NUR 2050 Final Exam Study Guide with Complete Solutions

What is a never event, and what are some examples of a never event? - ANSWER--shocking medical errors that should never occur -adverse events that are unambiguous -leads to serious disability or death -usually preventable. EX: CAUTI, DVT, stage 3/4 pressure injuries nosocomial Who qualifies for Medicare and what are the 3 parts of it? - ANSWER-- 65 years +- younger but disabled after receiving SSDI for 2 years -person who has end-stage renal disease or ALS. Medicare part A: "hospital insurance", limited home healthcare, and hospice care Medicare part B: covers doctors visits, medical equipment, home health care, labs, xray, preventative services Medicare part D: drug coverage What is Medicaid and who is eligible for it? - ANSWER--created to meet healthcare needs of poor -eligibility is income based What is HIPPA? What can the nurse do to make sure patient privacy is not breeched. - ANSWER-HIPPA is a law put in place to protect patients personal protected information. -Nurses should not share passwords -log off of computers after leaving -do not discuss patients using identifying information in the hallways/open areas What is orthostatic hypotension? What should be done to prevent this? - ANSWER-decreased ability to equalize blood supply when moving from a lying to standing position -results is a drop of 20+ in systolic pressure OR a drop of 10+ in diastolic pressure. -treat underlying cause such as dehydration -try to ambulate patient slowly Nursing interventions to prevent pressure ulcers and DVT? - ANSWER-DVT Prevention: -TED hoses-sequential compression device, ambulation/range of motion Pressure injuries: Repositioning every 2 hours, use of wedges/pillows under bony prominences, preventative dressings over bony prominences. What are sequential compression devices? - ANSWER-Inflatable sleeves that wrap around the legs that inflate with air one at a time to mimic walking. These are used to prevent DVT's. Antidote for coumadin and heparin - ANSWER--Coumadin: vitamin K -Heparin: protamine sulfate What should a nurse monitor for after an Esophagogastroduodenoscopy (EGD)? - ANSWER--Monitor vital signs (blood pressure, pulse, respiration) - as ordered Give the client throat lozenges or analgesics for throat discomfort. - Inform the client that he or she may have flatus or burp-up gas, which is normal. -Monitor for return of gag reflex What should a nurse monitor for after a colonoscopy? - ANSWER--Observe the patient closely for signs of bowel perforation. Signs of bowel perforations such as severe abdominal pain, nausea, vomiting, fever, and chills must be reported immediately. -Rectal bleeding What is thrombocytopenia? Symptom presentation? - ANSWER--Decrease in platelet count, includes decreased production and survival, and increased destruction (under 140,000) Panic level= less than 20,000 S/s-spontaneous/prolonged bleeding, petechiae, and ecchymosis What are nursing interventions/teaching for someone with thrombocytopenia? - ANSWER--Protect from injury, monitor for bleeding/bruising/red patches (petechiae and ecchymosis) -Avoid IM injections, strenuous activities, aspirin/NSAIDs/anticoagulants, or sharp foods -Put prolonged pressure over injection/venipuncture sites -Use electric razors, and eat cooked food (mushy/soft) -No enemas or rectal temp., use stool softeners to avoid hemorrhoids from straining What are safety concerns or interventions for pt going under a MRI? - ANSWER--Preprocedural ---Screen for internal/external metal objects ---Tattoos can swell/burn, won't last long -Procedure ---Lie very still, ear plugs available since a "crushing metal" noise can be heard ---Metal fillings in teeth may tingle ---If pt is claustrophobic may use sedatives -Contraindications ---Pregnancy, epilepsy, implanted devices ---If use of non-iodinated contrast is used, pt with renal disease What are safety concerns or interventions for pt going under a CT scan? - ANSWER--Preprocedural ---Assess for allergy to iodine, if it exists do not use contrast. If contrast needed might need Benadryl & prednisone prescription ---Obtain written consent, may be NPO 4 hours before procedure ---Check creatinine 1st!!! ---No jewelry, tattoos don't interfere, IV access -Procedure ---Lie very still, clicking noise should be heard ---If pt is claustrophobic may use sedatives -Contraindications ---Weight >300 lb. ---DO NOT use in pregnancy What are signs and symptoms of anemia. - ANSWER--Fatigue, SOB, exertional dyspnea, tachycardia, headache, dizziness, pallor (conjunctiva and hands) -In pernicious anemia, a large beefy tongue What is iron deficiency anemia and how does it present? - ANSWER--anemia caused by lack of iron -Decreased value (microcytic) of the size of the RBC. -Decreased color (hypochromic) of the color with the lack of iron What is anemia of chronic disease and how does it present? - ANSWER--Normocytic, RBC will present as normal, but less total RBC's -Anemia of chronic disease happens when you have an autoimmune disease or other illness lasts longer than three months and that causes inflammation. Chronic inflammation can affect your body's ability to use iron needed to make enough red blood cells What is Vit. B12/Folic Acid (Pernicious) deficiency anemia and how does it present? - ANSWER--Increased size (macrocytic) -Usually seen in pt who are vegan, are malnourished, lack the intrinsic factor (from decreased reflux or gastric bypass surgery) -B12 injections are usually given if defiency of b12 is not caused due to lack of it in diet. What is aplastic anemia and how does it present? - ANSWER-Aplastic anemia occurs when your bone marrow doesn't make enough red and white blood cells, and platelets. -patients tend to have immature red blood cells. What is hemolytic anemia and how does it present? - ANSWER--When RBC are destroyed faster than being produced. -Leads to an increase in bilirubin which can lead to jaundice (yellow everywhere) -Cell fragments seen in blood stream What is the therapeutic PTT goal for a patient on heparin therapy - ANSWER-therapeutic range: 1.5-2x normal PTT time (60-100 seconds) What occurs during respiratory alkalosis to arterial gases? - ANSWER-pH- elevated pCO2- decreased (more basic) HCO3-normal initially (will decrease as kidneys compensate by excreting bicarbonate What occurs during respiratory acidosis to arterial gases? - ANSWER-pH-decreased -pCO2-increased -HCO3-normal (will increase when kidneys retain bicarbonate to compensate) what occurs during metabolic alkalosis to arterial gases? - ANSWER-pH=increased HCO3- increased pco2 normal (will increase as lungs attempt to compensate by retaining O2) what occurs during metabolic acidosis to arterial gases? - ANSWER-ph-decreased-HCO3-decreasedPCO2-normal (will decrease as lungs attempt to compensate by blowing off CO2) respiratory alkalosis manifestations - ANSWER--tachypnea-change in loc-numbness-tetany-convulsions respiratory acidosis manifestations - ANSWER-shallow, weak respirations, decreased LOC, cardiac arrythmias, flushed warm skin metabolic alkalosis manifestations - ANSWER-symptoms related to decreased calcium, respiratory depression, tachycardia, symptoms of hypokalemia, hypertonic muscles metabolic acidosis manifestations - ANSWER-Nausea Anorexia Abdominal pain Diarrhea Decreased LOC Muscle twitching (hypercalcemia) Tremors Convulsions Increased rate and depth of respirations Skin warm and flushed Signs and symptoms of dehydration/fluid volume deficit - ANSWER--dizzy -weakness -fatigue -thirst -orthostatic hypotension -decreased pressure and elevated pulse -poor skin turgor -sunken eyeball -initial tachycardia, as it progresses causes severe bradycardia. what is hypocalcemia and what are the signs/treatment - ANSWER--low calcium (below 9) NEURO-twitching, numbness, tingling +Chvostek sign +trousseau sign cramping convulsions laryngeal spasm Cardiac-arrythmias (cardiac arrest) -replace calcium with oral supplements are IV -have 10% calcium gluconate available after thyroid removal surgery What is hypokalemia? signs/symptoms? - ANSWER--A serum potassium level less than 3.5 mEq/L. -cardiac arrythmias (hypotension, increased sensitivity to digoxin) -muscle weakness, pain -fatigue -weak respiratory muscles -anorexia -N &V -paralytic ileus Treatment for hypokalemia - ANSWER--teach rich foods in K+ (fruits and veggies) -teach diuretics will lower potassium -administer oral K+ as prescribed -IV K slowly-monitor K+ levels What is hyperkalemia? sign and symptoms? - ANSWER-A serum potassium level that exceeds 5.0 mEq/L. Manifestations include cramping leg pain, followed by weakness or paralysis of skeletal muscles. cardiac arrythmias bradycardia diarrhea What are the treatments for hyperkalemia? - ANSWER--Calcium gluconate has an immediate onset to alleviate hyperkalemia by lowering the threshold potential of a cell, decreasing the risk for ventricular fibrillation.