EXAM 1 continued - NURS198 - Ryno - Fun size

Physiological changes in aging?

1) sensory loss and changing the perception

-vision, hearing touch

2) decline of central nervous system and cognitive functions

3) decline of muscular and skeletal system

4) reduced ability to adapt to temperature changes

5) disease: arthritis, heart disease, alzheimer's

6) mobility problem: reliance on walkers/wheelchairs

7) thinner skin, bruise easy, dry skin

8) Slower HR

9) kidneys are slower = more toxicity build up

10) slower metabolism

If an older person comes in what do we want to assess and check first?

1) there medicaitons they are on - to see if that is causing confusion.

2) Get a urinalysis to check for a UTI

3) Want to rule out that it is dementia

Ageism

Discrimination based on age

Delirium vs Dementia

1. Delirium- Acute, dramatic onset, common causes= illness, toxin, withdrawal, usually reversible. Poor attention and fluctating arousal level. (sepsis, stroke, UTI) - affects consciousness

2. Dementia: Chronic, insidious onset, usually not reversible, attention usually unaffected and normal arousal level. - Doesnt affect consciousness

Role as a nurse with abuse

Report it no matter what.

Patients with cognitive issue are most at risk

What is polypharmacy?

the simultaneous use of multiple drugs to treat a single ailment or condition (5+ drugs)

Interventions for polypharmacy?

1. medical reconciliation - make sure they arent taking any duplicates.

2. BEERS crtieria ( which ones can older people take)

3. Have a daily planner and reminders

What is a chronic illness?

1) Anything longer than 6 months

2) Effects the whole family

3) Continuous help for illness

4) Persistance and adhere to the treatment plan

5) nonpharm treatements

Non-pharm treatment

- exercise, light therapy, music therapy, reminiscence therapy, relaxation techniques, massage, ice and heat therapy

Management for chronic illness

1) learn to live with it

2) able to grief the life you had is normal

3) financial - how are they going to afford this

4) Are there resources to help them

5) lifestyle changes

nursing process

Assessment

Diagnosis

Planning

Implementation

Evaluation

Hypovolemia

LOSS OF WATER AND ELECTROLYTES

DUE TO: Vomiting, diarrhea, burns, sweating, dehydration, organ dysfunction

SYMP: weight loss, decreased skin turgor, concentrated urine, less urine

hypovolemia treatment

replace water and electrolytes with balanced IV solutions

ISOTONIC SOLUTION: normal saline

monitor daily weight

Hypervolemia

EXCESSIVE FLUIDS IN BODY

DUE TO: Kidney Injury, CHF

SYM: EDEMA, increased urine output, HTN

treatment for hypervolemia

- diuretics

- monitor weight

Hypocalcemia

deficient calcium in the blood

DUE TO: too little calcium usually from hypoparathyroidism, malabsorption, pancreatitis, alkalosis, deficiency in VIT D

SYM: numb/tingling in toes and fingers

hyperactive deep tendon reflex

chvostek sign/trousseaus sign

Nurse intervention with hypocalcemia

Give calcium/vit D

nutrition education

Hypercalcemia

excessive calcium in the blood

Due to: too much calcium due to hypoparathyroidism

, malignant neoplastic disease ( turmors), immobilzation, vit d increase, diuretic use

SYMP: hypoactive deep tendon reflex

nurse intervention for hypercalcemia

1) diuretics

2) movement

3) calcitonin

4) find the underlying issue

Hyponatremia

deficient sodium in the blood

DUE to: too little sodium from diuretics, loss of gi fluids, renal disease, head trauma.

SYM: confusion, headache, muscle cramps, seizure, twitching, low BP, coma

Intervention for hyponatremia

1) fall and seizure precaution

2) mild = salt tablets

3) severe = hypertonic solution 3% solution

4) daily weight

5) intake and outtake

6) LR

7) Fluid restriction

Hypernatremia

high sodium

DUE TO: too much sodium

SYMP: thirst, sticky dry mouth and tongue, hallucinations, restless, irritable, seizure, twitching, high BP, death

Intervention Hypernatremia

1) fall and seizure precaution

2) hypotonic solution %0.45 normal solution

3) neuro check

Hypokalemia

deficient potassium in the blood

DUE TO: too little potassium due to diarrhea, vomiting, gastric suction

SYMP: constipated and ECG changes (FLAT T WAVES)

Nurse intervention for hypokalemia

1) give pottasium SLOW

2) cardiac telemetry

3) EKG

can give magnesium

Hyperkalemia

excessive potassium in the blood

DUE TO: too much pottasium from metabolic acidosis, renal insufficienses, NSAIDS

SYMP: TALL peaked t waves

Nurse interventions for hyperkalemia

1) telemetry

2) EKG

3) IV calcium gluconate

4) IV regular insulin/glucose(pulls in cell)

Diarrhea - make them poop!

Dialysis

Hypomagnesium

too little magnesium

Symp: insomnia, heart changes, increased tendon reflexes

Nurse intervention: give magnesium and seizure precaution

hypermagnesium

too much magnesium

symp: flushing, drowsy, low RR, cardiac arrest

Nurse intervention: vital signs, telemetry, give loop diuretic

which two electrolytes go together?

Potassium and magnesium

What is isotonic solution used for? %0.9 saline

blood loss

dehydration

fluid maintenance

What is hypotonic %0.45 normal saline used for?

used for someone with a lot of sodium and use slowly

Hypertonic solution %0.3 normal saline used for?

used for severe hyponatremia, use slow

What is insensible fluid loss?

The amount of fluid loss on a daily basis from the lungs, skin, respiratory tract, and water excreted in the feces. The exact amount cannot be measured.

Respiratory Alkalosis

Ph level rises above 7.45 carbon dioxide falls below 35

Caused by hyperventilation, pneumonia, ARDS

Symp: SOB, dizziness, chest pain, numbness in hands and feet

Respiratory Acidosis

Ph drops below 7.35 carbon dioxide level rises above 45

Cause by hypoventilation, pneumonia, COPD, asthma, benzos, opioids(overdose)

SYMP: confusion, lethargy, dyspnea, palm cyanotic skin

metabolic alkalosis

pH > 7.45 ----- HCO3 > 26

Caused by antacid(tums) overdose, loss of body acid = vomiting and ng suction

SYMP: tachycardia, dysrhythmias, muscle weakness, and lethargy, n/v, tingling in toes and fingers, lightheaded

metabolic acidosis

pH < 7.35 ------- HCO3 < 22

Caused by DKA, kidney failure, shock, starvation, diarrhea, and dehydration, will kill your organs

SYM: headache, confusion, drowsy, high RR and depth, nausea, vomiting, low BP, cold and clammy skin

IN COPD which ABG abnormality?

RESP acidosis

What is the role of the scrub nurse?

extra set of hands for the surgeon, remain in the sterile field- gowned & gloved

What is the role of the circulator nurse?

Grab supplies, fluid intake, sterile and sponge count. DONT WAnt anything left in the body. Documentation

Side effects of benzos with pre op meds?

They are anti-anxiety and make you sleepy. You want to monitor their RR and BP. You want them to stay in bed and not get up.

Pre-op nursing care

*explain the procedure

*explain the diagnosis

*explain ostomy care and the importance of turn/cough/deep breathing/IS

*Potential for Foley and other drains

*lessen patient anxiety

*make sure patient understands the care

+ baseline assessment and vitals

*informed consent

*meds needed?

*preparing site, cleaning/shaving skin

Pre op

Begins with the decision to have surgery and lasts until patient is transfered to the OR or procedure bed

Intra-op

Admission to surgical department goes til they are in recovery room

Intra-op nursing interventions

•Time outs

•Serve as Patient Advocate

•Monitoring

•Counts

•Documentation

•Allergic Monitoring (Latex)

•Prevent Complications (Pressure injury, etc)

•Maintain sterile / aseptic area

post-op

Admission to recovery room to complete recovery and last follow up visit with physician.

Priority assessment with POst op?

AIRWAY, breathing, circulation

post op teaching

- Manage nausea and vomiting

- Monitoring for gas passing and bm

- deep breathing/coughing

- isometric leg exercises to prevent DVT

- repositioning/turning

- wound care

- infection prevention

- time lines for activities

- meds- when to take and not take

- keep up with doc visits

Types of Anesthesia

general: put to sleep

regional: epidural/ spinal block

local: wounds, burns

conscious sedation: short term and minimally invasive

Malignant hyperthermia

A hereditary condition of uncontrolled heat production that occurs when susceptible people receive certain anesthetic drugs. Causing body temp to sky rocket

treatment: dantrolene

What is medication tolerance?

more medication is required to achieve the same therapeutic effect

OLDCART

O- onset

L- location

D- duration

C- characteristics

A- aggravating factors

R- relieving factors

T- treatment

Different pain scales

Numeric scale, face scale (wong baker) , non verbals, FLACC (infants)

What meds are used for low- moderate pain?

1) NSAID

2) acetaminophen

3) aspirin

What meds are used for mild-severe pain?

OPIOIDS

Major side effects of opioids?

respiratory depression, constipation, sedation

HOw do you administer strong opioids?

SLOWLY

What is an opioid antagonist?

Naloxone (Narcan) - this is given to help with an overdose it blocks opioid activity

what is an opioid agonist?

Opioids that activate and bind receptors - morphine

What is dumping syndrome?

This is when the stomach empties quickly after eating and the client experiences uncomfortable to severe side effects. Usually secondary to gastric bypass, gastrectomy or gall bladder disease.

What does dumping syndrome cause?

Malabsorption due to diahrrea and diaphoresis

What interventions do you want to do to prevent dumping syndrome?

1. eat slow

2. drink fluids between meals not with them

3. room temp food

4. sit/rest after eating

5. EAT protein with every meal

6. sit in low fowlers (30 degrees)

Atopic Dermatitis

Eczema

How to treat: Topical treatment (antihistamine)

steroid cream

cold compress

Avoid what causes exacerbations: chlorine in the pool, avoid long baths,

Herpes Zoster

Shingles

-remains dormant in body- reactivated through stress, illness, immunosuppression

-occur along dermatome(rely on nerve connections to spine) and face

-Painful, when its on one side of body, it will not be on the other.

-Its contagious in the weeping stage

-can cause blindness

-Med they will be on: Acyclovir

Psoriasis

-Chronic autoimmune skin disease that causes skin cells to grow faster than usual, resulting in dry, scaly patches, commonly on the front of knees, posterior elbows plus trunk and scalp.

-Psoriasis frequently causes an inflammatory arthritis of joints and pitting of the nails

-Treatment: immunosuppressant, creams, ointments, oral medications, and injectable medications

KELOID SCAR FORMATION

• Benign overgrowth of scar tissue

• Can occur wherever there is a skin injury but usually forms on earlobes, shoulders, cheeks or the chest

• Risk factors include Brown or Black skin and younger age (20-30 years)

• Compression of wounds may help prevent keloids

• Treatment options include corticosteroid creams, laser therapy, or surgical removal

SEBORRHEIC KERATOSIS

• Common benign skin growth

• Tends to occur with aging

• No treatment required

• Slightly raised, brown or tan lesions that look waxy or scaly (May resemble a wart or a piece of gum)

• Only removed if irritating or the client uncomfortable with appearance

PRECANCEROUS & CANCEROUS SKIN LESIONS

• Most common type of cancer

• Frequently related to sun exposure

• Prevention: Use of sunscreen and avoiding sun exposure

• Skin inspection for non-healing lesions or abnormal dark lesions

• Prevention of all types of skin cancer involves protection from excessive sun exposure

ACTINIC KERATOSIS (PRECANCEROUS)

• Chronic sun damage to exposed areas like face, scalp, ears, nose and hands

• Scaly flaky lesions that feel like sandpaper when rubbed

• Precancerous lesions that may develop into a squamous cell carcinoma

• Risk of actinic keratosis is minimized by reducing sun exposure and protecting skin from ultraviolet (UV) ray damage.

• Treatment is usually with liquid nitrogen or 5-fluorouracil cream (chemo cream)

BASAL CELL CARCINOMA

• Most prevalent, rarely spreads or causes death

• Appears on sun exposed hands, face, neck, scalp

• Small waxy nodule with a central ulcer

• Rarely metastasizes, spreads locally

• Reoccurrence is common to other skin areas

SQUAMOUS CELL CARCINOMA

• Also arises from sun-damaged skin

• Often occurs from actinic keratosis

• Less aggressive than melanoma, but can occasionally spread deeper

• Rarely, may metastasize by blood or lymph

• Rough, thickened, scaly tumor

• May be asymptomatic or may

TREATMENT FOR BCC AND SCC

-Prevention with sunscreens all year and minimize sun exposure

-Protective clothing, avoid tanning beds, broad brim hats

-Surgical removal

-Alternatives: radiation, topical chemotherapeutic creams (5-FU

ABCDE's of Melanoma

Asymmetry, Border, Color, Diameter, Evolving

MALIGNANT MELANOMA

-Cancerous neoplasm present in dermis and epidermis

-Manifests as a change in nevus or a new growth on the skin

-Color is dark, red, blue colored or a mix, irregular shape

-Itching, rapid growth, ulceration, bleeding, metastasizes

-Treatment: Surgical excision, chemotherapy

• Malignant skin cancer

• Highly curable if caught early

• 5-year survival = 94%

Bariatric Surgery

•Results in weight loss of 10% to 35% body weight within 2 to 3 years

•Improvement in comorbid conditions

•Selection by multidisciplinary team

•Selection criteria has changed to include BMI of 30 for clients with comorbid conditions(diabetes, htn, etc)

18-65

Bariatric Surgery types

-Roux-en-Y Gastric Bypass (RYGB)

-Sleeve Gastrectomy (SG)

-Adjustable Gastric Banding (AGB)

-Biliopancreatic Diversion with Duodenal Switch (BPD/DS)

-Intragastric Balloon

-Endoscopic Sleeve Gastroplasty (ESG)

Bariatric surgery pre op

includes months of education, counseling and evaluation. Know risk and benefits of surgery, complications, postsurgical outcomes, lifestyle changes, dietary changes, lifelong follow-up, lab testing.

Bariatric surgery intra op

Prep

anesthesia

procedure

PACU for monitoring

Bariatric expectations post op care

•Assess to ensure goals for recovery are met

•Assess for absence of complications

•Manage pain

•Nutritional status

•Fluid volume balance

•Decrease anxiety

•Body image changes

Bariatric surgery problems and potential complications

•Hemorrhage

•Venous thromboembolism

•Bile reflux

•Dumping syndrome (early and late)

•Dysphagia

•Bowel or gastric outlet obstruction

Sodium Functions

Nervous System

Fluid Balance

Hyponatremia symptoms

confusion

muscle cramps/weakness

seizures

Hypernatremia symptoms

irritability

muscle twitching

seizures

Potassium function

cardiovascular system

muscular system

Hypokalemia symptoms

ECG changes- PVCs, flat T wave, prominent U wave, prolonged P wave

constipation

muscle cramps

Hyperkalemia symptoms

ECG changes- peaked T waves, wide QRS, absent P wave

diarrhea

muscle weakness/paralysis

Calcium function

Neuromuscular system

Bones

hypocalcemia symptoms

Hyperactive reflexes

numbness/tingling to face and extremities

Chvostek and Trousseau sign

Hypercalcemia symptoms

Hyperactive reflexes

confusion/psychosis

bone pain/fractures

kidney stones

Magnesium function

cardiovascular system

neuromuscular system

hypomagnesemia symptoms

hyperactive reflexes

muscle cramps

hypermagnesemia symptoms

hypoactive reflexes

muscle weakness

respiratory distress

reduced LOC

pH range

7.35-7.45

PaCO2 range

35-45 mmHg

HCO3 range

22-26 mEq/L

what does PaCO2 indicate

respiratory

what does HCO3 indicate

metabolic