Capstone PNR 207 Exam 2 Questions And Well Elaborated Solutions

Capstone PNR 207 Exam 2 Questions And Well Elaborated Solutions Neonate with club feet - serial casting is the preferred treatment. Begun shortly after birth before discharge from hospital. Successive casts allow for gradual stretching of the skin and tight structures on the medial side of the foot. Down Syndrome assessment findings - High-arched, narrow palate, protruding tongue, transverse palmar crease Care of elderly - constipation, osteoarthritis use of naproxen for pain may cause gi bleeding assess stool, skin care, hair becomes thin and slows growth, skin is more fragile due to loss of collagen fibers, skin wrinkles and sags, Assess bowel habits, question risk factors. Dermatitis - may benefit from oatmeal or starch therapeutic bath with tepid water Colostomy (opening into the colon) care stoma site - pale stoma indicates a compromised blood supply and should be reported immediately. Avoid foods that are constipating, Whole kernel corn, tomatoes, and shrimp. Ileostomy care (opening in the ileum, liquid effluent) - Diarrhea - Treat with loperamide (antidiarrheal) Occult blood - is suspected when stool changes from a normal brown appearance to a dark black color with a sticky appearance Immobilized pts - at risk for pressure injuries, loss of bone mass, pneumonia, permanent loss of function. Use prevention techniques such as sheepskin pads, water mattresses, pulsating air pads. ROM exercises are necessary so that movement improves venous circulation by compression of muscles on the venous walls. PPI - Decrease the rate of gastric acid secretion. Suffix zole Cytoprotective - drug coat stomach GERD - Encourage low fat foods to decrease reflux ie: gelatin, baked chicken, low fat meats Paget's disease - Bone pain is a common early manifestation; nurse should assess pain intensity to determine if treatment is effective Status Epilepticus - At risk for further seizures. O2 and suctioning may be needed after any seizure to clear the airway and maximize oxygenation. The beds side rails should be padded to minimize risk to the pt. Grand Mal - tonic clonic seizures, be prepared to administer lorazepam IV Absence seizure - 15- 30 seconds without loss of posture Huntington chorea - degenerative neurologic disorder characterized by abnormal movements (chorea). It begins with pt being fidgety, progresses to constant movement and intellectual decline. Death usually occurs within 15-20 yrs of diagnosis Multiple Sclerosis - Exercise is very beneficial for the MS pt to relieve spasticity and improve coordination. Because of fatigue, it is often difficult to convince MS pts to exercise. Swimming provides considerable benefits as water exercise is less fatiguing. IV methylprednisolone is the standard treatment for acute attacks Parkinsons - Basic pathophysiology, caused by depletion of dopamine and excess of acetylcholine. Decreased swallowing ability can lead to inadequate nutrition Alzheimers - VA provides respite care up to 30 days/year Depression with suicidal ideation - medication may take several weeks to be therapeutic, protect from self injury Mental Health - Positive/Negative symptoms: Hallucinations, disorganized thought, and delusional systems are the positive symptoms that respond to neuroleptics. Negative symptoms such as withdrawl and inactivity do not respond to neuroleptics Schizophrenia - The exact cause is unknown, however, current research favors the theory that there is a neurologic basis with a genetic component. Borderline personality disorder - Assess daily for self-mutilation Lithium levels - frequent blood levels, use contraception, avoid caffeine Amitriptyline - may take several weeks to become effective Methimazole (hyperthyroidism) - All replacement hormones should be taken on a strict schedule Diabetes Type 1 - no insulin, will need replacement for life Diabetes Type 2 - pancreas may still make some, but either not enough or too many glucose molecules ingested at one time Hypoglycemia - cold and clammy, give candy. Provide source of quick acting carbohydrate/glucose such as orange juice HA1C - Normal range 4-6%. Assesses the degree of blood sugar control over the preceding 2-3 months Fructosamine assay - is a diagnostic test used to assess the degree of diabetic control of blood sugar over the preceding 2-3 weeks FVD - IV fluid replacement initiated with severe dehydration Thyroid care: - If pt needs potassium iodine, make sure to dilute and admin through straw to avoid staining teeth. If pt is due for thyroid panel bloodwork, instruct not to take asa 2 days before test Levothyroxine (hypothyroidism) - Abruptly stopping hormone replacement can cause pt to go into myxedema coma. S/S of myxedema coma include dizziness, respiratory distress, hypoglycemia, hypothermia Addisons disease - Corticosteroids should be taken every day. Take with food. Do not stop abruptly Cortisol levels - are collected during both day and night to take into account alterations associated with circadian rhythm. Do not need to be fasting, but increases in activity level may promote stress and alter results Care of post surgical - pt. hand surgery. Capillary refill over 5 seconds is an indication of diminished perfusion