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TABLE OF CONTENTS Fluids and Electrolytes............

Acid-Base Balance................... . Burns....................................... .

13 16

Oncology.................................. .............................................................................. 22 Endocrine................................ .............................................................................. 3 Cardiac.................................... .............................................................................. !2 "syc#iatric Nursing................. . %astrointestinal....................... . Neuro....................................... .. )aternity Nursing................... $1 &2 1'( 11(

*es+iratory.............................. .............................................................................. 13& Ort#o+edics............................. *enal........................................ ,uestions................................. Final T#oug#ts........................ E-aluations.............................. Ta.le o/ Contents /or C0........ "ediatric................................... 1(( 1!' 1! 1$ 1 6 .1 .1 &

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NOT1CE TO FAC2LT3 All 4aterials used during any 5urst *e-ie6 Ser-ices se4inar are co+yrig#ted and are not /or use 6it#out t#e sole +er4ission o/ )arlene 5urst in any /or4 or /as#ion. T#is 4aterial is not intended /or lecture use .y any Sc#ool o/ Nursing 6it#out +er4ission. NOT1CE TO ST20ENTS 1/ you are a student 6#o #as o.tained t#is .oo7 /ro4 a +ast +artici+ant o/ 4y 6or7s#o+s . . . . .S5A)E8 S5A)E8 S5A)E999 "lease understand t#at t#is .oo7 is 6ritten to acco4+any t#e li-e or -ideo lectures +resented in t#e class itsel/ or 4y 1nternet Tutorials. T#is .oo7 is only an outline o/ 6#at is needed to +ass NCLE:. 1 #o+e you 6ill ;oin 4e in a li-e or -ideo class or on t#e 1nternet to rea+ t#e /ull .ene/its o/ 4y 4aterials. %eneral Class 1n/or4ation - "lease turn o// ALL cell +#ones and +agers. -T#is class )A3 NOT .e recorded in any 4anner. <T#is included ta+e recording or -ideoing.= -Class Ti4e> A)-(") ? "lease note t#at eac# class is +resented in a +articular se@uence i/ your instructor co4+letes t#e 4aterial /or t#at day8 you 4ay get out +rior to ( ").

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FL210 AOL2)E E:CESS> 53"E*AOLE)1A Define: too much volume in the l. Causes: a. CHF: heart is___________, CO __________, decreased___________ erfusion, !O__________ "the volume sta#s in the__________________ $. RF: %idne#s aren&t____________________ a. 'l(aselt)er Fleets enemas 'll * have a lot of___________________ +,F with -a $. 'ldosterone .steroid, mineralocorticoid/ 0here does aldosterone live1 2-ormal action: when $lood volume 3ets low .vomitin3, $lood loss, etc./ 4aldosterone secretion increases4 retain NaB6aterC $lood volume ______ "" Diseases with too much aldosterone: 2also seen with liver disease and heart disease 1._______________________ 2. ""Disease with too little aldosterone: 1.

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e. A05 <anti-diuretic #or4one= -ormall# ma(es #ou retain or diurese1 Retain1__________________________ 2 'DH ro$lems 5oo 6uch Retain Fluid ,olume S+'DH S#ndrome of +na ro riate 'DH Secretion !rine 8lood "Concentrated ma(es 9:s 3o u "Dilute ma(es 9:s 3o down s ecific 3ravit#, -a -ot enou3h 7ose .diuese/ Fluid ,olume D+ Dia$etes +nsi idus !rine 8lood

'DH lives in ituitar#; (e# words to ma(e #ou thin( otential 'DH ro$lem: craniotom#, head in<ur#, sinus sur3er#, trans henoidal h# o h#sectom# "'nother name for anti2diuretic hormone .'DH/ is ,aso ressin. 5he dru3 ,aso ressin .=itressin or DD',= .Desmo ressin acetate/ ma# $e utili)ed as an 'DH re lacement in Dia$etes +nsi idus.

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f. S?S@ of F,A: Distended nec( veins? eri heral veins: vessels are________________ =eri heral edema, third s acin3: vessels can&t hold an#more so the# start to C,=: measured where1______________________; num$er 3oes_________ 6ore ....6ore 7un3 sounds: =ol#uria: (idne#s tr#in3 to hel #ou__________________________ =ulse:________________; #our heart onl# wants fluid to 3o__________________ +f the fluid doesn&t 3o forward it&s 3oin3 to 3o_______________into the__________ 8=:_______________________ move volume................more

0ei3ht:____________________ an# acute 3ain or loss isn&t fat2it:s fluid 3. 5reatment: 7ow -a diet Diuretics 7oo "8ume@B ma# $e 3iven when 7asi@B doesn:t wor(. 5hia)ide .HC5C/ %2s arin3 8ed rest induces_____________________ "when #ou are su ine #ou erfuse #our (idne#s more h. +nterventions: =h#sical 'ssessment Dive +,F:s slowl# to elderl# " 0atch la$ wor( with all diuretics "Deh#dration and electrol#te ro$lems

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FL210 AOL2)E 0EF1C1T> 53"OAOLE)1A 8i3 5ime DeficitFShoc( l. Causes: 7oss of fluids from an#where 5horacentesis, aracentesis, vomitin3, diarrhea, hemorrha3e 5hird s acin3 .when fluid is in a lace that does #ou no 3ood/ "$urns "ascites Diseases with ol#uria 2. 0ei3ht Decreased S(in 5ur3or Dr# mucous mem$ranes Decreased !rine Out ut (idne#s either aren&t $ein3___________________or the# are tr#in3 to _________ 8=1______________ .less , less______________________/ =ol#uria2 Oli3uric2 'nuric2

=ulse1_____________, heart is tr#in3 to um what little is left around C,=1 ___________, less volume, less__________ =eri heral ,eins?-ec( veins Cool A@tremities . eri heral______________in an effort to shunt $lood to __________________/ !rine S ecific Dravit# 2. 5@and-ursin3+nterventions:6ild Deficit: Severe Deficit: , if uttin3 out an# urine at all it will $e_____

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,uic7ie 1A Fluid Lecture +sotonic: Do in the vascular s ace and sta#s thereH A@am les of +sotonic Solutions: _______________ H# otonic: Do in the vascular s ace, han3 out a little while and reh#drate, $ut the# do not sta# in the vascular s ace......+f the# sta#ed in the vascular s ace the# wouldn&t $e h# otonic.......the# would $e______________________. 5hese solutions 3o in and han3 out and reh#drate, then the# move into the cell and the cell $urns the remainder u in cellular meta$olism. 5he# are h#dratin3 solutions, $ut the# won&t drive #our ressure u $ecause the# do not sta# in the vascular s ace. H# ertonic Solution: 2 ,olume e@ ander and solution that draws fluids into the vascular s ace. 2 A@am les: D1I0, *J -aCl, EJ -aCl, DE 7R, DE K2 -aCl, DE -aCl, 5=H# otonic Solution: 2 Causes a fluid shift from the vascular s ace into the cells. 2 A@am les: D2.E 0, K2 -aCl, I.**J -aCl

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)A%NES12) AN0 CALC12) Fact: 6a3nesium is e@creted $# 7idneys and it can $e lost other wa#s, too .D+ tract/ 5y+er4agnese4ia Causes: Renal Failure 'ntacids 5y+ercalce4ia Causes: H# er arath#roidism: too much 5hia)ides .retain__________/ +mmo$ili)ation .#ou have to $ear wei3ht to (ee Ca in ____________________/ $ones =ulse (idne# stones "ma<orit# made of calcium 5@: 6oveH FluidsH =hos ho Soda M Fleets enema 2$oth have hos horous "Ca has inverse relationshi with .

D5R&s 6uscle 5one Flushin3 'rrh#thmias 0armth 7OC 63 ma(es #ou________________ Res irations 5@: ,entilator Dial#sis Calcium 3luconate "Calcium 3luconate in the resence of ma3nesium2 the# inactivate each other

0hen #our serum calcium 3ets low 51NT> 1/ you 6ant to get )g arathormone .=5H/ (ic(s in and ulls Ca from the________________and uts in the $lood... .therefore, the serum____________3oes u Review . Hurst Services

"0hen #ou drive =hos u , Ca 3oes_______________. D Ca @uestions rig#t8 t#in7 4uscles 1st. Steroids 'dd what to diet1 Safet# =recautions1 "6ust have ,itamin _____ to use Ca. "Calcitonin serum Ca

53"O)A%NESE)1A Causes: Diarrhea 2 lots of 63 in intestines 'lcoholism "alcohol su resses 'DH M it:s h# ertonic 2not eatin3 2drin(in3

53"OCALCE)1A Causes: H# o arath#roidism Radical -ec( 5h#roidectom#

-o An tou3h .

51NT> 1/ you 6ant to get )g D Ca @uestions rig#t8 t#in7 4uscles 1st. S?S@: 6uscle 5one 2Could m# atient have a sei)ure1 Stridor?lar#n3os asm 2 airwa# is a_______________________ OChvoste(&s 2 ta chee( O5rousseau&s 2 um u 8= cuff 'rrh#thmias 2 heart is a D5R&s 6ind Chan3es Swallowin3 =ro$s 2 eso ha3us is a___________ 5@: Dive some 6D Chec(__________function .$efore and durin3 +, 63/ -C7AP scenario answers:
'. 8. C. D. call the doctor decrease the infusion Sto the infusion Reassess in 1E min.

5@: ,it D 'm ho3elB =hos horous $indin3 dru3 +, Ca 'lwa#s ma(e sure on a

Sei)ure =recautions 0hat do #ou do if #our atient $e3ins to c?o flushin3 and sweatin3 when #ou start +, 631

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SO012) Kour -a level in #our $lood is totall# de endent on how much 6ater #ou have in #our $od#. 5y+ernatre4iaE0e#ydration 5oo much -a; not enou3h water Causes: h# erventilation heat stro(e D+ S?S@: Dr# mouth 5hirst# 2 alread# deh#drated $# the time #ou&re thirst# Swollen ton3ue -euro chan3es 2 8rain doesn&t li(e it when -a&s messed u 5@: Restrict Dilute t with +, Fluids 5@: =t needs =t doesn&t need . 2 s#cho3enic ol#d# sia "loves to drin( 2DE0 .su3ar M water/ 2S+'DH 5y+onatre4iaE0ilution 5oo much water; not enou3h -a Causes: 2vomitin3, sweatin3 then drin(in3 H2O "this onl# re laces the water

Dilutin3 ma(es serum -a 3o________________________ +f havin3 neuro ro$s: -eeds h# ertonic saline Dail# wei3hts 2means R ac(ed with articlesR +f #ou&ve 3ot a -a ro$lem #ou&ve +MO 3ot a_______________ ro$lem. *2EJ -S 7a$ wor(
Feedin3 tu$e ts 2 tend to 3et

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"OTASS12) A@creted $# 7idneys %idne#s not wor(in3 well, the serum otassium will 3o______________________ 5y+er7ale4ia Causes: (idne# trou$les aldactone 2 ma(es #ou retain_______________. 5y+o7ale4ia Causes: 2vomitin3 2-D suction 2diuretics 2not eatin3 S?S@: 8e3ins with muscle twitchin3 5hen roceeds to wea(ness, 5hen flaccid aral#sis 5@: Dial#sis 2 %idne#s aren&t wor(in3 Calcium 3luconate 2decreases 7ife2 5hreatenin3 'rrh#thmias S?S@: 6uscle Cram s M wea(ness
0e have lots of % in our stomach

5@: Dive %H 'ldactone

Aat % Dlucose and insulin 2 +nsulin carries_______________M________________ into the cell 2 'n# time #ou 3ive +, insulin worr# a$out__________________M %ae@alateB 2 3iven for h# er(alemia 2 e@chan3es -a for % in the D+ tract Sodium and =otassium have an relationshi

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EFtras9 6a<or ro$lem with =O %1 'ssess !O $efore?durin3 +, %. 'lwa#s ut +, % on a______________________________. 6i@ wellH -ever 3ive +, %__________________________________H 8urns durin3 infusion1 +s it o(a# to add to a $a3 that&s alread# u and runnin31

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AC10-BASE BALANCE 6a<or chemicals #ou have to remem$er F 8icar$, H#dro3en, CO2 7un3 chemical4CO 2 %idne# chemicals 48 and H 5here&s onl# one wa# to 3et rid of CO2. 0hat is it1 5hese chemicals can either ma(e #ou sic( or com ensate. +t de ends on which i4.alance #ou have. +n res irator# acidosis?al(alosis, which or3ans are sic(1 0ho&s 3oin3 to fi@ ever#thin3 .com ensate/1 0hat are the chemicals the (idne#s use to com ensate with1 +n meta$olic acidosis?al(alosis which or3ans are sic(1 +f the# are sic(, who&s 3oin3 to fi@ thin3s .com ensate/1 0hat is the onl# chemical the lun3s have to com ensate with1 Do the lun3s com ensate slowl# or Suic(l#1 Do the (idne#s com ensate slowl# or Suic(l#1

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Co4+ensation meta$olic

acidosis res irator# (idne#s com ensate retain?secrete 8 e@crete H 8icar$ on '8D:s ____ al(alosis meta$olic lun3s com ensate RR _____to save CI2 =CO2 ______ res irator# (idne#s com ensate e@crete 8 retain H 8icar$ on '8D:s ____

lun3s com ensate RR _____ to $low off CI2 =CO2________

*es+iratory Acidosis .h# oventilatin3/ +s this a lun3 ro$lem or a (idne# ro$lem1 0hat&s the ro$lem chemical1 Do we have too much or too little of this chemical in the $od#1 How did this ha en1 0ho&s 3oin3 to com ensate1 +ncreased CI24Decreased 7OC +ncreased CI2 4 Decreased I2 5reatment4 Fi@ the ro$lemHHHH Dru3 to hel correct acidosis1 8e aware of dru3s that decrease RR. Restless t1
Hurst Review Services Restlessness thin( H# o@ia F+RS5 1>

H# o@ia ma# $e one of the first si3ns of Res irator# 'cidosis

earl# h# o@ia

late h# o@ia

*es+iratory Al7alosis .h# erventilatin3/ 5hin( a$out the name. 0ho:s sic(1_______________________ Situation: H#sterical atient. 0ell, are we 3oin3 to wait until the (idne#s (ic( in1 8reathe into a_____________________________ ________________________________________. 6a#$e sedate. 5P: 5reat the ro$lem. )eta.olic Acidosis 5hin( a$out the name. 0ho:s sic(1_______________________ 0ho:s 3oin3 to com ensate1_________________ Scenario: D%', Starvation 0hen #ou&re starvin3 #ou $rea( down __________, roduce __________, (etones are__________. 5P: 5reat the ro$lem )eta.olic Al7alosis 5hin( a$out the name. 0ho:s sic(1 Scenario: ,omitin3 5P: 5reat the ro$lem. 0hat would these cause1 =neumothora@ =neumonia 'l(a Selt)er?'ntacids -D to suction Contusion to lun3 arench#ma 8ro(en ri$s =atient 3ettin3 lots of +,= $icar$ Hint: 'n#time #ou have oor 3as e@chan3e, thin( Res irator# 'cidosis R. acid R. acid R. acid R. acid R. acid R. acid R. acid R. al( R. al( R. al( R. al( R. al( R. al( R. al( 6. acid 6. acid 6. acid 6. acid 6. acid 6. acid 6. acid 6. al( 6. al( 6. al( 6. al( 6. al( 6. al( 6. al( 0ho:s 3oin3 to com ensate1

0ho:s 3oin3 to com ensate1

Factoid: acidosisFh# er(alemia .acidosis ma(es % lea( out of cell/ al(alosisFh# o(alemia .al(alosis ushes % $ac( into the cell/ Hurst Review Services


B2*NS 25he ris( of death increases in the ver#______________and the ver#___________________. 20here do most $urns occur1 2'fter a $urn man# different atho h#siolo3ical chan3es occur. 0HK1 a. $. c. 0h# does lasma see out into the tissue1 +ncreased ermea$ilit# 0hen does the ma<orit# of this occur1 0h# does the ulse increase1 'n#time #ou&re in a F,D, =ulse_________________ 0h#doesthecardiacout utdecrease1 7ess____________to um out.

d. e. f. 3.

0h# does the urine out ut decrease1 %idne#s are either tr#in3 to hold on or the# aren&t $ein3 0h# is e ine hrine secreted1 6a(es #ou , shunts $lood to vital or3ans

0h# are 'DH and aldosterone secreted1 Retain____________M_____________with aldosterone and Retain with 'DH 5herefore #our $lood volume will 3o__________________

20hat is the most common airwa# in<ur#1___________________________________ ____________________________________________________________________ oisonin3 2-ormall# o@#3en should $ind with hemo3lo$in. Car$on mono@ide can run much faster than o@#3en . . . . 5herefore, it 3ets to the hemo3lo$in first and $inds . . . . . Can o@#3en $ind now . . . . #es?no 2 Car$on mono@ide oisonin3 cannot $e determined with O2 saturations; the sat monitor ic(s u an#thin3 that is $ound to hemo3lo$in so if car$on mono@ide is $ound to the H$ then the sat ma# a ear normal 2 Car$o@#hemo3lo$in: $lood test to determine car$on mono@ide oisonin3 -ow the atient is .

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From this information do #ou thin( it would $e im ortant to determine if the $urn occurred in an o en or closed s ace1 20hen #ou see a atient with $urns to the nec(?face?chest #ou had $etter thin( what1 2' atient is $urned over >IJ of their $od#. How do #ou thin( this is determined1 "Astimate of 5otal 8od# Surface 'rea HeadF_____________Aach armF____________Aach le3F___________ 'nterior trun(F__________=osterior trun(F__________ DenitaliaF 2One of the most im ortant as ects of $urn mana3ement is 2+t is not uncommon for al$umin to $e 3iven after a ma<or $urn. .-ot 3iven durin3 the first 2> hours/. Kou (now that al$umin holds onto_______________in the vascular s ace. 25his will increase?decrease the vascular volume. 20hat will it do to (idne# erfusion1 20hat will it do to 8=1 20hat will it do to cardiac out ut1 20ill this hel correct a fluid volume deficit1 20hen #ou start 3ivin3 a atient al$umin #ou (now that the vascular volume will increase. 0hat will ha en to the wor( load of the heart1 2+f #ou stress the heart too much #ou (now that the atient could $e thrown into fluid volume __________________. 2+f this occurs what will ha en to CO1 20hat will the lun3 sounds $e li(e1 2On an# atient who is receivin3 fluids ra idl#, what is a measurement .hint: heart/ #ou can ta(e hourl# to ma(e sure #ou:re not overloadin3 them1 2+s it im ortant to (now that the $urn occurred at 11:II .m.1 0h#1 8ecause #ou (now that fluid thera # .for the first 2> hours/ is $ased on the time the in<ur# occurred, not when treatment was started. .

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Common rule: Calculate what is needed for the first 2> hours and 3ive half of it durin3 the first N hours. 5his is the =ar(land Formula. 1st N hours F 1?2 of total volume 2nd N hours F 1?> of total volume *rd N hours F 1?> of total volume 5o calculate fluid re lacement ro erl# #ou also need to (now the atient:s wei3ht and 58S' affected. +f the atient is restless it ma# mean fluid re lacement is inadeSuate, ain, or h# o@ia. "=riorit#: ____________________ +f #ou had to ic(, which of the followin3 would #ou choose to determine if a atient:s fluid volume is adeSuate1 5heir wei3ht or their urine out ut1 2' atient:s res irations are shallow. Kou (now the# are retainin3 what1 5herefore, which acid2$ase im$alance will the# have1 2' atient was 3iven onl# E m3 of 6or hine when the order was for a ma@imum of 1Im3. 0h# did the nurse do this1 20h# are +, ain meds referred over +6 with $urns1 20h# is the atient 3iven a tetanus to@oid lus the immune 3lo$ulin1 .1/ .2/ 5etanus 5o@oid: "ta(es 22> wee(s to 3et the '8:s +mmune 3lo$ulin: thin( immediate rotection er or lower $od# $urns1 .active immunit#/ . assive immunit#/

2Do #ou thin( there is more death with u

2' atient has a circumferential $urn on their arm. 0hat does this mean and what should #ou $e chec(in31 2+f a atient:s vascular chec(s in this arm are $ad the doctor ma# do what rocedure to relieve ressure1 2' atient was wra ed in a $lan(et to sto the $urnin3 rocess. Since the flames are 3one does that mean the $urnin3 rocess had sto ed1 20hat else could have $een done to sto the $urnin3 rocess1 2How else did the $lan(et hel 1 Held in____________________ __________________________________________________and (e t out________________
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20h# is it im ortant that <ewelr# $e removed1

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20hat (inds of thin3s do #ou loo( for to determine if an# airwa# in<ur# has occurred1 2' fole# catheter was inserted so #ou could measure urine out ut. 2How often will this need to $e monitored1 2+s it ossi$le that when #ou insert the catheter that no urine will return1 0h#1 %idne#s are either attem tin3 to______________the fluid or the# mi3ht not $e $ein3 erfused adeSuatel#. 20hat would #ou do if the urine was $rown? red1 2+f there is no urine out ut or if it is less than 2Icc?hour, what would #ou start worr#in3 a$out1 20hat dru3s mi3ht $e ordered to increase (idne# erfusion1 2'fter >N hours, the atient will $e3in to diurese. 0h#1 8ecause fluid is 3oin3 $ac( into the ________________s ace. -ow we have to worr# a$out fluid volume_________________. 0hat will naturall# ha en to urine out ut durin3 this time1 25he atient:s serum otassium level is E.N. Kou (now that otassium li(es to live inside or outside of the cell1 0ith a $urn, what ha ens to cells1 So, what ha ens to the num$er of otassiums in the serum .vascular s ace/1 5herefore, #ou $etter monitor #our atient for which electrol#te im$alance1 h# o(alemia or h# er(alemia 20h# do #ou thin( 6#lantaB, =rotoni@B, =e cidB, and Re3lanB are ordered1
'ntacids: aluminum h#dro@ide, 'm ho3elB, or ma3nesium h#dro@ide, 6il( of 6a3nesiaB H2 'nta3onist: Cantac B, =e cid B,'@id B =roton =um +nhi$itors: =rotoni@ B, -e@iumB

20h# do #ou thin( the doctor wants the atient to $e -=O and have an -D5 hoo(ed to suction1 2+f a atient doesn:t have $owel sounds, what will ha en to the a$dominal 3irth1

2Do #ou thin( the atient will need more or less calories than $efore1 25he -D5 will $e removed when #ou hear what1
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20hen #ou start D+ feedin3s, what could #ou measure to ensure that the su lement was movin3 throu3h the D+ tract o(1 20hat is some la$ wor( #ou could chec( to ensure ro er nutrition and a ositive nitro3en $alance1 2Since the atient has 2nd and *rd de3ree $urns, is it ossi$le that the# could have ro$lems with contractures1 2Since the# have $urns on their hands, what are some s ecific measures that ma# $e ta(en1 2-ec(1 2+f a atient has a erineal $urn, what do #ou thin( the num$er one com lication will $e1 20hat is eschar1 2Does it have to $e removed1 2+f it:s not removed can new tissue re3enerate1 20hat li(es to 3row in eschar1 20hat t# e of isolation will #ou use with the atient1 25ravaseB or Colla3enaseB: en)#matic dru34O eats dead tissue 2Don:t use on face 2Don:t use if re3nant 2Don:t use over lar3e nerves 2Don:t use if area o ened to a $od# cavit#

2H#drothera # is also used to de$ride.

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Co44ondrugsused6it#.urns> a. SilvadeneB2soothin3, a l# directl#, if ru$s off a l# more, can lower the 08C, can cause a rash $. Sulfam#lon2can cause acid $ase ro$lems, stin3s, if it ru$s off a l# more c. Silver nitrate2(ee these dressin3s wet; can cause electrol#te ro$lems d. 8etadine B2stin3s, stains, aller3ies, acid2$ase ro$lems 20h# should these dru3s $e alternated1 28road s ectrum anti$iotics are avoided to revent su er2infections. However, the# will $e used until the wound cultures have returned. 2+f 3raftin3 is done, a ressure dressin3 will $e a lied in sur3er#... .5hen when the $leedin3 has sto ed the wound will $e left o en to air. 2+f the s(in 3raft should $ecome $lue or cool what would this mean1 2Sometimes the doctor will order for #ou to roll sterile T2ti s over the 3raft with stead#, 3entle ressure from the center of the 3raft out to the ed3es. 0h#1 2+f a atient has a chemical $urn what do #ou do1 2+f the atient has an electrical $urn there will usuall# $e 2 wounds. 0hat are the#1 2+f a atient comes in with an electrical in<ur# what is the first thin3 #ou should do1 20hat arrh#thmia is this atient at hi3h ris( for1 20ith electrical $urns to@ins can $uild u and cause___________________dama3e. 2+t is not uncommon for this atient to $e laced on a s ine $oard with a c2collar. 0h#1 Alectrical in<uries tend to occur in________________ laces. 2're am utations common1 0h#1

2Other com lications of electrical wounds: cataracts, 3ait ro$lems, and <ust a$out an# t# e of neurolo3ical deficit.

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ONCOLO%3 %eneral 1n/or4ation> 2 'lcohol O to$acco F co2carcino3enic 25o$acco is the 91 cause of reventa$le cancer. 2Sus ected dietar# causes of cancer: 2 7ow fi$er diet 2-itrites . rocessed sandwich meat/ 2 +ncreased red meat 2 'lcohol 2 +ncreased animal fat 2=reservative and additives -+ncreased incidents of cancer in the immunosu ressed "that is wh# there is a hi3her incident of cancer U a3e GI 25he most im ortant ris( factor for cancer F a3in3 2Cruciferous ve33ies .$roccoli, cauliflower, and ca$$a3e/, ,itamin ' foods .Colored ve33ies/, and ,itamin C could decrease ris( 2'frican 'mericans have a 3reater incident than Caucasians. 2=rimar# =revention: 0a#s to revent actual occurrence .sunscreen and no smo(in3/ 2Secondar# =revention: !sin3 screenin3s to ic( u on cancer earl# when there is a 3reater chance for cure or control 2Chronic___________________$rin3s a$out uncontrolled 3rowth of a$normal cells. 2Female: a. 6onthl# self2 $reast e@am a. Kearl# clinical $reast e@am for women U>I #ears old 2 8etween a3es 2I2* Q needed ever# * #ears $. 'nnual elvic e@am $. =a smear ever# * #ears if there&s $een no ro$lem c. 6ammo3ram2$aseline at *E2>I, #earl# after >I .2 views of each $reast/ c. Colonosco # at a3e EI then ever# 1I #ears.

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26ale: a. 6onthl# self2$reast e@am $. 6onthl# testicular e@am 2 testicular tumors 3row fast c. Kearl# di3ital rectal e@am and #earl# =S' . rostate s ecific anti3en/ for men over a3e EI a. Colonosco # at a3e EI then ever# 1I #ears CA2T1ON> .Chan3e in $owel?$ladder ha$its; A sore that does not heal; 2nusual $leedin3?dischar3e; Thic(enin3 or lum in $reast or elsewhere; 1ndi3estion or difficult# swallowin3; O$vious chan3e in wart or mole; Na33in3 cou3h or hoarseness/ 2Cancer can invade $one marrow4 anemia and throm$oc#to enia 2 Cache@ia2 e@treme wastin3 and malnutrition 2Radiation thera #: a. +nternal Radiation .$rach#thera #/ 2 0ith all $rach#thera #, the radioactive source is inside the atient; radiation is $ein3 emitted 1. !nsealed: atient and $od# fluid emit radiation 2isoto e is 3iven +, or =O 2usuall# out of s#stem in >N hours 2. Sealed or solid: atient emits radiation; $od# fluids not radioactive 2im lanted close or in the tumor
2+n 3eneral terms, do radiation im lants emit radiation to the 3eneral environment1

2 -ursin3 assi3nments should $e rotated dail#, so that the nurse is not continuousl# e@ osed 2 5he nurse should onl# care for one atient with a radioactive im lant in a 3iven shift 2=recautions: 2 rivate room 2restrict visitors "no visitors less than 1G #ears of a3e 2no re3nant visitors?nurses 2mar( the room 2wear a film $ad3e at all times 2 limit each visitor to *I min er da# 2visitors must sta# at least G feet from source
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2How can #ou hel revent dislod3ment of the im lant1 2%ee the atient on_______________. 2Decrease_________________in the diet. 2=revent $ladder__________________. 20hat do #ou do if the im lants $ecome dislod3ed and #ou see it1 "Don:t for3et this atient is immunosu ressed.

$. A@ternal Radiation .telethera #, $eam radiation/ 2!sual side effects: usuall# limited to the e@ osed tissues "er#thema, "sheddin3 of s(in, "altered taste, "fatiSue " anc#to enia .all $lood com onents are decreased/ ""man# si3ns and s#m toms are location and dose related. 2 +s it o(a# to wash off the mar(in3s1 2 +s it o(a# to use lotion on the mar(in3s1 2 =rotect site from sun for 1 #ear after com letion of thera # 2Chemothera #: wor(s on the cell c#cle 2 !suall# scheduled ever# *2> wee(s 2 6ost Chemo dru3s are 3iven +5 via ort 2 6an# a$sor$ throu3h the s(in and mucous mem$ranes; $e careful handlin3 them 2!sual side effects: alo ecia, -?5, mucositis, immunosu ression, anemia, throm$oc#to enia 2' atient&s 08C count must $e at least_____________$efore the# will receive their treatment. 2' vesicant is a t# e of chemo dru3 that if it infiltrates .e@travasates/ will cause tissue . 20hat are s?s@ of e@travasation1

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2 5he num$er one thin3 to remem$er with e@travasation is =RA,A-5+O-H 20hat do #ou do if this ha ens1

Deneral wa#s to revent infection:

2 =rivate room 2 0ash hands 2 Have own su lies in room

2 7imit eo le .visitors and nurses/ in room 2 Chan3e dressin3s dail# and +, tu$in3 2 Cou3h and dee $reath 2 -o fresh flowers or otted lants 2 'void crowds 2 Do not share toiletries 2 8ath warm moist areas dail# 2 0ash hands after touchin3 et 2 'void raw fruits and ve33ies 2 Drin( onl# fresh water 2Sli3ht increase in tem ma# mean se sis 2'$solute neutro hil count most im ortant

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S+eci/ic Ty+es o/ Cancer> Cer-ical Cancer 2Ris( Factors: se@? re3nanc# at #oun3 a3e, re eated S5D&s 2 Often as#m tomatic in re2invasive cancer 2 +nvasive cancer classic s#m tom: ainless va3inal $leedin3 2 Other 3eneral S?S@: water#, $lood2tin3ed va3inal dischar3e, le3 ain alon3 sciatic nerve, and $ac(?flan( ain 2lIIJ cure if detected earl# 20hat is the test that hel s dia3nose this1 '$normal 1 Re eat test 5@: 2 electrosur3ical e@cision, laser, cr#osur3er# 2 radiation and chemo for late sta3es 2coni)ation2 remove art of cervi@ 2h#sterectom#

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2terine Cancer 2Ris( Factors: 3reater than EI #ears of a3e, O famil# h@, late meno ause, no re3nanc# 6a<or S#m tom: ost meno ausal $leedin3 Other s?s@: water#? $lood# va3inal dischar3e, low $ac(?a$d ain, elvic ain D@: C'212E .$lood test/ to R?O ovarian involvement 5est to evaluate for metastasis: 2CPR 2+,= 28A 2C5 2liver and $one scan

5he most definitive dia3nostic test is DMC .dilatation M curetta3e/ and endometrial $io s# 5reatment: 1. Sur3er#: H#sterectom# "5'H .total a$d h#sterectom#/ F uterus and cervi@ onl#H 5u$es M ovaries removed1 2$ilateral oo horectom# .ovaries/ 2$ilateral sal in3ectom# .tu$es/ Radical H#sterectom# 2ma# remove all of the elvic or3ans 2 t ma# have colostom#, ileal conduit

"5he 3reatest time for hemorrha3e followin3 this sur3er# is durin3 the first 2> hours. =elvic con3estion of . sure she does what in the "0ill0h#1 ro$a$l# have a fole#; if she doesn&t #ou $etter ma(e "6a<or com lication with a$d h#sterectom#1___________________ ne@t N hours1 "6a<or com lication with va3inal h#sterectom#1_________________ "0h# is it so im ortant to revent a$dominal distension after this sur3er#1 "0e do not want tension on the______________ _____________. "Dehiscence and Avisceration "0h# do we avoid hi3h2fowler&s osition in this atient1 "6a# have an a$dominal and erineal dressin3 to chec(.
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"'s this atient is at ris( for neumonia, throm$o hle$itis, and consti ation what is one thin3 #ou can do to revent these com lications1 "'void se@ and drivin3. V 'lso avoid 3irdles and douches.

"'n# e@ercise, includin3 liftin3 heav# o$<ects that increases elvic con3estion should $e avoided. "+s it ossi$le that the atient could hemorrha3e lI2l> da#s after this sur3er#1 "+s a whitish va3inal d?c o(a#1 "Showers or $aths1 2. Radiation: intra2cavitar# radiation to revent va3inal recurrence *. Chemothera #: Do@oru$icinB, Cis latinB >. Astro3en inhi$itors: De ro2=roveraB, 5omo@ifenB, -ovade@B

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Breast Cancer 2 One has a * fold ris( increase of develo in3 $reast cancer if a first de3ree relative .mother, sister, dau3hter/ had re2meno ausal $reast cancer 2 %nown ris( factors: 2Hi3h dose radiation to thora@ rior to a3e 2I 2=eriod onset rior to a3e 12 26eno ause after a3e EI 2-o re3nancies .null arit#/ 2First $irth 3reater than *I 2S?S@: Chan3e in the a earance of the $reast .oran3e eal a earance, dim lin3, retraction, dischar3e from $reast/, or lum 25ail of S ence: 25@: 1. Sur3er# 2=ost2o care 28leedin31 2 dressin3s, $ac(, hemovac, Wac(son2 =ratt drain 2Alevate arm on side

2'ssociated nursin3 care: Sta# awa# from arm on affected side for lifetime of atient: -o constriction, no 8=&s or in<ections, wear 3loves when 3ardenin3, watch small cuts, no nail $itin3, and no sun$urn, no +, 28rush hair, sSuee)e tennis $alls, wall clim$in3, fle@ and e@tend el$ow. 0h#1 =romotes___________circulation 27oo( at incision 2Reach to Recover# .Su ort Drou /

27#m hedema " 5wo functions of the l#m hatic s#stem: fi3hts infection and romotes draina3e 1. Chemothera # dru3s: 5a@olB, 'driam#cinB 2. Astro3en rece tor $loc(in3 a3ents: 5om@ifenB .-olvade@B, 5amofenB/ *. Astro3en s#nthesis inhi$itors: 7u ronB, Colade@B E. Radiation
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Lung Cancer 27eadin3 cause of cancer death worldwide 2E Kear survival rate is 1>J 6a<or ris( factor: Smo(in3 "when #ou have sto ed smo(in3 for 1E #ears, the incidence of lun3 cancer is almost li(e that of a non2smo(er S?S@: hemo t#sis, d#s nea .ma# $e confused with 5$, $ut 5$ has ni3ht sweats/, hoarseness, cou3h, chan3e in endurance, chest ain, leuritic ain on ins iration, dis laced trach "ma# metastasi)e to $one D@: a. 8ronchosco # 2-=O re and -=O until_____________________returns 20atch for res irator# de ression, hoarseness, d#s ha3ia, ST em h#sema $. S utum s ecimen time to o$tain1 2+s this sterile1 20hat should the t do first1 "5r#in3 to decrease $acterial count in the mouth. $. C5 d. 6R+ 5@: Sur3er#: 5he main t@ for sta3e + and ++ a. 7o$ectom#: 2chest tu$es and sur3ical side u a. =neumonectom# 2=osition on_______________s i d e 2 -o chest tu$es. 0h#1 'void severe lateral ositionin34 mediastinal shift B 28est

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Laryngeal Cancer Ris( factors: Smo(in3 .an# form of to$acco use/, alcohol, voice a$use, chronic lar#n3itis, industrial chemicals S?S@: Hoarseness, difficult# swallowin3, $urnin3, sore throat, swellin3 in nec(, loss of s eech, no earl# si3ns, mouth sores, lum in nec(, color chan3es in mouth?ton3ue, dentures do not fit an#more, unilateral ear ain D@: 7ar#n3eal e@am, 6R+ 5@: 1. Sur3er#: 5otal lar#n3ectom# .removal of vocal cords, e i3lottis, th#roid cartila3e/ 2Since the whole lar#n@ .remem$er this includes the e i3lottis/ is removed this atient will have a ermanent _____________________________. 2=osition ost2o 1 2-D feedin3s to rotect the suture line . eristalsis could disru t suture line/ 26onitor drains 20atch for carotid arter# ru ture 2Ru ture of innominate arter#2medical emer3enc# 2FreSuent mouth care 2 de cr ea s e $ ac te ri a l c ou nt in th e mo ut h 2 -=O atients tend to 3et neumonia 28i$ .acts li(e a filter/ 2Humidified environment "Remem$er, with a total lar#n3ectom# '77 $reathin3 is done throu3h the stoma. 1. Radiation *. Chemothera # O$turater Can #ou atient with a total lar#n3ectom# .... 0histle1 ______ !se a straw1 Hurst Review Services Smo(e1 Swim1


Suctionin3 2Sterile or -on2sterile techniSue1 2H# ero@#3enate when1 20hen do #ou sto advancin3 the catheter1 2' l# suction when1 "Don:t $e mean.B

2+ntermittent or continuous1

2Suction no lon3er then__________seconds. 20atch for arrh#thmias. 20hich nerve can $e stimulated1 20hen va3us nerve is stimulated, heart rate___________ 2 +s this atient h# o@ic1

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Colorectal Cancer <C*C= 26a# start as a ol# 22?* colorectal cancer occurs in the rectosi3moidal re3ion 2 6ost freSuent site of metastasis: liver 2ta(e $leedin3 recautions 2 Other ro$lems to watch for: 8owel o$struction, erforation, fistula to $ladder?va3ina 2Ris( Factors: inflammator# $owel diseases, 3enetic, chronic consti ation .retainin3 carcino3ens/, dietar# factors .refined car$s, low fi$er, hi3h fat, red meat, fried and $roiled foods/, if #ou have a first de3ree relative with CRC #our ris( <ust increased *P the norm 2 QEJ of those who 3et CRC are U EI #ears old 2Screenin3: 2Fecal occult $lood testin3 should $e3in at EI 2Fle@i$le si3moidosco # ever# E #ears after a3e EI or colonosco # ever# 1I #ears after a3e EI 25he definitive test for CRC F colonosco # S?S@: 26ost common si3ns are: rectal $leedin3, anemia, and chan3es $owel ha$its? stool 2Other S?S@: $lood in the stool, va3ue a$dominal ain, fati3ue, a$d fullness, une@ lained wei3ht loss 26a# $ecome o$structed .visi$le eristaltic waves with hi3h itched tin3lin3 $owel sounds/ 5@: 2Sur3er#, radiation and chemo .DOCF E2F!B/ 26a# have a colostom# ost2o a. colectom#2 art of colon removed 2ma# not need colostom# $. a$domino2 erineal resection2removal of colon, anus, rectum "Can #ou ta(e a rectal tem on this client1
5hin3s that should $e avoided for >N hours rior to collection of stool sam le: 'S', ,it C, an# anti2 inflammator# dru3, and erio@idase containin3 foods .$eets, horseradish/

Don:t ta(e rectal tem if throm$oc#to enic, a$dominal2 erineal resection, immunosu ressed.

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Bladder Cancer 2Dreatest ris( factor: smo(in3 26a<or S#m tom: =ainless intermittent 3ross?microsco ic hematuria D@: C#stosco # 5@: Sur3er# .all? art of $ladder/ 2 !rinar# diversion .urostom#/ 2+leal conduit .a iece of the ileum is turned into a $ladder; ureters are laced in one end; the other end is $rou3ht to the a$d. surface as a stoma/ 26a# $e im otent 2Hourl#______________ 2+ncrease fluids: .____________________2________________cc of fluid er da#/ 2flush out conduit 26ucus normal1 2 +ntestines alwa#s ma(e mucus 2Chan3e a liance in a.m. .5his is when out ut will $e at its lowest/.

"+t is O% to lace a little iece of > P > inside stoma durin3 s(in care to a$sor$ urine... .<ust don:t for3et to remove it.

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"rostate Cancer

25his t. comes to the doctor with s?s@ of $eni3n rostatic h# er lasia .8=H/: hesitanc#, freSuenc#, freSuent infections, nocturia, ur3enc#, dri$$lin3. 2 6ost common si3n is 3ross ainless hematuria 2Di3ital rectal e@am done and rostate is hard? nodular; this usuall# means rostate cancer. D@: 1. 7a$ wor(: 2=S' increased 2 =rostatic S ecific 'nti3en .=S'/ 2 this is a rotein that is onl# roduced $# the rostate 2 normalF X> n3?ml 2 if #ou have a two or more 1st de3ree relative with rostate C', start =S' $# at least a3e >E 2al(aline hos hatase .if Y means $one metastasis/ " rostate Ca li(es to 3o to s ine, sacrum, and elvis 2+ncreased acid hos hatase 1. 8io s# 2when rostate C' is sus ected, a $io s# must $e done for confirmation rior to sur3er#. 25@: 1. 0atchful 0aitin3: in earl# sta3es .for as#m tomatic, older adults with other illnesses/ 1. Sur3er#: a. Radical =rostatectom# .done with locali)ed rostate C'/ 2ta(e out the rostate and the atient is cancer free 2ma# have AD due to udendol nerve dama3e 2ma# have incontinence .%e3el/ 2 atient is sterile 2if there is no l#m h node involvement, no Y in acid hos hatase, and no metastasis the sur3eon will tr# to reserve the udendol nerve

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$. =rostatectom# .5!R= Z transurethral resection of the rostate/ 2!suall# reserved for 8=H to hel urine flow, not a cure for rostate C' 2-o incision 26ost common com lication1 20ith other rocedures #ou have to e@ lain ris( of im otenc#?infertilit# 2+s it normal to see $leedin3 after this sur3er#1 2Continuous $ladder irri3ation Z maintains atenc#, flush out clots "*2wa# catheter "no (in(s "su$tract irri3ant from out ut 2(ee u with amount of irri3ant instilled 2Rule: -ever hand or manuall# irri3ate catheter with fresh sur3er# without a sur3eon:s order. 20hat dru3 do #ou 3ive for $ladder s asms1 8 M O su ositor#B, Ditro anB "alwa#s assess rior to selectin3 an im lementation answer "alwa#s assess the atient first 20hen catheter is removed what do #ou watch for1 25em orar# incontinence e@ ected . erineal e@ercises/ 2'void sittin3, drivin3, strenuous e@ercise; do not lift more than 2I l$s... .0h#1 2ColaceB .avoid strainin3/ 2+ncrease fluids *. Radiation >. Chemothera # E. Hormone thera # 2 ma # deceas e tes tos terone throu3h $ilatera l orchiecto m# 2Astro3ens 27u ronB

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Sto4ac# Cancer

Ris( factors: 2H2 #lori 2=ernicious anemia 2'chlorh#dria

+f #ou have either of these, #our ris( for stomach cancer <ust went !=

Related to: 2 ic(led foods, salted meats?fish, nitrates, increased salt 28illroth ++ . artial 3astrectom# with an anastomosis/ "causes atro hic 3astritis 25o$acco and 'lcohol S?S@: 6ost common: Heart $urn and a$d discomfort Other S?S@: loss of a etite, wei3ht loss, $lood# stools, coffee23round vomitus, <aundice, e i3astric and $ac( ain, feelin3 of fullness, anemia, stool O for occult $lood, achlorh#dria .no HC7 in the stomach/, o$struction .4Oa$dominal distension, -=O, n?v, ain, -D tu$e to suction for a$d decom ression/ D@: ! er D+, C5, ADD

5@: 1. Sur3er# . referred/: Dastrectom# 2Fowlers osition .decrease stress on 20ill have -D tu$e .for decom ression/ "+s it o( to re osition1 22 ma<or com lications: '. dum in3 s#ndrome '. 8212 deficient anemia Z =ernicious anemia 2 Schillin3:s test .measures the urinar# e@cretion of ,itamin 8212 for dia3nosis of ernicious anemia/
4O no stomach4O no intrinsic factor 4O can:t a$sor$ oral 82124O can:t ma(e 3ood R8C:s 4O


t is anemic

2. Chemothera #: E2F!B, Do@oru$icinB, 6itom#cin2CB, Cis latinB *. Radiation

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EN0OC*1NE l. T#yroid "ro.le4s 2=roduces * hormones .5*, 5>, Calcitonin/ 2Kou need__________________to ma(e these hormones. .5his is dietar# iodine/ 25h#roid hormones 3ive us________________H 5y+ert#yroid TOO )2C5 ENE*%399 <%ra-es 0isease= 2nervous 2a etite 2wei3ht 2sweat#?hot 2e@o hthalmus 2attention s an 2irrita$le 2D+ 28= 2th#roid

"+f #ou drew a serum 5> level on this atient would it $e increased or decreased1 Dia3nosis: th#roid scan 5P: '. 'ntith#roids: =ro acilB, =5!B, 5a a)oleB 2Sto s the th#roid from ma(in3 5H&s 20e want this t to $ecome euth#roid .euFnormal/ 25a ered and discontinued 8. +odine Com ounds .=otassium iodideB, 7u3ol&s solutionB, S S%+B/ 2Decreases vascularit# 2Dive in mil(, <uice, and use straw C. 8eta 8loc(ers: +nderalB 2Decreases HR, 8= 2Rule: Do not 3ive $eta $loc(ers to asthmatics or dia$etics. decreases m#ocardial contractilit# 2 could decrease cardiac out ut

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D. Radioactive +odine .one dose/ 20estroys th#roid cells4 h# oth#roid 2Follow radioactive recautions 1/ Sta# awa# from_______________________for___________hours 1/Don:t______________________an#one for_____________hours 20atch for th#roid storm "5h#roid storm, th#roto@icosis, and th#roto@ic crisis are the same. "+t is h# erth#roidism multi lied $# lII A. Sur3er#: th#roidectom# . artial?com lete/ 2=ost2o : "5each how to su ort nec( "=ositionin3 "Chec( for $leedin3 "-utrition . re M ost2o / "'ssess for recurrent lar#n3eal nerve dama3e " could lead to vocal cord aral#sis, if there is aral#sis of $oth cords airwa# o$struction will occur reSuirin3 immediate trach "5rach set at $edside " H# ocalcemia " Swellin3 " Recurrent lar#n3eal nerve dama3e "5each to re ort an# c?o ressure "'ssess for arath#roid removal

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5y+ot#yroid <no energy= <)yFede4a= 20hen this is resent at $irth it&s called cretinism .ver# dan3erous, can lead to slowed mental and h#sical develo ment if undetected/ 2S?S: 2fati3ue 2D+ 2wei3ht 2hot?cold 2s eech 2no e@ ression Kou ma# $e ta(in3 care of a totall# immo$ile atient 25@: 2S#nthroidB, =roloidB, C#tomelB 2Do the# ta(e these meds forever1 20hat will ha en to their ener3# level when the# start ta(in3 these meds1 2=eo le with h# oth#roidism tend to have_____________

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2. "arat#yroid "ro.le4s "5he arath#roids secrete____________________which ma(es #ou ull calcium from the _______________and lace it in the $lood. 5herefore, the serum calcium level 3oes ______. "+f #ou have too much arathormone in #our $od# the serum calcium level will $e . "+f #ou do not have an# arathormone in #our $od# the serum calcium level will $e . H# er arath#roidism F H# ercalcemiaFH# o hos hatemia 25oo much________________________. 2Serum calcium is____________. Serum hos is_________. 25@: =artial arath#roidectom# 2 when #ou ta(e out 2 of #our arath#roids =5H secretion decreases H# o arath#roidismFH# ocalcemiaFH# er hos hatemia 2-ot enou3h_____________________. 2Serum calcium is__________. Serum hos is________. 25@:

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3. Adrenal "ro.le4s> 3ot to have adrenals to handle stress 2 arts: a. Adrenal 4edulla .e ine hrine, nore ine hrine/ 1. 'drenal 6edulla =ro$lems: =heochromoc#toma 2$eni3n tumors that secrete e i and nore i 28= 2=ulse 2Flushin3?dia horetic 2,6' .van#lmandelic acid test/: a 2> hour urine s ecimen is done and #ou are loo(in3 for increased levels of e i?nore i .also called catecholamines/ "0ith a 2>[ urine #ou should_____________________________________ the first voidin3 and_____________________the last voidin3. 25@: sur3er# $. adrenal corteF 1. Dlucocorticoids "Chan3e #our mood "'lter defense mechanisms "8rea(down rotein?fat "+nhi$its insulin 1. 6ineralocorticoids "'ldosterone "6a(e #ou retain__________M "6a(e #ou lose_______________________________ . Too )uc# a. ,ascular S ace a. Serum =otassium Not Enoug# a. ,ascular S ace a. Serum =otassium *. Se@ hormones
0e secrete steroids normall#, $ut the s?s@ are more ronounced when t is receivin3 oral or +, steroids

Dru3s: Solu2medrolB, Solu2CortefB, =redisoneB, and De@amethasone B

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"'drenocorticotro in hormones .'C5H/ and cortisol mean the same thin3. 5he# refer to the hormones of the adrenal corte@. 0hen #ou hear the word \steroid] this is referrin3 to the same thin3s. 5oo man# steroids F H# ercortisolism .<ust another word/

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A. Adrenal CorteF "ro.le4s l. AddisonGs disease .adrenocortical insufficienc#/ 2+f this atient is insufficient do the# have enou3h 3lucocs., mineralos., or se@ hormones1 2Focus on aldosterone "-ormall#, aldosterone ma(es us retain -a?0ater and lose %.....-ow we don&t have enou3h .insufficient/ so we will lose _____ and ______ and retain____________. 25he serum % will $e .

25he ma<orit# of the s?s@ are a result of the H# er(alemia initiall#. " 8e3innin3 with muscle twitchin3, then roceeds to wea(ness, then flaccid aral#sis S?S@: "Some s?s@ have an un(nown etiolo3#. 2anore@ia?nausea 2h# er i3mentation 2decreased $owel sounds 2D+ u set 2h# o3l#cemia 2white atch# area of de i3mented s(in .vitili3o/ 2H# otension .due to Y ca illar# ermea$ilit# and .a$ilit# for vessels to constrict/ "+f #ou chec(ed this atient&s $lood?urine for adrenocorticotro in hormones... would the# $e resent or a$sent1________________________

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25@: 2com$at shoc( .losin3________________and___________________/ 2 rocessed fruit <uice?$roth .has lots of______________________/ 2+ M O 2+f this atient is losin3 -a their 8= will ro$a$l# $e ______. 2 losin3 -a M water 25he# will ro$a$l# $e 3ainin3?losin3 wei3ht1 2-ursin3 DP: Fluid ,olume___________________ 20ill $e laced on a mineralocorticoid .dru3 aldosterone/ . . . FlorinefB 20A+DH5 is ver# im ortant in ad<ustin3 their meds. =t has an overni3ht 3ain of L l$s. 4 what do we do with their '6 dose1 .5est ta(in3 strate3#: Fluid retention...........thin( heart ro$lems first/ Overni3ht loss of L l$s. 4 what do we do with their '6 dose1 "=t has edema or their 8= is u 4 "=t&s 8= is steadil# 3oin3 down4 2'ddisonian Crisis2 severe h# otension and vascular colla se

Rule: 0hen on a medicine where wei3ht has to $e monitored, (ee wei3ht within ^ 2 l$s of their norm

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2. Cus#ingHs Syndro4e .A@o3enous administration: someone who is ta(in3 steroids for the treatment of asthma, autoimmune disorders, or3an trans lantation, cancer chemothera #, aller3ic res onses,/ Cushin3:s disease .Ando3enous: $ilaterall# adrenal h# er lasia, ituitar# adenoma increases secretion of 'C5H, mali3nancies, adrenal adenoma or carcinoma/ 25hese ts have too man# 3lucocorticoids, mineralocorticoids, and se@ hormones. 23rowth arrest 2thin e@tremities?s(in .cortisol can romote li ol#sis/ 2increased ris( for infection 2h# er3l#cemia 2 s#choses to de ression 2central o$esit# .fat redistri$ution; li o3enesis/ 2$uffalo hum .fat redistri$ution/ 2heav# trun( .fat redistri$ution/ 2oil# s(in?acne 2women with male traits 2 oor se@ drive .li$ido/ " Hi3h levels of adrenal steroids interfere with the a$ilit# of the ituitar# 3land to secrete 7H and FSH and for the testes to ma(e testosterone. 2hi3h 8= Fluid ,olume 2CHF 2wei3ht 3ain 2moon faced .can $e due to fat redistri$ution or fluid retention/ "Since this t has too much mineralocorticoids .aldosterone/, the serum % will . "+f #ou did a 2> hour urine on this atient the cortisol levels would $e_______________. 5@: 2adrenalectom# .unilateral or $ilateral/ 2if $oth are removed4 lifetime re lacement 2Suiet environment 20hat does this atient need in their diet re2treatment1 % 2 _____, -a 2 _____, =rotein 2 _____ Ca 2 _____ 2'void infection 20hat mi3ht a ear in their urine1 Steroids decrease serum Ca $# ma(in3 #ou e@crete it throu3h D+ tract.

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(. 0ia.etes Ty+e 1> .+DD6/ 25a(e insulin 2usuall# starts in childhood 2First si3n ma# $e_______________. =atho: Kou have to have insulin to carr# 3lucose out of the vascular s ace over to the cell.........since there is no insulin the 3lucose <ust $uilds u in the vascular s ace .$lood?serum/.............the cells are starvin3 so the# start $rea(in3 down rotein and fat for ener3#.......when #ou $rea( down fat #ou 3et __________.acids/.....-ow this t is acidotic .res irator# or meta$olic1/ -ow lots of s?s@ come a$out: 2+olyuria .with accom an#in3 wei3ht loss/ 2+olydy+sia .thirst/ 2+oly+#agia 0ill oral h# o3l#cemia a3ents such as 3lucotrol, micronase or dia$eta wor( in this atient1
Somo3#i =henomenon: re$ound henomenon that occurs in 5# e + dia$etic, client has normal or Y

5y+erglyce4ia E 3 +Gs

8D levels at $edtime, and 8D dro s in earl# mornin3 hours ._22*'6/. Client:s $od# attem ts to com ensate $# roducin3 counter2re3ulator# hormones to increase 8D resultin3 in h# er3l#cemia. 5P: Y $edtime snac( and ` intermediate actin3 insulin .-=HB insulin, 7enteB insulin/
Dawn =henomenon: Resultin3 from a decrease in the tissue sensitivit# to insulin that occurs

$etween E2N '6 . re2$rea(fast h# er3l#cemia/ caused $# a release of nocturnal 3rowth hormones. 5P: 3ive intermediate2actin3 insulin .-=HB insulin, 7enteB insulin/ at 1I=6

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Ty+e 11> .-+DD6/ 25hese eo le don&t have enou3h insulin or the insulin the# have is no 3ood. 25hese atients are usuall# overwei3ht. 5he# can&t ma(e enou3h insulin to (ee u with the 3lucose load the t is ta(in3 in. 25his t# e of dia$etes is not as a$ru t as 5# e +. 2+t&s usuall# found $# accident; or the atient (ee s comin3 $ac( to the doctor for thin3s li(e a wound that won&t heal, re eated va3inal infections, etc. 25@: 2Start with diet and e@ercise, then add oral a3ents, then add___________________. Deneral 5reatment of Dia$etes: 26a<orit# of calories should come from: "com le@ car$os EE2GIJ "fats 2I2*IJ " rotein l222IJ "Dia$etics tend to have disease. 20h# are dia$etics rone to C'D1 Su3ar de osits and destro#s vessels <ust li(e ______. 2Hi3h fi$er diet .(ee s 8S stead#; ma# have to decrease insulin/ "Hi3h fi$er slows down 3lucose a$sor tion in the intestines, therefore eliminatin3 the shar rise?fall of the $lood su3ar 20ait until 8S normali)es to $e3in e@ercise 20hat should the t do re2e@ercise to revent h# o3l#cemia1 2A@ercise when 8S is at it&s hi3hest or lowest1 2A@ercise same time and amount dail# 2How do oral h# o3l#cemic a3ents wor(1 __________________ ancreas to ma(e insulin; "note: not all oral h# o3l#cemic a3ents stimulate the ancreas to ma(e insulin
6edication chlor ro amide .Dia$inese/B 3li i)ide .Dlucotrol, Dlucotrol P7/B 3l#$uride .Dia$eta, Dl#nase/B metformin .Dluco ha3e, Dluco ha3e PR/B acar$ose .=recose/B io3lita)one .'ctos/B rosi3lita)one .'vandia/B 'ction Stimulates release of insulin from ancreas Stimulates release of insulin from ancreas Stimulates release of insulin from ancreas Dec rate of he atic 3lucose roduction and chan3es the 3lucose u ta(e $# tissues Dela# a$sor tion of 3lucose from D+ tract +nc 3lucose u ta(e in muscles, dec endo3enous 3lucose roduction +nc 3lucose u ta(e in muscles, dec endo3enous 3lucose roduction

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2How is the insulin dose determined1 "the dose is increased until the________________________ more M in the urine 2Re3 .clear/ ... -=H .cloud#/.... which one do #ou draw u first1 20hat is the onl# t# e of insulin #ou can 3ive +,1

is normal and until there is no

2Hemo3lo$in '1C: $lood test; 3ives an avera3e of what #our $lood su3ar has $een over the ast * months. 2=atient should eat when insulin is at its _____. I"ea7J> T#in7 #y+oglyce4ia 20hat ha ens to #our 8S when #ou are sic(? stressed1 "normal ancreas can handle these fluctuations; an increase in the 8S when sic(?stressed is a normal reaction to hel us fi3ht the illness?stressor 2Rotation of sites .Rotate________________an area first/ 2's irate1 20hat are the s?s@ of h# o3l#cemia1

20hat should the t do1 2'fter the 8S is u , what should the# do1 2Kou enter a dia$etic atient&s room and the# are #ou treat this t li(e he is h# o or h# er3l#cemic1 2DEI0 .hard to ush; and if #ou have a choice #ou need a lar3e $ore +,?an3iocath/ 2+n<ecta$le Dluca3onB .used when there is no +, access/ 2=revention: Aat and 5a(e insulin re3ularl#; Snac(s 2

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Com lications: l. 0ia.etic Ketoacidosis 2an#thin3 that increases 8S can throw a atient into this .infection, illness, s(i in3 insulin/ 2ma# $e the first si3n of dia$etes 2have all the usual s?s of 5# e + dia$etes -ot enou3h insulin4 8S 3oes s(# hi3h4 =ol#uria, =ol#d# sia, =ol# ha3ia4 fat $rea(down .acidosis/ 4 %ussmaul&s res irations .tr#in3 to $low off CI2 to com ensate for the acidosis/ also, as the atient $ecomes more acidotic the 7OC 3oes down 25@: 2Find the cause 2Hourl# 8S and % 2+, insulin 2 +nsulin decreases $lood su3ar M otassium $# drivin3 them out of the vascular s ace into the cell. 2A%D 2Hourl# out uts 2'8D&s 2+,F&s4 Start with -S. . . .then when the 8S 3ets down to a$out *II switch to DE0 to revent throwin3 the atient into h# o3l#cemia 'ntici ate that the 6.D. will want us to add_________________to the +, solution at some oint. 2. 55NK <#y+ertonic #y+eros4olar non-7etotic co4a= 2loo(s li(e D%', $ut no acidosis 26a(in3 <ust enou3h insulin so the# are not $rea(in3 down $od# fat . . . no fat $rea(down . . . .no (etones no (etones . . . .no acidosis 20ill this atient have %ussmaul:s res irations1

+n the -C7AP world:

Ty+e 1C0KA

Ty+e 11 C55NK

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*. ,ascular =ro$lems: a. ,ascular =ro$lems 20ill develo oor circulation ever#where due to vessel dama3e .su3ar irritates the vessel linin3; accumulation of su3ar will decrease the si)e of vessel lumen therefore decreasin3 $lood flow/ 1. Dia$etic retino ath# 2. -e hro ath# $. -euro ath# 1. Se@ual ro$lems2im otence?decreased sensation 2. foot?le3 ro$lems2 ain? aresthesia?num$ness "Review of Dia$etic Foot Care 1. -euro3enic $ladder 2. Dastro aresis .stomach em t#in3 is dela#ed so there is an increased ris( for as iration/ c. +ncreased Ris( for +nfection

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Nor4al Blood Flo6 T#roug# t#e 5eart Deo@#3enated $lood enters the ri3ht atrium... then to the ri3ht ventricle... 5hen the ulmonar# arter# .this is the onl# arter# in the $od# that carries deo@#3enated $lood/... then the $lood enters the lun3s where it 3ets some o@#3en... then the o@#3enated $lood leaves the lun3s via the ulmonar# veins .these are the onl# veins in the $od# that carr# o@#3enated $lood/... then the $lood enters the left side of the heart .the 8+D $ad um /... it first 3oes throu3h the left atrium and then to the left ventricle... 5he aorta is the $e3innin3 of the arterial s#stem. 5he o@#3enated $lood is delivered throu3hout the $od#. Once all the of o@#3en has $een used u out of the arterial $lood then the arterial s#stem ties $ac( into the venous s#stem and the $lood is carried $ac( to the heart and the entire rocess $e3ins a3ain. +n ri3ht sided heart failure the $lood is not movin3 forward into the lun3s... +F it does not move forward, then it will 3o $ac(wards into the venous s#stem. +n left sided heart failure the $lood is not movin3 forward into the aorta and out to m# $od#... +F it does not move forward, then it will 3o $ac(wards into the lun3s.
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5o6 To Assess Cardiac Out+ut> COE5* : SA <+reload8 a/terload8 and contractility=

CO must remain fairly constant to perfuse my body. In this equation, as you can see, stroke volume and HR are inversely related. If my HR decreases, for whatever reason, say I had a really, really slow or a really fast arrhythmia, my S will have to increase to maintain the same CO. !nd, visa versa, if my S chan"es for whatever reason.. .say I lose a lot of volume#blood $maybe I had sur"ery, or maybe I was badly burned% and all my volume is leavin" my vascular space. &ell my heart rate will increase to try and compensate for the decrease in the volume I have left to pump around. !t some point my HR cannot increase enou"h to compensate so that my CO drops. &hen my CO drops, I am not perfusin" as well as I used to. So you can see why CO is so important. &hat happens in this equation when I have too much volume' !t first my S will "o up. ..but after a while if I "o into fluid volume e(cess my heart muscle is stretched out really, really far so now the heart starts to fail. )y heart is failin"... the HR increases in an effort to compensate and maintain the same CO to provide perfusion to the body. !fter while, thou"h, even thou"h the body is sayin" *Oh my "osh+ I,ve "ot so much more fluid to pump around, I am "oin" to have to pump harder and faster to make blood "o forward.* !t some point the heart cannot compensate enou"h and CO drops so perfusion drops.

+f #our heart is wea( what will ha en to cardiac out ut1 +f #our cardiac out ut is decreased will #ou erfuse ro erl#1 a. 0ill #ou erfuse #our $rain ver# well1 $. Heart c. S(in d. 7un3s a. =eri heral ulses e. %idne#s 0hat will ha en to $lood ressure1 +nitiall# 2______________ 7on3 term 2

Cardiac Out ut 5hin( 7AF5 ,entricle

'rrh#thmias are no $i3 deal until the# affect #our cardiac out ut.

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l. C#ronic Sta.le Angina 2Decreased $lood flow to m#ocardium4 ischemia or necrosis4 tem orar# ain? ressure in chest "usuall# caused $# C'D 20hat $rin3s this ain on1 20hat relieves the ain1 25@: a. -itro3l#cerin 2Causes venous and arterial .

25his result will cause decreased reload and afterload. =reload is the amount of $lood returnin3 to the ri3ht side of the heart from the $od#. .h# ervolemia/ 'fterload is the ressure in the aorta and eri heral arteries that the left ventricle has to um a3ainst to the $lood out. 5he ressure is referred to as resistance... in other words... how much resistance the ventricle has to overcome to 3et the $lood out of the ventricle and to the $od#.

2'lso causes dilation of________________arteries which will increase $lood flow to the actual heart muscle .m#ocardium/. 25a(e 1 ever# ______ min P ______ doses 25each client to remove the cotton from the container as it a$sor$s the dru3 2O(a# to swallow1 2%ee in dar(, 3lass $ottle; dr#, cool 26a# or ma# not $urn or fi)) 25he atient will 3et a_____________. 2Renew how often1 2'fter -5D, what do #ou e@ ect the 8= to do1 2 -ever leave an unsta$le atient

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$. 8eta 8loc(ers .+nderalB . ro ranolol/, 7o ressorB .which is 5o rol P7B or meto rolol/, 5enorminB .atenolol/, Core3B .carvedilol// 20hat do 88&s do to 8=, =, and m#ocardial contractilit#1 20hat does this do to the wor(load of the heart1

8eta $loc(ers $loc( the $eta cells.. these are the rece tor si3hts for the catecholamines4 the e i and nore i. So we <ust decreased the contractilit#.... So what ha ened to m# CO1 ________________. So we___________________the wor(load on m# heart. 5his is a 3ood thin3 to a certain oint $ecause we decreased the wor(load on the heart, $ut could we decrease atient:s cardiac out ut .HR and 8=/ too much with these dru3s1 ____________.


Calcium Channel 8loc(ers .=rocardia P7B .nifedi ine/, CalanB .vera amil/, -orvascB .amlodi ine// 20hat do these do to the 8=1 25he# also dilate coronar# arteries.

d .

' s i r i n 2dose is determined $# the h#sician .N1 m32 *2E m3/

2=t Ad.: 2avoid isometric e@ercise .e@ercises that ma(e #our muscles sSuee)e?tense u / 2avoid overeatin3 2rest freSuentl# 2avoid e@cess caffeine or an# dru3s that increase HR 2wait 2 hours after eatin3 to e@ercise 2dress warml# in cold weather .an# tem erature e@treme can reci itate an attac(/ 2ta(e -5D ro h#lacticall# 2smo(in3 cessation 2sto smo(in3?lose wei3ht 0O EAE*3T51N% 3O2 CAN TO 0EC*EASE LO*KLOA0
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2. Acute Coronary Syndro4es> )18 2nsta.le Angina 2Decreased $lood flow to m#ocardium leads to ischemia?necrosis or $oth1 2Does the atient have to $e doin3 an#thin3 to $rin3 this ain on1 20ill rest or -5D relieve this ain1 2S?S@: 2 ain 2cold?clamm#?8= dro s ` cardiac out ut 2& 08C:s and & tem " due to inflammation 20hat are the cardiac en)#mes that are drawn1 C=% .C%266, C%288, C%268/ 7DH .l, 2, *, etc./ 20hich isoenMy4e is the most sensitive indicator of an 6+1 Tro+onin <cardiac .io4ar7erBcardiac 4ar7er= -#ig# s+eci/icity /or 4yocardial cell in;ury -al6ays nor4al in non-cardiac 4uscle diseases --ele-ates sooner D stays ele-ated longer 2can .e detected 3-6 #rs a/ter onset o/ c#est +ain -can last 6- days a/ter #eart da4age 20hich en)#mes?mar(ers are most hel ful when the t dela#s see(in3 care1 ________________and 2Serial en)#mes and mar(ers will $e drawn on the atient .the freSuenc# de ends on the doctor:s order/
88F 8rain 66F S(eleton 6uscle 68F Heart

2A%D chan3es 2vomitin3

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20hen a client resents to the AD with an# form of chest ain 3ive them an 's irinB. 20hat is the DOC for ain1 20ho 3reets ever# atient with chest ain1 20hat untreated arrh#thmias will ut the atient at ris( for sudden death1 20hat dru3s are 3iven to treat this1 20hat is a si3n of to@icit# with 7idocaineB1 20hat is an im ortant side effect of 'miodaroneB1 20hat are #ou worried a$out with other arrh#thmias1 2Head u osition. 0h#1 Decreases on heart and increases .

-"C1 . ercutaneous coronar# intervention: includes all interventions such as =5C' .an3io last#/ and stents/ 2!sed with sin3le and dou$le vessel disease 2ma<or com lication of the an3io last#: "Don:t for3et the atient ma# $leed from heart cath site 2+f an# ro$lem occurs 2 3o to sur3er# """Chest ain after rocedure: call 6D at once 2 re2occludin3H
2 Coronary Artery By+ass %ra/t <CAB%=

2with multi le $loc(a3es 2left main occlusion which su lies the entire 7,

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5@: Reha$: "Smo(in3 Cessation "Ste ed2Care lan .increase activit# 3raduall#/ "Diet chan3es 2 -o fat, -o salt, 7ow cholesterol "-o isometrics e@ercises 2 +ncreases wor(load of heart "-o valsalva 2 no strainin3; no su "0hen can se@ $e resumed1 "0hat is the sa/est time of da# for se@1 "8est e@ercise for 6+ t1 25each s?s@ of heart failure: 2 0ei3ht_________________________ 2 'n(le__________________________ 2 Shortness of______________________ 2 Confusion ositor#; colace

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3. Fi.rinolytics 2Doal: Dissolve the clot that is $loc(in3 $lood flow to the heart muscle4 decreases the si)e of the infarction 2Stre to(inaseB 25='B 25-%aseB .one time ush/ 2RetavaseB

2How soon after the onset of ain should these dru3s $e administered1 " 5he sooner the $etter. 2Stro(e: 26a<or com lication: 2Have to 3et a 3ood histor#. 0ant a 3ood $leedin3 histor#. 2'$solute Contraindications: +ntracranial neo lasm, +ntracranial $leed, Sus ected aortic dissection, internal $leedin3 2Durin3 and after administration: 5a(e $leedin3 recautions, watch rh#thm .re erfusion arrh#thmias/ draw $lood when startin3 +,&s, decrease unctures
8leedin3 =recautions:

0atch for $leedin3 3ums 0atch for hematuria 0atch for $lac( stools !se an electric ra)or !se a soft tooth$rush -o +6:s 'nti latelets are another im ortant com onent of fi$rinol#tic thera #. 2's irin 2=lavi@B 2Reo ro +,B 2+nte3rilinB .continuous infusion to inhi$it latelet a33re3ation/

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(. Cardiac Cat#eteriMation 2=re2 rocedure: 2's( if the# are aller3ic to____________1 2'lso we want to chec( their (idne# function 2$ecause the atient will e@crete the d#e throu3h their (idne#s. 2 H o t s h o t

2=al itations normal =ost2 rocedure: 20atch uncture site 2'ssess e@tremit# distal to uncture site .E2 =s/ 5he E2 =s 2=ulselessness 2=allor 2=ain 2=aresthesia 2=aral#sis 28ed rest, flat, le3 strai3ht P G2N hours; can am$ulate after this 2Re ort ain 'S'= 26a<or Com lication:

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!. "ace4a7ers 2!sed to increase the heart rate with s#m tomatic $rad#cardia 25he# de olari)e the heart muscle.. .ho efull# a resultant contraction will occur. "De olari)ation 2 when electricit# is 3oin3 thru the muscle "Re olari)ation 2 restin3, ventricles are fillin3 u with $lood 2* 5# es: l. 5em orar# 2. =ermanent *. 5ranscutaneous

2Demand: (ic(s in onl# when t needs it to 2Fi@ed rate: fires at a fi@ed rate constantl# 2+t:s o( for the rate to increase $ut never decrease

Al6ays 6orry i/ t#e rate dro+s .elo6 t#e set rate.

26onitor the incision 26ost common com lication in earl# hours1 electrode______________________ 2+mmo$ili)e arm 2=RO6 to revent fro)en shoulder 2S?S@ of malfunction: 'n# si3n of decreased CO or decreased rate 2=t ed: "Chec(_____________dail# "+D card "'void microwaves? 6R+s "'void contact s orts

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6. C5F CHF is a com lication that can result from ro$lems such as cardiom#o ath#, valvular heart disease, endocarditis, 'cute 6+ 7eft2sided failure 2 ulmonar# con3estion 2d#s nea 2cou3h 2$lood2tin3ed, froth# s utum 2restlessness 2tach#cardia 2S2* 2ortho nea 2nocturnal d#s nea Ri3ht2sided failure .cor ulmonale/ 2enlar3ed or3ans 2edema 2wei3ht 3ain 2distended nec( veins 2ascites

-ew 5erminolo3#: S#stolic: heart can:t contract and e<ect Diastolic: ventricles can:t rela@ and fill D@: a. Swan Dan) catheter .is a t# e of central line that measures ressures inside the heart/ 2Hel s to determine the cause of decreased cardiac out ut 2%iller com lications: air em$olus, ulmonar# infarction a . ' 2 l i n e "6easures 8= continuousl# on a monitor "-A,AR use an '2line as an +, site, #ou ma# draw $lood from an '27ine, $ut do not administer medication via the '27ine " Kou do have to $e careful with an '2line $ecause if #ou do not have the connections on #our ressure tu$in3 secured ro erl# then the $lood will move u in the tu$in3 or if #ou do not have the sto coc(s in the ro er osition #our atient could $leed out. "'llen:s test Z a chec( for alternative circulation ""' l# ressure to clients ulnar and radial arteries at the same time, as( client to o en and close hand, hand should $lanch, release the ressure from the ulnar arter# while continuin3 to com ress the radial arter# and assess the color in the e@tremit# distal to the ressure oint4 in(ness should return within G seconds .indicatin3 the ulnar arter# is sufficient to rovide hand with adeSuate circulation if radial arter# is occluded with a2line/ "Chec( distal circulation while in lace 25he E2 =s: 2=ulselessness, 2=allor, 2=ain, 2=aresthesia, 2=aral#sis

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c. 8-=: 82t# e natriuretic e tide "secreted $# ventricular tissues in the heart when ventricular volumes and ressures in the heart are increased; sensitive indicator; can $e ositive for CHF when the CPR does not indicate a ro$lem " +f #our atient is on -atrecorB, #ou will need to turn it off for 2 hours rior to drawin3 #our 8-= $ecause it will 3ive #ou a false hi3h d. CPR .enlar3ed___________, ulmonar#____________/ c. Achocardio3ram c. -ew Kor( Heart 'ssociation Functional Classification of ersons with CHF: Classes 12> 2 Class > $ein3 the worst 5@: a. Di3italisB .7ano@inB, Di3o@in/ 2used with atrial fi$rillation; ma# increase wor(load contraction heart rate ""when the heart rate is slowed this 3ives the ventricles more time to fill with $lood cardiac out ut (idne# erfusion 0ould diuresis $e a 3ood thin3 or $ad thin31 2 0e alwa#s want to diurese heart failure ts.....the# can&t handle volume 2di3itali)in3 dose 2 loadin3 dose 2normal di3 levelF "How do #ou (now the Di3o@in is wor(in31 "S?S@ of to@icit#1 earl#: ', -, , late: arrh#thmias vision chan3es

"8efore administerin3 do what1 "6onitor electrol#tes 2all electrol#te levels must remain normal, $ut %O is the one that causes the most trou$le $. Diuretics .7asi@B, HC5CB, 8ume@B, Dia)ideB/
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2Decreases reload 2 'ldactone ma# $e 3iven to decrease aldosterone levels 20hen do #ou 3ive diuretics1 $. 'CA inhi$itor andH or a 8eta 8loc(er 2A@am les of 'CA inhi$itor include: .,asotecB.enala ril/, 6ono ril B .fosino ril/, Ca oten B .ca to ril/ 2A@am les of 8eta 8loc(ers include: .+nderalB . ro ranolol/, 7o ressorB .which is 5o rol P7B or meto rolol/, 5enorminB .atenolol/, Core3B .carvedilol// "if the dru3 ends in Z ril it is most li(el# a 'CA inhi$itor "if the dru3 ends in 2lol it is most li(el# a 8eta 8loc(er c . 7 o w D i e t 2decreases reload 2watch salt su$stitutes 2salt su$stitutes can contain a lot of e@cessive 2cannedH rocessed foods M O5C:s can contain a lot of sodium d. 6iscellaneous 2elevate head of $ed 2lI] $loc(s under the head of the $ed 2wei3h dail# .re ort 3ain of _____to ____ l$s/ 2re ort sHs@ of recurrin3 failure - a

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$. "ul4onary Ede4a 27eft ventricle has failed and $lood is $ac(in3 u to the lun3s 2Severe h# o@ia 20hen does this usuall# occur1 2S?S@: 2Sudden onset 28reathless 25@: 27asi@B .furosemide/ 2decreases reload and afterload throu3h diuresis and vasodilation/ 2>I m3 +, ush 3iven over 122 minutes 2H# otension and ototo@icit# 28ume@B .$umetanide/ 2 can $e 3iven +, ush or as continuous +, to rovide ra id fluid removal 2 122 m3 +, ush 3iven over 122 minutes 2-itro3l#cerin +, 2vasodilation; decreases afterload 2 decreased afterload F increased CO $ecause the heart is um in3 a3ainst less ressure and more $lood can $e moved forward. 2Di3o@in 2some still use this to 3et the $lood movin3 forward 26or hine sulfateB .mor hine/ 2 2 m3 +, ush for vasodilation to decrease reload and afterload 2-atrecorB .nesiritide/ 2infusion; short term thera #; not to $e 3iven more then >N hours 2vasodilates veins and arteries and has a diuretic effect 2=rimacorB .milrinone/ 2infusion; short term thera # 2vasodilates veins and arteries 2Do$utamineB 2increases cardiac out ut 2Restless?an@ious 2=roductive cou3h

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Severe CHF, cardio3enic shoc(: 8alloon =um .+'8=/ 25his decreases the wor(load on the heart and allows the wea( heart muscle to rest 2! ri3ht osition, le3s down +m roves______________________ =romotes______________________of $lood in lower e@tremities 2=revention when ossi$le: "chec(______________ "avoid fluid volume

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. Cardiac Ta4+onade .$lood has lea(ed into ericardial sac/ 2S?S@: 2 Cardiac Out ut 2C,= 28= 2heart sounds 2nec( veins 2 ressures in all > cham$ers are the same 2shoc( 2 arado@ical ulse .=ulsus arado@us/ 2 5his is when the 8= is 3reater than 1I mm H3 hi3her on e@ iration than on ins iration 2narrowed ulse ressure 2this is the difference $etween the s#stolic and the diastolic 25@: 2 ericardiocentesis and sur3er#

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. Arterial 0isorders 2+f #ou have atherosclerosis in one lace #ou have it ever#where. 2+t is a medical emer3enc# if #ou have an acute arterial occlusion .num$, cold, ain, no ulse/ 26ore s#m tomatic in lower e@tremities. 2+ntermittent claudication 2'rterial $lood isn&t 3ettin3 to the tissueO coldness, num$ness, decreased eri heral ulses, atro h#, $ruit, s(in?nail chan3es, and ulcerations 2Rest ain means severe o$struction 2Since arterial $lood is havin3 difficult# 3ettin3 to the tissue, if #ou elevated the affected e@tremit# the ain would increase or decrease1 2'rterial disorders of the lower e@tremities are usuall# treated with either an3io last# or endardectom#.
8uer3er&s Disease

2inflammation of veins?arteries 2men 2heav# smo(in3, cold, emotions "causes vasoconstriction of vessels 2lower e@tremities?sometimes fin3ers 25P: "sto smo(in3 "avoid cold "h#dration "3an3reneOam utation
Ra#naud&s Disease

"wear shoes that fit well "avoid an# trauma to feet "$#2 ass sur3er#

25his is the female atient that 3ets u set?cold?smo(es and her fin3ers .on $oth hands/ turn $lue, then white, then red 2+s ainful and can ulcerate 2'void the cause

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&. 0AT 2Causes: $lood stasis, vessel in<ur#, $lood coa3ulation ro$s. 25he $lood can 3et to the tissue, it <ust can&t 3et awa#. 2S?S@: "edema "tenderness " ositive Homan&s .ver# controversial/ "warmth

7eave the air $u$$le in 7oveno@ when administerin3 medication A@ ellin3 the air ma# lead to loss of medication? incorrect dose

6edication He arin Fi$rinol#tics Coumadin =lavi@ 's irin 7oveno@ =ersantine

7a$ a=55 =5, fi$rino3en level a=55, HC5 =5, +-R Does not reSuire la$s Does not reSuire la$s Does not reSuire la$s Does not reSuire la$s

'ntidote =rotamine Sulfate 'minoch roic acid .amicar/ ,itamin % n?a n?a n?a n?a

"these dru3s either revent latelet a33re3ation or revent the clot from 3ettin3 $i33er 2 -ormal a=55 .same as =55/ is 2I2* G seconds, a thera eutic level for a atient that is on a medication that reSuires a=55 to $e monitored should $e 1.E2 2@ the normal 2-ormal =5 is Q.G211.N seconds, normal +-R is 1.*22.I 2For most atients a thera eutic +-R is 2.I2*.I, althou3h an +-R of *.I2>.E ma# $e considered thera eutic de endin3 on the atient 5@: 2Sur3er# 28ed rest 2Alevate 2 to increase venous return; decrease oolin3 25AD hose 2 to increase venous return; decrease oolin3 2!sed with SCD:s man# times 20ith a (nown clot 5AD:s or SCD:s ma# not $e used 20arm, moist heat 2 decreases inflammation 2"re-ention is the (e#H 'm$ulation, h#dration, isometrics, SCD:s .also called =CD:s/

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C#ronic Arterial 1nsu//iciency =ain =ulses Color 5em erature Adema S(in Chan3es !lceration Dan3rene Com ression +ntermittent claudication . ro3resses to rest ain/ Decreased or ma#$e a$sent =ale when elevated, red with lowerin3 of le3 Cool '$sent or mild 5hin, shin#, loss of hair over foot?toes, nail thic(enin3 +f resent will involve toes or areas of trauma on feet . ainful/ 6a# develo -ot !sed C#ronic Aenous 1nsu//iciency =ain =ulses Color 5em erature Adema S(in Chan3es !lceration Dan3rene Com ression -one to achin3 ain de endin3 on de endenc# of area -ormal .ma# $e difficult to al ate due to edema/ -ormal .ma# see etechiae or $rown i3mentation with chronic condition/ -ormal =resent 8rown i3mentation around an(les, ossi$le thic(enin3 of s(in, scarrin3 ma# develo +f resent will $e on sides of an(les Does not develo !sed

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"S3C51AT*1C N2*S1N% *EA1EL 0e+ression 2loss of interest in life&s activities 2ne3ative view of world 2'nhedonia, loss of leasure in usuall# leasura$le thin3s 2!suall# related to loss 20hat does this atient loo( li(e1 20ei3ht 3ain in mild de ression. 20ei3ht loss in severe de ression. 2Cr#in3 s ells with mild to moderate de ression. 2-o more tears with severe de ression. 2=atients ma# $e irrita$le .due to decreased serotonin/ 2Do the# have ener3#1 2Do the# need hel with self2care1 2Hel e@ erience accom lishment. 2Careful with com liments, these ma# ma(e the atient feel worse. 2=revent isolation 2+nteractin3 with others actuall# ma(es the atient feel $etter, even if the# don:t want to do it. 2+f severel# de ressed, sittin3 with atient and ma(in3 no demands ma# $e the $est thin3 that #ou can do. 2Can these eo le ma(e sim le decisions1 2'ssess suicide ris( 2's de ression lifts, what ha ens to suicide ris(1 2' sudden chan3e in mood toward the $etter ma# indicate that the atient has made the decision to (ill himself. 2Alderl# are articularl# at ris( for suicide; elderl# men tend to $e ver# successful $# usin3 ver# lethal methods. 2Can the# have delusions?hallucinations1 2're their thou3hts slowed1 2Can&t concentrate
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2Slee distur$ances common. 2+n mild de ression, h# ersomnia. 2+n moderate to severe de ression, insomnia. 2Denerall#, de ressed atients have difficult# fallin3 aslee , sta#in3 aslee , or have earl# mornin3 awa(enin3.

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)ania 2Continuous Hi3h 2Amotions 7a$ile 2Fli3ht of ideas 2Delusions2false idea "Delusions of 3randeur "Delusions of ersecution "Do #ou ar3ue a$out the $elief1 "Do #ou tal( a lot a$out the delusion1 "7et the t (now #ou acce t that he?she needs the $elief, $ut #ou do not $elieve it. 27oo( for the underl#in3 need in the delusion, for e@am le, delusions of ersecution, the need is to feel safe, delusions of 3randeur, the need is to feel 3ood a$out self or self2esteem needs, 2Constant motor activit#4 e@haustion 2+na ro riate dress 2Can&t sto 2'ltered slee to eat atterns

2S endin3 s rees 2=oor <ud3ment 2-o inhi$itions 2H# erse@ual, and ma# e@ loit other atients. 26ani ulates4 fails4 "6ani ulation ma(es them feel secure, owerful "Set limits; staff must $e consistent 2Decreased attention s an 2Hallucinations

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25@: 2Decrease stimuli 27imit 3rou activities 2Feels most secure in one2on2one relationshi s 2Remove ha)ards 2Sta# with t as an@iet# increases 2Structured schedule 2=rovide activit# to re lace ur oseless activit# 20ritin3 activities rovide ener3# outlet without too much stimulation 28rief, freSuent contact with the staff. 5oo much intense conversation stimulates atient 2 Fin3er foods 2 %ee snac(s availa$le 20ei3h dail# 2 0al( with t durin3 meals 2 Don&t ar3ue or tr# to reason 20ill tr# to RcharmR #ou 28lame ever#$od# 26a(e sure di3nit# is maintained. 2=atient ma# do thin3s or sa# thin3s that the# wouldn:t normall# do. 2Dru3s: HaldolB, 5hora)ineB, C# re@aB, Ris erdalB .decrease a3itation and h# eractivit#/ 27ithiumB .anti2manic/ 2'nticonvulsants .used to sta$ili)e mood/

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Sc#iMo+#renia 2Focus is inward; the# create their own world 2+na ro riate affect, flat affect, or $lunted affect 2Disor3ani)ed thou3hts .loose associations: interru ted connections in thou3ht, confused thin(in3/ 2Ra id thou3hts 2Wum from idea to idea 2Acholalia 2-eolo3ism "See( clarification .R+ don&t understand/ "Do these words mean an#thin31 2Concrete thin(in3 20ord salad 2Delusions 2 Hallucinations, auditor# most common; visual ne@t most common 2Child2li(e mannerisms 2Reli3iosit# 25@: 2Decrease stimuli 2O$serve freSuentl# without loo(in3 sus icious 2Orient freSuentl# .im ortant to remem$er that atient ma# (now erson, lace, and time and still have delusions and hallucinations/ 2%ee conversations realit# $ased. 26a(e sure ersonal needs are met. 26edications.

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Suicide 2Do the# have a lan1 20hat is the lan1 2How lethal is the lan1 Duns, car crashes, han3in3, and car$on mono@ide are ver# lethal lans. 2Do the# have access to the lan1 2Have the# attem ted1 20atch for: "isolatin3 self "writin3 a will "collectin3 harmful o$<ects "3ivin3 awa# $elon3in3s 2Alderl# men are articularl# at ris(, and are successful in attem ts. 2=rovide safe environment .91/ 2Safe2 roof room 2Contract to ost one 2Direct, closed ended statements a ro riate 2Re2channel an3er4 e@ercise 2Sta# calm4 an@iet# conta3ious 2Restraints2 "Chec( ever# lE minutes; remem$er h#dration, nutrition, M elimination 2.-ot used much an#more on s#chiatric units/ 2O$servation at 1E, *I minute intervals or one2to2one if the client cannot contract for safet#.

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"aranoia 2'lwa#s sus icious, $ut have no reason to $e 20h#1 8ecause the# are res ondin3 in a wa# that is consistent with their aranoid $eliefs 2Remem$er, #ou can:t e@ lain awa# delusions or false $eliefs 2Duarded in relationshi s 2=atholo3ic <ealous# 2H# ersensitive 2Can&t rela@ 2-o humor 2!nemotional 2Craves reco3nition 27ife is unfair 2Aver#$od# else has the ro$lem 2Reacts with ra3e 25@: 28e relia$le 2+f #ou sa# #ou will do somethin3, #ou must do itH 28rief visits 28e careful with touch 2Res ect ersonal s ace 2'void whis erin3 2Don&t mi@ meds 2Can&t handle overfriendl# 28e matter2of2fact 2'lwa#s +D meds 2Aatin32sealed foods 2-eed consistent nurses 2-o com etitive activities
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28e honest

AnFiety 2a universal emotion 20e have all felt an@ious 2+t $ecomes a disorder when it interferes with normal functionin3. 2Deneral comments a$out an@iet#: increases erformance at mild levels, decreases erformance at hi3h levels. 2=atients ma# not need the nurse:s resence in mild an@iet#; however, nurse should sta# with hi3hl# an@ious atient. 25he atient who is hi3hl# an@ious needs ste 2$#2ste instructions

%eneraliMed anFiety disorder 2Chronic an@iet# 2=erson lives with it dail# 2Fati3ued due to constant an@iet# and muscle tension. 2!ncomforta$le 2See( hel 5@ : 2Short2term use of an@iol#tics 2Rela@ation techniSues: dee 2$reathin3, ima3er#, dee muscle rela@ation 2Wournalin3 over time to 3ain insi3ht into an@iet#, ea(s and valle#s, tri33ers

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"ost-trau4atic stress disorder 2results from e@ osure to life2threatenin3 event; severe trauma, natural disasters, war. 2relive the e@ erience, ni3htmares, and flash$ac(s 2emotional num$in3 2difficult# with relationshi s 2isolates self 5@: 2Su ort 3rou s.

25al( a$out the e@ erience, $ut don:t ush 26edications ma# $e hel ful.

O.sessi-e-Co4+ulsi-e 0isorder 2O$session4 recurrent thou3ht 2Com ulsion4 recurrent act 2Can&t sto 2Come from an unconscious conflict?an@iet# 2-eed structured schedule 2'llow time for rituals 2Can&t erform ritual4 'n@iet# level 3oes u if he can:t erform the ritual. Kou should never ta(e awa# the ritual without re lacin3 it with another co in3 mechanism, such as an@iet# reduction techniSues. 2Do not ver$ali)e disa roval 5@: 25ime dela# techniSues, rela@ation techniSues 26edications, such as SSR+s .Selective Serotonin Reu ta(e +nhi$itors/ or 5C's .5ric#clics antide ressants/

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0issociati-e disorders 5he atient uses dissociation as a co in3 mechanism to rotect self from severe h#sical and or s#cholo3ical trauma. 6a# see with clients who have histor# of h#sical or se@ual a$use -ot commonl# occurrin3 or seen. Client nor others ma# $e aware of the ro$lem e@ce t that client ma# have eriods of time or events that he cannot remem$er. Dissociative +dentit# Disorder .multi le ersonalities/ is e@treme e@am le of dissociative disorder 5@: 2=atient must rocess the trauma over time. 26edications ma# $e used to treat co2e@istin3 de ression, an@iet#.

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Alco#olis4 2De ressant 20ithdrawal: "+26ild tremors, nervous, nausea "++2+ncreased tremors, h# er, ni3htmares, disorientation, hallucinations, increased ulse, increased 8= "+++26ost dan3erous, severe hallucinations .visual and (inesthetic are most common/, 3rand mal sei)ures 2Sta3e ++ and +++ are D5&s .alcohol withdrawal delirium/.. ..%ee li3ht on 2+ and ++4 am$ulate 'n@iol#tics: don:t $e afraid to 3ive. Remem$er that the atient has a tolerance to alcohol, and a cross2tolerance to other C-S de ressants. He can handle medications ever# two hours. D5s should $e revented. 5he atient is ver# fri3htened durin3 the e isode. Deto@ rotocol usuall# includes thiamine in<ections, multivitamins, and erha s ma3nesium. 2Chronic ro$lems: .caused $# thiamin?niacin deficiencies/ a. %orsa(off&s s#ndrome .disoriented to time; confa$ulate/ $. 0ernic(es s#ndrome .emotions la$ile, mood#, tire easil#/ 2Other S?S@: " eri heral neuritis "liver and ancreas ro$lems "im otence "3astritis 263 and % lost 26a<or defense mechanisms1 Denial and rationali)ation

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2'nta$use: deterrent to drin(in3 2=atient has to si3n consent form, must sta# awa# from an# form of alcohol, includin3 cou3h s#ru s, aftershaves, colo3nes, etc. 212 ste ro3rams ver# effective treatment ort once deto@ is over

2Client must have a rela se revention lan in lace. 6ust have su

2Famil# issues emer3e once the alcoholic is so$er. 'll of the d#namics chan3e, and this causes stress. Ot#er su.stance a.useBaddiction 25he issues are the same: intense cravin3, difficult# Suittin3, man# attem ts to Suit, fatal if left untreated, use denial and rationali)ation. 5he atient:s life is controlled $# the dru3.

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AnoreFia 2Distorted $od# ima3e 2Sees a fat erson when loo(in3 in the mirror, even when wei3ht is LE ounds. 2=reoccu ied with food, $ut won&t eat. =lans meals for others 2=eriods sto 2Decreased se@ual develo ment 2A@ercise 27oses wei3ht !ses intellectuali)ation as defense mechanism Hi3h achiever, erfectionistic 5@: 2+ncrease wei3ht 3raduall#. 26onitor e@ercise routine. 25each health# eatin3 and e@ercise. 2'llow atient in ut into choosin3 health# food items for meals. 27imit activit# and decisions if wei3ht is low enou3h to $e life threatenin3.

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Buli4ia 2Overeat4 vomit 25eeth 27a@atives, diuretics 2Strict dieter; fasts; e@ercises 28in3es are alone and secret "out of control when $in3in3 .ma# consume thousands of calories at one sittin3, ma# steal food from 3rocer# or 3ar$a3e can/. =atient s ends more and more time o$tainin3 food. " leasura$le4 intense self2criticism 2-ormal wei3ht 20ith $oth 2 feel li(e the# are in control 5@: 2Sit with t at meals and o$serve l hour after 2'llow *I minutes for meals 2Don&t tal( a$out food 2'n3r# #ou&ve ta(en this control awa# 2Famil# ro$lems usuall# the cause 2Families tend to den# conflict and ro$lems. 2Self2 esteem $uildin3 is im ortant.

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"ersonality disorders 6ost commonl# encountered: $orderline ersonalit# disorder =atients are intensel# emotional. 6ani ulative Suicidal 3estures Self2mutilation 6a# also $e de ressed or $ulimic. 6a# a$use su$stances. Fear of a$andonment, man# ne3ative relationshi s. 5o this erson, an# relationshi is $etter than no relationshi . 6a# $e se@uall# romiscuous. 5@: +m rove self2esteem. 5reat co2dia3noses. Rela@ation techniSues. Anforce rules and limits. Don:t reinforce ne3ative $ehaviors. 5reat self2mutilation and suicidal 3estures in matter2of2fact wa#.

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"#o.ia 20ith a ho$ia, does the o$<ect the erson is scared of resent dan3er1 26ust have a trustin3 relationshi 2Desensiti)ation, must occur over time 2Don&t tal( a$out ho$ia a lot 2Follow2u is the (e# to successful treatment

"anic 0isorder 2Sta# G feet awa# 2Sim le words 2Have to learn how to sto the an@iet# 25each that s#m toms should ea( within ten minutes. 25each <ournalin3 to mana3e an@iet#. 2Hel s the atient 3ain insi3ht into the ea(s and valle#s of an@iet# and tri33ers. 2Rela@ation techniSues

5allucinations 20arn $efore touchin3 2Don&t sa# Rthe#R 27et the t (now #ou do not share the erce tion 2Connected with times of an@iet# 2+nvolve in an activit# 2Alevate head of $ed 25urn off 5, Offer reassurance, the client is fri3htened.

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ECT <Electro-Con-ulsi-e T#era+y= 2Can induce a 3rand mal sei)ure 2For severe de ression, and manic e isodes 2-=O, void, atro ine 2Si3ned ermit is necessar#. 2Series of treatments, de ends on atient res onse 2,er# effective treatment, and ver# humane with current meds. 2'nectine 2=ost rocedure: 2 osition on side 2sta# with atient 2tem orar# memor# loss 2reorient 2+nvolve in da#:s activities as soon as ossi$le.

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"syc#otro+ic )edications Antidepressants:

5C': older dru3s .amitri t#line, nortri #line, imi ramine/ Ris( of overdose, onl# one wee(:s worth of meds if atient has suicidal thou3hts !sed still for OCD and some de ressed atients. -ot first choice an#more. 'nticholiner3ic side effects: dr# mouth, $lurred vision, urinar# retention, decreased tears, di))iness, sedation 8ecause the# cause sedation, ma# $e 3iven at ni3ht. 5he# aid in slee then. SSR+: first line of dru3s now. 7ess incidence of side effects. Common side effects: headache, increased sweatin3, $lurred vision, se@ual side2effects, wei3ht loss. -ot 3reat ris( for overdose. 5wo to si@ wee(s $efore com lete thera eutic effect: true with all antide ressants. =atient ma# feel calmer ri3ht awa#, and worr# less. 6'O+: ro$lem with food and dru3 restrictions 2tran#lc# romine .=arnateB/, henel)ine sulfate .-ardilB/, fluvo@amine maleate .7uvo@B/ Cause h# ertensive crises if foods or dru3s containin3 t#ramine or e ine hrine2li(e su$stances are in3ested. 6onoamine o@idase is needed to $rea( down t#ramine and e ine hrine. +f it is inhi$ited, then t#ramine remains hi3h and increased $lood ressure occurs. Foods to avoid: a3ed cheese, avocados, raisins, $eer, red wines. -o over2the2counter cou3h or cold medications containin3 e hedrine or e hedrine 2li(e su$stances. 0arnin3s are on la$els. =atients must $e willin3 to a$ide $# restrictions. 5hese dru3s are not first choice dru3s an#more. Serotonin S#ndrome: otentiall# fatal condition.

Serotonin levels are too hi3h. S#m toms: tach#cardia, h# ertension, fever, sweatin3, shiverin3, confusion, an@iet#, Restlessness, disorientation, tremors, muscle s asms, muscle ri3idit#. +ncreased ris( when ta(in3 more than one antid ressant, use of St.Wohn:s 0ort with meds.
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Anxiolytics: used for short2term treatment, atient ma# a$use and $ecome addicted.

8en)odia)e ines: dia)e am, lora)e am, al a)olam, chlordia)e o@ide, flura)e am -on2$en)os: $us irone .not addictive/. 8en)os: sedate, di))iness, consti ation, raise sei)ure threshold, rela@ the atient.

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Antipsychotics: Typical, Atypical

5# ical are older dru3s .chlor roma)ine .5hrora)ineB/, thiorida)ine .6ellarilB/, flu hena)ine .=roli@inB/, halo eridol .HaldolB/. 0or( well on s#chotic s#m toms. 6an# side2effects includin3 A=S .d#stonia, a(athisia, seudo ar(insonism/ 0hat is d#stonia1 5onic contractions of muscles of mouth and torso, ma# affect $reathin3 if not treated. -eeds immediate treatment with 8enadr#l or Co3entin. 0hat is a(athisia1 Restlessness 0hat is seudo ar(insonism1 S#m toms mimic ar(inson:s disease; ill2rollin3 tremors, mas(2li(e face, muscle ri3idit#, droolin3. =otential irreversi$le effects: tardive d#s(inesia 5D is manifested $# uncontrolla$le movements of ton3ue, face. 't# icals: are newer dru3s Clo)a ine .Clo)arilB/, ris eridone .Ris erdalB/, olan)a ine .C# re@aB/, )i ra)idone .DeodonB/, ari i ra)ole .'$ilif#B/ 7ess incidence of A=S. -eurole tic mali3nant s#ndrome: otentiall# fatal adverse effect for an# anti s#chotic: Severe muscle ri3idit#, h# er #re@ia, stu or, d#s a3ia, la$ile ulse and $lood ressure. Sto meds, treated s#m tomaticall#, and usuall# in +C!. Clo)a ine carries ris( of a3ranuloc#tosis; therefore, 08C levels are monitored freSuentl#.

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Anticonvulsants: used to sta.iliMe 4ood. Commonl# used are: car$ama)e ine .5e3retolB/, val roe@ sodium .De a(oteB/, 3a$a entin .-eurontinB/, lamotri3ine .7amictalB/, o@car$a)e ine .5rile talB/ 0or( well in manic states. Side effects include drowsiness, verti3o, $lurred vision, unstead# 3ait. 'nticonvulsants are to@ic to liver; therefore, liver function should $e monitored. Lithium: used to sta$ili)e mood -arrow thera eutic window. 7evels must $e monitored. I.G to 1.2 mAS?7 is maintenance level. ! to 1.E mAS?7 is used for acute manic states. Si3ns?s#m toms of lithium to@icit#: hand tremors, - M ,, slurred s eech, unstead# 3ait. 7evels of 2.I to 2.E mAS?7 are considered life2threatenin3. =atient must $e tau3ht to (ee food, fluid, and e@ercise levels constant. +f chan3ed, lithium levels chan3e.

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%AST*O1NTEST1NAL l. Dia3nostic 5ests a. 2++er %1 27oo(s at the eso ha3us and stomach with d#e 2-=O ast midni3ht 2-o smo(in3 2smo(in3 increases motilit# which will affect the test a. Bariu4 Ene4a 2Clear liSuids 27a@ative or enemas until clear; ma# have to drin( 3allon of Do27#tel#B. Kumm#HH 26a(e sure atient has a__________________________ ost 2 rocedure c. %astrosco+y <E%08 endosco+y= 2-=O re 2Sedated 2-=O until what returns1 20atch for erforation

d. Li-er .io+sy 2Clottin3 studies re 2,ital si3ns re 2How do #ou osition this atient1 2A@hale and hold .3ets the dia hra3m out of the wa#/ 2=ost: 7ie on_____________side ,ital si3ns e. "aracentesis 2Removal of fluid from the eritoneal cavit# .ascites/ 2Have atient void 2=osition 2,ital si3ns

5wo main functions of the liver 1/ _________________8od# 2/ Hel s to______________8lood

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2. "ancreatitis 25he ancreas has two se arate functions: a. endocrine 2 insulin $. e@ocrine 2 di3estive en)#mes 25wo t# es of ancreatitis: a. acute: 91 causeFalcohol, 92 causeF3all$ladder disease $. chronic: 91 causeFalcohol 2S?S: "=ain2Does the ain increase or decrease with eatin31 "'$dominal distension?ascites .circulatin3 ancreatic en)#mes dama3es ca illaries4 ascites/ "'$dominal mass 2 swollen________________ "Ri3id $oard2li(e a$domen .3uardin3 or $leedin3/ "8ruisin3 .around um$ilical area .Cullen:s si3n/ or flan( area .Dra# 5urner:s/ "Fever .inflammation/ "-?, "Waundice "H# otension "Serum li ase and am#lase "08C&s "8lood su3ar 2 ancreas is sic( "SDO5, SD=5 2 liver en)#mes "=5, =55 "Serum $iliru$in "H?H .Hemo3lo$in M Hematocrit/ 7iver An)#mes SDO5F'S5 SD=5F'75

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25@: "Control ain a. Decrease 3astric secretions .-=O, -D5 to suction, $ed rest/ 2 want the stomach em t# and dr# $. Dru3s: "=ain mana3ement $e3ins with an o ioid =C' "DemerolB is the traditional DOC "=ast research sa#s mor hine?codeine causes more s asm of the s hinctor of Oddi .muscle surroundin3 the e@it of the $ile duct and ancreatic duct into the duodenum/4new research finds this to $e untrue. Due to increased concerns with adverse dru3 reactions with DemerolB, the h#sician ma# utili)e fentan#l atches; =C' narcotics; DilaudidB and 5oradolB ma# $e used for ain relief. "Steroids "'nticholiner3ics "=rotoni@B . roton um inhi$itor/ "CantacB, =e cidB "'ntacids "6aintain F M A $alance "6aintain -utritional Status4 ease into a diet "+nsulin

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3. Cirr#osis 27iver cells are destro#ed and are re laced with connective?scar tissue4 alters the circulation within the liver4 the 8= in the liver 3oes u 4

7iver An)#mes SDO5F'S5 SD=5F'75

_________________________________________________________________. 2S?S: "Firm, nodular liver "'$dominal ain 2 liver ca sule has stretched "Chronic d#s e sia " C h a n 3 e i n $ o w e l h a $ i t s "'scites "S lenome3al# 2 immune s#stem has (ic(ed in " D e c r e a s e d s e r u m a l $ u m i n " + n c r e a s e d S D O 5 M S D = 5 "'nemia 2Can ro3ress to he atic ence halo ath#?coma 25@: "'ntacids, vitamins, diuretics "-o more alcohol .don&t need more dama3e/ "+ M O; dail# wei3hts .'n# time #ou have ascites #ou have a fluid volume ro$lem/ "Rest "=revent $leedin3 .$leedin3 recautions/ a$dominal Hurst"6easure Review Services 3irth

"6onitor <aundice 2 3ood s(in care "'void narcotics 2 liver can&t meta$oli)e dru3s well when it&s sic( "Diet: a. Decrease rotein $. 7ow -a diet

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(. 5e+atic Co4a 20hen #ou eat rotein, it transforms into , and the liver converts it to urea. !rea can $e e@creted throu3h the (idne#s without difficult#. 0hen the liver $ecomes im aired then it can&t ma(e this conversion, so what chemical $uilds u in the $lood1 0hat does this chemical do to the 7OC1 2S?S: "6inor mental chan3es?motor ro$lems "Difficult to awa(e "'steri@is "Handwritin3 chan3es "Refle@es "AAD "Fetor 2'n#thin3 that increases the ammonia level will a33ravate the ro$lem. 2 7iver eo le tend to $e D+ $leeders 25@: "-eom#cin Sulfate .decreases ammonia2 roducin3 $acteria in the 3ut/ "7actulose .decreases serum ammonia/ "Cleansin3 enemas "Decrease______________in the diet "6onitor serum ammonia

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!. Bleeding Eso+#ageal Aarices 2Hi3h 8= in the liver . ortal H5-/ forces collateral circulation to form. "5his circulation forms in * different laces4 stomach, eso ha3us, rectum 20hen #ou see an alcoholic atient that is D+ $leedin3 this is usuall# what it is. "!suall# no ro$lem until ru ture. 25@: 2Re lace $lood 2,S, C,= 2O@#3en .an# time someone is anemic, O@#3en is needed/ 2Sandostatin .lowers the 8= in the liver/ 2Sen3sta(en 8la(emore 5u$e 263 Sulfate .enema; flushes an# $lood out/ 2-eom#cin .decreases ammonia roducin3 $acteria/ 2Saline lava3e

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6. 2lcerati-e Colitis and Cro#nHs 0isease 2!lcerative Colitis4 ulcerative inflammator# $owel disease "<ust in the lar3e intestine 2Crohn&s Disease4 also called Re3ional Anteritis; inflammation and erosion of the ileum "can $e found an#where 2S?S@: 2diarrhea 2rectal $leedin3 2wei3ht loss 2vomitin3 2cram in3 25@: 2hi3h fi$er or low fi$er1 2 tr#in3 to limit motilit# to hel save fluid 2avoid cold foods and smo(in3 2 hot foods can increase motilit# 2antidiarrheals "onl# 3iven with mildl# s#m tomatic ulcerative colitis clients; does not wor( well in severe cases 2anti$iotics2 sulfonamides .DantrisinB/ 2steroids 2sur3er#: '. 2lcerati-e Colitis> l. 5otal Colectom# .ileostom# formed/ 2. %oc(&s =ouch?W =ouch .no e@ternal $a3; have valve/ *. Remove colon?rectum and attach ileum to anal area4 tem orar# colostom# 2 'n#time someone has a D+ tract sur3er# M the# return with a tem orar# colostom#, the ur ose of the colostom# is to allow the intestines time to rest M heal. 8. Cro#nHs> .tr# not to do sur3er#/ l. 6a# remove onl# the affected area 2deh#dration 2$lood in stools 2anemic 2re$ound tenderness 2fever

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21leosto4y Care> .continuous liSuid draina3e/ 2avoid foods hard to di3est; rou3h foods 2Datorade in summer 2at ris( for (idne# stones .alwa#s a little_____________________/ 2Colosto4y Care> 2re3ulation is throu3h $owel trainin3 and irri3ation 25he further down the colon the stoma is, the more formed the stool will $e $ecause _____________is $ein3 drawn out. 7ocation of Stoma Descri tion of Stool +rri3ation1 ascendin3 transverse descendin3 20hen is the $est time to irri3ate1 2same____________ever#da# 2after a 25he further down the colon, the less #ou have to irri3ate. $. A++endicitis 2Related to a low fi$er diet 2S?S@: 2Denerali)ed ain initiall# " Aventuall# locali)es in the ri3ht lower Suadrant .6c8urne#&s oint/ 208C&s 2-?, 2Re$ound tenderness 2Anema1 26ost done via la arosco e unless erforated. 2'fter an# ma<or a$dominal sur3er#, what is the osition of choice1 liSuid semi2soft formed

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. "e+tic 2lcers 2Common cause of D+ $leedin3 2Can $e in the eso ha3us, stomach, duodenum 26ainl# in males or females1 2Arosion is resent S?S@: 8urnin3 ain usuall# in the mide i3astric area?$ac( 25@: 'ntacids: "7iSuid or ta$lets1 "5a(e when stomach is em t# and at $edtime 2 when stomach is em t# acid can 3et on ulcer.. .ta(e antacid to rotect ulcer =rilosecB, =revacidB, =rotoni@B, -e@iumB " roton um inhi$itor; decreases acid s e c r e t i o n s 2CantacB, =e cidB, '@idB .H2 antononist/ 2D+ Coc(tail .donnatel, viscous lidocaine, 6#lanta ++B/ 'nti$iotics for H. =#lori: 8ia@inB, 'mo@ilB, 5etrac#clineB, Fla3#lB Carafate: forms a $arrier over wound so acid can&t 3et on the ulcer Decrease stress Sto smo(in3 Aat what #ou can tolerate; avoid tem erature e@tremes and e@tra s ic# foods; avoid caffeine .irritant/ -eed to $e followed for one #ear Dastric ulcers: la$orin3 erson; malnourished, ain is usuall# half hour to l hour after meals; food doesn&t hel , $ut vomitin3 does; vomit $lood Duodenal ulcers: e@ecutives; well2nourished; ni3httime ain common and 22* hours after meals; food hel s; $lood in stools

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&. 0u4+ing Syndro4e 25his is when the stomach em ties too Suic(l# and the atient e@ eriences man# !ncomforta$le to severe side effects 2S?S@: 2fullness 2 al itations 2faintness 25@: 2semi2recum$ant with meals 2no fluids with meals .drin( in2$etween meals/ 2lie down after meals 2decrease car$os .car$s em t# fast/ 1'. 5iatal 5ernia 25his is when the hole in the dia hra3m is too lar3e and the stomach moves u into the thoracic cavit#. " Other causes of hiatal hernia: con3enital a$normalities, trauma, and sur3er# 2S?S@: 2heart$urn 2fullness after eatin3 25@: 2Small freSuent meals 2Sit u l hour after eatin3 2Alevate HO8 2Sur3er# %ee the stomach down 2re3ur3itation 2d#s ha3ia 2wea(ness 2cram in3 2diarrhea

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11. 5y+erali4entation <total +arenteral nutrition= <T"N= 2==- . eri heral arenteral nutrition/ 2%ee refri3erated; warm for administration; let sit out for a few minutes rior to han3in3 2Central line needed; filter needed 2-othin3 else should 3o throu3h this line .dedicated line/ 2Discontinued 3raduall# to avoid 2Dail# wei3hts 26a# have to start ta(in3 2Chec( urine 2'ccu2chec(s SG hours 2Do not mi@ ahead 2 mi@ture chan3es ever#da# accordin3 to electrol#tes 2Can onl# $e hun3 for 2> hours; Chan3e tu$in3 with each new $a3 2+, $a3 ma# $e covered with dar( $a3 to revent chemical $rea(down 2-eeds to $e on a um 2Home 5=-2em hasi)e hand washin3 26ost freSuent com lication4 . .

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Assisting t#e )0 insert a central line> 2have saline availa$le for flush; do not start fluids until ositive confirmation of lacement .CPR/ 2 osition 2+f air 3ets in the line what osition do #ou ut the atient in1 20hen #ou are chan3in3 the tu$in3, how can #ou avoid 3ettin3 air in the line1 2Clam it off 2,alsalva 25a(e a dee $reath and H!666666 20h# is an @2ra# done ost2insertion1 2chec( for 26a(e sure #our atient does not have a

"=ush?=ause: 0hen administerin3 meds via central line this is the techniSue that should $e used with flush

"5he smallest s#rin3e #ou should use with a central line is lIcc; an#thin3 less than this would e@ert too much ressure could lead to catheter dama3e. Hurst Review Services 1IE

NE2*O 1. Assess4ent 27OC 2=u illar# chan3es .normal u il si)e is 22G mm/; corneal assessment 2Hand 3ri s?lifts le3s? ushin3 stren3th of feet .stren3th, eSualit#/ 2,ital si3ns .late/; ulse ressure will widen with increased +C= 2How does the atient react to ain1 2Does the atient c?o headache1 2Can the atient s ea(1 5his shows a hi3h level of $rain fi 26ovement .a$sence of movement is the lowest level of res onse/ " ur oseful verses non2 ur oseful .no@ious stimuli/

2Oculoce halic refle@ .doll&s e#e refle@/: assesses $rain stem function; e#elids o en.. .Suic(l# turn head to the ri3ht.. .e#es should move to the left; +f e#es remain stationar#.. .refle@ a$sent

2+ce water Calorics .oculovesti$ular refle@/: assesses $rain stem function; irri3ate ear with EIcc&s of cool water.. .normall# e#es will move to irri3ated ear and ra idl# $ac( to mid2 osition

28a$ins(i or lantar refle@: 0hen the lateral as ect of the foot is stro(ed the toes should fle@ .curl u / X1 #ear oldF O8a$ins(i is O%; 2 is $ad U1 #ear old F 2 8a$ins(i is O%; O is $ad

2Refle@es: IFa$sent, lOF resent, diminished, 2OFnormal, *OFincreased $ut not necessaril# atholo3ic >OFh# eractive

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2. 0iagnostic Tests a. CT 2with?without contrast .d#e/ 2ta(e ictures in slices 2(ee head still?no tal(in3 a . ) * 1 20hich is $etter C5?6R+1 2+s d#e used1 2+s radiation used1 2' ma3net is used 20ill $e laced in a tu$e where t will have to lie flat. 2Remove <ewelr#?-o credit cards?-o acema(ers 2Do fillin3s in teeth matter1 20ill hear a thum in3 sound 20hat t# e of atient can&t tolerate this rocedure1 2Can tal( and hear others while in tu$e c. Cere.ral An giogra+#y 2P2ra# of cere$ral circulation 2Do in thru femoral arter# 2=re: 20ell h#drated?,oid?=eri heral ulses?Droin re ed 2A@ lain the# will have a warmth in face and a metallic taste; aller3ies1 +odine, shellfish 2=ost: 28ed rest for 1222> hours 2Remem$er care of heart cath. =t 2'n em$olus can 3o lots of different laces: "'rm, Heart, 7un3, %idne# 2Chan3e in 6otor?sensor# deficits
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, one2sided ,

, and_________________

d. )yelogra4 2P2ra# of s inal su$2arachnoid s ace 2D#e is in<ected and ta$le tilts to move d#e around -ursin3 care with either: .1/ oil 2-=O .2/ water2solu$le 2+ncrease fluids

27i3ht sedative

20atch for s?s@ of menin3itis .chills, fever, O %erni3, O 8rudins(i, vomitin3, nucchal ri3idit#, hoto ho$ia/ 2%erni3 . atient is l#in3 with thi3h fle@ed on a$domen ...o com letel# e@tend/ 28rudins(i .when nec( is fle@ed, (nees and hi s fle@ion too/ e. EE% 2Records electrical activit# 2Hel s dia3nose________________ 2Screenin3 rocedure for coma 2+ndicator of $rain death 2=re : 2Hold sedatives 2-o caffeine 2-ot -=O .Dro s $lood su3ar/ 2Durin3 rocedure: 0ill 3et a $aseline first with t l#in3 Suietl#; ma# $e as(ed to h# erventilate; ma# flash li3hts in atient&s face .* Flat AAD:s F 8rain Death/ osite le3 cannot

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/. "uncture 2=uncture site: lum$ar su$arachnoid s ace .*rd2>th/ 2=ur ose: 25o o$tain s inal fluid 25o chec( for $lood 25o measure ressures 25o administer dru3s intrathecall# .$rain, s inal cord/ 2How is the atient ositioned and wh#1 2CSF should $e clear and colorless .loo(s li(e water/ 2=ost2 rocedure: lie flat P N hrs; increase fluids 20hat is the most common com lication1 25he ain of this headache_________________when the atient sits u and________________when the# lie down. 2How is this headache treated1 8ed rest, fluids, ain med, and $lood atch 25erniation> when $rain tissue is ulled down throu3h foramen ma3num as a result of a sudden dro in +C=.

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3. 1n;uries 2' small hematoma that develo s ra idl# ma# $e fatal, while a massive hematoma that develo s slowl# ma# allow the atient to ada t. a . E + i d u r a l 5 e 4 a t o 4 a 25his is ru ture of the middle menin3eal arter# .fast $leeder/
2+n<ur#4 7oss of consciousness4 Recover# eriod4 Can&t com ensate an# lon3er4 -euro chan3es

2Amer3enc#H 25@: 8urr Holes and remove the clot; control +C= 2's( Tuestions to +D the t# e of in<ur# and the treatment needed: "Did the# ass out and sta# out1 "Did the# ass out and wa(e u and ass out a3ain1 "Did the# <ust see stars1 a. Su.dural 5e4ato4a 2!suall# venous 2Can $e acute, su$acute, or chronic 25@: acute: immediate craniotom# and remove clot; control +C= Chronic: imitates other condition; remove clot: control +C= "8leedin3 M Com ensatin3 2neuro chan3es F ma@:d out c. Scal+ 1n;ury 2Scal ver#

v a s c u l a r 20atch for infection

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d. S7ull 1n;ury 26a#?6a# not dama3e $rain; this is what determines #our s?s@ 2O en fracture4 dura torn 2Closed fracture4 dura not torn 20ith $asal s(ull fractures #ou see $leedin3 where1 28attle&s si3n: $ruisin3 over______________. 2Raccoon e#es . erior$ital $ruisin3/ 2Cere$ros inal rhinorrhea 2 lea(in3 s inal fluid from #our 28lood# s inal fluid 2-on2de ressed s(ull fractures usuall# do not reSuire sur3er#; de ressed do reSuire sur3er# e. Concussion 25em orar# loss of neurolo3ic function with com lete recover# 20ill have a short .ma#$e seconds/ eriod of unconsciousness or ma# <ust 3et di))#? see s ots 25each care 3iver to $rin3 t. $ac( to AR if the followin3 occurs: 2Difficult# awa(enin3?s ea(in3 2Confusion, Severe headache, vomitin3 2=ulse chan3es, !neSual u ils, One2sided wea(ness /. Contusion 28rain is $ruised with ossi$le surface hemorrha3e 2!nconscious for lon3er and ma# have residual dama3e All o/ t#ese are signs t#at t#e 1C" is going 9

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(. %eneral Care /or Any "atient 6it# a "ossi.le 5ead 1n;ury or 1ncreased 1ntracranial "ressure 2'ssume a c2s ine in<ur# is resent until roven otherwise 2%ee $od# in erfect ali3nment 2%ee sli3ht traction on head 2How do #ou tell CSF from other draina3e1 O For_______________; halo test 2Ansure adeSuate nutrition: "need increased calories "steroids increase $rea(down of_________________M________________________________ __________________________________________steroids decrease cere$ral edema "cannot have -D feedin3s if have CSF rhinorrhea "0hen a atient emer3es from a coma4 lethar3ic4 a3itated "-eed a Suiet environment 2 stimuli: could romote sei)ures "=ad side rails "-o narcotics "-ormal +C=F] lE "+C= varies accordin3 to osition "5he $rain can com ensate onl# to a certain oint as the s(ull is a ri3id cavit#.

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2S?S@ of Y +C=: "Aarliest si3n1 "S eech1 "Res irations1 2 =attern ma# chan3e e@: Che#ne Sto(es, 'ta@ic

"+ncreasin3 drowsiness "Su$tle chan3es in mood "Tuiet to restless "Flaccid e@tremities "Refle@es a$sent "=rofound coma2 u ils fi@ed M dilated "=ro<ectile vomitin3 .vomitin3 center in $rain is $ein3 stimulated/ "Decere$rate osturin3 .arched s ine, lantar fle@ion/; worst "Decorticate osturin3 .arms fle@ed inwardl#; le3s e@tended with lantar fle@ion/ "Hemi aresis Z wea(ness "Hemi le3ia Z aral#sis "Facial =aral#sis

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25reatment of Y +C=: "Osmotic Diuretics .6annitolB, Dl#cerolB/ 4 ull fluid from the $rain cells4 uts it in the 3eneral circulation4 this increases circulatin3 $lood volume; Since these dru3s increase $lood volume, what does this do to the wor(load of the heart1 Due to the increase in circulatin3 $lood volume, does this ut the atient at ris( for F,D or F,A1 "7asi@B is freSuentl# 3iven with these dru3s to enhance diuresis. "Steroids .DecadronB2 de@amethasone/ 2 decrease cere$ral edema "H# erventilation4 al(alosis 4$rain vasoconstriction4 decreased +C= "=CO2 is (e t on the low side .*E/, if lower =CO2 too much it will cause too much vasoconstriction resultin3 in decreased cere$ral erfusion and $rain ischemia "%ee tem $elow lII.> .an increased tem will increase cere$ral meta$olism which increases +C=/ "'void restraintsH$owelH$ladder distensionH hi fle@ionH valsalva isometricsH no snee)in3H no nose $lowin3 "Decrease suctionin3Hcou3hin3 s inal cord in<ur# 2autonomic d#srefle@ia

"S ace nursin3 interventions 2 an#time #ou do somethin3 to #our t., +C= increases "0atch +C= monitor with turnin3, etc "8ar$iturate induced coma2decreases cere$ral meta$olism . heno$ar$ital2luminal/ "Alevate the head of $ed "%ee head in midline so <u3ular veins can drain "6onitor the Dlas3ow coma scale .loo(s at e#e o enin3, motor res onses, ver$al erformance/ 6a@ score F 1E "Restrict fluids to l2II to lEII cc er da# .too much fluid increases +C=/

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-Lays to Ensure Cere.ral Tissue "er/usion> "0atch for $rad#cardia .not um in3 out much volume/ "0atch for increased 8= .heart um in3 a3ainst more ressure, so not as much $lood can 3et out of heart 21C" )onitoring 0e-ices> ",entricular catheter monitor or Su$arachnoid Screw "Dreatest ris(1 "-o loose connections "%ee dressin3s dr# .$acteria can travel throu3h somethin3 that is wet much easier than somethin3 that is dr#./

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)ATE*N1T3 N2*S1N% "A*T 1 First Tri4ester <Lee7 1 t#roug# Lee7 13= l. =resum tive Si3ns of =re3nanc# 'menorrhea 2 what is the name of the hormone that causes this1 -?, FreSuenc# 2 can $e one of the first si3n 8reast 5enderness 2 e@cess hormones 2. =ro$a$le Si3ns of =re3nanc# ' ositive re3nanc# test2 since it is $ased on the resence of hCD levels .there are other conditions that can Y hCD levels/ Doodell&s si3n .softenin3 of__________; second month/ Chadwic(&s si3n .$luish color of va3inal mucosa and cervi@; wee(_____/ He3ar&s si3n .softenin3 of the lower uterine se3ment; 2nd?*rd month/ !terine enlar3ement 8ra@ton Hic(s Contractions .throu3hout re3nanc#; move $lood throu3h the lacenta/ =i3mentation of s(in 22linea ni3ra 22facial chloasma .mas( of re3nanc#/ '$dominal striae *. =ositive Si3ns of =re3nanc# Fetal heart$eat: Do ler4 Fetal movement !ltrasound 2. Dravidit#: 9 of times someone has $een re3nant =arit#: 9 that reached via$ilit# 5='7: acron#m that 3ives #ou further information on arit# 5F term =F reterm 'F a$ortion2 this includes s ontaneous and elective a$ortions 7F livin3 children *. -a3ele&s Rule: Find the first da# of the 76= 'dd ___ da#s Su$tract ___ months 'dd ___ #ear .2IIE, 2IIG/ Fetosco e4

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G. =atient 5eachin3: a. -utrition: > food 3rou s +ncrease calories $# ______ er da# after the first trimester 2adolescent Ycalories $#__________after the first trimester +ncrease rotein to ______ 3rams er da# A@ ect to 3ain ____ l$s first trimester ,itamin su lements a. A@ercise: -o hi3h im act; wal(in3 and swimmin3 are $est; Do not start a heav# ro3ram unless alread# doin3 so

EFercise *ule> 0onHt let your #eart rate get a.o-e 1('
c. Dan3er Si3ns: Sudden 3ush of va3inal fluid 8leedin3 =ersistent vomitin3 Severe headache '$dominal ain +ncreased tem Adema -o fetal movement d. Common Discomforts: -?, FreSuenc# Fati3ue +ncreased va3inal secretions ,aricose veins Hemorrhoids 8ac(ache d. 6edications: f. Smo(in3: L. How often should a re3nant atient visit the 6D1 "First 2N wee(s "2N2*G wee(s "*G2 deliver# N. 8efore an ultrasound what will #ou as( the atient to do1 20hat a$out an ultrasound rior to a rocedure1 8reast 5enderness 5ender 3ums Heart$urn -asal stuffiness 'n(le edema Consti ation 7e3 cram s

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SECON0 T*1)ESTE* <Lee7 1( t#roug# Lee7 26= Q. A@ ected wei3ht 3ain er wee(: lI. Should the atient still $e e@ eriencin31 -?, ll. Tuic(enin3: l2. 0hat should the fetal heart$eat $e durin3 the second trimester1
"12I to 1GI: normal "11I to 12I: worried and watchin3 "7ess than 11I anic

8reast tenderness


l*. %e3al e@ercises: e@ercises to stren3then the u$ococc#3eal muscles; these muscle hel sto urine flow, hel
revent uterine rola se.

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T51*0 T*1)ESTE* <Lee7 2$ t#roug# Lee7 ('= l>. 0ei3ht 3ain: lE. FHR: lG. How is fetal osition? resentation determined1 0hat should #ou have the atient do first1

' re3nanc# is considered at term if it advances to *N to >I wee(s.

+f the atient is havin3 contractions, should these maneuvers $e done durin3 or $etween contractions1 l>. =atient 5eachin3: a. Si3ns of la$or: 7i3htenin3: 2usuall# occurs 2 wee(s $efore term 2when the resentin3 art of the fetus .usuall# the head/ descends into the elvis 28reathe easier, $ut urinar# freSuenc# is a ro$lem .a3ain/ An3a3ement: 25he lar3est resentin3 art of the fetus is in the elvic inlet 2'3ain we ho e is the head that is resentin3 first 2So the resentin3 art is at the I Station. 2Fetal stations: measured in cm, measures the relationshi of the resentin3 art of the fetus to the ischial s ines of the mother.

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8ra@ton Hic(s Contractions: 6ore freSuent and stron3er Softenin3 of the____________ 8lood# show Ru ture of______________ Sudden $urst of____________, called Diarrhea $. 0hen should the atient 3o to the hos ital1 20hen the contractions are_________min. a art or when the_______________ru ture. .

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l . Non-Stress Test> 20ant to see two or more accelerations of ______$eats?minute .or more/ with fetal movement. 2'cceleration is when the fetal heart rate has an a$ru t increase from the $aseline. 5his is visuali)ed on the fetal heart monitor. 5he increase is 21E $eats?min a$ove the $aseline and lasts at least 1E seconds $ut the heart rate should come $ac( to $aseline within 2 min. 2Aach increase should last for ______seconds and recorded for ______ min. 2Do #ou want this test to $e reactive or non2reactive1 Reactive: 5wo or more accelerations of fetal heart rate of 1E $eats?min lastin3 21E sec , associated with each fetal movement in 2I min

-on2Reactive: -O fetal heart rate accelerations or accelerations X 1E $eats?min or lastin3 X 1E sec throu3hout an# fetal movement durin3 the testin3 eriod; if the test does not meet reactive criteria listed a$ove after >I min the test is considered non2reactive
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l&. Contraction Stress Test> OFytocin C#allenge Test - =erformed on hi3h ris( re3nancies: reeclam sia, maternal dia$etes, and an# condition in which lacental insufficienc# is sus ected. 2 5his determines if $a$# can handle the stress of an____________________________ .

2 !terine contractions decrease $lood flow to the uterus and to the lacenta. 2+f this decrease of $lood flow is 3reat enou3h to cause h# o@ia in the fetus the fetal heart rate will decrease from the $aseline HR .deceleration/ 2 Do not want to see__________________________________ ______________________________________. "5his means utero lacental insufficienc#. 2 Do #ou want a ositive or ne3ative test1 -e3ative: -o late decelerations, a minimum of * contractions lastin3 >I2GI sec in a 1I min time frame =ositive: =ersistent and consistent late decelerations occurin3 with more than half of the contractions

25his test is rarel# erformed $efore how man# wee(s1

*esults are good /or one 6ee7

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2'. True la.or 2Re3ular or irre3ular contractions1 2Contractions increase or decrease in freSuenc# and duration1 2Discomfort in $ac( and radiates to a$domen. 2 0hat ha ens to the ain level with a chan3e in activit#1 2l. False la.or 2Contractions1 20here is the discomfort1 20hat ha ens to the ain with a chan3e in activit#1 22. E+idural Anest#esia> =osition: 7ie on left side, le3s fle@ed, $ac( not as arched as with lum$ar uncture. "Diven in sta3e l at *2> cm dilation. "!suall# no headache "6a<or com lication1 "6onitor 8= "+,F&s 8olus with 1IIIcc of -S or 7R to fi3ht h# otension "=ositionin3: =ut in semi2fowlers on side to revent vena cava com ression ""+f the vena cava is com ression it will decrease venous return, reduce cardiac out ut and $lood ressure, and decrease lacental erfusion ""chan3e osition from side to side hourl#

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23. T#e "atient *ecei-ing OFytocin <"itocinN= 2-eed one2on2one care 28e alert for: H# ertonic la$or Fetal distress !terine ru ture 2Com lete !terine Ru ture: throu3h the uterine wall into the eritoneal cavit# 2 S?S@: sudden, shar , shootin3 ain .\somethin3 3ave wa#]/, if in la$or the contractions ma# sto and the ain will $e relieved, si3ns of h# ovolemic shoc( due to hemorrha3e, if the lacenta se arates, the fetal heart tones will $e a$sent 2 +ncom lete !terine Ru ture: throu3h the uterine wall $ut sto s in the eritoneum $ut not into the eritoneal cavit# 2S?S@: internal $leedin3, ain ma# not $e resent, fetus ma# or ma# not have late decals, t ma# vomit, faint, have h# otonic uterine contractions and lac( of ro3ress, fetal heart tones ma# $e lost ,8'C .,a3inal 8irth 'fter C2Section/ 6om:s are at hi3hest ris( of havin3 uterine ru ture $ecause the scar from the c2section could ru ture 20ant a contraction rate of l ever# 22* minutes with each lastin3 GI seconds 2Discontinue: a. the contractions are too often $. the contractions last lon3er than QI seconds c. fetal distress "O@#tocin is i33# $ac(ed into a main +, fluid, so when #ou discontinue the O@#tocin ma(e sure #ou do not turn off #our main +, fluid 20hat osition should the atient receivin3 o@#tocin $e laced1 2Su ine is contraindicated in all re3nant women 2-ow, if the atient has an# unreassuin3 fetal heart tones .li(e fetal $rad#cardia/ then we will ut the atient on their left side to enhance uterine erfusion. Otherwise an# osition is fine. 20hat should $e done with the infusion if late decelerations occur1 5urn it off and hurr# u and 3et some$od# who (nows more than #ou.

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2(. E4ergency 0eli-ery 2Alevate HO8 20ash hands 2Somethin3 clean under $uttoc(s 2Decrease touchin3 of va3inal area 2's head crowns tear amniotic sac 25ell atient to ant?$low to decrease ur3e to ush 2=lace hand on fetal head and a l# 3entle ressure 20hen head out feel for cord around nec( 2Aase each shoulder out2 do not ull on the $a$# 25he rest will deliver fast 2%ee $a$#&s head down 2Dr# $a$#"" 2%ee $a$# at level of uterus 2=lace on mother&s a$domen 2Cover $a$# 20ait for lacenta to se arate 2Can ush to deliver lacenta 2+ns ect lacenta for intactness 2Chec( firmness of uterus
+F #ou do feel the cord around the $a$#:s nec(, tr# to sli the cord over the $a$#:s nec( with #our fore fin3er. DO -O5 C!5 5HA CORDH

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2!. Nor4al "ost-"artal "eriod a. ,ital si3ns: 54 ma# increase to _1II.>____ durin3 1st > hrs 8=4 sta$le HR4EI2LI common for______________da#s 5ach#cardia ost a r t u m1 5 h i n ( # e 4 o r r # a g e

$. 8reasts: Soft for ___ to____ da#s then en3or3ement. c. '$domen: soft?loose; diastasis recti d. D+: +s hun3er common1 e. 2 t e r u s > 2+mmediatel# after $irth the fundus is in midline 2 to * fin3er $readths $elow um$ilicus 2' few hours after $irth it rises to level of um$ilicus or one F8 a$ove 20ant fundus to $e firm 2 0hat is the first thin3 #ou do if the fundus is $o33#1 2 it until it is firm and then chec( for 2Fundal hei3ht will descend one F8?da# 2 0hat is the ro er term for when the fundus descends and the uterus returns to its re2 re3nanc# si)e1
6eds used to firm the uterus and sto $leedin34=itocinB, mether3ine,and hema$ate

2'fter ains are common first 22* da#s es eciall# with $reast2feedin3 /. Loc#ia> 2Ru$ra: *2> da#s 2Serosa: >2lI da#s 2'l$a: lI22N da#s .can $e as lon3 as G wee(s/ 2Clots are o(a# as lon3 as the# are no lar3er than a .

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g . 2 r i n e o u t + u t > 20h# should the le3s $e ins ected closel#1 # . " e r i n e a l C a r e > 2ice ac(s intermittentl# for first G2l2 hours 2 decrease edema 2warm water rinses 2sit) $aths 22> times er da# 5hese are indicated if the a t i e n t h a s h a d a 2anesthetic s ra#s e isiotom#, laceration, or hemorrhoids 2chan3e ads freSuentl# 2teach to re ort foul smell 2re ort lochia chan3es =eri =ad Rule: 0e do not want the t. to saturate more than eri ad?hr. i. Breast Care> 2cleanse with warm water after each feedin3; let air dr# 2su ort $ra

2ointments for soreness or e@ ress some colostrum and let it dr# 2$reast ads 2 a$sor$ moisture 2initiate $reast feedin3 'S'= after $irth 2if $reast feedin3 interru ted: 2increase caloric inta(e $# EII calories 2fluid?mil( inta(e: 2-on2$reast feedin3 mothers: 2ice ac(s, $reast $inders, chilled ca$$a3e leaves 2Chilled ca$$a3e leaves decrease inflammation and decrease en3or3ement 2 -o stimulation of the $reast

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; .

" o s t + a r t u 4 i n / e c t i o n > $irth; A. Coli?8eta hemol#tic stre

2 +nfection within lI da#s after

25each ro er h#3iene .front to $ac( cleansin3/ and handwashin3 2!suall# 3et cultures and anti$iotics. ;. "ost+artu4 #e4orr#age> "earl#2when more than EII cc $lood lost in first 2> hrs "late2after 2> hrs, u to G wee(s ost artum "causes: uterine aton#, lacerations, retained fra3ments, force s deliver#

4. )astitis> 2Feed $a$# freSuentl# 2Sta h#lococcus 2alwa#s offer the affected $reast first 2!suall# occurs around 22> wee(s

8indin3 the $reast and the use of ca$$a3e leaves to relieve en3or3ement is onl# used if $reast feedin3 is 28ed rest $ein3 discontinued =atient 5eachin3 5i ermanentl# ' $reast when 2Su feedin3 ort $ra mother, who does not have mastitis, should offer the o osite $reast 8ut initiatin3 $reast feedin3. if 6om is 3oin3 to 2 A@am at N'6 the mother ma# start $reast feedin3 on the ri3ht $reast, 28indin3 .canle: cause more sta3nation/ continue to $reast feed, at the 1I '6 feedin3 the mother should offer the left $reastshe first. needs initiate $reast 2 Chilled ca$$a3e leaves feedin3 freSuentl# or um . 2=C- .o( with $reast2feedin3/ 2=ain med

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2 6 .

1 4 4 e d i a t e 2Suction 2 Clam and cut the cord 26aintain $od# tem

N e 6 . o r n

C a r e >

2' 3ar: Done at _____ and _____ minutes 7oo(s at HR, R, muscle tone, refle@ irrita$ilit#, color 0ant at least____________.

""5ells us how much resuscitation the $a$# needs.

2Ar#throm#cin .3tts or ointment/ for e#e ro h#lactics for -eisseria 3onococcus 2Ar#throm#cin will (ill the most ra idl# 3rowin3 S5D, which is1 2'Suame h#ton . romotes formation of clottin3 factors/ 2$. Cord Care> Dries, and falls off in 1I to 1> da#s. Cleanse with each dia er chan3e usin3 alcohol. Fold dia er $elow cord -o immersion till off; watch for infection. 2N. 0h# do $a$ies sometime e@ erience h# o3l#cemia after $irth1 "8a$ies at 3reatest ris( for h# o3l#cemia include those that are lar3e for 3estational a3e, small for 3estational a3e, reterm, and $a$ies of dia$etic 6oms. 2Q. 0hen does atholo3ic < a u n d i c e o c c u r 1 2!suall# means Rh?'8O incom ati$ilit#

*I. 0hen does h#siolo3ic <aundice occur1 2Due to normal hemol#sis of e@cess R8C&s releasin3 $iliru$in

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*# SensitiMation or *# /actor Occurs when #ou have an Rh2 mother with an RhO fetus RhO $lood from $a$# comes in contact with mother&s Rh2 $lood 6om:s $lood is most li(el# to come in contact with the $a$#:s $lood when the lacenta se arates at $irth. +t can also ha a$domen. en durin3 a miscarria3e, amniocentesis, or when there is trauma to 6om:s

6other loo(s RhO $lood as a forei3n $od#, an anti3en. 6other roduces anti$odies to the $a$#:s RhO $lood 5he first offs rin3 is not affected $# the '8&s 'n Rh2 sensiti)ed mom 3ets re3nant a3ain: She&s 3ot these '8&s waitin3 for the RHO $lood to come around so she can attac( it 5he chances of an Rh2 6om havin3 anti$odies to RhO $lood increases with each re3nanc# and each e@ osure to RhO $lood $ecause once #ou have these anti$odies the# never 3o awa#. 6other&s $lood enters $a$# thru lacenta4 Hemol#sis H# er$iliru$inemia, anemia H#dro s fetalis CHF -eurolo3ic dama3e eryt#ro.lastosis /etalis

+ndirect Coom$&s: 2done on mother; measures 9 of '8&s in $lood Direct&s Coom$&s: 2done on $a$#; tells #ou if there are an# '8&s stuc( to the R8C&s 0hat do #ou do if #ou have a RhO fetus and a sensiti)ed mother1 0hen is rho3am 3iven1 2destro#s fetal cells that 3ot in mother&s $lood; has to do this $efore '8&s can $e formed; Rho3am is 3iven with an# $leedin3 e isode

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CO)"L1CAT1ONS OF "*E%NANC3 l. )iscarriage 2'lso called s ontaneous a$ortion 2S ottin3 common durin3 re3nanc# $ut the com$ination of $leedin3 and cram in3 is more indicative of a miscarria3e 2S?S@: $leedin3, cram in3, $ac(ache 26easure hCD levels 2 we worr# when levels dro 25@: 8ed rest, '$stinence from se@, Sedation +f miscarria3e imminent4 +,, 8lood, D M C .dilatation M curetta3e/

2. 5ydatidi/or4 4ole <4olar +regnancy= 28eni3n neo lasm, can turn mali3nant 2Dra e2li(e clusters of vesicles 26a#?ma# not have a fetus involved 2How does this start1 2S?S@: 2uterus enlar3es too fast 2a$sence of FH5&s 2$leedin3 .sometimes will have vesicles/ 2Confirmed with__________________ 2Small mole4 D M C .have to em t# the uterus/ 2Do not 3et re3nant; follow2u ver# im ortant 2+f it $ecomes mali3nant it is called choriocarcinoma. 20ill do CPR to determine metastasis 20ill measure hCD&s______________until normal; rechec(ed S 22> wee(s; then ever# 122 months for G months to a #ear.
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3. Ecto+ic "regnancy 25his is a 3estation outside the____________. 20here does it usuall# occur1 2Confirmed with an__________________. 2First si3n1 2S?S@: =atient will e@hi$it the the usual s?s@ of re3nanc#.... 5hen ain 2s ottin3 or ma# $e $leedin3 into the eritoneum 2+f a atient has had l ecto ic re3nanc# she is at ris( for another. 25@: 6ethotre@ateB is 3iven to 6om to sto the 3rowth of the em$r#o to save the tu$e. +f the 6ethotre@ateB does not wor(, a la arosco # ma# $e done, a small incision will $e made into the tu$e and the em$r#o will $e removed. 25he entire tu$e ma# have to $e removed. ' la arotom# is done if the tu$e has ru tured or in an advanced eto ic re3anc# 2if the tu$e does ru ture #our atient could hemorrha3e and ma# need a $lood transfusion

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(. "lacenta "re-ia 26ost common cause of $leedin3 in the later months .usuall# the Lth/ 25he lacenta has im lanted wron3 2'n ultrasound will $e done to confirm lacental location 25he lacenta $e3ins to rematurel# se arate when the cervi@ $e3ins to dilate and efface4 $a$# doesn&t 3et o@#3en 2-ormall#, the lacenta should $e attached where in the uterus1 2S?S@: 2 ainless $leedin3 in 2nd half of re3nanc# .ma#$e s ottin3 or ma# $e rofuse/ 25@: 2Com lete revia usuall# reSuires hos itali)ation .from as earl# as *2 wee(s until $irth/ to revent $lood loss and fetal h# o@ia if she 3oes into la$or 2+f there&s not much $leedin34 $ed rest and watch 2Rule out other sources of $leedin3 2=ad counts, monitor fetus 26onitor for contractions4 call 6D .not 3oin3 to $e a normal deliver#/ 2Deliver# method of choice1 2Do not erform elvic e@am

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!. "lacenta 2+s the lacenta im lanted normall#1 26a#$e artial or com lete 2+t se arates rematurel#4 8leedin3 .e@ternal or concealed/ 2 ma#$e $leedin3 into uterus 2Seen in last half of re3nanc# 2!ltrasound to confirm the dia3nosis 2Causes: 6,' Domestic violence Ra id decom ression of the uterus .mem$ranes ru ture/ 'ssociated with M 2S?S@: 2=ain 2Difficult to al ate fetus .uterus is full of $lood/ 28oard2li(e a$domen 26ethod of deliver#1

R!7A: Do not do va3inal e@ams in the resence of une@ lained va3inal $leedin3

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6. 1nco4+etent Cer-iF 25his is when the cervi@ dilates rematurel#. 2Occurs in the________________month. 25his t. will have a histor# of re eated, ainless, 2nd trimester miscarria3es.

25@: 2=urse2Strin3 suture .cercla3e/ at l>2lN wee(s 2 reinforces the cervi@ 26a# have a c2section to reserve the suture 2 some doctors cli the suture so the atient can deliver va3inall# 2NI2QIJ chance of carr#in3 the $a$# to term

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$. 5y+ere4esis %ra-idaru4 2Starts li(e re3ular mornin3 sic(ness 2A@cessive vomitin34 deh#dration4 starvation4 death 2R?5 hi3h levels of_______________M_________________ 20hat ha ens to the: 28= ___ 2H?H ___ 2!O___ 2% ___ 20ei3ht___ 20h# is there acetone .(etones/ in the urine1 25@: 2-=O P >N hours 2+,F&s2*III cc&s for lst 2> hours 2=hener3anB continuous +, 2 some doctors <ust 3ive Re3lanB +,=8 25hiamine ST .vitamin 821 deficit/ 2Anvironment1 2Oral h#3iene 2+s it o(a# to tal( a$out food1 20h# should the emesis $asin $e (e t out of si3ht1 2G2N small, dr# feedin3s followed with clear liSuids 2Foods?liSuids should $e ice cold or steamin3 hot 20ell2ventilated room

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. "reecla4+sia 2+ncreased 8=, roteinuria, edema after 2Ith wee( 2if 6om:s re2 re3nant $aseline 8= is not (nown then 1>I?QI is considered to $e mild reeclam sia 2S?S@: 2sudden wei3ht 3ain 2face and hands swollen 2headache, $lurred vision 2h# er2refle@ia .increased D5R/ 2clonus 20hen #ou see a atient that 3ains 2 or more ounds in a wee( watch closel#. 26ild: $ed rest as much as ossi$le, increase rotein 2Severe: 2Sedation to dela#_______________________ 2,aliumB is not the dru3 of choice here 263 Sulfate is the DOC 263 Sulfate: sedates, anticonvulsant, vasodilates 2 0hen 63SO> is used, chec(s for ma3nesium to@icit# should $e done S 122 hours. 25hese include: 8=, res irations, D5Rs, M 7OC. !rine out ut is monitored hourl# M serum ma3nesium is chec(ed eriodicall#. 2+f 63SO> is used la$or will sto unless au3mented with =it. 2+f diastolic U lII4 H#drala)ine B .a resoline/ 2Onl# cure1: 2'fter deliver#, how lon3 is the atient at ris( for sei)ures1 2Sin3le room 2,er# Suiet environment 2Dim the li3hts
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&. Ecla4+sia 20hat is the turnin3 oint from reeclam sia to eclam sia1 26onitor the FH5&s 20atch la$or 20atch for heart failure

l'. "re4ature La.or 27a$or that occurs $etween 2I2* L wee(s 25@: 2Sto the la$or: 5ocol#tics: 263 Sulfate 28rethineB .ter$utaline/ 2 8etamethasone .CelestoneB/ a corticosteroid is 3iven to 6om +6 in order to 3et it to $a$#. 25he ur ose is to stimulate maturation of the $a$#:s lun3s in case reterm $irth occurs. 2=reterm la$or can sometimes $e sto ed $# h#dratin3 6om and $# treatin3 va3inal and urinar# tract infections.

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ll. "rola+sed Cord 20hen the um$ilical cord falls down thru cervi@ 2 6ost li(el# to ha en when resentin3 art is not en3a3ed and mem$ranes ru ture. 2So alwa#s, alwa#s, alwa#s chec( FH5s when mem$ranes ru ture either s ontaneousl# or artificiall#. 2+f this occurs $efore com lete dilation4 immediate c2section 2 +f cord is $ein3 com ressed #ou would see varia$le decelerations in FH5. 2+f cord ceases to ulsate4 fetal death; we want the cord to ulsate $ecause this tells us $a$# is 3ettin3 some o@#3en 2Fetal $rad#cardia is an indicator of rola se 25@: 27ift head off cord until 6D arrives if ossi$le 2%ee manuall# ushin3 the head u to relieve ressure on the cord. 27et someone else do all the re arations for an emer3enc# C Section 25rendelen$ur3 or (nee chest osition 2 Do this if #ou have fetal $rad#cardial $ut can&t relieve ressure on cord manuall# 2O@#3en 2 want to ma(e sure what little $lood is 3ettin3 to $a$# is h# ero@#3enated 26onitor fetal heart tones 2Saline dressin3s around cord if rotrudin3 from va3ina 2=ush it $ac( in1

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Drou 8 Stre tococcus .D8S/

7eadin3 cause of neonatal mor$idit#

Routinel# assess for D8S ris( factors durin3 re3nanc# and on admission to 7MD 5ransmitted to infant from $irth canal of the infected mother durin3 deliver# 'll re3nant women should $e cultured $etween *E2*L wee(s of 3estation

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Ris( factors for neonatal D8S:

reterm $irth less than *L wee(s, O renatal cultures in current re3anac#, remature ru ture of mem$ranes .lon3er than 1 Nhr/, ostitve histor# for earl#2 onset neonatal D8S, intra artum maternal fever hi3her than 1II.>a F, revious infant with D8S

5est or culture =ositive1 'nti$iotic ro h#la@is offered .+,/

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+f the# do not have a culture when the mother 3oes into la$or or if the mother has a ris( factor then an anti$iotic ro h#la@is offered .+,/

5reatment: Dru3 of Choice1 =C-

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*ES"1*ATO*3 T # o r a c e n t e s i s 2=re2 rocedure: CPR and ,S 2=ositionin3: Sittin3 u over the $edside ta$le Can:t sit u 1 7ie on unaffected side with HO8 at >E a 2 =atient must $e ver# still, no cou3hin3 or dee $reaths 25he fluid is $ein3 removed from the_______________________ 2's the fluid is removed the lun3 should_________________. 2Since #ou are removin3 fluid, the t could 3o into a fluid volume _______________. 5herefore, #ou should $e chec(in3 the_____________________ __________________________________________________. 2=ost2 rocedure: another CPR .

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C#est 20hat has ha ened that the t. needs a chest tu$e1 2=atient will have an occlusive sterile dressin3 at insertion site 20hat is the ur ose of the water2seal1 5o romote______________________flow out of leural s ace 2Do #ou want to see fluctuation in the water seal tu$e1 0ant to see fluctuation with res iration.that means the 3ood connection/ 20hat are we watchin3 the dail# CPR&s for1 Re e@ ansion of the lun3s. 2Fluctuation will sto when the lun3 has re2e@ anded, (in(?clot in tu$in3, or if suction is not wor(in3 ro erl#. 20h# is it im ortant to (ee the $ottles?=leur2AvacB $elow the chest1 5o romote 3ravit# draina3e. 20hat do #ou do if the tu$in3 $ecomes disconnected1 +f there is sterile connector in the $ed side #ou can connect that, that would $e wonderful $ut if not then reconnect the same tu$in3, + (now that is not sterile $ut + won:t die immediatel# die with that $ut if air enters . neumothora@/ can (ill #ou. 20hat do #ou do if the $ottles $rea( and the water seal is lost1 "Kou do whatever #ou have to do to re2esta$lish the water seal. 5here mi3ht $e a 3lass of ice itcher. 3lass of ice water/ 3ra$ it and connect the tu$e in the water and call li3ht for ur fren to $rin3 #ou the new s#stem. 2+f the chest tu$e is connected to suction, 3entle continuous $u$$lin3 is e@ ected. 2Continuous, ,i3orous? e@cessive $u$$lin3F air lea( in the s#stem 2=nuemonthora@...e@ ect intermittent $u$$lin3
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2Call 6D if the draina3e is U1IIml?hr or if draina3e $ecomes 8R+DH5 red 2Do not \mil(] or \stri ] a chest tu$e without an 6D order 2 -A,AR clam a chest tu$e without an order 20hen the doctor removes the chest tu$e the atient will need to ta(e a dee $reath and hold or valsalva and a etroleum dressin3 with >P> will $e laced over the site

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"ul4onary E4.olis4 25his can occur if a atient $ecomes deh#drated, has venous stasis, or has $een ta(in3 $irth control ills. ' throm$us forms, dislod3es .em$olus/, and 3oes to the lun3s. 2S?S@: 2H# o@emia 9l 2short of $reath, cou3h, t RR
7ittle2 's#m tomatic 6edium2S#m tomatic 7ar3e2 Death

2D Dimer O .increased with ulmonar# em$olus; $lood test/ 2 loo(s at coa3ulation activit#

2,T scan .a ventilation? erfusion scan that can detect an em$olus; done in radiolo3#/ "loo(s at $lood flow to the lun3s, d#e is used, remove <ewelr# from chest area so that it will not 3ive false results 2hemo t#sis 2 ulse 2chest ain .Shar , sta$$in3/ 2CPR 25P: =reventH 2o@#3en 2ventilator 2watch R, 2'8D&s 2He arinB, CoumadinB, 7oveno@B 2decrease ain 28= in lun3s 2=I2 "=ulmonar# H5- H# o@ia 2 t lun3 8= 2 t wor(load on ri3ht side of heart
""H# o@ia is the num$er one cause of ulmonar# h# ertension""

2fever? 08C:s .inflammation/

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C#est Trau4a Deneral treatmentF chest tu$es, O2, CPR, ventilation and elevate HO8 l. 5e4ot#oraFB"neu4ot#oraF 28lood or air has accumulated in the .

20hat has ha ened to the lun31 2Hemothora@2 s?s@ de end on si)e, .W$reath sounds, res irator# distress 2=neumothora@2 Su$ T air, leuritic ain, Y RR 2-ever ull out a enetratin3 o$<ect 25horacentesis, chest tu$es, dail# CPR 2. Tension "neu4ot#oraFO .5rauma, =AA=/ 2=ressure has $uilt u in the chest? leural s ace and has colla sed the lun34 ushes ever#thin3 to the o osite side .mediastinal shift/ ressure

2S?S@: Su$ T air, a$sence of $reath sounds on one side, as#mmetr# of thora@, res irator# distress, 2Can $e fatal as accumulatin3 ressure com resses vessels4 decreases venous return, 4 decreases cardiac out ut 25@: lar3e $ore needle is laced into the 2 nd +CS to allow e@cess air to esca e, find the cause, chest tu$es 3. O+en +neu4ot#oraF .suc(in3 wound/; o enin3 throu3h chest allows air into leural s ace 25@: "Have the atient inhale and e@hale forcefull# or valsalva .ta(e a dee $reath and hold or hummmmm/ "8oth of these will increase the intra2thoracic ressure so no more outside air can 3et in the $od# "5hen lace a iece of etroleum 3au)e over the area Z5a e down how man# sides1 "Have t sit u if ossi$le to e@ and lun3s. 5rauma atients sta# flat.

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Fracture o/ sternu4Bri.s . m o s t c o m m o n / 2S?S@: 2tenderness 2cre itus .$ones 3ratin3 to3ether/ 2 shallow res 2non2narcotic anal3esic 2su ort in<ured area with hands; turn on side .tr#in3 to limit movement/


2these ts will usuall# $e ut on the ventilator with =AA= .=ositive And A@ irator# =ressure/ 2 on ventilator 2on rate " On end e@ iration the vent e@erts a ressure down into the lun3s to (ee alveoli o en "im roves 3as e@chan3e, decreases wor( of $reathin3. "+n this atient =AA= e@ ands the thora@, reali3ns ri$s "8+='=: used a lot with =ulmonar# edema; ma# do =rior to intu$ation "C='= .Continuous =ositive 'irwa# =ressure/ 2$reathin3 on their own

""'n#time #ou see =AA=, C='=, or ressure su ort on a ventilator #our riorit# nursin3 assessment is to chec( $ilateral (. Flail C#est <)ulti+le *i. Fracture= 2S?S@: 2 ain 2 arado@ical chest wall movement .seesaw chest/; chest suc(s inwardl# on ins iration and uffs out on e@ iration 2 5o assess chest s#mmetr# alwa#s stand at foot of $ed to o$serve how the chest is risin3 and fallin3 2d#s nea, c#anosis 2 increased ulse 25@: 2sta$ili)e the area, intu$ate, ventilate 2 ositive ressure ventilation sta$ili)es the area

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O*T5O"E01CS l. Fractures 2S?S@: 2continuous ain 2unnatural movement 2deformit# 2shortenin3 of e@tremit# 25@: 2+mmo$ili)e the $one ends lus the ad<acent <oints 2Su ort fracture a$ove and $elow site 2muscle s asm .shortenin3 of e@tremit#/ 2cre itus 2swellin3 2discoloration 6a(es me worr# a$out com artment s#ndrome

26ove e@tremit# as little as ossi$le 5hese three done to revent further in<ur#. 2S lints hel revent fat em$oli and muscle s asm.

20hat do #ou do with o en fractures1 2-eurovascular chec(s: ulses, color, movement, sensation, ca illar# refill, tem

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2Co4+lications> a. S#oc7 .. Fat e4.olis4> 0ith what t# e of fractures do #ou see this1 lon3 $ones e.3 femur, others are elvic fractures and an# crushin3 in<ur#. "S#m toms de end on what1.where it 3oes/ 2=etechiae or rash over chest 2con<unctival hemorrha3es 2snow storm on CPR "#oun3 males.tend to $e ris( ta(ers/ "first *G hours.if #ou are 3ettin3 a fat em$olism, most of the time #ou will 3et it in first *G hours/ a. Co4+art4ent syndro4e> 5his is when a fracture has not $een elevated and has not had ice ac(s. Fluid accumulates in the tissue and im airs tissue erfusion. 5he muscle $ecomes swollen and hard and the atient com lains of severe ain that is not relieved with ain meds. "!n redicta$le "=ain is dis ro ortionate to the in<ur# "+f undetected ma# result in nerve dama3e and ossi$le am utation. Common areas1. fore arm or the Suadrice s/ 5@: 2loosen the cast. to restore the circulation/; $i2valve the cast 2fasciotom#. the doctor will cut down into the tissue to relieve the ressure and to restore the circulation/ 2$e careful of the answer \Remove cast.]. to remove the cast the# should have the reall# reall# reall# $ad neurovascular chec(b+ do not have an# time to call the doctorbthat + need to act save that erson:s e@tremit#../ $ut if + have an#time left to wor( then i will call the doctor $efore + remove the castb. .loosen the cast would $e # favorite answer $ecause there is still the cast in lace/ ortho edic nurses have cast cutters readil# availa$le. to loosen an to remove the cast/. "instruct the client the cast saw does not touch the s(in, $ut it does vi$rate ..0elayed union> healin3 doesn&t occur at a normal rate Non-union> failure of $one ends to unite; ma# reSuire $one 3raftin3 "S?S@ .$oth/: ersistent discomfort and movement 2Cast Care> "+ce ac(s on sides "-o indentations "!se alms for lst 2> hours 2 castin3 material is wet "%ee uncovered and dr# "Do not rest cast on hard surface or shar ed3e
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"Cover cast close to 3roin with lastic "Alevate "-eurovascular chec(s "0hat do #ou do if #our atient com lains of ain1 5he first thin3 #ou do is a neurovascular chec(. +f neurovascular chec( is o(a# then t can have ain medication $ut ma(e sure to come $ac( within less than *I mins and chec( for the ain. +f the atient still has the ain after the ain medication also then we have to assume for the com artment s#ndrome.

-othin3 3oes into the cast no matter how itch# is that or how soft the thin3 is rovided. 5he rule is nothin3 3oes into the cast. 5he onl# thin3 #ou can do is offer them a cool $low air in the cast and that will chan3e the sensation of itchiness.

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2. Traction

"Decreases muscle s asm, reduces, immo$ili)es

"Should it $e intermittent or continuous1 Should $e continuous, rule is never release the traction unless #ou 3ot a doctors order. 8ecause if #ou release traction the muscle s asm can occur and further in<ur# ma# ha en. "0ei3hts should han3 freel#. 5he# should not touch the floor, the# should not touch the $ed and the# should not touch an#thin3. . "%ee t ulled u in $ed and centered with 3ood ali3nment.

"A@ercise non2immo$ili)ed <oints "Ro es should move freel# and (nots should $e secure "A33 crate "Foot $oard "5# es: l. S7in traction25his is when ta e or some t# e of material is stuc( to the s(in and the wei3hts ull a3ainst it. 2+s the s(in enetrated1 no 25# es: 8uc(&s M Russell&s 26ust do 3ood s(in assessments. $ecause this rocedure can tear off m# s(in cause it:s the s(in traction./ 2. S7eletal traction25his traction is a lied directl# to the $one with ins?wires. 2!sed when rolon3ed traction is needed. 25# es: Steinman in, Crutchfield, or Dardner20ells ton3s, Halo vest 26ust monitor the in sites and do in care. "Sterile tech1 .Kes sterile techniSue $ecause the in 3oes u to the $one and if infection occurs then osteom#elitis./ "Remove crusts1 .Kes we are 3oin3 to remove the crust that is formed in the in insertion site $ecause the $acteria li(e to live in the crust and we do not want to 3row the $acteria./ the draina3e is $rin3in3 out the infection and if the crust is formed the draina3e cannot come out and #ou do not want that. "+s serous draina3e o(a#1 Kes serious draina3e is o(a# that is <ust a clear fluid.
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3. Total 5i+ *e+lace4ent 28uc(&s traction is used freSuentl# re2o to immo$ili)e. 2=ost2O : 2-eurovascular chec(s 26onitor drains .Don&t want fluid to accumulate in tissue/

2Firm mattress .<oints need su ort/: an# ortho aedic sur3er# need firm mattress to su ort the <oints.. true for arthritis, ortho aedic in<uries or whatever./ 2Over2$ed tra e)e. hel $uildin3 u the $od# stren3th bb.. is 3ood to use assistive devices e.3 crane wal(er etc..cause #ou need to have some $od# stren3th $efore usin3 the assistive device./ +t also hel them to 3et into the $ed an, ull themselves in the $ed and that sort of thin3s. 2=ositionin3: "neutral rotation 2 toes to the ceilin3 "limit fle@ion; want e@tension of hi "a$duction or adduction 20hat e@ercise can the t do while still confined to $ed1 +sometric e@ercisebthat means sSuee)in3 the Suads and sSuee)in3 the 3luts. 0hen #ou are sSuee)in3 the muscles then #ou are maintainin3 the muscle tone and increasin3 the venous return. +ncreasin3 the venous return is ver# im ortant to revent D,5. =reventin3 the stasis of the $lood. 20hat is the ur ose of the trochanter roll1 5o revent e@ternal rotation. +f we did not revent e@ternal rotation then it could cause hi to o out, hi dislocation. Kou also need to mention the resence of trochanter in #our nurses note. 2-o wei3ht2$earin3 until ordered $# 6D 2'void crossin3 le3s, $endin3 over that is 3oin3 to dislocate so $ecareful. 2+s it o(a# to slee on o erated side1 -o, until the doctor sa# sob$ut if the
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doctor let him? her do that then it:s fine. 2+s h#dration im ortant with this atient1 Kes cause #ou 3ot some$od# who is immo$ile all the time, a lot more sedentar# than the# used to $e so we are worried a$out neumonia and D, we will $e encoura3in3 a lot of fluids. 2Stresses to new hi <oint should $e minimal in the first *2G months. 2+s it o(a# to 3ive ain meds in the o erative hi 1 7et:s not do that $ecause + thin( the# have enou3h trauma in the affected le3. 2Co4+lications> 1. 0islocationC circulator#?nerve dama3e 2S?S@: 2shortenin3 of le3, a$normal rotation 2can:t move e@tremit# 2" ain. some$od# who was doin3 <ust fine $ut suddenl# somethin3 wron3, need to $e concern/ 2. 1n/ection 2 ro h#lactic anti$iotics .<ust li(e with heart valve re lacement/ 2remove fole# and suction 'S'=. $ecause these thin3s har$or infection. 5here is a forei3n $od# in #our $od# li(e for e.3 artificial heart valve. +f #ou have infection, the $acteria first want to 3o to the forei3n $od# whether it is in the heart or in the hi . 5he infection can cause so much dama3e that the sur3er# has to $e com letel# redone a3ain. So this is the $asic ns3 conce t that if an#$od# has a forei3n $od# + their $od# the# alwa#s have to $e in ro h#lactic anti$iotic $efore 3oin3 to an# invasive rocedure for instance 3oin3 to the dentist, mold remove, 3astrosco # or $ronchosco # etc. 3. A-ascular Necrosis .death of tissue due to oor circulation/ (. 144o.ility +ro.le4s

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2"t. Ed.> "8est e@ercise1 0al(in3 would $e the $est e@ercise for this atient when the doctor sa#s it:s o(a#. 5he second $est e@ercise is swimmin3. 8ut what a$out QI #ear old lad#bshe can:t 3o swimmin3 and even wal(in3111 Roc( in a roc(in3 chair. she can do it/ "'void fle@ion4 low chairs, travelin3 lon3 distances, sittin3 more than *I minutes, liftin3 heav# o$<ects, e@cessive $endin3 or twistin3, stair clim$in3 "C=6: .Continuous =assive 6otion/ used mainl# for (nee re lacements "ver# im ortant to chec( the an3le of fle@ion... .could ruin the sur3er# if too much fle@ion occurs. Kou need to administer ain medication with this C=6 $ecause this rocedure is ainful./

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(. A4+utations 2=erformed at the most distal oint that will heal. 5he doctor tries to reserve the (nee and el$ow.. if the# can/b.$ecause when + will use m# rosthesis one da# and if the# reserve me (nee m# 3ait will a ear more normal and if the# reserve m# el$ow would $e eas# to use the rosthesis further. 2=ost2O : "%ee what at the $edside1 ' tourniSuet in case of massive haemorrha3e. "Alevate on illow for first 2> hours. 5hen how do #ou elevate1 8# elevatin3 the foot of the $ed. "=revent hi ?(nee contractures. How1 A@tensionbwe want e@tension of the e@tremit#. "=hantom ain 20hat is the first intervention to decrease hantom ain1 Diversional 'ctivit#. #ou are 3oin3 to 3ive a ain medicine too $ut show the ncle@ eo le some diversional activit# $efore #ou 3ive the ain medicine/b.least invasive first. 2Seen more with '%'&s. a$ove the (nee am utation/ 2!suall# su$sides in * months. 8ut in some atients it sta#s forever. -ever 3oes awa#. "-C7AP 5i : =ain: use other thin3s first rior to ill; the definition of ain is what the atient sa#s it is; 'lwa#s assess the client:s ain $# havin3 them rate their ain on a ain scale .i.e. l21I/. "0h# is lim$ sha in3 im ortant1 For the rosthesis..#ou want the lim$ sha e li(e a cone at the end.. rounded and smaller at the end/ that wa# it 3onna fit down in the rosthesis $etter. "0hat is worn under the rosthesis1 ' lim$ shoc( "0h# is it im ortant to stren3then the u er $od#1

"+s it o(a# to $ear wei3ht on a new stum ? rosthesis1 -O, not until it:s well healed. "+s it o(a# to massa3e the stum 1 5he other cases #ou are worried a$out massa3in3 $ecause #ou ma(e cause ulmonar# em$olism $# the clotbthat case t has their whole lim$ $ut here massa3e is 3ood $ecause it =romotes circulation _ and decreases tenderness. "How do #ou teach a t to tou3hen the stum 1
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.for the rosthesis/ =ress into a soft______ illow. 5hen into a firm__ illow. 5hen the $ed_______. 5hen a chair.

How to wal( with the wal(er1 =atient should: 5a(e the wal(er u ut it in front of them a little $it and wal( into the wal(er .

Crutches when #ou are wal(in3 u and down stairs: ! with the 3ood and down with the $ad.

+f someone 3ot a stro(e and the# are usin3 a cane: 5he# need to use their can cane their side of the stron3est.. not onl# affected side of course/ For instance..the atient has ri3ht sided stro(e so his left side of his $od# 3onna $e wea(er so he should hold the cane with his ri3ht hand.

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*ENAL l. %lo4erulone+#ritis .acute can lead to chronic/

2+nflammator# reaction in the 3lomerulus._________ . 2'nti$odies lod3e in the 3lomerulus; 3et scarrin3 M decreased filter b so the (idne#s are not wor(in3 correctl# now. 5he stre tococcus $acteria is the main cause for this infection. 26ain cause: 2S?S@: 2sore throat 2flan( ain .C,' tenderness/ costoverte$ral an3le tenderness 2malaise 28= .3o u / 2headache 2facial edema 28!- M Creatinine. 3onna 3o u / 2!O. 3onna 3o down/ 2sediment? rotein in urine 2urine s ecific 3ravit#. 3o u $ecause t not assin3 urineb So will $ecome ver# concentrated./ 2fluid volume e@cess $ecause the# are not e@cretin3 fluid that:s wh# their face and lim$ are sweallin3.S 2anemia can occurer#thro oietin . no matter what disease if an#time with an# disease if (idne# is not wor(in3, (idne# can not ma(e enou3h er#thro oietin and if there is not enou3h er#thro oietin then #ou can not mature red $lood cells. 5hen no wonder the atient is anaemic. 25@: 23et rid of the stre 2dial#sis. not ever#$od# with 3lomerulone hritis has to $e dial#ses $ut it de end on how $ad the case is./ 2+f the 8!- is increased what should $e done with the rotein in the diet1 Decrease.. as a 3eneral rule with (idne# eo le we 3onna decrease rotein to the (idne# eo le. 2-a1 decrease $ecause the atient alread# in fluid volume e@cess. 2Car$os1 +ncrease $ecause car$s 3ives us ener3#.
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"%ee s us from

$rea(in3 down rotein for ener3#.. that:s what we dun:t want/

28ed rest $ecause $ed rest induces diuresis. 'nd diuresis is im $ecause the# are in fluid volume e@cess and we need to 3et rid of some of the fluids. 2+ M O and dail# wei3htsbwith all (idne# eo le that:s the standard rule and also the# are in fluid volume e@cess. 2How is fluid re lacement determined1 8# their losses O EIIcc "to account for insensi$le fluid loss.EIIcc/ 2Diuresis $e3ins in l22 wee(s after onset. 28lood and rotein ma# sta# in the urine for months. 25each s?s@ of renal failure: "6alaise, headache, anore@ia, nausea, vomitin3, decreased out ut, wei3ht 3ain

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2. Ne+#rotic Syndro4e 2+nflammator# res onse in the 3lomerulus4 $i3 holes form so rotein starts lea(in3 out in the urine4 now the t is h# oal$uminemic .no al$umin in the $lood/ 4 without al$umin #ou can&t hold on to fluid in the vascular s ace4 so where does all the fluid in the vascular s ace 3o1 Out into the tissue____4 now the atient is edematous4 since all the fluid is 3oin3 out into the tissue what has ha ened to the circulatin3 $lood volume1 decreaed___4 the (idne#s sense this decreased volume and the# want to hel re lace it4 Renin2'n3iotensin s#stem (ic(s in4 aldosterone roduced4 retention of sodium__and water______________4 $ut is there an# rotein .al$umin/ in the vascular s ace to hold it1 -o4 so where does this fluid 3o1 +nto the tissue so the t would $e more and more and more oedematous. 5otal 8od# Adema F 'nasarca__ 25@: 2$ed rest. for diuresis/ 2diuretics 2-a1 decrease alread# anasarca 2 rotein1 +ncrease this is the e@ce tion in the %idne# disease where #ou can have more =rotein. 2 rednisone. decrease the inflamation/ "shrin( holes so rotein can:t 3et out "immunosu ressed dial#sis

7asi@ and al$umin administerin3: when #ou 3ive al$umin it will draw the fluid to the vascular s ace $ut if #ou do not 3ive with 7asi@ atient mi3ht 3o to fluid volume e@cess.

Co44on *ule> Li4it +rotein 6it# 7idney +ro.le4s eFce+t 6it# Ne+#rotic Syndro4e.

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3. *enal Failure 2ReSuires $ilateral failure 25# es: a. =re .$lood can&t 3et to the (idne#/ "h# otension, decrease heart rate, decreased cardiac out ut $. +ntra .dama3e has occurred inside the (idne#/ "3lomerulone hritis, ne hrotic s#ndrome, mali3nant h# ertension, D6 "mali3nant h# ertension .uncontrolled H5-/ and D6 cause severe vascular dama3e c. =ost .urine can&t 3et out of the (idne#/ "enlar3ed rostate, (idne# stone, tumors, ureter o$struction, edematous stoma -C7AP Sam le Tuestion 'nswers: a. $. c. d. Call 6D 5urn from side to side +rri3ate Reassess in 1E min

2S?S@: 2Creatinine and 8!-bb3oin3 to 3o u .$ecause #ou are not a$le to e@crete it/ 2S ecific 3ravit# .concentrated so 3oes u / "Fi@ed s ecific 3ravit# "6a# lose a$ilit# to concentrate and dilute urine. "Fluid challen3e, 2EI cc $olus .done in acute renal failure, not in chronic/ 2'nemia "not enou3h er#thro oetin 2H5retainin3 volume 2CHF 2'nore@ia, nausea, vomitin3. .$ecause we are retainin3 to@ins/ 2+tchin3 frost 2 uremic frost 2'cid2$ase?fluid and electrol#te im$alances "retain hos horous2 serum calcium decreasb.2 now the calcium ulled from the $one and now + 3ot renal failure and osteo orosis.
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25wo hases of 'cute Renal Failure: a. Oli3uric hase F,A "0hat has ha ened to !O1 Decreases H# er(alemia "5his atient is in a fluid volume e@cess $ecause the# are retainin3 fluid. 1 "0hat do #ou thin( will ha en to the %O1 +t will increaseb$ecause #ou are not e@cretin3 the fluid. $. Diuretic hase "0hat is ha enin3 to the !O1 +ncreases "5his atient is in a fluid volume deficit which can lead to .Shoc(/ F,D "0hat do #ou thin( will ha en to the %O1 Decrease H# o(alemia

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(. 5e4odialysis .the machine is the 3lomerulus/ and #ou (now that the 3lomerulus is #our filter 2+f the atient is aller3ic to He arin the# can&t $e hemodial#sis .5his is a 3enerall# acce ted standard in man# areas; if the t is aller3ic to he arin, hemodial#sis can $e used if another solution with an anti2clot ro ert# is used i.e. cathflo/ 2+s done *2> times er wee(; so the atient has to watch what in $etween treatments1 0hat the# eat and drin(1 2de ression

suicide(one of the ways to do suicide is to eat too many things that they are not supposed to have like bananas because if serum potassium get high they will get a life threating arrhythmias and they will die.
2Alectrol#tes and 8= are watched constantl# .durin3 the rocedure/

2Can all atients tolerate hemodial#sis1 -o.... some of the eo le mi3ht 3o to shoc( when hemodial#sis/ es eciall# 2unsta$le cardiovascular s#stem .$ecause we are ta(in3 out a lot of volume out of them./ 26ust have a circulator# access: a. '2, shunt $. Fistula c. Draft d. 5em orar# catheters .'sch catheter/ "utili)ed for short term access while the ermanent access \matures]. 5# icall# used for QI da#s or less. "Do not use an# of the a$ove for +, access .drawin3 $lood, administerin3 meds. etc./ atient has an alternate circulator# access what is the associated nursin3 care1 Hurst20hen Reviewa Services

+ do not want an# $lood ressures, no needle stic(s, no constriction on that arm .+ do not want them to wear a watch on that side, no elastic $anda3e no carr#in3 of urse on that side./ $ecause #ou do not want an#thin3 to im air circulation tot the alternate circulatin3 device at all. Kou can al ate the device and when #ou al ate #ou can feel the thrillb "5hrill Z cat urrin3 sensation. and it should ulsate/ "8ruit. when #ou auscultate #ou will hear a $ruit/ " Feel a thrill... Hear the $ruitH

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!. "eritoneal 0ialysis 25his is when dial#sate is warmed and infused into the eritoneal cavit# $# 3ravit# throu3h a catheter. 5he fluid .2III22EII ml/ sta#s in for an ordered amount of time .dwell time/. 5hen the $a3 is lowered and the fluid alon3 with the to@ins, etc., is drained. 20h# do we warm the fluid1 "Cold romotes vasoconstriction 2 limits $lood flow .we dun want vasoconstriction here $ecause #ou will limit the $lood flow and if #ou limit the $lood flow then #ou will limit the flow of to@ins/ " 0ant vasodilatation .we warm the fluid to romote vasodilation and to 3et more $lood flow so that more to@ins can $e ulled out./ 20hat should the effluent?draina3e?fluid loo( li(e1 Clear and, straw2colored if the# are cloud# F + would have to assume infection. "should $e a$le to read a news a er throu3h the draina3e?effluent 20hat t# e of atient 3ets eritoneal dial#sis1 Some$od# who cannot ta(e hemodial#sis li(e the erson who have unsta$le vascular s#stem. 20hat if all the fluid doesn:t come out when #ou lower the $a3 to the floor1 5hat:s when #ou re osition #our atient and turn them from side to side $ecause we want all the to@ins to drain out. 22 5# es of =eritoneal Dial#sis: a. C'=D .Continuous 'm$ulator# =eritoneal Dial#sis/ 5his t# e of dial#sis is not for ever#$od# $ecause for this dial#sis atient #ou need to have a semi stron3 atient that has the a$ilit# and desire to $e active in the treatment and also have the a$ilit# to learn and follow instructions. +t:s done > times a da#, L da#s a wee( e@chan3e does not have to $e done durin3 ni3ht. 5he# can do it if the# want to do not have to $ecause the atient is 3oin3 throu3h the rocedure the whole da# lon3.DO the atient with arthritis so this1 Hurst Review Services 1GE

-o $ecause the fluid causes ressure on the $ac(

c. CC=D .Continuous C#cle =eritoneal Dial#sis/ 2connects their eritoneal dial#sis catheter to a c#cler at ni3ht and erforms the e@han3e while slee in3; Disconnects in the '6.; has more freedom

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6. CA"0 <Continuous A4.ulatory "eritoneal 0ialysis= 2a t# e of eritoneal dial#sis 26ust have a semi2stron3 atient that has the ener3# and the desire to $e active in their treatment and that also has the a$ilit# to learn and follow instructions. 2Done > times er da#; L da#s a wee(. 2+s an e@chan3e done at ni3ht1 -ot usuall#, if the# want the# could $ut the# are doin3 the rocedure the whole da# lon3. 2Could a atient with disc disease or arthritis do this1 -O $ecause Fluid causes ressure on $ac( . eo le with this rocedure alwa#s com lain the $ac( ain and discomfort alwa#s. +t:s <ust a art of it. 2Could a atient with a colostom# do this1 -o $ecause hi3h ris( for infection would $e too hi3h. 2Com lications: " eritonitis 91 .a$d. ain, eritonitis, cloud# effluent lst si3n/ "constant sweet taste "hernia "altered $od# ima3e?se@ualit# 2+ncrease what in the diet1 a. Fi$er 2O have decreased eristalsis due to a$dominal fluid $. =rotein 2O 8i3 holes in eritoneum "anore@ia "low $ac( ain

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6. Continuous *enal *e+lace4ent T#era+y <C**T= 2 =risma is the name $rand of the (idne# .filter/ utili)ed in man# facilities. 2t# icall# done in an +C! settin3 on atients whose cardiovascular status would have difficult# with hemodial#sis due to the drastic fluid shifts 2hemodial#sis is more a33ressive; at an# 3iven time durin3 hemodial#sis there is a ro@imatel# *II ml of $lood in the machine .(idne#/; However, with CRR5 there is onl# a ro@imatel# NI ml of $lood in the machine. .=t:s $lood/ 6. 2ltra/iltration 2onl# ullin3 off water <out o/ t#e +atiet not sodiu4 and 6ater .ut ;ust t#e 6ater= 2ma#$e utili)ed with eritoneal dial#sis or hemodial#sis 2same rinci les a lied as with hemodial#sis For instance, doctor came and told the atient that #ou do not need hemodial#sis toda#. + will <ust ultra2filter #ou toda# cause $# seein3 #our electrol#te ever#thin3 is erfect <ust water is more111 0hich electrol#te is messin31 Sodium..cause that is the onl# electrol#te that cares a$out water. So now at this oint of time when the atient is full of water is h# onatremic or h# ernatremic11 +f #ou are full of water #our serum sodium 3onna 3o down $ecause dilute ma(es num$er 3oes down.So the atient is h# onatremic.

. Kidney Stones <urolit#iasis8 renal calculi= 2S?S@: 2 ain .n?v?vasova3al res onse/ 208C:s in urine 2hematuria

2'n#time #ou sus ect a (idne# stone 3et a urine s ecimen 'S'= and have it chec(ed for R8C:s. +f R8C:s are resent, then it:s ro$a$l# a (idne# stone and the atient will 3et ain medicine immediatel#. 25@: 25oradolB4 DilaudidB
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2increase fluids2 ma#$e sur3er#

2strain urine 2 A@tracor oreal shoc( wave lithotri s# .AS07/ . rocedure that $ro(e the stone into ieces/ the# are small ieces of stone and can ass throu3h the urine. 0hen the atient come $ac( with the Fole# Cather #ou mi3ht see the sand at the $ottom of the Fole# $a3 . that:s a 3ood si3n that means the stone is comin3 out./ "worr# a$out arrh#thmias

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Fluid D Electrolyte and Acid- Base 1. Avaluation of successful resolution of a fluid volume deficit ma# $e demonstrated $# which of the followin31 1. 5he 2. 5he *. 5he >. 5he atient demonstrates an a$sence of ostural h# otension and tach#cardia atient adheres to rescri$ed dietar# sodium restrictions atient maintains wei3ht loss atient maintains a serum -a a$ove 1>E mAS

2. 6s. Stone is admitted with a serum ma3nesium deficit. 'ssessment reveals a ositive 5rousseau:s and Chvoste(:s si3ns. 0hich of the followin3 nursin3 dia3nosis would $e most a ro riate1 1. Hi3h ris( for in<ur# R?5 increased neuromuscular irrita$ilit# 2. Hi3h ris( for in<ur# R?5 fractures secondar# to loss of calcium *. Fluid volume deficit R?5 deh#dration >. 'ctivit# intolerance R?5 s(eletal muscle wea(ness *. 6s. Fair is a LL #ear old female. Her hus$and re orts that she has had a oor a etite over the ast two wee(s, with occasional nausea and vomitin3. 0hen laced on a cardiac monitor various a$normal heart $eats are noted. 8ased on this data, the nurse would sus ect that 6s. Fair is e@ eriencin3. 1. H# 2. H# *. H# >. H# onatremia erma3nesemia ercalcemia o(alemia

>. 5he nurse is carin3 for a thoracotom# client, one da# ost o erative on >IJ humidified o@#3en. '8D results are: =O2FQI, =CO2F>Q, HFL.*I, HCO*F2G. 8ased on this information, which of the followin3 nursin3 actions would $e $est1 1. =osition in hi3h fowlers and encoura3e cou3hin3, dee $reathin3, evaluate airwa# atenc# 2. =lace in rone osition and reSuest res irator# thera # to erform ostural draina3e and ercussion thera # *. Call the doctor and advise him of the '8Ds; antici ate increase in o@#3en ercenta3e >. 'dminister anti2an@iet# a3ent and assist the client with a re$reathin3 device to increase o@#3en levels

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E. +t is IGII and a client is scheduled for a cardiac catheteri)ation at INII. 7a$orator# wor( com leted five da#s a3o showed: % *.I mAS?7, -a 1>N mAS?7, 3lucose 1LN m3?d7. He com lains of muscle wea(ness and cram s. 0hich nursin3 action should $e im lemented at this time1 1. 2. *. >. Hold ILII dose of s ironolactone .'ldactoneB/ Ancoura3e eatin3 $ananas for $rea(fast Call the h#sician to su33est a stat % level Call for a twelve lead ACD

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Burns G. ' client is admitted to the AR with second and third de3ree $urns to her anterior chest, $oth arms, and ri3ht le3. =riorit# information to determine at the time of admission would include which of the followin31 1. 2. *. >. =ercenta3e of $urned surface area 'mount of +, fluid necessar# for fluid resuscitation 'n# evidence of heat inhalation or airwa# ro$lems Circumstances surroundin3 the $urn and contamination of the area

L. ' famil# mem$er of a client who has sustained an electrical $urn states, \+ don:t understand wh# he has $een her a wee(, the $urn doesn:t loo( that $ad.] 5he nurse:s res onse would $e $ased on which of the followin31 1. 2. *. >. Alectrical $urns are more rone to infections Alectrical $urns are alwa#s much worse than the# loo( on the outside Cardiac monitorin3 is im ortant since $urns alwa#s affect cardiac function Alectrical $urns can $e dece tive as underl#in3 tissue is dama3ed

N. ' client has severe second and third de3ree $urns over LE ercent of his $od#. 0hich assessment findin3 indicates an earl# ro$lem with shoc(1 1. 2. *. >. A i3astric ain and sei)ures 0idenin3 ulse ressure and $rad#cardia Cool and clamm# s(in and tach# nea %ussmaul res irations and lethar3#

Q. Durin3 a first aid class, the nurse is instructin3 clients on the emer3enc# care of second de3ree $urns. 0hich of the followin3 interventions for second de3ree $urns of the chest and arms will $est revent infection1 1. 2. *. >. 0ash the $urn with an antise tic soa and water Remove soiled clothin3 and wra victim in a clean sheet 7eave $listers intact and a l# an ointment Do nothin3 until the victim arrives in a $urn unit.

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Oncology 1I. 5o romote safet# in the care of a client receivin3 internal radiation thera # the nurse would: 1. Restrict visitors who ma# have an u er res irator# infection 2. 'ssi3n onl# male care 3ivers to the client *. =lan nursin3 activities to decrease nurse e@ osure >. 0ear a lead lined a ron whenever deliverin3 client care 11. 0hich of the followin3 measures should the nurse ta(e while a client has a radium im lant for the treatment of uterine cancer1 1. 2. *. >. Avaluate the osition of the a licator ever# two hours =lace on a low residue diet to decrease $owel movements Ancoura3e the use of the $edside commode ever# 122 hours Decrease fluid inta(e to decrease radiation in $ladder

12. ' client with lun3 cancer and $one metastasis is 3rimacin3 and states, \+ am a little uncomforta$le, ma# + have somethin3 for ain1] 0hich of the followin3 should the nurse do first $efore administerin3 ain medication1 1. 2. *. >. Chec( the chart to determine last medication Ancoura3e client to refocus on somethin3 leasant -otif# doctor that medication is not wor(in3 'ssess the severit# and location of ain

1*. ' client on chemothera # has a 08C count of 12II mm. 8ased on this data, which of the followin3 nursin3 actions should the nurse ta(e first1 1. 2. *. >. Chec( tem erature S>h 6onitor urine out ut 'ssess for $leedin3 3ums O$tain an order for $lood cultures

1>. ' client is admitted to the out atient unit in the Cancer Center for his chemothera #. He is lethar3ic, wea(, and ale. His 08C count is *III. 0hich of the followin3 nursin3 interventions would $e most im ortant for the nurse to im lement1 1. 2. *. >. Asta$lish emotional su ort =osition for h#sical comfort 6aintain res irator# isolation Hand washin3 rior to care

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1E. 0hich of the followin3 ro erl# stated nursin3 dia3noses would $e a riorit# for a GE2#earold client immediatel# after her modified radical mastectom# and a@illar# dissection1 1. 2. *. >. 'n@iet# related to the mastectom# S(in inte3rit#, im airment of, related to mastectom# 'lteration in comfort related to incisional ain Self2care deficit related to dressin3 chan3es

1G. ' client had a radical mastectom# for cancer in her ri3ht $reast. 'fter she returns to #our unit, which of the followin3 would $e the most a ro riate for her1 1. 2. *. >. 7eft side with ri3ht arm rotected in a slin3 Ri3ht side with ri3ht arm elevated Semi2fowlers osition with ri3ht arm elevated =rone osition with ri3ht arm elevated

1L. ' client with rostatic cancer is admitted to the hos ital with neutro enia. 0hich si3ns and s#m toms are most im ortant for the nurse to re ort to the ne@t shift1 1. 2. *. >. 'rthral3ia and stiffness ,erti3o and headache Deneral malaise and an@iet# 5em erature elevation and lethar3#

1N. ' *22#ear2old male with acute l#m hoc#tic leu(emia .'77/ is admitted with shortness of $reath, anemia, and tach#cardia. 8ased on this nursin3 assessment, the most a ro riatel# stated nursin3 dia3nosis would $e: 1. 2. *. >. 'ltered rotection, immunosu ression: 7eu(emia +m aired 3as e@chan3e related to decreased R8Cs =otential for infection related to altered immune s#stem =otential in<ur# to decreased latelets

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Endocrine 1Q. ' atient is admitted with dia$etic (etoacidosis. Kou note his res irator# rate to $e *N. Considerin3 his condition #ou are aware that this increased rate is a result of: 1. 2. *. >. 'n effort $# the $od# to com ensate for res irator# acidosis 'n effort $# the $od# to remove e@cess acid from the $od# 'n effort $# the $od# to su l# more o@#3en to the de leted tissues 'n effort $# the $od# to conserve CO2

2I. 5he client is admitted with acute h# o arath#roidism. 5o maintain client safet#, which item is most im ortant to have availa$le1 1. 2. *. >. 5racheostom# set Cardiac monitor +, monitor Heatin3 ad

21. 5o evaluate for the desired res onse of calcium 3luconate in treatin3 acute h# o arath#roidism the nurse would monitor the client most closel# for: 1. 2. *. >. +nta(e and out ut Confusion 5etan# 8one deformities

22. 0hich s#m tom is most im ortant for the nurse to re ort to the ne@t shift a$out the client with h# er arath#roidism1 1. 2. *. >. '$dominal discomfort Hematuria 6uscle wea(ness Dia horesis

2*. 5he nurse would caution the client with h# oth#roidism a$out avoidin3: 1. 0arm environmental tem eratures 1. -arcotic sedatives 2. +ncreased h#sical e@ercise 2. -um$ness and tin3lin3 of fin3ers 2>. +n lannin3 care for the client with h# erth#roidism, the nurse would antici ate the client to reSuire: 1. 2. *. >. A@tra $lan(ets for warmth O hthalmic dro s on a re3ular $asis +ncreased sensor# stimulation FreSuent low calorie snac(s

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2E. 5he elderl# client with h# er arath#roidism should $e cautioned a$out: 1. =atholo3ical fractures 2. Decreasin3 fluid inta(e 1. 5etan# and tin3lin3 of fin3ers 2. +ncreasin3 h#sical activit# 2G. 5he nurse is aware that which of the followin3 statements made $# the client indicates a correct understandin3 of steroid thera # for 'ddison:s Disease1 1. 2. *. >. \+:ll ta(e the medicine in the mornin3 $ecause if + ta(e it at ni3ht it mi3ht (ee me aware.] \+:ll ta(e the same amount from now on.] \+:ll increase m# otassium $# eatin3 more $ananas.] \+:ll $e eatin3 foods low in car$oh#drates and salt.]

2L. 0hich nursin3 action has the hi3hest riorit# in carin3 for the client with h# o arath#roidism1 1. Develo a teachin3 lan 2. =lan measures to deal with cardiac arrh#thmias 1. 5a(e measures to revent a res irator# infection *. 'ssess la$orator# results 2N. ' client is 3oin3 to have a arath#roidectom#. 0hich of the followin3 foods would the nurse discoura3e the client from eatin31 1. 6il( roducts 1. Dreen ve3eta$les 2. Seafood 2. =oultr# roducts 2Q. 0hich of the followin3 t# es of foods would the nurse encoura3e the client with h# o arath#roidism to eat1 1. Hi3h hos horus 2. Hi3h calcium 1. 7ow sodium 2. 7ow otassium *I. ' client is admitted for a series of tests to verif# the dia3nosis of Cushin3:s s#ndrome. 0hich of the followin3 assessment findin3s would su ort this dia3nosis1 1. 8uffalo hum , h# er3l#cemia, and h# ernatremia 2. -ervousness, tach#cardia, and intolerance to heat 1. 7ethar3#, wei3ht 3ain, and intolerance to cold 2. +rrita$ilit#, moon face, and dr# s(in
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*1. One hour after receivin3 L units of re3ular insulin, the client resents with dia horesis, allor, and tach#cardia. 5he riorit# nursin3 action would $e: 1. 1. 2. *. -otif# the doctor Call the la$ for a $lood 3lucose level Offer the client mil( and crac(ers 'dminister Dluca3on

*2. ' client was admitted for re3ulation of her insulin. She ta(es 1E units of Humulin insulin at N:II a.m. ever# da#. 't >:II .m., which of the followin3 nursin3 o$servations would indicate a com lication from the insulin1 1. 2. *. >. 'cetone odor to the $reath, ol#uria, and flushed s(in +rrita$le, tach#cardia, and dia horesis Headache, nervousness, and ol#di sia 5enseness, tach#cardia, and anore@ia

**. ' client received re3ular insulin, G units, * hours a3o. 0hich of the followin3 assessments would $e most im ortant to re ort to the ne@t shift1 1. 2. *. >. %ussmaul:s res irations and dia horesis 'nore@ia and lethar3# Dia horesis and trem$lin3 Headache and ol#uria

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Cardio-ascular *>. ' client with sudden onset of dee vein throm$osis is started on a He arinB +, dri . 0hich of the followin3 additional orders should the nurse Suestion1 1. 2. *. >. Cold wet ac(s to the affected le3 Alevate foot of $ed si@ inches Commode rivile3es without wei3ht2$earin3 Alastic Stoc(in3s on unaffected le3

*E. 5he nurse is carin3 for a client with dee vein throm$osis .throm$o hle$itis/ of the left le3. 0hich of the followin3 would $e an a ro riate nursin3 3oal for this client1 1. 2. *. >. 5o decrease inflammator# res onse in the affected e@tremit# and revent em$oli formation 5o increase eri heral circulation and o@#3enation of affected e@tremit# 5o re are client and famil# for antici ated vascular sur3er# on affected e@tremit# 5o revent h# o@ia associated with the develo ment of ulmonar# em$oli

*G. 0hich of the followin3 si3ns indicate effective C=R1 1. 'deSuate ca illar# refill 1. -ormal s(in color 2. S#mmetricall# dilated u ils *. =al a$le carotid ulse *L. ' ermanent demand acema(er set at a rate of L2 is im lanted in a client for ersistent third de3ree $loc(. 0hich of the followin3 nursin3 interventions would indicate a acema(er d#sfunction1 1. 2. *. >. =ulse rate of NN and irre3ular ' ical ulse rate re3ular at GN 8lood ressure of 11I?NI, ulse of LN 5enderness at site of acema(er im lant

*N. ' client with an irre3ular ulse rate of 1N1 and a % level of *.I mAS?7 has 7ano@inB ordered. 5he nurse should: 1. 2. *. >. Dive the di3o@in since the ulse is within normal limits Holds the di3o@in since the ulse is irre3ular Call the doctor to re ort the otassium Hold the di3o@in since to@icit# occurs with hi3h otassium levels

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*Q. 5he nurse has administered su$lin3ual nitro3l#cerin .-itrostatB/ to a client com lainin3 of chest ain. 0hich of the followin3 o$servations is most im ortant for the nurse to re ort to the ne@t shift1 1. 2. *. >. 5he client indicates the need to use the $athroom 8lood ressure has decreased from 1>I?NI to QI?GI Res irator# rate has increased from 1G to 2> 5he client indicates the chest ain has su$sided

>I. ' L22#ear2old client has an order for di3o@in .7ano@inB/ I.2E m3 =O in the mornin3. 5he nurse reviews the followin3 information: a ical ulse: res irations: lasma di3o@in level: GN 1G 2.2 n3?ml

8ased on this assessment, which nursin3 action is a ro riate1 1. 2. *. >. Dive the medication on time 0ithhold the medication, notif# the h#sician 'dminister e ine hrine 1:1III stat Chec( the client:s $lood ressure

>1. ' client develo s severe crushin3 chest ain radiatin3 to left shoulder and arm. 0hich =Rmedication should the nurse administer1 1. 2. *. 1. Dia)e am .,aliumB/ =O 6e eridine .DemerolB/ W6 6or hine sulfate W, -itro3l#cerine .-itrostatB/ S7

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*es+iratory >2. 0hen o$tainin3 a s ecimen from a client for s utum culture and sensitivit# which of the followin3 instructions would $e $est1 1. 2. *. >. 'fter ursed li $reathin3 cou3h into container ! on awa(enin3 cou3h dee l# and e@ ectorate into container Save all s utum for * da#s in covered container 'fter res irator# treatment e@ ectorate into container

>*. 0hich of the followin3 is the most effective method for the nurse to evaluate the effectiveness of tracheal suctionin31 1. -ote su$<ective data such as, \6# $reathin3 is much im roved now.] 2. -ote o$<ective findin3s such as decreased res irator# rate and ulse 1. Consult with res irator# thera # to determine effectiveness 2. 'uscultate the chest for chan3e or clearin3 in adventitious $reath sounds >>. 'fter a $ronchosco # is com leted with a client, which of the followin3 nursin3 o$servations would indicate a com lication1 1. 2. *. >. De ressed 3a3 refle@ S utum strea(ed with $lood 5ach# nea 0idenin3 ulse ressure

>E. 5he nurse is carin3 for a client with neumonia. 0hich of the followin3 nursin3 o$servations would indicate a thera eutic res onse to the treatment for the infection1 1. 2. *. >. Oral tem erature of 1I1 F., increased chest ain with non2 roductive cou3h Cou3h roductive of thic( 3reen s utum, client state he feels tired Res irations at 2I, with no com laints of d#s nea, moderate amount of thic( white s utum 0hite cell count of 1I,III mm, urine out ut at >I cc?hr, decreasin3 amount of s utum

>G. Durin3 the shift re ort, a client:s ventilator alarm is activated. 0hich action would the nurse im lement first1 1. -otif# the res irator# thera ist 1. Chec( the ventilator tu$in3 for e@cess fluid 2. Deactivate the alarm and chec( the s irometer *. 'ssess the client for adeSuate o@#3enation

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>L. 5he nurse is carin3 for a client who has a E #ear histor# of chronic lun3 disease. 5he nursin3 assessment reveals a severel# d#s neic client, ulse at 1>I, res irations la$ored, and sli3htl# c#anotic. 'n a ro riate nursin3 action to relieve the client:s d#s nea would include: 1. 2. *. >. 'dminister o@#3en at >IJ heated mist 'ssist the client to cou3h and dee cou3h Alevate the head of the $ed, low flow o@#3en =osition the client rone and assess $reath sounds

>N. ' nurse is the first on the scene of a motor vehicle accident. 5he victim has suc(in3 sounds with res irations at a chest wound site and tracheal deviation toward the unin<ured side. !ntil emer3enc# ersonnel arrive, the riorit# nursin3 action for the nurse is to: 1. 2. *. >. 7oosel# cover the wound, refera$l# with a sterile dressin3 =lace sand $a3 over the wound Sit the client u =lace a firm airti3ht, sterile dressin3 over the wound

>Q. 5he nurse is carin3 for a client who has $een immo$ili)ed for three da#s followin3 a erineal rostatectom#. 5he client $e3ins to e@ erience sudden shortness of $reath, chest ain, and cou3hin3 with $lood2tin3ed s utum. +mmediate nursin3 actions would include: 1. 2. *. >. Alevate the head of the $ed, $e3in o@#3en, assess res irator# status 'ssist the client to cou3h, if unsuccessful then erform masotracheal suctionin3 =osition in su ine osition with le3s elevated; monitor C,= closel# 'dminister mor hine for chest ain; o$tain a 12 lead ACD to evaluate cardiac status

EI. Kour client $ecomes e@tu$ated while $ein3 turned. He is c#anotic and has $rad#cardia and arrh#thmias. 0hich action would $e the hi3hest riorit# while waitin3 for a h#sician to arrive1 1. 2. *. >. +mmediatel# $e3in C=R +ncrease the +, fluids =rovide o@#3en $# am$uin3 and maintainin3 the airwa# =re are the medication for resuscitation

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Ort#o+edic E1. ' client had a $elow2the2(nee am utation due to ro$lems with 3an3rene. Durin3 the first 2 hours after sur3er# which nursin3 action would $e most im ortant1 1. 1. 2. *. -otif# the doctor of a small amount of serosan3uineous draina3e Alevate the stum on a illow to decrease edema 6aintain the stum flat on the $ed $# lacin3 the client in the rone osition Do assive ran3e of motion 5+D to the unaffected le3

E2. ' client is admitted with a fractured ri3ht hi . 5he doctor writes an order for 8uc(:s traction. +n lannin3 care for a client in 8uc(:s traction, the nurse would: 1. 2. *. >. 5urn the client ever# two hours to the unaffected side 6aintain client in a su ine osition Ancoura3e client to use a $edside commode =revent foot dro $# lacin3 a foot $oard to the $ed

E*. ' client has a lon3 cast on his ri3ht le3. His ri3ht foot is ale and cool to touch. 'n anal3esic has offered no relief to the severe le3 ain after >E minutes. 8ased on these o$servations, the first action of the nurse should $e: 1. 2. *. 1. ' l# a heatin3 ad to the ri3ht toes Re eat the dose of the anal3esic stat Remove the cast immediatel# -otif# the doctor immediatel#

E>. Followin3 hi re lacement sur3er#, an elderl# client is ordered to $e3in am$ulation with a wal(er. +n lannin3 nursin3 care, which statement $# the nurse will $est hel this client1 1. 2. *. >. Sit a low chair for ease in 3ettin3 u in the wal(er 6a(e sure ru$$er ca s are resent on all > le3s of the wal(er 8e3in wei3ht2$earin3 on the affected hi as soon as ossi$le =ractice t#in3 #our shoes $efore usin3 the wal(er

EE. 5o revent neurolo3ical com lications for a re2school client with a full2le3 cast, the nurse would schedule re3ular chec(s of: 1. 2. *. >. Femoral ulses 7evels of consciousness 8lood ressure readin3s Sensor# testin3 of affected foot

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EG. ' teena3er has had a re air of an o en com ound fracture of the ti$ia and fi$ula. 'n e@ternal fi@ation device has $een a lied to sta$ili)e the fracture. 8efore administerin3 in site care, the nurse should chec( which of the followin31 1. 2. *. >. Correct ali3nment ' earance of in sites 5i3htness of screws ,ital si3ns

EL. 0hich nursin3 assessment su33ests a com lication of a laster of aris cast a lication the arm1 1. 2. *. >. 5he client states that the wet cast feels \warm] 5he client is a$le to move his fin3ers and thum$ freel# 5he client states that his little fin3er feels \aslee ] 5he wet cast a ears 3ra# and smells sli3htl# must#

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*enal EN. +n lannin3 the diet teachin3 for a child in the earl# sta3e of ne hrotic s#ndrome, the nurse would discuss with the arents the followin3 dietar# chan3es: 1. 2. *. >. 'deSuate rotein inta(e, low sodium 7ow rotein, low otassium 7ow otassium, low calorie 7imited rotein, hi3h car$oh#drate

EQ. 0hich of the followin3 clients is a li(el# candidate for develo in3 acute renal failure1 1. 2. *. >. ' female with recent ileostom# due to ulcerative colitis 6iddle a3e male with elevated tem erature and chronic ancreatitis 5eena3er in h# ovolemic shoc( followin3 a crushin3 in<ur# to the chest Child with com ound fracture of ri3ht femur and massive laceration to left arm

GI. ' client is e@ eriencin3 severe ain from renal calculi. 0hich of the followin3 is a riorit# in the nursin3 care lan1 1. 2. *. >. 'dminister ain medication as often as needed accordin3 to doctor:s orders Ancoura3e fluid inta(e to hel flush the stone throu3h 'ssist the client to am$ulate to romote drainin3 the $ladder +rri3ate the $ladder to maintain urinar# atenc#

G1. +n order to maintain ase sis, the client on home eritoneal dial#sis should $e tau3ht to: 1. 2. *. >. Drin( onl# distilled water Ca the 5ench(off catheter when not in use 8oil the dial#sate one hour rior to a ass Clean the arteriovenous fistula with h#dro3en ero@ide dail#

G2. ' client has a histor# of oli3uria, h# ertension, and eri heral edema. Current la$ values include 8!- 2E, % E.I. 0hich nutrients should $e restricted in this client:s diet1 1. 2. *. >. =rotein Fats Car$oh#drates 6a3nesium

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%astrointestinal G*. ' client had sur3er# for cancer of the colon and a colostom# was erformed. =rior to dischar3e, the client states that he will no lon3er $e a$le to swim. 5he nurse:s res onse would $e $ased on which of the followin31 1. Swimmin3 is not recommended, the client should $e3in loo(in3 for other areas of interest 2. Swimmin3 is not restricted if the client wears a water ti3ht dressin3 over the stoma 1. 5he client cannot 3o into water onl# u to that area stoma area, he can 3o in water onl# u to that area 2. 5here are no restrictions on the activit# of a client with a colostom#, all revious activities ma# $e resumed G>. ' client who is fourth da# ost2o a endectom# com lains of severe a$dominal ain. Durin3 the initial assessment he states, \+ have had two almost $lac( stools toda#.] 0hich nursin3 action is most im ortant1 1. Start an +, with DE0 at 12E cc?hr 1. +nsert a naso3astric tu$e 2. -otif# the doctor *. O$tain a s ecimen GE. 5he nurse is carin3 for a client with a erforated $owel secondar# to a $owel o$struction. 't the time the dia3nosis is made, which of the followin3 would $e a riorit# in the nursin3 care lan1 1. 2. *. >. 6aintain the client in a su ine osition -otif# the client:s ne@t of (in =re are the client for emer3enc# sur3er# Remove the naso3astric tu$e

GG. ' nursin3 assessment of a client with a hiatal hernia is most li(el# to reveal1 1. 2. *. >. ' $ul3e in the lower ri3ht Suadrant =ain at the um$ilicus radiatin3 down into the 3roin 8urnin3 sensation in mid2e i3astric area each da# $efore lunch 'wa(enin3 at ni3ht with heart$urn

GL. 5he nurse is carin3 for a client osto erative ileostom#. 0hich of the followin3 nursin3 o$servations would relate to a osto erative com lication1 1. 2. *. >. 5he ileostom# does not reSuire dail# irri3ations to maintain function 5he stoma a ears ti3ht and there is a decreased amount of stool 'n im action a ears to $e formin3 in the distal anal area ' wei3ht 3ain of E ounds related to increased fluid retention

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Neurological GN. 5he client has $een lethar3ic, $ut res ondin3 to ver$al commands. 5he nurse now assesses that the client is res ondin3 $# withdrawin3 to no@ious stimuli. 5he most a ro riate nursin3 action would $e: 1. 2. *. >. =lan on reassessin3 the client in one hour -otif# the doctor that the client is deterioratin3 =lace the client in 5rendelen$ur3 osition Call the famil# and tell them the client is im rovin3

GQ. 5he nurse enters the room and discovers the client has ri3ht sided aral#sis, and uneSual u ils. 5he most a ro riate ne@t ste for the nurse is to: 1. 2. *. >. Call the doctor 'ssess the res irator# status Determine the level of consciousness =erform a com lete neurolo3ical evaluation

LI. ' client is one wee( ost cere$rovascular accident. 5he nurse notes the client does not res ond readil# to movement or o$<ects in eri heral fields. 8ased on this nursin3 assessment, an a ro riate nursin3 dia3nosis is: 1. 2. *. >. +m aired ad<ustment +neffective individual co in3 Sensor2 erce tual alteration Self2care deficit

L1. 5he client is transferred to the -euro !nit after develo in3 ri3ht sided aral#sis and a hasia. 0hich of the followin3 should $e included in the nursin3 care lan in order to romote communication with the client1 1. 2. *. >. Ancoura3e client to sha(e head in res onse to Suestions S ea( in a loud voice durin3 interactions S ea( usin3 hrases and short sentences Ancoura3e the use of radio to stimulate the client.

L2. 0hat would $e the most a ro riate ne@t action for the nurse to ta(e after notin3 the sudden a earance of a fi@ed and dilated u il in the neuro client1 1. 2. *. >. Re2assess in E minutes Chec( client:s visual acuit# 7ower the head of the client:s $ed Call the doctor

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L*. 0hich instruction would $e included in lannin3 care for a client with si3ns of increased intracranial ressure1 1. 2. *. >. Ancoura3e cou3hin3 and dee 2$reathin3 to revent neumonia Suction airwa# ever# 2 hours to remove secretions =osition the client in the rone osition to romote venous return Determine cou3h refle@ and a$ilit# to swallow rior to administerin3 =O fluids.

L>. ' client with a closed head in<ur# $e3ins to vomit. 0hich assessment is the most im ortant for the nurse to re ort when callin3 the h#sician1 1. 2. *. >. +ncreasin3 lethar3# Heart rate NI Sodium level of 1>E =resence of facial s#mmetr#

LE. 5he nurse is o$servin3 a client for com lications followin3 a craniotom#. 5he client $e3ins com lainin3 of thirst and fati3ue. 0hich nursin3 o$servation is most im ortant to re ort to the h#sician1 1. 2. *. >. S ecific 3ravit# of urine is increased, urine is foul smellin3 Fluid inta(e over ast 2> hours has $een *III cc !rine out ut in e@cess of >III cc in 2> hours =resence of diarrhea and e@coriation of anal area

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EENT LG. ' client with 3laucoma has e@ erienced severe restriction of eri heral vision. He as(s the nurse if his vision will 3et $etter. 5he nurse:s $est res onse would $e $ased on which of the followin31 1. 2. *. >. +f he maintains his medications and reduces the ressure, his vision will im rove 5he current dama3e to vision is ermanent, maintainin3 his e#e dro s will revent further dama3e 'fter the acute e isode, sur3er# will $e scheduled to remove his lens which will increase vision 'fter the ressure is sta$ili)ed, the doctor will reevaluate his vision and rescri$e 3lasses to correct his vision

LL. 'n adult male client com lains of loss of hearin3 while irri3atin3 his ear to remove cerumen for $etter o$servation of the t#m anic mem$rane the client comments that he is 3ettin3 di))#. 5he nurse would sto the rocedure and: 1. 2. *. >. -otif# the doctor immediatel# 6onitor for chan3es in intracranial ressure 0arm the irri3ant and resume the rocedure A@ lore the canal with a cotton a licator

LN. 5he nurse is carin3 for a client who has <ust returned to his room after havin3 a scleral $uc(lin3 rocedure done to re air his detached retina. 0hich of the followin3 is an im ortant nursin3 action on the o erative da#1 1. 2. *. >. Remove readin3 material to decrease e#e strain Closel# assess for resence of nausea and revent vomitin3 'ssess color of draina3e from affected e#e 6aintain sterilit# for S*h saline e#e irri3ations

LQ. ' client has a cataract removed from his left e#e. 0hich of the followin3 is an im ortant nursin3 intervention in the immediate osto erative eriod1 1. 2. *. >. =osition on ri3ht side with head sli3htl# elevated =lace client on his left side to rotect e#e =erform sensor# neuro chec(s ever# 2 hours 6aintain com lete $ed rest for the first >N hours

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NI. 5he nurse is carin3 for a client with 6eniere:s s#ndrome. 5he nurse stands directl# in front of the client when s ea(in3. 0hich of the followin3 $est descri$es the rationale for the nurse:s osition1 1. 2. *. >. 5his ena$les the client to read the nurse:s li s 5he client does not have to turn her head to see the nurse 5he nurse will have the client:s undivided attention 5here is a decrease in the client:s eri heral visual field

Blood N1. ' client is 2 da#s osto erative aortic aneur#sm resection. ' com lete $lood count reveals a decreased red $lood cell count. 5he nursin3 assessment is most li(el# to reveal which of the followin31 1. 2. *. >. Fati3ue, allor, and e@ertional d#s nea -ausea, vomitin3, and diarrhea ,erti3o, di))iness and shortness of $reath 6alaise, flushin3, and tach#cardia

N2. ' client who is receivin3 a $lood transfusion is e@ eriencin3 a hemol#tic reaction. 5he nurse would antici ate which of the followin3 assessment findin3s to validate this reaction1 1. 2. *. >. H# otension, $ac(ache, low $ac( ain, fever 0et $reath sounds, severe shortness of $reath Chills and fever occurrin3 a$out an hour after infusion started !rticaria, itchin3, res irator# distress

"Review Tuestions rovided $# 6arlene:s friend and mentor S#lvia Ra#field. +f #ou would li(e to urchase the $oo( from which these Suestions were ta(en, lease see #our facult# mem$er.

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Final 5hou3hts
Kou are -O5 S!==OSAD to (now ever#thin3 ri3ht now. Kou have ever#thin3 #ou need to ass if #ou stud# the information ro erl#. Kou do not have to 3o $ac( and stud# all of #our notes from school or read #our 6ed2Sur3 $oo(. -o $od# can %-O0 that much information. KO! do not have to (now that volume of material $ecause the -C7AP eo le (now #ou are a 8R'-D -A0 -!RSA 8ut #ou $etter (now this material and + mean '77 OF +5H 0a#s to stud#: 1. 1. Re etition, Re etition, Re etition Once #ou thin( #ou (now a to ic .li(e F,A/ write out a s(im # set of notes with <ust Sue words on it and see if #ou can lecture. 20hen #ou are loo(in3 at #our Sue words is an#thin3 comin3 to mind 20hat did we sa# in class that:s su osed to $e comin3 into m# mind now.

2-othin3 comin3 into #our mind.....need to stud# more A@am le: F l u i d , o l u me A @ c e s s 2other word for it1 2what is it1 2CHF1 2Renal Failure1 2aldosterone1 2+f #ou cannot loo( at these words one at a time and hold #our head u and lecture on it O!5 7O!D, then #ou need to stud# more.

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Record #ourself lecturin3 on one to ic at a time. 27isten to self_____________; 7isten for #our 2Chec( #ourself a3ainst #our notes to see what #ou are leavin3 out 20e listen to ourselves $etter than an#one else 2+f #ou can________it #ou can__________itH 2+ have said thin3s a CAR5'+- wa# on =!R=OSA... .#ou need to sa# it tooH

* . >. E.

5 h e \ 0 h # 1 ] S u e s t i o n 2Do #ou (now the 0h#:s $ehind s?s@, causes, interventions1 Stud# at least the 6ed2Sur3 with a friend Stud# ractice 2R!7A: 5here is no wa# to (now this information the wa# + am tellin3 #ou to (now it and stud# it and F'+7.

27et:s ractice a. $. 5ell #our friend, \How CHF causes F,A] 5ell #our friend how aldosterone can cause shoc(1

c. A@ lain Dia$etes +nsi idus to #our friend L. N . Kou must master #our notes in this wa# O-A SA-5A-CA '5 ' 5+6AH % n o w # o u r C D 2this is the icin3 on the ca(e 2there is a 7O5 of information on the CD... Kou do not have to rint out ever# document on the CD4unless #ou want to... $ut #ou do need to $e sure to rint out the 6oc( -C7AP so when #ou watch the D,D of the rationales #ou can ta(e notes on each Suestions and the 6ana3ement and dele3ation notes #ou can use while watchin3 the 6ana3ement and Dele3ation lecture on #our D,D Q. L. %now #our D,D Remem$er this a$out the moc( -C7AP..........+ romise + will $e ha # if + 3et more ri3ht than wron3H

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're #ou 3oin3 to 3et Suestions on to ics #ou:ve never heard of1 2can + still ass1 2+f + haven:t heard of$od# else has eitherH

11. 11. 12. lE.

+f + urchase ever# -C7AP Suestion $oo( in the world, will + have all of the Suestions1 0hen + select an answer will + feel confident + 3ot it ri3ht1 Kou must not 3et u set if #ou are not feelin3 confident +f #ou stud# ro erl# the hi3her the level of Suestion #ou will 3et, the worse #ou will feel, and the $etter #ou:ll do on the testH 2+f all the answers loo( ri3ht #ou either haven:t studied or #ou are in the hi3her level Suestions Stud#in3 ro erl# will (ee #ou out of the low level Suestions 2low level does not mean eas#


2these are the hardest ones $ecause the# are memori)ed facts lG. 5he test is testin3 for 6+6+6!6 com etenc#1 2+n other words, the a$solute minimum #ou must $e $efore the# will turn #ou loose on the 3eneral u$lic

2Kou do not want to $e <ust minimumHH lL. Kou will never $e more motivated than #ou are now to ass1 2have a new <o$ 2have a new car note 2#our famil# is e@cited for #ou lQ. 6a<or life events 2+f #ou are 3ettin3 married, divorced, if there is a death or sic(nesses then these are distractors. .6an# un reventa$le/ 2I. Kou will have a wide ran3e of emotions when #ou come out of the test 6ad, de ressed, sic( 21. Could + come out of the test and thin( of *N Suestions + missed1 Can + still ass1 22. 0hat if + 3et 2 Suestions that seem almost identical1 2*. +s it true the com uter is loo(in3 for #our w e a ( n e s s 1 2Rule: #ou alwa#s feel li(e #ou 3et more of what #ou are wea( in

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2>. 'lternate format items; +nnovative items 2+f #ou 3et_________Suestions on #our test #ou 6+DH5 3et ____ innovative item Suestions that count 2However,_________Suestions on #our test will $e ilot Suestions4this is for the R- .these do not count for #ou or a3ainst #ou and #ou will not (now which ones are ilot/. 25he 7=- will have 2E ilot Suestions. 2'll of these ma# $e innovative items which would ma(e #ou thin( #ou had lL of these t# es of Suestions. 2Remem$er <ust $ecause a Suestion has a chart or 3ra h that does not mean it is an alternate format item. 2Charts and 3ra hs have $een on the test forever. 2-ow, #ou ma# not 3et an innovative Suestion at '77... that does not mean #ou did not do well on the test... that <ust means #ou were luc(# and did not 3et one of those t# es of Suestions. 2Kou can view e@am les of these Suestions at www.ncs$n.or3 2Kour riorit# Suestion is _________________________ .

2E. +s it true that ever# so man# eo le that come throu3h the doors of the testin3 center will 3 e t t h e w h o l e t e s t 1 25he of Suestions #ou 3et de ends on how #ou are answerin3 the Suestions 2KO! determine the num$er of Suestions #ou 3et $# the wa# #ou studied. 2G. 0ill m# friend $e encoura3in3 to me after the# ta(e their test1 2L. +:m on lNI and + onl# have E minutes left... .what do + do1 a. $. start clic(in3 C li(e + did on the 'C5 slow down

O$viousl# #ou must have $een doin3 o( or the com uter would have '7RA'DK cut off. For the com uter to still $e tic(in3 alon3 #ou were still in the $all3ame and C7OSA to assin3. Kou <ust needed to 3et a few more ri3ht at that oint.

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2N. 0hat if +:m on lLG and the com uter cuts off... .+ wasn:t finished, $ut +:ve run out of time1 Can + still ass1 20hen #ou run out of time the com uter will onl# 3rade #ou on the last ___ Suestions #ou too(. 25hat:s the wa# it is. 2SO #ou $etter ho e #ou 3ot more ri3ht than wron3 in the last GI. 2Q. 0hat if m# com uter 3oes ast the minimum num$er .doesn:t cut off at LE/... .what should #ou tell #ourself1 2For ever# additional Suestion #ou 3et ast LE #ou are still in it even if it 3oes all the wa# to 2GE. 2Remem$er the minimum num$er an 7=- can 3et is NE and the ma@ is 2IE *I. 0hat if + ta(e the whole test.....can + still ass1 2N. +f + 3et the last Suestion ri3ht does that mean + assed1 2-ot necessaril# .ma# have $een a ilot Suestion/ 2N. 6# teachers said harmacolo3# has reall# increased on the test... .what do + do1 2=harmacolo3# is more than <ust dru3s... .also includes care of the central line, +, thera #, calculatin3 dru3s?+,:s, $lood administration, total arenteral nutrition.... 2N. 0hat:s the num$er l reason eo le fail $oards1

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6iscellaneous +nformation
2Stud#in3 at wor( doesn:t wor( 2Kou must set aside dedicated time <ust for -C7AP stud# 2+t too( us > da#s to 3o throu3h the notes; how lon3 will it ta(e #ou to 3o throu3h the material and ver$ali)e as instructed1 2How do + 3et m# results1 See the State ReSuirements document on #our CD. 2+ made reall# 3ood 3rades on the dia3nostic readiness tests + too( at school. Doesn:t matter.....#ou:ve never had a test li(e ncle@ $eforeH 2+:m a 7=-, +:m a =aramedic... .#ou $etter for3et what #ou have seen $ecause -C7AP thin(s of #ou as a $rand new nurse, fresh out of school 2How come some eo le that didn:t ma(e 3ood 3rades assed $oards1 28ecause when #ou are dum$ #ou (now it ahead of the dum$ erson overcom ensates in their stud#in3 25a(e e@tra +D 25he# will ta(e #our icture .#ou 0+77 have e@o thalmus in the icture/ 25he# will 3et #our fin3er rint 2Kou can:t carr# an#thin3 into the testin3 area 2%ee some snac(s in the car 25here are 2 re2 ro3rammed o tional $rea(s, $ut #ou can ta(e as man# $rea(s as #ou need to ta(e durin3 the test. 25he first o tional $rea( is after 2 hours of testin3. 25he second o tional $rea( is after * 1?2 hours of testin3. 28!5 the Hurst Review wa# is to ta(e a $rea( HO!R7KH 2+:m 3onna sit here till + finish this test1 8ad mista(e... .#ou $etter ta(e #our $rea(s 2Kou have G hours to ta(e the test.....#our time is tic(in3 when #ou are on $rea(s. 27=-s have E hours to ta(e the test 25ell #our friend to ic( #ou u in an hour and a half1 8i3 mista(e... Kou need to lan on 3oin3 in and ta(in3 the entire G hours to ta(e the test.
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25a(e a <ac(et 2+f #ou are 3oin3 throu3h a hos ital orientation rior to ta(in3 -C7AP... .listen closel#. 6a# hear some test content .restraints, advanced directives, infection control/ 25here is not \ma3ical eSuation] for the amount of time #ou should stud# the ac(et $efore #ou schedule #our test. Kou are read# to ta(e the test when #ou can ,AR8'7+CA the entire ac(a3e and #ou can teach it. 2Kou can:t ta(e a calculator in the testin3 room with #ou. 5he# will rovide #ou with a dr# erase $oard for an# calculation ro$lems #ou ma# have on the test 2!nsuccessful1 Call usH 0e want to hel . 0e will not dessert #ou. Com lete our remediation ro3ram and ='SSH 2+f #ou are unsuccessful #ou:ve onl# $een dela#ed >E2QI da#s. Don:t 3o into de ression and thin( $ad of #ourself... .Wust ass it in >E2QI da#sH 2Some states ma(e #ou wait >E da#s... Other states ma(e #ou wait QI da#s. 2See the State ReSuirements document on #our CD. 2+f #ou are unsuccessful and #ou ta(e the -C7AP a3ain. Kou will not 3et the same Suestions. 5hose Suestions are \$loc(ed.] Kou ma# 3et a Suestion on the same to ic, $ut never will #ou 3et the AP'C5 same Suestion. 2Once #ou have selected an answer, #ou C'--O5 3o $ac( to chan3e an answer or view the Suestion.

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1. 0hat did #ou li(e most a$out this class1

2. 0hat did #ou li(e least a$out this class1

*. Did #ou li(e the lecture st#le1

>. Did this class meet #our e@ ectations1

E. 0ould #ou recommend this class to others1

G. Can #ou identif# an# chan3es that would im rove learnin3 in this class1

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6# instructor was: 1. 6# instructor was: .=lease circle #our res onse/

Cheerful ! $eat Sincere =rofessional Dress =rofessional =resentation Resourceful %nowled3ea$le Followed the outline?content =rovided contact information
"Amail?=hone -um$er

'3ree '3ree '3ree '3ree '3ree '3ree '3ree '3ree '3ree

Disa3ree Disa3ree Disa3ree Disa3ree Disa3ree Disa3ree Disa3ree Disa3ree Disa3ree

2. Did #ou feel #our instructor was a roacha$le1 *. 'dditional Comments:

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Eth Da# CD 5a$le to Contents Fast Facts for Central 7ines State ReSuirements o 7ocation of =earson 5estin3 Centers2htt :??www.ncs$n.or3? AR 5ria3e AR 5ria3e 'nswers and Rationales Si3ns and S#m toms of '$use o Se@ual '$use o -e3lect o =h#sical '$use o Domestic '$use o Alderl# '$use Reference 0e$sites Sta3es of 7a$or 6aslow:s Hierarch# of -eeds -ormal ,ital Si3ns for Children 6edication Calculation Reference o Calculatin3 Safe Dru3 Dosa3e for Children Cranial -erves Develo mental 6ilestones for Children '3es *2G '3e Characteristics of =la# 5# es of Shoc( Sta3es of Develo ment 5estin3 Strate3ies +mmuni)ation -ursin3 Dele3ation Her$al 6edication o =ossi$le Side Affect o Other medications that ma# $e affected $# Her$al medication -ormal la$ values o =anic la$ values Oncolo3# =ain 6edication 7a$or and Deliver# =ain 6edication 6ana3ement and Dele3ation -otes 6oc( -C7AP +nsulin Chart 8lood 5ransfusion +nfectious Control 6easures 'ssi3nment, riorit#, care mana3ement Tuestions 'ssi3nment, riorit#, care mana3ement 'nswers and Rationales 6aternit#?=riorit# Tuestions 6aternit#?=riorit# 'nswers and Rationales Da# > Tuestions and Rationales Fire Safet#

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"ediatric Nursing *e-ie6

1. -utrition 'ssessment 2Deneral 3rowth within E2QEJ for hei3ht, wei3ht and head circumference is desired. 5he EIJ is the median 3rowth.EJ would $e the lowest in 3rowth measurement and QEJ would $e the hi3hest in the 3rowth measurement. 27a$orator# test for assessin3 nutritional status is: hemo3lo$in, hematocrit, al$umin, creatinine and nitro3en.

2=h#sical assessment for nutritional status includes: for hair u alwa#s want the child hair to $e soft and shin#. Child oorl# nourished the hair would $e dr#, $rittle, easil# $rea(a$le.

'lso fin3er nailb..teach us a$out h#3iene and also a$out emotional status of the child

S(inb.if ale ma# $e the si3n of anemia. A#eb.if it is sun(enbfor deh#dration.

2How man# cu s of mil( should a l> month old consume dail#1 'vera3e of 22* cu s... some children mil( $ut if the# drin( too much mil( the# won:t $e eatin3 some other food so some other deficit will occur so ever#thin3 should $e $alanced. 2' school a3e child reSuires how man# calories er da#1 'vera3e of 1GII calories $ased on their wei3ht.

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2. =ain 'ssessment 0hat ain assessment tool is commonl# used for infants 2 months to L months of a3e1 F7'CC: Face, le3s, activit#, cr#in3, consulu$ilit#. Aach one of which worth 2 oints. So o is no ain whereas 1I is the worst ain. 5he 0on3 8a(er =ain Ratin3 Scale is used on children at what a3e1 * #ears and older.

2Scale is I .no ain/ to E .most ain/

5he -umerical Scale for children is used at what a3e1 Z E #ears and older.Scale is I .no ain/ to lI .worst ain/

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Res irator# S#stem

0hat are o$serva$le si3ns for res irator# d#sfunction in children1 Z'ccessor#b. muscles use 2Flarin3b. nares 2Circumoralb.. allor 2Sternalb.. retractions 2=allor 2Ca illar# Refill U 3reater than * _ seconds . $oth allor and ca illar# refill/ 0hat is Res irator# S#nc#tical ,irus .RS,/1 2'cute viral infection which affects the $ronchioles. 2'ffects children 2 months Z 2 #ears. How is RS, manifested1 28e3ins with a sim le !R+ ; nasal dischar3e; mild fever; d#s nea; non roductive aro@#smal cou3h; tach# nea with flarin3 nares; retractions; ossi$le whee)in3_____________ How is asthma different from RS,1 'sthma is inflammation of the airwa#s resultin3 in o$struction. 2is reversi$le

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Ast#4a Si3ns and S#m toms: 2Cou3h, Shortness of $reath_____________, audi$le whee)in3____________, rolon3ed A@ irator# whee)in3, restlessness, c#anosis 0hat is the most im ortant lesson in roactive care for asthma atients1 'sthma education, s ecificall# identif#in3 tri33ers___________________that reci itate e isodes . ets, foods, environmental conditions, emotional situations/ a fish would $e an a ro riate et for the asthma atient. 0hat would $e an a ro riate et for a child with asthma1 ' fish PLEASE REFER TO THE FOLLOWING HANDOUT FOR MORE DETAILED INFORMATION ON ASTHMA

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Ast#4a 2Chronic in/la44atory disorder of the airwa# 20hat is ha enin3 in the erson:s airwa#1 Adema, inflammation, tenacious secretions, and smooth muscle s asms .whee)in3 and $ronchos asm/, decreased e@ irator# airflow 26ost common chronic childhood disease 2mainl# in male children, $ut eSuali)es in adolescents 2 'frican 'mericans at 3reatest ris( 2 5he ma<or cause of a$sentees from school 2 One of the ma<or dia3noses for children $ein3 admitted to hos itals and AR visits 2Causes?5ri33ers: ma<or cause: aero aller3ens Other causes or tri33ers: 2environmental aller3ens .dust mites and roaches/ 2smo(e .an# form/ 2dust 2 ets 2e@ercise 2chan3e in weather 2 cold air, stron3 emotions 2chan3e in environment .movin3 to new home or new school/ 2food 2medication 2 Seen freSuentl# in children with mothers under the a3e of 2I2 un(nown etiolo3#

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2S?S@: 2Recurrent e isodes of whee)in3 .on end e@ iration/ 2as the o$struction $ecomes worse the whee)in3 $ecomes more hi3h itched 2can:t catch their $reath 2hac(in3 non2 roductive cou3h 2in the a$sents of a res irator# infection es eciall# at ni3ht 2therefore the child is tired at school 2chest ti3htness 2d#s nea 2 retraction in infants 2 h# erressonance of chest with ercussion 2 loud $reath sounds 2wet lun3s 2S#m toms usuall# seen at ni3ht and earl# mornin3 -S#m toms of acute asthma attac(: Child ma# start to c?o itchin3 in front of the nec( or the u er $ac( Child will start out feelin3 restless and c?o of a H'. Child will also $e tired, irrita$le, hac(in3 non2 roductive cou3h, chest is startin3 to 3et ti3ht, as secretions increase the cou3h $ecomes rattlin3 and roductive .clear froth# s utum/. 2 'ttac( $ecomin3 more sever: 5r# to $reath more dee l#, e@ irator# hase is rolon3ed, audi$le whee)in3, a ears ale, red ears, dar( red li s and ma# $ecome c#anotic, restless, an@ious e@ ression, sweatin3, #oun3er children assume the tri od sittin3 osition, whereas the old child will sit u with shoulders hunched over with hands on le3s or $ed to facilitate use of accessor# muscles, 25he more sweatin3 and the more the atient refuses to lie down... the worse the e isode. +f the# are l#in3 down it is not a $ad e isode 2'$sence of lun3 sounds as swellin3 and secretions increase as attac( ro3resses 2Re eated e isodesF $arrel chest

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D@: 2Hard to dia3nose asthma in infants $?c man# conditions can cause whee)in3 and retractions and it is also hard to see if an infant has a rolon3ed e@ irator# hase. 2Chronic cou3h with no si3ns of infection or whee)in3 on e@ iration is enou3h to dia3nosis asthma. 2=ulmonar# function test: hel s to determine the resence and de3ree of lun3 disease and res onse the res irator# thera # 2S ironmetr# function test relia$le for children older than E #rs 2=ea( e@ irator# flow rate .=AFR/: ma@ airflow that can $e forcefull# that can $e e@haled in one second. 2Aach child:s =AFR $ased on a3e, race, hei3ht and 3ender. Draded $ased on color coded cate3ories .3reen, #ellow, and red/ 2Dreen: NI21IIJ of ersonal $est2asthma under control 2Kellow: EI2LQJ of ersonal $est2si3nals asthma not under control, t ma# have an acute e@acer$ation 2Red: EIJ of ersonal $est2severe airwa# narrowin3
=ea( A@ irator# Flow 6eter .=AF6/ 6eter should $e at )ero $efore $e3innin3 test -othin3 in mouth Stand u strai3ht %ee ton3ue $ac( 27i s ti3ht around mouth iece Fast hard uff .8lowin3 out forcefull#/ Re eated * P .*I seconds $etween each uff/ Record hi3hest readin3 Same time dail# 28efore medication and 1E min after medication is administered

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25@: -'cute 'sthma 'ttac(: 2Humidified I2 2 A ine hrine ST or ST 5e$utaline in AR settin3 3iven 2 Dive Suic( relief rescue mediation: 2+, corticosteroids: =ednisoneB, Solu26edrolB 28eta 2 a3onist: 2'l$uterolB .inhaled or =O/ 26eta roterenolB .inhaled or =O/, 25er$utalineB .inhaled or =O/ 2induced asthma attac( if ta(en 1I21E $efore e@ercise 28rochodilator: 27on3 actin3: SalmeterolB .servent/ 26ethl#)anthines: amino haline and theo h#lline 25hera utic ran3e for theo h#lline: E21E mc3?ml 2'n#thin3 over 2I mc3?ml and atient is to@ic 2.s?s@: nausea and vomitin3... and then the heart is affected/ 2'nticholen3erics: .atro ine/ for $roncos asms 2these dru3s have severe side effects 2 7on3 5erm Control . reventer meds/ 2steroid, -S'+DS .cromol#n sodium/, $rochodilators, ne$uli)ers, meter dose inhaler .6D+/, $eta 2 a3onist, corticosteroids .inhaled $# 6D+ or ne$uli)er, =O/ 27eu(otriene modifiers 2decrease inflammation and $roncos asms

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D@: 2-ot for acute e isodes 2Sin3ularB, C#floB

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Deneral treatment of 'sthma: 2Chest =h#siothera # 2=ercussion, vi$ration, sSuee)in3 the chest and $reathin3 e@ercises 2Do not administer this thera # durin3 an acute e isode 2'ller3# shots 2onl# administer aller3# shots if emer3enc# eSui ment is availa$le in case of ana h#lactic shoc( 20hen in cold air, $reath throu3h nose, wear mas( or cu hands over nose mouth .creates warm air/, 2'ller3# roof the house 28low a in wheel to e@tend e@ irator# time 2Ancoura3e activit# that reSuires a short $urst of ener3#: $ase$all s rints, swimmin3 .$ecause #ou are $reathin3 in humidified air and since #ou are e@halin3 under water #ou are e@tendin3 #our e@ irator# time/ 2Discoura3e an# e@ercise that reSuires endurance: soccer or distance runnin3 26onitor I2 sat 2Ancoura3e fluids to liSuef# secretions, $ut no cold fluid $ecause that could induce a $roos asm 2Small freSuent meal2 to revent a$d distention which will revent the dia hra3m from e@ andin3

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Cystic Fi.rosis 8esides the res irator# com lications of c#stic fi$rosis, what other s#stem is affected1 5he D.+ s#stem. 0hat t# e of en)#mes can $e 3iven to hel im rove di3estion1 =ancreatic en)#mes..when #ou have the child with c#stic fi$rosis then #ou have to s rin(le the en)#mes on their food and on their snac(s ever# time the# eat..and #ou never want the en)#mes to touch the li s or it can $urn the li s. 0hat t# e of diet should a child with c#stic fi$rosis $e on1 2Hi3h calorie, Hi3h rotein, and well $alanced 2a low fat diet is su33ested to ensure the atient has a well $alanced diet. 20hen eatin3 hi3h fat foods, encoura3e to add more en)#mes 20ater solu$le vitamins ', D, A and % su lemented 2,itamins ', D, A, and % are usuall# in a fat solu$le form, $ut since the atient can not a$sor$ the fat, the vitamins must $e 3iven in a water solu$le form. Descri$e the stools of a atient with c#stic fi$rosis. Steatorrhea .fatt# and frof# stool/ 0hat is the dia3nostic test for c#stic fi$rosis1 5he sweat chloride test. How is c#stic fi$rosis usuall# discovered1 Some$od# (issin3 the $a$# and the $a$# taste ver# salt#. 5herefore, the child is at ris( for what electrol#te im$alance1 h# onatremia +n the new$orn, what is the earliest si3n1 5he# never ass the meconium. 22meconium ileus 0hat are the mucous secretions li(e with c#stic fi$rosis1 5hic( and stic(#. 5hat:s wh# the# can not ass the meconium. Hurst Review Services 211

+s c#stic fi$oris inherited1 Kes $ut #ou must 3et the 3ene from each arent. 0o6ns Syndro4e 0hat t# es of infections are Downs S#ndrome children rone to develo in31 Res irator#. Sim l# $ecause the# have oor immune s#stem. 0hat is the most common t# e of defect associated with Downs S#ndrome1 Heart defect 5he rimar# aim in 3enetic counselin3 is to inform the arents of their ris(__________.

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Dastrointestinal S#stem
0hat is the difference $etween DAR .Dastroeso ha3eal Reflu@/ and DARD .Dastroeso ha3eal Reflu@ Disease/1 DAR is the assa3e of 3astric contents into the oeso ha3us .

DARD is the chronic form DAR.... tissue dama3e to res irator# structure Z which can lead to =neumonia and $ronchos am. 5he nurse laces the infant with DAR in what osition1 2=ositionin3 is ver# controversial. 2u ri3ht osition feedin3s and at ni3ht 2. elevated rone osition/ rone decreases reflu@, im roves the stomach em t#in3, decreases the chance of as iration 2$est osition after feedin3: rone with head elevated 2avoid uttin3 child in car seat $ecause it increases intraa$dominal ressure 2Alevated rone osition 5irsc#s+rungs 0isease 0hat is Hirschs run3s Disease1 2Hirschs run3s Disease is a con3enital anomal# .also (nown as a3an3lionic me3acolon/ that results in a mechanical O$struction alon3 the $owel. 0hat art of the $owel does Hirschs run3s Disease usuall# affect1 5he si3moid colon 0hat are the resentin3 s#m toms of Hirschs run3s Disease1 ZConsti ation. in hirschs run3s disease there is one art of intestine which donot have nerves. a3an3lionic/ the food and fluid 3o thorou3h the intestine until that art and sto s cause there is no #ou have the accumulation of the $owel content in that area.remem$er111 no nerves no eriltalsisbso consti ation. 2'$dominal distention.or the child mi3ht have ri$$on li(e stools. 2Ri$$onli(e__________________________.foul smellin3/
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"yloric Stenosis How is #loric stenosis different from DAR1 =#loric stenosis results in ro<ectile vomitin3 usuall# after feedin3. 'nd the# are read# to eat a3ain $ecause these $a$ies are hun3r#. DAR results in s eedin3 u formula with 3astric <uice. '$dominal assessment of =#loric Stenosis reveals: 'n Olive sha ed mass in the e i3astrium re3ion .near um$ilicus/bthat:s the enlar3e #lorus. 5his enlar3e #lorus reduced the o enin3 of the stomach so the content in stomach is ver# hard to assbso ressure $uild u in the stomach and a$dominal distentionbthe ro<ectile vomitin3 is also the result of the ressure in the a$domen. 0hat would $e some im ortant nursin3 interventions for an infant with =#loric Stenosis1 2H#dration 2+nta(e and out ut__________ 2Dail# wei3ht_______________ 2!rine s ecific 3ravit#b

5he treatment for #loric stenosis would $e sur3er#. 5he# will o en the stomach o enin3 and ma(e it eas# to ass the fluids and foods.

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Cle/t +alateBCle/t li+ 0hat would $e a to nursin3 dia3nosis for a client with cleft alate?cleft li 1 2'lternation in nutrition. 'n#time when #ou were feedin3 the $a$# with clef li or cleft alate #ou need to ut thin3s on the side of the chec( not in the center of the mouth. Otherwise the $a$# will $e in the ris( of choc(in3. Feed with elon3ated ni le or ru$$er ti ed s#rin3e down the side of the mouth 0hen a $a$# is $orn with a cleft li and alate which ro$lem do the# correct first1 5he li b$ecause when #ou $orn the alate is made of cartila3e and cartila3e does not do well the# 3onna wait until there is more $one formed in the alate and the# hurr# u and re air the li to romote $ondin3. 0h# should an infant with a cleft li and alate $e $u$$led .$ur ed/ freSuentl#1 2the# swallow lots of air. 'nd that ushed them to ris( for a$dominal distention which uts them to ris( for vomitin3 and as iration. that:s where am scared at/ 5he nurse should osition a child in the $ac( or side l#in3 osition followin3 cleft li re air 2Doal is to rotect suture line 2DO -O5 =7'CA +- rone osition =OS+5+O-. 0hat will the suture line $e cleaned with ost2o 1 saline 0hen is the $est time for cleft alate re air to $e done1 2$efore s eech develo s $etween 1 and 2 0ith cleft alate re air, wh# do we avoid uttin3 thin3s in the child:s mouth .hard thin3s in articular/1 220e don:t want to disru t the suture line. 5he# have to $e in the soft diet until it is well healed. 're s eech defects common after a cleft alate re air1 Kes, $ecause the alate is ver# im ortant to hel #ou articulate words. 0hat restraint would the nurse select followin3 cleft li re air1 0e sta# awa# from restraints $ut if #ou had to ic( the restraints ic( the el$ow restraints $ecause that:s 3onna (ee their arm strai3ht that:s wh# the# can:t 3et their hands to the mouth. 2follow hos ital olic# concernin3 restraint use

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1ntussusce+tion 0hat are the clinical manifestations of intussusce tion1 ZSudden onset 2Cram in3 2'$dominal_________________ 2+nconsola$ilit# 2Drawin3 u of (nees 0hat is an intussusce ted $owel1 25his is when a iece of the $owel 3oes $ac(wards inside of itself formin3 an o$struction. ' classic s#m tom of intussusce tion is1 Currant <ell# stool. maroon 3ot a $lood in it and mucous in it./ 0hat should #ou $e monitorin3 closel# in a child with intussusce tion1 5heir stoolsb$ecause the doctor want to (now if it fi@ed $# itself... the# were havin3 current <ell# toolbcurrent <ell# stool $ut suddenl# it sto s and have a normal stool that means it fi@ed $# itself/ sometime the# have to do sur3er# $ut sometimes $arium enema will wor(. 8ut even after sur3er# and $arium enema doctors (ee them for * da#s in hos ital $ecause the# mi3ht come $ac(. So we 3onna watch them for a while. Celiac 0isease Celiac S ruce is a 3enetic mala$sor$tion disorder in where there is ermanent intestinal intolerance to 3luten. +n another words the# are aller3ic to it. +m ortant teachin3 with Celiac Disease: 27ife lon3 disorder 2-o food with 3lutens .ve3eta$le rotein/ 2Cannot have 8RO0. 0hat do these letters stand for1
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8arle#. R#e, oats and wheat. 2Can have RC:s. 0hat do these letters stand for1 Rice, corn, so#

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Eso+#ageal Atresia and Trac#eoeso+#ageal Fistula +n eso ha3eal atresia, wh# can:t the saliva ma(e it to the stomach1 2the eso ha3us ends in a $lind ouch that means eso ha3us is closed out at the $ottom and not connected to the stomach. 0h# do $a$ies with eso ha3eal atresia not have meconium1 25he# never swallowed an# amniotic fluid. How are $a$ies with tracheoeso ha3eal fistula or eso ha3eal atresia usuall# feed1 0ith the 3astrostom# feed. Strai3ht into the stomach. 0hen stud#in3 tracheoeso ha3eal fistula, what are the * C:s1 fistula is an o enin3. Cou3hin3, choc(in3 and c#anosisb$ecause #ou have fistula $etween trachea and eso ha3us. As eciall# durin3 drin(in3 that:s wh# the teacher told #ou to watch the first feedin3 so closel#. 8ecause if the# starts cou3hin3 and $u$$les comes out throu3h their nose means the# mi3ht have this disorder. 5hat:s wh# #our teacher told #ou the first feedin3 should $e sterile either sterile water or a $reast mil(b$ecaue if the# as iratebthe# want somethin3 sterile as irated. 0ith tracheoeso ha3eal fistula, the t# e where there is a connection $etween the eso ha3us and trachea, what would the to nursin3 dia3nosis $e1 =otential for as iration. 8efore corrective sur3er# of a tracheoeso ha3eal fistula the infant is laced on his $ac( with his head and shoulders elevated. 0h#1 2we want the secretions to ool in the lower eso ha3us. Kou want the secretion there than over into the lun3. 0h# is it not uncommon for a mother to have h#dramnios.sometimes called ol#h#draminous/ with infants with D+ tract ro$lems1 25he $a$# never swallowed an# amniotic fluids. 5he amnion 3rows u 3rows u and 3rows u . 0ith im erforate anus there is no rectal o enin3. 5herefore, the $a$# will not ass the meconium. 'n#time when #ou have some$od# that have the sur3er# of D+ tract the# mi3ht come $ac( with tem orar# colostom#. 5he ur ose of an# tem orar# colostom# is to rovide the time for the intestine to rest and heal.

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Sic(le Cell Disease is a hereditar# disorder in which the hemo3lo$in is artl# or com letel# re laced $# a sic(le sha ed hemo3lo$in. 5here is a reduced O@#3en carr#in3 ca a$ilit# now. Clinical 6anifestations of SCD are: =ain in the area of involvement. 2'nore@ia 2A@ercise intolerance .

-ursin3 care for a child with Sic(le Cell Crisis would include:

28ed rest
- 5 y d r a t i o n
t h i s i s 1 t h i n 3 t h e n o Z

t h a t t h e

w o u l d

s t o

s i c ( l i n 3 r o c e s s .

' n a l 3 e s i c s 2 ' n t i $ i o t i c s Z=ossi$l# $lood transfusions and o@#3en.

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C#ild#ood Cancer 7eu(emia is the most common form of childhood cancer. 5he definition of leu(emia is: 2cancer of the $lood formin3 tissue 2 roliferation of immature 08C:S. now #ou 3ot some$od# who is immunosu ressive and there is so much of w$c that there is no room for latelets, now #ou are rone to throm$oc#to enia too. 'nd we dun have room for R8Cs too so anemia too . when #ou thin( of leu(emia thin( a$out these */ 5wo t# es of leu(emia: l. '77 .acute l#m hoid leu(emia/ 2. '67 .acute m#elo3enous leu(emia/ Clinical manifestations leu(emia are: 2Fever 2=allor 2 ' n o r e @ i a 2 = e t e c h i a e ,a3ue a$dominal ain 2Aasil# acSuired infections 0ilms tumor or ne hro$lastoma are found where1 2in the (idne# or as an a$dominal mass 5he most common resentin3 si3n is: swellin3 or non2tender mass on one side of the a$domen. Some ver# im ortant thin3s to remem$er with 0ilms 5umor are: 2Don:t al ate the a$domen 2Dentle care with $athin3 or movin3 atient Z

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H#droce halus is a distur$ance of ventricular circulation of the cere$ral s inal fluid in the $rain. So we have $uildu of CSF so increase intracranial ressure. Clinical manifestations of h#droce halus are: 2=al ation of the anterior fontanel 2Dilated scal veins. 2De ressed e#es 2+rrita$ilit# 2Chan3es in 7OC and hi3h itched cr# . $ut an# $a$ies with increase +C= and menin3eal infection have hi3h itched cr#/ Sur3ical treatment for h#droce halus consists of the insertion of a ,= .ventriculo eritoneal shunt/. Drain out the e@cess fluid. =ost2o care of a ,= shunt includes: 2FOC measurement. frontal occi ital circumference/ 2Fontanel and cranial suture line assessment 2're the# $ul3in3 or sun(en1 28ul3in3F +ncreased +C= 26onitor the tem erature 2Su ine osition H#droce halus is freSuentl# associated with m#elomenin3ocele. another word sac( on the $ac( that can $e filled with s inal fluid s inal nerves and ma# $e even the art of the s inal cord/

bb.Some$od# if $orn with s inal $ifida..#our teacaher told #ou to reserve that sac( do not them to ru turebso the $a$# is ut into rone and sometime the doctor will order to ut the moistened sterile dressin3 over the s inal $fida to revent from dr#in3 and hurr#in3 to the sur3er#.

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6usculos(eletal S#stem
Scoliosis is lateral curvature and rotation of the s ine. 2Can $e 3enetic 6ana3ement of scoliosis consists of the three O:s. 0hat are the * O:s1 l. o$servation 2. orthosis .su orts or $races/

*. o eration .s inal fusion with rod/

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Cardiovascular S#stem
Rheumatic fever is an inflammator# disease that occurs after an infection with 3rou ' $eta haemol#tic stre tococcus . stre love to attac( 2 or3ans heart and (idne#s./. 5he ma<or cardiac clinical manifestation of rheumatic fever is carditis. 5hera eutic mana3ement for rheumatic fever includes: =enicillin D or Ar#throm#cin Ka6asa7i 0isease %awasa(i Disease is characteri)ed $# wides read inflammation of the small and medium si)ed $lood vessels with coronar# arteries $ein3 most sus ec ti$le. 5reatment for %awasa(i Disease consists of: 2Hi3h dose +, immuno3lo$ulin 2Salic#late or as irin thera # 28ed rest 0hat would $e the nursin3 assessment of a child with cardiac d#sfunction1 2'ssess nutritional status .failure to thrive, oor wei3ht 3ain, fati3ue with feedin3, oor feedin3 ha$its. 2Color, chest deformities, unusual ulsations, res irator# effort, clu$$in3 of fin3ers, $ehavior .(nee2chest osition or sSuattin3 seen in some t# es of heart diseases/ 2A@cessive sweatin3 durin3 feedin3 is also associated with heart disease.

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5eart 0isease 0hat is con3enital heart disease1 2' structural or functional defect of the heart or 3reat vessels resent at $irth. +n children, t# es of cardiac defects are classified $# $lood flow atterns =atterns. .A@am les: increased ulmonar# $lood flow, decreased ulmonar# $lood flow, o$struction to $lood flow out of the heart, mi@ed $lood flow within the heart or 3reat arteries/ %eneral O-er-ie6 o/ 5eart "ro.le4s in C#ildren CHF usuall# due to con3enital heart defects in children. Aarl# S?S@: 2+ncreased =ulse at rest and with sli3ht e@ertion 2+ncreased RR 2Scal sweatin3 .infants mainl#/ 2Fati3ue 2Sudden wei3ht 3ain 21 ound or more in one da# is F7!+D 5@: 27isten to lun3s 2Control room tem 2Sit u 2Rest 2Decrease stimuli 2Cool, humidified o@#3en 2!ninterru ted slee

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-utrition: Should $e well rested rior to eatin3 .feed when wa(es u and when showin3 si3ns of hun3er... suc(in3 to decrease cr#in3/ Small, freSuent feedin3s .not as tirin3/; increased calories.....have increased meta$olic rate Feed S* hours.....ever# 2 hours doesn:t 3ive $a$# enou3h rest... .ever# > hours reSuires increased volume.....can:t handle 5a(es a$out l?2 hour for an infant to ta(e com lete a feedin3... . rolon3in3 the feedin3 leads to e@haustion and decreased rest eriods !se soft ni le with little lar3er o enin3 so $a$# won:t have to wor( so hard 6a# need 3ava3e es eciall# if in res irator# distress 8reastfed $a$ies ma# need additional su lements for calories

!suall# do not have to restrict man# adverse effects Rarel# need fluid restrictions as it is so hard to 3et them to ta(e fluids an#wa#. where as in the adult we have to do that/ Di3o@in: 26ain si3ns of to@icit#... .$rad#cardia, vomitin3 .earliest si3n/ 2+nfants... .hold if =X1 1I 2Children... hold if =X LI 2!se <ud3ement: alwa#s com are to revious readin3s 2-ormal di3 level.....N22 u3?7. I.N22/ 2+nfants rarel# 3et more than l cc .EI mc3, I.IEm3/ 2Dive l hour $efore or 2 hours after feedin3s 2Do not mi@ with food?fluid 2 > hours ast due on dose1 Hold dose and 3ive ne@t dose on time 2 ,omits1 Do not 3ive more 26issed 2 doses in a row1 Call 6D 2 Do not increase or dou$le dose 2'lwa#s chec( dose Hurst Review Services with another nurse

'CA inhi$itors: Ca otenB, ,asotecB 20atch for decreased 8=, (idne# ro$s, cou3h. cou3h mi3ht $e + the adult too $ut whenever the t with 'CA inhi$itor has a dr# cou3h then the medicine should $e sto ed and has to re lace $# another one./ 25he# $loc( aldosterone. .so not retainin3 as much -a and not e@cretin3 as much otassium. . .therefore aldactone and otassium su lements ma# not $e needed and could cause h# er(alemia 7asi@B +nfant formulas have more sodium than $reast mil( H# erc#anotic S ells: 5reatment 2+nfant. ...(nee2chest 21IIJ o@#3en 26or hine for sedation 6onitor Cardiac Out ut 7oose clothes 7oose dia ers #ou do not want to restrict res iration an#wa#b.$oth/ Tuiet la# -o stress Res ond to cr#in3 Suic(l# +nfection1 5reat rom tl#. . .can:t handle fever. . increases wor(load on the heart.

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)iscellaneous Cardiac 1n/o> Affects of chronic h# o@ia: l. =ol#c#themia 2increased R8C:s .$od# thin(s it should ma(e more due to h# o@ia/ $ecause the $od# thin( the# are h# o@ic and have to ma(e more red $lood cells to carr# o@#3en. 5his ma(es the $lood to $e so thic(b 2thic(ens $lood; ma# lead to stro(e 2(ee h#drated for thinin3 that $lood. 2no room for latelets . so much more red $lood cells/ 2 . C l u $ $ i n 3 2thic(enin3 and flattenin3 of fin3er ti s and toes. s ecificall# the nail $ed/

2. =oor 3rowth ma# also $e seen in chronicall# h# o@ic children 2. SSuattin3: not seen as much due to earl# +.D. and sur3er# in first #ear.+.DF identif#/ when children are in the la#3round and if suddenl# the# sSuatt down that could $e the si3n of heart defect/

*. H# erc#anotic s ells .$lue s ells, tet s ells/ 2mainl# seen in tetralo3# of fallot EIJ of $rain 3rowth occurs in first #ear of life . if the# are h# o@ic durin3 these time with an# reason then the# could have some si3nificant dela#s/

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S"EC1F1C 5EA*T 0EFECTS 'c#anotic Defects

l. Aentricular Se+tal 0e/ect 0hich side of the heart is stron3er1 7 or R 5he left side of the heart is alwa#s stron3er than the ri3ht. 5his is when there is an o enin3 $etween the ri3ht and left ventricle .in the se tum/ 0hen the left ventricle sSuee)es down it shoots $lood forward into the aorta li(e it:s su osed to, $ut -O0 since there is a hole $etween these 2 cham$ers $lood can now shoot over to the ri3ht side of the heart .ri3ht ventricle/. Since the left ventricle is the stron3est art of the heart.....when it sSuee)es down on $lood it does so with 3reat force therefore it reall# SHOO5S $lood over to the ri3ht side. 5his increases the volume on the ri3ht side of the heart. 5he ri3ht side is havin3 to um harder so this can lead to ri3ht sided heart failure. 6an# close s ontaneousl# durin3 the first #ear of life.

How do we (now someone has it1 2Si3ns of heart failure 26urmur

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2. Atrial Se+tal 0e/ect> 0hich is stron3er the 7' or the 7,1 5he left ventricle is the stron3est art of the heart. 8ut is the 7' S5+77 stron3er than the R'1 Kes. 5here is an o enin3 $etween the ri3ht and left atria .in the se tum/. 0hen the left atrium sSuee)es down some $lood 3oes forward into the left ventricle <ust li(e it:s su osed to..... 8!5 since there is a hole in the se tum $lood can not onl# $e ushed forward it can now 3o to the ri3ht as well. 0hen the left atrium sSuee)es down it is not as forceful and stron3 as the left ventricle.....$ut it is still stron3er than the ri3ht atrium so the 7' over owers the ri3ht and $lood moves to the ri3ht. 5his is not as $i3 a deal as ,SD $ecause the $lood is not $ein3 shot over to the ri3ht with 3reat force.

How do we (now someone has it1 2Child ma# $e as#m tomatic 26a# have si3ns of heart failure 26urmur 2'trial arrh#thmias 6ost common treatment is sur3er# rior to school a3e.

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3. "atent 0uctus Arteriosus> -ormal fetal circulation: 8lood 3oes R'... .R,... .='... doesn:t 3o to lun3s... .instead when $lood leaves =' it 3oes strai3ht over to the aorta via the ductus arteriosis. 0h# does the $lood do this1 8ecause inutero the $a$#:s lun3s are colla sed and the $a$# 3ets o@#3en throu3h the lacenta.

5his ductus arteriosis is su osed to close when the $a$# is $orn and ta(es their first $reath. 0hen it closes then $lood flows from the =' to the lun3s etc... .<ust li(e in the adult. -ow thin( a$out the left side of the heart in this condition. Here comes the $lood 7', 7,, and then the $lood moves into the aorta. 0hen the $lood 3ets into the aorta it:s confused as to which wa# to 3o.......5he $lood sa#s \should + 3o strai3ht to the $od# or should + han3 a ri3ht here throu3h this o enin3 that was su osed to close]. 5here is a traffic <am of $lood in the aorta $ecause the $lood doesn:t (now which wa# to 3o. 5his leads to increased wor(load on the left side of the heart and therefore left sided heart failure. Some $lood is 3oin3 strai3ht li(e it:s su osed to, $ut some if 3oin3 ri3ht $ecause the left side is still stron3er than the ri3ht. How do we (now someone has it1 26a# $e s#m tomatic 26a# $e in heart failure 25he# have machiner# li(e murmur 5reatment: 2+ndomethacin . rosta3landin inhi$itor/ will close =D' 26a#$e sur3er#
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(. Coarctation o/ Aorta 5he aorta has a narrowin3 . retend there is a tourniSuet tied around the aorta/. 5his ma(es it harder for the 7, to um so the atient ma# wind u with left sided heart failure.

How do we (now someone has it1 25here is a 8+D difference in the ulses and 8= of the u

er and lower e@tremities. er and lower

25here is alwa#s a sli3ht difference in the ulses and 8= of the u e@tremities.....that:s wh# + said 8+D difference. 25he u 5reatment: 2Sur3er# 2Can do an3io last# in some er ressures are much 3reater than the lower ressures.

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!. "ul4onic Stenosis First #ou have to (now where the ulmonic valve is located. 5he o enin3 in the valve is ver#, ver# small. 5he ri3ht ventricles has to wor( harder to um the same amount of $lood throu3h a smaller o enin3... .the atient ma# develo ri3ht sided heart failure.

How do we (now someone has it1 26a# $e as#m tomatic 26a# have heart failure 26urmur 2Anlar3ed heart 5reatment: 2Sur3er# 26a#$e an3io last# 0ith all heart defects the child is at ris( for $acterial endocarditis... .this ma# $e how the defect is first discovered Aarl# si3n of a heart defect: Feedin3 ro$lems
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6. Aortic Stenosis> Same as with ulmonic stenosis, $ut now we are tal(in3 a$out the aortic valve. So when the 7, sSuee)es down to shoot the $lood into the aorta it has to do so with 3reater force to 3et the $lood throu3h a smaller o enin3.....this <ust increased wor(load on 7,........n o w atient is at ris( for left sided heart failure.

How do we (now someone has it1 2Decreased CO 26urmur 2Heart failure

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C#anotic Defects
Tetrology o/ Fallot Consists of > defects: a. ,SD a. $. c. =S Overridin3 aorta Ri3ht ventricular h# ertro h#

How do we (now someone has it1 2+nfants ma# $e c#anotic at $irth 2Others ma# have mild c#anosis that ro3ressivel# worsens durin3 first #ear 26urmur 2'cute c#anotic or h# o@ic s ells .$lue s ells?tet s ells/ "usuall# seen durin3 cr#in3, after feedin3, durin3 $m:s; "at ris( for sudden death, sei)ures 2Older children: SSuattin3, clu$$in3, oor 3rowth, e@ercise intolerance 5reatment: Sur3er#

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Trans+osition o/ t#e %reat Aessels

-otice the =' comes out of ri3ht ventricle and 3oes to the lun3s and then the $lood 3oes to the left side of the heart to 3et um ed out to the rest of the $od#.....5he =':s favorite lace to 3o is to the 7AF5 clu$ -oticed the aorta comes out of the left ventricle and then 3oes throu3hout the $od# and eventuall# winds u $ac( at the ri3ht side... 5he aorta:s favorite lace is the ri3ht clu$

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-otice the =' and aorta have swa ed laces. 5he# are still 3oin3 to their favorite clu$s. So #ou wind u with 2 se arate sets of circulation 3oin3 in and out of the heart. Kes some $lood is 3ettin3 out to the s#stemic circulation or the atient would $e dead at $irth. +nstead the $a$# is c#anotic at $irth, $ut alive. 0hat:s (ee in3 the $a$# alive1 25here is some other defect that is allowin3 that $a$# to 3et <ust enou3h o@#3en to sta# alive. How do we (now someone has it1 2!suall# c#anotic at $irth 2+f not ic(ed u on until older.........decreased 3rowth, oor feedin3 5reatment: Sur3er#

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)iscellaneous 1n/or4ation 0h# are new foods introduced to children one at a time1 0hat is the most common reason for failed toilet trainin31 +n children, u to one #ear of a3e, what are the ma<or causes of accidents1 5ead Lice 0hat is a common s#m tom of head lice1 Can lice 3o to other $od# arts $esides the head1 How are lice s read1 "in Lor4s How are inworms s read1 How do #ou collect a s ecimen to dia3nose inworms .entero$iasis/ C#ic7en +oF Chic(en o@ is rare due to the varicella vaccine; however, if a child does contract chic(en o@ the rimar# focus is to revent_________________in the lesions. 0hat home remed# can alleviate the itchin3 associated with chic(en o@1 're chic(en o@ conta3ious1 0hat ha ens to the 3rowth rate $etween G and l2 #ears of a3e1 How much earlier do 3irls e@ erience the onset of adolescence1 )ononucleosis 0hat is the name of the virus that causes infectious mononucleosis1 How is this virus s read1 Tonsillecto4y How should a child $e ositioned after a tonsillectom#1 'fter a tonsillectom#, wh# are $rown colored or red fluids not 3iven1 2we don:t want an#thin3 to 3et confused with______________ 'fter a tonsillectom#, what would indicate that hemorrha3e is occurrin31 2FreSuent_____________________ How man# da#s after a tonsillectom# is a child at ris( for hemorrha3e1 Common com laints after a tonsillectom#1
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Otitis )edia 0hat art of the ear is affected with otitis media1 0hat is $loc(ed with otitis media1 Austachian______________ Otitis media usuall# follows a what1 0hat will the t#m anic mem$rane loo( li(e with otitis media1 Can hearin3 loss occur with otitis media1 Do heatin3 ads hel the ain1 5reatment for otitis media: 2'void chewin3 27ie on affected side 2=revention: 2Sit u $lowin3 f o r f e e d i n 3 s 2Dentle nose

2! er res irator# +nfection1 2 la# \$lowin3] 3ames to (ee middle ear clear 2-o smo(e 26a# not can hear #ou 2Aar lu3s when atient has tu$es 2-ot an emer3enc# if 3rommet .tu$e/ falls out 0hat are =A tu$es1 How lon3 to t#m anotom# tu$es sta# in lace1 0h# are eanuts so dan3erous when as irated1 Often the mentall# challen3ed child will deli$eratel# do thin3s to dis lease the arents1 0h#1 0hen 3ivin3 +6 in<ections, wh# is the dorso3luteal muscle contraindicated in children who have not $een wal(in3 for at least a #ear1 0hen an infant has had a erineal sur3er#, what osition would #ou lace them in ost2o 1 =rone is contraindicated. 'n infant has <ust had an in3uinal hernia re air. 0hat is the ma<or ro$lem ost2o and how can it $e revented1
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