ATI COMP PREDICTOR

A NURSE IS PROVIDING D/C INSTRUCTIONS TO A PT WHO HAS TB AND IS BEGINNING TX W/ MULTIDRUG THERAPY. WHICH OF THE FOLLOWING PT STATEMENTS INDS AN UNDERSTANDING OF THE TEACHING?

-3 consecutive negative sputum tests will ind that the pt is no longer contagious. BUT Mantoux test will always be +.

-pts who have taken meds to tx TB for 2-3 consecutive weeks are no longer contagious. BUT, pts will need to continue med therapy for at least 6mos.

-meds for TB can damage liver. avoid consuming alc.

-reg follow-up visits needed w/ TB.

A NURSE IS CARING FOR A PT WHO HAS A CLOSED-HEAD INJ AND IS ON SEIZURE PRECAUTIONS. WHICH OF THE FOLLOWING ACTIONS SHOULD THE NURSE TAKE?

-no padded tongue blade (risk of asp and damage to teeth).

-no side rails raised

-set up suction equipment at bedside.

A NURSE IS DISCUSSING SECURITY MEASURES W/ A PT FOLLOWING DELIV OF AN INFANT. WHICH OF THE FOLLOWING STATEMENTS SHOULD THE NURSE MAKE?

-if pt or other responsible party must leave the room for any reason, the newborn should be transported to the newborn nursery.

-security sensor isn't removed until d/c from facility.

-2 plastic ID bracelets needed - one on arm and one on leg. ID #, name, date, time of birth, and sex are included. replace immediately if off or missing.

-ask for hospital ID prior to allowing anyone to transport their newborn (don't go by colored scrubs).

A NURSE IS CONDUCTING A PRENATAL CLASS ABT CAR SEAT SAFETY. WHICH OF THE FOLLOWING STATEMENTS BY A PT INDICATES AN UNDERSTANDING OF TEACHING?

-infants should remain in the rear-facing position until they're at least 2yrs old to ensure safety.

-secure the retainer clip at lvl of baby's armpits.

-car seat at 45 deg angle.

-extra blankets or padding should not be added to car seat (could create extra air btwn infant and seat = inj during MVC).

A NURSE IS PERFORMING TRIAGE FOLLOWING A MASS CASUALTY EVENT. WHICH OF THE FOLLOWING PTS SHOULD THE NURSE REC BE TRANSPORTED FIRST TO A HCF?

-a middle adult pt who has a sucking chest wound

-a child whose thigh is impaled w/ glass and has 2+ pedal pulses has good peripheral circ and, therefore, can wait.

-ad paralyzed from waist down - low SCI, not an immediate threat and can wait.

-OA w/ agonal breathing - near end of life. not transported first r/t min chance of survival.

A HHN IS PLANNING CARE FOR AN OA PT WHO HAS IMPAIRED VISION. WHICH INTERVENTIONS SHOULD THE NURSE INCLUDE IN THE PLAN TO PREVENT INJ IN THE HOME?

-secure any area rugs w/ a non-slip pad or adhesive strips to secure to the floor to prevent sliding.

-extension cords are removed from high-traffic areas in the home and placed along the edges of walls.

-have adequate lighting - use of light fixtures that use bulbs >40 watts to optimize visibility.

-mark edges of stairs w/ paint or colored tape for contrast.

A NURSE IS DELEGATING MEASUREMENT AND DOC OF A PT'S CAPILLARY BLOOD GLUCOSE LVL BEFORE LUNCH TO A LPN. WHICH ACTIONS SHOULD THE NURSE TAKE TO EVAL THE COMPLETION OF THIS TASK?

-ensure that the glucose lvl appears in the pt's med record - task completion!!

A NURSE IS PLANNING CARE FOR A GRP OF PTS. IDENTIFY THAT WHICH OF THE FOLLOWING TASKS IS OUTSIDE AN RN'S SCOPE OF PRACTICE?

-inserting a non tunneled percutaneous central venous catheter.

A NURSE IS CARING FOR A PT WHO IS HIV+ AND HAS PNEUMONIA. A FAM MEMBER ASKS THE NURSE, "WHAT IS CAUSING MY SISTER'S PNEUMONIA?" WHICH OF THE FOLLOWING RESPONSES SHOULD THE NURSE MAKE?

-"your sister must give permission for me to discuss her condition w/ you."

A NURSE MANAGER IS PREPPING A STAFF ED PROGRAM ABT CONFIDENTIALITY. WHICH OF THE FOLLOWING ACTIONS SHOULD THE NURSE TAKE FIRST?

-determine the staff's current knowledge of confidentiality requirements.

A NURSE IS CARING FOR A NEWBORN WHOSE GUARDIAN HAS REFUSED THE ROUTINE ADMIN OF ERYTHROMYCIN OINTMENT TO THE NEWBORN'S EYES. WHICH ACTIONS SHOULD THE NURSE TAKE?

-have the guardian sign the facility's refusal form and doc completion of the form.

-do NOT obtain a culture of the newborn's eye secretions for gonorrhea (as erythromycin is used as a prophylactic tx for gonorrhea for the prevention of ophthalmia neonatorum. - the cultures are not part of standard practice for providing care to a newborn).

A NURSE IS DELEGATING CARE FOR A GRP OF PTS. DELEGATE TO THE AP?

-perform postmortem care

(cannot check placement of enteral feeding tube).

A NURSE IS CARING FOR AN ANTEPARTUM PT WHO HAS JUST BEEN INFORMED THAT THEIR FETUS HAS ANENCEPHALY. THE PT ASKS THE NURSE, "DO YOU THINK I SHOULD TERMINATE MY PREG?" WHAT SHOULD THE NURSE SAY?

"Let's talk abt what YOU think you should do."

A NURSE IS PREPPING TO ADMIN A MIXTURE OF HALDOL 5mg/ml AND DIPHENHYDRAMINE 50mg/ml IM TO A PT WHO IS AGITATED. NURSING ACTION?

-avoid admin >1ml of med into the deltoid site. both haloperidol and diphenhydramine should be admin deep into a large muscle mass, such as the VG muscle!!

-use a 2-in needle for an IM injection of this combo of the 2 meds.

-inject air into both vials prior to withdrawing the meds. this action ensures that the nurse can easily withdraw the med when needed and that the med in the syringe isn't pulled back into the vials due to negative pressure being formed.

-the nurse should use a filter needle to withdraw med from an ampule; however, the filter needle is removed and replaced w/ a reg needle prior to admin. these meds for admin are being withdrawn from vials, not ampules.

A NURSE IS TEACHING A PT WHO HAS A NEW RX FOR HALDOL. INSTRUCTIONS INCLUDED IN THE TEACHING?

-rinse your mouth freq throughout the day - Haldol has antich s/e like dry mouth.

-taper Haldol slowly to avoid EPS - don't stop abruptly/immediately for sed!!

-reg eye exams (not ear) w/ Haldol.

-use sunscreen products or protective clothing to min unprotected exposure to sunlight b/c Haldol can cause photosensitivity.

A NURSE IS PROVIDING D/C TEACHING TO A PT WHO HAS A NEW RX FOR CODEINE PRN FOR PAIN. UNDERSTANDING OF THE TEACHING?

"I should take a stool softener w/ this med" - a/e of opioid analgesics is constip!!!

-may have urinary retention w/ codeine.

A NURSE IS CARING FOR A PT WHO IS TAKING VERAPAMIL AND STATES, "I TAKE MY MED W/ A GLASS OF GFJ EVERY AM." WHICH FINDING INDS A POSS MED-FOOD INTERACTION?

-drowsiness, hypotension (GFJ inhibits metab of this med - higher lvl of verapamil in the blood --> hypotension). + urinary frequency & wt gain.

A NURSE IS CARING FOR A PT WHO IS RECEIVING 0.9% SODIUM CHLORIDE VIA CONTINUOUS IV INFUSION THROUGH A PERIPHERAL IV SITE. THE PT HAS A NEW RX FOR CEFAZOLIN 1g VIA INTERMITTENT IV BOLUS TO INFUSE OVER 30 MINS. WHICH ACTIONS SHOULD THE NURSE TAKE WHEN INFUSING THE CEFAZOLIN?

-infuse the cef thru secondary tubing CC w/ the 0.9% NaCl infusion (piggyback it AFTER ensuring solutions are compatible).

-abx are time-crit meds (so do not wait to admin it).

A NURSE IS MONITORING A PT WHO RECEIVED ALTEPLASE DURING CORONARY ANGIOGRAPHY. ADVERSE EFFECT OF THE MED?

-bleeding around IV site, hematuria, or ALT LOC (IC BLEED!!!!).

A NURSE IS CARING FOR A SCHOOL-AGE CHILD WHO IS EXPERIENCING STATUS EPILEPTICUS. WHICH MED SHOULD THE NURSE EXPECT TO ADMIN?

lorazepam!!

-gabapentin, carbamazepine, and valproic acid are for LT mgmt of seizures

HERBAL SUPPLEMENTS AND WHAT THEY'RE SPECIFICALLY USED FOR:

(1) GINGER: n/v, motion sickness.

(2) GINKGO BILOBA: incs blood flow to the brain and improves memory.

(3) SAW PALMETTO: txs urinary cm caused by BPH

(4) GARLIC: txs HTN and elevated cholesterol lvls.

A NURSE IS TAKING A HX FOR A PT WHO DESIRES TO OBTAIN ORAL CONTRACEPTIVES FOR BIRTH CTRL. CONTRA TO USE OF ORAL CONTRACEPTIVES?

hx of thrombophlebitis (oral contraceptives inc risk of thrombosis).

-oral contraceptives can be used to tx a pt who has a hx of menorrhagia.

-no prev press and STI presence are both not contras for the use of OCs.

RFs FOR PROSTATE CANCER

-androgen therapy

-exposure to arsenic

-a diet high in red meat/fat

A NURSE IS ASSESSING A PT WHO IS NEAR THE END OF THE FIRST TRI DURING A ROUTINE PRENATAL EXAM. WHICH OF THE FOLLOWING ACTIONS SHOULD THE NURSE TAKEN WHEN IDENTIFYING THE FHR?

place the stethoscope midline and apply firm pressure just above the SP (first tri FHR).

-cannot measure uterine activity during the first tri (needs an external tocotransducer). cannot use Leopold's during to measure uterine activity during first tri - determines fetal presentation. does not help to measure it at lvl of umb.

A NURSE IS CREATING A PLAN OF CARE FOR A NEWLY ADMITTED PT WHO HAS ANOREXIA NERVOSA. INTERVENTION?

weigh the pt daily after the first voiding (when awakening). same scale, strict I&O's.

-stay with the pt for at least 1hr following meals.

-do NOT offer the pt rewards for eating at least 75% of meals - avoid bargaining w/ the pt and clearly state the behavs that are expected and the privileges that'll be restricted for noncompliance. consistency and firmness by staff will help to dec the pt's use of manipulation behav. restrictions on exercise until wt gain goal is achieved.

A NURSE IS FACIL A GRP THERAPY SESSION. A PT CONTINUOUSLY INTERRUPTS THE OTHER MEMBERS OF THE GRP. ACTION?

ask the pt to limit their comments to 2-3 per session. helps address interruptions while still allowing the pt to express their feelings.

-allow the pt to remain in the grp setting and speak to them after the session has ended.

A NURSE IS COUNSELING A PT WHO RECENTLY EXPERIENCED A SITUATIONAL CRISIS. WHICH OF THE FOLLOWING ACTIONS SHOULD THE NURSE TAKE TO ASSIST THE PT W/ COPING?

assist the pt in ID the cause of the issue.

A NURSE IS CARING FOR A PT WHO HAS BPD. ACTIONS?

-encourage physical activity as a safe way of redirecting violent behavior and relieving tension. encourage walking, jogging, and punching a bag.

-set limits on the pt's acting-out behavior to encourage sufficient self-ctrl b/c this is a behav that the pt lacks. all staff members working w/ the pt should maintain consistency to create a positive outcome w/ the pt.

-ID that rotating staff members working w/ the pt will help to dec splitting behavs and diminish fears of abandonment for the pt.

-encourage the pt to talk abt thoughts of self-mutilation to gain knowledge of the precipitating factors.

A NURSE IS CARING FOR A PT WHO HAS AN INDWELLING URINARY CATH. DEC RISK OF CAUTI?

-use surg aseptic technique when obtaining urine samples from the Cath port to prevent CAUTIs.

-keep drainage bag below the bladder lvl to prevent reflux of urine from the bag back into bladder.

-to dec CAUTI risk, EBP suggests performing periurethral care using mild soap/water.

-cath should not be replaced routinely to reduce risk of CAUTI.

SICKLE CELL CRISIS. NURSING ACTIONS?

encourage pt to inc fluid intake (dehyd incs viscosity of blood - sickling --> inc pain).

-keep room temp at or above 22.2C/72F b/c cold temps cause vasoconstriction and promote sickling.

-admin opioids as needed & keep extrems EXTENDED to promote venous return.

D/C TEACHING - PT W/ HF AND A RX FOR A 2000-mg SODIUM DIET. UNDERSTANDING OF TEACHING?

"I can have a frozen juice bar for dessert"

-avoid condiments on sandwiches like ketchup, mayo, and yellow mustard.

-avoid celery salt, onion salt, and garlic salt.

-avoid veggie juice.

LEFT-SIDED WEAKNESS. QUAD CANE WALKING?

advance the weaker leg forward to the cane FIRST.

-place cane 15-25cm (6-10in) in front of bod prior to stepping forward.

-quad cane is always placed on the stronger side of bod.

-keep elbow flexed 15deg when using the cane.

EGD. REPORT WHAT THE HCP?

abd pain (can be r/t perforation of bowel).

-sore throat is expected post-EGD. hypoactive BS are expected post-EGD r/t NPO status for at least 6hrs prior. flatulence is expected.

MS. ANTIC WHICH CM?

nystagmus (invol eye movements).

-bradykinesia r/t PD; aphasia is an inability to speak and interpret lang (cm assoc w/ a stroke); fasciculations are twitching of the face (cm assoc w/ ALS).

WATER-SEAL CHEST TUBE DRAINAGE SYSTEM. IMMEDIATE ACTION?

the drainage in the collection chamber is touching the tube (impairs suction and can --> TP. change out drainage systems before this occurs)!!

-WSC prevent air from re-entering the pleural space. done by presence of water in the bottom of the chamber. at least 2cm of water is needed.

PROVIDING TEACHING TO A PT AT 26WKS GEST AND IS SCHED FOR A 3HR OGTT. INSTRUCTIONS?

-avoid caffeine for 12hrs prior to test.

-maintain an unrestricted diet for 3d prior to test, including at least 150g of carbs each day.

-do not eat/drink during testing/overnight.

18HR PP FOLLOWING C BIRTH. REPORT WHICH FINDING?

unilateral tenderness of the LLE (DVT).

-LGF, uterine contractions during breastfeeding, and abd guarding are all expected findings post c-birth and pp!!

D/C TEACHING TO AN AD WHO HAS A NEW FIBERGLASS CAST ON THE TIBIA. INSTRUCTIONS?

-apply ice for first 24h to dec pain and reduce swelling (not heat).

-cover cast w/ plastic when bathing to keep cast dry/intact.

-report any loss of sensation, N&T, and paralysis --> can ind ischemia.

-keep leg elevated for the first 24hrs to reduce risk of swelling and circulation impairment.

VB12 DEF. FINDINGS?

glossitis (smooth/beefy-red tongue).

-SCA: jaundice of sclera r/t RBC destruction and release of bili into the vasc system.

-IDA: fissures at corners of mouth r/t lack of iron.

-COLD ANTIBODY ANEMIA: experiences blanching of the fingers. this disorder causes the arteries of the hands and feet to constrict in response to cold temps.

BRONCHIOLITIS. RR OF 72/min. INFANT IS RECEIVING IVF THERAPY AND THE PARENT ASKS WHY IV IS NEC. NURSING RESPONSE?

"your baby is breathing too fast to drink" - bronchiolitis in babies --> tachypnea (oral fluids are contra).

-abx are NOT used to tx bronchiolitis unless there's an underlying bacterial inf like OM or PNA!!

POSTOP, TOTAL THYROIDECTOMY. PRIORITY FINDING?

drooling (inds ob and poor gas exchange - occurs due to swelling or bleeding at op site. +diff swallowing, stridor, and dyspnea.

-tingling of fingers, tetany, and muscle twitching = hypocalc!!

CARBON MONOXIDE POISONING. EXPECTED FINDING?

hypotension (due to vasodilating effect of carbon monoxide).

-experiences musc weakness rather than rigidity.

-inhaled steam inj --> ulcerations in oral cav.

-direct burn/inj: singed nasal/facial hairs.

POSTOP, TONSILLECTOMY. NURSING ACTIONS?

place child in SF w/ their head turned to the side: fails drainage of secs.

-avoid coughing and clearing the throat - can agg surg site and cause bleeding --> hemorrhage. no C&DB here.

-avoid admin liquids to the child thru a straw b/c it can cause damage to the surg site and result in bleeding.

-admin analgesics to the child q4hrs for the first 24-48hrs to reduce pain and promote comfort.

STOMAS/OSTOMIES

-should be moist, shiny, and pink/red. peristomal area is intact.

-mild soap/water is used to cleanse skin. NO moisturizing soaps as they can interfere w/ adherence of the pouch.

-measure and mark desired size for skin barrier. then cut the opening 0.15-0.3cm (1/18-1/8in) larger, allowing only the stoma to appear thru the opening.

-if nec, apply barrier pastes to creases. then apply skin barrier and pouch.

FIBERGLASS CAST

-ice 24-48hrs

-handle plaster cast w/ palms, not fingertips, until cast is dry to prevent denting the cast.

-prior: clean/dry area. tubular cotton web roll is placed over area to maintain skin integrity.

-after: position pt so that warm, dry air circulates around and under the cast (support casted area w/o pressure under or directly on the cast) for faster drying and to prevent pressure from changing the shape of the cast. use gloves to touch the cast until completely dry.

-elevate cast during first 24-48hrs to prevent edema. elevate arm casts above heart lvl. leg is elevated on several pillows.

-room for 1 finger btwn skin/cast.

-provide assistive devices (sling to support weight of an arm cast or cast shoes/boots to facilitate walking).

-inspect q8-12hrs.

-itching under cast is relieved by blowing cool air from a hair dryer into the cast. cover cast w/ plastic bag before baths and showers to keep the cast dry.

-report SOB, skin breakdown, and constip - mobility comps.

CAM METHODS (provided by specialized licensed or certified practitioners)

-ACUPUNCTURE/PRESSURE: needles or digital pressure along meridians to alter bod func or produce analgesia.

-HOMEOPATHIC MEDICINE: admin doses of substances (remedies) to pts who are ill, that would produce cm of specific disease states in a well person, to bring about healing.

-NATUROPATHIC MED: diet, exercise, env, and herbal remedies to promote natural healing.

-CHIROPRACTIC MED: spine manip for healing.

-MASSAGE THERAPY: stretching and loosening muscles and connective tissue for relaxation and circ.

-BIOFEEDBACK: using tech to inc awareness of various neurological bod responses to min extremes.

-THERAPEUTIC TOUCH: using hands to help bring energy fields into balance.

NATURAL PRODUCTS AND HERBAL REMEDIES

-ALOE: wound healing

-CHAMOMILE: anti-inflamm, calming.

-ECHINACHEA: enhances immunity.

-GARLIC: inhibits plt agg.

-GINGER: antiemetic

-GINKGO BILOBA: improves memory

-GINSENG: incs phys endurance

-VALERIAN: promotes sleep, reduces anxiety.

RENAL CALCULI

-DIET: dec intake of purine sources such as organ meats, poultry, fish, gravies, red wine, and sardines; lemon or orange juice can be consumed to alkalinize the urine.; cystine - limit animal protein intake.

-MEDS: allopurinol prevents formation of uric acid + K+ or sodium citrate/bicarb alkalinizes urine.; AMPG and captopril lower urine cystine

ALLERGIC TRANSFUSION RXN

-ONSET: during or up to 24h after transfusion.

-results from a sensitivity rxn to a component of the products.

-MILD: itching, urticaria, and flushing. stop transfusion, initiate an infusion of 0.9% NaCl using new tubing. admin an antihistamine, such as diphenhydramine. if HCP res to restart, do it slowly.

-ANAPHYLACTIC: bronchospasm, laryngeal edema, hypotension, & shock. stop transfusion. admin epi, corticosteroids, vasopressors, O2, or CPR if ind. remove blood tubing from IV access and initiate an infusion of 0.9% using new tubing.

CIRCULATORY OVERLOAD R/T BLOOD TRANSFUSION:

-can occur any time during transfusion.

-transfusion is too rapid for pt. OAs or those w/ preexisting inc circ volume are at inc risk.

-crackles, dyspnea, cough, anxiety, JVD, and tachycardia. can progress to pulm edema.

-slow/stop. position pt upright w/ feet lower than the lvl of the heart. admin O2, diuretics, and morphine as rx.

ACUTE HEMOLYTIC TRANSFUSION RXN

-immediate or can manifest during subsequent transfusions.

-results from a transfusion of blood products that are incompatible w/ the pt's blood type or Rh factor. can occur following transfusion of as few as 10ml of a blood product.

-can be mild or life-threatening (--> DIC or circ collapse).

-findings: fever, chills, low-back pain, tachycardia, hypotension, chest tightening/CP, tachypnea, nausea, anxiety, hemoglobinuria, and an impending sense of doom.

-stop transfusion. remove blood tubing from IV access. avoid further blood product admin. initiate an infusion of 0.9% w/ new tubing. monitor VS and fluid status. send blood bag and admin set to the lab for testing.

LITHIUM S/E

-GI DISTRESS: admin med w/ meals or milk.

-FINE HAND TREMORS: admin propanolol + adjust to lowest poss dosage, give in divided doses, or use LA formulations. inc in tremors is reported r/t lith tox.

-POLYURIA/MILD THIRST: use spironolactone; maintain adequate fluid intake by consuming 1500-3000 ml fluid.

-WT GAIN

-RENAL TOX

-GOITER/HYPOTHYROIDISM: w/ LT tx. obtain baseline thyroid lvls prior and then annually.

-BRADYDYSRHYTHMIA, HYPOTENSION, AND ELEC IMBALANCES.

LITH TOX

-LVL <1.5: diarrhea, n/v, thirst, polyuria, muscle weakness, fine hand tremor, slurred speech, & lethargy.; cm at low lvls often improve over time. - these are common adverse effects.

-LVL 1.5-2: ongoing GI distress, mental confusion, poor coord, coarse tremors, & sed - admin new dosage based on blood lith and sodium lvls. if cm are severe, it can be dec to promote excretion. withhold med and notify HCP. - these are early indications.

-LVL 2-2.5: extreme polyuria of dilute urine, tinnitus, invol extrem movements, blurred vision, ataxia, seizures, severe hypotension --> coma and poss death from rest comps. - whole bowl irrigation may be rx.

-LVL >2.5 = severe tox: oliguria, seizures, rapid progression of cm --> coma/death (HEMODIALYSIS would be needed).

IM INJECTIONS

-VL: for infants 1yr and younger.

-VG: preferred, for injecting volumes up to 3ml.

-DELTOID: smaller muscle mass, can accommodate 1-2ml of fluid.

-18-25G, 5/8-1.5in long, and inject at a 90 deg angle. 1-3ml solution. divide larger vols into 2 syringes and use two diff sites.

-z-track prevents med from leaking bak into sub tissue.

MDI

-shake inhaler 5-6x

-take a deep breath, and then exhale.

-press inhaler and then inhale slowly. continue to breathe slow/deeply for 3-5s.

-hold breath for 10s to allow the med to deposit in your airways.

-take inhaler out of mouth and slowly exhale thru pursed lips.

NG AND GASTROSTOMY TUBES

-do not admin sublingual meds.

-do not crush specially prepped oral meds (extended/time-release, fluid-filled, and enteric-coated).

-admin each med sep and do not mix w/ enteral feedings.

-completely dissolve crushed tablets and capsule contents in 15-30ml of tepid water prior to admin.

-to prevent clogging, flush the tubing before/after each med w/ 15-30ml of water. flush w/ another 30-60ml of water after instilling all the meds.

TRICYCLIC ANTIDEPS: amitriptyline (or imipramine

doxepin

nortriptyline

amoxapine

trimipramine

desipramine

clomipramine)

-can take 10-14d+ before TCAs begin to work and max effects might not be seen until 4-8wks.

-for dep and dep eps of bipolar disorders.

-A/E:

(1) OH: monitor before/1hr after.

(2) ANTICH EFFECTS: dry mouth, blurred vis, photophobia, urinary hesitancy or retention, constip, and tachycardia - chew sugarless gum/sip on water, wear sunglasses when outdoors, eat foods high in fiber, partic in reg exercise, inc fluid intake to at least 2-3L/day. void just before taking med.

-ECG changes....r/t toxicity - cardiac effects + seizures.

SELECTING IV SITE FOR OAs

-apply clean tourniquet or BP cuff 10-15cm (4-6in) above insertion site to compress only venous blood flow

-CHOOSE: distal veins first on nondom hand. a site that isn't painful or bruised and will not interfere w/ activity.

-AVOID: varicose veins that are perm dilated + veins in inner wrist w/ bifurcations, in flexion areas, near valves, in LE, and in the antecubital fossa (except for emergency access). veins in back of hand. sclerosed/hard. veins in extrem w/ impaired sensitivity (scar tissue, paralysis), LNs removed, recent infiltrated, a PICC line, or an AV fistula or graft. veins that had previous venipunctures.

-inserted w/ bevel UP.

-NOTE: date/time, insertion site/appearance, size, type of deg, IVF and rate, number/locs/conds of prev attempted caths. the pt's response.

PRESUMPTIVE SIGNS OF PREGNANCY

-subjective cm or objective findings.

-signs also might be a result of physiological factors other than pregnancy (peristalsis, infections, stress).

-amenorrhea, fatigue, n/v, urinary frequency, breast changes - darkened areolae/enlarged Montgomery's glands, quickening (at 16-20wks gest), uterine enlargement.

PROBABLE SIGNS OF PREGNANCY

-signs can be caused by physiological factors other than pregnancy (pelvic congestion or tumors)

-make HCP think pt is preg.

-abd enlargement,

-hegar's sign: softening and compressibility of lower uterus.

-chadwick's sign: deepened violet-bluish color of cervix and vag mucosa.

-goodell's sign: softening of cerv tip.

-ballottement: rebound of unengaged fetus.

-Braxton hicks: painless, irreg, relieved by walking.

-positive preg test.

POSITIVE SIGNS OF PREG

-fetal heart sounds

-vis of fetus by US

-fetal movement palpated by an experienced examiner.

VERIFYING PREG:

-blood and urine tests look for hCG (production can start as early as implantation day, detected as early as 7-8d before expected menses).

-higher lvls of hCG --> multifetal preg, ectopic, hydatidiform mole (gest trophoblastic disease), or a genetic ab such as DS.

-lower lvls of hCG --> miscarriage, ectopic.

-some meds: anticonvulsants, diuretics, tranquilizers can cause false pos or false neg preg results.

GPV

GTPAL

-GRAVIDITY: number of pregs.

-PARITY: #of pregs in which fetus/es reach at least 20wks of preg, not the number of fetuses. parity is not affected whether the fetus is born stillborn or alive. nullipara = no preg beyond stage of viability.

-VIABILITY: the point in time when an infant has the capacity to survive outside uterus (gen 22-25wks).

-TERM:

*early-term: 37wks and 0 days thru 38wks and 6 days.

*full-term: 39wks and 0d thru 40wks and 6d.

*late-term: 41wks and 0d thru 41wks and 6d

*post-term: >/=42wks and 0d.

-PRETERM: from viability up to 37wks.

-ABORTIONS/MISCARRIAGES: prior to viability.

-LIVING CHILDREN.

RFs FOR OSTEOPOROSIS

-Asian American and White American.

-age >50yrs.

-fam hx and thin, lean bod build.

-females = >risk of primary osteoporosis r/t decline in estrogen lvls following menopause or ovary removal increasing the rate of bone resorption.

-males have a higher risk of secondary r/t a dec in testosterone leading to dec bone mass.

-tobacco smoke exp and high alcohol intake (3+ drinks/day) causes dec bone formation and inc bone absorption.

-excess caf consumption causes excretion of calc in urine.

-hx of malabsorption disorders limits calc available

-lack of physical activity or prolonged immobility.

-secondary: comorbidities such as endocrine and chronic airway disorders like COPD, asthma. meds over a prolonged period (loops/corticos/thyroid meds/anticonvs); LT lack of wt bearing (SCI, sedentary life); OAs have an inc risk of falls.; high PO4- intake incs rate of calc loss. drinking >40oz/day of carbonated bvgs incs osteoporosis risk due to the amt of PO4-consumed.

ALC INTOX

-slurred speech, nystagmus, dec LOC (stupor, coma), dec motor skills, response arrest, peripheral collapse.

-chronic use: direct cardiovascular damage, liver damage, erosive gastritis and GIB, acute pancreatitis, and sexual dysfunction.

-ALC WITHDRAWAL: abd cramping; vomiting; tremors; restlessness; inc HR; transient hallucs/illusions; anxiety; inc BP, RR, & temp; and tonic-clonic seizures.

-DTs: severe disorientation, psychotic cm, severe HTN, cardiac dysrhythmias, and delirium.

SEDS/HYPNOTICS/ANXIOLYTICS

-INTOX: inc drowsiness/sed, ag, slurred, uncoordinated, nystagmus, disorientation, n/v.; RD and dec LOC.

-WITHDRAWAL CM: anxiety, insomnia, diaphoresis, poss psychotic runs, hand tremors, n/v, hallucs/illusions, psychomotor ag, and poss seizure activity.

CANNABIS

-want euphoria.

-CHRONIC USE: inc risk for lung cancer/resp effects; probs w/ ADLs

-marijauna

-in high doses: occurrence of paranoia (delusions, hallucs).

-inc app, dry mouth, and tachycardia.

-WITHDRAWAL CM: err, aggression, anxiety, insomnia, lack of app, restlessness, dep mood, abd pain, tremors, diaphoresis, fever, H/A.

CNS STIMULANTS

-MILD TOX: dizziness, irr, tremor, blurred vision.

-SEVERE: hallucs, seizures, EXTREME fever, tachycardia, HTN, CP, poss CV collapse and death.

-WITHDRAWAL: dep, fatigue, craving, excess sleeping or insomnia, dramatic unpleasant dreams, psychomotor retardation, and ag. poss occurrence of suicidal ideation.

ALC WITHDRAWAL MEDS: BENZOS

-chlordiazepoxide, diazepam, lorazepam, oxazepam.

-EFFECTS: maintain VS, dec seizure risk, dec in withdrawal cm intensity, sub therapy during alc withdrawal

ALC WITHDRAWAL MEDS: THE ADJUNCTS

-carbamazepine, clonidine, propanolol, atenolol.

-EFFECTS: dec in seizures --> carbamazepine.; dep of autonomic response --> dec BP/HR --> clonidine, propanolol, atenolol.; dec in craving --> propan/atenolol.

-seizure pre, measure baseline VS and continue, check HR prior to admin of propanolol and withhold if <60/min.

ALC ABSTINENCE MAINTENACE MEDS: DISULFIRAM

-when used cc w/ alc, it'll cause acetaldehyde syndrome - n/v, weakness, sweating, palps, and hypotension. can prog to resp dep, cardiovascular supp, seizures, and death.

-monitor LFTs

-avoid use or contact w/ any products that contain alc (cough syrup, aftershave lotion, mouthwash, hand sanitizer) + wear medic alert bracelet. + med effects (the potential for acetaldehyde syndrome w/ alc ingestion) persist for 2wks following d/c of disulfiram.

ALC ABSTINENCE MAINTENACE MEDS: NALTREXONE

-suppresses cravings/pleasurable effects of alc (also used for opioid withdrawal)

-take w/ meals to dec GI distress.

ALC ABSTINENCE MAINTENACE MEDS: ACAMPROSATE

-taken orally 3x/day to reduce the unpleasant effects of abstinence (dysphoria, anxiety, restlessness).

-pt ed: diarrhea can result. maintain adequate fluid intake to prevent dehydration. avoid use in preg.

OPIOIDS: METAHDONE SUB

-prevents abstinence syndrome and removes the need to obtain opioids.

-methadone sub is used for withdrawal and LT maintenance.

-methadone is slowly tapered to produce detox. at approved tx center.

OPIOIDS: CLONIDINE

-for withdrawal (effects r/t autonomic hyperactivity - diarrhea, n/v).

-does not reduce the craving for opioids.

-dry mouth: gum, hard candy, water.

-drowsy: avoid activities that require mental alertness.

OPIOIDS: BUPRENORPHINE

-agonist-antagonist used for both withdrawal and maintenance.

-decs feelings of craving and can be effective in maintaining compliance.

-sublingual

NICOTINE: BUPROPION

-decs nicotine craving and cm of withdrawal.

-dry mouth: gum, ice, candy, and water.

-avoid caf and CNS stims to ctrl insomnia.

MORE ABT NICOTINE TXS

-GUM: chew over 30 mins; avoid eat/drinking 15 mins prior to/while chewing gum; use of nicotine gum isn't rec for >6mos.

-PATCH: applied in AM and removed 16hrs later at bedtime (to avoid nightmares); remove patch prior to MRI.

NICOTINE: VARENICLINE

-agonist

-promotes release of dopamine to stem pleasurable effects of nicotine.

-reduces cravings as well as the severity of withdrawal cm.

-reduces incidence of relapse by blocking desired effects of nicotine.

-monitor BP during tx; monitor for glycemic ctrl; follow instructions for titration; can cause neuropsych effects (unpredictable behavior/mood changes/suicidal ideation). notif HCP if n/v, insomnia, new-onset depression, or suicidal thoughts occur.

DEFENSE MECHANISMS: ALTRUISM

-dealing w/ anxiety by reaching out to others.

-ADAPTIVE USE: a nurse who lost a fam member in a fire is a volunteer firefighter.

DEFENSE MECHANISMS: SUBLIMATION

-dealing w/ unacceptable feelings or impulses by unconsciously sub acceptable forms of expression

-ADAPTIVE USE: a person who has feelings of anger and hostility toward their work supervisor sublimates those feelings by working out vigorously at the gym during their lunch pd.

DEFENSE MECHANISMS: SUPPRESSION

-voluntarily denying unpleasant thoughts and feelings.

-ADAPTIVE: a student puts off thinking abt a fight they had w/ a friend so they can focus on a test.

-MALADAPTIVE: a person who has lost their job states they'll worry abt paying bills next week.

DEFENSE MECHANISMS: REPRESSION

-unconsciously putting unacceptable ideas, thoughts, and emotions out of awareness.

-ADAPTIVE: a person prepping to give a speech unconsciously forgets ab the time they were young and kids laughed at them while on stage.

-MAL: a person who has a fear of the dentist continually forgets to go to their dental appts.

DEFENSE MECHANISMS: REACTION FORMATION

-unacceptable feelings or behavs are controlled or kept out of awareness by overcompensating or demonstrating (the opposite behavior of what's felt).

-ADAPTIVE: a person who is trying to quit smoking repeatedly talks to ads abt the dangers of nicotine.

-MAL: a person who resents having to care for an aging parent becomes overprotective and restricts their freedoms.

DEFENSE MECHANISMS: UNDOING

-performing an act to make up for prior behavior (most commonly seen in kids).

-ADAPTIVE: an ad completes their chores w/o being prompted after having an argument w/ their parent.

-MAL: an individual buys their significant other flowers and gifts after an incident of partner abuse.

DEFENSE MECHANISMS: RATIONALIZATION

ADAPTIVE: an ad says, "They must already have a bf" when rejected by another ad.

MAL: a YA explains they had to drive home from a party after drinking alc b/c they had to feed the dog.

DEFENSE MECHANISMS: DISSOCIATION

-disruption in consciousness, memory, identity, or perception of the env that results in compartmentalization of uncomfortable or unpleasant aspects of oneself.

-ADAPTIVE: a parent blocks out the distracting noise of their children in order to focus while driving in traffic.

-MAL: a person forgets who they are following sexual assault.

DEFENSE MECHANISMS: IDENTIFICATION

-conscious/un assumption of the characteristics of another individual or grp.

-ADAPTIVE: a child who has a chronic illness pretends to be a nurse for their dolls.

-MAL: a child who observes their parent be abusive toward the other parent becomes a bully at school.

DEFENSE MECHANISMS: PROJECTION

-attributing one's unacceptable thoughts and feelings to another who does not have them.

-MAL: a married pt who is attracted to another person accuses their partner of having an extramarital affair.

ORIENTATION PHASE

-NURSE:

*introduction

*set contract: meeting time, place, freq

*discuss conf

*build trust by establishing expectations and boundaries.

*set goals

*explore pt's ideas, issues, and needs.

*explore meaning of testing behavs

*enforce limits on testing or other inappropriate behavs

-PT:

*meet w/ nurse, agree to contact, understand limits/expectations, partic in setting goals, begin to explore own thoughts/exps/feelings, explore the meaning of own behavs.

WORKING PHASE

-NURSE:

*maintain relationship according to the contract; perform ongoing assessment to plan and eval therapeutic measures; facil the pt's expression of needs and issues; encourage the pt to problem-solve; promote pt's self-esteem; foster positive behavioral change; explore and deal w/ resistance; recognizing transference and countertransference issues; reassess the pt's probs/goals and revise plans as nec; support pt's adaptive alts and use of new coping skills; remind pt abt the date of termination.

-PT:

*explore problematic areas of life; reconsider usual coping behavs; examine own world view and self-concept.; describe major conflicts and various defenses; experience intense feelings and learn to cope w/ anxiety rxns.; test new behavs; begin to dev awareness of transference situations; try alt solutions.

HEAT LOSS OCCURS BY 4 MECHANISMS: CONDUCTION

loss of bod heat resulting from direct contact w/ a cooler surface. preheat a radiant warmer, warm a stethoscope and other instruments, and pad a scale before weighing the newborn. newborn should be placed directly on the parent's chest and covered w/ a warm blanket w/ a cap placed on head.

HEAT LOSS OCCURS BY 4 MECHANISMS: CONVECTION

flow of heart from bod surface --> cooler env air. place bassinet out of the direct line of a fan or AC vent, swaddle newborn, and keep head covered. any procedure uncovered is done under a radiant heat source. keep ambient temp of the nursery/pt's room at 22-26 deg C (72-78 deg F)

HEAT LOSS OCCURS BY 4 MECHANISMS: EVAPORATION

loss of heat as surface liquid is --> vapor. gently rub the newborn dry w/ a warm sterile blanket (adhering to standard pre) immediately after birth. if thermoreg is unstable, postpone the initial bath until the newborn's skin temp is 36.5 deg C/97.7 deg F. when bathing, expose only one bod part at a time, washing and drying thoroughly.

HEAT LOSS OCCURS BY 4 MECHANISMS: RADIATION

PPH: RFs

-uterine atony or hx of uterine atony.

-overdistended uterus.

-prolonged labor, oxytocin-induced labor.

-high parity

-ruptured uterus

-comps during preg (previa, abruptio placentae)

-precipitous delivery

-admin of mag sulfate therapy during labor

-lacs and hematomas

-inversion of uterus

-subinvolution of uterus

-retained placental fragments

-coagulopathies (DIC).

PPH: EXPECTED FINDINGS

-uterine atony (hypotonic or boggy)

-blood clots > 1 quarter

-perineal pad sat in 15mins or less

-constant oozing, trickling, or frank flow of BRB from vag/

-tachycardia & hypotension

-pallor, loss of skin turgor, cool/clammy skin

-oliguria.

PPH: NC

-determine QBL immediately following birth.

-weigh all blood, measure fluids.

-firmly massage uterine fundus.

-monitor VS.

-assess for source of bleeding (height, firmness, position - if uterus is boggy, massage fundus to inc muscle contraction. lochia for color, quant, clots....)

-assess bladder for distention. insert an indwelling urinary Cath to assess kidney func and obtain an accurate measurement of UO.

-maintain or initiate IVF (isotonic; colloid vol expanders like albumin; and blood products like pRBCs and FFP).

-provide O2 at 10-12L/min via NRB FM and monitor O2sat.

-elevate legs to a 20-30deg angle to inc circ to essential organs.

PPH: OXYTOCIN

-promotes uterine contractions

-assess uterine tone and vag bleeding

-monitor for A/E of water intox (lightheadedness, n/v, h/a, malaise) --> cerebral edema.

PPH: METHYLERGONOVINE

-ctrls PPH

-assess uterine tone and vag bleeding - do not admin to pts who have HTN. monitor for A/E --> HTN, n/v, and h/a.