NUR 2243 Final Review PDF

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NUR 2243 FINAL REVIEW- Holt Acid base imbalance - Causes of meta alk, meta acid, resp alk, resp acid- look at cartoons! - What is a complication of diuretic? o Meta alkalosis Meta alk Muscle weakness- teach pt ab fall prevention - Too many tums Normal urine output per hour = 30 mL - If pt has significantly less should not give anything with potassium in it, can cause hyperkalemia Excess ADH - Dilutes body fluids - As a result, a person is at risk for hyponatremia HYPERNATREMIA - Can cause decreased LOC - Tube feedings can cause it Oliguric renal disease - Low urine output - When renal excretion is decreased, decrease foods high in magnesium or any other electrolytes bc not able to get rid of them HYPOKALEMIA - Dysthymias - Postural Hypotension - Muscle weakness – FALL PRECAUTIONS HYPERKALEMIA - Put on cardiac monitoring bc dysrhythmias Protein in the urine is never normal: - Indicates decreased renal function s/s DKA - Rapid/deep breathing - Polydipsia - Polyuria - Polyphagia Antidote for DKA: insulin Antidote for HHS: fluid replacement Know its working bc increased LOC- tested with GCS What diabetic med should you hold bf CT scan? o metformin

Liver cirrhosis - Low sodium to reduce ascites - Don’t have to avoid protein all together- just keep an eye on the levels

Complication after paracentesis - Urine output less than 30 could indicate that they punctured the bladder Esophageal varices - Maintain airway Vasopressin - SE chestpain bc can cause a heart attack PSE- systemic encephalopathy - Typically can happen from high ammonia levels - What can help? o Diet low in protein o Lactulose- teach increased bowel movements and diarrhea ( how body rids ammnia) Hepatitis A B C o How its contracted ?  A  Close personal contact, shellfish  B  Blood transfusions  C  Med used : o Ribovarin- takes forever to work : people need to make sure take religiously- teach ab pill organizer  Cant be speread via casual contact  Going overseas don’t have fresh fruit veggies bc washed in contaminated water Transplant Rejection o Symptoms had previously return o Fever o Contact hcp asap If person has SOB - Sit up first Paracentesis - Draining fluid bc of ascites - Know procedure: o Have them void before hand o Sitting upright and leaning over if having trouble breathing 24 hr - Note time first voided, get rid of that urine and collect urine 24h after that. - Read q completely when it comes to infection control- use common sense Meningitis - Infection in meninges - Manifestation o Nuchal rigidity Transsphenoidal hypophysectomy o At risk for meningitis

o o

Assess vitals If clear/yellow drainage from nose- Check for glucose- halo effect

With any type of surgery in head: prevent increased ICP - Teach not to bend over SIADH - Dilutes body fluids - Can cause hyponatremia - Need to be put on fluid restriction Cushing’s - Taper off steroids - Prednisone o Avoid crowds, heat, sunlight- may need to use another drug if you work outside a lot - Low carb, low calorie, low sodium diet o Bc weight gain, sodium retention in cushing’s Addisons Hyperaldosteronism: Conns syndrome - Most common cause is tumors - low potass- HYPOkalemia - Low sodium – HYPERnatremia? - Meta alk- high pH Diabetes insipidus - Often given vasopressin o Increase urine output (initially) o Decrease specific gravity o Decrease urine osmolality Effective tx Decreased urine output that is more concentrated TPN is a risk for: - Metabolic alkalosis - What are some adverse effects of this o Positive Chvostek’s sign – hypocalcemia? o Pts that are anxious, irritable o If you have a pt in the ED and you have to give IV med - Simple things first- start IV - Least invasive first What lab value is an indicator of polyuria - Serum osmolarity - Normal 275-295 Starlix - Antidiabetic - Give before meals Continuity of care- give nurse who had the pt last night the same pt

Daily weights is best way to check pts fluid status CKD -

Know -

Pt should maintain proper balance of intake and output If you see a pt with edema and trouble breathing and they’re getting 150 ml/hr, check w doctor to see if want to discontinue CKD very sensitive to fluid shifts Pts who have HTN and CKD are often given o ACE inhibitors is first line for CKD bc helps w perfusion o High BP can lead to kidney disease albumin levels Protein 3.5-5.5 You can adjust pts albumin by diet- restricting or increasing protein in diet

Adventitious lung sound - Crackles - > indicate fluid overload s/s digoxin toxicity - Nv - Vision changes - Anorexia Dialysis - Fluid has to be warmed - Pts temp reading will mirror temp of dialysate Hemodialysis - Moves from higher to lower concentration diffusion Fistulas - Given for dialysis - Sometimes they mature sometimes they don’t - AV fistula o Don’t take blood from it or measure blood pressures in that arm o Listen for bruit (swoosh), feel the thrill( vibration) - Often heparin is used to keep blood flowing o Risk fo bleeding o Protamine sulfate is antidote - Don’t give meds before dialysis- gets taken right out Peritoneal dialysis - Dialysate fluid that comes out: effluent o if its cloudy could indicate infection like peritonitis (hot belly) - Constipation can cause flow of fluid in/out to be slowed o Avoid constipation Kidney transplant - Impt vitals o to measure blood pressure to ensure kidney is getting perfused what labs are used to evaluate kidney function? - bun/creat

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if lab values start coming back like before transplant, could mean rejection o may need to increase immunosuppressant dosage

as pt is waking up from anesthesia - help w breathing bc pts can be confused, agitated, may not have gotten all anesthesia out of system - monitor o2 sat ( low o2 may be causing agitation) - take deep breaths, help lung expansion venturi mask: deliver pure o2 10- 100% . set liters per hour at 4 or higher albuterol – short term beta 2- long acting - Flovent - Seravent If chest tubes come unlogged from chest - Cover it w gauze, call hcp - If chest tube comes off machine- sterile water - Tube in water helps prevent collapsed lung- you don’t want air to get outside the lung( pneumothorax) - Will have pain where inserted, encouraged to take deep breaths, given incentive spirometer - Know steps of how to use a peak flow rate for asthma pts o Shake it to get tab down to zero o Pt takes deep breath, indicator will go to red, green o Know how to use a spacer  Hard time coordinating pressing inhaler down and inhaling  Doesn’t matter if coordinated or not with spacer, it suspends it in to get full effect of med Thoracentesis - Removing fluid from lungs - Complication o Tension pneumothorax  Symptom is a deviated trachea PE risk factors - Factor 5 leiden- abnormal clotting disorder - Sedentary lifestyle: obesity - Smoking - Long bone break - Surgery - Dvt Know normal values for: ptt Platelet Hemoglobin Hematocrit Cbc labs If you’re trying to intubate bc of low o2 - And its not successful: don’t let them be without oxygen

If intubated pt shows signs of hypoxia - Check for DOPE o Displaced tube o Obstruction ( mucus plug) o Pneumothorax o Equipment problem - First thing you do is check lungs first: check pt before machine Pts on ventilator o Mouth care to avoid infection o Upper peak airway pressure limit  When airway pressure reaches max amt set by resp therapist: alarm sounds bc if not brought down, it can stretch the lungs too much - Always have a bag valve mask ready incase manual breathing is needed Why is zantac given to pts on ventilators - To prevent ulcers Warfarin - What do pts need to be concerned about o Vitamin K - Vegetarians need to be careful about eating too much salad Can counteract the warfarin Would you give a sq injection with an 18 g? - No Tpa -

Also known as altpase Clot buster

Refractory hypoxemia - Even in the presence of 100% oxygen What is gold standard of diagnosing PE? - STAT pulmonary angiography Any suspicion of PE: immediately do pulmonary angio If numbness in mouth - Respiratory alkalosis - Know symptoms CARDIAC- EXAM 2 Murmur heard on right side of sternal border - You may get a diagram to look at - Rhythm strips o Vtach o Brady o Pvcs o V fib Catropril Imdor Cyclosporin- sandimmune - Immunosuppressant...