250 exam 1

Define the elements of the RBC differential and how they relate to the different types of anemia

Clinical manifestations for iron deficiency anemia

• include lab and diagnostic tests

Clinical manifestations for vitamin B12 anemia

• include lab and diagnostic tests

Clinical manifestations for sickle cell anemia

• include lab and diagnostic tests

iron deficiency anemia

• nursing care

• pt education

vitamin B12 anemia

• nursing care

• pt education

sickle cell anemia

• nursing care

• pt education

Describe transfusion methods and the role of the nurse

Describe the equipment that must be used for a blood transfusion

List the nursing responsibilities for each stage of a transfusion

transfusion reaction / complication: febrile

• cause

• manifestations

• priority nursing action

• treatment

transfusion reaction / complication: hemolytic

• cause

• manifestations

• priority nursing action

• treatment

transfusion reaction / complication: allergic (mild)

• cause

• manifestations

• priority nursing action

• treatment

transfusion reaction / complication: anaphylaxis (severe allergic)

• cause

• manifestations

• priority nursing action

• treatment

transfusion reaction / complication: bacterial (sepsis)

• cause

• manifestations

• priority nursing action

• treatment

transfusion reaction / complication: circulatory overload

• cause

• manifestations

• priority nursing action

• treatment

Describe the physiologic factors that increase the risk for a DVT

What potential complications is the nurse trying to avoid in a patient with a DVT

Explain the role of the nurse in caring for a patient with a blood clot

• include patient education

Discuss equipment and procedures for initiation and maintenance of intravenous therapy

what are the components of IV administration systems?

Primary tubing – delivers continuous IV fluids

Secondary tubing – used for intermittent medications (“piggyback”)

Clamping mechanisms – regulate or stop flow

Flow-control devices – infusion pumps or controllers

Add-on devices – injection ports, extension tubing, filters

what are the IV add-on devices

Access Devices

• Luer-Lok

• Injection port or cap

Flow-Control Devices

• Stopcock

• Multiflow adapter and Y set

Safety Devices

• Filter

Extension set

what are the infusion delivery devices?

Gravity (no pump): Uses gravity to regulate infusion flow

Electronic infusion pump: Delivers precise fluid volumes and rates

PCA pump: Allows patient-controlled analgesia administration

Syringe pump: Delivers small-volume medications accurately

What are the complications of IV therapy?

Bruising / ecchymosis: Discoloration from bleeding under skin

• Usually d/t needle insertion or frail veins

Hematoma: Localized blood collection causing swelling

• Usually d/t needle insertion or frail veins

Infiltration: Nonvesicant fluid leaks into surrounding tissue

Extravasation: Vesicant medication leaks into tissue causing damage/blistering

Phlebitis: Inflammation of the vein causing redness, warmth, tenderness, streaking

• Can occur with or without thrombosis or infection.

• Types: Chemical, mechanical, bacterial, post-infusion

Thrombosis: Blood clot formation within the vein causing pain, swelling, sluggish infusion

Infection: Redness, purulent drainage, fever, tenderness at insertion site

Occlusion: Blocked catheter flow caused by thrombus, precipitates, or lipid buildup

Air embolism: Air enters bloodstream

• Intervention: Clamp tubing, place patient on left side, low Fowlers, notify provider

Catheter embolism: Catheter fragment migrates

• Intervention: Remove the catheter and apply a tourniquet proximal to site, notify provider immediately

Pulmonary embolism: Clot obstructs pulmonary circulation

• Intervention: Emergency response, oxygen, crash cart nearby, provider notification, anticoagulation therapy

Septicemia: Bloodstream infection (usually bacterial)

• Manifestations: Fever, chills, tachycardia

• Intervention: Obtain cultures, administer antibiotics

Allergic reaction: Hypersensitivity response (usually d/t antimicrobial, biologic, blood products)

• Manifestations: Rash, wheezing, anaphylaxis

• Intervention: Stop infusion, assess airway

What are the teaching needs for the pt with an IV line?

What are the different types of peripheral and central IV lines?

• purpose

• insertion techniques used (tunneled or not)

• nursing responsibilities

Peripheral Access

1. Short peripheral catheters: Short-term IV therapy

• tingling, numbness, or “pins and needles” during insertion may indicate

nerve involvement (stop, remove, assess)

2. Midline catheters: Intermediate therapy

• not for vesicant meds, parenteral nutrition, or routine blood draws due to risk of extravasation injury; monitor for infiltration and phlebitis

Central Access

1. Central vascular access device (CVAD):

2. Peripherally inserted central catheters (PICC): Long-term medications/TPN

3. Nontunneled percutaneous central venous catheters (CVC): Access to central circulation

4. Tunneled catheters: Access to central circulation

5. Implanted ports: Chemotherapy

6. Hemodialysis catheters: Dialysis access

Describe the care of a central line dressing

Explain the body’s compensatory mechanisms to avoid fluid imbalances.

Describe how hydrostatic and oncotic pressure contribute to fluid shifts.

Explain how disturbances to filtration lead to edema and 3rd spacing

fluid deficit

• clinical manifestations

• lab data

• nursing interventions

fluid overload

• clinical manifestations

• lab data

• nursing interventions

NS

• full name / contents

• tonicity

• effect in fluid balance

• purpose / use

• nursing evaluation

½ NS

• full name / contents

• tonicity

• effect in fluid balance

• purpose / use

• nursing evaluation

LR

• full name / contents

• tonicity

• effect in fluid balance

• purpose / use

• nursing evaluation

D5LR

• full name / contents

• tonicity

• effect in fluid balance

• purpose / use

• nursing evaluation

D5NS

• full name / contents

• tonicity

• effect in fluid balance

• purpose / use

• nursing evaluation

D5 1/2NS

• full name / contents

• tonicity

• effect in fluid balance

• purpose / use

• nursing evaluation

D5W

• full name / contents

• tonicity

• effect in fluid balance

• purpose / use

• nursing evaluation

albumin

• full name / contents

• tonicity

• effect in fluid balance

• purpose / use

• nursing evaluation

hypernatremia

• etiology

• clinical presentation

• treatment

true hyponatremia

• etiology

• clinical presentation

• treatment

dilutional hyponatremia

• etiology

• clinical presentation

• treatment

hyperkalemia

• etiology

• clinical presentation

• treatment

hypokalemia

• etiology

• clinical presentation

• treatment

hypercalcemia

• etiology

• clinical presentation

• treatment

hypocalcemia

• etiology

• clinical presentation

• treatment

hypermagnesemia

• etiology

• clinical presentation

• treatment

hypomagnesemia

• etiology

• clinical presentation

• treatment

Describe the role of the RN during the preoperative period

• including patient preparation

Explain the elements of patient teaching

Delineate the role of the RN and the surgeon regarding informed consent

Identify patient factors that increase the patient’s risk for complications during and immediately after surgery

• things that might keep the patient from having surgery

Describe the role of the circulating nurse

Define balanced anesthesia and give examples of medication classes used

What procedures are used to ensure the identity of the patient and the accuracy of the planned surgical procedure?

Describe the elements of the nursing assessment in the PACU, focusing on the areas of concern

post-op complication: hypoxia

• etiology

• prevention

• clinical presentation

• nursing interventions

post-op complication: fluid volume / blood loss

• etiology

• prevention

• clinical presentation

• nursing interventions

post-op complication: hypothermia

• etiology

• prevention

• clinical presentation

• nursing interventions

post-op complication: pain

• etiology

• prevention

• clinical presentation

• nursing interventions

post-op complication: atelectasis / PNA

• etiology

• prevention

• clinical presentation

• nursing interventions

post-op complication: post-op nausea and vomiting

• etiology

• prevention

• clinical presentation

• nursing interventions

post-op complication: ileus

• etiology

• prevention

• clinical presentation

• nursing interventions

post-op complication: constipation

• etiology

• prevention

• clinical presentation

• nursing interventions

post-op complication: urinary retention

• etiology

• prevention

• clinical presentation

• nursing interventions

post-op complication: wound healing / skin integrity

• etiology

• prevention

• clinical presentation

• nursing interventions

post-op complication: VTE / DVT

• etiology

• prevention

• clinical presentation

• nursing interventions

Describe the elements of discharge instruction

• including what to report to the provider

Define how cancer cells disturb normal physiology and body functions

How is tumor grading, classification and staging determined?

How is it used in cancer treatment?

consequence of cancer / CA tx: bone marrow suppression

• brief patho

• manifestations

• nursing interventions (include diet / meds when indicated)

consequence of cancer / CA tx: diarrhea / constipation

• brief patho

• manifestations

• nursing interventions (include diet / meds when indicated)

consequence of cancer / CA tx: fatigue

• brief patho

• manifestations

• nursing interventions (include diet / meds when indicated)

consequence of cancer / CA tx: motor & sensory deficits

• brief patho

• manifestations

• nursing interventions (include diet / meds when indicated)

consequence of cancer / CA tx: nutritional deficits

• brief patho

• manifestations

• nursing interventions (include diet / meds when indicated)

consequence of cancer / CA tx: pain and discomfort

• brief patho

• manifestations

• nursing interventions (include diet / meds when indicated)

Identify the goals of cancer treatment

• consider the 3 levels of “prevention” and their interventions

Discuss the potential psychosocial spiritual consequences of a cancer diagnosis

Identify specific communication techniques to address end of life suffering (words that heal)

radiation therapy

• brief description

• pt teaching

• side / adverse effects

• nursing interventions

chemotherapy

• brief description

• pt teaching

• side / adverse effects

• nursing interventions

hormonal manipulation

• brief description

• pt teaching

• side / adverse effects

• nursing interventions

oncologic emergency: sepsis

• brief description

• early vs late manifestations

• priority nursing action

• nursing interventions

oncologic emergency: DIC

• brief description

• early vs late manifestations

• priority nursing action

• nursing interventions

oncologic emergency: SIADH

• brief description

• early vs late manifestations

• priority nursing action

• nursing interventions

oncologic emergency: SCC

• brief description

• early vs late manifestations

• priority nursing action

• nursing interventions

oncologic emergency: hypercalcemia

• brief description

• early vs late manifestations

• priority nursing action

• nursing interventions

oncologic emergency: SVCS

• brief description

• early vs late manifestations

• priority nursing action

• nursing interventions

oncologic emergency: TLS

• brief description

• early vs late manifestations

• priority nursing action

• nursing interventions