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NR324 / NR 324: Adult Health I Exam 1 Key Concept Review (Latest 2021 / 2022) Chamberlain College of Nursing
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Module 1 – Professional Nursing I Concept Guide Education & interventions to promote mobility o Use active ROM for patients that can move o Use PROM for patients who cannot move o Isometric exercises o Incorporation of pillows, wedges, overheard trapeze, hand rolls o Assist with ambulation o May require conditioning exercises o May need to stand-by help client in a controlled fall o Obtain appropriate assistive devices canes, walkers, crutches, gait belt Effects of immobility, Interventions to treat the effects of immobility o Venous stasis blood pooling, compression of small vessels o Increased coagulability due to coagulation factors o Deep vein thrombosis treat prophylactically lovenox treat prophetically with SCDs & TED hose to apply pressure o Orthostatic hypotension due to inability to maintain bp o Glucose intolerance o Constipation / Paralytic Ileus / Decreased Peristalsis o Urinary tract infection o Renal calculi o Depression o Sleep disturbances o Activity intolerance Age-related growth and development changes, associated education/interventions- o Infants/toddlers Cannot recognize danger Tactile exploration of environment Put everything in mouth Car safety Needs to be properly secured in the car seat, rear facing in the middle back Totally dependent o Preschoolers Play extends to outdoors Safety of playground equipment Need of outdoor supervision Risk for injury if playing near streets More adventurous o School-age children Trusting authoritative figures or people who claim to be Drowning and firearms are the leading cause for injury o Adolescents False confidence, feel indestructible Risk taking behaviors
Smoking, alcohol, drugs, prescription meds, texting while driving, driving unsafely to impress peers, loud music Most lack adult judgment Homicide is #2 cause of death o Adults #1 cause of death: unintentional poisoning Alcohol, prescription medication May be exposed to injury in the workplace Chemicals, tools Lifestyle choices Some decline in strength and stamina others maintain fitness o Older adults Proximity to RN station is patients that are fall risk (older adults) Loss of muscle strength Loss of joint mobility Slowing reflexes Sensory losses Risk for burns College Age Students: What are the health risks? * o Sleep deprivation o IBS Safety – Home safety o Co2 monitoring Odorless, colorless gas Produced by burning fuels, gas, wood, oil, kerosene Faulty furnace or gas/water heater Nonconventional ways to stay warm like an oven Prevention: carbon dioxide detector Treatment: 100% humidified air o Poisoning Food, household chemicals, lead, medicines, cosmetics Prevention: proper food handling, storage, preparation, cabinet locks, store poison, keep poison control telephone number available Treatment: depends on the type of poison ingested; antidotes, charcoal, etc. o Scalds and burns Elderly have decreased sensation Heating pads may burn Hot water, grease, sunburn, cigarettes Prevention: guardrails by fireplace, turning pot handles, sunscreen, care when warming food in microwave o Fires Cooking fires Smoke inhalation Home heating equipment Prevention
Smoke alarms Caution with cigarettes Fire extinguisher No candles left unattended Safety with holiday lights Care with electrical cords o Falls Prevalent in those 65+ Slippery floors, stairs, rubs, low toilet seat, high bed Tripping hazards, scatter rugs, electrical cords Inadequate lighting Prevention Nonskid footwear Tidy clothes Proper lighting Grab bars/rails No scatter rugs Exercise regularly to increase balance and mobility o Firearms injury Youth suicides Domestic violence Prevention Firearms safety Education for parents and children Proper locked storage Keep ammunition separate o Suffocation/Asphyxiation/Drowning Suffocation Infants younger than 1 year Accidental death: drowning & choking Children 1-18 years Prevention/intervention Know the proper crib safety for infants Watch for small, removeable parts Cut food into tiny pieces Pay attention to mobiles, strings, cords, plastic bags Know the Heimlich maneuver Apply a barrier to pool Know CPR
o Health-care-related safety CO2 monitoring* Equipment related accidents Fire/electrical hazards R.A.C.E P.A.C.E P.A.S.S Restraints Falls Most common incident reported in hospitals More frequent at change of shift, nights, weekends, holidays Activate Fire Alarm (1) o R.A.C.E o A activate alarm Radiation safety: o Clustering of care for patients who have implanted radiation* o Exposure prevention Wear protective shielding (usually a lead vest) Stand behind protective glass (xray) Cluster care/limit exposure (brachy or systemic therapy) Body mechanics o How should nurses maintain good body mechanics? Good posture/ proper body alignment Work at comfortable height Keep objects close to body Use smooth movements Lift with legs not with the back o Remember that the use of assistive devices is not just for patients Ethics- know your definitions. o Beneficence Promote positive actions to help others Encourages the nurse to do good for the patients o Non-maleficence Importance of preventing harm o Fidelity Keeping obligations or promises to patients, to follow through with care o Veracity The nurse’s obligation to tell the truth to the best of his/her knowledge o Social Justice* Equality and fairness regardless of age, gender, sexual orientation, religion, race, ethnicity, and/or education o Moral Distress Occurs when the nurse knows the ethically correct action to take but the nurse is constrained from taking it o Autonomy*
The right to make own decision about their health care o Self-determination Self-determination is the right to choose such as food Module 2 Falls and Fall risks* o Prevalent in those 65+ o Tripping hazards o Inadequate lighting o Ask about history of falls o Remove SCD devices when the patient is not in bed o Reassess at least every shift to determine changes in patient status o Move the patient closer to the nurses station o Assess for confusion or disorientation o Assess for postural hypotension o Environment safety Adjust the lighting in the room Call light within reach Answer call light promptly Clean, dry floors Personal items within reach Bed in lowest position Urinal within reach Client education (how to use the call light and when to call for help) o Offer to use the bedpan, bedside commode, urinal, prior to leaving the room o Up to 3 side rails raised o Document use of safety measures o Hourly or more frequent rounding o Place patient on fall risk precautions
Fibromyalgia o Causes: genetic, musculoskeletal pain amplifies painful sensations by affecting the way the brain and spinal cord process painful and nonpainful signals o Symptoms: Intermittent worsens with stress, sleep deprivation, increased activity, and weather conditions Burning, gnawing pain & stiffness may be present all over the body, neck & extremities Muscle tenderness and/or numbness and tingling in extremities Sleep disturbances Headache / sensitivity to noise, odor, light Jaw pain Cardiovascular Dyspnea, chest pain, dysrhythmias Blurred vision and dry eyes Neurological Forgetfulness and concentration problems GI Abdominal pain, diarrhea, constipation, heartburn GU Dysuria, urinary frequency, urgency, pelvic pain o Interventions/treatments* Promote restful sleep habits Avoid alcohol & caffeine Regular exercise and/or PT Stress management Osteoarthritis o Causes: cartilage degenerates and synovial fluid decreases bone hypertrophies o Symptoms: pain, stiffness, tenderness, loss of flexibility, grating sensation, bone spurs, swelling o Interventions/treatments* Acetaminophen is primary drug of choice Symptoms relieved with rest Non-pharmacologic treatments Heat or cold application Positioning Balance rest with exercise PT to promote muscle strengthening
Osteoporosis o Causes Decreased bone mass caused by lack of calcium, calcium loss, or decreased estrogen or testosterone o Symptoms Fracture Spine, hips, wrists most at risk Dowager’s hump or kyphosis Loss of height o Interventions/treatments- pain is not a normal finding* Mobility and weight bearing exercises Diet Maintain healthy weight Calcium rich food Avoid use of tobacco and/or smoking Paget’s Disease o Causes – exact cause is known possible familial and genetic links o Symptoms Pain Increased temp over affected bone and localized symptoms Hypercalcemia if pt. is immobile o Interventions/treatments- this is about pain management* Non-steroidal anti-inflammatory drugs for pain relief Osteomalacia- marked bone density. VITAMIN D deficiency* Rheumatoid arthritis o Cause Autoantibodies (rheumatoid factors) attack healthy tissue causing inflammation, cartilage break down and bone destruction Primarily affects synovial joints, but is systemic and can affect the vascular system or body organs o Symptoms Joint pain Deformity Loss of function Fever, weakness, and weight loss Symptoms do not improve with rest o Interventions/treatments NSAIDs or DMARDS (methotrexate) Non-pharmacologic interventions Heat/cold therapy, balance rest & exercise, positioning & PT
Gout o Causes: Uric acid causes an immune response which causes inflammation may be inherited o Symptoms: Swelling and pain, impaired mobility, flank pain, dysuria o Interventions/treatments- KNOW YOUR MEDICATIONS* Elevation Bedrest for the first 24 hours NSAIDs Indocin Colchicine (long term) Allopurinol o Nodule (tophus) Joint inflammation Usually affects one joint (greater toe), but can settle in other joints (systemic) Systemic Lupus Erythematosus (SLE) o Cause Combination of environmental exposure and genetic factors ANA destroys nucleated cells and form large complexes leading to an inflammatory immune response that destroys tissue and organs Systemic progressive inflammatory connective tissue disorder Onset may be acute or slow Periods of remission and exacerbation Affects women 10 times more than men, most often women ages 20- years o Symptoms On remission there may be no signs / symptoms Flare up Fatigue Fever Generalized weakness Dry, scaly, raised “butterfly” rash, on the face and other sun exposed areas Non-severe joint inflammation Alopecia Sjogren’s syndrome o Interventions/treatments Immunosuppressants: methotrexate Non-pharmacologic treatment Avoid prolonged sun exposure & IV light Avoid harsh perfumed substances Cleanse skin with mild soap, thoroughly pat dry, apply moisture Electromyography (EMG)
o What is it? * Measures muscle response or electrical activity in response to nerve’s stimulation of the muscle o What is it for? * Used to detect neuromuscular abnormalities o Why do you do it? * To find out if muscles are responding the right way to nerve signals Bone & Joint health, diagnostics o X-ray Electromagnetic waves creates pictures of the inside of the body o MRI Medical imaging technique that uses a magnetic field and computer- generated radio waves to create detailed images of the organs and tissues in the body Transplants of bone o Allograft Bone or tissue that is transplanted from one person to another o Autograft Bone or tissue that is transferred from one spot to another on the patient’s body Calcium o Too little calcium Children may not reach their full potential adult height Adults may have low bone mass risk for osteoporosis Vitamin D o Fat soluble vitamin o Promotes calcium absorption in the gut and maintains adequate serum calcium and phosphate concentrations to enable normal bone mineralization and to prevent hypocalcemic tetany Zinc o Involved in cellular metabolism o Support immune system o Contributes to wound healing o If deficient, diarrhea, and the cold Other vitamin supplements??? pH o 7.35-7.45 normal range o pH measures hydrogen ions in the blood o balance of pH and bicarbonate is largely controlled by the lungs and kidneys
Respiratory Acidosis o Causes Respiratory depression Anesthesia, overdose, increase ICP, airway obstruction, reduce alveolar capillary diffusion, (pneumonia, COPD, ARDS, PE) Right lung Decrease in pH (lower than 7.35) Left lung Increase PCO2 (increase 48 mmHg) Retention of CO2 by lungs o Symptoms Hypoventilation hypoxia Rapid, shallow respirations Low blood pressure Skin/mucosa pale to cyanotic Headache Hyperkalemia Dysrhythmias (increase in K+) Drowsiness, dizziness, disorientation
Respiratory Alkalosis o Causes Hyperventilation Anxiety PE Fear mechanical ventilation Too little H+ o Symptoms Hyperventilation Increase rate and depth Tachycardia Low or normal blood pressure Hypokalemia Numbness & tingling of extremities Hyper reflexes & muscle cramps Seizures Increase anxiety and irritability Metabolic Acidosis o Causes Increase in H+ production DKA Hypermetabolism Decrease H+ elimination Renal failure Decrease HCO3 production Dehydration Liver failure Increase HCO3 elimination Diarrhea Fistulas o Symptoms Headache Decrease in BP Hyperkalemia Muscle twitching Warm, flushed skin (vasodilation) Nausea, vomiting Decrease in muscle tone Decrease in reflexes Confusion Increase in drowsiness
Metabolic Alkalosis o Causes Increase HCO Antacids admin of sodium bicarbonate Decrease H+ NG suctioning, prolonged vomiting, hypercortisolism o Symptoms Confusion Dysrhythmias Tachycardia from decrease in K+ Compensatory irritability Nausea Vomiting Diarrhea Tremors Muscle cramps Tingling & toes (decreased serum Ca++) Positioning patients, use of assistive devices o Positioning clients with proper alignment in bed Positioning to suit client needs Help client breathe Prevents contractures caused by immobility Medication administration, Dosage calculations AROM* o Active range of motion – those who can help move PROM* o Passive range of motion – those who cannot help move Restraints o Time frames Document every 2 hour for medical restraints Must be removed every 2 hours o Order requirements* 24-hour order (medical restraint)