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Comp Review

Comp Review

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Published by xoxo318
comprehensive review
comprehensive review

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Published by: xoxo318 on Sep 13, 2013
Copyright:Attribution Non-commercial


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finalwhen you have a pt with a cast what is your priority=
circulation, movementandsensation... assesscirculationby pulse checkmovementby movingfingerschecksensationbyaskingif they can feel anything
when you have a child with a arm cast what is priority
>checkperipheralpulsesin affectedarea
invasion of client privacy.. what would be a good example of violating patient privacy-a client was brought to er after serious accident needs to go to a procedure needs aninformed accident who do you go to ?
never a friendonly closefamily member
you are doing rounds, in planning client rounds, which client will you collect the datafirst?
look for a pt who will fall into categoryof ABC-- ABCis priority
You have a patient who came from surgery the initial nursing action is= (immediatelyafter post op
) your action is ABC(infectiondoesntset in until 72 hrs do not answerthat)
your pt has sever headache he was given analgesic how does it give pain release=
gait control mechanism
Bilroth I- gastro dudenostomy II- gastro jujenostomy If they have has abdominalsurgery what will they come back with?
NGT(inorder to removeexcessair you needto addNGTfor first 24-48 hrs after surgery*whichof the physicianordersdo you question?Neverirrigatea NGTstatuspost abdomensurgery
you have a pt w/ acute gastritis, which medication that you find on your pt chart iscontraindicated =
NSAIDS(irritate to stomachIbuprofen,aspirin, steroids)
acid base- ph-7.35-7.45paCO2= 35-45Respiratorypa O2= 80-100%HCO3= 22-28GI/Kidney(metabolic)(21-26)<---Acidosis ^ Alkalosis--->UGIT- NGT/Vomiting > left with metabolic alkalosis (if it comes out your mouthalkalosis)LGIT- Diarrhea > left with acidosis (comes from your anus is acidosis)Respiratory Acidosis > COPD= Asthma, bronchitis, Pulmonary EmphysemaTrap CO2= CO2+H2O> H2CO3- Resp acidosis
bronchitis usually stays with the ptHyperventilate (RR^ deep rapid)Hypoventilate (RR down shallow)Which diet do you not give to COPD pts?-
A pt has fat embolis (from fracture of long bone) clot that has moved... DX: CXR if fatembolis goes into lungs it is called pulmonary fat embois
Osteoarthritis- degenerative;older population;unilateral; pain=restpain goesaway
RA- inflammatory- no specific age; elderly pts; autoimmune condition; symmetrical;pain-rest pain still there labs: ^ESR (inflammatory condition) measures how fast RBSmove; positive rheumatoid factorHerniated slip disk (intervertebral disk) If a pt with a known herniated disk c/o rt/ltbuttocks pain is a result of?
musclespasmon herniateddisk
computation: dr orders medication0=7.5 mg IM BIDS= 10mg/mL7.5X 1ml = 0.75 ml10when you have a pt with AKA= what type of dressing=
compressiondressingwhat isimmediatenursinginterventionif dressingcomesoff? Rewrapcompressionstocking
Compartment syndrome= increased pressure in a muscle compartment= Fasciotomy=opening into fascia do muscles decrease in size decrease in edema > wound care=moist sterile normal saline dressingWhen giving a flu vaccine first question to ask = ask if they are allergic to eggspulmonary emphysema- CO2 maximum of 2 liters to patientsSystemic lupus- s/sx- butterfly rash; polymyalgia (muscle pain); polyarthalgia (jointpain)If a pt fractures a leg what kind of acute pain will he have= nonseceptive pain- pain 6months or lesswhat do you do with a cast -- elevate the leg to release edema and swelling; how longdo you allow for cast to dry 24-48 hrs; NI- tap on cast for itching or apply coldcompressesGI: liver cirrhoses - crackles- pulmonary overload- no flat veins; no increase urineoutput; no rapid pulsenurse plan of care knowing which of the following american asian- they believe in Yinand Yangalbuterol- bronchodilator; tachycardia; asthma; respiratory distressCOPD (resp. acidosis) when you have a pt ventilator dependent alarm is going on >What is initial NI when trying to trouble shoot for ventilator that keeps alarming- Useambubag for patient - ventilator not workingOsteoarthritis- pain in the joints; dull aching painyoung female pt going for cxr- are you pregnantwhen you are assisting client going for pulmonary angiogram? are you allergic to seafoodwhat manifestation to indicate you are allergic to contrast medium? Respiratorydistress
if you have a pt w/ a fx and cant feel anything on lt finger and slow capillary refill anddecrease pulses what do you do first? Call physician because it is life threateningIf a pt has pulmonary TB what are not manifestations? Mark all that apply- no stridor,no fever; non productive cough, chills, anorexia, wt loss, night sweatsif you have a pt who went for ORIF of hip- when trying to turn pt do not cross legs useabduction pillow (away from mid-line)compartment syndrome- from a severe fx pt asks how did he develop compartmentsyndrome? Swelling in muscle unable to expand. increase pressurept w/ multiple trauma admitted to hosp w/ fx and placed a cast, in positioning leg w/ cast what do you do? elevate legs continuosly for 24 hours to decrease presence ofedemawhat is this diformity- pt goes to er for lower leg, injured leg looks shorter and smallerthan other leg; painful and ecchymosis? Contusion fractureSPrain- jointSTrain- muscleskin traction- use bandagesskeletal traction- pins goes into bonesPt asking nurse why do you need box extension traction (example of skin traction)before going too surgery, what is the purpose?
to decreasemusclespasms
pt w/ pulmonary TB- DX = sputum culture-Imodium- anti-diarrrheaPt has chest tube- monitor for Subcutaneous emphysema> crepitus secondary toemphysema> refers to airpt went for sx, pt diet changed from NPO to clear liquids, what should pt have beforegiving clear liquids? bowel sounds; normal BS is 4-32pt went for EGD, what is highest priority for this client? GAG reflex (any procedure thatgoes through the throat)if a pt goes for chemo what is sx: nausea, anemia, neutropenia, depressed bonemarrow= decreased RBC, WBC, Platelets, (-penia is decreased) which of thefollowing will you not expect for chemotherapyif your patient has chronic gastritis (stomach) what do you have to absorb vitamin B12(decrease b12=pernicious anemia) ? IF (intrensic factor)what is your NI priority if your patient has multiple myeloma (bone marrow)? increasefluid intake (proper hydration)characteristic myeloma-dumping syndrome- rapid emptying of stomach contents from duodenum; what aremanifestations= pale;
(no dry skin, bradycardia, no double vision)What are you going to tell pt after a CT scan w/ dye?
warmflushingsensationas youinject into body,
fluids will not be restricted, not painful, test does not take 2-3 hrspt w/ acute pancreatitis what 2 enzymes will be affected? Amylase and Lipase; whatposition do you avoid= supine (flat)

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