NURSING RN 2349 | NU2349 Key Concepts for Final Exam | COMPLETED NURSING 1 FINAL | Already Graded A.

NU2349 Key Concepts for Final Exam 1. How does age and gender affect responses to pain? ▪ Children learn indirectly from their parents and caregivers how to respond to pain, as far as the level of pain that justifies a complaint, how to express pain, when to stop complaining about the pain and who to approach for help when experiencing pain. ▪ *Socialization of children will influence the way they respond to pain as adults ▪ About 80% of the elderly experience chronic, moderate to severe pain. ▪ National Institutes of Health stated that women believe emotions of fear and anxiety effect their perception of pain adversely, whereas men focus more on the physical aspects. ▪ Women are known to have a lower pain threshold and tolerance, and seek medical attention more frequently than men. ▪ *Heart attacks are the number one threat to women – since they do not experience typical symptoms and type of pain, they are not hospitalized and treated as aggressively as men. ▪ Women also experience more microvascular changes such as narrowing of the small coronary vessels. ▪ Most prevalent painful disorders seen in both genders, but mainly women include fibromyalgia, Raynaud’s disease, rheumatoid arthritis, multiple sclerosis, headaches, facial pain, and TMJ. ▪ Most prevalent painful disorders seen in both genders, but mainly men include pancreatitis, duodenal ulcer, and ankylosing spondylitis. ▪ Men have a higher chance of injury related to sports and motor vehicle accidents. 2. What is intractable pain? Examples? ▪ Pain that is refractory or resistant to some or all forms of treatment. o Pain due to a known cause - such as malignancy, nerve compression or entrapment, phantom limb pain, spinal cord damage, and myofascial syndromes - and is resistant to therapy is referred to as chronic intractable pain. o Incurable pain – goal is to reduce discomfort 3. What is Neuropathic pain? Example? ▪ Pain that results from injury to a nerve, malfunction of neural transmission process, or impaired regulation. o Frequently described as paroxysmal (sudden spasm-like pain) o Examples: pain associated with trigeminal neuralgia, postherpetic neuralgia, and diabetic peripheral neuropathy 4. What is nociceptive pain? Examples? ▪ Pain in response to potentially damaging stimuli o Occurs when the pain impulse is processed normally over intact nerves o Two types of nociceptive pain: somatic and visceral 5. What somatic pain? Examples? ▪ Pain that originates from the bones, joints, muscles, skin, and connective tissue o In the skin and superficial structures - sharp, pulsatile, and well-localized o In the deep structures – dull, aching, pulsatile, not well localized o Examples: burns, lacerations, fractures, infections, inflammatory conditions, 6. What is visceral pain? Example? ▪ Pain arising from the body organs or gastrointestinal tract o Intermittent, achy, crampy pain – poorly localized o Examples: Menstrual cramps, GI pain, appendicitis, gall stones, angina, bowel distention, pancreatitis 7. Describe referred pain? Example? ▪ Transfer of visceral pain sensations and deep somatic pain through the autonomic nervous system to a part of the body distant from the actual origin of the pain o Pain felt in area other than where stimulus occurs o Example: myocardial infarction felt in the jaw or down the left arm 8. What is breakthrough pain? Examples? ▪ A transitory increase in pain that occurs in addition to persistent pain o Commonly seen in advanced stages of cancer and late-stage diseases such as AIDS. o Acute "flare up" of pain in a patient who is on regular doses of pain medication for persistent pain. o Treated by "rescue" pain meds. These are quick acting meds that don't stay in the body long...e.g. quick release morphine. o *Think cancer pain 9. Know differences between acute and chronic pain, S/S, examples of each and treatment options of each. ▪ Acute pain: usually short term and quick onset. Responds well to treatment. Can be a new flare up during chronic pain. o S/S: Increases systolic BP, increased HR and force of contraction, increased respirations, dilated blood vessels to brain, increased alertness, dilated pupils, rapid speech o Example: burn, muscle injury, fractured bone, surgical wound o Treatment: Acetaminophen, NSAIDs, Opioids, Adjuvants o *goal is to find and remove underlying cause ▪ Chronic pain: Sudden or slow onset of mild to severe pain that is usually long term – typically slow onset. Poorly localized, hard to treat. Pain that lasts more than 6 months. o S/S: mild to severe pain that does not go away as expected after illness or injury, described as shooting, burning, aching, or electrical pain, discomfort, soreness, tightness, or stiffness. o Example: migraine headaches, sickle cell crisis, osteoarthritis, rheumatoid arthritis, cancer pain, fibromyalgia o Treatment: Physical therapy, occupational therapy, NSAIDs, nerve blocks, opioids, nonsteroidal anti-inflammatory drugs 10. Describe prolonged stress response and the cascade of harmful effects to the body system-wide. ▪ Chronic stress that disrupts nearly every system in the body: o Suppress immune system o Upset digestive and reproductive systems o Increase risk of heart attack and stroke o Speeds up the aging process ▪ Can cause psychiatric illnesses such as anxiety disorders, clinical depression, and PTSD ▪ Prolonged stress can result in crisis and burnout (p. 259) o Crisis: an event that drastically changes the person’s routine that is perceived as a threat to self. Usual coping mechanisms are ineffective, resulting in anxiety and inability to function adequately. 5 phases of crisis: precrisis, impact, crisis, adaptive, postcrisis o Burnout: person cannot cope effectively with physical and emotional demands of the workplace May result in grief, moral distress, guilt, physical illness, negative attitude, and maladaptive coping techniques (alcohol use, smoking…) 11. Know how to assess pain in a patient. What questions should you be asking? ▪ Ask: what makes it better/worse, does it interfere with daily function, how often, intermittent/constant, where is it located, what is the quality of the pain, is there a pattern, when did it begin, how would you rate it (pain scales), have you had this type of pain before, what have you tried to relieve it. 12. How does pain affect vital signs? ▪ Acute pain o Increases BP, HR, respirations o Dilated pupils o Dilated blood vessels to brain causing increased alertness o Rapid speech ▪ Chronic pain o Decreased pulse rate o Changeable breathing patterns o Withdrawal o Constricted pupils o Slow/monotone speech ▪ Behavioral response o Withdrawing from painful stimuli o Moaning o facial grimacing o crying o agitation o guarding ▪ Psychological response o Anxiety o Depression o Anger o fear 13. Physiologic dependence involves what? What would the physiologic S/S be when opioids are removed from a patient who has a history of opioid abuse? ▪ Involves emotional-motivational withdrawal symptoms such as a state of unease or dissatisfaction, a reduced capacity to experience pleasure, or anxiety, upon cessation of drug use or engagement in certain behaviors. ▪ Early S/S o Watery eyes, runny nose, sweating, running, anxiety or irritability, poor sleep, muscle pain ▪ Later S/S o Cramping, diarrhea, vomiting, increased BP & HR, restlessness, shakiness, chills, sweating, gooseflesh, dilated pupils 14. What is tolerance? How does it differ from abuse? ▪ Tolerance is a state of progressively decreasing responsiveness to a frequently used drug. o Characterized by a person's diminished response to a drug, which occurs when the drug is used repeatedly and the body adapts to its presence. As a result, a larger dose of the drug is needed to achieve the effect originally obtained by a smaller dose. ▪ Differs from abuse because abuse is when the person becomes dependent on the drug or medication and its effects, versus not receiving therapeutic effects 15. What are mind-body therapies? Examples? ▪ Therapies in which there is a dynamic relationship between the mind and body and the ways in which the mental, emotional, spiritual, and social aspects interact and affect behavior and health. ▪ They recognize individuals capacity for self-awareness, self-knowledge, and capacity to ignite self-healing ▪ Examples: relaxation, meditation, guided imagery, biofeedback, hypnotherapy, journaling, support groups, cognitive-behavioral therapy, prayer, and music. 16. What are the 5 C’s of pain management? 1. Comprehensive assessment 2. Consistent use of assessment tools 3. Continuous reassessment 4. Customized plan of care 5. Collaborative approach 17. What is the role of interleukin? Released causes fever with infection ▪ An interleukin is a group of naturally occurring proteins that mediate communication between cells. ▪ They regulate cell growth, differentiation, and motility. They are particularly important in stimulating immune responses, such as inflammation. 18. What are specific age related concerns regarding thermoregulation? ▪ The skin acts to control body temperature by conduction of hear through the skin for evaporation or absorption by other objects, radiation of heat from body surfaces, convection of heat by air currents, and evaporation of sweat. ▪ Newborns cannot protect against heat loss. Infants and older adults are most susceptible for heat loss due to the effects of environmental temperature extremes. ▪ Infants lose 30% of their body heat through their head, which is proportionally larger than the rest of their body. ▪ Older adults have a decreased metabolism, decreased vasomotor control, and loss of subcutaneous tissue which is the cause for inability to maintain body heat. 19. What are some treatments for a fever that would be appropriate in caring for a patient with a fever? ▪ Have them drink fluids ▪ OTC fever reducers – acetaminophen, NSAIDs ▪ Remove excess clothing ▪ Cool packs ▪ Cooling blanket ▪ Cool fluids PO/IV ▪ Gastric lavage with cool fluids ▪ Antipyretics 20. What are the methods for taking a temperature? What can cause variations of temperatures when using oral thermometer? Which method is considered the most accurate for obtaining a core temperature? ▪ Oral o Variations that impact oral temp: air temperature, probe placement, and ingestion of fluids ▪ Rectal o Most accurate! ▪ Axillary ▪ Temporal ▪ Tympanic ▪ Body surface temperature 21. Describe the classification of fevers. Constant, intermittent, relapsing, remittent. ▪ Intermittent: spike ▪ Remittent: mild fluctuation ▪ Constant: barely any fluctuation, temperature remains elevated ▪ Relapsing: fever disappears for 24 hours, then reappears ▪ Sustained: continuous ▪ Crisis: extreme drop ▪ Lysis: return to normal at natural rate ▪ Hyperpyrexia: dangerously close to 105 degrees 22. Know how heat is lost through evaporation, conduction, convection and radiation. Know examples of each and interventions for each. ▪ Evaporation: when water is converted to vapor and lost from skin or mucous membranes o Maintain humidity in the air – use a humidifier ▪ Conduction: process where heat is transferred from a warm to cool surface by direct contact o Dress appropriately o Protect skin from cool contact ▪ Convection: transfer of heat through currents of air or water o Emersion in warm bath ▪ Radiation: the loss of heat through electromagnetic waves emitting from surfaces that are warmer than the surrounding air o Wear a hat outside o Use heat lamp to acquire heat 23. What is malignant hyperthermia? What are the risk factors? What are the assessment findings? What are treatment options for it? ▪ Malignant hyperthermia – a life threatening, acute pharmacogenic disorder, developing during or after general anesthesia. o Genetic predisposition and one or more triggering agents provoke MH Triggering agents: all volatile anesthetics (chloroform, ether, halothane, enflurane, isoflurane, sevoflurane, and desflurane) and depolarizing muscle relaxants (suxamethonium). ▪ Risk factors – genetic predisposition, multiminicore myopathy, central core disease ▪ Assessment findings – tachycardia, arrhythmia, rise in temperature, masseter spasms, metabolic acidosis, elevated creatinine, rise of end expiratory CO2, rigor of muscles, hypoxemia, skin flushing o rhabdomyolysis indicates severity ▪ Treatment – stop anesthesia, hyperventilate with 100% O2, deepen anesthesia with benzodiazepines, barbiturates, opioids, or propofol. Dantrolene profusion, check ABGs immediately, then in 30 mins, 4 hours, 12 hours, and 24 hours. Begin overall body cooling through NG tube. 24. What are the S/S of hyperthermia? Primary interventions? Why would you not use a fan in the hospital setting? ▪ Example: heat exhaustion, heat stroke ▪ S/S: o Elevated body temperature, convulsions, flushed skin, tachycardia, tachypnea, warmth to the touch ▪ Interventions: o Fever treatment, malignant hyperthermia precautions, temperature regulation, and vital sign and temperature monitoring every 2 hours, determine cause of fever, observe for clinical signs that accompany fever. ▪ Fans are discouraged due to infection control concerns, and may dry out respiratory passages 25. What are the S/S of hypothermia? Primary interventions? ▪ S/S: o Body temperature less than 95°F o Decreased, irregular pulse, respirations, BP o Severe shivering (initially) o Pale, cool, shiny skin o Decreased urine output o Disorientation and/or drowsiness ▪ Interventions: o Temperature regulation o Vital sign monitoring o For pts with temp <85°F: warmed IV fluids, heating pads, heating blankets, warm pads o *DO NOT use electric blankets – vasoconstricted skin burns easily o *DO NOT apply pulse oximetry probes to a vasoconstricted finger 26. What are risk factors for impaired thermoregulation? ▪ Lower body temperature ▪ Diminished response to infection ▪ Residing in very cold or hot climates ▪ Age – young and old ▪ Low socioeconomic status ▪ Impaired cognition ▪ Underlying health conditions ▪ Genetics ▪ Environmental exposure ▪ Substance abuse 27. What are the 7 rights to drug administration? 1. Right medication 2. Right patient 3. Right dosage 4. Right route 5. Right time 6. Right reason 7. Right documentation 28. What are safety precautions a nurse should employ when dealing with an angry or unstable patient? ▪ Stay between the patient and the door ▪ Get help ▪ Use restraints only if needed 29. What disease processes might make a patient a higher risk for falls? ▪ Orthostatic hypotension ▪ Fainting episodes ▪ Sensory deficits ▪ Dementia ▪ Bone degeneration ▪ Osteoporosis ▪ Degenerative joint disease ▪ Stroke ▪ Seizures ▪ Multiple sclerosis ▪ Peripheral neuropathy 30. What is a sentinel event? ▪ any unanticipated event in a healthcare setting resulting in death or serious physical or psychological injury to a patient or patients, not related to the natural course of the patient's illness 31. What are the interventions to prevent post-op complications? ▪ Consult from dietitian to create food plan ▪ Encourage patient and family members to express feelings and concerns ▪ Monitor for signs of infection ▪ Position patient on side away from surgery site ▪ Documenting drainage or bleeding ▪ Teach how to properly clean incision site 32. What are the different types of anesthesia? What are the advantages/ disadvantages of each? ▪ Local anesthesia o Temporarily stops sensation of pain in specific area of the body o Patient remains conscious ▪ Regional anesthesia o Numbing only the portion of the body that will be operated on o Injection given into the nerves that provide feeling to that area ▪ Spinal anesthesia o Used for loweer abdominal, pelvic, rectal, or lower extremity surgery o Injected into fluid of spinal canal ▪ Epidural anesthesia o Similar to spinal, also used for surgery of lower limbs o Thin catheter placed in epidural space in mid-lower back outside of spinal space ▪ General anesthesia o Patient is unconscious during surgery o Cannot be aroused, even by painful stimulation o Require assistance in maintaining airway o Cardiovascular function may be impaired 33. When does the care of a preoperative patient stop? ▪ When the patient enters into the surgical suite 34. What is informed consent? When is it waived? ▪ The process in which the patient receives information about a specific procedure or therapy, alternative procedures and therapies, and the expected outcomes of each ▪ It is waived in lieu of providing the needed emergency care (life or limb) 35. What are the nurse’s obligations in ethical decisions ▪ Be aware of and sensitive to issues ▪ Assume responsibility to own moral actions ▪ Function as a team member ▪ Support the patient and family members ▪ Support patients who are not being allowed to decide ▪ Use and participate in institutional ethics committees ▪ Advocate for your patient 36. What is accountability? ▪ Staying answerable for your decisions and actions with regard to nursing diagnoses and independent interventions 37. What is Autonomy? ▪ Informed self-direction; acting, feeling, thinking independently 38. What is negligence? ▪ Failure to act in a reasonable and prudent manner 39. What is pyelonephritis? S/S? TX? Patient teaching? ▪ Infection of the upper urinary tract that may involve ureters, renal pelvis, and papillary tips of the collecting ducts ▪ If unchecked, it can extend into the tubules of the nephron, creating potential for renal failure ▪ S/S: o Painful urination o Frequent urination o Back pain o Flank pain at CVA o Fever o Chills o Nocturia o Nausea o Vomiting o Colicky abdominal pain ▪ Treatment: o Antibiotics o Encourage fluids o Urinate every 2-3 hours o Sitz bath if irritation occurs on urethra ▪ Teaching: o Complete full course of antibiotic therapy o Maintain prescribed schedule to ensure therapeutic blood levels o Maintain proper hygiene 40. What are kidney stones? S/S? TX? Patient teaching? ▪ Buildup of calcium ▪ Affect males more often than females ▪ Etiology is unclear factors contributing to stone formation include acidic urine and concentration of precipitating elements in the urine and increased rate of calcium absorption from the gut. Genetic factors might also be a factor ▪ S/S o Flank pain o Nausea and occasionally vomiting o Abdominal pain o Ipsilateral testicle or ipsilateral labium pain o Urinary frequency and urgency o Less common symptoms: gross hematuria without pain, uti, fever, nausea, vomiting ▪ Treatment: o Pain control o Iv fluids o Surgery o Analgesics o Thiazide diuretics are often administered for calcium calculi to reduce urinary calcium excretion ▪ Pt. Teaching: o Dietary management for prevention of renal calculi focuses on changing the urine composition. o Increase fluids to 2.5-3 liters per day o Calcium intake is limited o Animal proteins are limited 41. What is glomerulonephritis? S/S? TX? Risk factors? • Inflammation of the glomerular capillaries • The glomerular becomes inflamed and impair the kidneys ability to filter urine • Eventually, the glomeruli become inflamed and scarred, and slowly lose their ability to remove waste and excess water from the blood to make urine. • S/S o Latent period is one to two weeks after a strep throat infection and three to six weeks after an impetigo infection. o If glomerulonephritis occurs within one to four days of a streptococcal infection, that is suggestive of preexisting renal disease. o First clinical symptom is dark urine, or cola colored caused by hemolysis of red blood cells that have penetrated the glomerular basement membrane o Periorbital edema occurs suddenly o Hypertension is present o These symptoms (hematuria, edema, and hypertension) are known as nephritic syndrome • Treatment: o Control edema and have a low sodium diet o Fluid restriction o Penicillin o Loop diuretics such as furosemide (Lasix) o Dialysis o Kidney transplant • Risk factors: o Patients with heart defects, such as a damaged or artificial heart valve 42. What is ulcerative colitis? S/S? TX? Complications? ▪ Chronic inflammatory bowel disorder that affects both the mucosa and submucosa of the colon and rectum ▪ Exacerbations and remissions ▪ No cure ▪ S/S: o Diarrhea o Abdominal pain in LLQ o Rectal bleeding o May also include anemia symptoms: dehydration fatigue, anorexia, weight loss, and generalized weakness. o Patents should be monitored for tachycardia, hypotension, pallor, and blood loss ▪ Treatment: o Medications: Anti-inflammatory drugs Antibiotics Dietary supplements o Surgery Colostomy Ileostomy Colectomy o Iv fluids o Enema ▪ Complication: o Toxic megacolon 43. What is Chronn’s disease? S/S? TX? Risk factors? ▪ Chronic inflammatory bowel disorder with a relapsing and remitting course. Once remission is achieved, the main aim of management of chorn’s id maintenance of that remission ▪ Begins with the small inflammatory lesion of the intestinal mucosa. Eventually, the inflammation continues and progression through all layers of tissue is seen. ▪ As the disease progresses, the inflammation causes the bowel wall to thicken and become fibrotic, and a narrowing of the intestinal lumen occurs. ▪ S/S: o Abdominal pain and tenderness o Pain relieved with defecation o Eating can initiate the discomfort o Weight loss ▪ Risk factors: o Age before 30 o Ethnicity (whites highest) o Family history o Smoking o Nonsteroidal anti-inflammatory medications o Where you live ▪ Treatment: o Surgery o Medications: anti-inflammatory drugs, vitamins, antibiotics o Dietary fiber 44. What is a bowel obstruction? S/S? TX? ▪ Paralytic or mechanical obstruction ▪ Mechanical obstruction may arise from within the lumen or bowel wall or by a lesion external to the bowel that compresses it externally ▪ Paralytic is intestinal obstruction due to partial or complete arrest of intestinal peristalsis ▪ S/S o Colicky, midabdominal pain often over a period of days o Vomiting early in course ▪ Treatment: o Correction of fluid, electrolyte, and acid-base abnormalities o Bowel decompression o Endoscopic therapy o Medications o Surgery 45. What are the causes of hypo or absent bowel sounds? ▪ Large bowel obstruction 46. Patient teaching regarding constipation. ▪ Increase the intake of high finer foods ▪ Increase fluid intake ▪ Increase physical activity to stimulate peristalsis ▪ Provide privacy for using toilet ▪ Encourage patient not to ignore the urge to defecate 47. What is stress incontinence? Causes? Who is most at risk for it? ▪ Involuntary loss of small amounts of urine with increased intra-abdominal pressure ▪ Loss less than 50ml in the absence of an overactive bladder ▪ Causes o Pregnancy o Childbirth o Obesisty o Chornic constipation o Straining at stool ▪ Activities that produce leakage of urine include: o Exercise o Laughing o Sneezing o Coughing o Lifting 48. Interventions for hypo/hypervolemia, causes? Complications? Who is most at risk? ▪ Hypovolemia: o Loss of fluid and electrolytes from the ECF. Loss of blood volume ▪ Interventions Hypovolemia: o Identify high risk patients, monitor I &O, daily weights, assess breath sounds, monitor peripheral edema, sodium restrictions, administer diuretics, elevate edematous extremities, position patients in semi- fowlers position and reposition every 2 hours to prevent skin breakdown in edematous skin ▪ Causes Hypovolemia: o Surgery, trauma, uterine rupture, dehydration ▪ Complications Hypovolemia: o Hypovolemic shock: heart pumps fast but not as powerfully, resulting in a rapid, weak pulse, and orthostatic hypotension ▪ Who is most at risk for hypovolemia: o Older adults, infants, children, and any patients with conditions associated with fluid loss ( diabetes insipidus, vomiting, diarrhea, fever) ▪ Hypervolemia: o Excessive retention of sodium and water in the ECF. ▪ Hypervolemia interventions: o Monitoring intake and output and observing patients for signs and symptoms of fluid overload ▪ Causes of hypervolemia: Renal failure, heart failure, and liver failure ▪ Complications with hypervolemia: Edema 49. Be able to interpret ABGs. ▪ Pg. 262 Med surg book 50. Assessing IV sites, Complications? S/S and TX. Phlebitis – Hard palpable cord along vein track, will have redness, warmth over site, pain, elevated body temp. Infiltration – leakage of IV fluid out of vein into surrounding tissue, signs are swelling, coolness to the touch, pain, and blanching of skin. Remove IV Nerve damage from vein puncture – electric sensation running along nerve, numbness or tingling in the area or pain Extravasation – do not remove until determined if there is an antidote, if so put in cannula, than remove cannula and elevate extremity. First step in reducing infection to vein site is hand washing, do not touch site unless sterile gloves worn Piggyback – used for intermittent medication administration and one shorter in length than primary IV. Nurse should check for compatibility between piggyback solution and continuous solution In older adults if use of a tourniquet is to distend (make bulge) the vein must be careful not to tear or pinch fragile skin and not left on for extended length of time. Lef t on too long causes hematoma or bruising. Inserting needle into older adult hold skin taut and insert on top of vein 51. Normal amount of urine output. ▪ 30mL/Hr. ▪ 800-2000mL per day 52. Know what a pressure ulcer is. Causes? Who is at risk? Impaired skin integrity. Bedridden and immobile pt’s. Using lifts can cause it, vertical pressure over boney prominence, friction from being moved across bed surface and by shearing when slides down in bed Pressure ulcers result from compromised blood flow and tissue ischemia 53. What is passive immunity? ▪ Temporary when antibodies are created by another human.. passed on 54. What is innate immunity? ▪ Immunity that is inherent within a species and develops regardless of exposure also called natural immunity. ▪ Present at birth 55. What is acquired immunity? ▪ Immunity that is not present at birth and develops either as a result of exposure through an external source, such as colostrum or injection of immunoglobulin. 56. What is Immunoglobulin G? What type of immunity does it achieve? ▪ Most abundant immunoglobin in the body and is further divided into 1, 2, 3, and 4 ▪ IgG is the principal antibody found in the blood and tissues ▪ It is passed thru the placenta to protect against bacterial and viral infections in fetuses 57. What is exudate? What does it contain? When is it normal? When is it abnormal? Be able to describe types of drainage. ▪ Accumulated fluid in a cavity ▪ The fluid and white blood cells that move from the circulation to the site of injury ▪ Serous exudate: straw colored, light yellow and watery almost clear ▪ Sanguineous: bright red drainage ▪ Serosanguinous: mix of bloody and straw colored, pale yellow to blood tinged and watery ▪ Purulent: thick yellow, green and brown contains pus indicates infection 58. What is the function of Basophils? ▪ Have an effect against fungus ▪ Play a role in inflammation 59. What is the function of eosinophils? ▪ Release highly toxic granules that kill parasites and other microorganisms ▪ Produce cytokines, leukotrienes, and prostaglandins ▪ Present in mucous secreted during allergic reactions ▪ Found in the tissues ▪ IgE 60. What is the function of natural killer cells? ▪ Circulate in the blood ▪ Able to detect and attack a limited number of abnormal cells, such as tumor cells and cells infected with the herpes simplex virus (HSV). ▪ They are also able to kill cells that are coated in antibody, a process known was antibody-dependent cell-mediated cytotoxicity. 61. What are leukocytes? What is their function? ▪ WBC ▪ Originate from the bone marrow ▪ Leukocytes spend most of their time in storage, in lymphoid tissues, or dispersed throughout the host tissues. ▪ They use blood as transport system to travel to areas of the body they are needed ▪ Associated with adaptive immune system 62. What are neutrophils? What are their function? What is a shift to the left? ▪ The most numerous granulocytes and thought to be the most important ▪ They are especially reactive to bacteria, and the number of circulating neutrophils greatly increases during bacterial infections ▪ First responders to chemotaxis and rarely found in healthy tissue ▪ Shift to the left means there is an infection or inflammation present and the bone marrow is producing more WBC and releasing them before they are fully mature 63. What are the age related changes in immunologic function? ▪ Babies do not have a developed adaptive immune system. They receive much of their initial acquired immunity from their mothers in the form of colostrum during first few days of bresfeeding and immunizations ▪ As children develop their naïve immune systems incline them to having more infections than adults. This is due to the lack of memory cells, which means that any infection that overwhelms the innate immune system will cause 4-10 days of illness ▪ Young adulthood is a time of good health but have to watch for many autoimmune diseases ▪ Older adults are more at risk 64. What is immunosuppressive therapy? Why/when is it used? Patient education? ▪ Immunosuppressive drugs that have been designed to target specific phases of the immune response. ▪ Drugs are used in combination to permit lower doses of each drug and to minimize side effects ▪ Pg 1179 med surg 65. Osteoarthritis: noninflammatory degenerative joint disease characterized by degeneration of the articular cartilage, hypotrophy of bone at the margins, and changes in synovial membranes. S/S : Join pain, referred pain (knee or thigh pain), tenderness in affected join, joint warmth and soft tissue swelling, crepitus (crinkling, crackling, or grating feeling or sound in joints, skin, or lungs), Heberdens nodes (hard nodules or enlargements of the tubercles of the last phalanges of the fingers) and Bouchards nodes (body enlargements of the proximal interphalangeal joints) TX: Aerobic exercise, physical therapy, nutrition, nonsteroidal anti-inflammatory drugs, acetaminophen for pain control, intra-articular injections, steroid injections, surgery Education: Patient should be able to know how to control pain, ROM techniques Interventions: breathing control, or the patient my need analgesics or narcotics, nurse will evaluate pain levels, work to maintain ROM, work with other heal care team members 66. Osteoporosis: low bone mass, michroarchitectual deterioration, compromised bone strength, and increased risk of fracture S/S: First indication is first fracture, “silent disease”, and decrease in height, sometimes accompanied by kyphosis (hunchback), brittle, weak, and misshapen as the bone loses volume Tx: nutrition increase calcium and vitamin D, Bisphosphonates, exercise, physical and occupational therapy, surgery Interventions: give additional vitamin D supplements with calcium, exercise, occupational therapy (weight bearing exercises) 67. Gout: metabolic disorder that primarily affects men and stems from elevated urate levels in the body S/S: rapid development of pain and edema in one affected joint, swelling, pain, decreased range of motion, fever, headache, and hypertension. TX: bedrest, heat, ice, elevation, medications, lifestyle change, Interventions: use prober use of medications, avoid purine foods, and maintain urinary output of 2000mL or more a day, weight loss might be recommended. Patient teaching: about low purine diet helps reduce serum uric acid. Foods include refined cereals; white bread, pasta, and flour; milk and milk products; sugar and sweets; gelatin; all fats; nuts and peanut butter; vegetables 68. Osteomalacia : metabolic disease that causes poor and delayed mineralization fo the bone cells in mature bones Causes: Vitamin D deficiency TX: Drink more milk and tings with vitamin D, sunlight exposure, vitamin D supplement S/S: skeletal pain and tenderness without a history of injury, hips are site of the most complaint of pain, low back pain, pain in ribs, feet, and other areas, waddling gait 69. Osteomyelitis: serious infection of the bone that is often difficult to treat Causes: stem from infection that has spread through the blood to the site of infection. Associated with diabetes or vascular problems TX: IV antibiotic therapy, surgery S/S: puncture wound, mild trauma, or obvious fracture, pain Complications: loss of function of the joint above or below the infection, leg length discrepancies or deformities, renal insufficiency or hearing loss due to antibiotics 70. Fibromyalgia: chronic widespread diffuse musculoskeletal pain, stiffness, and tenderness S/S: muscoskeletal pain, stiffness, and tenderness, fatigue, insomnia TX: Alleviation of pain and the management of any associated symptoms, conditions, and contributing factors, analgesia, antidepressants, and muscle relaxants, limit caffeine and alcohol, acupuncture Patient teaching: pain management, physical fitness, sleep, and psychological wellbeing. Pain management includes adherence to medication regimens, monitoring pain characteristics, participation in physical activity, and prompt follow up with health care team. Start exercise at a low level and gradually increase. Sleep increase by avoiding caffeine, alcohol, and heavy meals before bedtime. 71. Hyperkalemia S/S: Muscle weakness, dysrhythmias, flaccid paralysis, intestinal colic, Tall TWaves on ECG, slow irregular pulse, restlessness, hyperactive bowel sounds Interventions: Monitor I &O, Monitor K, monitor ECG, Caution potassium rich food intake, assess muscle weakness Causes: renal failure, potassium sparing diuretics, high potassium intake, acidosis, major trauma Hypokalemia S/S: CARDIAC, Fatigue, anorexia, nausea, vomiting, muscle weakness, dysthymias, Flat T wave on ECG, paresthesia, hypotension, thread weak pulse, orthostatic hypotension Interventions: monitor I &O and K levels, encourage potassium rich foods, administer potassium sups, initiate fall precautions, monitor ECG Causes: Diuretics, GI fluid loss through vomiting, diarrhea, steroid administration, anorexia or bulimia 72. Hypercalcemia S/S: muscle weakness, constipation, anorexia, nausea, vomiting, polyuria, polydipsia, kidney stones, bizarre behavior, bradycardia, dysrhythmias Treatment: Monitor I & O, Monitor vital signs, monitor serum Ca levels, monitor ECG’s, encourage fluid intake to prevent stone formation, encourage fiber to prevent constipation, eliminate calcium sups and foods, avoid calcium based antacids, use loop diuretics such as furosemide (Lasix) Causes: hyperparathyroidism, malignant bone disease, prolonged immobilization, excess ca++ rich foods, thiazide diuretics, excessive dietary intake of Ca foods, excessive intake of antacids for gastric distress, vitamin D intoxication, lithium therapy Hypocalcemia: S/S: Positive Trousseau’s and Chvostek’s signs, diarrhea, numbness and tingling of extremities, muscle cramps, tetany, convulsions, laryngeal spasms, cardiac irritability, paresthesia of fingers and lips, hyperactive DTR’s, decreased HR, Hypotension TX: monitor I&O, serum Ca, encourage increased calcium intake, administer calcium sups, avoid over stimulation, calcium gluconate or chloride by slow IV push in emergency, monitory airway if severe Causes: overuse of diuretic’s or steroids, GI fluid loss through vomiting, gastric suction or diarrhea, anorexia or bulimia, increased secretion of aldosterone, metabolic alkalosis, kidney disease 73. Hypermagnesemia S/S: flushing and warmth of skin, hypotension, drowsiness, lethargy, hypoactive DTR’s, depressed respirations, bradycardia TX: monitor vital signs, airway, and reflexes, avoid magnesium based antacids and laxatives, restrict dietary intake of foods high in magnesium, provide rehydration, emergency treatment includes IV calcium gluconate, dialysis in clients with renal failure Causes: renal failure, adrenal insufficiency, untreated diabetic ketoacidosis, Mg treatment in preeclampsia of pregnancy, lithium ingestion, excess antacids Hypomagnesemia: S/S: neuromuscular irritability, disorientation, mood changes, dysrhythmias, increased sensitivity to digitalis, tetany, hyperactive DTR’s, hypoactive bowel sounds, constipation, positive Trousseau’s and Chvostek’s sign TX: Monitor I&O, vital signs, encourage foods high in magnesium, avoid alcohol, if on digoxin, monitor pulse and observe for toxicity, administer oral or IV magnesium sulfate, monitor DTR’s Causes: chronic alcoholism, malabsorption, malnutrition, diarrhea, diabetic ketoacidosis, prolong gastric suction 74. Hyperphosphatemia S/S: short term: tetany symptoms.. Tingling of extremities and cramping Long term: calcification in soft tissue TX: monitor serum phosphorus level, tetany, administer aluminum hydroxide with meals to mid phosphorus if severe Causes: renal failure, hyperthyroidism, chemotherapy, excess use of phosphate-based laxative Hypophosphatemia S/S: paresthesia, joint stiffness, seizures, cardiomyopathy, impaired tissue oxygenation TX: monitor serum phosphorus level, calcium levels, start TPN slowly to avoid drops in phosphate Causes: refeeding after starvation, alcohol withdrawal, diabetic ketoacidosis, respiratory acidosis 75. Hypernatremia S/S: Thirst, elevated temp, dry mouth and sticky mucous membranes, hyperthermia, tachycardia, orthostatic hypotension, restlessness, irritability, seizures, coma TX: Monitor I&O, sodium level, vital signs, LOC, ECG, auscultate lung sounds, provide oral hygiene, restrict sodium in diet, beware of hidden sodium in foods and medications, increase water, administer IV solutions that do not contain sodium, administer loop diuretics for patients with poor kidney excretion Causes: excessive sodium intake, water deprivation, diabetes insipidus, health stroke (dehydration), hyperventilation, burns, administration of hypertonic tube feeding, excessive intake of oral sodium, excessive sodium retention: kidney failure, Cushing syndrome Hyponatremia: S/S: anorexia, n/v, weakness, decreased DTR’s, hypothermia, tachycardia, bounding pulse, hypotension, lethargy, confusion, muscle cramps, seizures, hyperactive bowel sounds, abdominal cramps, pale dry skin and mucous membranes TX: monitor I&O, weight, increase sodium intake, administer IV saline infusion and take seizure precautions, fluid restrictions, monitor LOC Causes: excessive sweating, GI fluid loss (wound drainage), NG tube suction of isotonic GI contents, Adrenal insufficiency, Excessive intake of hypotonic solutions, syndrome of inappropriate ADH, decreased secretion of aldosterone, low sodium diet, hyperglycemia 76. What is the role of chloride? ▪ Most abundant anion in the extracellular fluid ▪ Bound with sodium or potassium ▪ Health adult should consume 2.3grams of chloride a day with 1.5 grams of sodium to replace daily losses and maintain serum blood levels NOC outcomes for pt’s with excess fluid (electrolyte and acid base balance, fluid balance, and hydration) when it is normal reduction or absence of edema, flat neck veins with head of bed elevated 45 degress and clear breath sounds without crackles Atelectasis – decreased breath sounds and possibly dullness Hypotonic solutions - Hypertonic solutions – 5% dextrose in lactated ringers (do not administer with cardiac or renal dysfunction; monitor for circulatory overload and do not administer this with rapid fluid replacement Isotonic Normal – 0.9% NS, D5W, LR – used when replenishing electrolytes or fluids for Know lactated ringers – balance electrolytes solution with major electrolytes in the same concentration as in blood (contains sodium, potassium, calcium, chloride, and bicarbonate as lactate) Avoid LR if pt’s blood is pH is alkaline (decompensate) Normal saline .9% saline is used when commonly given to restore ECF volume as well as increase sodium level 5% dextrose in sterile water - Sometimes classified as hypotonic solution (hypo diseases)- Provides calories for metabolic needs; promotes diuresis of body fluids Diarrhea baby what would you expect to find in fluid deficit … depressed fontanels Daily weight is the priority assessment for clients with excess fluid Metabolic-Respiratory acidosis/alkalosis Regardless of the cause, shallow or ineffective respirations lead to retention of CO2. CO2 retention increases the acid load in the body, leading to respiratory acidosis. Can use incentive spirometer Respiratory alkalosis - occurs when the lungs excrete too much CO2. By reduction the acid load in the body the body becomes alkalotic. Anything that increased the rate and death of respirations can cause respiratory alkalosis (anxiety, pain, fever, hyperventilation, hypoxia) Client admitted with a state of alkalosis which medication should the nurse review for potential interaction – digoxin/aspirin Client is admitted with severe abdominal pain which ABG values should the nurse expect to see – a low bicarbonate level (22-29) Acidosis – we need compensation because we are too acidic Alkalosis – we need to decompensate because we are too basic and need more acidity to balance out (more spice in life) Metabolic acidosis – occurs when there is addition of acid to the body or loss of base (renal failure, diabetes, and inadequate oxygen) Metabolic alkalosis – Metabolic alkalosis occurs when there is a loss of acid or an accumulation of base in the body. Acid is lost primarily through the upper GI tract and may occur with vomiting or with suctioning out of GI secretions through a nasogastric tube. An accumulation of base may occur through the use of antacid medications, especially with the use of baking soda (sodium bicarbonate) as an antacid Sodium – brain (seizures) Calcium/magnesium – respiratory muscles and muscles Potassium – heart Assess first when accident or medication error happens Call doctor to clarify order Know labs Is skin or dehydration more important Maslow hierarchy of needs – Level one - Physiological needs (basic needs food, oxygen, water, sleep, sex constant body temp Level two – Safety Needs (security, protection, freedom from fear, anxiety, and chaos and need for law and order and limits Level three – Belongingness and love needs- intimate relationships, love, affection, and belonging and work to overcome loneliness and alienation, family, home and be a part of group Level four – Esteem needs (people need to have a high self-regard and have it reflected to them from others. Self -esteem needs are met, we feel confident, valued and valuable Level five – Self Actualization (we are hard wired to be everything that we are capable of becoming. Capable of becoming is highly individual (artist must paint etc) up to that person to choose a path resulting in inner peace and fulfillment. Catheter and safety infection – Reasons for parental therapy -maintain or correct fluid balance, maintain or correct acid base or electrolyte, administer medications, replace blood or blood products Central Venous Cath’s (non-tunnled)– Used when peripheral IVs are all used up (the tip of cath shld lie distal one third of superior vena cava). PICC line you do not check BP or take venipunctures in same arm. Requires flushing SASH (saline administered medication saline and then heparin) positive pressure technique (clave used to compensate for negative displacement of fluid or blood) tip of cath is in SVC, used short term 7 days Risk for – infection with tracheostomy Subcutaneous/Tunneled central cath – can remain in longer and if infection is detected at the exit site Know routine drugs Meds – Bactrim: sulfamethoxazole and trimethoprim Sulfonamides are classified by their rate of absorption and excretion. Sulfonamides have many potentially problematic drug-drug interactions. Bleeding times may be increased for patients taking anticoagulants, such as warfarin. The combination of sulfonamides with oral hypoglycemic agents may lead to excessive drops in blood glucose. There is a cross-sensitivity with diuretics, such as acetazolamide and the thiazides, and with sulfonylurea antidiabetic agents. Use of these agents in patients with previous hypersensitivity to sulfonamides can induce a skin abnormality called Stevens-Johnson syndrome. Patients who are stabilized on phenytoin (Dilantin) may experience signs of phenytoin toxicity (e.g., nystagmus or ataxia). The combination of trimethoprim and sulfamethoxazole (Bactrim) produces a sulfonamide with a folic acid antagonist. This results in a synergistic effect against certain bacteria. Know your age brackets- nursing considerations for the age group Toddlers accidental Adolescents Infants Geriatrics Adult Review questions at end of chapter for thermoregulation and acute/chronic pain Show Less