RN Concept-Based Assessment Level 3 EXAM - Focused Review

RN Concept-Based Assessment Level 3 Online Practice A - Focused Review 1. Health Promotion / Wellness / Disease Prevention a. Immunizations i. Immunizations currently prevent 2-3 million deaths p er year, according to the WHO. ii. One of the most cost-effective public health interventions. b. Obesity Management i. Recommendation for 150 minutes of moderate intensity exercise per week. ii. A BMI of 30 or higher is considered obese iii. Dietary interventions like cutting calories or making healthier choices can reverse obesity. 2. Human Growth and Development a. ADHD/ADD i. Warning signs include inattention, hyperactivity, and impulsivity. ii. Medications include Adderall, Ritalin, Concerta, and Focalin iii. There is no cure for ADHD, but through medication and therapy, condition can be managed successfully for life. b. Autism Spectrum Disorders i. Impacts how a person perceives and socializes with others ii. Risk factors include having a sibling with ASD, having older parents, and low birth weight. iii. Autism support groups can be found to share information and experiences. c. Cerebral Palsy i. Group of disorders that affect movement and muscle tone or posture. ii. Caused by damage that occurs to the immature brain as it develops, most often before birth. iii. Most signs and symptoms appear during infancy or preschool. d. Developmental Delays i. Parents and healthcare professionals partner to monitor for developmental milestones. ii. Most major developmental disabilities develop prior to birth. iii. Delays can be caused by genetics, pregnancy problems, premature birth, and other unknown causes. e. Down Syndrome i. Condition in which an extra chromosome is present. ii. Down syndrome occurs when an individual has a full or partial extra copy of chromosome 21. iii. Approximately 1 in 700 babies is born with Down Syndrome in the United States. f. Genetic Predisposition i. An increased likelihood of developing a particular disease based on a person’s genetic makeup. ii. Results from a specific genetic variation, often inherited from a parent. g. Newborn Complications i. Hypoglycemia is one of the most common newborn complications, along with jaundice, and birth injuries. ii. Low birthweight newborns need additional attention paid to breastfeeding and keeping warm. iii. Newborns with severe asphyxia need post-resuscitation care in the hospital. 3. Inflammation a. Diverticulitis i. Infection/inflammation of pouches (diverticula) that can form in the intestine. ii. Abdominal pain and fever are often present in a patient experiencing diverticulitis iii. Diverticula are common after age 40, but do not usually cause issues. b. Glomerulonephritis i. Acute inflammation of the kidney, typically caused by an immune response. ii. Symptoms include hematuria, proteinuria, hypertension, and edema. iii. Caused by post-streptococcal glomerulonephritis, bacterial endocarditis, and viral infections. c. Inflammatory Bowel Disease i. IBS is a term that includes both Crohn’s disease and ulcerative colitis. ii. Inflammatory response in the GI tract. iii. Symptoms include diarrhea, fever, fatigue, abdominal pain, cramping, occult blood, reduced appetite, and unintended weight loss. d. Nephritis i. Condition in which nephrons become inflamed and can adversely affect kidney function. ii. Early symptoms included puffy face, hematuria, and urination less than usual. iii. Can be caused by an infection like strep throat, or another illness like lupus. e. Pancreatitis i. The pancreas has two main jobs, to release digestive enzymes into the small intestines and to release insulin and glucagon into the bloodstream. ii. Symptoms include fever, tachycardia, nausea, vomiting, swelling in abdomen, and abdominal pain after eating high fat foods. iii. Can be caused by autoimmune disease, alcohol consumption, infection, gallstones, and trauma 4. Mood and Affect a. Bipolar Disorder i. Mental disorder that causes unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day to day tasks. ii. Often treated with lithium. iii. Risk factors include having a parent or sibling with bipolar disorder, periods of high stress, and drug/alcohol abuse b. Depression i. Mood disorder that causes persistent feelings of sadness and loss of interest. ii. Can be treated with medication and psychotherapy. iii. If suicidal ideation occurs call a physician, hotline, close confidant, and spiritual leader c. Personality Disorders i. Rigid or unhealthy pattern of thinking, functioning, and behaving. ii. Includes paranoid, schizoid, schizotypal, antisocial, borderline, histrionic, narcissistic, avoidant, dependant, and obsessive- compulsive personality disorders. iii. Most likely due to a combination of genetic and environmental factors like relationships and living circumstances d. Postpartum Depression i. Symptoms include excessive crying, difficulty bonding with the babe, mood swings, and reduced energy/interest/pleasure ii. Can develop into postpartum psychosis including confusion, obsessive thoughts, hallucination, delusions, and paranoia iii. New fathers can actually experience postpartum depression, as well, according to Mayo Clinic. e. Suicidal Behavior i. National Suicide Prevention Lifeline is manned 24/7 ( ) ii. Imminent sign may be a sudden change in brighter mood or giving away valuables. This likely means the person has made a plan. iii. Suicide is 10th leading cause of death in the United States. 5. Perfusion a. Congenital Heart Defects i. A problem with the structure of the heart that is present at birth. ii. The most common type of birth defect. iii. Ventricular septal defect occurs in 2-7% of all live births. b. Eclampsia i. High blood pressure results in seizures during pregnancy. ii. Magnesium sulfate is the treatment for active seizures and prevention of future seizures. iii. Typically occurs during or after the 20th week of gestation. c. Gestational Hypertension i. Occurs in about 6% of all pregnancies and can develop into preeclampsia. ii. Diabetes, kidney disease, history of HTN, younger than 20, older than 40, pregnant with multiples, and African American descent. iii. Provider may want to do fetal movement counting, nonstress testing, a biophysical profile, or doppler flow studies to ensure the health of the baby. d. HELLP Syndrome i. Symptoms are lethargy, fluid retention, nausea, headache, upper abdominal pain, blurry vision, and seizures. ii. Complications can include disseminated intravascular coagulation, placental abruption, kidney failure, and pulmonary edema. iii. Usually occurs in the last 3 months of pregnancy or shortly after childbirth. e. Preeclampsia i. Was formerly called toxemia. ii. The only cure for preeclampsia is to give birth. iii. Even after delivery, symptoms can last another 1-6 weeks. f. Sickle Cell Anemia i. An inherited disorder in which there aren’t enough healthy red blood cells to carry oxygen throughout your body. ii. Usually presents around 5 months of age, definitely showing signs and symptoms within the first year of life. iii. Only cure for sickle cell anemia is a bone marrow or stem cell transplant. 6. Stress and Coping a. Addictive Behaviors i. There are support groups for nearly every type of addiction available online and in-person. ii. Inpatient rehabilitation is an effective treatment for drug and alcohol addiction. iii. Behavioral addiction follow the same pattern as substance-based addictions. b. Crisis i. Breathing exercises can assist in bringing individuals down from a crisis event. ii. Exercise, rest, and healthy eating can help an individual remain free from crisis events. iii. Crisis centers are available for voluntary and involuntary admissions, depending on coverage and availability. c. Eating Disorders i. Most common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder. ii. Daily weights should be implemented in the hospital setting. iii. Patients should be monitored after meals to prevent purging. d. Obsessive Compulsive Disorder i. Obsessions are unwanted, intrusive thoughts, images, or urges that trigger intensely distressing feelings. ii. Compulsions are repetitive behaviors that a person with OCD feels the urge to do in response to an obsessive thought. iii. Typically treated with medication (SSRIs) in combination with psychotherapy. e. Posttraumatic Stress Disorder i. Commonly seen in direct-combat soldiers and victims of physical and sexual abuse. ii. Treated commonly with cognitive behavioral therapy. iii. Symptoms include flashbacks, nightmares, and severe anxiety related to the triggering event. f. Substance Use Disorder i. Disease that affects a person’s brain and behavior and leads to an inability to control the use of a legal or illegal drug or medication. ii. Common substances abused are alcohol, nicotine, methamphetamines, and opioids. iii. Often coincides with depression, ADD, and PTSD RN Concept-Based Assessment Level 3 Online Practice B 1. Cellular Regulation a. Benign Tumors i. An abnormal group of cells that serves no purpose. ii. A benign tumor is not a malignant tumor, which is cancer. iii. 9 out of 10 women experience benign breast tissue changes. b. Carcinoma and Adenocarcinoma i. Adenocarcinoma is a cancer that starts in glandular cells of the body. ii. Diagnostic testing includes biopsy, CT scan, and MRI iii. Can be treated with surgical removal, radiation therapy, and chemotherapy depending on the progression and location of the tumor. c. Leukemia i. Leukemia is cancer of the blood or bone marrow. ii. The first signs of leukemia maybe be fatigue, unexplained fever, abnormal bruising, headaches, excessive bleeding, unintentional weight loss, and frequent infections. iii. Most common cancer in children and teens, accounting for almost 1 out of 3 cancers. d. Lymphoma i. Main subtypes are Hodgkin’s lymphoma and non-hodgkins lymphoma. ii. Symptoms include painless swelling in the lymph nodes, persistent fatigue, fever, night sweats, SOB, unexplained weight loss, and itchy skin. iii. Risk factors include being male, having an impaired immune system, and developing certain infections like Epstein-Barr virus and Helicobacter pylori infection. e. Melanoma i. Melanoma is a skin cancer that can spread earlier and more quickly than other skin cancers. ii. 1 in 50 Americans will develop melanoma in their lifetime. iii. Melanoma is the 2nd most common cancer in people ages 15-29. f. Sarcoma i. Grows in connective tissue. ii. Risk factors include familial history, Paget’s disease, or exposure to radiation. iii. Most often, the first sign of sarcoma is a painless lump. 2. Cognition a. Alzheimer’s Disease i. Most common cause of dementia ii. Gradually worsens over time. iii. No current cure available, but treatment for symptoms is available. b. Dementia, Delirium, and Confusion i. Dementia is characterized by a decline in memory, language, problem solving and other thinking skills that affect a person’s ability to perform everyday activities. ii. Delirium often happens during alcohol withdrawal, after surgery, or with dementia. iii. Confusion can result from severe dehydration. c. Schizophrenia i. An abnormal interpretation of reality. ii. Requires lifelong treatment. iii. Symptoms include delusions, hallucinations, disorganized thinking, abnormal motor behavior, and negative self care. 3. End of Life a. Palliative Care i. Focused on providing relief from the symptoms and stress of the illness. ii. Palliative care can help match treatment options to the patient’s goals. iii. Often used with diseases like cancer, CHF, COPD, kidney failure, liver failure, ALS, Parkinson’s, and dementia b. Terminal Illness i. Disease that cannot be cured or adequately treated and is reasonably expected to result in death of the patient. ii. Patient can be set up with support groups to assist with their transition to end of life. iii. Hospice services can be utilized for patients suffering from terminal diagnoses. 4. Human Growth and Development a. See above Practice A (same topics) 5. Immunity a. Hypersensitivity/Allergy and Anaphylaxis i. Anaphylaxis is a severe, life-threatening allergic reaction. ii. More than 50 million Americans suffer from allergies each year. iii. Allergic rhinitis can be seasonal or perennial. b. Multiple Sclerosis i. Potentially disabling disease of the brain and spinal cord. ii. Immune system attacks the myelin that covers nerve fibers and causes communication problems between your brain and the rest of your body. iii. Symptoms include numbness, weakness, tremor, vision problems, slurred speech, fatigue, and dizziness. c. Rheumatoid Arthritis i. Autoimmune disease that causes joint pain and damage throughout the body. ii. RA joint damage usually occurs bilaterally. iii. Symptoms include joint pain, joint swelling, joint stiffness, and loss of joint function. 6. Inflammation a. See above Practice A (same topics) 7. Intracranial Regulation / Neural Regulation a. Epilepsy i. Fourth most common neurological disease. ii. Seizures can present as a momentary blank stare, loss of awareness, or uncontrolled twitching. iii. Three types of seizures include focal onset, generalized, and unknown onset. b. Parkinson’s Disease i. Unknown cause with no cure. ii. Progression of symptoms is often different from person to person due to the diversity of the disease. iii. Small handwriting, and loss of smell are early signs of Parkinson’s disease. c. Stroke / Brain Attack i. Kills nearly 140,000 Americans each year. ii. Stroke costs the US an estimated $34 billion each year including the cost of healthcare services, medicines, and missed work. iii. Risk of having a first stroke is nearly twice as high for blacks than for whites. 8. Mood and Affect a. See above Practice A (same topics) 9. Perfusion a. See above Practice A (same topics) 10. Reproduction a. Ante, Inrta, and Postpartum Care i. Antepartum patients should take a multivitamin daily that contains folic acid. ii. Polyhydramnios is excess amniotic fluid surrounding the fetus. iii. Premature rupture of membranes presents with a sudden gush of fluid from the vaginal area b. Family Planning and Preconception Counseling i. Family planning is featured as part of a goal for Healthy People 2020. ii. Family planning services include contraceptive services, pregnancy testing, STD services, and HIV prevention education. iii. Twenty percent of all unintended pregnancies occur among teens. c. Infertility i. Disease of the reproductive system that impairs the body’s ability to perform the basic function of reproduction. ii. Affects about 11% of the reprodiuctive-age population iii. Smoking causes decreased fertility. d. Menopause i. Usually occurs naturally, most often after age 45. ii. A woman reaches menopause when she has not had a period for one year. iii. First signs of menopause include irregular periods, vaginal dryness, hot flashes, chills, night sweats, and sleep problems. 11. Newborn Care a. Placental Complications i. Complications include low lying placenta, retained placenta, and placental abruption. ii. Placental insufficiency is a blood flow disorder marked by a reduction in the mother’s blood supply. iii. There can be infarcts in the placenta b. Postpartum Hemorrhage i. Usually happens within one day of giving birth, but can happen as long as 12 weeks after. ii. 1-5% of women who have a baby have postpartum hemorrhage. iii. Can be caused by tear in the cervix, tear in a blood vessel in the uterus, blood clotting disorders, and placenta problems. c. Prematurity i. Each year, an estimated 15 million infants are born preterm. ii. Preterm birth complications are the leading cause of death among children under 5 years old. iii. ¾ of those deaths could be prevented with current, cost-effective interventions. d. Preterm Labor i. Occurs when regular contractions result in the opening of your cervix after week 20 and before week 37 of the pregnancy. ii. Smoking, over/underweight, poor prenatal care, alcohol and drug use can all lead to preterm labor. iii. Age and ethnicity of the mother can also effect preterm labor. 12. Stress and Coping a. See above Practice A (same topics) 13. 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