Gold standard for nclex Exam 13 2024

Gold standard for nclex Exam 13 2024Guillain-Barré syndrome (GBS) What is it? What does it affect? Most life threatening complication? Gold standard for testing? - - A condition in which the immune system attacks the nerves - Affect- Ascending muscle weakness and absent deep-tendon reflexes - Compication- Neuromuscular respiratory failure is the most life-threatening complication. Inability to cough Shallow respirations Dyspnea and hypoxia Inability to lift the head or eyebrows - Gold standard- Forced vital capacity (spirometry) is the gold standard for assessing early ventilation failure. Sjögren's syndrome What is it? What does it affect? Treatment? - - Moisture-producing exocrine glands of the body are attacked by white blood cells - Causes- Dry eyes (xerophthalmia) and dry mouth (xerostomia) - Can lead to corneal ulcerations, dental caries, and oral thrush. Skin - dry skin and rashes Throat and bronchi - chronic dry cough Vagina - vaginal dryness and painful intercourse - treatment - preservative-free artificial tears artificial saliva Infectious mononucleosis What is it caused by? S/S ? Most serious complication? - - Caused by the Epstein-Barr virus - Fatigue, fever, sore throat, splenomegaly, swollen lymph nodes. - Spleen rupture is a serious complication - Airway obstruction from swollen lymph nodes Patent ductus arteriosus (PDA) s/s ? - - Connection between aorta and pulmonary artery - Machine like murmur Atrial septal defect s/s At risk for what? - - Systolic mumur - At risk for CHF and pulmonary hypertension - Increased respiratory exertion (eg, grunting) requires further assessment for CHF Mitral stenosis and aortic regurgitation s/s - Diastolic murmur Aortic stenosis s/s - Systolic ejection murmur Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Intervention? - -Fluid restriction to <1000 mL/day -Oral salt tablets to increase serum sodium -Hypertonic saline (3%) during the first few hours for clients with markedly decreased serum sodium and severe neurologic manifestations -Vasopressin receptor antagonists (eg, conivaptan)