IBS symptoms - increase amount of fiber for constipation predominant - promote healthy coping skills with the child, talk about problems - ensure adequate exercise

Answer 309

uses contrast media to visualize the colon - no informed consent is needed - **USE OF LAXATIVE IS GOOD AND ASSIST IN EXPELLING THE CONTRAST** WORRY MORE ABOUT TELLING THEM NOT TO EAT OR DRINK ANYTHING PRIOR - take cathartic to empty stool **COLONOSCOPY** - no prophyl antibiotics fro healthy clients - no food or drinking prior - clear liquid diets the day prior - drink polyethyelene glycol as directed the day before **POST COLONOSCOPY EXPECTED FINDINGS** - polyethylene glycol is prescribed as bowel preparation for colonscopy - abdominal cramping - frequent, watery stools - recurring flatus REPORT = signs of perforation - positive rebound tenderness - abdominal distension - boardlike (rigid) abdomen **CLEANSING ENEMAS** - should be administered at room temperature or warmed - place in sims position (left lateral with one knee flexed - hang the enema bag no more than 12 inches or 30 cm above the rectum to avoid rapid adminstration - lubricate the ebema tip and gently insert 3-4 inches into the rectum - direct tubing tip towards the umbilicus to prevent intestinal perforation - encoyrage to hold enema for as long as possible (5-10 mins) if cramping occurs, slow administration rate

Answer 310

- ppl who have experienced terrifying, traumatic event (war, tonardo, rape, plane crash) **3 months or more after trauma** - less than 3 months = acute stress disorder **FIRST STEP TOWARD RESOLUTION = readiness to discuss the details of the traumatic event without experiencing high levels of anxiety** MANIFESTATIONS - re-expericing the traumatic event - **they are usually restless and hypervigilant** - avoiding reminders of the trauma - difficulaty concentrating - **persistent angry, fearful mood** - increased anxiety = **clients with high anxiety levels 8/10 and pacing behavior are demonstrating distress and require IMMEDIATE ATTENTION as they might harm themselves or others - emotional arousal**

Answer 311

**PARALLEL PLAY** autonomy vs shame & doubt - PLAY ON THEIR OWN but still around eachother - **they thrive on rituals and routines** - they play next to each other and are happy to be in the presence of peers but they do not play directly with one another - tactile play - not interacting - **independent don’t wanna play with anybody = egocentric** **PROCEDURES EDUCATION** - teach them about the procedure immediately before it is performed **INFANTS (birth to 1 year)** - focus on their own activity - play in the presence of others - **separation anxiety produces more stress to infants than any other factor** - separation or stranger anxiety starts at 6 months and peak at 10-18 months and can last until age 3 **SEPARATION ANXIETY INTERVWNTION** - provide visual reminders of the parent in pictures - encourage the parent to leave stuffed animals - given plenty oppotyunity to play **TOILET TRAINING** - easier than uirna - child should be able to pull down clothes - **child may be ready when they are able to communicate and follow directions** **fun facts about toddlers** - head cirucmference increases by 1 inch during the second year until 5. its less than 0.5 a year from there - chest circumferance is greater than abdominal circumference

Answer 312

**PRETEND, ASSOCIATIVE, IMAGINATIVE PLAY** - iniative vs guilt = they intiate and feel guility for things that happens to them like sickness - they think they caused their sickness and its a punishment - imitating adults - play with eachother together in groups - engage in similar activity or play with the same or similar items - **play is unorganized without specific goals or rules** - borrow items from each other without directing each others play - respond best to positive reinforcement and rewards (stickers) - magical thinkers **TOYS** - playing dress up - using household toys, telephones, medical kits, dolls and puppets **initiative vs guilt** - work on their FINE MOTOR (finger dexterity - work on BALANCE ( tricycles, dance class, iceskates - Characterized by **CO-OPERATIVE play (play with eachother together in groups)** - they like to PRETEND = **HIGHLY IMAGINATIVE** - they can draw and copy a scare

Answer 313

**COOPERATIVE PLAY** - **complex and competitive** - play with one another with specific goal (building castle from blocks) - have set of rules - COMMON GOAL - **patients should provide them with schoolwork during hospitalization** **PROCEDURES EDUCATION** - use simple diagrams with correct anatomical terms

Answer 314

- **TREATMENT = carbamazepine** - unilateral excrutiating facial pain along the trigerminal nerve (CRANIAL NERVE 5) - not life threatening - **electric shock like pain in the lips, gums and severe pain along the cheekbone** TRIGGERED BY - touch - talking - hot/cold air or intake

Answer 315

- **after ROM = prioritization is assessing the fetal status (fetus heart tones)** - pregnant clients are tested for GBS (group B strep) colonization at 35-37 and RECEIVE PROPHYLACTIC ANTIBIOTICS DURING LABOR IF RESULTS ARE POSITIVE **NITRAZINE PH TEST** - used to differentiate between amniotic fluid which is alkaline and normal vaginal fluid which is acidic - **bluish color suggest ROM** - recent sexual intercourse should be reported to the health care provider **presence of blood or semen may result in false positive nitrazine ph test**

Answer 316

1. Ofactory 2. Optic 3. Oculomotor 4. Trochlear 5. Trigerminal 6. Abducens 7. facial 8. acoustic/vestibulococlear 9. glossopharyngeal - swallowing 10. vagus 11. spinal accessory 12. hypoglossal **O**h **O**h **O**h **T**o **T**ouch **A**nd **F**eel **A** **G**irls **V**agina **A**h **H**eaven FUNCTIONS **S**ome **S**ay **M**arry **M**oney **B**ut **M**y **B**rother Says Big Brains **M**atter **M**ost - S = sensory - M = motor - B = both **CEREBELLUM** - balance and posture - coordination - heel to shin test is used to assess cerebellar fucntion **ROMBERG TEST** - loss of balance when eyes is closed and legs together indicates positive

Answer 317

- **Gravida**: number of times preggo regardless of outcome - **Term**: 37 weeks or beyond - **Preterm**: between 20 weeks and 36 weeks 6days - **Abortion**: ending before 20 weeks - **Living**: living to determine if a client is currently pregnant, combine term, preterm and abortions. if the gravida is greater, then the client is currently pregnant

Answer 318

- heart rate less than 40 or over 130 - systolic less than 90 - respiratory rate less than 8 or above 28 - O2 levels less than 90 - urine output less than 90 in 4 hrs - chnage in loss of conciousness that does not respond to treatment

Answer 319

PLIMAWV - phenytoin - lithium - isotretinoin - methrotrxate - ACE inhibitors - warfarin - valproate - alcohol - NSAIDS

Answer 320

- **CHOREA (INVOLUTARY, tic-like movement)** - respiratory complications - autosomal dominant that causes **progressive nerve degeneration** - hereditary, not spontaneous **INTERVENTION** - genetic counseling is recommended - one carrier parent is needed to cause disease

Answer 321

- kava and valerian root: used for anxiety, insomnia and depression

Answer 322

- pulsatile mass in the preumbilical area slightly to the left of midline = **MONITOR FOR HEMORRHAGEE*** - very high priority, even over peritonitis **MANIFESTATION** - back:abdominal pain - bruits heard upon auscultation **ABDOMINAL AORTIC ANEURYSM** - monitor for peripheral pulses - monitor renal - monitor neurologic status **ENDOVASCULAR ABDOMINAL AORTIC ANEURYSM REPAIR** - done via femoral artery so check groin puncture sites for bleeding - NO ABDOMINAL INCISION IS REQUIRED - NO CHEST TUBE REQUIRED - monitor fluid intake and urine output = kidney function

Answer 323

• Acetaminophen - N-acetylcysteine • Benzodiazepines - Flumazenil • Beta-blockers - Glucagon • Carbon Monoxide - 100% 02 • Heparin - Protamine Sulfate • Iron - Deferoxamine • **O**piods **O** - Nal**O**x**O**ne • Warfarin - Vitamin K **natrexone is for opiod DISORDER**

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