NUR2571 Professional Nursing II PN2 Final Exam Review.pdf, Exams of Biochemistry

Download NUR2571 Professional Nursing II PN2 Final Exam Review.pdf and more Exams Biochemistry in PDF only on Docsity! 1 NUR2571: Professional Nursing II / PN2 Final Exam Review s/s of fluid overload - Hypervolemia or Over Hydration Cardiovascular Changes • Increased pulse rate • Bounding pulse quality • Elevated blood pressure • Decreased pulse pressure • Elevated central venous pressure • Distended neck and hand veins • Engorged varicose veins • Weight gain Respiratory Changes • Increased respiratory rate • Shallow respirations • Shortness of breath • Moist crackles present on auscultation Skin and Mucous Membrane Changes • Pitting edema in dependent areas • Skin pale and cool to touch Neuromuscular Changes • Altered level of consciousness • Headache • Visual disturbances • Skeletal muscle weakness • Paresthesias Gastrointestinal Changes • Increased motility • Enlarged liver Chvostek’s sign what is it and why is it important - Assessing for hypocalcemia (positive Chvostek’s sign usually occurs with alkalosis) 2 Dehydration – what would you expect lab values to look like The Patient With Dehydration • When possible, provide oral fluids that meet the patient's dietary restrictions (e.g., sugar-free, low-sodium, thickened). • Collaborate with other members of the interprofessional team to determine the amount of fluids needed during a 24-hour period. • Ensure that fluids are offered and ingested on an even schedule at least every 2 hours throughout 24 hours. • Teach unlicensed assistive personnel to actively participate in the hydration therapy and not to withhold fluids to prevent incontinence. • Infuse prescribed IV fluids at a rate consistent with hydration needs and any known cardiac, pulmonary, or kidney problems. • Monitor the patient's response to fluid therapy at least every 2 hours for indicators of adequate rehydration or the need for continuing therapy, especially: • Pulse quality • Urine output • Pulse pressure • Weight (every 8 hours) • Monitor for and report indicators of fluid overload, including: • Bounding pulse • Difficulty breathing • Neck vein distention in the upright position • Presence of dependent edema • Assess the IV line and the infusion site at least hourly for indications of infiltration, extravasation, or phlebitis (e.g., swelling around the site, pain, cordlike veins, reduced drip rate). • Administer drugs prescribed to correct the underlying cause of the dehydration (e.g., antiemetics, antidiarrheals, antibiotics, antipyretics). **specific gravity increase with dehydration What medication is given for high potassium? sodium polystyrene sulfonate (Kayexalate) Diuretic furosemide s/s of circulatory overload aka PULMONARY EDEMA **Monitor Respiratory efforts** The patient will present with acute pulmonary edema when cardiac output cannot be maintained. Other symptoms include, cyanosis, orthopnea, hypertension, headache, tachycardia, chest tightness, and cough. Symptoms set in near the end of the transfusion or within six hours of completion. What if you run out of TPN, what should you have at bedside ready to hang until TPN arrives** **use 10% percent dextrose until pharmacy sends up TPN, also you need to take out of fridge for an hour know ABGs 5 - As COPD advances, FEV and FVC ratio decreased 6 ▪ CXR o Expected reference range is 100% o Mild = <70% o Moderate to severe = <50% - Reveals hyperinflation of alveoli and flattened diaphragm in late stages of emphysema - Often not useful for diagnosis of early or moderate disease ▪ Pulse oximetry - Clients with COPD usually have oxygen levels less than the expected 95%=100% ▪ AAT levels used for AAT deficiency (alpha1 antitrypsin) - A deficiency in a special enzyme produced by the liver that helps regulate other enzymes (that help breakdown pollutants) from attacking lung tissue Pt receiving digoxin nursing interventions • Monitor apical pulse for 1 full minute before administering withhold and call provider if <60 bpm or >100 bpm, or with any changes in rate, rhythm, or quality of pulse • Therapeutic effect is to increase cardiac output and slow HR • Crosses placenta and breast milk • Use cautiously with hypokalemia, hypercalcemia, hypomagnesemia, diuretic use, hypothyroidism, myocardia infarction, renal impairment, obesity, • Adverse rxn/Side effects o Fatigue, bradycardia, anorexia, nausea, vomiting, arrythmias • Toxicity o Confusion, irregular pulse, loss of appetite, nausea, vomiting, diarrhea, tachycardia, visual changes (uncommon) such as blind spots, blurred vision, color changes, seeing spots Dopamine in CHF what should the patient vitals be if the medication is working • low dose dopamine protects renal fxn during vigorous diuresis for CHF associated with renal insufficiency • helps circulate oxygen-rich blood more efficiently • increases amount of urine the body produces to help body rid of extra fluid building up in lungs, arms, and legs • raises BP • BP should be normal if mediation is working (meaning 120/80 or around that) Administering blood to CHF pt what should you pay close attention to • Pay attention to fluid overload (Lasix in between each unit) s/s right sided heart failure vs left sided heart failure Left to Lungs, right to everything else 7 education of patient with new diagnosis of heart failure notify provider of rash or decreased sense of taste notify provider if swelling of face or extremities occur remind client that BP needs to be monitored for 2 hours after initial dose to detect hyptotension take meds as prescribed take diuretics in morning and early afternoon maintain fluid and sodium restriction increase dietary intake of potassium (cantaloupe or bananas) if taking potassium-losing diuretics, such as loop/thiazides check weight daily at the same time, notify of 2lbs. gained in one day or 5lbs. in one week schedule regular follow-up visits get vaccinations (pneumococcal and yearly influenza) stop smoking know worsening sx such as dyspnea, persistent cough or wheezing, edema, tiredness/fatigue, decreased appetite nausea, increased HR 10 NURSING ACTIONS RATIONALES After Infusion 12. When the transfusion is completed, discontinue infusion and dispose of the bag and tubing properly. Bloodborne pathogens may be spread inadvertently through improper disposal. 13. Document. The patient record should indicate the type of product infused, product number, volume infused, time of infusion, and any adverse reactions. pernicious anemia how is it diagnosed and treatment of it Vitamin B12 deficiency anemia results in failure to activate enzymes that move folic acid into precursor RBCs cells so cell division and growth into functional RBCs can occur. These precursor cells then undergo improper DNA synthesis and increase in size. This type of anemia is called megaloblastic or macrocytic anemia because of the large size of these abnormal cells. Causes of vitamin B12 deficiency include vegan diets or diets lacking dairy products, small bowel resection, chronic diarrhea, diverticula, tapeworm, or overgrowth of intestinal bacteria. Anemia resulting from failure to absorb vitamin B12 (pernicious anemia) is caused by a deficiency of intrinsic factor (a substance normally secreted by the gastric mucosa), which is needed for intestinal absorption of vitamin B12. Vitamin B12 deficiency anemia may be mild or severe and usually develops slowly. Indications of this type of anemia include pallor and jaundice, glossitis (a smooth, beefy-red tongue) (Fig. 40-3), fatigue, and weight loss. Patients with pernicious anemia may also have paresthesias (abnormal sensations) in the feet and hands and poor balance. **Treatment Vitamin B12** ulcerative colitis assessment of patient how would anemia develop HIV lab test and count know normal Zidovudine what is it and what complications should you watch for What is candidiasis and in what disease processes does it occur Thrush How is HIV transmitted Unprotected sex, passed from mother to baby, needles, contaminated blood What is Kaposi sarcoma A cancer that causes lesions in the soft tissues. 11 What is a sedimentation rate and what does it measure and normal values Prednisone what foods should people consume when on this medication and why Rheumatoid arthritis patient and methotrexate education RA clinical manifestations Major effects of long term glucocorticoid use Systemic lupus what aggravates episodes and what helps this process, assessment of this patient , hydroxychloroquine what is it how does it work and side effects What is lupus nephritis Lupus nephritis is inflammation of the kidney that is caused by systemic lupus erythematous (SLE). Also called lupus, SLE is an autoimmune disease. Withlupus, the body's immune system targets its own body tissues. Lupus nephritis happens when lupus involves the kidneys. Discharge instructions for patient with SLE Otitis media s/s 12 What are timolol gtts used to treat Are drops to decresase the pressure of the eye for Glaucoma Myasthenia gravis s/s • S/S: mild diplopia (double vision) and unilateral ptosis (eyelid drooping) caused by weakness in extraocular muscles, weakness may also involve face, jaw, neck and hip • Complications arise when severe weakness affects muscles of swallowing, chewing and respiration, respiratory distress is manifested by tachypnea, decreased depth,abnormal ABGs, 02sat under 92% and decreased breath sounds • Bowel and bladder incontinence, paresthesias, and pain in weak muscles • Myasthenic crisis: sudden motor weakness, dyspnea with risk of resp failure, absent cough and swallow reflexes (risk of aspiration), incontinence of B&B most often caused by insufficient dose of medication Discharge instructions for cataract surgery Do eye drops as prescribed, watch for hemorrhage indicated by sudden sharp pain s/s of cataract formation Signs and symptoms of cataracts include: • Clouded, blurred or dim vision • Increasing difficulty with vision at night • Sensitivity to light and glare • Need for brighter light for reading and other activities • Seeing "halos" around lights 15 • Maintain effective breathing • Monitor meals, teach pt. to bend head slightly forward while eating and drinking to improve swallowing • Avoid people with resp. infections pt with herniated cervical intervertebral disk s/s carbamazepine what is it used for and side effects what is a tensilon test and what does it show Test is to confirm MYASTHENIA GRAVIS Diagnosis is confirmed with IV edrophonium chloride, which allows acetylcholine to bind with receptors and temporarily improves symptoms, weakness return after effects of tensilon wear off C5 fracture what can patient do ATI Question for this: A nurse is developing a plan of care for a client who has a spinal fracture and complete spinal cord transection at the level of C5. Which of the following rehabilitation goals should the nurse add to the clients’s plan of care? Answer: Ability to self-feed with the use of adaptive equipment What is a brudzinski sign Guillian barre what is it what is caused from s/s treatment 16 • S/S: weakness or paresis or partial paralysis progressing upward from lower extremities(paralysis in GB is from ground to brain)about 20% end up with respiratory paralysis requiring vent • Paresthesias (numbness and tingling) and pain • Muscle aches, cramping and nighttime pain • Resp. compromise and or failure • Difficulty with extraocular eye movements, dysphagia, diplopia, difficulty speaking • Autonomic dysfunction (orthostatic hypotension), hypertension, change in HR, B/B dysfunction, flushing, and diaphoresis • Diagnostic; nerve conductiontest results are diminished, elevated protein in CSF • Management: supportive care • Plasmapheresis: plasma is removed and separated from whole blood; blood cells are then returned without plasma to remove antibodies that cause disorder • Monitor resp rate, depth BS and vital capacity, secretions, gag reflex and swallowing • Monitor CV status Alzheimer’s nursing care of these patients What are clinical manifestations of primary dementia MSE exam for dementia what is the criteria What clinical manifestations seen in moderate phase of dementia Adverse effects of gingko balboa Donepezil for Alzheimer’s education about taking this med should include what Diverticular diseases s/s, foods patient should eat, foods to stay away from Exacerbation of ulcerative colitis lab values, foods to avoid and foods to eat 17 Hyperthyroidism and thyroid crisis how to treat Hyperthyroidism what assessment results What lab values to watch in patient with primary hyperthyroidism Myxedema coma nursing interventions Post op thyroidectomy what lab values are important Graves disease what lab values diagnose Hypothyroidism medication use Position for a post thyroidectomy patient Diabetes, insulins used when, s/s hypoglycemia and hyperglycemia, know when to use glucagon and when to use CHO, know insulins, know difference between type I and type II diabetics, foot care, diabetic and influenza vaccine, s/s of diabetic ketoacidosis, insulin pump what is only type of insulin that can be used in pump and given IV, nursing interventions for a patient with diabetic neuropathy, how to reduce risks of complications from DM, risk factors for developing type II diabetes, s/s of uncontrolled type I diabetic, Psoriasis treatment Complications of phototherapy in treatment of psoriasis Asthma exacerbation what is treatment How a patient should be taught to use a metered dose inhaler s/s of patient with emphysema theophylline what is it used for and patient education while taking this medication dietary education for COPD patient side effects of fluticasone use things to do before you suction a patient on a vent isolation for TB patient ATI Question: A nurse is admitting a client who has active tuberculosis to a room on a medical-surgical unit. Which of the following room assignments should the nurse make from the client? Answer: a room with air exhaust directly to the outdoor environment nursing education for rifampin and pyrazinamide, side effects, lab values, ex pected effects diagnostics for TB, clinical manifestations of TB Parkinsons medication used to treat Selegiline used to treat what type of drug is it and what foods need to be avoided