CMS Level 3 Practice A

Alzheimer’s Disease

  • Early Stages: characterized by relapse memory issues.

  • Mild Stages: exhibit mild cognitive dysfunction. Common signs include:

    • Forgetting what was just read

    • Getting lost while driving

  • Advanced Stages: individuals require help with Activities of Daily Living (ADLs).

Hyperthyroidism

  • Signs and Symptoms (S/s):

    • Enlarged thyroid gland

    • Positive bruit over the thyroid

    • Nodule present

    • Exophthalmos

    • Anxiety

    • Weight loss

    • Bruit over thyroid --> indicative of Graves’ disease.

  • Considerations:

    • Recent iodine contrast scan or intake of amiodarone necessitates monitoring for hyperthyroid signs.

  • Diagnosis (Dx):

    • Laboratory tests showing increased T3 and T4 levels

    • Needle biopsy

  • Treatment (Tx):

    • Radioactive iodine therapy, patients may need to take propranolol for symptom management.

Death Manifestations

  • Decreased Urine Output (UO)

  • Decreased Respiratory Rate (RR), cyanosis observed

  • Increased Heart Rate (HR)

  • Mottled extremities

Palliative Care

  • Eligibility for hospice care begins when curative or life-saving treatments are discontinued, such as chemotherapy.

  • Availability: Palliative care can be accessed throughout the illness regardless of treatment regimen.

  • Components of Palliative Care:

    • Incorporates various therapies aimed at enhancing the client's comfort. This includes:

    • Holistic therapies such as yoga, meditation, and pet therapy to improve quality of life.

  • DNR Status:

    • No requirement for DNR at onset of palliative care; curative treatments can continue simultaneously.

  • Settings for Palliative Care:

    • Available in both home and inpatient environments.

Hospice Care (Inpatient)

  • Symptoms to Monitor:

    • Clients nearing death may be at risk for dyspnea, indicated by poor gag reflex and gurgling throat sounds (death rattle).

    • While maintaining oxygenation is not a primary concern at this stage, air hunger and excess secretions can increase distress, anxiety, and agitation, necessitating a revision of care plans to address these needs.

    • Morphine may relieve air hunger; however, current regimens should prioritize pain and nausea management.

Diaphragm (Contraceptive)

  • Education:

    • Women should be refitted for the diaphragm after experiencing a 20% weight change.

    • Require annual checks by a provider.

    • Inspect diaphragm prior to each use.

    • Utilize spermicide with every act of intercourse.

Signs/Symptoms of Addiction

  • Indicators:

    • Decrease in self-image

    • Increased feelings of anxiety and depression.

Antisocial Personality Disorder & Bulimia

  • Weight Monitoring:

    • Newly admitted clients with eating disorders should be weighed daily for the first week, then three times weekly per prescription.

    • Communicate that privileges are based on treatment compliance.

  • Nursing Approach:

    • Do not argue or bargain; explain that privileges depend on treatment compliance such as:

    • Weight gain or absence of purging behaviors.

    • Stay with the client for 1 hour post-meal to prevent purging.

Acute Poststreptococcal Glomerulonephritis in Children

  • Monitoring Needs:

    • Regular tracking of BUN and creatinine levels.

    • Precise daily intake and output accounts to detect changes in fluid balance.

    • BP checks every 4 to 6 hours to catch acute hypertension early.

    • Maintain strict records of daily weight.

Betamethasone Use in Preterm Labor

  • Indication:

    • Administered to enhance fetal lung maturity but does not decrease uterine contractions.

  • Other Medications:

    • Terbutaline and magnesium sulfate are used to decrease uterine contractions, not betamethasone.

Immunizations for 12-Month-Old Infants

  • Recommended Immunization:

    • Hepatitis B (HepB) is suitable for immunocompromised infants due to lack of live virus content.

Schizophrenia and Delusions of Reference

  • Client statement indicating delusions of reference:

    • "Someone is trying to get a message to me through this newspaper."

  • Understanding Symptoms:

    • Delusions of reference are when events or stimuli are interpreted as client-centric messages.

Seizure Assessment in Epilepsy

  • Preictal Phase Indicator:

    • Client reports: "I suddenly smell a foul odor."

Eclampsia Management

  • Nursing Actions after Seizure:

    • Administer oxygen via non-rebreather at 10 L/min along with suction, IV fluids, magnesium sulfate, indwelling catheter insertion, and monitoring vitals.

Discharge Teaching for Gastric Bypass

  • Understanding Expected Behavior:

    • Client should recline for 30 min post-meal to avoid dumping syndrome.

Nursing Care for OCD

  • Patient Management:

    • Teach thought-stopping techniques to disrupt compulsive habits and provide alternatives.

Lung Cancer Symptoms

  • Expected Manifestation:

    • Persistent cough observed in clients suffering from lung cancer.

End-of-Life Care Practices

  • Client Comfort Measures:

    • Apply lip balm to combat dryness and promote comfort at the end of life.

Defense Mechanisms in Clients

  • Denial Example:

    • Client refusing to acknowledge the substance use issue.

Delirium Understanding

  • Common Myths:

    • Delirium usually manifests quickly (not slow over weeks) and can be triggered by illness stressors or dehydration.

Organ and Tissue Donation Awareness

  • Understanding by Parents:

    • Assurance that organ donation does not visibly alter the body, allowing for an open casket.

Obesity Management Education

  • Exercise Recommendations:

    • Clients should engage in 30 minutes of walking at least five days a week.

Congenital Lesions during Labor

  • Patient Monitoring:

    • Close observation of HPV lesions for potential obstruction during childbirth.

Alzheimer’s Early Assessment

  • **Typical Findings:

    • The client often misplaces familiar objects, reflective of early cognitive decline.

Family Discussions About Organ Donation

  • Key Understandings:

    • The deceased must remain on life support for organ viability until removal occurs.

Sickle Cell Anemia Management

  • Signaling Stroke Risk:

    • Report severe headaches immediately as they may indicate a stroke risk.

Hysterosalpingography Teaching

  • Pain Awareness:

    • Client may experience shoulder pain as a referred sensation post-procedure.

Care for MS Clients

  • Energy Conservation Strategies:

    • Emphasis on scheduling rest breaks to prevent fatigue.

EpiPen Usage

  • Proper Administration Steps:

    1. Remove activation cap.

    2. Forcefully insert into thigh.

    3. Hold injector in place for 10 seconds.

    4. Massage injection site for 10 seconds and seek immediate medical attention thereafter.

Managing Thrombocytopenia Care

  • Precautions:

    • Initiate fall precautions to mitigate injury risk in clients.

Palliative Care Understanding

  • Surgical Intentions:

    • Palliative surgeries aim to alleviate pain associated with a disease rather than cure.

Intimate Partner Violence Awareness

  • Generational Patterns:

    • Physical intimate partner violence often becomes cyclical across generations.

Radiation Therapy Education

  • Client Instructions:

    • Clients should not bathe on chemotherapy treatment days to reduce infection risk.

Community Health Evaluations

  • Indications of Undue Influence:

    • Noting changes in living arrangements raises a concern for potential exploitation in vulnerable clients.

Glomerulonephritis Nursing Strategy

  • Weight Monitoring:

    • Holding a strict record of daily weight is vital for assessing fluid status.

Assessment of Cerebral Palsy Children

  • Feeding Positioning:

    • Positioning the child upright during feeding to enhance food movement and minimize aspiration risk.

Autism Spectrum Disorder Behaviors

  • Behavioral Indicators:

    • Expect to see ritualistic and repetitive movements.

Alcohol Use Disorder Indicators

  • Key Client Statements:

    • Recognition of concern from partners or family regarding alcohol consumption may signal issues.

Hemorrhagic Stroke Monitoring

  • Routine Checks:

    • Clarification required for alteplase infusion orders, as it may aggravate bleeding in hemorrhagic strokes.

Nutritional Teaching for Leukemia Patients

  • Safety Practices:

    • Proper food handling methods to reduce infection risk due to neutropenia must be emphasized.

Developmental Delays in Newborns

  • Assessment Findings:

    • Expect to restrict attention to large objects in a 7-month-old infant indicating possible sensory developmental delay.

Genital Herpes Management Teaching

  • Lesion Care Instructions:

    • Clients should clean lesions daily with saline to prevent secondary infections.

Workplace Bullying Reporting

  • First Steps:

    • Validate claims of heavier work assignments to recognize the situation and address appropriately.

Down Syndrome Expectations

  • Physical Assessment:

    • Anticipate clients to display decreased muscle tone indicative of Down syndrome.

Diaphragm Contraception Guidelines

  • Refitting Needs:

    • Women should seek refitting post-significant weight changes, pregnancy, or surgical changes.

Smoking Cessation with Nicotine Patches

  • Client Understanding:

    • Expect user comprehension of the gradual tapering of patches over several weeks during cessation efforts.

Clomiphene Citrate Teaching

  • Expected Medication Side Effects:

    • Include breast tenderness as a common side effect of clomiphene citrate.

Managing Anorexia Nervosa Care Strategies

  • Nutrition Augmentation:

    • Increase dietary intake by utilizing increments of 100 calories to minimize overwhelm.

Family Planning Teaching on IUDs

  • Regular Checks:

    • Clients should regularly check for strings to ensure proper placement of the IUD.

Mental Health Response Observations

  • Client Statements in Assault Cases:

    • Explanation of procedures to lower anxiety and build trust during vulnerability.

Postpartum Teaching on Newborn Care

  • Correct Informational Response:

    • Acknowledge the time for umbilical cord separation as up to three weeks.

Borderline Personality Disorder Indicators

  • Personal Relationship Traits:

    • Expect unstable interpersonal relationships and dependence on others for decision making.

Chemotherapy Post-Care Instructions

  • Preventative Actions:

    • Ensure personal cleanliness with glassware to mitigate infection risks.

Elder Abuse Monitoring for Decision-Making Influence

  • Proper Identifications to Watch For:

    • Care arrangements open to exploitation or undue influence in vulnerable clients.

Acute Glomerulonephritis Assessment Signs

  • Expected Findings:

    • Expect renal function issues such as dark or rusty urine due to hematuria.

Melanoma Prevention Strategies

  • Self-Monitoring Practices:

    • Instruct clients to maintain a body map for tracking skin changes.

Evaluation of Client Personality Disorders

  • Schizoid Characteristics Identification:

    • Recognizing signs of disinterest in close relationships points to schizoid personality traits.

Alcohol Use Disorder Assessment Tool

  • Preferred Instrumentation:

    • The Addiction Severity Index is critical for assessing substance use disorder severity.

Palliative Care Topics

  • Components to Discuss:

    • Discuss available therapies that alleviate pain without aiming to cure the illness.

Bipolar Disorder Maniacal Care Strategies

  • Practical Eating Solutions:

    • Provide finger foods to enhance nutritional intake during periods of hospitalization.

Pregnancy Evaluations for Symptoms of Complications

  • Critical Indicators:

    • Watch for elevated alanine aminotransferase as possible HELLP syndrome indication during gestation.

Supporting New Parents in Neonatal Care

  • Client Learning Acknowledgment:

    • Encourage education of care pertaining to newborn jaundice and need for close monitoring.

Acute Pancreatitis Expectation Management

  • Expected Laboratory Findings:

    • Anticipate elevated WBC counts due to inflammation in the client.

Parkinson’s Disease Client Education

  • Handling Dietary Changes:

    • Encourage offering soft foods and cold fluids for easier swallow.

Assessment for Central Cyanosis in Newborns

  • Priority Indicators:

    • Central cyanosis indicates a potentially life-threatening condition needing immediate attention.