Comprehensive Nursing Lecture Notes – Mobility, Nutrition, and Test Strategies

Read ENTIRE question ➜ read ALL answer options ➜ re-read question before marking.
- Prevents misreading key qualifiers (“least”, “first”, “best”, etc.).
Slow, deliberate pace is rewarded; exams are not a race.
- First one done ≠ highest score.
If stuck > ≈ 2 min:
- Apply elimination tactics to reach a 50/50 guess.
- Choose and move on—do not dwell on previous item once submitted.
Avoid “call the provider” unless:
- No other action within nursing scope can improve situation.
- Question clearly states data collection already complete.
Rely on evidence-based practice, not personal anecdotes or “what happened to my cousin.”
“Least invasive, most effective” comes before invasive/expensive steps (e.g., position change & pulse-ox before ABG draw).
Visualize scenarios if you are a picture/kinesthetic learner (e.g., imagine patient actually ambulating with a walker).
Email etiquette mirrors test strategy: read faculty messages slowly; all needed info is usually present.

Stand on patient’s weak/affected side when ambulating; anticipate fall toward stronger side due to center-of-gravity shift.
Ensure devices sized correctly to prevent brachial-plexus & skin injuries.

“Cane opposite affected leg” (COAL) – cane held on strong side, advances with weak leg.
“Walker with affected leg” (WALF) – move walker forward simultaneously with weak leg.

Axillary bar: ≈ 2 finger-breadths (≈ 5 cm) below axilla when standing straight.
Handgrip at wrist crease/elbow flexed ≈ 20–30°. Weight borne through hands, not axilla.
Incorrect high crutch ➜ risk to brachial plexus nerves.
Gait styles (visual chart referenced):
- 2-point, 3-point, 4-point, swing-through. Pick based on weight-bearing order from PT.
Stairs mnemonic: “Up with the good, down with the bad.”
- Ascend: good leg → crutches + bad leg.
- Descend: crutches + bad leg → good leg.

Oxygenation: sit pt up, encourage pursed-lip breaths, apply pulse-ox before ABG.
Pain/comfort: reposition, distraction, non-pharm before opioids unless severe.
Assessment before implementation unless life-threatening obvious.

Causes: weak LES, hiatal hernia (sliding or para-esophageal).
Teach:
- Small, low-fat meals; avoid late-night eating (≥ 2–3 h before bed).
- Avoid caffeine, chocolate, carbonated drinks, peppermint, spicy food, high-fat food.
- Weight reduction, loose clothing.
- Sleep with HOB ↑ 6–8 in or on left side (reduces reflux but does not “empty” stomach).
Meds: PPIs, H2 blockers, antacids.
Chronic GERD ➜ risk Barrett’s esophagus ➜ esophageal CA; surveil.
Stomach acidity reminder: $pH\approx2-3$ ; foods rarely make stomach more acidic, they just irritate esophagus.

"Six F’s" risk: Female, Fat, Fertile (pregnant), Forty, Fair (Caucasian), Family history.
Pre-op diet: low-fat, low-spice to minimize biliary colic.
Post-cholecystectomy: resume diet slowly; very fatty meals may trigger diarrhea due to continuous, dilute bile drip.

Uric acid crystallizes in cooler joints (big toe, fingers).
Diet: low-purine—limit red meat, organ meats (liver, kidney), anchovies, alcohol (esp. beer, wine).
Meds: allopurinol, colchicine; encourage hydration to aid renal excretion.

Inborn error: cannot metabolize phenylalanine (an amino acid).
Screen at birth via heel-stick.
Diet lifelong: avoid high-phenylalanine proteins—milk, cheese, eggs, soy, tofu; use special medical formula; avoid aspartame (contains phenylalanine).
Requires vitamin/mineral supplementation for growth.

Common after partial gastrectomy or bariatric surgery.
Patho: Hyperosmolar chyme rapidly enters jejunum → water shifts into bowel; pancreas over-secretes insulin → post-prandial hypoglycemia, cramping, diarrhea.
Management:
- Small, frequent meals high-protein, high-fat, low-carb.
- No liquids with meals; drink between meals.
- Lie down ~30 min after eating; avoid sugary/carb drinks.

Gas-forming foods to limit: beans, cabbage, Brussels sprouts, onions, carbonated drinks.

Needed for ACE-I or K-sparing diuretics (spironolactone) causing hyper-K.
Avoid high-K foods: bananas, potatoes, tomatoes, avocado, salt substitutes (most contain KCl), dried fruits.

Must be water-based & transparent at room temp.
Allowed: water, clear broth, apple/white grape juice, tea/coffee (no milk), gelatin, Popsicles without red/purple dye, clear sodas.
Not allowed: milk, orange juice with pulp, puréed soups, anything opaque.
Colonoscopy prep: avoid red/purple dye to prevent false GI bleed impression.

Edema assessment sites: ankles, sacrum, lungs for crackles.
Dehydration signs: skin tenting, concentrated urine.
Sodium & potassium inverse relationship: diuretics altering one may shift the other.

High-risk conditions: stroke, ↓ LOC, dementia, Parkinson’s, myasthenia gravis, spinal cord injury.
Verify NG/OG tube placement primarily by X-ray; pH check as secondary.
For pancreatitis: best choice is naso-jejunal (NJ) or surgically placed jejunostomy so food bypasses stomach & duodenum, reduces pancreatic stimulation.
Tube-feeding intolerance (distention, cramping, diarrhea): stop feed, assess, consult dietitian/MD; consider formula rate, concentration.
Change feeding bag/tubing every 24 h to reduce infection risk.

Toddlers often eat less volume; monitor for vitamin deficiencies during picky stages.
School-age caloric needs adjust with growth spurts; education on balanced diets essential.

Boot-camp review sessions available (topics & schedule posted; e.g., nutrition next week).
During exams: no food, gum, or opaque bottles; only fully clear water bottles without labels.
Temperature disputes in classroom: bring layers instead of adjusting thermostat excessively—maintain patient-like environment.