ATI MED SURG STUDY GUIDE Review 2024 - LAB VALUES- NORMAL FINDINGS

674 BASIC CARE AND COMFORT: What are dietary restricions for acute kidney injury and chronic kidney disease? - ...Acute Kid inj: Restrict potassium, phosphate, magnesium during oliguria phase. Restrict fluids as ordered by md. (Diet high in protein) Chronic kid dis: Restrict sodium, potassium, phosphorous and magnesium. Restrict fluids as ordered by md. (Diet high in carbs, and moderate fat) 743 MALE REPRO SYSTEM: TURP - ...Performed using a resectoscope, inserted through the urethra and trims away excess prostatic tissue, enlarging the passageway of the urethra through the prostate gland. Nursing Actions: Pre-op: Cardio, resp and renal systems s/b carefully assessed prior to surgery. Ensure client understands procedure and what to expect post-op. Post-op; Placement of an indwelling 3-way catheter. Drains urine and allows for installation of a continuous bladder irrigation (CBI) of normal saline (isotonic) or another prescribed irrigating solution to keep the cath free of obstruction. Cath Obstructed (bladder spasms & reduced irrigation outflow) turn off CBI and irrigate with 50ml of irrigations solutions using a large piston syringe. CONTACT surgeon if unable to free clot. Record amount of irrigating solution instilled (generally very large volumes ) and the amount of return. Th difference equals urine output (irrigating solution - amount in drain bag =total urine output) Cath has large balloon (30-45ml) that is taped tightly to the leg, creating tractions do that the balloon will apply firm pressure to the prostatic fossa to prevent bleeding. This make the client feel a continuous need to urinate. Instruct client NOT to void around the cath as this caused bladder spams. AVOID kinks in the tubing. Monitor vital signs and urinary output. MONITOR for bleeding (persistent bright red bleeding unresponsive to increase in CBI and traction on the cath or reduced HGB levels) REPORT to provider. Assist to ambulate as soon as possible to reduce risk of DVT. ATI MED SURG STUDY GUIDE Review 2024 - LAB VALUES- NORMAL FINDINGS Medications to admin: analgesics, antispasmodics (bladder spams) , abt (prophylaxsis) , stools softener(avoid straining) REMOVAL of cath: Monitor urinary output, initially may be uncomfortable, red in color and contain clots. COLOR of urine should progress toward amble in 2-3 days. EXPECTED OUTPUT : 150-200ml every 3-4 hours. CONTACT provided if unable to void. MOBILITY AND IMMOBILITY: Quad cane use with hemiplegia: - ...Use on strong side. 549 PUD: How to prevent dumping syndrome - ...Group of manifestations that occur following eating. Shift of fluid to the abd is triggered by rapid gastric emptying or high carb ingestion.Client will have vasomotor symptoms (syncope, pallor, palpations dizziness, headache) MEDICATIONS: admin powdered pectin or octreotide (Sandostatin) sq if manifestations are severe and not effectively controlled with dietary measures. arcabose (Prandase) slows the absorption of carbs dicyclomine(Bentyl) antispasmodics Monitor I&O PREVENTION: Lying down after meals slow the movement of food within the intestines. Limit the amt of fluid ingested at one time Eliminate liquids with meals, for 1 hours prior to and following a meal Consume high protein, high fat, low fiber, low - moderate carb diet. Avoid mils, sweets or sugars (fruit juices, sweetened fruit, milk shakes hone syrup jelly. ) Consume small frequent meals rather than large meals. 1104 Post Op Care ROM; Early Ambulation; Leg exercises; ted hoses; sequential device - ...Apply pneumatic compressions stockings or elastic stocking. Early ambulating, leg exercises, SCD's 699 Renal Calculi: Kidney Stone-Diet Restrictions - LIMIT intake of food high in animal protein(reduction of protein intake decreases calcium precipitation) LIMIT sodium intake REDUCED calcium intact (dairy products) AVOID CALCIUM OXALATE: Spinach, black tea, rhubarb, coca, beets pecans, peanuts, okra, chocolate, wheat germ, lime peel Swiss chard. AVOID STRUVITE: dairy products, red and organ meats, whole grains. AVOID URIC ACID: decrease intake of purine source (organ meats, poultry, fish, gravies, red wine, sardines MEDICATIONS: allopurinol (Zyloprim) prevent formations of uric acid Potassium or sodium citrate or sodium bircarbonate is used to alkalinize the urine. Thiazide diuretics(hydrochorothiazide) used o increase calcium reabsorption. captopril (Capoten) used to lower urine cystine alpha mercaptopropionylglycine (AMPG) used to lower urine cystine HEALTH PROMOTION MAINTENCE: Safe sex practices-Health wellness screening; condom usage - ... 674 PHARMACOLOGICAL/PARENTRAL THERAPY: Acute kidney injury Med Adverse Reaction lead to toxicity - ...AVOID nephrotoxic medication or combining 20 more will lead to nephron destruction: 451 BLOOD/BLOOD PRODUCTS: 1 unit blood = 1 gram per dl will raise RBC Allergic Reactions; Eval therapeutic response: S/S Hypoxia Intervention transfusion - S/S Hypoxia: fatigue; irritability; ALLERGIC REACTIONS: Immediate: mild/life threatening, chills, fever, low back pain, tachycardia, flushing, hypotension, chest tightening or pain, tachypnea, nausea, anxiety, hemoglobinuria Febrile: 30-6 hours after transfusion: chills, fever, flushing, headache, anxiety, USE WBC filter ADMINISTER antipyretics. Mild Allergic: during or up to 24 hours after transfusion:itching, urticaria, flushing. ADMINISTER diphenhydramine (Benadryl) Anaphylactic: Immediate: wheezing, dyspnea, chest tightness, cyanosis ADMINISTER maintain airway, administer O2, IV Fluids, antihistamines, corticosteroids and vasopressors. STOP TRANSFUSION IMMEDIATELY if reaction is suspected. INITIATE 0.9% sodium chloride (use separate line so no more blood is infused into body) SAVE blood bag with the remaining blood and the blood tubing for testing at the lab following facility protocol 361 CARDIAC GLYCOSIDE & HEART FAILURE: Digoxin Admin What, how, S/E Antidote, Loading dose Maintenance dose Digoxin & diuretic not compatable (hypokalemia) Digoxin toxicity s/s how to treat - ...ADMINISTERED for: increase contractility improving cardiac output Take apical pulse for 1 minute, if less than 60 beats per min or irregular, HOLD digoxin, NOTIFY provider OBSERVE for nausea and vomiting. TAKE dose at same time every day DO NOT take at same time of antacids. Separate meds by at least 2 hours apart REPORT s/s toxicity :fatigue, muscle weakness, confusion, loss of appetite, REGULARLY have digoxin and potassium levels checked ANTIDOTE for dig tox: digibind 303 CARDIOVASCULAR DX & THERAPEUTIC P : Accessing/assessing implanted ports accessing hickman accessing picc line - ...IMPLANTED PORTS: Port is comprised of a small reservoir covered by a thick sputum. INSERTION LOCATION: surgically implanted into chest wall pocket cath is inserted into subclavian vein with tip in superior vena cava. INDICATIONS: long term (a year or more) need for vascular access commonly used for chemo PRE-PROCEDURE: apply local anesthetic to skin if indicated, Palpate skin to locate port body septum to ensure proper insertion of the needle. Clean the skins with alcohol for at least 3 seconds and allow to dry prior to insertion of needle, Access with a non coring (Huber) needle. POST-PROCEDURE: Flush with 10ml 0.9% sodium chloride or per facility protocol ...PICC LINES(HICKMAN,GROSHONG) Inserted by a specially trained nurse. 40-65cm with single or multiple lumens. Length of use: up to 12 months Insertion Locations: basilic or cephalic vein at lest one fingers breadth below or above the antecubital fossa. CATH is advanced until the tip is positioned in the lower one third of the superior vena cava. Indications: admin of blood, long term adm of chemo agents, abt, tpn. TAKE XRAY to make sure of tip placement COVER WITH GAUZE and replace within 24hours with transparent dressing ASSESS site q8hr: redness, swelling drainage tendereness and condition of dressing Use 10ml or larger syringe to flush with 303 COMPLICATION IV THERAPY: How to verify tip placement of picc - XRAY 912 PHARMACOLOGY: DM-Admin insulin Drawing up combo insulin Mixing insulin Onset, peak, duration, time Giving sq and changing sites vision impaired - ...ADMIN SQ, rotate sites to prevent lipohypertrophy (increased swelling of fat) or lipoatrophy (loss of fat tissue) within one anatomic sit (prevents day to day changes in absorption rate) COMBO INSULIN: clear to cloudy. draw up rapid/short acting (Lispro(Humalog) aspart(Novolog) glulisine (Apidra) first, then draw up short-acting lasting regular (Hum R, Nov R)or intermediate acting (NPH) Humulan N, detemir (Levemir) (DO NOT MIX WITH INSULIN) DO NOT mix long lasting insulin glargine (Lantus) TYPE WHEN ONSET PEAK DURATION TIME Rapid ac 10-30sec Short 30/60mi 1-2hr ac Intermed between meals/nite Long 1xdaily only admin anytime, but at same time each day VISION IMPAIRED: 494 DM: Electrolyte imbalance (Hypo magnesium) Therapeutic Range - ...SERUM MAG: less than 1.3mg/dl THERAPEUTIC RANGE: 470 Calculating protein Intake: - 0.8xkg 524 TPN: Client understanding - ...D10 if run out of TPN WHY: weight loss 7% body wt and NPO x5days or more hyper-metabolic state NEVER abruptly stop TPN. Speeding up or slowing down is contradicted can altar bgl significantly MONITOR vs q4-8h STERILE PROCEDURES: inc mas, when change cent line dsg change tubing and solution bag q24h even if not done. filter added to collect particles from solution DO NOT USE line for other IV bolus sol (prevents contamination and interruption of flow rate) DO NOT ADD anything to the solution d/t risk of contamination and incompatibility INTERVENTIONS: check capillary glucose q4-6h for 1st 24h Clients rec tpn freq need supp reg insulin until pancreas can increase it endogenous prod of insulin keep dextrose 10% in water at bedside in case the solu unexp ruin or the next bag is not avail. 461 GROWTH FACTOR: Epogen Neupogen Procrit Anemia secondary to renal failure - ...epoeten alfa (Epogen, Procrit): hematopoietic growth factor used to increase production of WBC MONITOR: increase B/P MONITOR: Hgb and Hct twice weekly MONITOR: cardiovascular event if Hgb increases to rapidly (greater than 1g/dl in 2 weeks) REINFORCE: important to have Hgb/Hct assessed q2week 409 HTN: s/e medications - ...MEDICATION S/E: Hypertensive crisis occurs when clients do not follow the medication therapy regimen CLINICAL MANIFESTATIONS: severe h/a, extremely high b/p (systolic 240mmhg, diastolic 120mmhg, blurred vision, dizziness, disorientation, epistaxis ADMINISTER IV antihypertensive therapies, nitroprusside(Nitropress), nicardipine(Cardene IV) labetalol hydrochloride as prescribed. before, during and after IV admin MONITOR b/p q5-15minutes. assess neuro, pupils, loc, muscle stregnth, ECG BE CAREFUL WITH getting OOB, driving, climbing stairs until medication effects are fully known. 412 ACE INHIBITORS: Lisonpril - ...NOTIFY provider if cough, it is s/e of ace. angioedema (swelling of tissues in throat that can progress to be life threatening. LOVONOX: Self admin - KEEP BUBBLE check ptt MENSTRUAL DIS MEONPAUSE: Adverse affects of meds - Calf pain 778 OSTEOPOROSIS: teaching alloprunil (Zyloprim) When to give - ...INADEQUATE intake of calcium and vit d stimulates parathyroid hormone to be released and triggered calcium to be pulled from bone. 46 OPIOD ANTAGONIST: Outcomes naloxone( Narcan) Hypersensitive to morphine: - ...MORPHINE hypersensitivity: resp rate drops below 8/min shallow, difficult to arouse. GIVE naloxone (Narcan) to reverse effects of morphine. 856 DI: Plan of Care - ...MEDICATIONS: ADH stimulants-carbamazepine (Tegretol) vasopressin (Pitressin) ADH replacement- desmopressin acetate (DDAVP) aqueaous vasopressin (Pitressing(intranasley)) Polyuria, polydypsia, nocturia, fatigue, dehydration awb extreme thirst, wt loss, muscle weakness, h/a constipation, dizziness, sunken eyes, tachycardia, hypotension, loss or absence of skin turgor, dry mucous membranes, 62 SEIZURES/EPILPESY: Dilantin adverse affects - ...DILATIN ADVERSE AFFECTS: phenytoin (Dilantin): AVOID oral contraceptives, decrease effectiveness AVOID warfarin use, decreases absorption VITMANIN MINERAL SUPPLEMENTS: Adverse affect of garlic therapy - ...Inhibits platelet formation 674 PHYSIOLOGICAL ADAPTION: Acute kidney injury eval client understanding of ??disacepure?? - ...Encourage clients to drink 2-3 liters daily unless restricted by provider. 434 ANEURISMS: s/s Aortic Dissection PVD aneurisms Thoracic outlet syndrome - ...S/S AORTIC DISSECTION: Sudden onset of tearing ripping and stabbing abdominal or back pain; Hypovolemic shock; diaphoresis, nausea, vomiting, faintness, apprehension, decreased or absent peripheral pulses, neurological deficits hypotension and tachycardia (initial) S/S THORACIC OUTLET SYNDROME: Severe back pain(most common)Hoarseness, cough, shortness of breath, and difficult swallowing, decrease in urinary output, S/S PVD ANEURYSMS: 760 ARTHROPLASTY: CPM - ...CPM: prescribed to promote motion in the knee and prevent scar tissue formation. CPM usually placed and initiated immediately after surgery. CPM provides passive range of motion from full extension to the prescribed amount of flexion. The prescribed duration of its use should be followed, but it should be turned off during meals. Positions of flexion of the knee are limited to avoud flexion contractures. AVIOD knee gatch and pillows placed behind the knee. 451 BLOOD/BLOOD PRODUCTS: Autolytic salvage blood - ...Clients blood is collected in anticipation of future transfusions(elective surgery) this blood s designated for and can be used only by the client. Clients may donate blood 5 weeks in advance up to 72 hr prior to surgery 829 BURNS: Energy intervention ABC - ...MODERATE AND MAJOR BURNS: Maintain airway and ventilation, A NG tube may be indicated for clients at risk for aspirations; Assist client to cough and deep breathe every hour Suction every hour or as need Keep head of bed elevated at all times Provide humidified supplemental oxygen as prescribed Monitor vital signs Maintain cardiac output: Fluid replacement within the first 24 hours RAPID fluid replacement is needed during the emergent phase to maintain tissue perfusion and prevent hypovolemeic(burn) shock Isotonic crystalloid solutions, 0.9% sodium chloride or lactated ringers solution 1014 CA DISEASE: Laryngeal cancer body disturbances body images - ... 1003 STOMATITIS GINGIVITIS: Dietary consolidations - ...AVOID: Avoid using glycerin-based mouthwashes or mouth swabs; Nonalcoholic anesthetic mouthwashes are recommended Administer a topical anesthetic prior to meals Discourage consumption of salty, acidic, or spicy foods Offer oral hygiene before and after each meal. Use lubricating or moisturizing agents to counteract dry mouth. CLIENT EDUCATION: Encourage client to rinse mouth with a solution of half 0.9% sodium chloride and half peroxide at least twice daily, and to brush teeth using a soft bristles toothbrush. Encourage client to eat soft, bland foods and supplement that are high in calories (mash potatoes, scrambled eggs, cooked cereal, milk shakes, ice cream, frozen yogurt, bananas, and breakfast mixes) Instruct client to take medication to control infection as prescribed (nystantin(Mycostating)) CARDIAC CATH: Post Op Care - ... EKG ABNORMAL: Following MI change in ekg strip expected changes - ... DM: Medication Education - ... 122 DISORDERS OF EYE: Expected findings Analyze findings - ...EXPECTED FINDINGS: Macular Degen: Lack of depth perception; objects appear distorted; blurred vision; loss of central vision;blindness; DX: Opthamoscopy; Snellen test Cataracts: Decreased visual acuity(reduced night vision; blurred vision; diplopia; glare and light sensitivity; halo around lights; progressive and painless loss of vision; visible opacity; absent red reflex DX: Snellen chart; Examine ext and int eye structors; Increase amount of light in room; Provide client with adaptive devices that accommodate for reduced vision Glaucoma: Open Angle: Most common causes rise in IOP, aqueous humor decreased outflow decreased due to blockages H/A; Mild eye pain; loss of perophreal vision; decreased accomondations; elevate IOP 21mm Hg; Angle closure: Rare; IOP rises suddenly angles closed off Rapid onset of elevate IOP; decreased of blurred vision; seein halos around lights; pupils are nonreacive to light; severe pain and nausea; photophobia DX: Tonometry;Gonioscopy