ATI MEDICAL SURGICAL DYNAMIC NOTES

● Nurse is providing instructions to the client with DM2 and a new prescription for metformin. Which of the statements indicates an understanding? ○ “I should take this medication with a meal” ● Nurse is teaching a client with CKD and a new prescription of erythropoietin. Which statement indicates an understanding? ○ “I am taking this medication to increase my energy level” ■ The goal of erythropoietin is to increase the level of hematocrit in clients who have anemia. When the medication is effective, the client should have a decrease in fatigue & improvement in activity tolerance. ● Adverse effect of enalapril ○ Orthostatic hypotension → the nurse should identify that dilation of arteries and veins causes orthostatic hypotension ● A nurse is caring for a client who has hypothyroidism. Which manifestation should the nurse expect? ○ Constipation ■ A client w/hypothyroidism can experience constipation d/t a decrease in the client’s metabolism, resulting in slow motility of the GI tract. The nurse should instruct the client to increase fiber and fluid intake to reduce the risk for constipation. ● Charge nurse teaching new nurse about caring for a client with MRSA. Which statement by the new nurse indicates understanding of the teaching? ○ “I will leave assessment equipment in the room to use on this client” ■ MRSA should follow contact precautions ● Nurse is providing teaching to a client w/IBS (irritable bowel syndrome). Which instructions should the nurse include in teaching? ○ Consume at least 2L water daily to promote normal bowel function ○ Increase fiber intake to at least 30 g/day ■ Dietary fiber helps produce bulky, soft stools and establish a regular bowel pattern. ● Expected findings with hyperthyroidism: ○ Restlessness ○ Elevated T3 level ○ Decreased weight ■ Elevated BP could be indicative of at risk for thyroid storm ● For a thoracentesis, what intervention should be included in the plan of care? ○ Thoracentesis → procedure to remove air or fluids from the lungs ○ **Encourage client to take deep breaths after the procedure ■ Does not to be NPO ■ Client can resume activity within 1 hour following procedure ● Dysphagia → difficulty swallowing; client is at greatest risk for aspiration d/t impaired sensation and function within the oral cavity ● Aphasia → communication impairment risk ○ Loss of ability to understand or express speech ● Ataxia → At risk for injury from falling ○ The loss of full control of bodily movements ● Hemianopsia → at risk for injury when ambulating ○ Blindness over half the field of vision ● A client with advanced COPD, what ABG results should the nurse expect? ○ PaCO2 = 56 → client with COPD retains PaCO2 d/t weakening and the collapse of alveolar sacs, which decreases area in the lungs for gas exchange and causes PaCO2 to increase above the expected range ○ pH = 7.38 → Normal (7.35-7.45) ■ Client with COPD will have pH less than 7.35 d/t poor gas exchange from elevated PaCO2 and HCO3 levels, along w/low O2 levels for an extended period of time ○ HCO3 = 24 → Normal (22-26) ■ A client with COPD will have high HCO3 levels as a result of the kidneys’ inability to excrete metabolic acids, leading to a retention of HCO3 in the blood and an increase in pH ○ PaO2 = 90 (45-35 - Normal) ■ Client with COPD will have low oxygen level d/t the weakening and collapse of alveolar sacs, which decreases the surface area in the lungs for gas exchange ● A client should avoid exposure of irradiated skin areas to the sun for at least 1 year after completing radiation therapy - skin in the radiation path is especially sensitive to sun damage ● Compartment Syndrome: ○ Client with CS experiences pain that increases w/passive movement ■ CS results from decrease in blood flow in the extremity because of a decrease in the muscle compartment size d/t cast that is too tight ○ Diminished pulse or pulselessness d/t lack of distal perfusion caused by a decrease in the muscle compartment size ○ Cap. refill greater than 2 seconds d/t lack of distal perfusion & venous congestion caused by a decrease in muscle compartment size ● Omeprazole (PPI) → suppresses gastric acid production ● Antacids; aluminum hydroxide → neutralize gastric acid ● Antibiotics; amoxicillin → reduce the growth of ulcer-causing bacteria