ATI MEDSURG B STUDY GUIDE (DOWNLOAD FOR GRADE A) 1) Inflammatory Bowel Disease: Dietary Recommendations (583) • low fiber • increased protein •
... [Show More] decreased calories Ulcerative Colitis and Crohn’s Disease • Eat foods high in protein and calories, and low in fiber • Identify foods that trigger clinical manifestations • Avoid caffeine and alcohol, take multivitamin w/ iron • Eat small frequent meals • Dietary supplements high in protein and low in fiber • Monitor for electrolyte imbalance especially potassium • Vitamin B12 Diverticulitis • Consume clear liquid until manifestations subside • Add fiber when solid foods are tolerated • Avoid seeds or indigestible material that can block diverticula (nuts popcorn) • Avoid alcohol. Limit fat intake to 30%, adequate fluids, bulk forming laxatives 2) Respiratory Management and Mechanical Ventilation: Need for Suctioning • Suction secretions to maintain airway and tube patency 3) Disorders of the Eye: Expected Findings (122) • Retinal detachment- flashes of light and blind spots curtain closing over eyes • Glaucoma- increased IOP causing gradual vision loss • Injury. Disease process, aging process • Macular degeneration(#1 cause of vision loss in ppl over 60), cataracts, glaucoma • MD: lack of depth perception, object distortion, blurred vision, loss of central vision, blindness • Cataracts: decreased visual acuity, blurred vision, diplopia, photo sensitivity, halo around lights, visible opacity, absent red reflex • Glaucoma: headache, mild eye pain, loss of peripheral vision, inc. IOP, photophobia, pupils non reactive to light 4) Disorders of the Eye: Analyzing Findings • IOP: 10-21 mm/Hg • Monitor for IOP • -monitor for decreased vision and light sensitivity • -Assess pt for aching or discomfort around the eye • -Tx severe plain and nausea with analgesics and antiemetics 5) Arthroplasty: Prevent complication- DVT, anemia, -Older adults @ higher risk CPM Prevent pressure ulcers Using a Continuous Passive Motion Machine • Promote motion and prevent scar tissue formation • Avoid flexion of hip greater than 90 degrees, don’t cross legs, abduction pillow, raised toilet seat • -Full extention to perscribed amt of flexion • -Placed and initiated right after surgery • -stopped for meals 6) Cancer Disorders (981) Laryngeal Cancer and Body Image Disturbance Consult speech language path. for clients who have difficulty speaking -Provide comfort to pt who have permenant loss of voice or disfigurment -Refer to counseling servcies as needed 7) Burns: Prioritizing Emergency Interventions (829) Airway -fluid and electrolyte -thermoregulation -infection • Maintain Airway and Ventilation (cough deep breathe, suction, elevate head of bed, oxygen), • monitor vitals • maintain cardiac output (IV access, fluid replacement in first 24 hours, rapid replacement during emergent phase, isotonic crystalloid solutions such as NaCl or Lactated Ringers, colloids such as albumin or synthetic plasma expanders after first 24 hours. Maintain urine output, possible administration of blood products), • monitor for shock, pain management (avoid IM or Sc administration, IV opioid analgesics, monitor for respiratory depression, meds before dressing change, nonpharm pain management), • prevent infection (restrict visitors, no plants or flowers, no fresh fruits or vegetables), • nutritional support( may need increased calories up tp 5,000, increase protein, may need TPN, ) • Restore mobility, • psychosocial support 8) Electrolyte Imbalances: (472) Safety, abc’s Evaluation of Potassium Chloride Therapy - hypokalmeia Never administer by bolus, 5-10 mEq/hr Assess for phlebitis Monitor urine output Diminished respirations and breath sounds Monitor cardiac rhythm (especially pts taking Digoxin), LOC, bowel sounds, kidney function, mg ca phosphorus, provide assistance with ADLs 9) Cardiovascular Diagnostic and Therapeutic Procedures: (294) Assessing Arterial Line (296) check placement -keep pressure -flush before between and after meds -watch for clotting Assess integrity of arterial waveform, monitor circulation in the limb with the line( cap refill, temp, color). Monitor respiratory and cardiac status, placement, prevent infection and blood clots 10) Cardiovascular Diagnostic and Therapeutic Procedures: (349) ECG Abnormalities Following Myocardial Infarction (351) Angina- ST depression/ T wave inversion indicates ischemia MI- T wave inversion indicates ischemia, ST segment elevation indicates injury, abnormal Q waves indicates necrosis 11) Head Injury: Monitoring CSF Leakage • Leakage from nose or ears • "halo" sign- yellow stain surrounded by blood on a paper towel, • fluid tests positive for glucose -report to dr 12) Diabetes Mellitus Management: (914) Client Education Regarding Medications Rotate injection sites, don’t aspirate for blood Eat at regular intervals, avoid alcohol intake, adjust insulin to exercise Take even if can't eat. -Clear-cloudy-cloudy- clear pull in short acting first then long acting -Must eat after injection or will have hypoglycemia 13) Tuberculosis: Client Teaching Regarding Medication Therapy Must take for 6-12 months No alcohol, may interfere with BC, report yellowing skin, drink lots of water, notify provider with vision or hearing changes 14) Aneurysms: 434 Signs and Symptoms of Aortic Dissection Aortic Aneurysm Gnawing feeling in abdomen, flank or back pain, Pulsating abdominal mass (do not palpate) Bruit. Increased BP -Severe back pain -Hoarsness, cough, SOB, difficulty swallowing -Decreased urinary output Aortic Dissection Sudden stabbing, tearing, ripping, abdominal or back pain Hypovolemic shock (diaphoresis, nausea, vomiting, faintness, apprehension) decreased or absent peripheral pulses, neuro deficits, hypotension and tachycardia (initially) 15) Hemodialysis and Peritoneal Dialysis: Complications (640) Hemodialysis: clotting, air bubbles, temperature of dialysate, regulation of ultrafiltration, hypotension, cramping, vomiting, bleeding, contamination, hypovolemia, disequilibrium syndrome. clotting/Infection of access site -Disequilibrium syndrome -use slow exchange rate - Administer anticonvulsant/barbituates if needed -Hypotensoin -IV fluids -Decreased HOB -Anemia -Monitor labs and provide blood products as needed -Infectious Diseases Peritoneal Dialysis: peritonitis, infection at access site, leakage, reflux, protein loss, hyperglycemia, hyperlipidemia, hypertension, obstruction 16) Peptic Ulcer Disease: Complications (549) Perforation/Hemorrhage: severe epigastric pain spreading across abdomen, rigid board like abdomen, hyperactive to diminished bowel sounds, rebound tenderness Pernicious anemia: pallor, glossitis, fatigue, paresthesia. Will need B12 injections. Dumping syndrome: syncope, pallor, palpitations, dizziness, headache -Heartburn, bloating, N&V -Pain, bloddy emisis or stools -weight loss, med. side effects 17) Fluid Imbalances: (473) Prioritizing Assessment Findings Safey, abc’s 18) Hemodynamic Shock: Ventricular Fibrillation (423) can cause cardiogenic shock -Dx- ECG, Ech, CT, Cardiac cath, chest x ray -Tx- Cardiac cath, Anticoagulants, defib shock to fix rythem 19) Acute Kidney Injury and Chronic Kidney (674) Disease: Evaluating Client Understanding Drink2 to 3 L, stop smoking, lose weight, NSAIDS with caution, diabetic and HTN control, take prescribed antibiotics. High protein diet, restriction during oliguric phase, potassium and sodium restriction according to stage of disease -Instruct pt to take ALL prescribed meds and ATB -Decreased dietary potassium, phosphate, and mag. -Increase protein, possible TPN 20) Gastrointestinal Therapeutic Procedures: (523) Teaching Colostomy Care Educate and a support person Odor causing foods: fish, eggs, asparagus, garlic, beans, and dark green leafy vegetables Gas causing foods: dark green leafy vegetables, beer, carbonated drinks, dairy products, and corn. Yogurt may decrease gas Ostomy involving small intestine: avoid high fiber foods for first 2 months, chew food well, increase fluids, and evaluate for blockage with addition of fiber Filters, deodorizers, or breath mint can minimize odor when pouch is open Encourage client to look at and touch stoma Normal stoma appearance, symptoms of blockage 21) Respiratory Management and Mechanical Ventilation: (199) Complications Following Extubation RR > 30/min or <8/min -BP or HR changes >20% baseline -SaO2 <90% -Dysrhythmias, increased ST segment -Sig. decrease in tidal volume -Labored resp. and increased use of accessory muscles -Restlessness, anxiety, decreased LOC -Monitor for resp. destress or airway obstruction such as ineffective cough, dyspnea, and stridor 22) Heart Failure and Pulmonary Edema: 361 Manifestations of Left-Sided Heart Failure Dyspnea, orthopnea, fatigue Displaced apical pulse, S3 heart sounds Pulmonary congestion(dyspnea, cough, pink frothy sputum) Altered mental status Manifestations of organ failure such as oliguria 23) Postoperative Nursing Care: Using an Incentive Spirometer (1104) Use at least every 2 hours. Promotes lung expansion, prevents atelectasis 24) Peripheral Vascular Diseases: (394) Clinical Manifestations of Thoracic Outlet Syndrome Discoloration of hand, arm pain and swelling, blood clots, lack of color in hand or arm, weak or no pulses, arm fatigue, numbness or tingling in fingers, weakness of arm or neck, lump near collarbone, weakening grip Neck, shoulder, and arm pain, numbness -Impaired circulation and flushed sensations to the extremities -Symptoms are reproduced when arm is positioned above the shoulder or extended 25) Cancer Treatment Options: (999) Dietary Considerations for a Client who has Stomatitis Use non-alcoholic glycerin based mouth wash Discourage consumption of salty, spicy, acidic foods Eat soft, bland foods high in calories (mashed potatoes, scrambled eggs, cooked cereal, milk shakes, ice cream, frozen yogurt, bananas, breakfast mixes) Oral hygiene before and after meals 26) Blood and Blood Product Transfusions: (450) Infusion of Autologous Salvaged Blood 5 weeks up to 72 hours in advance Salvaged blood from surgery can be recycled through cell-saver machine and transfused prescribed 27) Cardiovascular Diagnostic and Therapeutic Procedures: Cardiac Catheterization Postoperative Care (294) Apply an initial dressing of gauze and replace with transparent dressing w/i 24 hr -x ray to ensure placement -assess q8hr - Use 10mL or < syringe to flush -Clean port for 3 seconds and allow to dry -flush before, between, and after meds - no BP on arm with PICC 28) Disorders of the Male Reproductive System: Delegation of Postoperative Care Following Prostate Surgery vitals 29) Electrocardiography and Dysrhythmia Monitoring: Monitoring a Client for Risk of Pulmonary Embolism Caused by dysrythmia -dyspnea, chest pain, air hunger, decreased o2 30) Noninflammatory Bowel Disorders: Self‑Management Strategies High fiber diet reduce stress Instruct pt to limit irritating foods Keep food diary 31) Emergency Nursing Principles and Management: Mass Casualty Triage Red- emergent Yellow- need care soon Green- walking wounded Black- expected to die 32) Renal Diagnostic Procedures: IV Urography 33) Hyperthyroidism: Postoperative Care following a Thyroidectomy Keep trach @ bedside Vitals, assess for bleeding, laryngeal 34) Heart Failure and Pulmonary Edema Prioritizing Interventions Class I: Pt exhibits no symptoms with activity Class II: Pt has symptoms with ordinary exertion Class III: Pt displays symptoms with minimal exertion Class IV: Pt symptoms @ rest BASIC CARE AND COMFORT (6) 35) Peptic Ulcer Disease: Prevention of Dumping Syndrome instruct pt to avoid foods that cause distress -Monitor for orthostatic changes in v/s and tachycardia at these findings are suggestive of gastrointestinal bleeding -Have pt lie supine after eating 36) Renal Calculi: Dietary Restrictions Limit food high in animal protine -reduce calcium intake 37) Mobility and Immobility: Quad Cane Use with Hemiplegia Use cane on uneffected side -Advance cane at same time as affected limb -Stairs- -Up with the good and down with the bad 38) Postoperative Nursing Care: Prophylactic DVT ...............................................................................................................................................CONTINUED..... 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