U WORLD PHARMACOLOGY NCLEX REVIW 2021

T H E N U R S E S C O R N E R TABLE OF CONTENTS Pharmacology & Need to Know Medications Page 3-13 Fundamentals & Delegation Page 14-17 Ethical Principals & Law Page 18-20 Integumentary Page 21-23 Respiratory Disorders & Nursing Considerations Page 24-32 Disorders of the Heart & Circulation Page 33- 44 Musculoskeletal Disorders Page 45-47 Diabetes & Insulin Page 48 Contact Precautions & Infectious Disease Page 49-53 Renal Disorders & Nursing Considerations Page 54-58 GI Disorders Page 59-60 Spinal Cord Injuries Page 61-62 Neuro & Brain Page 63- 68 Visual/Auditory & Nursing Considerations Page 69- 71 Psychiatric Nursing Page 72- 75 Endocrine Disorders Page 76- 79 Reproductive & Sexual Health Page 80- 81 Maternal- Antepartum Page 82- 88 Labor & Delivery Page 89- 92 Postpartum & Newborn Page 93- 95 Pediatric Nursing Page 96- 100 PHARMACOLOGY Warfarin Vitamin k is the antagonist used to prevent blood clots in clients with atrial fibrillation, artificial heart valves, or a history of thrombosis Intake of vitamin k rich foods can decrease effect ( broccoli, spinach, liver) Monitor INR levels Pregnant women should not take Avoid aspirin, NSAIDS, and alcohol If recovering from a PE, Warfarin is usually taken for 3-6 months Antibiotics can affect INR levels INR level 3.0-3.5 contraindicated in pregnancy Adenosine First line drug therapy for SVT Administer over 1-2 minutes then flush with saline Find a line closest to the heart ACE Inhibitors End with -il, controls high blood pressure Check blood pressure before administering Check potassium levels before administering because these medications increase potassium levels Can cause a dry cough and reflex tachycardia Can have severe adverse effects of angioedema Do not take while pregnant Can cause orthostatic hypertension If a client cannot tolerate ACE inhibitor then they are prescribed ARBS (-an) drugs Calcium Channel Blockers CCB are like valium to your heart Help control atrial fibrillation End in -em like diltiazem Also end in -ine (Amlodipine) Most severe adverse effect is dizziness Do not drink grapefruit juice while taking this or statins Measure blood pressure before administering, if systolic is under 100 then you hold CCB Clients with hypertension should not take over the counter medications for colds, these medications have decongestants and can cause vasoconstriction Nicardipine Calcium channel blocker vasodilator Brings blood pressure down, usually after stroke and patients get extremely hypertensive (systolic over 240) The nurse should bring the blood pressure down but not below 170 (systolic) Priority nursing interventions are to monitor for hypotensive effects of this drug Beta Blockers Helps control heart rate and blood pressure (mainly heart rate) Side effects may be bronchospasms Do not give to people with asthma The nurse should assess for any wheezing May mask signs of hypoglycemia ARBS End with - an like Losartan (sartans) Should not be taken while pregnant Helps lower blood pressure Can cause hyperkalemia Do not take with salt substitutes Digoxin Increases cardiac contractility and slows the heart rate and conduction (slows the rate of conduction through the AV node) NOT a vasodilator Decreases workload of the heart It is used in heart failure and atrial fibrillation Excreted exclusively by the kidneys so need to check kidney function (creatinine and BUN) Digoxin toxicity: N/V, GI symptoms are the earliest sign, confusion, weakness, Toxic level above 2 visual symptoms, cardiac arrhythmias Hypokalemia can cause digoxin toxicity Treats A fib and heart failure Antiplatelet Therapy Drugs Increased risk for bleeding Helps prevent platelet aggregation Clients should be assessed for black tarry stools, bleeding gums, hematuria, bruising, monitor platelets Should not be taken with Ginko Inhibits platelet aggregation, prevents thrombus formation, and reduces heart inflammation Clients can receive this when they do not have signs of bleeding or low platelet levels Clopidogrel plavix , antiplatelet medication that should be discontinued 5-7 days before surgery Can increase risk of bleeding so the HCP should be notified if low platelet levels (<) Helps prevent blood clots Nitroglycerin Decreases preload Nitrate that causes vasodilation At risk for hypotension Can cause headache The nurse should follow up of the client feels dizzy or lightheaded 1 pill every 5 minutes and up to 3 doses EMS should be called if pain is not alleviated by 5 minutes after the first pill Headache and flushing are common side effects Sit or lie down before taking the pill Store away from heat and light Statin Helps lower cholesterol and reduce the risk of atherosclerosis and coronary artery disease Reduces LDL levels, triglycerides, and total cholesterol levels Taken at night with evening meals Muscle aches are a serious side effect Report muscle pains or weakness, could be a sign of rhabdomyolysis Liver function test should be assessed before giving Atorvastatin Lower LDL lipid levels Monitor for muscle pain or weakness NSAIDS All NSAIDS are associated with: GI bleeding, black tarry stools, stomach pain can be reduced if taken with food Kidney injury, long term use is associated with this Hypertension and heart failure Increase risk for bleeding Should be avoided in clients with kidney disease, nephrotoxic, COPD Long term use can cause peptic ulcers and chronic kidney disease, exacerbate hypertension and cardiac problems Naproxen Ibuprofen NSAID Commonly prescribed to relieve joint pain and inflammation Keterolac Toradol Highly potent NSAID Heparin Subcutaneous or IV anticoagulation medication Administer at 90 degrees or 45 degrees depending on how much adipose tissue they have Administer 2 inches away from umbilicus Works immediately Cannot be given for longer than 3 weeks (accept for lovenox) Antidote is protamine sulfate Lab test that monitors heparin is PTT PTT time should be 1.5 - 2.0 times the normal clotting time of 25-35 seconds Too long could cause spontaneous bleeding Can be given to pregnant women Risk is HIT (drop in the number of platelets) Heparin should be held when there is a drop in platelet TPA Must be administered in 3-4.5 hours Surgery within 2 weeks is contraindicated Platelet less than or coagulation disorders should not receive it Baclofen muscle relaxer Side effects: Fatigue and muscle weakness Teach: don't drink, don't drive, and don't operate heavy machinery for patients Flexeril Muscle relaxer Flex = muscle Ferrous Sulfate Iron supplement, avoid giving with calcium supplements and antacids because that decreases absorption Client should increase intake of fluids because these cause constipation Taking with vitamin c like orange juice enhances absorption Administer 1 hour before meals or 2 hours after meals Endocrine Medications Levothyroxine Medication for hypothyroidism Used to replace thyroid hormone Safe to take during pregnancy Do not take with antacids, calcium or iron (avoid over the counter multivitamins) Take on an empty stomach, in the morning, separately from other medications Lifelong therapy, blood test needed This medication will improve mood, higher energy levels, take up to 8 weeks to work, normal heart rate Takes 3-4 weeks for effect Corticosteroids Prednisone Given to combat inflammation in the lungs to COPD patients These medications can cause in increase in sugar If the patient is a diabetic, anticipate giving more insulin Started high dose then tapered slowly Desmopressin Treats diabetes insipidus Mimics ADH Increases renal water absorption and concentrates urine Clients receiving this must have their electrolytes closely monitored for water intoxication/ hyponatremia (headache, mental status, weakness) Severe hyponatremia may cause seizures, neurological damage, or death Methotrexate Treats rheumatoid arthritis and psoriasis Can cause bone marrow suppression, clients are at risk for infection They should avoid large crowds and receive killed immunizations (flu, pneumonia) Avoid alcohol (can cause hepatotoxicity) and pregnancy with these drugs Neurological Medications Levetiracetam Keppra Anticonvulsant prescribed for seizures Depresses the CNS and can cause drowsiness, this improves after a few weeks Associated with suicidal ideations and should be reported to the HCP Can trigger steven johnsons syndrome No driving until approved by HCP Sumatriptan Treats migraine headaches Work by constricting cranial blood vessels Contraindicated in clients with coronary artery disease and uncontrolled hypertension Scopolamine For motion sickness Apply 4 hours before Keep on for 72 hours Apply behind ear Phenytoin Dilantin, is an anti seizure medication with a therapeutic index of 10-20 Tube feedings decrease phenytoin absorption which can reduce the drugs effect and produce seizures The nurse should pause tube feedings for 1-2 hours before and after administration of these drug to increase absorption Early signs of toxicity include: horizontal nystagmus and gait unsteadiness Benzodiazepine Commonly taken at bedtime Antianxiety drug Do not ever stop abruptly Midazolam Versed Benzodiazepine commonly used to induce conscious sedation Flumazenil ( Romazicon) is the antidote to reverse benzo effects Infectious Disease Medications Medications for CDiff Patients are usually prescribed Flagyl ( Metronidazole) For severe C Diff vancomycin may be used Isoniazid (INH) For treatment of TB Can experience neurological effects due to the decrease in the body's ability to utilize B6 The patient needs additional doses of B6 Linezolid Zyvox Should not be taken with SSRI because can cause serotonin syndrome Macrolide Antibiotics Azithromycin These can cause prolonged QT intervals in patients ECG should be monitored Can also cause hepatotoxicity IV Vancomycin Draw trough prior to administration, 10-20 is a therapeutic level Infuse medication over at least 60 minutes Monitor blood pressure Assess for hypersensitivity (red man syndrome) Monitor for anaphylaxis Check IV site every 30 minutes CVC catheter is preferred Creatinine levels are the most important value to monitor because vancomycin can cause nephrotoxicityIf creatinine is high this is a complication of nephrotoxicity Tetracycline Helps fight bacterial infections of the skin Take on an empty stomach Avoid taking with dairy products, iron supplements, or antacids Take with a full glass of water Wear sunblock because risk of photosensitivity Use additional contraceptive medications Miscelleneous Drugs Docusate Sodium Stool softener that reduces straining during bowel movement, puts less stress on heart Straining can also cause bradycardia due to vagal response Furosemide Most commonly used drug for heart failure Lasix Ginko Can increase risk of bleeding Celecoxib COX- 2 I inhibitor Black box warning with increased risk for cardiovascular complications Back pain, nausea, vomiting, would need to be assessed immediately Morphine Decreases cardiac workload Pain treatment and terminal dyspnea Lidocaine Decreases cardiac irritability Isoniazid INH Avoid intake of alcohol and limit use of acetaminophen Take vitamin B6 to prevent leg tingling Avoid aluminum containing antacids Report changes in vision Report jaundice, dark urine Does not change color or urine, that is Rifampin Adverse effects: hepatotoxicity, peripheral neuropathy Rifampin: reduced the efficiency of oral contraceptives, changes the color of the urine, used for TB Codeine Opioid and is smaller doses is a cough suppressant Can cause constipation just like opioids do Take medicine with food Drink lots of water Sit on side of bed before getting up because it can cause hypotension in patients Transdermal Patches Never shave before placing patch Clonidine Antihypertensive patch that is reapplied every 7 days Do not remove patch if dizziness occurs Rotate site with each use KCL Available in many forms If a patient has difficulty swallowing, the nurse should consult with the pharmacist to see if there is other forms Maybe liquid Fentanyl Patch Fold when discarding Change every 72 hours Not cutting patches Do not apply heat over the patch (does not aid in absorption) Ear Drops Over 3 years years pull ear up and back Less than 3 pulled down and back Children should be placed prone or supine Warm ear drops to room temperature Drop medication against wall of the canal Rectal Suppository Age appropriate distraction Toddlers and infants toys Preschool and older children deep breaths or count Infant placed supine with knees and and feet raised Other children side lying with knees bent Use water soluble jelly Insert using 5th finger with children under 3 Hold buttocks together after insertion PCA PUMP Y tubing Connected with normal saline to keep vein open Continuous IV fluids used PCA pumps Children can use as long as they understanding of the device Aminophylline 10-20, above 20 is toxic Helps relax bronchioles Seizures in toxicity Isotretinoin Do not take vitamin A supplements, can cause toxicity Do not give blood on this medication For severe or cystic acne Most important to use 2 forms of contraception IV Furosemide May cause ototoxicity, especially in patients with kidney disease High doses should be administered slowly to prevent this ototoxicity in patients Sildenafil Viagra Nitrates and viagra are contraindicated with each other as it can cause life threatening hypotension The use of these should be reported to HCP Prednisone Glucose should be monitored in those receiving this Thiazide Diuretics End in -ide and -one Treats hypertension and edema Major side effects: hypokalemia (muscle cramps and dysrhythmias) hyponatremia (AMS and seizures) Hyperglycemia Allopurinol Used to prevent gout attacks Inhibits uric acid production and improves solubility Should be taken with a full glass of water and increase fluids (most important teaching) Methotrexate Used in the treatment of rheumatoid arthritis Adverse effects: bone marrow suppression, hepatotoxicity, gastrointestinal irritation Can lead to thrombocytopenia (small purple dots) Phenytoin Anticonvulsant for seizures Never stop taking abruptly Exception is the development of a rash that may indicate steven johnsons syndrome (flu like symptoms and a painful rash) Good dental care is a must, can cause gingival hyperplasia Can cause suicidal ideation and depression, this an adverse effect Aminoglycosides -micine ending (azithromycin, zithrominine, and clarithromycin) Treat serious Think “mice” think ears think ototoxic, tinnitus, vertigo, equilibrium, ringing of the ear, dizziness Another toxic effect is nephrotoxicity (monitor creatinine) IM or IV PO, does not absorb Oral micines will sterilize the bowels before surgery (neomincine and canominice) IV Fluids KCL Iv should not exceed 10 mEq/ hr Iv should be diluted and never given at a concentrated amount, high risk Opioids Can cause hypotension, this side effect is not as noticeable when the client is sitting down but when they stand up they can have orthostatic hypotension Those at highest risk for respiratory depression due to administration: the elderly, those with underlying pulmonary disease, snoring, obesity, smokers Adverse effect is paralytic ileus (absent bowel sounds) also can happen with potassium is low Itching is a normal side effect Opioid Analgesics Hydromorphone, morphine Control moderate to severe pain Side effects: sedation, respiratory depression, hypotension, constipation Client is at risk for falls and should not get out of bed unless with assistance Administer daily stool softeners Administer slowly over 2 to 3 minutes Recheck pain 15-30 minutes after administering the medication Transdermal Fentanyl Patch Can take up to 72 hours for full effect Not prescribed to patients 1 day post op or for acute pain because of the time it takes to reach full effect PPE Always take it off in alphabetical order Gloves, goggles, gown, mask OFF ON reverse for alphabetical for G but mask comes second Gown, mask, googles, gloves Canes Hold the cane on the strong side Postmortem Care Close clients eyes Replace dentures Disconnect all tubes and lines Straighten the body and limbs Place pad under perineum Wash body Allow family members to assist with care Place pillow under the head Fold towel to put under the chin to close mouth Speaking with an Interpreter Address client directly Speak in short sentences Pre conference with interpreter Use qualified interpreter when possible Avoid translation through family members The nurse should be mindful to choose interpreter with the patients prefered age, gender UAP Can perform passive range of motion exercises Take and document vital signs No trach care or cleaning Can collect urine specimen Cannot document color and characteristic of it They cannot offer orange juice to a client with hypoglycemia Can assist 1 day post op out of bed to the bathroom Cannot reinforce teaching Can remind client to use incentive spirometer Pick up blood products from the blood bank Can take vital signs before blood transfusion and after the first 15 minutes of the transfusion Can perform oral suctioning (not sterile) Report patient behavior but not monitor Can transport body to morgue Can give topical over the counter barrier creams Can do vitals and accuchecks Can delegate ADL’s Measure output in a drainage collection bag LPN Should be assigned stable clients with expected outcomes Cannot perform initial teaching, assessments, or evaluate a client’s condition Can do teaching reinforcement Can administer anticoagulant medications Can suction Can perform sterile procedures (catheterizations) Can auscultate lung sounds but cannot use that information to evaluate Can monitor RN findings Can monitor for bleeding Cannot start an IV, hang or mix IV meds, push IV meds They can maintain an IV and document the flow They cannot administer blood or mess with central lines Cannot plan care , the LPN can implement it Cannot perform or develop teaching, they can reinforce it Cannot take care of unstable patients They cannot do the very first of anything They can do tube feedings, but not the first They can change dressings, but not the first Cannot do admission, discharge, transfer, or the first assessment after a change Can not administer or monitor blood transfusions/ products Prioritization Age is not a criteria for prioritization Gender is not a criteria for prioritization Acute beats chronic (higher priority than) Post op is within 12 hours, beats medical or other surgical Stable patients: indicate they are stable, chronic illness, post op greater than 12 hours, regional anesthesia, experiencing the typical, expected signs and symptoms of the disease with which they were diagnosed Unstable: suspected, acute, post op less than 12 hours, general anesthesia, patient is unstable if they are experiencing unexpected signs and symptoms Always Unstable:Hemorrhage High fevers over 105 Hyperglycemia pulselessness/ breathlessness Prioritizing Organs :Brain, lung, then heart, then liver, kidneys, pancreas Assessment Assessment is the first step in the nursing process, the nurse should assess and then intervene when in doubt, ASSESS FIRST Modified Radical Mastectomy The breast, axillary nodes, and superior apical nodes are removed, but the muscles are preserved Complication of this is lymphedema, can prevent by positioning each joint higher than the proximal one Chemotherapy Can cause bone marrow suppression and tumor lysis syndrome Filgrastim stimulate neutrophil production Mastectomy Place client in semi fowler's position Affected side’s arm needs to be placed on several pillows to promote drainage Staff Management Never ignore inappropriate behavior by staff Ask yourself if what they are doing is illegal?If yes, tell supervisor No, then ask if anyone is in any immediate danger, if yes, then confront immediately because you don’t want to delay to put someone at risk If behavior is legal, no harmful, but simply inappropriate, then speak with them later on Nursing Responsibilities Prior to Surgery Client allergies and history are confirmed Assessment Confirming Informed consent has taken place Ensuring the client has been NPO Client voids before surgery Witnessing that the correct surgical site has been marked Error in Transcription Occurs when doctor does not sign order Doctor puts wrong amount or unit The handwriting is not legible Positioning Clients High fowlers for paracentesis Trendelenburg position and on the left lying side if suspected air embolism Position client with arms raised above head for chest tube placements After a liver biopsy the client should lay on the right side for at least 2 hours and then supine for an additional 12-14 hours Thoracentesis the patient is upright sitting position on the side of the bed leaning over on side table with pillow Occupational Therapy Teaches activities of daily living (bathing, dressing, cognitive or perception issues) Physical Therapy Focuses on mobility, ambulation, ability to walk, use the walker or other assistive devices Physical therapy focuses on “below the waist” rehabilitation Radioactive Disasters Do most good for the most people Start with victims farthest away from the radioactive explosion These victims are the most salvageable Jehovah witness Do not accept blood components of any type DO accept normal saline, Lactated Ringer’s etc., DO accept Epoetin alfa ETHICAL PRINCIPALS/ LAW Ethical Principle Veracity: being truthful Justice: treating every client equally regardless of background Accountability: accepting responsibility for actions and admitting errors Nonmaleficence: do no harm, it also relates to protecting clients who cannot protect themselves due to mental or physical condition Fidelity: fulfilling commitments and showing loyalty to one's self and others Beneficence: the action of promoting good will “Let’s talk about it” Informed Consent Surgeon explains the diagnosis and procedure (not the nurse) Client indicates understanding The client is competent and gives voluntary signature The nurse is responsible for witnessing the signature If the surgery requires additional procedures after the surgery has already begun and the consent has been signed for specific procedures, then medical power of attorney, next in kin, or legal guardian should be contacted to discuss Nurses role: witness client has signed, voluntarily and competently, document in medical record that client has signed with date and time, Physician is responsible for: explaining procedure, answering questions about procedure, offering alternative options, reinforcing right to refuse Incidence/ Occurrence Report Assault and injury Failure of treatment or intervention Hospital equipment fail Falls Never document an incident report was filed Failure to report an important lab value Mislabeled laboratory specimens Good Samaritan Law Prevents civil action when helping individuals off the job Cannot receive payment Essential for the nurse to perform in the same way as on the job (applying pressure if bleeding) Must act competently Standards of Nursing Practice and Care Universal criteria that are used to determine if appropriate, professional care has been delivered Sources used to define standards of care include statements from professional organizations, agency policies and procedures, textbooks, current literature, the Nurse practice act, and regulatory organizations Does not depend on good intentions Abuse Nurse has obligation to report abuse Child abuse is common in all children ages Most child abusers have low self-esteem Abusers have history of growing up in a domestic violence Abusers have substance abuse problems When child is dying and parents don’t want treatment, priority is to assess parents knowledge of situation Advance Care Planning This helps clients determine treatment plans and decision makers when or if the client is unable to do so Documents include: health care proxy (durable power of attorney or medical power of attorney) and living will (advance directive) Providing oxygen via nasal cannula is not considered resuscitation and can be given Local Organ Procurement Services Notified for every clinical death per hospital protocol Cardiac and respiratory support continue as organ donation is discussed or performed Consent is not needed by family if patient has signed to be organ donor Organ donation does not leave the body disfigured Reportable Instances to the Board of Nursing Practicing outside of scope Abandonment (leaving patients) Stealing narcotics Falsifying documentation Assault An act that threatens the client and makes them feel harm but they are not touched Battery Physical contact with a client without consent Quality Improvement Committee Assesses process standards (guidelines, systems, and operations) Assesses clinical issues that affect delivery of client care and client outcomes Implements processes to improve performances Sentinel Event Unanticipated event in the healthcare setting that results in death serious injury Radiation Contamination Radiation damages DNA, which causes cell destruction Early manifestations of radiation contamination include: oral mucosa ulcerations, vomiting, diarrhea, and low blood cell count Chemical Contamination Emergency PPE should be put on before decontamination Victims should be decontaminated outside the facility INTEGUMENTARY Pressure Injuries - Assess risk for pressure injuries using the Braden Scale - To prevent pressure injuries: - Use barrier creams - Foam pads to reduce pressure on bony prominences - Keep skin clean and dry - Reposition client with a turn sheet every 2 hours - Avoid pulling or dragging client - NO MASSAGES on bony prominences Unstageable wounds: Full thickness skin loss with slough or eschar Skin Cancer Skin Cancer Screening - Full medical workup of every mole is unnecessary - Rapid changing mole should be evaluated immediately - Melanomas can be any color - Melanomas don’t always occur as a new mole Risk factor for skin cancer: - immunosuppressant agents, - celtic ancestry traits - aging - high number of moles Tinea Corporis (Ringworm) - Teach about spreading the condition more - Wash hands - Very contagious Allergy Skin Testing Avoid antihistamines for 2 weeks before test and corticosteroids Can take albuterol Eczema Inflammatory rash caused by an immune response Milk, wheat, and egg whites can trigger - Wash clothes/ bedsheets in hot water Burns - Urine output best indicator of fluid replacement therapy - Lactated Ringers given for fluid volume replacement - Administer pain medication IV - Burns result in largest fluid shift first 24-72 hours (hypovolemia) - Hyperkalemia occurs, Muscle weakness, EKG tall peaked T waves, Cardiac arrhythmias hematocrit/ hemoglobin will be elevated because of fluid changes, Sodium is lost due to fluid shift so they will be hyponatremic - Providing proper nutrition through enteral feeding is highest priority when bowel sounds come back and they start peeing Psoriasis Exposure to sun can help slow and decrease exacerbations Poison Ivy Most important is to wash skin and get off any excess resin Linear appearance Infiltration Complication when solutions infuse into the surrounding tissues Discontinue the IV Assess the sight for swelling, redness, pain Elevate the affected extremity Apply cool or warm compress depending on the solution infiltrated Difference between infiltration and extravasation is the fluid infusing Extravasation Infiltration of drug into surrounding tissues Pain, blanching, swelling, redness Stop infusion immediately Elevate the extremity above the level of the heart Treatment of Frostbite Remove clothing and jewelry to prevent constriction Do not massage, rub or squeeze the area Immerse affected area in warm water Provide pain relief as the rewarming process is extremely painful Allow wounds to dry and then apply loose, nonadhesive dressings Monitor for signs of compartment syndrome Skin can appear mottled, blue or waxy yellow IM Injection Sites Dependent on a child’s age and muscle mass Vastus lateralis muscle is preferred for newborns less than 1 month old and infants age 1-12 months Vastus lateralis preferred for children less than 7 months Infants require 1 inch needles for IM injections Ventrogluteal not recommended until adult IM injection needle needs to be 22-25 in size Large bore needles for fluid resuscitation are 18 26 gauge is for subQ injections Latex Allergy Can develop from repeated exposure (healthcare workers) Food allergies such as avocados, bananas, tomatoes can signal latex allergy Warning signs of Cancer CAUTION MNEMONIC Change in bowel or bladder habits movement (blood) A sore that does not heal Unusual bleeding or discharge from body Thickening or lump in breast Indigestion or difficulty swallowing that does not go away Obvious change in wart or mole Nagging cough or hoarseness (persistent cough vs. seasonal) Cellulitis Inflammation from bacterial infection Characterized by redness, edema, fever, and pain Affected extremity should be elevated Flat or dependent position may worsen edema Applying a warm compress will promote circulation to the area RESPIRATORY DISORDERS Atelectasis Post op complication Clients may have difficulty breathing, hypoxia, and basal crackles The elderly, post op thoracic and abdominal surgery clients are at increased risk Incentive Spirometer Encourages clients to breath deeply with maximum inspiration Carbon Monoxide Poisoning Pulse ox does not correctly reflect oxygen saturation because carbon monoxide has a stronger bond to hemoglobin The nurses primary action is to deliver 100% oxygen through a non rebreather mask at 15 mL/hr May have symptoms of headache, dizziness, nausea Bronchitis Inflammation of the upper airway after viral infection Rhonchi are heard (low pitched wheeze) The sound resembles snoring or moaning Primarily heard during expiration but can be heard on inspiration Also heard in cystic fibrosis COPD Encourage clients who are losing weight and having loss of appetite to avoid drinking fluids during meals, eat small frequent meals, perform oral hygiene before meals Chronic air trapping and reduced gas exchange in these patients by decreasing ventilation