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focuses on loss prevention and loss control (liability control) --- prevent and minimize institutional and treatment factors that could lead to legal liability

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Risk management

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an infant with a palpable olive shaped mass and frequent vomiting

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Pyloric stenosis

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a child admitted with vomiting, weight loss and abdominal pain

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Gastroesophageal reflux

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decreased hemoglobin and hematocrit complaining of fatigue

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Fe deficiency anemia

question

1. Assist with implementations of care. 2. Perform procedures according to protocol. 3. Differentiate normal from abnormal 4. Care for physiologically stable patients. 5. Have knowledge of asepsis and dressing. 6. Ability to administer medications varies.

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Role of LPN

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1. Physiological [ breathing, food, water , sex, sleep, homeostasis, secretion] 2. Safety [ security of body, employment, resources, morality, the family, health, property] 3. Love/ Belonging [ friendship, family, sexual intimacy] 4. Esteen [ self- esteem, confidence, achievement, respect for others] 5. Self-actualization [ morality, creativity, spontaneity, problem solving]

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Maslow's Hierarchy.

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LIFE THREATENING! blood pH declines below normal (7.35-7.45) . Lack of insulin increases catabolism of fats --- leading to excessive production of ketones [acid substance] Ketones accumulate in the blood, lower pH and metabolic acidosis occurs

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Ketoacidosis

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7.35-7.45

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Normal blood pH

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when ketoacidosis is severe and patient loses consciousness Symptoms of impending: HA, drowsiness, weakness, confusion, hypotension, tachycardia, kussmaul's respirations (deep respirations) and fruity breath (from ketone bodies)

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Diabetic coma

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1. Administer insulin, IV fluids and electrolytes per orders 2. Monitor: electrolyte status, I&O and blood glucose levels 3. Insert and maintain an NG tube and urinary catheter as needed

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Nursing management of diabetic coma

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hyper-secretion of thyroid gland Looks like: hyperactivity, sensitivity to heat, rest/ sleep deprivation.

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Grave's disease

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1. Requires 4,000-5,000 calories/ day [Increase protein and carbohydrates] 2. Requires increased amounts of vitamins and minerals (offer 6-8 feedings/ day) 3. Increase foods high in carbs (Why? hyperthyroidism causes osteoporosis)- milk : ) 4. Don't give any stimulants (Don't give any food/ fluid that increases the metabolic rate)- Not Tea for instance

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Grave's disease diet

question

they stimulate the beta cells in the pancreas to release endogenous insulin [ Used for type 2 diabetes after nutrition and exercise measures have failed]

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Action of oral hypoglycemic agents

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deficiency of adrenocortical hormones Causes: surgical removal of adrenal cortex / inadequate pituitary ACTH / sudden stopping of exogenous adrenocortical hormone therapy Indications: weakness, hypoglycemia, dark pigmentation of skin Treatment: Hormone replacement therapy Nursing: 1. Monitor balance of fluids and electrolytes 2. VS/ weight/ client education 3. Diet, medications, activity level

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Addison's disease

question

cabbage, turnips, spinach, seafood

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Goitrogenic foods (promote goiter formation)

question

1.010-1.030

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Normal specific gravity

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decreased production of ADH from posterior pituitary or decreased renal response to ADH Symptoms: increased UO and increased plasma osmolality Causes: brain tumor, head injury, brain surgery, lithium therapy

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Diabetes insipidus

question

hypersecretion of adrenal hormones (mineralcorticoids, glucocorticoids, androgens)

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Cushing's syndrome

question

1. High protein, low- carb, high potassoim, low-sodium, low -calorie diet. 2. Prevent infection 3. Observe for hyperactivity and GI bleeding 4. Administer cortisone as ordered

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Nursing management of Cushing's syndrome

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Acquired hemorrhagic disorder: excessive destruction of platelets because of autoimmune response Looks like: easy bruising, heavy menses, petechiae Nu Management: Avoid aspirin and NSAIDS -- avoid constipation and using dental floss Instruct kids: no contact sports, bike riding, climbing, running. Contact HCP if there is a head or abdominal trauma; increased platelet count ( improvement)

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Ideopathic thrombocytopenia purpura (ITP)

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disease resuling from a deficiency of vitamin B3 (niacin) Symptoms: weakness, loss of appetite Niacin sources: meat, peanuts, beans

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Pellagra

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Exact cause unknown An autoimmune disease with viral and genetic components. It is a chronic progressive disease characterized by deterioration of the myelin sheath of the CNS and subsequent scarring via plaques throughout the brain and spinal cord Symptoms: ataxia , weakness, spasticity, nystagmus, paresthesias, incontinence, emotional instability Treatment: Comfort measures, exercise, medications, ambulation training, self- help devices

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MS

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facial paralysis, usually 3-5 weeks in length (involves the 7th cranial nerve), unknown cause Predispose: viruses and inflammatory diseases Symptoms: distortion of 1 side of the face, inability to close the eye, lacrimation Treatment: comfort measures, facial muscle exercises, braces and surgery

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Bell's palsy

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inflammatory disorder caused by a spirochete, spread by tick bites Symptoms: flat, slightly raised red lesions, fever, fatigue Treatment: Antibiotic treatment, NSAIDS to treat arthritic pain (d/t tissue damage) Do you have the flu at this time? (symptoms of the early [localized stage] of lyme disease begins 3-30 days after tick bite, "bull's eye lesions'"

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Lyme disease

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10-21 days (approx 2-3 weeks)

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Incubation period of chicken pox

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used to monitor heparin therapy; therapeutic level is 1.5-2.5 times the control

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Partial thromboplastin time

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Influenza infection

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The nurse cares for the client with a 2-year history of sickle cell disease. Which factor increases the risk of vasoocclusive sickle cell crisis?

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24 hour urine test that indicated lead poisoning, oral contraceptive use or poliomyelitis

answer

Coproporphyrin

question

a diagnostic tool for hemolytic anemia (newborn, drug reactions, transfusion reactions)

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Direct coombs

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test to diagnose syphilis

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Fluorescent treponemal antibody

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the hemoglobin and the hematocrit are increased

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Lab values of dehydration

question

1. Force fluids and provide isotonic IV fluids. 2. I&O (hourly output) 3. Daily weights ( 1 L fluid= 1 kg) 4. Assess urine specific gravity

answer

NU care of dehydration

question

Adult males (40-54%) Adult females (36-46% )

answer

Normal hematocrit levels

question

Hypertonic tube feedings without water supplements. Diarrhea/ hyperventilation/ diabetes insipidus/ inadequate water ingestion/ OTC drugs (alka-seltzer)

answer

Causes of hypernatremia

question

caused by acute kidney injury or chronic kidney disease, use of K supplements and burns

answer

Hyperkalemia

question

Vomiting/ Diuretics/ excessive administration of IV dextrose and water/ excessive water intake/ prolonged low- na diet

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Hyponatremia

question

( > 3.5) nasogastric drainage, vomiting, diarrhea, and use of diuretics

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Hypokalemia

question

increased hemoglobin and hematocrit levels in 12-24 hours

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Results of a transfusion of whole blood

question

A protein that has a strong osmotic effect; prevents plasma from leaking into interstitial fluid; third spacing occurs; Moves water from the extravascular to the intravascular space Seen: bilateral pretibial edema

answer

Albumin

question

kidney disease and cirrhosis

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Hypoalbuminemia

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(Can be injected, snorted, sniffed or smoked) Patient who has recently taken heroin will have the CNS depressed effects [ constricted pupils and slow shallow breathing, drowsiness and slurred speech, initial euphoria followed by dysphoria]

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Heroin use symptoms

question

Prone position is excellent if client can tolerate it. Skin breakdown is decreased and the hip and knee joints are extended. Hanging the foot off the bed counteracts foot drop.

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Positioning for someone with hemiplegia (paralysis of 1 side of the body)

question

anti-infective used to treat infections of the respiratory and urinary tracts S/E: abdominal cramps, diarrhea, confusion, hepatotoxicity

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Azithromycin and s/e

question

a neurological medication used to treat acute migraines with/without auras [Does not prevent HA]

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Zolmitriptan and S/E

question

neurological medication used to manage ADHD, narcolepsy and depression in the elderly

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Methylphenidate

question

a skeletal muscle relaxant used to relieve spasms from acute injuries

answer

Methocarbamol

question

when the client flexes the head, the client also flexes the head and knee (Medical Emergency: call doctor immediately) - don't document first

answer

Brudzinskis sign

question

unable to care for self, life-sustaining ventilator support essential

answer

Spinal cord injury C3 and above

question

unable to care for self; may self-feed with powered devices

answer

C4 and above s/cord injury

question

can drive electric wheelchair, may feed self with devices, can write and care for self, can transfer from chair to bed

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C5 and above s/c injury

question

can dress lower extremities, minimal assistance needed, independent in wheelchair, can drive car with hand controls

answer

C7 and above

question

same as c7, in general activities are easier

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c8 s/c injury

question

some independence from wheelchair, long leg braces for standing exercises

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T1-T4 s/c injury

question

still requires wheelchair, limited ambulation with long-leg braces and crutches

answer

T5-L2

question

may use crutches or cane for ambulation

answer

L3-L5

question

ambulation

answer

L5-S3

question

use of electrically induced seizures to treat severe depression; 2 medications given ( an anesthetic for sedation and a muscle relaxant) NU management after: 1. Take V/S 2. Observe client reaction and stay with client. 3. orient client (Remind them that memory loss is temporary)

answer

Electroconvulsive therapy

question

removal of prostate tissue through the urethra Preop: promote urinary drainage, assure nutrition, correct fluid and electrolyte imbalance Postop: assure patency of 3-way foley cather, assess for shock or hemorrhage, check dressing and drainage [Urine might be bright red for 12 hours], monitor continuous bladder irrigation, monitor I&O, avoid long periods of sitting or strenuous activity

answer

Transurethral Prostatectomy (TURP)

question

direct visualization of the bladder, using a cystoscope inserted through the urethra Pre: Bowel prep, force fluids, NPO if sedated, Lithotomy position Post: monitor character and volume of urine, check abdominal distention, fever

answer

Cystoscopy

question

Pro: Empty bladder every 4 hours even if there is no urge. Drink 2 L of fluid/ day. Don't use bubble bath, nylon underwear, or scented toilet tissue. Wear loose fitting cotton underwear. Drink cranberry juice every day, makes urine acidic, which decreases infection.

answer

UTI actions

question

4.5-8 (Kids: tends to be slightly acidic; helps protect against bacterial infections)

answer

pH of urine range

question

Sterile technique- clamp the drainage tube below the port, swab the tubing where the catheter connects to the drainage bag with betadine, using a sterile needle, aspirate the specimen of urine via the port

answer

Correct way to obtain a urine specimen from a patient with an indwelling foley catheter

question

provides x-ray visualization of kidneys, ureters, bladder Pre: Assess for allergies to shellfish, iodine, chocolate, eggs and milk, NPO after midnight. After injection: salty taste during injection Post: assess for edema, itching, wheezing, dyspnea (dye reaction)

answer

IV pyelogram (IVP)

question

Pyridium discolors urine red or orange and may stain fabrics

answer

Pyridium (phenazopyridine hydrochloride) *weird s/e

question

excessive fluids and waste products that are usually removed by the kidneys are removed through the peritoneal cavity. Catheter surgically inserted into the abdominal cavity. 1-2 L of fluid infused into peritoneal space by gravity using sterile technique. Fluids stay in cavity for 20 minutes and then drained by gravity. Dialysate should be warmed to body temperature. Weigh pt. before and after dialysis. It's infused into peritoneal cavity and then drained from abdomen.

answer

Peritoneal dialysis

question

a highly malignant cancer originating from astrocytes, etiology not known, more common in middle aged adults

answer

Glioblastoma multiforme

question

vascular malignancy associated with depressed immune status, possible etiology herpesvirus, involves skin surface, especially face and thorax, similar appearance to ecchymosis or purpura

answer

Kaposia sarcoma

question

related to cirrhosis or hepatitis, damaged liver cells undergo malignant transformation

answer

Hepatocarcinoma

question

aggressive tumor of melatin-producing cells at base of epidermis, increased risk with ultraviolet light exposure- and light skinned people

answer

Melanoma

question

Any type of transfusion reaction can be life-threatening; the blood should be stopped immediately if a change in the patient's status is noted; Keep IV line open by piggybacking normal saline directly into IV line; notify physician, observe signs and symptoms, obtain vital signs frequently, administer emergency drugs as ordered, obtain urine specimen

answer

Transfusion reactions

question

caused by the lack of intrinsic factor that causes absorption of vitamin B12 from the intestinal

answer

Pernicious anemia

question

S/s : anxiety, respiratory distress, crackles in the lung area, increased BP and neck engorgement Treatment: Raise the head of the bed. Administer O2 and IV Furosemide. Notify MD.

answer

Circulatory overload IV therapy

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