NUR 306 Extra Reviw

What are the key treatments for TTP?

Plasmapheresis, corticosteroids, caplacizumab (prevents platelets from clotting), rituximab, and splenectomy.

What is the key treatment action for HIT?

STOP administering heparin

factor Xa inhibitors, plasmapheresis, IVIG, and surgery to remove clots.

What are the key treatments for decreased platelet production?

Remove/treat the cause, platelet transfusion (usually when platelets are <10,000/µL), corticosteroids, and thrombopoietin receptor agonists.

What are the bleeding cues associated with thrombocytopenia?

Internal: joints, brain, retina. External: skin, mucosa, stool, urine.

What medications minimize the period of neutropenia? How are they given, what do they do?

Colony-stimulating factors: filgrastim and pegfilgrastim. They are given by subcutaneous injection, increase neutrophils

What are the side effects of Filgrastim and Pegfilgrastim

can cause injection-site pain/redness and bone pain.

What findings require immediate attention in a patient with neutropenia?

Fever or chills. D

Dyspnea, nonproductive cough, sore throat, dysphagia, oral/pharyngeal lesions, diarrhea, rectal tenderness, and vaginal itching.

What are common causes of neutropenia?

Medications (chemotherapy, anticonvulsants, antibiotics, H2 blockers); hematologic disorders (aplastic anemia, leukemia, myelodysplastic syndrome); infections (viral hepatitis, flu, HIV, measles); and other causes including lymphoma, other cancers, hemodialysis, and B12/folic acid deficiencies.

How can sepsis cause neutropenia

Platelets/WBCs/RBCs are being used up too fast causing a deficiency

How can autoimmune cause neutropenia

Immune system is destroying blood cells

How can bone marrow cause neutropenia

When it isnt making enough

What symptoms should a patient report immediately during a blood transfusion?

Fever (38°C), itching/pruritus, shortness of breath/dyspnea, back or chest pain, and hives/urticaria.

What type of saline should you prime blood with

0.9% Normal saline- isotonic; prevents RBCs from swelling

What should be assessed in the health history of a patient with anemia?

Recent blood loss, trauma, surgery

liver/endocrine/renal/GI disease, inflammatory disease

general diet, alcohol use,

medications/supplements/herbals, ASA, anticoagulants, NSAIDs, omeprazole, oral contraceptives, phenobarbital, phenytoin, penicillins, and sulfonamides.

What are the major system-specific cues of severe anemia? CNS

CNS: dizziness/vertigo, depression, impaired cognition, headache, numbness/paresthesia, ataxia, decreased coordination.

What are the major system-specific cues of severe anemia? GI

GI: anorexia, hepatomegaly, splenomegaly, abdominal distention.

What are the major system-specific cues of severe anemia? Cardiac

CV: tachycardia, palpitations, murmurs, S3.

What are the major system-specific cues of severe anemia? Respitory

Respiratory: dyspnea, tachypnea, orthopnea.

What is the treatment for hypothyroidism listed on the slide?

Levothyroxine (Synthroid), which replaces missing T4.

Why should you start low for levothyroxine?

To avoid raid HR and BP increase

How is levothyroxine monitored and administered? How often are blood draws needed? How long can the full effect take?

Monitor TSH; blood draws are needed every 4–6 weeks. Take it on an empty stomach. Full effect can take 6–8 weeks.

What are the early cues of hypernatremia?

Early: thirst, fatigue, dry mouth, orthostatic hypotension.

What are the later cues fro hypernatremia?

Later: confusion, altered level of consciousness, restlessness, irritability, seizures, or coma.

What are the nursing actions for SIADH?

Seizure/fall precautions; HOB flat or ≤10°; turn every 2 hours; frequent ROM; monitor I&O, LOC, electrolytes, and daily weights.

What discharge teaching is listed for SIADH?

Na+ and K+ supplements; fluid restriction of 800–1000 mL/day; use gum/ice chips to reduce thirst; check weight daily; know signs of electrolyte abnormalities and when to seek care.

How is severe SIADH hyponatremia treated when Na+ is <120 mEq/L?

3% hypertonic saline and fluid restriction (500 mL/day). Correct sodium slowly—no more than 8–12 mEq/L in the first 24 hours.

What medications can block ADH activity in SIADH?

Vasopressin receptor antagonists: conivaptan (Vaprisol) and tolvaptan (Samsca).

How is mild SIADH treated when Na+ is >125 mEq/L?

Fluid restriction of 800–1000 mL/day, furosemide (Lasix) to promote diuresis, and demeclocycline to dilute urine. Monitor K+, Ca, and Mg with furosemide and supplement as needed.

What are the early cues of hyponatremia?

Early: muscle cramping, irritability, headache, nausea.

What are the late cues of hypernoatremia?

Later/severe (<120 mEq/L): vomiting, decreased LOC, muscle twitching, confusion, seizures, and coma.

What are the priority nursing assessments for SIADH?

Neuro status, seizures, daily weight, fluid status (lower Na = more severe cues)

What are the priority nursing assessments for DI?

Hydration status, hypotension, I&O, neuro status

What are the treatments and nursing priorities from SIADH

Fluid restriction, hypertonic saline, medications to inhibit ADH, diuretics, monitor Na

What are the treatments and nursing priorities from DI

Fluid replacement, desmopressin, monitor Na

What are the early cues of HHS?

Dehydration with dry mucous membranes, tachycardia, and orthostatic hypotension

What are the late cues of HHS?

Severe neurologic cues can include somnolence, coma, seizures, hemiparesis, and aphasia.

What are the key cues of DKA?

Lethargy/weakness

dehydration with dry mucous membranes, tachycardia, and orthostatic hypotension

abdominal pain, anorexia, nausea/vomiting

sweet/fruity acetone breath

Kussmaul respirations.

What barriers to effective teamwork are listed?

Inconsistent team membership, lack of time/information sharing, hierarchy, defensiveness, conventional thinking, complacency, different communication styles, conflict, poor coordination/follow-up, distractions, fatigue/burnout, workload, misinterpretation of cues, and lack of role clarity.

What communication tools and strategies are listed for teams?

SBAR, call-out, check-back, handoff, teach-back, PASS, brief, huddle, debrief, leading teams, and conflict.

What five factors should a team leader consider when defining a plan?

Patient, time, people, equipment, and information.

What is the difference between a designated team leader and a situational team leader?

A designated team leader is assigned to lead and organize the team, establish goals, and facilitate communication/teamwork. A situational team leader is any team member with the skills to manage the situation at hand.

What are Ancillary Services?

Provide direct, task-specific, time-limited patient care. Examples: Physical Therapy (PT), Occupational Therapy (OT), Speech-Language Pathology (SLP), Social Work.

What are Support Services?

Provide indirect, service-focused tasks that facilitate the healthcare experience. Examples: Transporters, housekeeping/environmental services, dietary services.

What is a Coordinating Team?

Work-area members who manage the core operational environment and support the Core Team. Examples: Charge nurse, nurse manager, unit coordinator, administrative coordinator

What is a Contingency Team?

A time-limited team formed for emergent or specific events with members from various teams. Examples: Code Blue team, Rapid Response Team, Disaster Response Team.

What is the difference between Ancillary Services and Support Services?

Ancillary Services provide direct patient care (PT, OT, SLP, Social Work). Support Services provide indirect assistance that improves the healthcare experience (transport, dietary, housekeeping).

What is the difference between Coordinating Teams and Contingency Teams?

Coordinating Teams support daily operations and the Core Team. Contingency Teams are temporary teams assembled for emergencies or specific events.

What is the class, mechanism, key side effect, and nursing tip for Metformin?

Class: Biguanide | Mechanism: Decreases glucose production by the liver | Key Side Effect: GI upset | Nursing Tip: Hold before contrast studies; take with food to decrease GI upset

What is the class, mechanism, key side effect, and nursing tip for Glipizide?

Class: Sulfonylurea | Mechanism: Increases insulin production by the pancreas | Key Side Effect: Hypoglycemia | Nursing Tip: Take with meals; avoid alcohol

What is the class, mechanism, key side effect, and nursing tip for Empagliflozin?

Class: SGLT2 Inhibitor | Mechanism: Decreases renal glucose reabsorption and increases urinary glucose excretion | Key Side Effect: UTIs | Nursing Tip: Stay hydrated; take in the morning before meals

What is the class, mechanism, key side effect, and nursing tip for Sitagliptin?

Class: DPP-4 Inhibitor | Mechanism: Increases incretins, increases insulin release from the pancreas, decreases liver glucose production | Key Side Effect: Mild side effects | Nursing Tip: Generally well tolerated

What is the class, mechanism, key side effect, and nursing tip for Semaglutide?

Class: GLP-1 Agonist | Mechanism: Increases insulin release and decreases gastric emptying | Key Side Effect: Nausea | Nursing Tip: Weight loss benefit; may affect absorption of other medications

What is the class, mechanism, key side effect, and nursing tip for Repaglinide?

Class: Meglitinide | Mechanism: Increases insulin production by the pancreas | Key Side Effect: Hypoglycemia (less likely than sulfonylureas) | Nursing Tip: Give before meals

What is the type, onset/peak, key risk, and nursing tip for Lispro/Aspart?

Type: Rapid-Acting Insulin | Onset/Peak: 10–15 min onset, peak ~1 hr | Key Risk: Hypoglycemia | Nursing Tip: Give with meals

What is the type, onset/peak, key risk, and nursing tip for Regular Insulin?

Type: Short-Acting Insulin | Onset/Peak: 30–60 min onset | Key Risk: Hypoglycemia | Nursing Tip: Can be given IV

What is the type, onset/peak, key risk, and nursing tip for NPH Insulin?

Type: Intermediate-Acting Insulin | Onset/Peak: Peak 4–12 hr | Key Risk: Hypoglycemia | Nursing Tip: Monitor peak times

What is the type, onset/peak, key risk, and nursing tip for Glargine?

Type: Long-Acting Insulin | Onset/Peak: No peak | Key Risk: Hypoglycemia | Nursing Tip: Do NOT mix with other insulins

What is the type, onset/peak, key risk, and nursing tip for Degludec?

Type: Ultra-Long-Acting Insulin | Onset/Peak: Duration >24 hr | Key Risk: Hypoglycemia | Nursing Tip: Flexible timing

What are the 4 different ways to be diagnosed with diabetes

1) A1C of 6.5% or higher

2) Fasting plasma glucose of 126

3) Two hour plasma glucose level of 200 mg or greater

4) Classic symptoms of diabetes + random plasma glucose of 200 or greater

3 causes of anemia

Decreased RBC production, blood loss, increased RBC destruction

What can cause RBC decreased RBC production

Deficient iron, B12, folic acid

Decreased EPO

Decreased iron availability

What can cause increased RBC destruction

Sickle cell, meds, incompatible blood, trauma (cardiopulmonary bypass)

How is cobalamin deficiency/ pernicious anemia involve autoimmune system? What other disease it is associated with?

Autoimmune system destroys parietal cells. Parietal cells- intrinsic factor- needed for B12 absorption

What causes thrombocytopenia

Aplastic anemia, leukemia, infection, nutrition deficiency, therapy used for another problem

What type of drugs can cause thrombocytopenia

Myelosuppressive drugs- decrease platelets (ex. chemo)

What symptoms do TTP cause

MAHA, Thrombocytopenia, neuro changes, fever, renal issues

Why is ongoing potassium monitoring necessary during insulin therapy

Insulin drives potassium back into cells whihc can rapidly lower potassium and lead to hypokalemia and dysrthymias

What provider prescribed therapies would a nurse anticipate for SAIDH

Fluid restriction, hypertonic saline (3% NaCl) for severe hyponatremia, loop diruetics such as furosemide, vasopressin antagonists

Why must sodium be corrected gradually. How much should it increase an hour?

Rapid correction can cause osmotic demyelination syndrome.

Not increase by more than 8-12 in the first 24 hours

If pt hgb is 5.9 would is a priority action for the nurse

Prepare for PRBC transfusion

If the priority problem is neutropenic fever what complication could develop

sepsis