Class notes STUDY MATE 101

1. Activity Therapy group members work on specific task together to promote socialization and increase self-esteem 2. Addison's Disease: inadequate pituitary ACTH. Hyposecretion of adrenal hormones (mineralocorticoids, glucocorticoids, androgens). Steroids causes fluid retention à increase the BP a. Dark pigmentation of skin (conspicuous bronze skin coloration), low blood glucose, high serum potassium, hyperpigmentation. b. Pathophysiology: ↓ Na+ dehydration, ↓ Blood volume + shock, ↑ K+ metabolic acidosis + arrhythmias, ↓ Blood sugar + insulin shock c. Treatment: hormone replacement d. Adrenal crisis à promptly administer dexamethasone, hydrocortisone, or both. Administer later doses of hydrocortisone through IV until the patient’s condition stabilizes Ø The home care nurse visits a client with a diagnosis of Addison’s disease. The nurse determines that teaching is effective when client makes which of the following statements? • “I’ll take hydrocortisone (Cortef) in the morning.” à if steroid are taken at night, they may cause sleeplessness. 3. Adolescent Pregnancy 4. Advance Directives: written instructions completed by a competent individuals regarding end-of-life care (particularly life-sustaining treatment) to be implemented should they become incapacitated (i.e., serious illness or injury) in the future. • Durable POA for health care: • May be referred to as health care proxy • Different from living will in that individuals does not have to be terminally ill or in persistent vegetative state for durable health-care POA to take effect • Living will: based on a if-then basis 5. Agitation (2 questions): indicated by increased motor activity, decreased ability to relate to others, distorted perceptions, and loss of rational thought; when interacting with agitated client, it is important for the nurse to be supportive and protective. 6. Airborne Precautions: used with pathogens transmitted by airborne route; private room with monitored negative air pressure with 6 to 12 air changes per hour, keep door closed and client in room, can cohort or place client with another client with the same organism but no other organism; place mask on client if being transported; examples of disease in category includes measles (rubeola), M. tuberculosis, varicella (chickenpox), disseminated zoster (shingles). Ø The nurse observes a staff member enter the client’s room wearing a fit-tested respiratory device. The nurse determines care is appropriate if the staff member is caring for which client? • A client diagnosed with varicella. (Used with pathogens transmitted by airborne route; private room with monitored negative air pressure; keep door closed and client in room) 7. Alcohol withdrawal (2 questions): Alcohol sedates the CNS § Early S/S occur 4 to 6 hours after the last drink: include tremors, agitation, anxiety, insomnia, mild tachycardia, HTN § Delirium tremens: tremors, anxiety, panic, disorientation, hallucination, vomiting, grand mal seizures (first 48 hours after withdrawal) § Nursing responsibilities: administering sedation as needed, monitoring VS, seizure precautions, providing quiet, well-lighted environment § Alcoholic hallucinosis occurs 48 hours after last drink. o Indications: auditory, visual, or tactile hallucinations in absence of other psychotic behavior Ø The nurse cares for clients on the medical/surgical unit. The nurse admits a client for possible appendicitis. During the admission interview the client states, “Most days I drink about one pint of vodka.” The nurse knows that which is MOST likely time for the client to develop alcohol withdrawal delirium? • 48 to 72 hours after cessation of drinking (2-3 days). • Delirium occurs 2 to 3 days after not ingesting alcohol; symptoms: tremors, anxiety, panic, disorientation, confusion, paranoia, delusional symptoms, grand mal seizure, coma, and death; nurse should anticipate this occurrence, can be avoided with IV fluid and administration of sedatives/hypnot