Proctorreview2update (1) (1)

Page 1: Review 2

Page 3: Middle Adulthood

• Individuals in middle adulthood find satisfaction in nurturing and guiding the young.

• According to Erik Erikson, the task in this stage is generativity vs. self-absorption/stagnation.

• Focus: Offering support and guidance to future generations.

• Nurses should explore opportunities for clients to master these developmental tasks like volunteering and mentoring.

Page 4: Normal Breath Sounds

• Normal bronchovesicular breath sounds are moderate in intensity, resembling blowing during air movement through larger airways on inspiration and expiration.

• Reference: [Normal Breath Sounds Video](https://www.google.com/search?sca_esv=7c704608065062e&rlz=1C1ONGR_enUS1126US1126&sxsrf=ADLYWILY26dFpkbAx6dmBLJD7fmLctkmCw:1728091032488&q=NORMAL+BREATH+SOUNDS&tbm=vid&source=lnms&fbs=AEQNm0AVbySjNxIXoj6bNaq7uSpwmIS0gJlXN_LWYh5RkW9UG_J2iT2scTJ59gCgVXw95w_tbwv0XGMg5VNVmdZJUUbegAUXjP-3Az7ul0FDlU2m060AQTgcOz-juRJOL8a_aqHRTetPGBwPbgtpQZ8gRcw23IW5DFCVJMhba136jeZDPbJP1WFjmblAH9LAFyTrxytvYnnjJrgGW5b8BuXrDQWN lbMzlg&sa=X&ved=2ahUKEwjQ54XhiPaIAxUhTTABHXAuEUgQ0pQJegQIERAB&biw=1366&bih=607#fpstate=ive&vld=cid:3b04ba7d,vid:VtnMRG0ORLs,st:0)

Page 5: Enoxaparin Injection / Heparin

• Insert the needle for a subcutaneous injection at a 45° to 90° angle.

• Do not massage the area after injection.

• Do not expel the air bubble from the syringe before injection.

Page 6: Aromatherapy with Essential Oils

• Lavender oil: Can cause hormonal disruptions in small female children.

• Eucalyptus oil: Can aggravate seizures in individuals with epilepsy.

• For clients with asthma: Some essential oils may cause bronchospasms, so consult the provider before use.

Page 7: Albumin Levels

• Normal albumin range: 3.4 to 5.4 g/dL.

• An albumin level of 3 g/dL indicates protein deficiency.

• Low albumin increases the risk for pressure ulcers and poor wound healing.

Page 8: Heart Auscultation Areas

• Aortic area: Second right intercostal space

• Pulmonic area: Second left intercostal space

• Erb's Point: Third left intercostal space (left sternal border)

• Tricuspid area: Fourth left intercostal space (left lower sternal border)

• Mitral area (apex): Fifth left intercostal space (midclavicular line)

Page 9: Initiating IV Fluid Therapy

• Thread the IV catheter so the hub rests at the insertion site.

• Inserting the catheter up to the hub reduces contamination risk along its length.

Page 10: Urine Catheter Issues

• A client with an indwelling urinary catheter should have continuous urine flow.

• If a full bladder is confirmed (via bladder scan), irrigate the catheter to resolve blockage.

Page 11: Safety - Performing Hygiene Care

• The greatest safety risk is injury from overestimating a client's ability to assist with hygiene care.

• Always assess if they can help with their hygiene.

Page 12: Transferring a Client with Right-Sided Weakness

• Ask the client if they can bear weight.

• Position the chair on the left side of the bed.

• Have the client sit and dangle feet at the bedside.

• Use the stand-pivot technique to move to the chair.

• If there is left-sided weakness, position the chair on the right side.

Page 13: High Vitamin C Foods

• Brussels sprouts: 130 mg/110 g serve

• Oranges: 90 mg/165 g serve

• Bell peppers: 90 mg/50 g serve

• Broccoli: 80 mg/100 g serve

• Kiwifruit: 80 mg/76 g serve

• Grapefruit: 80 mg/240 g serve

• Cauliflower: 70 mg/115 g serve

• Kale: 60 mg/45 g serve

• Mango: 50 mg/130 g serve

• Strawberries: 60 mg/82 g serve

• Cabbage: 40 mg/97 g serve

• Bananas: 40 mg/440 g serve

• Optimal nutrient intake: 160 mg/2000 cal

• Minimum (bliss point): 55 mg/2000 cal

Page 14: Inserting Urine Catheter

• Watch this video for guidance: Inserting Urine Catheter

Page 15: Nurse Manager Functioning

• Client Educator: Imparts knowledge to clients and others.

• Client Advocate: Represents and supports the client's rights and needs.

• Client Care Provider: Oversees proper care provision; e.g., monitoring RN inserting a foley catheter.

• Case Manager: Coordinates care/resources without directly overseeing specific procedures.

Page 16: Dysphagia

• Using a straw may increase aspiration risk as it bypasses oral control necessary for safe swallowing. NO STRAW!

• Adjust the head of the bed to 90° during meals for safer swallowing.

• Take frequent breaks while eating to avoid fatigue.

• Tuck the chin when swallowing to aid in safe swallowing.

Page 17: Using a Wheelchair

• Lowering footplates before transfer helps prevent injury during the transfer.

• Stability: Allows feet to rest comfortably and prevents dangling.

• Proper Alignment: Reduces risk of twisting or overstretching during transfer.

Page 18: Signs and Symptoms of Hypocalcemia

• Tingling sensation around lips: Indicative of paresthesia.

• Positive Trousseau's Sign: Induces carpal spasm by inflating a blood pressure cuff.

• Muscle cramps: Due to increased neuromuscular excitability.

• Positive Chvostek Sign: Twitching of facial muscles in response to facial nerve tapping.

Page 19: Assessing a Client's Abdomen Steps

• Observe contours with a penlight.

• Determine bowel sounds using the stethoscope's diaphragm.

• Percuss the abdomen.

• Lightly depress the right lower quadrant with fingertips.

• Press deeply in the upper abdomen left of midline to detect aortic pulsation.

Page 20: Post Surgery Complication Signs

Abnormal Signs:

• Weak and thread pulses, tachycardia

• Restlessness can indicate hypovolemia and decreased tissue perfusion (may indicate active bleeding).

• Drop in blood pressure.

Normal Findings:

• Warm skin indicates normal thermoregulation or vasodilation.

• Brisk capillary refill indicates adequate peripheral perfusion, not associated with active bleeding.

Page 21: Stages of Grief

• Denial: Refusal to accept reality; e.g., a client with terminal illness expects to see children grow up.

• Bargaining: Making deals to prolong life.

• Anger: Resentment or frustration towards the situation.

• Acceptance: Coming to terms with reality and preparing for death.

Page 22: Stages of Grief Summary Diagram

• Denial

• Anger

• Bargaining

• Depression

• Acceptance

Page 23: Informed Consent Confirmation

• “The 3's”:

1. Nurse's signature indicates the client signed voluntarily in the nurse's presence.

2. Confirms the client has legal capacity and authority to provide consent.

3. Confirms the client provided consent without coercion.

Page 24: Ophthalmic Eye Drops Administration

• Hold the dropper about 1 cm from the eye to avoid contamination.

• For multiple medications, ensure a 5-minute interval between doses.

• Ask the client to gently close their eyes after administration to increase absorption.

Page 25: Risk for Falls - Teaching

• Loose or uneven carpeting on stairs increases fall risk.

• Instruct clients to secure carpeting with tacks.

• Furniture should be moved away from hallways.

• Use nonslip mats or rugs with rubber backing in bathrooms to reduce slip risk.

Page 26: Colorectal Cancer Prevention Guidelines

• FOBT Recommendation: Annually.

• Red Meat Intake: Reduce to lower colorectal cancer risk.

• Colonoscopy Screening: Every 10 years for average-risk individuals starting at age 45.

Page 27: Cranial Nerve VII

• Responsible for controlling muscles of facial expression.

• Expected assessment finding: symmetrical facial movements (e.g., equal smile).

Page 28: Linear Incision Cleaning

• Clean from the incision to surrounding skin to prevent bacteria spread.

• Use sterile solution and gauze.

Page 29: Elderly Care

• An environment with minimal distractions is crucial for effective learning in older adults.

• Antihypertensive medications can increase falls risk due to orthostatic hypotension.

Page 30: NG Tube Issues

• Inject 10 mL of air into the vent lumen to relieve obstructions in the NG tube.

• This method ensures tube patency.

Page 31: Difficulty Voiding Issues

• If male, have the patient stand or sit up for easier urination.

• Place bedpan at semi or high Fowler's position; supine is not recommended.

• Insert an indwelling catheter if it's been over 4 hours post-operation to prevent urinary retention complications.

Page 32: Anti-embolic Stockings Application

• Measure the length from heel to gluteal fold for proper fitting.

• Correct fitting is essential to prevent DVT by promoting circulation.

Page 33: Traditional Chinese Medicine

• Arranging a referral to a TCM practitioner respects the client's interest and facilitates access to qualified care.

Page 34: Medication Interactions

• Certain foods can interact with medications affecting absorption and effectiveness; e.g., grapefruit juice with statins.

• Awareness of food-drug interactions is essential.

Page 35: Chronic Pain

• Chronic pain significantly impacts quality of life, leading to feelings of hopelessness and depression.

Page 36: Implied Consent

• In emergency situations: If a patient is unconscious, healthcare providers can proceed with treatment under assumed consent.

• Applies in life-threatening situations when explicit consent can't be obtained quickly.

• Unconscious patients cannot provide informed consent, making implied consent relevant.