Adult Health Nursing - Final Exam Study Guide/Blueprint | NURS 372, Study notes of Health sciences

Download Adult Health Nursing - Final Exam Study Guide/Blueprint | NURS 372 and more Study notes Health sciences in PDF only on Docsity! University of Delaware School of Nursing NURS 372 Fall 2015 Final Exam Blueprint (REVISED 12/8/2015) Thoracic Surgery/thoracentesis 1 Endo tubes and Ventilator 3 Mechanical ventilation if they can’t generate spontaneous respirations if: cyanotic with shallow breathing, CMV – complete control Assist – specific tidal volume but patient can spontaneous breath but at that volume (can hyperventilate) – complete control SMV – can take spontaneous breaths PEEP – keep alveoli open to help with gas exchange Alarm – check patient (ABCs) – high pressure – secretions building up, kink in tube, might be biting on it, humidity in O2, low pressure - pull tube out, if cuff is deflated (if they’re talking/coughing) Endo tubes: How do you know if its in the right place? Chest x ray, check breath sounds, watch bilateral lung expansion COPD 5 ARDS/ARF 2 Hypoxemia – less than 60 PCO2 – number 1 sign of ARDS? – early: dyspnea, resp alkalosis (hyperventilation), chest x ray – late: white out chest x-ray – resp & metabolic acidosis diagnostics – chest x ray & ABGs – goals of care: treat cause – want them on lowest level of oxygen that meet the goal – PRONING (helps with increasing 02 stat – last resort) – check for skin breakdown Refractory hypoxemia – no matter how much O2 you give them, their O2 sat doesn’t increase Pneumonia 3 Community vs. hospital – diff & treatments, prevention – culture before antibiotics Community – Zithromax – hospital – clindamycin Young/old people Manifestations – productive fever, fremitus/dullness, chest x ray – fluids, fever Obstructive Sleep Apnea 2 INTERVENTIONS – sleeping positions, risk factors – males, morning headache Oral appliance – pull mandible & tongue forward CPAP vs BiPAP Never give sleeping pills Arthritis and Joint Replacement 3 OA- non inflammatory, asymmetrical, weight varied joints, stiffness in morning for first 30 minutes – intervention – lose weight – water aerobics, assistive device, NSAIDs, never immobilize over 1 week, diagnostic – CT scan – rule out RA – nosocomial infection – last resort would be to have joint replacement – genetic factors N372fall2015FinalExamblueprint_12.2015_kas/wfv RA- no known cause, inflammatory response, females, can be symmetrical, tender, painful joints to the touch, stiffness throughout the day, systemic, diagnostic: + NF factor, synovial fluid: straw colored, NSAIDs to DMARs (decrease pain/swelling) – ROM exercises, Hip Replacement: immobile patients – reposition q 2 hours, lovenox, stockings, stool softeners, no crossing legs, no pushing off bed/chairs, flexion/extension restrictions Sensory 3 Cataracts: problem with the lens, preventable (trauma, sunglasses), manifestations: decrease of vision especially at night, patient education of eye drops – should be no pain with surgery Retinal detachment: problem with retina – detaches form eyeball, it is emergency – signs: spider webs, etc. Painless loss of vision Pneumatic retina pasty – stay in position for 1-3 weeks – on bed rest Age related macular – problem with retina – blurred in different areas – blind spots – accumulation of waste products – photodynamic therapy: very sensitive from sunlight – stay inside for 5 days! Glaucoma: increase intraocular pressure, tunnel vision, - apathy Meniere’s disease – worst drunk feeling, bed rest, emesis basin, fall precautions Dysrhythmias 5 4-5 6 sec strips intervals EKG – alcohol pads – remove hair, etc. Inverted t wave: ischemia Electrolyte imbalance: u wave/large t wave Assess patient before anything Cardioversion (synchronized to QRS – A fib, A flutter, Vtach with pulse) vs. defib (mono vs. biphasic)- V fib Pacemaker and ICD 2 ICD- what to do when it fires – patient teaching Pacemaker – CPR precautions Hypertension 3 Stages! Confirmation – first visit & follow up Lifestyle modifications – weight, dash diet, reduce sodium, alcohol modification Meds: second after lifestyle mods, start with HCTZ – one month – if not working, higher dose/add another class – for stage 2: start with 2 drugs Patient education: hypotension signs Hypertensive crisis - meds, urgency, emergency (slurred speech) PAD/AAA 3 Atherosclerosis – most common cause, thoracic- deep, chest pain, want to know location abdominal aneurysm: asymptomatic – may be mass/ bruit – blue toe syndrome – small clots in toes – cyanosis complication: posterior rupture – severe back pain, flank hypovolemic shock small aneurysm: 4 cm N372fall2015FinalExamblueprint_12.2015_kas/wfv Compartment pressure – cause vascular problems – cut open to relieve pressure Phases: when they start, end, and nursing interventions Hospital: Alkaline: cause liquefaction of skin Airway management – intubate -diaphoresis shock – hypovolemia paralytic ileus shivering altered mental status fluid electrolyte shifts albumin would be used to pull blood parkland formula: total fluids 4ml x kg x percentage burn ½ given in first 8 hours ½ over next 16 hours wound care: delayed until patent airway and adequate circulation no antibiotics until infection is detected early & aggressive nutritional support (hypo metabolic state) no systemic until sepsis – IV always acute phase: diuresis – burn is completely healed/covered with graft phagocytosis, necrotic tissue sloughs, partial thickness heals outside in weighed during wound care – because everything is taken off dressing change – taking off – clean, applying – sterile rehab phase, starts asap, never ends protects wounds form sunlight for one year job site: acid vs. oil - interventions Priority Setting – Multiple Pts. 5 Simulation Lab: Oxygen Therapy 2 -CO2 narcosis (want ox sat at at least 90) Trach care/suctioning 3 Tolerance Order Sterile vs. non-sterile Chest tubes 2 Preparation for thoracentesis – local anesthesia/position of patient/watch for decreased breathe sounds, etc., look at hypovolemia Drainage – (50ml max per hour) – bedside – clamps, sterile water, sterile gloves 4x4 for if they take tubes out check for air leaks, troubleshooting subq, empyema, crepitus drainage systems – atrium vs. oasis for pneumothorax, when putting chest tubes in - pre-medicate – hold breath because you don’t want them to breathe in N372fall2015FinalExamblueprint_12.2015_kas/wfv Cardiac Monitoring 1 Code Blue 2 TOTAL # QUESTIONS: 100 N372fall2015FinalExamblueprint_12.2015_kas/wfv