Lecture 12/06/2023
Review for Comp 3
1. Ethical dilemmas
a. Negligence-failure to provide adequate care; unintentional tort
a. Failure to communicate concerns about elder client who is confused and is being discharged home is
an example of negligence
b. Assess pt with NO pulse doesn’t report til PM
b. Slander- Spoken remarks that cause harm Gossip
c. Assault – threat by words; intentional; intentional tort
d. Battery- act of harm... “base ball bat”; intentional tort
e. Libel- written “library” remarks of harm; intentional
2. Palliative care-long term serious but not always terminal, anytime, pain, curative treatment, invasive procedures
3. Hospice care- terminal; last 6months of life, pain management, no Invasive procedures
a. ethical dilemma PCP placing central line for antibiotic therapy pt in hospice
b. Terminal cancer pt needs assistance with pain management
4. Consent = signed by next of kin over phone w/ 2nd nurse witness; no sedation while signing; mentally, emotionally
competent; 18 years old or older; nurse is only witness, waived if urgent medical intervention need; Minor can only
give consent when- substance abuse, STI treatment, birth control, pg, emancipated 16 year old (marriage, PG, armed
forces, court order)
a. Informed consent can be signed when client is competent to make informed decision
5. Organ donation Not accepted by Johovas witness and orthodox Jewish only donation procurement team should ask
for organs
6. Acute Pancreatitis-expected SS= abd pain, sudden epigastric pain, LUQ radiates to back, N/V, weight loss, cullen and
turners signs, labs- lipase and amylase UP; aggravated by Alcohol, fatty food, recumbent position;>
7. retrograde peritonitis
8. Blood sugar –70-100 is normal
9. Malpractice- - not standard care=
10. TB= active – night sweats, fever, bloody sputum, weight loss
11. Restraints length of time and nurse management= need DR order, NEVER PRN, use half bow safety knot (easy
release); never attach to moveable part of bed, remove every 2 hours, offer fluids every 2 hours, offer bedpan toilet
every 2hours, least restrictive 1st
12. Steroids expected side effects= elevated blood sugar (give insulin), osteoporosis, lower WBCS, complication : cushing
syndrome
13. Pyridostigmine= for MS= Dry & Weak; autoimmune; inhibits cholinesterase; S/S= ptosis, diplopia, dysphasia,
dyspnea,
a. cholinergic crisis (med overdose) = S/S= abd cramps, N/V, low Bp, salivation, frequency; Antidote=
ATROPINE sulfate
b. myasthenic crisis (under dose) teaching check blood level, take w/ food, life -long therapy, avoid stress,
sickness, smoking
14. Development Pediatrics
a. Newborn normal HR 120-140
b. Infant ( 0-1 year)- use same nurse; UNOCCUPIED PLAY; rattle
i. VS= HR 80-150; RR 20-40
1. Delay 3m old who cant grasp objects
2. Delayed 3m old who does not smile requires follow up
3. Delayed 9m old who does not sit without support
4. 2m should= moro reflex,
c. Toddler – (1-3) egocentric, NO!!, PARALLEL PLAY; BALL, play vacuum
i. VS= HR 80-140; RR 20-40
1. 3 month old should be able to SMILE
2. 2 year old playing w/ HR of 68
3. Report 14m old who cant hold cup= Delayed
4. Report 6m who triples in weight ( should be 2x)
d. Preschooler- (3-6)- Magic thinking, pain punishment; ASSOCIATIVE PLAY; TRICYCLE, COLOR, FINGER PAINT,
doll, coloring book
i. VS=HR 80-130 RR 20-30
ii. 6 year old sitting eating snack with High HR130
iii. 5 years – skip, copy same sex parent
, iv. 3 year old 200 words
e. School age- industry (6-12)- contribute, WHY? Explain procedures; COOPERATIVE PLAY; VIDEO GAMES
PUZZLE, SPORTS
i. VS= HR 75-120 RR 16-22
15. Interdisciplinary conference/ mandatory reporting
a. PT= gross motor, walking, crutches , cane
i. 2 year old impaired gross motor and fine motor who was just dx with cerebral palsy
b. OT= fine motor and ADLS, feeding, dressing
ii. Occupational therapist referral for client who has Parkinson's disease and having trouble
performing activities of daily living
c. ST= language, communication , DYSPHAGIA
iii. Speech therapist , the client who has COPD and has developed dysphagia
d. Hospice
iv. Hospice care for Pt with terminal cancer and needs assistance with pain management at home
e. Outside public health agency
v. 27 year old who was admitted with confirmed STI
2. Hyperbilirubinemia in white and Asians = PKU is checked in heel stick ( needs sunlight, if super phototherapy
16. Dialysis=nursing interventions= monitor VS, minor elevation in temp, BUN creatinine before & after, weigh before &
after,
17. Peritoneal dialysis= nursing interventions=CS , daily weight, high fiber diet, drainage below abd complications =
peritonitis; if abd pain= (normal during 1st few exchanges 1-2 weeks) warm dialysate before admin w/ warmer
pad, itchy normal (Benadryl), heparin (clots)
a. Monitor for N/V this is adverse reaction
b. Pt receiving peritoneal dialysis which finding indicates peritonitis=cloudy, opaque outflow
18. Pericarditis= S/S = pain left ant chest, grating when inhale, fever, Labs-elevated WBC, troponin; nursing intervention=
high fowler leaning forward, o2, lab cultures Complications= cardiac tamponade, heart failure
a. Nurse develops a plan of care newly diagnosed w/ pericarditis nurse should next= review & identify pt
concerns
19. Documentation=
a. Ambulated from bed to doorway without assistance. No sob or diaphoresis. VS remain within baseline after
ambulating
20. Hazardous materials= how to handle
a. Use tongs for hazardous soaked clothing
21. Appendicitis= S/S= periumbilical pain descends to LRQ, McBurney's point, rebound tenderness, rigid abd, N/V, side
lying position w/ abd guarding, NO heat, NO enema, complication= peritonitis and sepsis
a. See first =Client has suspected appendicitis intense pain @ mcburneys point and now reports pain has
stoppped!!
22. Contact precautions- C diff, rsv, wound infections ( scabies /linear rash isolation)
i. Private room, don gown, gloves before entering
ii. Herpes doesn’t need dedicated equipment
23. Don PPE= Gown, mask, goggles, gloves= GowMGogGl
24. Doff PPE= Gloves, goggles, gown, mask= GloGogGowM
25. Heparin Iv drip to prevent clots= LABS PTT (45-100) and platelets (150,000-400,000)
a. Client receiving continuous heparin which is adverse reaction= platelet of 90,000
26. TB= 5cm immunosuppressed; 10cm healthcare worker, 15cm risk of TB
a. Can be discharged if HIV pt has induration of 5mm 24hrs after montoux test
27. COPD expected 02 saturation 88-92%
28. Chelation therapy= removes lead from circulating blood; contraindicated allergy to peanutsG6PD; don’t give w/iron;
29. Sickle cell nursing management IV and Po fluids, pain management, extremities extended promote venous return,
HOB 30 degrees
30. Glomerulonephritis diet= restrict Na, restrict K
a. Decrease k diet for 5 year old w/ glomerulonephritis
31. Addisons disease aka adrenal corticoid insufficiency = intervention life long glucocorticoid ; fatal if untreated; S/S=
dehydration, low Na, high K; exacerbation caused by stress, infection, trauma, surgery (avoid OTC meds, stress,
strenuous exercise ect; Complication Addisonian crisis S/S= severe headache, abd, leg, lower back pain, general
weakness, confusion, severe low BP, shock, low NA ( retain fluid)
a. Nurse is caring for client who has Addison's disease and is at risk for Addison's crisis next nursing action=
monitor BP frequently, daily weight go up ( retain fluid)
Review for Comp 3
1. Ethical dilemmas
a. Negligence-failure to provide adequate care; unintentional tort
a. Failure to communicate concerns about elder client who is confused and is being discharged home is
an example of negligence
b. Assess pt with NO pulse doesn’t report til PM
b. Slander- Spoken remarks that cause harm Gossip
c. Assault – threat by words; intentional; intentional tort
d. Battery- act of harm... “base ball bat”; intentional tort
e. Libel- written “library” remarks of harm; intentional
2. Palliative care-long term serious but not always terminal, anytime, pain, curative treatment, invasive procedures
3. Hospice care- terminal; last 6months of life, pain management, no Invasive procedures
a. ethical dilemma PCP placing central line for antibiotic therapy pt in hospice
b. Terminal cancer pt needs assistance with pain management
4. Consent = signed by next of kin over phone w/ 2nd nurse witness; no sedation while signing; mentally, emotionally
competent; 18 years old or older; nurse is only witness, waived if urgent medical intervention need; Minor can only
give consent when- substance abuse, STI treatment, birth control, pg, emancipated 16 year old (marriage, PG, armed
forces, court order)
a. Informed consent can be signed when client is competent to make informed decision
5. Organ donation Not accepted by Johovas witness and orthodox Jewish only donation procurement team should ask
for organs
6. Acute Pancreatitis-expected SS= abd pain, sudden epigastric pain, LUQ radiates to back, N/V, weight loss, cullen and
turners signs, labs- lipase and amylase UP; aggravated by Alcohol, fatty food, recumbent position;>
7. retrograde peritonitis
8. Blood sugar –70-100 is normal
9. Malpractice- - not standard care=
10. TB= active – night sweats, fever, bloody sputum, weight loss
11. Restraints length of time and nurse management= need DR order, NEVER PRN, use half bow safety knot (easy
release); never attach to moveable part of bed, remove every 2 hours, offer fluids every 2 hours, offer bedpan toilet
every 2hours, least restrictive 1st
12. Steroids expected side effects= elevated blood sugar (give insulin), osteoporosis, lower WBCS, complication : cushing
syndrome
13. Pyridostigmine= for MS= Dry & Weak; autoimmune; inhibits cholinesterase; S/S= ptosis, diplopia, dysphasia,
dyspnea,
a. cholinergic crisis (med overdose) = S/S= abd cramps, N/V, low Bp, salivation, frequency; Antidote=
ATROPINE sulfate
b. myasthenic crisis (under dose) teaching check blood level, take w/ food, life -long therapy, avoid stress,
sickness, smoking
14. Development Pediatrics
a. Newborn normal HR 120-140
b. Infant ( 0-1 year)- use same nurse; UNOCCUPIED PLAY; rattle
i. VS= HR 80-150; RR 20-40
1. Delay 3m old who cant grasp objects
2. Delayed 3m old who does not smile requires follow up
3. Delayed 9m old who does not sit without support
4. 2m should= moro reflex,
c. Toddler – (1-3) egocentric, NO!!, PARALLEL PLAY; BALL, play vacuum
i. VS= HR 80-140; RR 20-40
1. 3 month old should be able to SMILE
2. 2 year old playing w/ HR of 68
3. Report 14m old who cant hold cup= Delayed
4. Report 6m who triples in weight ( should be 2x)
d. Preschooler- (3-6)- Magic thinking, pain punishment; ASSOCIATIVE PLAY; TRICYCLE, COLOR, FINGER PAINT,
doll, coloring book
i. VS=HR 80-130 RR 20-30
ii. 6 year old sitting eating snack with High HR130
iii. 5 years – skip, copy same sex parent
, iv. 3 year old 200 words
e. School age- industry (6-12)- contribute, WHY? Explain procedures; COOPERATIVE PLAY; VIDEO GAMES
PUZZLE, SPORTS
i. VS= HR 75-120 RR 16-22
15. Interdisciplinary conference/ mandatory reporting
a. PT= gross motor, walking, crutches , cane
i. 2 year old impaired gross motor and fine motor who was just dx with cerebral palsy
b. OT= fine motor and ADLS, feeding, dressing
ii. Occupational therapist referral for client who has Parkinson's disease and having trouble
performing activities of daily living
c. ST= language, communication , DYSPHAGIA
iii. Speech therapist , the client who has COPD and has developed dysphagia
d. Hospice
iv. Hospice care for Pt with terminal cancer and needs assistance with pain management at home
e. Outside public health agency
v. 27 year old who was admitted with confirmed STI
2. Hyperbilirubinemia in white and Asians = PKU is checked in heel stick ( needs sunlight, if super phototherapy
16. Dialysis=nursing interventions= monitor VS, minor elevation in temp, BUN creatinine before & after, weigh before &
after,
17. Peritoneal dialysis= nursing interventions=CS , daily weight, high fiber diet, drainage below abd complications =
peritonitis; if abd pain= (normal during 1st few exchanges 1-2 weeks) warm dialysate before admin w/ warmer
pad, itchy normal (Benadryl), heparin (clots)
a. Monitor for N/V this is adverse reaction
b. Pt receiving peritoneal dialysis which finding indicates peritonitis=cloudy, opaque outflow
18. Pericarditis= S/S = pain left ant chest, grating when inhale, fever, Labs-elevated WBC, troponin; nursing intervention=
high fowler leaning forward, o2, lab cultures Complications= cardiac tamponade, heart failure
a. Nurse develops a plan of care newly diagnosed w/ pericarditis nurse should next= review & identify pt
concerns
19. Documentation=
a. Ambulated from bed to doorway without assistance. No sob or diaphoresis. VS remain within baseline after
ambulating
20. Hazardous materials= how to handle
a. Use tongs for hazardous soaked clothing
21. Appendicitis= S/S= periumbilical pain descends to LRQ, McBurney's point, rebound tenderness, rigid abd, N/V, side
lying position w/ abd guarding, NO heat, NO enema, complication= peritonitis and sepsis
a. See first =Client has suspected appendicitis intense pain @ mcburneys point and now reports pain has
stoppped!!
22. Contact precautions- C diff, rsv, wound infections ( scabies /linear rash isolation)
i. Private room, don gown, gloves before entering
ii. Herpes doesn’t need dedicated equipment
23. Don PPE= Gown, mask, goggles, gloves= GowMGogGl
24. Doff PPE= Gloves, goggles, gown, mask= GloGogGowM
25. Heparin Iv drip to prevent clots= LABS PTT (45-100) and platelets (150,000-400,000)
a. Client receiving continuous heparin which is adverse reaction= platelet of 90,000
26. TB= 5cm immunosuppressed; 10cm healthcare worker, 15cm risk of TB
a. Can be discharged if HIV pt has induration of 5mm 24hrs after montoux test
27. COPD expected 02 saturation 88-92%
28. Chelation therapy= removes lead from circulating blood; contraindicated allergy to peanutsG6PD; don’t give w/iron;
29. Sickle cell nursing management IV and Po fluids, pain management, extremities extended promote venous return,
HOB 30 degrees
30. Glomerulonephritis diet= restrict Na, restrict K
a. Decrease k diet for 5 year old w/ glomerulonephritis
31. Addisons disease aka adrenal corticoid insufficiency = intervention life long glucocorticoid ; fatal if untreated; S/S=
dehydration, low Na, high K; exacerbation caused by stress, infection, trauma, surgery (avoid OTC meds, stress,
strenuous exercise ect; Complication Addisonian crisis S/S= severe headache, abd, leg, lower back pain, general
weakness, confusion, severe low BP, shock, low NA ( retain fluid)
a. Nurse is caring for client who has Addison's disease and is at risk for Addison's crisis next nursing action=
monitor BP frequently, daily weight go up ( retain fluid)
