nur_280_comprehensive_review___comp__1__comp__2__comp__3___2023.

SUMMARY
NUR280
COMPREHEN
SIVEREVIEW
COMP1,COMP2
&COMP3 2023

,Nur 280 comprehensive review comp 1 comp 2 comp 32023
CompH#1


Spinal Cord Injury/Surgery/Procedure
- ExpectedHfinding:
o DecreasedHreflexes
o Numbness/tingling
o InabilityHtoHurinateH(fromHlowHspinalHcordHinjury)
- NotHExpected:
o DecreasedHRR.
o HeadacheH(increasedHICP)
o CSFHhaloH(yellowHfluid)
- Post-Op:
o Airway,Hcirculation
o MonitorHforHICP,HNeuroHchecks,HVSHclosely
- Complication:
o AutonomicHDysreflexia.HS/S:
▪ NumbnessH&HtinglingH(expected)
▪ SevereHhypotension
▪ CessationHofHbreathingH(notHexpected).
Heparin/EnoxaparinH(LMWH)
- AnticoagulantHthatHcanHbeHgiveHIVHorHSQ
o Labs:
▪ aPTTH30-40H(WNL),HwhileHonHHeparinHshouldHbeH1.5-
2xHtheHnormalHvalueH[aPTTHonHheparinH60-90]
▪ RiskHforHbleedingH(aPTTH>70)
▪ WarfarinH&HHeparinHuntilHWarfarinHreachesHtherapeuticHINRHlevelsH[2-3]
▪ H&HH(ruleHofHthumb,HhematocritH[37-
52]HwillHbeH3xHtheHamountHofHhemoglobinH[12-
18])Hexample:HHgBH8H=HHctH24,HorHHgBH10H=HHctH30
▪ PlateletsH1.5-2.5xHtheHnormalH(wantHthemHhighHnotHlow)
• NormalHPlateletsHRange:H150-400
- Antidote:
o ProtamineHSulfate
- Complication
o HITH(HeparinHInducedHThrombocytopenia)
▪ DueHtoHbeingHonHmedHforHlongerHthanHaHweek
▪ MonitorHforHs/sHofHbleeding
▪ Lab:HlowHplateletHcountH(<150)
o Interventions:
▪ StopHheparin
▪ DirectHthrombinHinhibitor
• LepirudinHandHArgatroban
▪ TreatHactiveHandHpreventHanyHnewHthrombosis

,- SQ Administration

, o Don’tHaspirateHorHexpelHtheHbubblesHoutHofHprefilledHsyringe

Colostomy
- DescendingHcolostomyHlocatedHonHLLQH(involvesHtheHlargeHintestines)
- StomaHshouldHbeHreddishHpink,HmoistHandHshinyH(SaundersHpg.H688)
o CallHMDHifHstomaHlooks:
▪ Pale/HPinkH(lowHh&hHlevels)
▪ DarkHpurple/HBlackH(compromisedHcirculation)
▪ ShrinkHinHsize/Dry
▪ SmallHamountHofHmucousHdrainHinHtheHbag
- ExpectHliquidHstoolHinHtheHimmediateHpostopHperiodHbutHbecomeHmoresHmoreHsolidHdepending
onHlocation
o AscendingHColon:Hliquid
o TransverseHColon:HlooseHtoHsemi-formed
o DescendingHColon:HcloseHtoHnormal
- EmptyHpouchHwhenH1/3Hfull
- MonitorHforHdehydrationH&HelectrolyteHimbalance
- AvoidHfoodHthatHcausesHexcessHgasHorHodor
o GiveHyogurtHtoHhelpHdecreaseHsmell
- AvoidHcontactHofHskinHwithHstool
- ShouldHstartHfunctioningH2-3HdaysHafterHsurgery

VentilatorHAssociatedHPneumoniaH(VAP)
- Prevention
o HOBHelevatedH>30Hdegrees
o ulcerHprophylaxisH(H2Hblockers)
o preventingHaspiration
o pulmonaryHhygieneH(chestHphysiotherapy,HposturalHdrainage/percussionHan
dHturning/re-positioningHQ2hours)
o removeHwaterHfromHcircuits,HandHsuctionHPRN.
o Vigilant,HfrequentHoralHcareHisHkey!
▪ brushingHteethHQ8hours,HantimicrobialHrinseHandHlipHmoisturizerHQ2hours
o Cough

Sepsis:
- BloodstreamHinfection/UTI,Hbacteria,Hfungi,Hvasodilation
o consideredHaHtypeHofHdistributiveHshock,HpreventionHisHkey.
- RiskHFactors:
o cancerHpatientsH(highestHrisk)
o malnutrition
o immunocompromised
o openHwounds
o DM,HCKD,HHepatitis,HHIV/AIDS
- S/S: