Med-surg final exam - this is the best quiz ever you can use it to pass soo good i ould fef want it PDF

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this is the best quiz ever you can use it to pass soo good i ould fef want it...

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( 1) ( A)Si t uat i on:Thi si sNonsoEnwel um cal l i ngabouta69ol dmanadmi t t edwi t hcompl ai nt sof s ev er ev omi t i nganddi ar r hea. Back gr ound:Mr .Tani sa69y ear ol dmal ewi t hdi agnosi sofhy pokal emi aadmi t t edf orv omi t i ngand di ar r heaf ort hepast48hour s. Ass essment :Thepat i ent ' sbl oodi nv es t i gat i onr ev eal spot as si um : 2. 9,cr eat i ni ne: 0. 9mg/ dL,BUN: 10mg/ Dl . Rec ommendat i on:Iwoul dsugges tt hatt hepat i entbes t ar t edwi t hel ec t r ol y t er epl acementt her apy wi t hpot ass i um i nt r av enousi nf us i on. ( B)Thel ev el ofmagnesi um hast obest r i ct l yc heck edi npat i entdi agnosedwi t hhypokal emi a becausel owl ev el ofmagnesi um i st hechi efcausef orhypokal emi a.I ft hi si snott r eat ed,t heni tcan s i mpl yaggr egat et hecondi t i oni ft hepat i entqui ckl y . Thecr eat i ni neandBUNl ev el sar ewi t hi nnor mal l i mi t s Cr eat i ni ne: 0. 9mg/ dL( 0. 51. 2mg/ dL) BUN: 10mg/ dL( 720mg/ dL) ( C)Thecl i ni calmani f es t at i onofhypok al emi aandi t sc ausesar e Weak ness Musc l ecr amps Ti ngl i ngsensat i on

   Caus e   

v omi t i ng di ar r hea Hy pomagnesemi a

Nur s i ngi nt er v ent i ons   

Ass essf orsi gnsands ympt omsofpot assi um defi ci encyt ot ak eappr opr i at epr ecaut i on measur es Admi ni s t erpot ass i um suppl ement sor al l y ,I Vasperor der Pr ov i depot as si um r i c hdi et

( D)

Ti me( hr )=1hr . Cal c ul at i onofv ol ume( ml ) Vol ume( ml )=Des i r eddos e( D) / Dosei nhand( H)*Quant i t y( Q) . Her e Vol ume( ml )=D/ H*Q =10/ 10*50

=50ml . Rat e( ml / hr )=50ml / hr . ( E) Thei nt er v ent i onst or educet hedi sc omf or tar e   

I ceappl i cat i oncanr el i ev epai n Adj us tt her at easpert hest andar dandpr ot ocol becauset hi smedi cat i oni si r r i t anti n nat ur e I nf or mt hepat i entaboutt heconcent r at i onoft hemedi cat i onsot hatt hepat i entget s pr epar edps y c hol ogi c al l yt oanex t ent .

(2)(A) Thenur set eachest hepat i entsel f car ebef or edi sc har ge: Pr ot ec t i v eey epat c h:Topr ev entacci dent alr ubbi ngorpoki ngoft heey e,t hepat i entwear sa pr ot ect i v eey epat c hf or24hour saf t ersur ger y ,f ol l owedbyey egl as seswor ndur i ngt hedayanda met als hi el dwor natni ghtf or1t o4week s .

Expect edsi deeffect s :Sl i ghtmor ni ngdi schar ge,r edness ,andasc r at c hyf eel i ngmaybeexpect ed f oraf ewday s ,andacl ean,dampwas hcl ot hmaybeusedt or emov es l i ghtmor ni ngey edi s char ge.

Not i f yt hephy si c i an:Becausec at ar actsur ger yi ncr easest her i skofr et i nal det achment ,t hepat i ent mustknowt onot i f yt hesur geoni fnewfl oat er si nv i si on,fl ashi ngl i ght s ,decr easei nv i s i on,pai n,or i ncr easei nr ednes soccur s . ( B)Causes :Mostcat ar ac t sdev el opwhenagi ngori nj ur yc hangest het i s suet hatmak esupy our ey e' sl ens .Somei nher i t edgenet i cdi sor der st hatcauseot herheal t hpr obl emscani ncr easey ourr i sk ofcat ar ac t s.Cat ar ac t scanal s obecaus edbyot herey econdi t i ons ,pas tey es ur ger yormedi cal condi t i onss uchasdi abet es .

( C) Admi ni s t er i ngdr ops Ri ghtt i me;r i ghtdos e,r i ghtr out e,r i ghtper sonandr i ghtey e.

How to apply eye drops. Always wash your hands before putting in the drops. Sit or lie with your head tilted backwards. Gently pull your lower lid down with one finger. Holding the bottle on the bridge of your nose or on your forehead, squeeze one drop into your eye. Close your eye and gently blot excess drops with a clean tissue If you think you are going to run out of your drops, please call the surgeon and ask for a prescription refill for whichever drops you are short of.

NOTE- Do not allow other people to use your eye drops. Throw away the drops when you have finished the course of treatment. Touchi ngt het i poft hecont ai neratanyt i mecan cont ami nat et hemedi cat i on. ( D)

Mrs. Johnson will have a controlled inflammation, thereby reducing vision loss and scarring Mrs. Johnson pupil will dilate or constrict. Mrs. Johnson will regain usual level of cognition. Mrs. Johnson will recognize awareness of sensory needs

( E)Cal cul at i onofvol ume( ml )ofdr ugr equi r ed. Vol ume( ml )ofdr ugr equi r ed=D/ H*Q =1/ 5*1 =0. 2*1 =0. 2ml . * Emer gencyant i dot eofx anax( Al pr az ol am)i sFl umaz eni l .

( 3) ( A)Di ffer encebet weenpr i mar yandsecondar yhyper t ensi on:

Pr i mar yHyper t ensi on:  Pr i mar yHy per t ens i oni st heel ev at i onofbl oodpr ess ur ewi t houtanyunder l y i ng di s ease  Ac ombi nat i onofgenet i candenv i r onmentf act or swhi c hl eadst oi nc r eased per i pher al v asc ul arr esi s t anc e,i ncr eas edbl oodv ol umecanr esul ti nPr i mar y hy per t ensi on  Sy mpat het i cner v ouss y s t em,Reni nAngi ot ensi nAl dos t er ones y st em pl ayavi t al r ol e i nt hedev el opmentofpr i mar yhy per t ensi on Secondar yHyper t ensi on:  Secondar yhyper t ensi oni st heel ev at i onofbl oodpr es sur eduet oanunder l y i ng c ause  Changesi nendoc r i nef unct i on,r enal s y s t em,neur ol ogi cal s y s t em c anl eadt o s econdar yhyper t ensi on  Secondar yhyper t ensi ondependi ngupont hecausec anbecl as si fi edi nt o Car di ov as cul arhy per t ensi on,Endoc r i nehyper t ensi on,Renal hyper t ensi on, Neur ogeni chyper t ensi on,Hy per t ensi ondur i ngpr egnanc y

Thecl i enti nt hegi v encasehasSecondar yHyper t ensi on.

 Rat i onal e:Thec l i entpr evi oushi st or ydoesnotshowHy per t ensi on,howev er , endocr i nec hangesduet odi etonl ycont r ol l edDi abet es ,Hy per l i pi demi a( whi ch c oul dl eadt oar t er i osc l er osi s ) ,Gout( whi c hcaneffectr enal f unct i on)ar et he under l y i ngcausest hati nc r easedper i pher alv asc ul arr es i s t anc eandcaused Secondar yHyper t ensi on.

Expl anat i on: Byusi ngDi mensi onalanal ysi smet hod:Theequat i oni ssetupi namanners ucht hat , onl yr equi r eduni t s( i . emL/ hr )ar eobt ai nedandr emai ni nguni t sar ec ancel l edoff Thenur ses houl ds ett hei nf us i onpumpatar at eof( mL/ hr )= =25mg250mL xhr5mg =( 251250)mL / hr =50mL/ hr

i i i .Possi bl er at i onal ef ort hi sl ossofmovement :  Theposs i bl er at i onal ef ort hel os sofmov ementcoul dbeduet oSt r oke( poss i bl y Hemor r hagi cst r ok e) .Hyper t ensi v ecr i s i s ,Di abet es ,Hy per l i pi demi a( whi c hcanl ead t oat her osc l er os i s )canl eadt or upt ur eofcer ebr al bl oodv es sel sr es ul t i ngi n bl eedi ng Twonur si ngi nt er vent i onst oi mpl ementatt hi st i me:  Admi ni s t r at i onofmedi cat i onsasor der edt ocont r ol t hebl oodpr ess ur eand moni t or i ngai r wayneur ol ogi cal s t at usandl ev el ofconsc i ous nes s  Headoft hebedi sel ev at ed,headi sposi t i onedi nmi dl i neComput edt omogr aphyor Magnet i cr es onancei magi ngar eor der ed.St r ok et eam i ssummoned i v .Thr eeor gansyst emst hatcanbedamagedbyuncont r ol l edhyper t ensi onandhow t hedamageoccur s:  1.Hear tandbl oodvessel s( Car di ovascul arsyst em) :Hyper t ensi onf orpr ol onged per i odsi ncr eas esper i pher al v as cul arr esi s t ance,i ncr eas edwor kl oadonhear t .  2.Br ai n( Cent r alner voussyst em) :Hy per t ensi ondamagest hei nt egr i t yoft he bl oodv ess el st hats uppl ybr ai nr esul t i ngi ndecr easedbl oodflow,i nadequat e oxy gensuppl yandpr omot eat her os cl er os i s .  3.Ki dneys:Hy per t ensi onc anst i mul at et her eni nangi ot ensi nal dost er ones y s t em, damageofr enal t ubul esduet oi nc r easedpr es sur ei nr enal ar t er i ol es .

v .Di schar get eachi ngpl anf ort hecl i entwi t hr at i onal es:  Thecl i enti sadvi s edt or educesodi um i nt ak e( 2. 4gm ofs odi um or6gmsofSodi um c hl or i de)Rat i onal e:Sodi um r est r i ct i onhel psi npr opercont r ol ofbl oodpr ess ur e andr es t or est her eni nangi ot ensi nal dos t er one,nat r i ur et i cpept i debal ance  Cl i enti sadv i s edt oav oi ds moki ngoral coholRat i onal e:Si nc e,smok i ngandal c ohol c oul dc ont r i but et oi ncr eas edcar di ov asc ul arcompl i c at i onsav oi di ngsmoki ng, al c ohol coul di ncr eas et heeffic acyoft hei nt er v ent i onsandpr ev ent scompl i cat i ons I mpor t anc eofi ncr eas edphy s i cal act i v i t y( 3045mi nut esperday )i st aughtt ot he c l i entRat i onal e:I ncr easedphy si c al act i vi t yhel psi npr omot i ngbl oods uppl yand pr ev ent sat her osc l er os i s ,wei ghtgai normet abol i ccompl i c at i ons  St r essmanagementt echni quesandsel fmeasur ementofbl oodpr ess ur ear e adv i sed.Adai l ychar tofbl oodpr ess ur e,bl oodgl ucos ecoul dhel pi nv i ewi ngt he pr ogr esoft hei nt er v ent i onsRat i onal e:Ps y chos oc i al f ac t or scoul dal sor es ul ti n i nc r easeofbl oodpr ess ur e,t huss t r es smanagementanddai l ydoc ument at i onof bl oodpr es sur ehel psi nr eass ur anceandsenseofwel l bei ngi nt hecl i ent  Thecl i enti sencour agedt ol oos ewei ghti fov er wei ghtRat i onal e:Si nc e,t hecl i enti s ex hi bi t i ngl ossofmot orf unct i ononones i deofbodyl oosi ngwei ghthel psi n i nc r easi ngt her angeofmot i onandhel psi nr ehabi l i t at i on

( 4)Expl anat i on: I dent i f yt hr eedi agnos t i cs t udi es ,wi t hr at i onal es ,t hatshoul dbeor der edbyt hepr ovi derand why .  Bl oodcul t ur eandsensi t i vi t yt odet ectt hecausat i veor gani smsandant i bi ot i c.  Compl et ebl oodcountandpr ocal ci t oni n-CBChel psi dent i f yf eat ur esof i nf ect i onsuchasl eucocyt osi s,andanemi a  Echocar di ogr aphy-Toi dent i f yval vul ardamageegveget at i ons. Pr ovi deaposs i bl eex pl anat i onf ort hes y s t ol i cmur murandanypat i entt eachi ng i mpl i cat i ons .  Syst ol i cmur murmaybeduet oval vul ardysf unct i onwi t hat r i ovent r i cul arval ve r egur gi t at i onorsemi l unarval vest enosi s.Themur muroccur sdur i ng syst ol e.  Thepat i entneedst obei nf or medaboutt hepossi bi l i t yofi nf ect i veval vul ar endocar di t i sandhear tf ai l ur et hatr esul t sf r om t hat . Bes i desI Vdr uguse,i dent i f yfiv eot herr i s kf act or sf ori nf ect i v eendocar di t i s .

 Ther i skf act or sofi nf ect i veendocar di t i sar epr ost het i ccar di acval ves, congeni t alhear tdi sease,pr evi ousi nf ect i veendocar di t i s,car di act r anspl ant wi t hval vul opl ast y • Thephar mac ys ends2gm Vancomy c i ni n500ml nor mal sal i neov er4hour s .What r at ewi l l t henur sesett hei nf usi onpumpt oi nf us e ? 2gi n500mLover4hour s =500ml / 4hr s=125ml / hr . Dur i ngi nf usi on,t hepat i ent ' ssk i nt ur nsr edandhec ompl ai nsof" bur ni ngal l ov er . "I dent i f y t hi sc ondi t i onandhowi ti st r eat ed. I mmedi at ehyper sensi t i vi t yr eact i on.Themanagementshoul dbedi scont i nuat i onof i nf usi on,admi ni st r at i onofant i hi st ami nes,hydr ocor t i soneandadr enal i ne. Af t eraweeki nt hehospi t al ,t hephy si ci anor der saPI CCl i net obepl ac edandconsul t s homeheal t hf orant i bi ot i cadmi ni s t r at i onandt eachi ng.Dev el opat eac hi ngpl anf orapat i ent whor equi r eshomeant i bi ot i ct her apy ,pr ov i di ngar at i onal ef oreac hi nt er v ent i on.  Uset heant i bi ot i csdoseasschedul ed.  St opwhenser i oussi deeffect ssuchassever eski nr ashoccur sandr epor tt o t heheal t hcar eper sonnel .  Cont i nueant i bi ot i ct her apydespi t ef eel i ngbet t er .  Pr operhandwashi ngandpr opercar eandhandl i ngoft hePI CCt opr event i nf ect i on,andar m.  St ayhydr at edt opr eventcl ot ....