HESI Milestone Exam 2 Version B (Blueprint) Final LATEST UPDATE 2023 GRADED A+

HESI Milestone Exam 2 Version B (Blueprint) Final LATEST UPDATE 2023 GRADED A+ lOMoARcPSD| Node number/ description Milestone Exam 2- Version B Display name NSG123.07.01.04 Continuous bladder irrigation A three-way (lumen) irrigation is used to decrease bleeding and to keep the bladder free from clots— one lumen is for inflating the balloon (30 mL); one lumen is for instillation (inflow); one lumen is for outflow. Continuous irrigation may be used with TURP. The amount of fluid recovered in the drainage bag must equal the amount of fluid instilled -- secondary hemorrhage may occur from overdistension If the patient complains of pain, the tubing is examined. The drainage system is irrigated with irrigating fluid (usually 50 mL), if indicated and prescribed, to clear any obstruction. Continuous bladder irrigation or bladder wash out is performed to help prevent urinary tract obstruction by flushing out small blood clots that may form after prostate or bladder surgery such as TURP or TURBT. Hesi hint: Instillation of hypertonic or hypotonic solution into a body cavity will cause a shift in cellular fluid. Use only sterile saline for bladder irrigation after TURP because the irrigation must be isotonic to prevent fluid and electrolyte imbalance. Clients with Foley catheters require perineal care and actual catheter care twice per day. NSG123.07.04.02 Urethritis Tests for sexually transmitted infections may be performed because acute urethritis caused by sexually transmitted organisms (i.e., Chlamydia trachomatis, Neisseria gonorrhoeae, herpes simplex) or acute vaginitis infections (caused by Trichomonas or Candida species) may be responsible for symptoms similar to those of UTIs. NSG123.07.05.01 Renal calculi risk Certain factors favor the formation of stones, including infection, urinary stasis, and periods of immobility, all of which slow kidney drainage and alter calcium metabolism. Several conditions, as well as certain metabolic risk factors, predispose patients to stone formation. These include anatomic derangements such as polycystic kidney disease, horseshoe kidneys, chronic strictures, and medullary sponge disease. Urinary stone formation can occur in patients with inflammatory bowel disease and in those with an ileostomy or bowel resection because these patients absorb more oxalate. Medications known to cause stones in some patients include antacids, 1 lOMoARcPSD| acetazolamide, vitamin D, laxatives, and high doses of aspirin HESI: Clients with the following conditions are at risk for developing calculi: 1. Strictures 2. Prostatic hypertrophy 3. Neoplasms 4. Congenital malformations 5. History of calculi 6. Family history of calculi NSG123.07.05.02 Calculi pain The immediate objective of treatment of renal or ureteral colic is to relieve the pain until its cause can be eliminated. Opioid analgesic agents are given to prevent shock and syncope that may result from the excruciating pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in treating renal calculus pain because they provide specific pain relief. NSG123.08.03.03 Imitrex contraindications Contraindications include a history of hypersensitivity reactions to the drug. Other contraindications are existing cerebrovascular or peripheral vascular syndromes NSG123.09.02.03 seizures The nurse determines whether the patient has an aura before an epileptic seizure, which may indicate the origin of the seizure (e.g., seeing a flashing light may indicate that the seizure originated in the occipital lobe).