NUR 308 Exam 1 Study Guide
NUR 308 Exam 1 Study Guide NUR 308
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This 13 page Study Guide was uploaded by Serena Buckley on Friday March 6, 2015. The Study Guide belongs to NUR 308 at University of Miami taught by Dr. McKay in Winter2015. Since its upload, it has received 175 views. For similar materials see Adult Health 2 in Nursing and Health Sciences at University of Miami.
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Date Created: 03/06/15
Study Guide NUR308 Exam I Spring 2014 Please note this study guide is not meant to replace the required reading practice questions case studies or review of lecture content in preparation for the exam It is intended to supplement your preparation Nursing care for an elderly patient as related to topics discussed SPICES tool etc 0 Elderly have decreased taste sight and hearing Core body temperature is lower typically around 97 degrees 0 SPICES 0 Sleep disruption I ask them how they slept I Restorative sleephow did you feel when you woke up 0 Problems with eating and feeding I 20 of elderly patients I Caused by dysphasia uncontrolled pain loss of appetite meds poor dentition financial problems 0 Incontinence o Confusion I Should not be considered normal in an elderly person I Dementia irreversible I Delirium reversible I Check oxygen Vitals med list 0 Evidence of falls I High rate of death in elderly I Caused by complications with mobility DVT pulmonary embolism pneumonia skin breakdown I Assess with Morse fall scale 0 Skin breakdown I Braden scale I Flip the patient Explain the mechanisms that in uence the movement of water and electrolytes Diffusion Osmosis Osmolarity Hydrostatic pressure Colloid osmotic pressure ADH ReninAldosterone What effect does a low serum protein level have 0 Serum levels indicate extracellular concentration 0 Diffusion the movement of solutes from high to low concentration 0 Osmosis water moving across a semi permeable membrane from low solute to high solute o Osmolarity the concentration of a solution SolutesSolution Regulated by ADH release I Normal 275290 mOsmkg I If osmolarity is high patient is dehydrated 0 O O O O O O O O O O O Osmolality the amount of solutes in water Osmotic pressure the ability of a solution to attract water Tonicity the measurement of the osmotic pressure of a solution isotonic hypertonic hypotonic Colloid Oncotic Pressure the pulling force from interstitial space into the blood vessels Maintained by protein I If albumin levels are low oncotic pressure will be low and uid will enter interstitial space causing edema Hydrostatic pressure pressure against vessel walls Forces molecules through capillary membrane Antidiuretic hormone ADH causes reabsorption of water Stimulated by decreased blood volume or increased serum osmolality Released from posterior pituitary I Diabetes insipidus pts have high levels of ADH and SIADH ReninAngiotensinAldosterone Cascade RAAS Increases blood pressure and volume via retention of sodium and water Atrial Natriuretic Peptide ANP decreases blood pressure and volume Released by atrial cells being stretched Causes a decrease in the RAAS cascade Increases GFR List the indicationstypes of uids nursing considerations for use of a hypotonic hypertonic or isotonic solution Isotonic same osmolality of serum Normal saline Ringers Fluid will stay in the vascular space Used to restore vascular volume Normal Saline 09 Ringers lactate D5W May cause circulatory overload Do not use with circulatory overload Don t use ringers lactate in alkalosis amp liver failure Only solution used with blood products Hypertonic higher osmolality than serum Causes ICF to shrink D 5 12 normal saline Used for cellular dehydration 45 saline 25 dextrose 33 saline May cause shock and increased ICP Do not use with anasarca cerebral edema hypotension Hypotonic lower osmolality than serum Causes ICF to swell D 5 W Used to treat intracellular dehydration Used for intravascular expansion D 5 12 Normal Saline 5 dextrose in 45 NS D5 Normal Saline D5 RL May cause circulatory overload Do not use with CHF DKA Can be used with increased ICP What assessment findings including lab values are common in a patient with hypovolemia and hypervolemia What is the earliest symptom of dehydration What is the nursing care for dehydrationhypervolemia 0 Isotonic Fluid De cit Hypovolemia 0 Mental Status change Low BP Low 02 sat tachycardia to compensate tachypnea dry mucous membranes weight loss poor skin turgor high specific gravity low grade temp postural hypotension o Treated with normal saline 0 Listen to lungs to monitor for uid volume overload 0 Isotonic Fluid Excess Hypervolemia o Edema SOB tachypnea hypertension low 02 sat pulse rate won t change but it will be bounding sudden weight gain decreased hematocrit distended neck veins hyponatremia low BUN normal creatinine low hematocrit low serum osmolarity o Diuretics Fluid restriction Electrolyte imbalances 0 Sodium Normal Range 135145 mEqL 0 Hypernatremia 0 Due to diabetes insipidus frequent urination decreased uid intake IV 0 Seizures confusion lethargy 0 Free water boluses hypotonic uids diuretics 0 Hyponatremia 0 Due to SIADH diuretics GI loss diaphoresis o Seizures uid overload decreased LOC o Restrict uid diuretics replace sodium 0 Avoid processed foods canned foods deli meat condiments 0 Potassium Normal Range 355 0 mEqL 0 Hyperkalemia 0 Due to excessive admin potassiumsparing diuretics renal failure adrenal insufficiency ACE inhibitors extensive trauma crushing injuries metabolic acidosis H moves into cell and pushes K into the blood stream 0 N amp V diarrhea irritability weakness paresthesias numbness cardiac conduction disturbance vfib cardiac arrest peaked T wave oliguria anuria o Treated with Insulin and D50 causes K to move back into the cell sodium bicarb if patient is acidodic calcium chloride stabilizes cardiac muscle Kayexelate 0 Avoid meats dairy products dried fruits fruits high in potassium bananas cantaloupe kiwi oranges vegetables high in potassium avocados broccoli dried beans or peas lima beans mushrooms potatoes seaweed soybeans spinach 0 Hypokalemia Due to starvation increased aldosterone GI losses potassiumlosing diuretics loop and thiazide trauma burns treatment of diabetic acidosis metabolic alkalosis potassium shifts into the cells Anorexia NampV lethargy diminished deeptendon re exes confusion mental depression muscle weakness weakness of respiratory muscles respiratory arrest the probable cause of death decrease in standing BP dysrhythmias ECG changes myocardial damage cardiac arrest prominent U wave kidney damage Treated with potassium replacement NEVER GIVEN IV PUSH Should eat meats dairy products dried fruits fruits high in potassium bananas cantaloupe kiwi oranges vegetables high in potassium avocados broccoli dried beans or peas lima beans mushrooms potatoes seaweed soybeans spinach Normal Calcium Range 90102 mgdl Hypocalcemia 0 Due to blood transfusions alkalosis kidney disease draining fistula dietary deficit decreased vitamin D decreased parathyroid hormone increased magnesium increased calcitonin Osteoporosis tingling convulsions NampV muscle spasm tetany Trousseau and chvostick test dysrhythmias cardiac arrest respiratory arrest numbness around the mouth Treated with calcium IV must be given slowly Vitamin D replacement oral calcium milk products green leafy vegetables salmon cereals pastas orange juice Hypercalcemia O 0 Due to immobilization carcinoma with bone metastases multiple myeloma increased calcium in diet antacids increased parathyroid hormone increased vitamin D steroid therapy Kidney stones decreased deeptendon re exes lethargy coma bone pain osteoporosis fractures muscle fatigue hypotonia decreased GI motility decreased cardiac activity dysrhythmias cardiac arrest Treated with normal saline push loop diuretics corticosteroids to decrease GI absorption Mithramycin to block parathyroid gland phosphate admin Normal Magnesium Range 1322 mEqdl Hypomagnesmia O O O 0 Due to poor nutrition alcoholism starvation hypercalcemia diarrhea draining GI fistulas increased aldosterone large losses of urine Agitation Depression Confusion Convulsions Parasthesias Tremor Ataxia Cramps Spasticity Tetany Tachycardia Hypotension Dysrhythmias Torsades de point polymorphic Vtach Causes Dig toxicity Treated with magnesium replacement Hypermagnesmia 0 Due to excessive magnesiumcontaining antacids enemas laxatives magnesium sulfate renal failure adrenocortical insufficiency o Drowsiness confusion coma muscle weakness paralysis hypore exia respiratory muscle paralysis hypotension ushing increased skin warmth vasodilation increased PR interval shortening QT interval T wave changes bradycardia cardiac arrest 0 Treated with uidsdiuretics dialysis calcium gluconate What types of foods are high in potassium sodium and calcium 0 High in potassium o Meats dairy products dried fruit bananas cantaloupe kiwi oranges avocados broccoli dried beans or peas lima beans mushrooms potatoes seaweed soybeans spinach 0 High in sodium 0 Processed or preserved foods 0 Smoked or pickled foods 0 Snacks 0 Condiments 0 High in calcium 0 Dairy products Describe the nursing care for a patient with the following vascular access devices Peripheral IV Central line PICC line Describe peripheral IV site selection and Assessment of peripheral IV site and nursing considerations 0 Peripheral IV 0 Easily clotted 0 Cannot be started on an arm that had a lymphectomy if there is edema on that arm if an IV has been infiltrated on that arm if they have an AV graft or an AV fistula Clean site with clorahexodene Put a transparent dressing over You will nto always get blood return in a peripheral IV Infiltration nonvesicant uid leaks out of the blood vessel into the tissue Extravasation vesicant uid leaks out of the vessel into the tissue Chemo potassium Dilantin phenytoin o Phlebitis in ammation 00000 0 Central Line a Catheter is entered peripherally but tip terminates at axilla o Remains for 24 weeks 0 Cannot take blood vessels 0 Meds must be nonvesicant 0 Peripherally Inserted Central Catheter PICC Line a Terminates in the superior or inferior vena cava o X ray verification is required 0 Cannot use that arm to lift more than five pounds or else the catheter will migrate What are the possible cardiac consequences related to hypokalemia and hyperkalemia Include specific EKG changes and specific management including medications 0 Hyperkalemia may cause vfib and cardiac arrest 0 Wide at P wave prolonged PR interval Widened QRS depressed ST segment Tall peaked T wave 0 Hypokalemia may cause a decrease in standing BP dysrhythmias myocardial damage and cardiac arrest 0 Slightly peaked P wave slightly prolonged PR interval ST depression shallow T wave prominent U wave 0 Watch potassium levels with digitalis diuretics and IV uids Describe the preoperative management of a patient including informed consents NPO status psychosocial needs premedicationsafety need for assistance post operatively and patient teaching 0 Premedication o Anticoagulants Coumadin Heparin must be stopped before surgery because we are worried about bleeding Coumadin and Heparin have antidotes Vitamin K and Protamine Sulfate in case of an emergency surgery a Monoamine oxidase Inhibitors should be stopped several weeks prior to surgery 0 Aspirin should be stopped seven days before surgery 0 NSAIDs should be stopped four days before surgery because we are worried about GI bleeds and renal impairment 0 St John s Wort should be stopped a week before surgery because it prolongs the effects of anesthesia o Ginkgo Garlic and Ginger should be stopped a week before surgery because they increase the risk of bleeding 0 Beta blockers BP meds antire ux meds should be continued 0 Patient is advised not to ingest anything by mouth for 46 hours before surgery 0 Prevents aspiration Explain the significance of preoperative assessment in order to identify patient s at risk for complications Use of herbal productsrefer to notes smoking etc 0 If someone is having an elective surgery we would ideally like them to stop smoking 810 weeks before surgery Nursing management related to NPO status and patient s prescribed scheduled medications such as HTN meds insulin Explain the role of the circulating nurse and the measures taken to assure patient safety during operative phase IePatient Identification Documentation Time out positioning Note specific possible complications With various positions and anesthesia Example Spinal versus general 0 General Anesthesia 0 Partial or total loss of sensation occurring With or Without loss of consciousness Stage 1 analgesia and sedation relaxation Stage 2 excitement delirium Risk for aspiration Stage 3 operative anesthesia surgical anesthesia Stage 4 danger may be suppressed too much 0 Emergence recovery from anesthesia 0 Spinal Block 0 Injection into the subarachnoid space into the CSF o 1 complaint is headache because of CSF leaks o 2 complaint is hypotension a Patient should slowly elevate their head 0000 What are the most common postoperative complications and the interventions for each IeAspiration Respiratory Complications Nauseavomiting painPCA urinary retention wound dehiscence Describe Malignant Hyperthermia including signssymptoms and treatment Describe the measures utilized to minimize infection in the OR 0 Malignant Hyperthermia o hypermetabolic state 0 More prevalent in young males Genetic 0 Elevated C02 is an early indicator and tachycardia 0 Muscle rigidity respiratory and metabolic acidosis hyperkalemia hypercalcemia Can occur up to 72 hours after surgery 0 Myoglobinuria presence of myoglobulin in the urine because of a break down in the muscles 0 Can be given dantrolene regular insulin With dextrose to combat the hyperkalemia 0 Describe teaching regarding lifestyle modification for HTN and PVD List the nursing interventions include patient teaching When a pharmacological agent is used in the treatment of hypertension Ie diuretics Beta blockers etc 0 Hypertension 0 0000 0 Medication specific information regarding optimal time of administration with or without meals and expectations of medication Change positions slowly to prevent postural hypotension Report medication side effects DASH diet Furosemide Lasix Loop Diuretic I Check I amp O potassium hypokalemia muscle weakness amp prominent U waves daily weights should be taken in the morning Enalapril ACE inhibitor I Monitor for hyperkalemia angioedema and cough Lopressor beta blocker vasodilates decreases heart rate I Monitor heart rate blood pressure I Masks signs and symptoms of hypoglycemia I Avoid hot tubs really hot showers baths ASA aspirin antiplatelet aggregator I StrokeMI prevention 0 Peripheral Vascular Disease 0 Same lifestyle modification as coronary disease patients Identify the signs and symptoms for PVD What is the significance of intermittent claudication and rest pain 0 Peripheral Vascular Disease 0 Intermittent claudication diminished hair growth thick brittle slow growing nails shiny thin fragile taut skin dry and scaly skin cool skin temperature diminished or absent pulses pale blanched appearance with extremity elevation rubor in dependent position reactive hyperemia decreased motor function ulcer formation with advanced disease ABI of 05095 0 Intermittent claudication muscle pain in the calf that occurs during exercise and is relieved by rest Peripheral arterial disease 0 Rest pain is indicative of very advanced peripheral vascular disease Compare and contrast the findings associated with arterial ulcers and venous Ulcers How are they treated include positioning Arterial Ulcers 0 0000000 Intermittent claudication Small circular deep ulcerations red beefy lack of hair cool to touch DO NOT USE COMPRESSION Legs should be in a dependent position Raise the back of the bed Treat like a diabetic patient Wear close toed leather wellfitted shoes Inspect toes daily Go to a podiatrist to get nails trimmed 0 Venous Ulcers o Irregular ill defined margins varying sizes copious serous exudate red granulation to necrosis skin is brownish brawny possible edema aching or heaviness o Treated With vitamin C protein zinc multivitamin promote mobility compression Unna s boot goes on wet and dries debridement granulation What are the 6 P s acute arterial occlusion 0 Pain 0 Pallor Mottled appearance 0 Pulselessness 0 Paresthesia 0 Poikilothermia coldness 0 Paralysis Identify the risk factors findings and complications associated With DVT 0 Risk Factors Virchow s Triad o Venous Stasis Heart Disease Dehydration Immobility Paralysis Incompetent vein valves Obesity Pregnancy Age over 40 years Female 0 Vessel Wall Injury Trauma Infection Venipuncture IV infusion of irritant solutions Pacemaker History of DVT varicose veins Previous major surgery 0 Hypercoagulability Hemolytic anemias Increased viscosity Inherited coagulation disorders Trauma or surgery Malignancy Oral contraceptive use I Dehydration 0 Manifestations 0 Local pain or tenderness o Unilateral edema or swelling 0 Local warmth redness o Mild fever 0 50 have no symptoms 0 Complications 0 Pulmonary embolism 39 02 sat will drop they will become tachypnic have SOB and chest pain First sign is mental status changepatient has a feeling of impending doom Describe pharmacologic and mechanical prophylaxis for DVT 0 Anticoagulant therapy a Do not aspirate or massage afterwards 0 Mechanical prophylaxis 0 Promote mobility 0 Use compression devices 0 Avoid oral contraceptives and smoking Explain the treatment options for a patient diagnosed with a DVT Include Coumadin and Heparin therapy Labs and patient teaching 0 Prevent further clot formation do not break down preexisting clots 0 Heparin o SQ or IV Short half life Monitor PTT normally in 30s Goal is 6075 every 6 hours Assess for possible bleeding Use bleeding precautions Monitor for HIT o Antidote Protamine sulfate 0 Coumadin 0 PO Initiate concurrently with Heparin therapy Long half lifetakes 23 days to establish a therapeutic level Monitor PTINR Moderate foods with Vitamin K Bleeding precautions Antidote Vitamin K 00000 000000 Decribe the care of a patient following amputation including pain managementpositioningcrutch walking 0 Assess Vital signs mental status dressing surgeon changes first dressing 0 Avoid exion because the patient may develop a contracture 0 Keep patient prone but monitor airway 0 Use compression bandage figure 8 dressing because it decreases edema and swelling Describe the triggers and management of a patient with Raynaud s disease and Buergers Include patient teaching 0 Buerger s Disease 0 Arterial problem 0 Men 2040 years of age Middle eastern Asian jewish 0 Only occurs in smokers 0 In ammation in lower extremities arteries and veins 0 Raynaud s Disease 0 Occurs with exposure to stress tobacco caffeine cold and vibration 0 Severe cases may use calcium channel blockers vascular smooth muscle relaxants vasodilators iloprost o Sympathectomy surgical destruction of the sympathetic innervation to that part of the body What are the signssymptoms associated with AAA and expansionrupture Describe the postoperative assessment following AAA repair 0 6 Ps 0 May be treated with anticoagulants thrombolytics calcium channel blockers pain meds balloon angioplasty embolectomy Identify the P QRS T wave on EKG including normal parameters and corresponding physiology ie P wave represents Atrial depolarization Identify Normal Sinus Rhythm Sinus Bradycardia and Sinus tachycardia Describe the common etiologies for Brady and Tachy rhythms and treatment SS complications interventions for Pericarditis endocarditis include pertinent teaching 0 Automaticity o The ability of the heart to depolarize initiate an impulse Without external intervention 0 Holter monitor 0 Cardiac monitor for ambulatory patients over a 24 hour period I Sinus Bradycardia 0 Rate less than 60 o Caused by beta blockers calcium channel blockers digoxin hypothermia MI 0 Treated With atropine and transcutaneous pacers 0 Symptoms hypotension chest pain diaphoresis weakness dizziness SOB I Sinus Tachycardia a Rate greater than 100 o Caused by stress epinephrine too much atropine MI dehydration pain drugs fever 0 Must be treated even if asymptomatic a May use digoxin beta blockers Blood Pressure Cardiac Output X Peripheral Resistance 0 Cardiac Output 0 The amount of blood pumped by the heart in one minute 68L 0 Heart Rate X Stroke Volume 0 Stroke Volume how much blood is ejected With each beat 70 mLs affected by I Preload the stretch of the ventricles at the end of diastole Affected by volume status dehydration decreases preload venous return to the heart diuretics decrease preload I Afterload the resistance that the ventricle is pumping against Right and left sided Pulmonary vascular resistance and systemic vascular resistance Vasodilators decrease afterload I Contractility pumping of the heart Digoxin improves contractility Metabolic syndrome a very common disorder that is usually a triad of HTN Hyperlipidemia Diabetes and elevated BMI
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