N3: Final Exam Study Guide

1. CAM (Complementary & Alternative Medicine) a. What is Complementary? i. “In addition to…” modern medicine b. What is Alternative? i. “Instead of…” modern medicine c. Define “Chi” i. Chinese life force that provides warmth and protection from illness and injury. d. Reiki i. Use of hands to correct energy fields/chakras. Energy flows from universe into patient. Can help increase WBC and RBC production. Realignment of energy flow. e. Ayurveda i. Indian medicine. Preventive medicine that teaches health is balanced by nature, body, mind and spirit. Uses oils, diet, senses and behavior. f. Guided Imagery i. Focusing on an image either created by the therapist or by the patient’s mind. Uses all 5 senses. S/E are sleepiness and extreme relaxation. g. Biofeedback i. Uses thoughts to control physiological body responses. Electrodes are placed on patient to monitor body response to stress. Patient then relaxes those areas during times of pain, anxiety, temperature, HTN, TMJ, H/A, etc. 2. Stroke a. What test needs to be done right away when a stroke patient comes to an ER? i. CT SCAN immediately! This will help determine what type of stroke has occurred. ii. CT doesn’t require NPO status or any contrast. Results are immediate. b. A patient started having a headache at 4am and started slurring their speech around 0415. If they do, in fact, have an embolic stroke, how long is their window to be able to get TPA? Hint: First symptom was the headache. i. “Golden 3-Hour window” from the “last time normal” to the time the TPA is administered. 3. ICP a. ICP is… i. Intracranial Pressure (pressure within the skull) b. A normal ICP is… i. 7-15mmHg c. What things increase ICP? i. Anything that makes your face RED increases ICP ii. Blowing nose, sneezing, lowering HOB, swelling (tumors, stroke, meningitis, etc.). d. If a patient is at increased risk for increased ICP a patient who is intubated will be at 30-45% and a non-intubated person will be at 15% to 45%. Why? i. Elevating the HOB improves venous drainage and decreases ICP e. What do hypertonic saline and Mannitol do for ICP? i. Mannitol: takes ICP fluid to kidneys for removal ii. Hypertonic Saline: pulls fluid from the tissues into the bloodstream, such as burns, ICP and post-op to reduce swelling. f. Why is clustering a bunch of activities together for a patient with increased ICP a bad idea? i. This can increase ICP. Therefore the nurse must decrease stimuli and maintain a calm, low noise, low light, and stress-free environment. g. Why is giving a stool softener a good idea? i. We don’t want these patients to STRAIN with their bowel movements, as it will increase ICP. h. What are the early indicators of increased ICP? What are the late indicators? Early Indicators Late Indicators H/A (usually BAD and prolonged) N/V Blurry Vision Pupillary changes Cheyne Stokes (from lack of O2 to brain) Widening Pulse Pressure (sys-dys=pp) Bradycardia Bulging Fontanels (in infants) Irritability (in infants) i. What is Cushing’s triad and what does it tell you? i. Indicates LATE increase in ICP ii. BAD NEWS! iii. Symptoms Include: 1. Bradycardia 2. Widening Pulse Pressure 3. Cheyne Stokes (changes in respirations) j. What are the bad posturing poses we talked about and what might they indicate? i. Decerebrate Posturing 1. Pointed toes, arms down, wrists are flexed out ii. Decorticate Posturing 1. Everything is pulled towards the core 4. Liver a. Know your liver labs i. ALT: 3-35 IU/L or 8-20 units/L ii. AST: 5-40 units/L iii. ALP: 30-120 units/L iv. Bilirubin: 0.1-1.0 mg/dL v. PTT: 11-12.5 sec vi. INR: 0.7 – 1.8 vii. Hemoglobin: 12-18g/dL viii. Platelets: 100,000 – 400,000 ix. Ammonia: 15-45mcg/dL (or 11-32 umol/L) x. Creatinine: 0.5-1.2 mg/dL xi. Albumin: 3.5 – 5.0 g/dL xii. Potassium (K+): 3.5-5.5 meq/L b. What is going on with lab levels in Liver Dysfunction? Levels that are going UP Levels that are going DOWN ALT AST ALP Bilirubin Creatinine Ammonia PTT/INR (prolonged) Hemoglobin Platelets K+ (initially) Albumin c. What do you give to reduce ammonia levels? i. Lactulose d. Initially, potassium can be very low in liver failure, but it gets tricky later on in the disease as kidneys are affected. e. Why are liver failure patients at such great risk for bleeding? What labs reflect this problem? i. Liver is highly vascularized ii. LOTS of blood vessels! f. Hepatitis A, B, and C: What are the symptoms, and how are they spread (vowels versus consonants). Hep A Hep B Hep C Symptoms: Mild, flu-like sx Spread: Fecal – Oral Route Contaminated food/water, Shellfish Symptoms: anorexia, N/V, jaundice, fever, rashes, light colored stool, dark urine Spread: Blood – Body Fluids Sex, healthcare workers, needles, drug users, hemodialysis pts., babies Symptoms: Flu-like sx (can be severe) Spread: Blood – Body Fluids, IV drug users, 5. Mobility a. CMS, CMS, CMS: This is VERY IMPORTANT IN FRACTURES. What does it stand for and how do you measure it? i. CMS stands for: Circulation, Motion, Sensation 1. Circulation: pulses, capillary refill 2. Motion: can they move? 3. Sensation: N/T, feeling b. RICE: What is it? What do we use it for? (almost all injuries, right)? i. RICE stands for: Rest, Ice, Compression, Elevation ii. Helps prevent swelling. Vasoconstriction. c. Hip Surgery. Knee Surgery. What are the risks? What things do you assess for? Why? i. Circulation, sensation and motion distal to the affected area. ii. PT is at risk for: DVT, wound infection, hematoma, hip dislocation, and neurovascular compromise.