NUR 160 final exam latest 2023 graded A

NUR 160 final exam latest 2023 graded A COPD Barrel chest/clubbed fingers Caused by smoking Encourage purse lips breathing Orthopneic position Nasal cannula-Keep at low flow Wein off of o2 Elevated HOB Asthma, bronchitis, emphasema Many rest periods Many Small meals Best position for breathing Orthopneic Pursed lip breathing In through the nose, out thru the mouth PSA Prostate Specific Antigen-0.04 Proscar Women need to wear gloves, Should not come into contact with during child bearing years. Used for symptoms of BPH, Cannot donate blood Coumadin PT/INR 2-3, Increase risk of bleeding if taken with Tylenol. Assess for bleeding; if having bloody stools, look to see if pt is taking Coumadin. Must take at the same time every evening. Stop taking 5 days before surgery, Vit K is the reversal agent Morphine Schedule 2, Does not contain acetaminophen BBW-respiratory depression. For severe pain Percocet Do not exceed 4000 mg Acetaminophen, oxycodone acetaminophen, moderate to severe pain, Schedule 2 Tylenol-Acetaminophen Do not exceed 4000 mg acetaminophen/day, Mild to moderate pain, Analgesic, antipyretic, Check IV dose, Non opioid analgesic, Can cause acute liver damage. Prednisone Anti-inflammatory, must wean off, cortico-steroid, BBW-DVT/PE, Avoid vaccines, Montior blood sugar, can cause cushing syndrome, weight gain, poor healing Fosamax-Alendronic acid can treat or prevent osteoporosis in post-menopausal women/men, once a week, empty stomach, sit up for 30 minutes, take in the morning with 8 ounces of water. Motrin-ibuprofen Best OTC for RA, NSAID, Can alternate with Tylenol, BBW-GI bleed, MI, store calcium-vit D, Prevent osteroporosis, Vit D toxicity can cause hyperkalemia, Teach pt to eat dairy and green leafy veggies B12 Deficiency can cause pernicious anemia, Source organ meats, eggs, shellfish, and dairy, intrinsic factor is needed for absorption Syphilis Can cause infertility STIS's in general Encourage safe sex, limit partners, testing, vaccines like HPV Herpes Can see it on the mouth, genitals and anus, Use anti-viral to treat symptoms, Sitz bath, no intercourse with open sores. TURP Trans-urethral resection of the prostate, treatment for BPH, CBI until urine is light yellow/pink, Educate on impotence, Flomax- doesn't affect bp Hospice-end of life care Wants to alleviate symptoms, provide support, No life saving measures are performed, funded by the state, must have 6 months or less, patient must desire services, family doesn't have to give up control. Palliative care Act of total care of the pts disease and is not responsive to curative treatmentEnd of life care. What is a spiritual counselor? Clergy, Religious Doctor or nurse? Clergy What is pre-op screening Physical, pre-op teaching, blood work, consent, testing, Code Status What is a blackbox warning? Something that the FDA deems to have serious hazards S/sx of glaucoma High IOP 12-22, eye pain, headaches, lends cannon adjust to light, lose peripheral vision, halos; Tx= Mitotic eye drops- burn educate timolol, beta blockers, surgery, marijuana. Mixing insulin Clear to cloudy What can be delegated to STNA/UAP? Bath, ambulation, dressing Serous drainage Clear and watery plasma Purulent Thick, yellow, green Serosanguineous Pale, red, watery mixture Sanguineous Bright red pH range 7.35-7.45 CO2 range 35-45 Bicarb range 22-26 s/sx metabolic acidosis Low pH, low bicarb, Metabolic acidosis causes Alcohol, kidney failure, diarrhea, DM, Dehydration S/sx metabolic alkalosis High pH, High bicarb Metabolic alkalosis causes Gastric acid loss, hypomagnesemia, hypocalcemia, Cushings disease, Diuretics, NG suctioning. s/sx respiratory acidosis low pH high CO2 Respiratory acidosis causes COPD, asthma, sedation, pulmonary edema, pneumonia s/sx respiratory alkalosis High pH, low CO2 Respiratory alkalosis causes Anxiety, fever, hyperventilation, pregnancy, neuromuscular disorder, severe obesity. Diets Clear liquid, NPO, Thickened Why do early ambulation? Prevent DVT's Osteoarthritis Pain worsens as the d at goes on, stiff and sore joints, detect by BMD test, Degenerative joint disease, limited ROM, non-systemic, may feel grading or cracking when walking, heberdens nodes, Excedrin for pain. Osteoporosis Back pain caused by collapsed vertebrae, loss of height, bones fracture more easily, if someone has a hip fx- monitor hemoglobin (RBC's are made there and immature RBS's will escape)Pain worsens with coughing or sharp movements, pathological fx, BMD. Rheumatoid arthritis Inflammation of the synovial membranes, pain is worse in the morning, don't put pillows between or under knees- due to contractures. Systemic Walking with cane, walker and crutches Needs to be 6 inches in front of feet, use on strong side, On stairs- Up with good leg first, down with crutches. Cast care Don't get wet, don't touch when wet, don't stick anything inside. What to watch for: Bleeding and cap refill s/sx of infection Fever, redness, swelling, pain Primary prevention Ways to prevent disease, vaccines Pt education on total hip replacement Sit on a high elevated toilet seat, sit only 15 minutes at a time, partial weight bearing exercise, walk with assistance if needed Pathological fractures Due to disease process, bones break without fractures, doesn't want to ambulate What is compartment syndrome Five leads to peripheral edema leads to tissue hypoxia. Compartment syndrome treatment Surgery- fasciotomy, keep appendage below heart level, oxygen therapy, IV fluids, physical therapy exercises. Fluid volume deficit Dry with tenting turgor, hypotension, tachycardia, provide fluids, check daily weights, skin care, I&O, PO, IV fluids. Cancer of the penis In the glands, inguinal nodes, and surrounding organs, Generally 50+, uncircumcised, poor hygiene, frequent UTI's. 7 p's of orthopedic and peripheral vascular assessment 1. Pain 2. Pallor 3. Parathesia/numbness 4. Paralysis 5. Polar 6. Puffness 7. pulselessness Proscar Hormone, androgen inhibitor, ONLY FOR MEN, women should avoid handling unless wearing gloves, most common SE are impotence, decreased libido and sexual dysfuntion Coumadin Anticoagulant, most common SE is bleeding. PT/INR Morphine Schedule 2, opioid anlgesic. Moderate to severe pain. SE ARE respiratory depression, bradycardia, sedation, confusion, dizziness, euphoria, N/V Percocet oxycodone/acetaminophen, schedule 2, opioid analgesic, SE are respiratory depression, drowsiness,dizziness, confusion, HA, sedation, euphoria, N/V Norco hydrocodone bitartrate with acetaminophen, schedule 2 antitussive opioid analgesic, SE drowsiness, respiratory depression, Pulmonary edema, confusion, tachycardia, bradycardia, N/V, anorexia, and constipation Prednisone Steroid, treats inflammation Fosamax Bone-reabsorption inhibitor, prevents breakdown of bones. PO, can cause esophageal irritation. Always on an empty stomach with a full glass of water and in high Fowler's position for 30 minutes Motrin NSAID, anti-inflammatory, Fever reducer calcium and vitamin D Always given together (osteoarthritis) Topics to include in preop teaching Informed consent, GI prep, Skin prep, Latex allergy, Respiratory prep, Cardiovascular consideration, urinary considerations, Pain control tubes, preop meds Dehiscence A surgical complication in which a wound ruptures along the surgical site. HypERkalemia s/sx Muscle cramps, Urine abnormalities, Respiratory distress, Decreased cardiac contractility, EKG changes, Reflex changes HypOkalemia s/sx Alkalosis, shallow respirations, irritability, confusion and drowsiness, weakness and fatigue, arrhythmias, lethargy, thready pulse. HypERnatremia s/sx Fever (low grade), flushed skin, restless, irritable, increased fluid retention, high blood pressure, edema, decreased furinary output, dry mouth, skin flushed, agitation, thirst HypOnatremia s/sx Stupor/coma, Anorexia, Lethargy, Tendon reflexes decreased, Limp muscles (weakness) Orthostatic hypotension, Seizures/HA, Stomach cramping HypERcalcemia s/sx Constipation, norexia, N/V, muscle weakness, polyuria, polydipsia, kidney stones, (CAMPS mneumonic) HypOcalcemia s/sx Convulsions, Arrhythmias, Tetany, Spasms/stridor (CATS mneumonic) HypERmagnesemia s/sx Low everything (energy, BP, HR, RR, Reflexes), vasodilation, Diaphroesis, Skeletal muscle weakness. HypOmagnesemia s/sx Dysphagia, HTN, tachycardia, Hyper reflexes Hypernatremia causes Loss of water more than sodium from the body/too many salt tablets/overuse of table salts HypOnatremia causes Inadequate sodium intake/Loss of GI fluids, V/D, Diaphoresis, Massive edema HypERkalemia causes High potassium intake:decreased kidney excretion, Renal failure, Metabolic acidosis, Excessive use of salt substitutes. HypOkalemia causes Decreased potassium intake, N/V/GI suction, Skin losses (diaphoresis), Metabolic acidosis HypERcalcemia causes Movement of calcium from bone to circulation, Immobilization, Increased levels of Vit D. HypOcalcemia causes Excess binding of calcium ions, Excess alcohol intake, alkalosis, Diuretics, Chronic renal failure. Hypernatremia NI VS, safe environment for confused pt, I&O, Daily weights, decrease sodium intake, monitor water loss from fever. HypOnatremia NI I&O if pt is receiving diuretics, VS, Neuro checks, daily weight, restrict fluid intake, fluid replacement with fluids containing sodium. HypERkalemia NI Decrease intake of foods high in potassium, Administer loop diuretics, VS, telemetric values to detect dysrhythmias, I&O. HypOkalemia NI Monitor bowel sounds, I&O, monitor lab findings in kidney function. Monitor telemetric values. HypERcalcemia NI Administer diuretics, encourage pt to drink 3000 to 4000 L of fluids per day, monitor I&O HypOcalcemia NI VS, lung sounds (stridor, dyspnea, or crowing), Monitor treatment for underlying causes, Monitor ECG, Monitor I&O Syphilis Can cause infertility. Herpes Tx is acyclovir, type 1 oral and tx is used when there is a breakout. Type 2 is genital and tx is taken daily. If in labor, with an active breakout, Csection. Mixing insulin: NPH, Regular. NPH: Long acting (cloudy) Regular: fast acting (clear) Insulin lets sugar into the cells, glucagon stimulates liver to release glycogen into blood stream. NG tube care No coated extended release tablets. Respiratory alkalosis Cause: anxiety, hyperventilation, obesity. Tx: Brown paper bag breathing. Respiratory acidosis Cause: asthma, COPD, Pulmonary edema, sedation. Tx: assist with ventilation, clear airway, breathing tx, inhalers. Metabolic alkalosis Causes: gastric acid loss (vomiting) Tx: Antiemetic, fluid and electrolyte replacement Metabolic acidosis Causes: Diarrhea Tx: Sodium Bicarb administration.