ATI RN Medical Surgical Questions & Answers

Brachytherapy - ANSWERSInternal radiation therapy implant Vagina, abdomen or IV Private room with sign on door Wear dosimeter film badge Visitors: 30 mins, 6ft from source No pregnant or <16 yo visitors or staff Lead container for spontaneous loss of item Pt to maintain position to avoid dislodging item Plan of care for pt with clostridium difficile - ANSWERSContact precautions Quad cane use with hemiplegia - ANSWERSUse cane on unaffected side (bad side can't hold cane!) Advance cane 6-10" Advance weak leg Move strong leg past cane Stairs: up with the good and down with the bad Hypersensitivity to morphine - ANSWERSNarcan as antagonist If resp. <12/min, discontinue and admin Narcan Do not use with other depressants Older pts do not metabolize as well Cardiac Catheterization (PICC line) - ANSWERSProvider inserts, except PICC: trained RN Verify with x-ray before use Initial gauze dressing, then transparent w/in 24hr Tape cath hub for stability Remove dressing distal to proximal Measure to note migration Assess q8h Clean port for 3 seconds and allow to dry Flush with 10ml or smaller syringe Flush before, between, and after meds No BP on arm with PICC Beta blockers - ANSWERSFor patients with MI or unstable angina Decrease cardiac output Monitor BP and pulse Fatigue, weakness, depression, sexual dysfunction Do not suddenly d/c Know signs of hypoglycemia besides tachycardia Evaluating client understanding of TPN - ANSWERSAdmin. after 7% BW loss or 5+ days NPO Monitor glucose q4-6h for 24 hours At risk for hyperglycemia, may need extra insulin Never stop abruptly Admin. through PICC or central line Dysrhythmias and Management - ANSWERSSymptomatic bradycardia <60/min: Atropine, isoproterenol Pacemaker A. fib, SVT, ventricular tachycardia with pulse: Amiodarone, adenosine, verapamil Synchronized cardioversion Ventricular tachycardia w/o pulse, v. fib: Amiodarone, lidocaine, epinephrine Defibrillation Lab values assoc. with hyperthyroidism - ANSWERSDecreased serum TSH Increased FTI and T3 Failure of expected rise in TSH with thyrotropin-releasing hormone stimulation test Thyroid storm - ANSWERSSudden surge of large amt of thyroid hormones into the bloodstream Hyperthermia Hypertension Delirium Vomiting and abdominal pain Hyperglycemia Tachydysrhythmias Chest pain Dyspnea Diabetes mellitus foot care - ANSWERSKeep foot dry and clean Shoes at all times for protection Test water temp with hands Head injury - ANSWERSRespiratory status Assess changes in consciousness with GCS Cranial nerve fx Amnesia Length of time of lost consciousness Monitor for ICP: -CSF leaking out ear or nose (halo sign) -Headache -Restlessness, irritability, decreasing consciousness -Deteriorating motor fx -Seizures -Cushing reflex (widening pulse pressure) Assessment of post-op dressing - ANSWERSAssess drains/tubes for patency Check dressings for drainage and reinforce Sanguinous -> serosanguinous -> serous Assess wound for infection Report excess or purulent drainage to surgeon Monitoring patency of arteriovenous graft - ANSWERSAssess for thrill or bruit which indicate patency Ear irrigation - ANSWERSClean outer ear 30-50 ml Warm water Auricle up and back Thrombolytic therapy for stroke - ANSWERSRestores cerebral blood flow Give meds w/in 6 hours of initial symptoms Not for hemorrhagic stroke Not for pt with anticoagulant therapy MRI to rule out hemorrhagic stroke before therapy Autologous salvaged blood - ANSWERSAutologous blood is donated from patient before procedure to be used only on self. Pt may donate blood 5 weeks to 72 hrs before surgery Must have Rx from provider Prioritizing interventions for burns - ANSWERSAirway Fluid and electrolytes esp. 1st 24h Thermoregulation Infection Skin care following radiation treatment - ANSWERSGently wash skin with mild soap and pat dry Do not remove or wash off radiation "tattoos" No powders, lotions, ointments, perfumes, deo to skin Do not expose to sun or heat source Soft, non-constricting clothes Inspect skin for damage