Exam 2 pt 1

hyper vs hypo thyroidism and both

Muscle weakness

Cold intolerance

Anxiety and nervousness

Puffy face

Tachycardia

Brittle nails

Weight gain

Diarrhea

Insomnia

Hair loss

Short and light periods

Decreased sweating

Bulging eyes

Constipation

Heat intolerance

Depression and irritability

Fatigue

Increased sweating

Nail thickening and flaking

Bradycardia

Irregular and heavy periods

Muscle/joint pain

Weight loss

HYPOTHYROIDISM

• define

• etilogy/cause (3)

• prevention?

 Reduced or absent hormone secretion from thyroid gland, results in decreased metabolism

 Etiology: Hashimoto’s, thyroid surgery, Radioactive iodine (RAI) therapy treatment

 No prevention, key is early detection

think: body SLOWS DOWN

HYPOTHYROIDISM: recognize cues

• s/s

• labs (3)

• what can it cause and interventions (3)

• what to report (1)

• at risk for (1)

• TX (1)

• Decreased metabolism

• Sleepy, weakness, anorexia, muscle aches, paresthesia

• Constipation, cold intolerance, low libido

• Labs: Reduced T3, T4, TSH high

• Decreased gas exchange

- Monitor oxygenation

• Reduced perfusion

- Monitor BP, HR/rhythm

- Report chest pain

• Risk for myxedema coma: medical emergency

- TX: Lifelong thyroid replacement

MYXEDEMA COMA

• hypothyroidism or hyperthyroidism

• what is it

• s/s (6)

• hypothyroidism

 Serious, rare complication

 Dangerously reduced cardiopulmonary and neurologic function

 Reduced LOC, cognition

 Respiratory failure

 Hypotension

 Hyponatremia

 Hypothermia

 Bradycardia

 Emergent treatment

HYPOTHYROIDISM: CARE COORDINATION AND TRANSITION MANAGEMENT

• what medication is used to treat hypothyroidism? (1)

 Home care management

 Self-management education

 Hormone replacement therapy and side effects

 Levothyroxine (Synthroid): lee - vow - thigh - rocks - in

• Monitor and SE

 Health care resources

HYPERTHYROIDISM

• define

• etiology/causes (3)

 Excessive thyroid hormone secretion from thyroid gland, results in hypermetabolism and increased Sympathetic nervous system (SNS) activity (fight or flight) (increased: bp,hr, rr)

 Etiology: Graves’, Toxic multinodular goiter, excess thyroid hormone replacement

HYPERTHYROIDISM: recognize cues

• s/s

• conditions (3)

• labs (4)

• diagnostics (3)

• Weight loss, increased appetite, heat intolerance, vision changes

• Exopthalamos (buldging eyes), eyelid retractions, goiter

• Labs: High T3, T4, low TSH, TRAb Thyrotropin Receptor Antibody (TRAb): used to diagnose Graves' disease (positive if high)

• Diagnostics: high: RAIU (radioactive iodine uptake), US (ultrasound, enlarged thyroid), ECG

HYPERTHYROIDISM:

• medical management (3)

• surgical management (1)

Medical management:

• Drug therapy

• Methimazole: meh - thin - ah -zole

• Iodine

• RAI therapy

Surgical management:

partial or total thyroidectomy

SURGICAL PRIORITIES: THYROID

• preoperative (2)

• Thionamide

• postoperative: interventions (2) risks (4)

Preoperative

• Thionamide (thigh-oh-mide) drug to regulate thyroid

• Iodine prep

• Normal pre-op priorities

Postoperative

• Avoid neck extension, monitor ABCs

• Risks: hemorrhage, compromised airway, parathyroid injury (low Ca), laryngeal nerve damage

ACUTE THYROTOXICOSIS (THYROID STORM)

• hypo or hyperthyroidism

• define

• results from (1)

• s/s (10)

• management (3)

• hyperthyroidism

•  Excessive amounts hormones released

  • Life-threatening emergency

  • Results from stressors

   Manifestations:

  • Severe tachycardia, HF

  • Shock

  • Hyperthermia

  • Agitation, seizures, coma

  • N/V/D

   Management:

  • Aggressive treatment w/ meds

  • Monitor for dysthymias

  • ABCs

THYROID CANCER

• types (4) FAMP

• Papillary

• Follicular

• Medullary

• Anaplastic

HYPOPARATHYROIDISM

• define

• when can it occur

• monitor

• tx

• Decreased function of parathyroid gland; serum calcium levels cannot be maintained (LOW CALCIUM LEVELS) (normal range: 8.5 and 10.5 mg/dL)

• Occurs post-surgically after thyroid or parathyroid removal, or after surgery for head and neck cancer

Monitor

• calcium

Treatment

• high-dose calcium supplements,

HYPERPARATHYROIDISM

• define

• causes what (2)

• monitor: (3)

• tx: (3)

• Increase in parathyroid hormone; hypercalcemia ( > 10.5); hypophosphatemia (normal: 2.5 and 4.5 mg/dL)

• monitor for:

• Kidney stones, calcium deposits, bone lesions

Treatment

• Drug therapy via cinacalcet (sin- uh-kal-set), bisphosphonates, Parathyroidectomy

A 42-year-old female seeing her primary health care

provider. She reports being tired all the time, and

muscle aches and pains. Assessment reveals a heart

rate of 54/min and a BP of 94/60. The nurse notes non-

pitting facial edema especially around the eyes, and in

the hands and feet. The client’s health history includes

radioactive iodine (RAI) for hyperthyroidism.

1. Which condition does the nurse anticipate this client

has?

hypothyroidism

The primary health care provider orders laboratory work that includes thyroid function tests.

2. Which results does the nurse anticipate?

A. Normal T3 and T4 levels

B. Decreased TSH level

C. Increased T3 and T4 levels

D. Decreased T3 and T4 levels

D

4. Which teaching points will the nurse include about this condition? (Select all that apply.)

A. “Eat a low-fiber diet and drink plenty of fluids.”

B. “Keep a record of how many hours you sleep in a 24-hour period.”

C. “Report any difficulty with orientation to time, place, or person.”

D. “Take your medication every day at the same time.”

E. “Call the provider if you develop an unsteady gait or hand tremors.”

BCDE

The nurse has provided teaching about hypothyroidism.

Which client statement indicates that further nursing

teaching is needed?

A. “I will check my heart rate and BP every day.”

B. “I will include fiber in my diet and drink plenty of water.”

C. “I will call my provider if I notice any changes in level of consciousness.”

D. “I will no longer need to take medication when I feel better in a few months.”

D

 What are the priority nursing interventions for

Maria during the acute phase?

 Why is temperature monitoring critical in

hyperthyroidism management?

 What complications should the nurse monitor for

if Maria requires thyroid surgery?

 What patient teaching is essential before RAI

therapy?

 How would you address Maria's concerns about

her eye changes?

What are the priority nursing interventions for Maria during the acute phase?

Monitor vital signs

Why is temperature monitoring critical in hyperthyroidism management?

If overheated it can trigger a thyroid strom

What complications should the nurse monitor for if Maria requires thyroid surgery?

Bleeding/hemorrhage , compromised airway, nerve damage, ABCs , infection

What patient teaching is essential before RAI therapy?

Chemo precautions

How would you address Maria's concerns about her eye changes?

Discuss that hey hyperthyroidism has caused it and go over graves disease and that there are surgical options available for her. Tell her to use artificial tears

hypocalcemia s/s (6)

• tingling or numbness (especially in lips, fingers, feet)

• muscle cramps or spasms

• fatigue or lethargy

• mood changes like irritability or confusion

• positive Chvostek (sh-vos-tec) sign

• positive trousseau (True- sew) sign

what meds can you give for low calcium

• tums ( calcium carbonate)

• IV calcium

Diabetes: pathophysiological review

glucose: how is it absorbed, what does it stimulate

insulin: how’s it stimulated, what does it do

normal insulin metabolism

• action of insulin

• expected glucose range

• action of counterregulatory (bodily agents that oppose insulin ) hormones and examples (4)

• when does insulin rise rapidly in blood

• when does it peak

• when does it decline

Insulin raises rapidly in blood in the first hour or two after eating a meal

Insulin peaks at about 1 hour

Insulin declines after eating a meal

Diabetes Mellitus

• define

• causes (2)

• increases risk of what (2)

DM: Chronic multisystem disease characterized by hyperglycemia

• Abnormal insulin production

• Impaired insulin use

Risks: Increased risk of heart disease and stroke for patients with DM

Diabetes types:

• Type 1

• Type 2

• Latent Autoimmune Diabetes of Adulthood (LADA)

• Maturity-Onset Diabetes of the Young (MODY)

• Gestational DM

Type 1 Diabetes

An autoimmune condition where the pancreas produces little to no insulin because the immune system attacks and destroys insulin-producing beta cells. It typically requires lifelong exogenous insulin administration.

Type 2 Diabetes

A metabolic disorder characterized by insulin resistance, where the body’s cells do not respond effectively to insulin. Over time, the pancreas may also fail to produce enough insulin to maintain normal glucose levels.

Latent Autoimmune Diabetes of Adulthood (LADA)

Often called "Type 1.5," this is a slow-progressing form of autoimmune diabetes that occurs in adults. It is frequently misdiagnosed as Type 2 initially, but it eventually requires insulin as beta cell function declines.

Maturity-Onset Diabetes of the Young (MODY)

A rare form of diabetes caused by a mutation in a single gene (monogenic). It usually presents before age 25 and is inherited through families, affecting how the body produces or uses insulin without the presence of autoimmunity or obesity.

Gestational DM

High blood glucose levels that are first recognized during pregnancy. It occurs when placental hormones cause insulin resistance that the mother's pancreas cannot overcome, typically resolving after childbirth but increasing future risk for Type 2.

Type 1 (insulin dependent)

• define

• what’s required

• what absent

• s/s: 6

• without treatment can lead to what

• Autoimmune body’s own T cells attack & destroy β cells

(source of insulin)

• β cells continue to be destroyed (80-90% reduction) until make NO insulin!

• Insulin REQUIRED for all humans! →Exogenous insulin

• NO ENDOGENOUS INSULIN!!- Pancreas makes NO insulin!

• Genetic predisposition/exposure to virus

• Usually affects people under 40 yrs.

• S/S: polydipsia, polyuria, polyphagia, fatigue, wt. loss, blurred vision

• Without treatment DKA

Type 2 (non-insulin dependent)

• describe

• what’s present

• whats needed

• #1 risk factor

• s/s the three P’s + 5

• onset

• 4 metabolic abnormalities

Insulin insufficient to meet needs or cells resistant to action of insulin, or both

ENDOGENOUS INSULIN PRESENT! (main difference from Type I)

• Exogenous insulin needed to supplement

Usually affects people >35yrs, but more Kids lately

#1 Risk factor= Obesity

The "3 P's" of diabetes—Polyuria (frequent urination), Polydipsia (excessive thirst), and Polyphagia (extreme hunger)

S/S: fatigue, recurrent infections, prolonged wd. healing, visual changes (blurred vision), numbness or tingling in hands or feet

onset: gradual! But progressive

4 metabolic abnormalities:

• Insulin resistance

• Decreased insulin production (pancreas)

• Inappropriate glucose production (liver)

• Adipokines alter glucose & fat metabolism

type 1 (5-10% of diabetes) vs type 2 (90-95% of diabetes)

DKA: Diabetic Ketoacidosis

• associated with what type of diabetes

• define

• s/s (3)

HHS: Hyperosmolar Hyperglycemic State

• define

• associated with what type of diabetes

• s/s (4)

• big difference from DKA

Unlike DKA, there is enough circulating insulin to prevent the breakdown of fats into ketones, so acidosis is absent (pH stays > 7.30)

Latent Autoimmune Diabetes of Adulthood (LADA)

• define (2)

• also referred to as

• when is it DX

• Slow, progressive form of autoimmune diabetes

• Sometimes referred to as Type 1.5

• Varying degrees of insulin resistance

• Diagnosed >30 years of age

Maturity – Onset Diabetes of the Youth (MODY)

• define

• chacteristics

• it is not what

• when is it DX

• Inherited mutation in one of at least six known genes that results in loss of insulin function and hyperglycemia

• Usually diagnosed in younger adults but can be found at any time in adulthood

• Resembles T1DM with insulin requirements and potential for diabetic ketoacidosis (DKA)

• It is NOT an autoimmune condition

Gestational Diabetes

• when does it develop

• high risk factors (3)

• complications (3)

• 1st line tx

• risks

• Develops during Pregnancy, 2nd or 3rd trimester

• High Risk (screen at 1st visit): obesity, advanced maternal age, strong family history of DM2

• Complications: C-section, perinatal death, neonatal complications

• 1st line: Nutrition Therapy, then move to insulin if needed

• Risk of developing DM 2 increases (50%) as well as future pregnancies

Diabetes: cues: assessment

• HX

• Labs

labs also include glucose tolerance test

Lab Assessment: Normal range, prediabetes, diabetes

• Glycosylated hemoglobin (A1C)

• fasting blood glucose

• glucose tolerance (2-hour postprandial glucose (PPG))

diabetes: ongoing assessment (3)

• Glycosylated hemoglobin (A1C),

• Continuous glucose monitoring (CGM)

• Blood glucose monitoring (BGM)

A patient with type 1 diabetes mellitus is learning about blood glucose monitoring. The nurse teaches the patient to check blood glucose before meals. What is the recommended preprandial glucose target range?

A. 50 to 100 mg/dL (2.8–5.6 mmol/L)

B. 80 to 130 mg/dL (4.4–7.2 mmol/L)

C. 100 to 180 mg/dL (5.6–10.0 mmol/L)

D. 140 to 200 mg/dL (7.8–11.1 mmol/L)

B

diabetes: analyze cues and prioritize hypotheses: analysis

• priority collaborative problems for pts with DM (5)

• Potential for injury due to hyperglycemia

• Potential for surgical complications due to health complexities with DM

• Potential for injury due to peripheral neuropathy

• Potential for kidney disease due to reduced kidney perfusion

• Potential for acute complications associated with glucose related emergencies: DKA or HHS

Metabolic syndrome

• factors (4)

• Simultaneous presence of metabolic factors that increase risk for type 2 DM

• Abdominal obesity

• Hyperglycemia

• Hypertension

• Hyperlipidemia

chronic hyperglycemia

• causes

• consequences

• negativly effects all aspects of body

Diabetes: Generate Solutions & Take Action: Planning and Implementation (5)

• Preventing injury from hyperglycemia

• Enhancing surgical recovery

• Preventing injury from peripheral neuropathy

• Reducing the risk for kidney disease

• Preventing complications

diabetes: planning & implementing

• non pharmacologic (5)

• drug therapy (6)

NON PHARMACOLOGIC

• Pt & Caregiver Teaching

• Follow up programs

• Nutrition therapy

• Exercise therapy

• Self-monitoring of blood glucose (SMBG)

DRUG THERAPY

• Insulin

• Oral agents

• Enteric-coated Aspirin

• ACE inhibitors

• ARBs

• Antihyperlipidemic drugs

diabetes: pharmacological interventions things to think about

• Medication selection

• Cost

• Patient’s ability to manage multiple medications

• Side effects

• Patient’s body in response to the medication

• Polypharmacy

diabetes: pharmacological interventions: classifications, suffix and meds. MATCH

Classes:

• biguanides

• incretin Mimetics (GLP-1 agonists)

• sodium-glucose cotransporter 2 (SSGLT2) inhibitors

• DPP-4 inhibitors

• insulin stimulators (secretagogues) (2)

• insulin sensitizers

• alpha-glucosidase inhibitors (2)

• amylin analogs

MEDS:

Sulfonylureas

Ending in –tides

Metformin

Miglitol

Thiazolidinediones

Ending in -flozin

Pramlintide

Meglitinide (Glinides)

Ending in –gliptin

Acarbose

• Biguanides

• Metformin

• Incretin Mimetics (GLP-1 Agonists)

• Ending in –tides

• Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors

• Ending in -flozin

• DPP-4 Inhibitors

• Ending in –gliptin

• Insulin Stimulators (Secretagogues)

• Sulfonylureas

• Meglitinide (Glinides)

• Insulin Sensitizers

• Thiazolidinediones

• Alpha-Glucosidase Inhibitors

• Acarbose

• Miglitol

• Amylin Analogs

• Pramlintide

insulin:

put meds in categories:

• insulin detemir

• insulin aspart

• regular insulin

• insulin degludec

• insulin glulisine

• NPH insulin

• insulin lispro (Humalog)

• insulin glargine U-100

Type: Onset (min), Peak (hr), Duration (hr)

• rapid acting (3)

• short acting

• intermediate acting

• long acting (2)

• ultra long acting

nutritional therapy

• what to watch

diabetes: physical activity

• what can it help with (2)

• education (2)

• Can decrease insulin requirements

• Can improve cardiovascular disease

• Depending on severity of diabetes some

patients may need to alter exercises

• Educate patients to check glucose levels

before exercise

Health Promotion/Disease Diabetes Prevention (3)

Care of Patients with Hematologic (blood) Conditions

• priority concepts (2)

• the interrelated concepts in this chapter are (5)

The priority concepts:

• Perfusion

• Immunity

• The interrelated concepts in this chapter are

• Cellular Regulation

• Clotting!!!

• Gas exchange

• Infection!!!

• Pain!!!

Blood

• plasma %

• other components (5)

• blood cells & % (3)

• 3 major functions

Thrombocytopenia

• define

• leads to (3)

• risk (1)

• inherited or acquired?

• Types: (4)

• pt education (4)

• Define: Thrombocytopenia: abnormally low platelet levels (< 150,000/uL) in the blood

• leading to impaired clotting, easy bruising, and excessive bleeding. BLEEDING RISKS

• can be inherited or acquired

• Types:

• Immune thrombocytopenic purpura (ITP)

• Thrombotic thrombocytopenic purpura (TTP)

• Heparin-induced thrombocytopenia (HIT+)

• Acquired thrombocytopenia from decreased platelet production

Education: Bleeding precautions: avoiding contact sports, using soft toothbrushes, electric razors, and wearing protective footwear.

Normal platelet count

154,000-450,000

IMMUNE Thrombocytopenia Purpura (ITP)

• platelets are coated with what

• what does the body do in response

• treatment (3)

• what to avoid and why (1)

• what do Romiplostim (Nplate) & eltrombopag (Promacta) do?

• Platelets are coated with antibodies.

• Body recognizes this and DESTROYS them. (ITP)

• Treatment –

• Steroids

• IV IgG

• Splenectomy

Avoid IM injections- to help prevent bleeding!!!

*Romiplostim (Nplate) & eltrombopag (Promacta) increase production of platelets

Heparin Induced Thrombocytopenia (HIT+)

• define

• leads to (2)

• Treatment (2)

• alternatives to heparin (3)

• define: Immune mediated adverse drug reaction caused by the emergence of antibodies that activate platelets in the presence of heparin

• Leads to: Platelet count plummets, micro clots occur

• Treatment:

• stop heparin

• send a HIT test

alternatives to heparin:

• Anticoagulate with IV lepirudin or argatroban (LA)

• Plus warfarin for a few weeks

Neutropenia

• define

• primary risk

• what to monitor, how to calculate (steps 1-4), normal, when to be concerned, when is it severe

• neutropenic precautions

• patient education

• define: low neutrophils (WBC) (<1000cells/uL)

• primary risk infection

• Monitor: Absolute Neutrophil Count (ANC)

• How to monitor ANC:

1. Find the WBC, the polys and bands on your CBC.

WBC 2.0

Polys 14.8%

Bands 5%

2. Add the polys and bands.

(14.8 + 5 = 19.8)

3. Multiply the sum of the polys and bands by the WBC.

19.8 x 2.0 = 39.6

4. Multiply the product by 10.

- 39.6 x 10 = 396

• The normal range for the ANC = 1.5 to

  8.0 (1,500 to 8,000/mm3).

• ANC: CONCERN when <1,000, severe when <500

• Neutropenic precautions:

• wash hands often

• no flowers

• avoid flossing

• use electric razor

• avoid crowds or sick people

• no fresh fruits of veggies

• take temp often (emergency > 100.4)

Patent education:

• Limit Visitors

• Diet – fruits/veg?

• Monitoring temp frequently

• Mask, crowds

• T>100.5 = CALL, draw blood cultures

Delegation in Neutropenia:

• CNA
  LPN

• RN

Hemophilia and von willebrand’s disease

• what are they

• risks (1)

• interventions (1)

• supportive care (3)

• patient education (4)

• Disorders that cause defective or deficiency in clotting factors. (effect clotting cascade)

• High bleed risk, take preventative measures.

• If they do bleed, replace missing Factors, can do preventatively.

• Supportive care (transfuse, oxygen, IV fluids, etc.)

• Teach them same as Thrombocytopenia (bleeding risks what to avoid):

• avoiding contact sports, using soft toothbrushes, electric razors, and wearing protective footwear.

Von Willebrand Disease

• effects what percent of population

• define

• treatment (4)

• 1% of population

• Missing von Willebrand Factor for clotting (glycoprotein)

• Treatment:

• DDAVP (desmopressin) makes the body release more vWF

• Factor VIII (8)

• Birth control pills – estrogen ^VWF & FVIII release

• Pain meds?

Hemophilia

• define

• The Royal Disease (Queen Victoria)

• X-linked recessive gene – Mom-> son

• Missing Factor VIII (8) or IX (9)

BLOOD CANCERS

new section

Leukemia (Myelodysplastic Synd (MDS)

• define

• leads to (3)

• Bone marrow cranks out immature abnormal leukocytes

• causes: Abnormal WBC accumulate (don’t have normal cell cycle) - become overcrowded

• Abnormal WBCs clog spleen, liver, lymph, bone, etc. Even develop solid masses

• no single cause: Can be genetic and environmental radiation, chemicals, viral infxn

Leukemia

• define

• caused by

• leads to

• most common sites

• other sites involved

Leukemia Classifications

• four types of leukemia cancers

• based on what (5)

• Based on onset, clinical manifestations and clinical findings

• Acute or Chronic

• Myelogenous (RBC) or Lymphocytic (WBC)

• Four types of leukemia cancers:

• 1/3 acute myeloid leukemia AML (immature cells) – Allogeneic hematopoietic stem cell transplant (HSCT), INDUCTION sends 70% into remission

• ¼ acute lymphocytic leukemia ALL

• chronic myelogenous leukemia CML

• chronic lymphocytic leukemia CLL

Types of leukemia

• chronic or acute

• type of bone marrow cells that are affected

• lymphocytes

• myeloid cells

• Chronic or Acute - Are the cells mature

(look like normal white blood cells) or

immature (look more like stem cells)?

• Type of bone marrow cells that are affected

• Lymphocytes, it is called lymphocytic leukemia

• Early forms of myeloid cells -- white

blood cells (other than lymphocytes), red

blood cells, or platelet-making cells

(megakaryocytes) -- are myeloid

leukemias (also known as myelocytic,

myelogenous, or non-lymphocytic

leukemias)

LEUKEMIA: Recognize Cues

• hx

• assessment and s/s

• psyche assessment

• how to dx

• imaging assessment

LEUKEMIA: Analyze Cues & Prioritize Hypotheses

• Potential for infection due to reduced Immunity and chemotherapy

• Potential for injury due to poor clotting from thrombocytopenia and

chemotherapy

• Fatigue due to reduced gas exchange and increased energy demands

LEUKEMIA: Generate Solutions & Take Action:

Planning & Implementing

• Preventing infection and promoting immunity

• Minimizing injury

• Conserving energy

Malignant Lymphomas – 5% of Cancers Recognize Cues: Assessment

• originate in what

• describe

• s/s

• interventions: early, limited advanced stage

• Originate in BM & lymph

• Large, painless lymph node(s)

• Fevers, night sweats, unplanned weight loss

• Some have no symptoms at time of diagnosis

Malignant Lymphomas Take Action: Interventions

• Early stage with favorable prognostic features: short duration of ABVD chemotherapy (usually two cycles including doxorubicin, bleomycin, vinblastine, and dacarbazine) followed by restricted involved-field radiation therapy (IFRT)

• Limited stage with unfavorable features: longer course of ABVD chemo (4-6 cycles) then, higher dose of IFRT

• Advanced stage: ABVD chemo without radiation

Hodgkin's Lymphoma (10% of lymphomas)

• caused by

• risk factors

• describe

• what gets destroyed

Multiple Myeloma

• define

• risk factors

• assessments

• treatment

Polycythemia Vera

• define

• assessment

• interventions

Cancer of the RBCs

• Massive production of RBCs

• Excessive leukocyte production

• Excessive platelet production

• Recognizing Cues: Assessment

• Facial skin is flushed, warm

• Intense itching

• Hypertension!!!

• Poor gas exchange

• Bleeding problems

Interventions

• Fatal if untreated

• Therapeutic phlebotomy!!!

• Apheresis

• Increase hydration!!!

• Promote venous return

• Anticoagulants, other drug therapy!!!

A client with polycythemia vera is admitted with

shortness of breath, hypertension, and weak pulses in

the right foot. Which nursing intervention is the

priority?

A. Assess hydration status.

B. Evaluate blood pressure

C. Elevate lower extremities on pillows

D. Use soft-bristle toothbrush to prevent bleeding

A

Bone Marrow Biopsy

• pt position

• med used

• risk