NUR 2349 / NUR2349 Final Exam Review (Latest 2021 / 2022): Professional Nursing I / PN 1 -, Study Guides, Projects, Research of Nursing

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NUR2349 Final Exam Review

- Pt that transfers form one floor to another floor o If they tell you hey I got pain, vitals support it, you need to assess them. Even before talking to doctor you should check the orders because maybe they have an order for something to take - Know Potassium levels, Calcium Levels o Calcium levels should be 8.6-10.2 mg/dl ▪ Low is hypocalcemia ▪ High is hypercalcemia o Potassium levels are 3.5-5. ▪ Low is hypokalemia ▪ High is hyperkalemia - S/S malignant hypothermia

o Is an inherited muscle disorder due to a complication from certain drugs or anesthesia o S/S ▪ Caused by increased muscle calcium and increased metabolism ▪ Include tachycardia, dysrhythmias, muscle rigidity of the jaw and upper chest, hypotension, tachypnea, skin mottling, cyanosis, and myoglobinuria (muscle proteins in the urine). ▪ The most sensitive indication is an unexpected rise in the end-tidal carbon dioxide level with a decrease in oxygen saturation and tachycardia

- Imagery use with your patient, why and what it is o It is the use of words to guide the imagination in positive wats o It is used for distraction of patients - Conversion question—F to C o F to C: (X-32) * 0.5556=C o C to F: (C x 1.8) + 32=F - Why do we put hats on babies? o Don’t want the heat to go away, maintain body temperature, most of the heat is coming from the baby’s head - Hypothermia—different ways it can happen o Little skinny baby at risk because of not a lot of insulation o Newborn want to be fatter so it can help with insulation - Having bad abdominal pain, ask about something they like, like family o Severe pain you can talk to them but they won’t hear you, lack of inability to focus with so much pain o Select the right time to talk to them so they can concentrate - Different types of pain and the causes o Intractable ▪ Is unrelating or severe constant pain that is hard to control

o Neuropathic ▪ Unknown cause ▪ Used to refer to pain that is believed to be sustained by a set of mechanisms drive by damage to or dysfunction of the PNS and/or he CNS ▪ Example: Burning hand pull hand away from the stove) o Chronic ▪ Unknown cause ▪ Result of faulty process ▪ After 6 months o Nociceptive ▪ The result of actual or potential tissue damage or inflammation and is often categorized as being somatic or visceral. Somatic pain arises from the skin and musculoskeletal structures, and visceral pain arises from organs. ▪ Examples include pain-associated trauma, surgery, burns, and tumor growth. o Visceral ▪ Pain that arise from organs ▪ It a type of nociceptive pain, which means that is caused by medical conditions that produce inflammation, pressure, or an injury.

- Opioids

o Opioids produce their effects by interacting with opioid receptor sites located throughout the body, including in the peripheral tissues, the GI system, and the spinal cord and brain. When an opioid binds to the opioid receptor sites, it produces analgesia and unwanted effects such as constipation, nausea, sedation, and respiratory depression o Constipation SE o Pt education to avoid ▪ Dietary changes

• Exercise increasing fiber in diet, increase fluids use stool softeners if necessary last resort - Taking vitals o Off VS reading, do it again, and then ask them about it, did they do something to cause it to be elevated? - Different type of therapy o Mind-body types ▪ Ex: Meditation, Acupuncture, Relaxation, Massage, Music, Pet therapy, Guided imagery, Prayer - Proper interventions with pt who has fever o Antipyretics o Analgesics o Hydration

o Cooling packs

- What to do if assess pain of pt who doesn’t speak English o Warren Baker Face pain scale - S/S Hyperthermia o - Pt and using techniques to bring fever down, what happens if they start to shiver o Tepid bath o You should stop and assess o Shivering means the body is cooled to quickly o Do not give heated blanket - Why do we have pain? o Indicated something is wrong, protective for us - Pain can trigger physiological stress responses with the body o Heart increase o BP elevated o Produces the cascade of harmful effects ▪ Stress hormones ▪ Cortisol ▪ Glucagon ▪ Insulin ▪ Testosterone levels - Mall walking o Climate control for older adult because of the weather, safer - How come we don’t give meds like Demerol for chronic pain o Doesn’t last long and easy addiction - Best way we can assess the core temp of a pt o Rectal - Exemplars of hypothermia o Prematurity o Frostbite o Brain injury o Environmental exposure - Heat exhaustion and Heat stroke and infection o Hyperthermia examples - Methadone is for? o Cheap drug o Helpful for heroin addicted patients while detoxing o How it acts and what it does for the body? ▪ o Effects on brain ▪ Binds to the opioid receptors in the brain to black the pain response

▪ Methadone can also be used to treat chronic pain

- Someone is sick with fever o No fans in the room because ▪ Circulate more infection/germs in the air - Classifying and documenting fevers o Constant ▪ Fever is constant

o Intermittent

▪ Fluctuate widely over 24 hours ▪ Fever comes and goes o Relapsing

▪ Relapsing fever refers to two similar illnesses, both of which cause high fevers. The fevers resolve, only to recur again within about a week.

• Most likely caused by bacteria of the borrelia species. o Remitted fever ▪ A fever pattern in which temperature varies during each 24-hour period but never reaches normal. Most fevers are remittent and the pattern is not characteristic of any disease, although in the 19th century it was considered a diagnostic term. - Pt with fever o Hyperthermia o At risk for: Hypovolemia ▪ Decreased of circulation blood volume - Never give aspirin to children o Put’s them at risk for Reyes syndrome - If kid is sick o DO NOT keep them covered **- Antibiotics DO NOT work for a virus
• Meds with adverse reactions to NSAIDS** o Blood thinners ▪ Coumadin, warfarin, anticoagulants, Lovanox, Plavix o At risk for gastric bleed - Pain types o Breakthrough ▪ Breakthrough and can be really strong, controlled o Intractable ▪ We can’t get a handle on the pain. Is resistant to different therapies. Uncontrollable o Psychosomatic ▪ Can’t find a reason for it, psychological reason o Acute ▪ Sudden pain and resolves within 6 months

o Chronic ▪ Persistent lasting more than 6 months ▪ Pain management is aimed at keeping them at a decent level

- Impaired thermoregulation risk factors o - Stereotypical question o Chinese lady on vitamins and takes care of her body example - Hypothermia—Kid fell through a pond and you get him out, what do you do? o Get the wet clothes off to not lose heat o 5X greater heat loss when clothes are wet o Wear wool - Your giving someone IV narcotic/opioid and they are getting very tired and hard to arouse, not responding to physical or verbal simulation o You need to FIRST stop o Considered giving Narcan ▪ Take time to work, they can be confused and combative when they come to o Call code blue right away o Not breathing well, bag them - Why always ask about pain o It is a vital sign, the fifth one, asses routinely - Narcan/Naloxone o Breathing and respirations are slow - 5 C’s pain management o Comprehensive assessment o Consistent use of tools o Continuous reassessment o Customize plan of care o Collaboration - Med to admin during a malignant hyperthermia situation, medical emergency? o Give Dantrolene o Hyperventilate, use oxygen - How come old people get cold easier o Skinny o Circulation poor o Slow metabolism - Addiction o Compulsive engagement in a rewarding stimuli despite adverse effects - Physical dependence o Physical condition caused by chronic use of tolerance forming drugs, in which abrupt or gradual drug withdrawal causes unpleasant physical symptoms

- Pseudoaddiction o A patient asking for more pain medication due to pain but it appears to the healthcare providers that they are addicted due to drug seeking behaviors but will go away when pain is managed. In true addiction the pt will use drugs even after pain resolves. - Tolerance o Diminished effects of medication due to repeated use - After a shot o It is okay to have redness and hurt some - Thick medication and give an injection o Inject it slowly o Inject quick it hurts a lot o Ex Penicillins, Rocephin - Expressive aphasia is o Is a loss of ability to verbally communicate but pt is still able to understand what is being said. AKA Broca’s Aphasia