PN1 Final Exam 1. Best Practice (Pg.5) a. To promote client safety and continuity of care excellent practice is for a nurse to use I-SBAR-R when
... [Show More] contacting a health care provider for an order i. I=Identification of self and client ii. S=Situation iii. B=Background iv. A=Assessment v. R= Recommendation vi. R=Read back 2. Inter-Generational Families (Pg. 18) a. Also called multigenerational families b. 2 or more related generations living together as a functioning family. (Sometimes 3-4 generations) c. Reasons- economic support, child care, emotional support 3. Lab data for malnutrition (Pg. 675) a. Have a BMI of less than 20 when undernourished b. Decreased Albumin level of <3.8 g/dL is seen with protein deficiency c. Serum proteins (most widely used) d. Serum Albumin, creatnine and BUN 4. How to assist a patient and family through a crisis (Pg. 843) a. Be an active listener b. Assist family to cope with situation in positive manner c. Keep family informed d. Prepare family to cope with an unwanted outcome e. Help family understand clients condition so they understand 5. Parenting styles (Pg. 25-26) a. Authoritarian: i. Most common ii. Clear division of who is in control and who must obey. iii. Parents set the rules and distribute consequences and rewards depending on child’s adherence to parents rules and guide lines b. Authoritative i. Democratic or active parenting ii. Provides behavioral guidelines and encourages children to think about the consequences of behavior iii. Parents actively reinforce child’s positive behavior and are significantly involved in monitoring child’s behavior and explain expectations c. Permissive: i. “Hands off” parenting technique, thought as neglectful bc of minimal parental interventions ii. Freedom to learn from their own mistakes iii. Children raised this way struggle as adults because they do not recognize boundaries or limits 6. Distress family and communication (Pg. 26 Box 2-3) a. Poor communication between members, including dishonesty, hostility, sarcasm, silent treatment and frequent misunderstandings b. Neglect of basic needs c. Anger control issues d. Unrealistic expectations of family members 7. Acidosis/Alkalosis (know the change in pH) (Pg. 222 Figure 11-1) a. Normal is 7.35-7.45 b. Acidosis: <7.35 (7.0 Neutral, 6.8 Death) c. Alkalosis: >7.45 (7.8 Death) 8. Therapeutic communication (Pg. 32) a. Active listening: Really listening to what client is saying and attempting to understand. Take in voice tone, pitch and inflections, watch body language and explore and clarify to ensure accurate understanding. At times humor, touch, silence or confrontation maybe appropriate. b. Show empathy, be able to imagine one’s self in their circumstances c. An offer of sympathy may hinder therapeutic communication because the client may not feel comfortable when someone “feels sorry for them” 9. Communication challenges (Pg. 33) a. Language barriers, cultural barriers, vision and hearing impairment b. Lack of time to talk with patient because nurse is so busy, jump to conclusions about what clients’ needs are based on past interactions c. Divorced families: Unresolved issues of anger that complicate communication d. Domestic Violence: Issues of domestic violence present an extremely difficult communicative climate 10. Confrontation (Pg. 33) a. Negative meaning, angry feelings, harsh words and conflict b. Productive confrontation i. Can be used as a technique in a respectful, tactful and nonthreatening manner, doing this can help facilitate the client’s move toward self-examination and opportunities for growth ii. This can be used when patient is engaging in maladaptive or poor defense mechanisms such as denial iii. Should be productive, respectful, tactful and non-threatening 11. Prodromal- incubation- convalescence (Pg. 74) a. Incubation: Time between entry of infectious agent in the host and the onset of symptoms. b. Prodromal: Time from the onset of nonspecific symptoms until specific symptoms begin to manifest. Host maybe infectious c. Convalescent: The beginning of the disappearance of acute symptoms until the client returns to previous state of health 12. What are the risk factors for an infection (Pg. 77) a. Imbalanced Nutrition: Less than body requirements or more b. Ineffective protection c. Impaired tissue integrity d. Impaired oral mucous membrane e. Impaired skin integrity f. Deficient knowledge 13. What is the meaning of systemic infection (Pg. 74) a. Affect entire body and involve multiple organs, such as AIDS 14. Alkalosis and OTC medications (Pg. 233 Table 11-4) a. Antianxiety: Ativan & Xanax b. Benzo’s/Sedatives/Hypotics: Ambein, Restoril, Halcion & ProSom c. Centrally acting skeletal muscle relaxants: Valium, Lioresal & Dantrium d. Electrolyte Supplements: Calcium plus vitamin D, Potassium chloride (K-Dur) 15. Look up (All ready answered on question 80) a. Respiratory Acidosis b. Respiratory Alkalosis c. Metabolic acidosis d. Metabolic Alkalosis 16. Osmosis and diffusion (Pg. 203-204) a. Osmosis: is diffusion of water through a semipermeable membrane from a region of higher water concentration to a region of lower water concentration. Only water (solvent) molecules move through the membrane; the dissolved molecules do not b. Diffusion: Tendency of molecules of gases, liquids or solids move from a region of higher molecular concentration to a region of lower molecular concentration until an equilibrium is reached. This movement is caused by kinetic energy in molecules. For example Carbon dioxide moves by diffusion from the blood stream where the concentration is higher, into the lungs for elimination 17. IV therapy, what to react to first (jugular and hand distention) a. Jugular- pneumothorax b. Hand distention- phlebitis, dislodgement 18. Drops per min on an IV (Pg. 253) total fluid volume Drop factor Drop per min Total time ( min) 19. Infusion related infection (Pg. 257) a. Phlebitis 20. Look up signs and symptoms of TB (Pg. 351) a. Low grade fever that recurs in a specific pattern b. Persistent cough c. Hemoptysis d. Hoarseness e. Dyspnea on exertion f. Night sweats/ fatigue g. Weight loss and enlarged lymph nodes 21. What to teach a patient about Lasix a. Take in AM b. Do not take if planned activities in AM 22. What are common medication for asthmatics (Pg. 364) a. Aminophyline b. Steriods Bronchodilators c. Theophylline d. Histamine Corticosteroids e. Mucolytics f. Anticholinergics 23. What does a patient with pneumothorax look like? (Pg. 386) a. Pneumothorax occurs when blunt trauma to chest causes a broken rib that pierces the pleura and lung, allowing air to enter between the pleura. b. Short of breath, shifted trachea, Dyspnea and cyanosis, Cough is forceful and unproductive, Resp and heart rate are elevated, and Breath sounds are diminished. Claims to feel very anxious 24. How do you use an incentive spirometer, and what does it look like (Pg. 347) a. Measures the amount of air in one inhalation, is ordered to air the client when coughing and deep breathing are inadequate b. Plastic device with number on the side, ball inside a tube with a hose and a mouth piece that you place your mouth around and inhale 25. What are the signs and symptoms to know if suction is needed a. Patient is gagging on secretions, coughing without being productive, choking on sputum, cyanotic 26. How to improve cardiac output 27. Pulmonary edema (Pg. 380) a. Life threatening condition characterized by a rapid shift of fluid from plasma into pulmonary interstitial tissue and alveoli. b. Gas exchange is impaired, generally has cardiac cause such as left ventricular failure or MI. c. Excess fluids in the lungs, collects in numerous air sacs in lungs d. Cough, pink/frothy sputum, Dyspnea 28. How to prevent venous thrombosis (Pg. 458) a. Wear BLT compression stockings (Antiembolism stockings) b. Take anticoagulants or thrombolytic meds are prescribed 29. What do the following look like? a. Shingles (Pg. 1075): Clusters of small vesicles over the peripheral sensory nerve (face, scalp and eyes), crust develop after several days. Rash looking b. Psoriasis (Pg. 1083): Most commonly effected areas are scalp, elbows, knees and torso. Large red patches covered with thick silvery scales on the outermost layer of epidermis c. Eczema (Pg. 1081): Chronic, superficial inflammation that evolves into pruritic red, weeping, crusted lesions d. Ring worm (Pg. 1076): Round and reddened with slight scaling, pale center 30. How do you prevent infections from spreading a. Wash hands b. Cover mouth and nose when sneezing c. Clean surfaces and objects properly 31. What are the normal drainages you would see in a post-surgical patient (Pg.1068) a. Serosanguineous exudate 32. What is (Pg. 1262) a. Primary prevention: Focuses on preventing the initial use or preventing further uses that may lead to abuse or dependence. Aimed at school aged children, educate them about substances and their effects b. Secondary prevention: Focuses on preventing ongoing use from becoming a situation of abuse or dependence c. Tertiary: Focuses on returning the client to a drug-free state. 33. Herpes Zoster (Shingles) (Pg. 1075) a. Cluster of small vesicles over the course of a peripheral sensory nerve. 2/3 of clients have lesions just in the thoracic region (Neck-Lower back) Crusts develop in several days. b. Symptoms are mild to severe pain, itching, fever and malaise. In older adults it can last for months or years. c. Zovirax, Valtrex, Famvir may be given for severe pain or immunosuppressed patients. Narcotic analgesics are prescribed for severe pain. d. Recommended for adults 60 yrs an older 34. What is a pressure ulcer and how is it prevented and treated (Pg. 1087-1094) a. Also known as bedsores, localized areas of tissue necrosis that tend to develop when soft tissue is compressed between bony prominence and external surface such as mattress or chair for prolonged period of time b. Assess Braden scale for risks during admission and at least every 48 hours, do head to toe assessments and note any red spots c. Offer supportive surfaces and beds to distribute weight such as egg- crate mattress, Kin Air bed and Roto Kinetic bed d. Avoid placing pt on bony prominences and turn patient at least every 2 hours, use 30 degree position when side-lying, raise heel of patients, avoid massaging over bony prominences 35. What are C & S tests? (Pg. 405) a. Determines presence of microorganisms and determines antibiotic that will kill or inhibit growth of microorganism b. Normal value is negative for microorganism growth c. Assists in diagnosis of bacterial endocarditis d. Blood sample is done before administration of antibiotics 36. What is melanoma (Pg.135) a. The most serious form of skin cancer 37. Transmission and types of contacts (Pg. 68-69) a. Vector Borne: Contact with contaminated animate hosts- Animals, Insects b. Airborne: Droplet nuclei or dust particles are suspended in air. Inhaling microorganisms carried by moisture or dust particles in air- Coughing, Talking, Sneezing c. Direct contact: Transfer of agent from an infected person to a host by direct contact Touching, Bathing, instruments used in treatments, Secretions from client 38. What to ask a patient when they are complaining of pain (Pg. 116) a. Rate it on a scale from 1-10 b. P= What provokes the pain and Palliative measures (alleviating factors) Q= Quality of pain (throbbing, aching) R= Region (location) and Radiation S= Severity (quantity of pain 0-10 scale) T= Timing (Onset, duration, frequency) 39. What are the factors of pain? O= Onset (New or chronic pain) L= Location (one or more sites) D= Duration (Intermittent or persistent) C= Characteristics (Somatic- Sharp, dull or aching) (Visceral- Cramping, squeezing) (Neuropathic- shooting, burning, electrical, tingling numbness) A= Aggravating factors (What makes the pain worse) Alleviating factors (What makes it better) R= Relieving factors (What makes the pain better) T= Treatment (Pharmacological/ nonpharmacological) (Past or present) 40. What is pain (Pg. 112) a. Serves as a protective mechanism b. Occurs when sensory input from injured tissue causes peripheral nociceptors and central nervous system pain pathways enhance future responses to pain stimuli. c. Long-lasting changes in cells within the spinal cord afferent (ascending) and efferent (descending) pain pathways may thus occur a brief noxious stimulus. 41. What is pleurisy (Pg. 359) a. Painful condition that arises from inflammation of the pleura, or sac that encases the lung b. Sharp or stabbing in nature and pain increases during inspiration c. Occurs in disorders such as viral infections, cancer of the lung, TB, HF and pulmonary embolism 42. What is a deviated septum (Pg. 333) a. Cartilage that separates the nostrils is misaligned, resulting in partial airway obstruction. b. Most common breathing impairment 43. How to know if you have pharyngitis (Pg. 340) a. Sore throat is the primary symptom b. Client shows erythema and inflammation of the pharynx and tonsils c. Fever, enlarged tender cervical lymph nodes, d. Typically viral, (80%) with onset of hoarseness, cough, rhinitis and malaise e. Bacterial (20%), abdominal pain, vomiting and headache 44. Know the structure of the heart a. Encapsulated by a protective sac called the pericardium and consists of three layers- endocardium, myocardium and epicardium i. Endocardium is made of endothelium cells that line the inside of the heart, the 4 heart valves and arteries, capillaries and veins making the circulatory system closed. ii. Myocardium consists of striated muscle and varies thickness depending on heart chamber. Left ventricle pumps blood to the body there fore it’s the thickest chamber. iii. Epicardium surrounds the outside of the heart iv. Pericardium consists of 2 layers 1. Parietal pericardium (outer layer) is fibrous loose sac that surrounds the heart 2. Visceral pericardium lines the great vessels and is also called the epicardium when it lines the walls. v. The pericardial space is between the 2 pericardium layers and is filled with fluid vi. The heart is a hollow muscular organ containing 4 chambers that empty and fill blood with each contraction (depolarization) and recovery phase (repolarization) of the cardiac muscle 1. The upper chambers are the atris and the lower chambers are the ventricles, when the atria contract, blood is forced in the ventricles vii. Contraction of the right ventricle pump blood into the pulmonary arteries and on to the lungs (pulmonary circulatory system). viii. Contraction of the left ventricle pumps blood into the aorta and out the entire body (systemic circulatory system) ix. The myocardium of left ventricle is thicker than the right ventricle because more force is needed to pump blood throughout body x. Heart has 4 valves: Tricuspid, bicuspid (mitral), pulmonic and aortic. The pulmonic and aortic valves prevent blood from flowing back into the ventricles from the pulmonary and aorta during repolarization 45. What are modifiable changes for heart disease (Pg. 432 Table 21-1) a. Hypertension b. Tobacco smoking c. Elevated serum triglyceride, total cholesterol and LDL levels d. Lower levels of HDL e. Type 2 DB f. Stress g. Excessive dietary intake of saturated fats, carbs and sodium h. Drug use 46. Heal promotion (what does it mean) a. The process of enabling people to increase control over, and to improve their health. It moves beyond a focus of individual behavior towards a wide range of social and environmental interventions 47. Infective endocarditis (Pg. 424): Caused by bacteria, fungi or virus. a. Vegetation: Microorganism invade the valves, the form fibrinous substance called vegetations b. Scar tissue: vegetation cause scar tissue on the valves, resulting in hard, brittle valves that do not close properly and allow blood to flow back into the previous chamber 48. Cardiac anatomy a. Stenosis b. Prolapse: c. Insufficiency 49. Nitroglycerin Spray a. Treats episodes of angina in people with coronary artery disease. Spray may also be used just before activities that may cause these episodes b. Comes as a spray to use on or under the tongue. Used either 5-10 min before activites or the first sign of an attack c. If using Nitromist push button 10 times. If using Nitrolingual push 5 times and do not spit out or rinse mouth for 5-10 min 50. What is the goal for a patient with high blood pressure (Pg. 466) a. Keeping blood pressure within normal limtits 51. How do you get high blood pressure under control (Pg. 466) a. 1st: Encourage client to try diet and life style changes b. 2nd: Try Diuretic or beta blocker c. 3rd: Increase drug doseage or adding a second antihypertensive drug from another class d. 4th: Last step is implemented by adding a 2nd or 3rd antihypertensive 52. What is the first line of medication to give to a patient with hypertension? (What class is it) (Pg. 476) a. Diuretics i. Thiazide: Hygroton, Zaroxolyn ii. Loop: Lasix, Edecrin iii. Potassium Sparing: Midamor, Aldactone iv. Aldosterone receptor blockers: Inspra, Aldactone 53. Wheezes a. Stridor: Crowing (Croup, large airway tumor) b. Pleural friction rub: Creaking, grating (TB, Pumonary Infarction) c. Rhonchi: Low-pitched, snoring (Asthma, tumor) 54. Delayed wound healing (Pg.1068) a. Factors that affect negative wound healing includes age, oxygenation, smoking, drug therapy, obesity and diseases such as DB 55. What type of skin cancer metastasize (Pg. 1070) a. Malignant Melanoma i. It can metastasize to every organ in the body through the blood stream and lymphatic system 56. How to break the chain of infection (Pg. 71) a. Cleansing: Removal od soil or organic material from instruments and equipment used in providing client care (Wash hands, wear proper PPE) b. Disinfection: Elimination of pathogens, except spores, from inanimate objects. Use chemical solutions to clean them such as alcohol, sodium hypochlorite, quaternary ammonium and phenolic solutions c. Sterilization: Process of destroying all microorganisms including spores. “Sterile technique” Achieved by steam, dry heat and ethylene oxide has 57. Stages of pressure ulcers (Pg. 1088) a. Stage 1: Nonblanchable erythema of intact skin, No blanching maybe noticeable in darkly pigmented skin. b. Stage 2: Partial-thickness skin loss involving epidermis, dermis or both. Ulcer is superficial and presents clinically as abrasion, blister or shallow crater c. Stage 3: Full-thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend down to but not through the underlying fascia. May look like a deep crater with or without undermining or tunneling d. Stage 4: Full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures. Undermining and tunneling may be associated with stage IV e. Unstageable: A full thickness tissue loss where slough (yellow, gray, tan) or eschar (black or brown) covers the base of the wound bed) Ulcer is unstageable until debridement 58. Signs and symptoms of fluid imbalance in a burn patient (Pg.82) a. Hypovolemic Shock b. Early signs are often missed until they become pronounced; early sounds include mild tachycardia and mild hypotension. Presents with anxiety, restlessness, delayed cap refill and increased resp rate. Kidney function decreases in urine output of less then 10 mL/hr. Skin feels cools, clammy and appear mottles. c. Experience severe vomiting and diarrhea, tachycardia, arrhythmias and chest pain 59. What are the things that are needed to know before giving a. Lisinopril (Pg. 438 & 468) i. Monitor for hypotension, hyperkalemia and renal failure ii. Cough is a common side effect iii. Drug may increase glucose level iv. Monitor for sore throat, fever, edema in hands and feet, irregular heart beat b. Digoxin (Pg. 1326) i. Slow conduction to the ventricles ii. Take apical pulse for 1 full min iii. Monitor serum digitalis level and toxicity which is Fatigue, anorexia, halos around lights, unsteady gait c. Lasix (Pg. 557) i. Monitor output, maintain fluid restriction, weigh client daily ii. Thiazide diuretics should be avoided because they decrease urinary calcium excretion when taking long term 60. Know something about buergers disease (Pg.460) a. Inflammatory disease of small and medium arteries and veins that lead to vascular obstruction. b. Hands and feet are mainly involved the distal tip of hands and feet become reddened when held in dependent position. At first pain in palm of hand and arch of the foot is main symptom then pain becomes more severe. c. Client may experience numbness. Burning pain, pain at rest and decreased sensation in hands and lower extremities. Skin color changes, cold sensitivity, ulcers, and gangrene occur in later stages. d. Occurs in men between 20 and 40 of Israeli, Indian and Asian decent 61. Raynaud’s disease (Pg.461-462) a. Intermittent spasm of the digital arteries and arterioles resulting in decreased circulation to the fingers and toes. b. Spasm can least 15 minutes, fingers become pale and then cyanotic c. Women are 9 times more likely to be affected then men d. Secondary Raynaud’s begins later in life between the ages of 35-40 e. Tell patient to avoid decongestants, caffeine, exposure to cold, repetitive hand movements and stressful situations 62. Looks at the Braden Scale- what to teach about taking care of a patient at risk for a pressure ulcer (Pg.1093) a. Establish repositioning/turning schedule for clients. Including pressure-reducing support surfaces b. Use 30 degree position when side-lying position is used c. Prevent direct contact between bony prominences using pillow and foam wedges d. Encourage clients to shift weight in wheelchair every 15 min, limit sitting time to 1 hr at a time whether in bed, chair or wheelchair 63. Know the difference between atherosclerosis and arteriosclerosis (Pg. 434) a. Atherosclerosis: Fat deposits are called plaque and forms early in life as fatty streaks accumulate on arterial vessel walls. A person ages the fat cells, or LDL accumulate in vessels and injure the vessel walls b. Arteriosclerosis: Narrow and hardening of the arteries. A build up of lipids, collagen and smooth muscle cells narrows the lumen of the vessel. Decrease blood flow through the vessel causes decreased perfusion to cells beyond the narrowed or hardened area 64. Know action of beta adrenergic medication (Pg.467) a. Given to block the epinephrine and nonrepinephrine receptor sites. With these receptor sites blocked, the vessels do not constrict and the blood has less resistance flowing through the vessel. 65. What to teach a patient about Coumadin therapy and pulmonary embolism (Pg. 379) a. Use a soft toothbrush to prevent trauma to the gums (bleeding) b. Inspect the skin for bruises or petechiae c. Use electric razor to avoid scratching skin d. Report nosebleeds, tarry stool, hematuria e. Eat consistent amount of green leafy veggies f. Avoid medications including aspirin g. In females monitor menstrual flow 66. What does hypertension (uncontrolled) lead to a. Stroke or heart attack 67. What are things that influence a patient’s pain experience (Pg.114) a. Age b. Pervious experience with pain c. Drug abuse d. Cultural norms account for the differences in client’s individual responses to pain 68. What is cardiac output and how is it determined a. Amount of blood pumped by the heart per minute b. Cardiac output is the product of two variables, stroke volume and heart beat. Heartbeat is a count of the number of times a heart beats per min. Stroke volume is the measure of the volume of blood that is pushed out of the ventricles with every beat. c. The formula is CO=SV X HR 69. What is important to think about when dealing with a patient with facial burns (Pg.1100) a. There is a possibility of Respiratory Tract Damage b. Heat and smoke cause airway inflammation and edema of the respiratory mucosa c. Carbon monoxide inhaled along with heat and smoke attach to hemoglobin, forming the compound carboxyhemoglobin 70. Know normal electrolyte levels for (pg. 83) a. Sodium 136-145 mEq/L b. Potassium 3.5-5.5 mEq/L c. Chloride 98-106 mEq/L 71. Signs and symptoms of pneumonia (Pg. 347) a. Sudden high fever b. Productive cough yielding abnormally thick and discolored sputum c. Dyspnea, course crackles and diminished breath sounds d. Complain of pleuritic chest pain (Stabbing in nature and increases with inspiration) e. High WBC and ABG’s reveal decrease in PaO2 72. Know the nursing process (Pg. 7-8) a. Assessment: Provides subjective and objective behavior including vitals b. Nursing Diagnosis: Gathering physical, psychological, social, emotional and spiritual data c. Planning: Goal setting, desired result that the client works toward achieving. d. Implementation: Plan activities in such ways as to promote goal attainment e. Evaluation: Judgment about an outcome, measure factual results against planned expectations to determine success 73. What are signs and symptoms of cardiac and pulmonary pain a. Pressure, fullness, burning or tightness in chest b. Crushing or searing pain the radiates to back, neck, jaw, shoulders and one or both arms c. Pain the lasts more than few minutes or gets worse with activity, goes away and comes back or varies intensity d. SOB/ Dizziness / Weakness e. Nausea/vomiting 74. Define homeostasis (Pg. 200) a. Ongoing process; that is, the body simply does not reach a state of equilibrium and remain there. If it is interrupted or changed, it can lead to disease, disorder or death. b. Small changes constantly occur in response to physiological processes and to maintain the constancy of internal environment within a normal range. 75. What is our body content most like? (What type of saline is most used) (Pg. 205) a. 0.9% saline solution 76. Know (Pg. 206) a. Intracellular Fluid: Compartment contains all the water and ions inside the cells. i. By far the largest amount of water in the body, approx. 65% b. Extracellular Fluid: Compartment contains the remaining body fluids. Fluid outside of the cells. c. Intravascular Fluid: Plasma in the blood vessels and the lymph in the lymphatic system 77. What is hypo and hyperkalemia (Pg. 210) a. Hypokalemia: Low serum potassium indicates hypokalemia, excessive low gastric fluids and use of diuretics can place patient at risk for this. i. Potassium wasting diuretics such as furosemide (Lasix), chlorothiazide (Diuril) can cause Hypokalemia ii. Can cause cardiac arrest is <2.5 mEq/L b. Hyperkalemia: Elevated serum potassium lever. Renal disease patients develop hyperkalemia bc potassium cannot be excreted by the kidneys. i. Inhibits action of digitalis 78. What is difference between hypertonic and isotonic (Pg. 247) a. Hypertonic fluid: Solution increases osmotic pressure and draws fluid from the cells and interstitial spaces. Cellular dehydration may result if fluid is infused beyond the client’s tolerance b. Isotonic Fluid: Solution increases only extracellular fluid volume. Cardiac overload may result if fluid is infused beyond clients tolerance 79. Know what phlebitis is (Pg. 257) a. May result from either mechanical, chemical trauma or bacterial invasion of the site b. Precursor of sepsis c. Look for reddened area or pink/red stripe along vein, warmth and swelling indicates phlebitis. Pt complaining of tenderness and warmth. Vein might feel rope-like to palpation. 80. What are a. Metabolic alkalosis (pg. 239): Occurs as a result of excessive accumulation of bicarbonates or excessive loss of H ions. i. As a result of acid-based imbalance, arterial pH increases as HCO3, increases or arterial CO2 decreases. ii. pH >7.45 PCO3 Normal HCO3 >26 mEq/L b. Metabolic acidosis (pg. 234): An acid-based imbalance that results in arterial pH decreasing below 7.35. i. Result of either bicarbonate reserves decreasing below 22 mEq/L or production of acid due to metabolism. ii. pH<7.35 PCO3 Normal HCO3 < 22 mEq/L c. Respiratory alkalosis (pg. 230): Depletion of CO2 resulting in the increase of pH above 7.45. i. pH>7.45 PCO3 <35 mmHg d. Respiratory acidosis (Pg.224): Retention of carbon dioxide that occurs when there is an abnormal accumulation of CO2. i. Acute pH<7.35 PCO3 >45 mmHg ii. Chronic pH <7.35 PCO3 >45 mm Hg HCO3 >26 mEq/L 81. Who is at risk for dehydration a. Elderly 82. What are signs and symptoms of left sided heart failure (Pg. 445-446) a. Caused by left ventricular myocardial infarction, aortic valve stenosis, prolapsed valve complications and hypertension. i. Lungs become congested with fluid ii. Patient becomes cyanotic, dyspneic, restless and coughs up blood-tinged sputum. Breath sounds have moist crackles iii. Patient has tachycardia and low BP iv. Client becomes confused 83. Know all about PPE a. Gloves, gowns, mask, face shield/mask 84. Know the difference between a. Pulmonary edema (pg. 380) i. Life threatening condition characterized by a rapid shift of fluid from plasma into pulmonary interstitial tissue and alveoli. ii. Gas exchange is impaired, generally has cardiac cause such as left ventricular failure or MI. iii. Excess fluids in the lungs, collects in numerous air sacs in lungs 1. Cough, pink/frothy sputum, Dyspnea b. Peripheral edema (Pg. 215) i. Excess fluid in either tissues or extremities 1. Symptoms: Pitting edema in extremities, Edematous area are tight, smooth, dry. Shiny, pale, cool skin, Puffy eyelids, Weight gain 85. Know about these of nutrition a. Calcium: Aids in bone and teeth formation i. Provides muscle contraction and relaxation ii. Aids blood clotting iii. Aids in nerve transmission iv. Promotes normal heart rhythm v. Sources are Milk, Cheese, Green leafy veggies b. Vitamin (Pg. 669): Main source of vitamins are fruits and vegetables. Water-soluble vitamins B and C are not stored in the body; however, fat-soluble vitamins A, D, E and K are stored in the body and if taken in excess can become toxic to the body. c. Minerals: Necessary for tissue building and protection of skin, bone, hair and nails (Pg. 670). There are 7 of them: Look at pgs. 678-679 Table 33-4 for more detailed explanation of them i. Calcium ii. Chloride iii. Magnesium iv. Phosphorus v. Potassium vi. Sodium vii. Sulfur 86. Know about IV infusion (Pg. 247-253) a. Purpose of an IV is to correct fluid and electrolyte imbalances, administer meds, blood products and provide nutritional supplements. b. Infusion set includes insertions spike with protective cap, drip chamber, tubing with slide clamp and regulating (roller) clamp, an injection port and a protective cap over the needle adapter. c. PICC line is inserted for long IV therapies d. Select vein for an IV that is most distal end to maintain integrity of vein e. Calculating hourly the flow rate Number of hours i. Total volume infuse ¿ mL infusion rate ¿ hour ii. Calculate actual infusion rate (per min) total fluid volume Drop factor Drop per min Total time ( min) 87. Know how to write an objective nursing diagnosis (Pg. 76) a. Gathered information through physical examination and the diagnostic and laboratory findings b. Physical exam includes systematic physical exam, head to toe, check ROM, if there is redness/warmth anywhere, fever with increased pulse, secretions ore exudate of skin, Auscultation of the lungs 88. When do you document a. Right after the medication is given b. Right after cares are done 89. Know what to teach a patient about quitting smoking (Pg. 1273) a. Nicotine replacement therapy by patch, nasal spray, inhaler or gum helps break habit but it is important that the patient DOES NOT smoke while using the patch b. Exercise program will help with stress management and minimize weight gain, relaxation techniques will help too c. Support of family and friends are very important d. Relapse is highest in the first few weeks and diminishes considerably after 3 months 90. Know how to determine what kind of environment to teach in a. When there is minimal distractions b. When the patient is rested and focused Show Less [Show Less]