NR601 Final Exam Study Guide 2024 Chamberlain College of Nursing, Exams of Nursing

Download NR601 Final Exam Study Guide 2024 Chamberlain College of Nursing and more Exams Nursing in PDF only on Docsity! NR601 Final Exam Study Guide 2024 Chamberlain College of Nursing Genitourinary Disorders o Urinary incontinence - know the types and how to differentiate them; Urge Incontinence-Leakage preceded by urgency-inability to store urine because of uninhibited contractions of the bladder muscle. Stress Incontinence-Leakage with effort, exertion, sneezing, or coughing-inability to store urine because of inadequate sphincter closure. Mixed incontinence-Presence of both urgency and stress symptoms-combination of urge and stress physiology. Nonspecific- predisposing factors for each type; Urge incontinence- Diabetes, musculoskeletal disease, CVA, Dementia, MS, Normal-pressure hydrocephalus, Parkinson’s disease, Spinal cord injury, Spinal stenosis Stress Incontinence-pulmonary disease medications that contribute to this issue; Alcohol-, Alpha-adrenergic agonists (Clonidine)-outlet obstruction in men, alpha-adrenergic blockers (Cardura, Tamsulosin)-stress leakage in women, ACE inhibitors (Lisinopril)- associated cough worsens stress incontinence, Anticholinergics (Cogentin, Benadryl)-impaired emptying, retention, Antipsychotics (Risperidone) anticholinergic effects, rigidity and immobility, CCBs (Diltiazem) impaired detrusor contractility and retention, Cholinesterase inhibitors (Aricept)-urinary incontinence, Estrogen-worsens stress and mixed leakage in women, Gabapentin, pregabalin(Neurontin, lyrica)-pedal edema causing nocturia nighttime incontinence, Loop diuretics(Lasix)- polyuria, frequency, urgency, Narcotic analgesics (hydrocodone)-urinary retention, NSAIDS (ibuprofen, aleve)-pedal edema causing nocturnal polyuria, Sedative hypnotics (Ambien)-sedation, delirium, immobility. Thiazolidinediones (Actos)- pedal edema causing nocturnal polyuria, Tricyclic antidepressants (Amitriptyline, Tofranil)-anticholinergic effects, sedation. treatments. Lifestyle- (All types)-weight loss, reducing caffeine and alcohol intake, decreasing fluid intake before bed, smoking cessation, earlier dosing of loop diuretics. Behavioral-(Urge, stress, mixed)- bladder training (timed voiding), pelvic muscle exercises. Medications (Urge, urge-predom stress) Prescribe only if BT/PME fail to achieve desired outcome. Antimuscarinic drugs (Oxybutynin- Ditropan), beta-3 agonist (mirabegron-Myrbetriq). Minimally invasive procedures -(Refractory urge, stress not responsive to behavioral or medications)- Botulinum toxin injections to detrusor through cystoscopy, sacral nerve modulation- percutaneous implant of trial electrode at the s3 sacral root if it works permanent lead with pacemaker is implanted, percutaneous tibial nerve stimulation Surgery-(Stress-gold standard with highest cure rates)-colposuspension (Burch procedure) and proximal or mid urethral slings. Periurethral coaptate injection o Urinary tract infection - signs and symptoms; suprapubic pain, dysuria, frequency, and urgency. Flank pain, CVA tenderness, and fever are typical of upper UTI or pyelonephritis. first line treatment; Cystitis- Nitrofurantoin 100mg BID x5 days, TMP/SMZ DS x 3 days- (avoid if UTI in past 3 months), Fosfomycin 3 gm single dose, pivmecillinam 400mg BID x 5 days. Pyelonephritis- Ciprofloxacin 500mg BID x 7 days, Levofloxacin 750mg QD x 7 days, TMP/SMZ DS x 14 days, betalactam 10-14 days. best indicators bacteriuria, pyuria, o Benign prostatic hyperplasia - physical exam findings and common symptoms; DRE may reveal enlarged, smooth, rubbery, symmetric prostate, if hyperplasia involves only the transitional zone, DRE is unremarkable. Symptoms- incomplete bladder emptying, frequency, intermittency, urgency, weak stream, straining, nocturia medications for treatment and their side effects; alpha-blockers (terazosin, tamsulosin)- ejaculatory dysfunction 5-alpha-reductace inhibitors (Finasteride, dutasteride)- decreased libido, erectile dysfunction, ejaculation dysfunction, gynecomastia, breast tenderness. phosphodiesterase-5 inhibitors- (Viagra, Cialis)—headache, dyspepsia, and back pain. lifestyle changes avoidance of caffeine and alcohol, avoiding fluid intake 2 hrs before bed, avoidance of carbonated beverages and artificial sweeteners, keeping a bladder diary, o Prostate cancer - when to screen - PSA and DRE men aged 50-70. exam findings palpable lesion, elevated PSA o Erectile dysfunction - relationship to male sexuality; contributes to decreased sexual activity but is not a part of healthy aging risk factors vascular disease, diabetes, hypertension, hyperlipidemia, smoking, atherosclerotic arterial disease, neurological disorders affecting the sacral spinal cord, medications with anticholinergic effects (antidepressants, antipsychotics, antihistamines). o Menopause - GSM treatment-vaginal moisturizers- topical estrogen if symptoms are persistent or severe. Sexuality o Sexual health & older adults - changes versus the younger population—sexual interest does not decline. Immediate erections (males) and lubrication (females) decreases with age o Sexually transmitted infections in the general population increasing rates of syphilis, chlamydia and gonorrhea in older population, less than 10% condom use in this demographic and in special populations (e.g., HIV) MSM have higher risk of HIV, WSW have higher risk of chlamydia o Screening Tools in the general population immunizations-flu, TDAP, veracella, pneumococcal. DEXA scan for bone density after age 65 for women, after age 70 for men. Mammogram every 2 years for women age 50-74, colonoscopy o Major depressive disorder - symptoms in older adults versus younger populations; chronic pain, lower quality of life, and increased disability- somatic complaints (often Gl), illness anxiety, irritability . more likely to have psychotic and severe depression with weight loss and decreased appetite. LESS LIKELY TO HAVE LOW SELF ESTEEM OR GUILT. best first line treatments for older adults SSRI (sertraline) or SNRIs (venlafaxine) o Sleep disorders - risk factors-substance related and addictive disorders, anxiety, depressive disorders, bipolar, OCD, trauma and stressor related disorders, somatic symptom and related disorders. medication effects-low dose doxepin safe, ramelteon-safe, Z-drugs-adverse outcomes in driving safety, falls and fractures, cognition, sedation, and physiologic dependence. sleep hygiene -engage in at least 20 min per day low-intensity exercise, exposure to natural light in afternoon, limit screen time, keep regular bed time, make sure bedroom is dark and quiet, bed is for sleeping and sex, get out of bed if you cant fall asleep, avoid caffeine, nicotine, and other stimulants after dinner, limit fluid intake after 6pm, avoid foods that may be disruptive before sleep, avoid naps, if you nap keep it less than 30 minutes / day. 1. Obstructive sleep apnea - diagnosis and treatment-polysomnography is gold standard testing and diagnosis. When sum of apneas and hypopneas is greater than 5 per hour OSA is present. C-PAP or APAP is standard treatment. If this is not tolerated, oral appliance to maintain airway ok for mild disease. Extremely severe OSA- surgical evaluation- maxillomandibular advancement, laser-assisted uvulopalatoplasty (LUAP), Uvulopalatopharyngoplasty UPPP, radiofrequency ablation, pharyngeal implants, implanted hypoglossal nerve stimulation, and tracheostomy. Palliative and Hospice Care o Difference in care/focus palliative versus hospice care-Palliative care is appropriate for any patient with a serious condition who prefers to focus on symptom management v/s cure focused management. Hospice care is intended for patients at end of life with a terminal condition with life expectancy 6 months or less. o Palliative care treatment of depression—multifocal treatment-counseling spiritual support, exercise and meaningful work. SSRIs, stimulant like methylphenidate if patient has shorter life expectancy, anorexia-not discussed in the book. Physiologic Changes of Aging o Know the stages of frailty and what are the hallmarks of each stage-PREFRAILTY- can be reversible FRAILTY-unintentional weight loss, self-reported exhaustion, weakness (reduced grip strength), slow walking speed, low physical activity. o Risks of frailty-hospitalization, inpatient mortality, loss of ADLs, increased physical limitations, falls and fractures, nursing home placement o Pain/discomfort assessment and treatment- musculoskeletal complaints often underreported -assumed normal aging. Caution with analgesia-BEERS criteria. Psychosocial Changes of Aging o Psychosocial and developmental theories - Disengagement theory, activity theory, continuity theory, Eriksons stages of development, Bandura’s self-efficacy theory. know what patient behaviors align with each theory; DISENGAGEMENT THEORY— withdrawal from relationships, stops participating in social activities; ACTIVITY THEORY—maintains social interaction and activity. May continue working, or volunteer; CONTINUITY THEORY—maintains same levels of activity, relationships, etc as when they were younger. Aging in place is primary consideration family support actions. Health Disparities, Cultural Competence, and Health Promotion o Components of informed consent-disclosing information, assuring voluntariness, assessing competency and competency- understanding of information, appreciation of the information, reasoning with the information, expressing a choice. o Cultural competence - a set of congruent behaviors, attitudes, and policies that come together in a system, organization, or among professionals that enables effective work in cross-cultural situations cultural humility—dynamic and lifelong process; places emphasis on addressing power imbalances and promotes interpersonal sensitivity through partnerships with and learning from patients. hallmarks of therapeutic clinician relationships—respect and congruence with values and beliefs. Providers should maintain an awareness for opportunities and the need to identify the potential for cross-cultural exchanges o Dealing with medical error-disclosure is an ethical obligation. 1-disclose the occurrence of the error, explain the nature of the potential harm and provide the information needed to enable the patient to make informed decisions about future medical care. 2. Acknowledge the error and express professional and compassionate concern toward the patients 3. Explain efforts that are being taken to prevent similar occurrences in the future 4. Provide for continuity of care of patients who have been harmed o Health promotion = Wellness visits-one welcome to medicare visit within first 12 months, and annually = Medication reconciliation—should be done with each encounter. Accurate knowledge of medications is crucial to appropriate prescribing. = Immunizations - Pneumococcal -1 dose PPSV23 (consider 1 dose PCV 13 in high risk patients. ) = Screenings- bone density (DEXA), Colorectal CA (colonoscopy), Prostate CA (DRE, PSA), breast CA (mammogram), lung CA (LowDose CT) = Smoking cessation - assistive treatments; pharmacotherapy in combination with counseling most successful. 5 As-assess, advise, agree, assist, and arrange. Nicotine replacement (gum, patch etc), bupropion SR, Varenicline (Chantix). chemoprevention for upper airway CA- not discussed in the book = Surveillance after cancers - colon CA, breast CA- not discussed in the book o Elder Abuse - ageism by the public and health professionals Federal funding for programs that support older adults-Medicare (part A-inpatient/SNF-no premium) (Part-B-outpatient/preventative-monthly premium) (Part-C-medicare advantage/replacement plans)(Part D-prescriptions-monthly premium). Medicaid- must be at or higher than 133% of the federal poverty level (Below poverty level) Veteran’s health-all healthcare covered-if outside 40mile radius of nearest VA may use community provider- combine with medicare and medicaid Other topics Pneumonia - know CURB-65 and how to apply to clinical scenarios Community-Acquired Pneumonia Severity Score=CURB-65 1 point per factor. Confusion Disoriented person, place, time Uremia >20 mg/dL RR > 30 bpm Low BP S/D 90/60 Age > 65 Increased age 0-1 outpatient, 2 inpatient 3-5 ICU