FILL IN THE GAPS OF KNOWLEDGE
Rubella is requires Droplet Precautions, thus wearing a surgical mask is important
Palmar Flexion (Trousseau’s sign) while obtaining the blood pressure is a sign of hypomagnesemia, impairing calcium regulation and contributing to neuromuscular excitability.
Muscle pain after starting atorvastatin can be a sign of myopathy or rhabdomyolysis.
- The client should stop the medication immediately and go to the ER
- Taking a warm shower and strecthing is a TEMPORARY SOLUTION vs MEDICAL EMERGENCY
The HOB for a client in Buck’s Traction should be kept between 10 and 20 degrees.
- Ensures appropraite alignment and prevents the client from sliding in the bed
- Weights should hang freely and not touch the floor
- The pollow should be under the calf, not the knee. Pillow should end above the ankle
A patient who had a liver transplant 48 hrs ago is at risk for graft rejection due to rising AST and ALT lvls.
- Commonly occurs from 4th to 10th days postop
- rising lvls of these labs can become acute graft rejection
- S/sx include tachycardia, fever, RUQ or flank pain, diminished bile drainage or change in bile color, or increased jaundice
- Moderate amount of serosanguinous is not concerning because the drainage is not purulent or foul-smelling
Dizziness after hemodialysis often indicates hypotension or fluid volume depletion, which can occur due to excessive fluid removal during dialysis
- Can lead to falls, fainting or even shcok
- Assess vitals
Daily weights are gold standard for monitoring fluid balance
Following cataract surgery, the nurse should educate the client about the prescribed eye drops they will need
- Write it down for reference
- Emphasize appropriate follow up
- Maximum benefit of improvement of this surgery may be delayed for up to several weeks
- Should avoid activites that can raise IOP, such as intercourse, tight shirt collars, and straining during BM
- SAFEST sleeping position is on the unaffected (GOOD EYE) to prevent edema
- Semi-fowlers
Compartment syndrome occurs when pressure increases within one or more compartments, leading to decreased blood flow, tissue ischemia, and neurovascular damage.
- Should notify PHCP so that they can loosen or perform fasciotomy
- Cast can only be removed with a PHCP’s order
- 5 P’s Pain, Pallor, Pulseless, Paresthesia, Pressure
A subtotal Thyroidectomy requires the nurse to monitor the client for complications usch as laryngeal edema
- S/sx: horse voice, difficulty swallowing, and stridor
- Postop steroids may be given to prevent complication
- Assess airway patency
- Hypocalcemia: CAN OCCUR due to removal of parathyroid gland, which REDUCES CIRCULATING BLOOD CALCIUM LVLs.
- Assess for Chvostek and Trousseau’s
- To prevent this they may be started on 3 grams of calcium per day as soon as they can start oral diet
- Airway equipment and calcium gluconate at bedside incase
Norepinephrine is a neurotransmitter of the catecholamine family
- Released by postganglionic sympathetic neurons
- Exerts effects on target organs through adrenergic receptors
- Causes: Vasoconstriction, increased HR, and increased contractility
- FIGHT OR FLIGHT RESPONSE
- Used in shock and hypotension
- May require arterial line placement for continuous BP monitoring
Primary purpose of albumin administration with severe liver cirrhosis is to Enhance Oncotic Pressure
- helps maintain fluid balance with the bloodstream and prevents fluid from leaking into the inerstital spaces.
- In liver cirrhosis, there is decrease in albumin production, leading to hypoalbuminemia and reduced oncotic pressure
- Giving albumin can prevent ascites and edema
Log rolling after lumbar spinal fusion is ordered to protect the client from injury
- Keeps the spinal column straight and in alignment to prevent further injury
- Three individuals required
- Performed using a transfer sheet or board
An EARLY vital sign change in a patient with decreased HGB and HCT is TACHYCARDIA
- Tachycardia is present due to compensatory mechanisms for low blood volume
- Hypotension is NOT an early sign of hypovolemic shock
Hinduism: they. prefer cremeation as their method of disposing of the decseased.
- Cremation is forbidden in Islam, mormonsim, and eastern orthodox
Before pregnancy, a client who has a BMI of 28 (overweight) should be recommended a total weight gain of 7-11.5kg (15-25)
- 300 additional calories a day
- 8 8 ounces a day
- underweight 400 cal vs overweight 200 cal
- Protein is crucial (dairy, eggs, notes) Whole grains (energy)
- Folic acid before they become preganant to prevent neural tube defects
- Calcium is important
- Vitamin D is essential for teeth and bones for baby
- Iron helps produce more blood for baby (meat, beans, take with vitamin c)
- DHA brain develop for baby (fish and supplements)
- Iodine found in animal protein
- BMI <18.5 (TOTAL GAIN: 28-40LB)
- bmi 18.5 - 24.9 (TOTAL GAIN: 25-35LB)
- BMI 25-29.9 (15-25LB)
- Avoid NSAID(Acetaminophin okays)
The client who expresses feeling self-conscious abt their hair and states they would like to wash it before undergoing diagnostic tests and procedures, How should the nurse prioritize the client’s care?
- Reflecting client centered-care by prioritizing well being while ensuring the essential medical tasks are completed afterward.
- Addressing hygiene first, if time permits, promotes dignity and comfort, key priniciples of nursing care
A child with cycstic fibrosis is preparing for chest physiotherapy, prior the nurse should administer the prescribed bronchodilator
- Should be administered 15-30 min before CPT
- This will facilitate the passage of the mucous
- CPT should be performed at least 30 min before meals to increase palatability of the meal
- Contraindications of CPT include rib fractures, increased ICp
The nurse should consider the cognitive development of young children and how it impacts their understanding of death espcially for someone they know
- Nurse should listen to and support these children according to their level of understanding
Medications with a narrow therapeutic index (NTI) should be administered precisely as prescribed to avoid adverse effects or therapeutic failure
- Meds like this include: antiepileptic drugs, immunosuppressants, anticoagulants, and antiarrhythmics
The type of intravenous tubing used to adminsiter mannitol should be filtered
- Mannitol is an osmotic diuretic indicated for cerebral edema
- Mannitol may crystallize when exposed to low temperatures
- Thus tubing with filter
- Used in early oliguric phase of acute renal failure
- Enough renal blood flow and glomerular filtration must remain to enable the drug to reach the renal tubules
- Can also be used to promote excretion of toxic substances, reduce ICP, and treat cerebral edema
The nurse should question giving Phenytoin to a client schedule for electroconvulsive therapy (ECT)
- Taking anticonvulsants (pheytoin) will increase the seizure threshold and may weaken the efficacy of ECT
- Benzos and anticonvulsants should be avoided in clients receiving ECT
- Antidepressant meds and antipsychotics may be given concurrently with ECT
- PPIs are typically given on the day of treatment to prevent gastric reflux and aspiration
Gaining too little weight can lead to premature birth and low infant birth weight
Gaining too much weight can also result in premature birth and obesity in the child in later life
Prioritization
- ABC’s
Airway (Ventilation - Air moving IN&OUT) - some time of airway obx
Breathing (Gas exchange - exchange CO2 for O2) - tachypnea
Circulation (O2 in blood - out to the tissue) - pulses, temperature, warm skin, cap refill less than 3 seconds, GIVE FLUIDS, pressors
The nurse recognizes that wehn ausculatating lung sounds, bronchovesicular lung sounds are best heard posteriorly, between the scapular
- Bronchovesicular sounds occur over major bronchi where there are fewer alveoli
- Moderate in pitch and amplitude and are normally equal during inspiration and expiration
Common side of dexmethypehnidate is appetite supprssion
- Med is used to treat ADHD
- Side effects: poor weight gain, malnutrition, and growth delays especially concerning in adolescents.
When flushing a central vascular access device such as a PICC LINE, the nurse should flush each lumen with NS in a 10 ml syringe
- 10 ml is necessary because of its pressure to remove adequate debris and any fibrin clots that could form
- A pulsatile technique can remove fibrin clots on the end of the catheter.
When performing postmortem care the nurse should elevate the HOB for easier family viewing
- This prevented discoloration of the face and provide a dignifited appearance for family viewing
- Cover the body with a clean sheet
- Place head on a pillow and leave arms outside covers if possible
- Close the client’s eyes
- Leave dentures in mouth
The nurse should remain the client that vaginal intercourse may be painful after the vaginal and cervical colposcopy
- This diagnostic procedure helps detect herpes simplex virus, HPV, cervical cancer, and other abnormal tissue
- Small amount of bleeding is normal
When taking isoniazid for pulmonary TB, it is important to monitor liver enzymes
- First line med for pulmonary TB
- Combined with other antiTb meds because of emerging drug resistance
- Hepatotoxicity is a common adverse effect that can occur, thus reporting any jaundice and clay colors stools is important
- Monitoring liver enzymes will help detect for any early hepatotoxcitiy
A client who is postop following a hypophysectomy (removal of pituitary gland) should be reported to the PHCP when they have an hourly UOP of 125 ml
- Following a hypohysectomy, the client is at risk of developing diabetes insipidus(DI)
- An hrly UOP of 125 ml would be considered polyuria because in 24 hours, that would equate to 3000 ml
- Sign of DI is polyuria and pale urine
- Monitor for Increased ICP, headaches, urine output and vital signs
- Avoid blowing their nose, coughing or straining
- Adverse effect of procedure is CSF leakage, increased ICP, infection and DI
For a client with AFIB who has a pulse of 126, the nurse should assess for angina
- Patient has RVR with a pulse of 126, which can signficantly reduce cardiac outpit and compromise perfusion
- Thus leading to Myocardial ischemia, presenting as angina
A pt prescribed digoxin and furosemide should be have their serum electrolytes monitored
- these meds increase renal perfusion when taken together leading to potassium loss
A client who developed a thyroid storm should be prescribed propranolol
- Thyroid storm is a medical emergency and complication of hyperthyroidism
- S/sx include fever, tachycardia, HTN, and cardiac dysrhythmias
- Tx: corticosteroids (dexamethasone decrease conversion from t3 to t4), propranolol reduces HR and BP, and antithyroid meds such as proplthiouracil
Statement made by a student would indicate effective teaching about Measles, Mumps, and rubella (MMR) vaccine, if they say “its safe for breatfeeding women to receive the MMR vaccine”
- Research shows that it does not interfere with mother’s immune response or reduce its effectivness and poses no harm to the infant
- It a live weaken vaccine
- Contraindicated in severely immunocompromized individuals and pregnant women
- two dose vaccine, first done between 12 and 15 months, and second between 4 and 6 years
When collecting a 24 hour urinalysis the client should urinate in the toilet
- That initial void marks the start of the test, WHICH IS NOT SAVED AND SHOULD BE FLUSHED
- All urine voided by the client during the following 24 hr period must be collected and stored in the designated collection bottle provied by lab
- 24 hr urinlysis is used to assess kidney function
- Collection specimen will need to be refrigerated or kept on ince for the 24 hr testing period
The hallmark symptoms of ulcerative colitis are intermittent episodes of abdominal cramping and watery, bloody diarrhea
- Ulcerative colitis is a chronic inflammartory bowel disease in which the large intestine becomes inflamed and ulcerated, leading to flareups of water or bloody diarrehea.
- Severe exacerbation require prompt hospitalzation
- Intravenous fluids and blood transfusions are given as needed for dehydration and anemia
- Normal osmolality lvl shud be from 275 to 295, an elevated osmlarity lvl means the blood is more concentrated than normal and often indicates a fluid volume deficit
- The normal range for urine specific gravity is 1.005 to 1.030. A specific urine gravity above 1.020 indicates concentrated urine and can indicate a fluid volume deficit
A significant precipitator of digoxin toxicity is hypokalemia
- The client should have adequate intake of food rich in potassium
- Renal impairment, temporary dehydration, and NSAID use can reduce renal clearnace of digoxin, increasing the likelihood of digoxin toxicty
- Range of digoxin is 0.5 to 2.0
Physiolgoical anemia of pregnancy is a result of an increase in plasma rather thatn an actual decline in the number of RBCs
- this dilutional effect leads to a decrease in concentration of rbcs, causing a relative anemia
- Its also important assess iron status, and ensuring the increased demands and meet to prevent iron deficiency anemia
- provide education on iron rich foods
When developing a plan of care for a client who had bariactric surgery, the nurse should apply pneumatic compression devices
- Following this surgery, the client is at risk for hemorrhage, wound disruption, pneumonia, and infection
- venous thromboembolism is a signifcant complication and may be mitigated using pneumatic compression devices as well as chemical prophylaxis
- Its common for ambulate within six to 8 hrs postop to prevent such complications
The nurse preceptor is obersving a newly hired nurse assigned clients IT WOULD REQUIRE FOLLOW UP IF THE NURSE DID WHAT
READ THE QUESTION AND PAY ATTENTION TO WHAT IT IS ASKING
A suprapubic catheter should be looped and taped to the client’s abdomone
- Decreases the tension on the tubing, decreasing the risk of dislodging
The nurse is caring for a newborn immediately after. It would be appropriate if the nurse placed the infant skin to skin with a parent
- The newborn is at risk of cold stress during the first few hours of post intrauterine life.
- The nurse should dry the newborn thoroughly and place the newborn skin-to skin
- APGAR should be done at one and five minutes.
- The higher the score, the more stable 7 to 10 are reassuring
- Suction is only performed if indicated
When assess a client taking prescribed methimazole for hyperthyroidism, the nurse should notify the physician when they have a sore throat
- Methimazole may cause rare agranulocytosis (low neutrophils)
- Sore throat is a sign of possible infection
- PTU is preferable to methimazole in tx for thyroid storm
- PTU faster onset, but methimazole is more potent
When measuring abdominal girth, standard practice dictates using umbilicus as the landmark to be utilized.
An overdose of lithum may be fatal if not treated
- S/sx: N/V, diarrhead, and neurologic delay, confusion, ataxia, and coarse tremors.
- Obtaining vital signs is a priority to determine overrall health
The nurse receives a prescription for sevelamer. The nurse plans to administer this med with the client’s meals
- A phospatephate binder used to tx hyperphosphatemia with CKD
- decreases phosphorus lvl by binding with food
- Dietary rx of beans fish and nuts to help tx hyerphophatemia
- side effects include constipation which may lead to paralytic ilues