Med surge final

Term
1 / 50
Sally Smith is a 57 year old woman who regularly visits her gynecologist and adheres to scheduled mammography as recommended by the United States Preventive Services Task Force (USPSTF). According to these recommendations, how often is she participating in a screening mammography?
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Terms in this set (50)
Sally Smith is a 57 year old woman who regularly visits her gynecologist and adheres to scheduled mammography as recommended by the United States Preventive Services Task Force (USPSTF). According to these recommendations, how often is she participating in a screening mammography?
b. Biennially (once every 2 years)
Lois Lane is a 72 year old woman who weighs 136 pounds and is a 36 pack year smoker. Lois regularly consumes excessive amounts of alcohol and has six children. Which of these risk factors predisposes her to breast cancer?
b. Smoking
c. Excessive alcohol consumption
e. Older age
Mary Margaret is a 65 year old woman who regularly visits her gynecologist, has been evaluated as high-risk for developing breast cancer, and adheres to scheduled mammography as recommended by the American College of Obstetricians and Gynecologists as well as the American Cancer Society. According to these recommendations, how often is she participating in a screening mammography?
a. Annually (yearly)
The nurse is reviewing the medication record for a male client with ulcerative colitis experiencing diarrhea. Which medication would the nurse question?
C. Metoclopramide
The nurse is providing a discharge education for a patient newly diagnosed with ulcerative colitis. Which food selection should the nurse instruct the patient to avoid?
B. Whole grain bread with sesame seeds
The nurse is educating a patient with ulcerative colitis who has a new colostomy. Which instructions should the nurse include in her teaching plan? Select all that apply.
A. Notify the provider if the stoma appears dusky or purple
D. Contact your provider if you do not have a bowel movement for more than two days
E. Increase dietary calcium intake and vitamin D
A nurse caring for a patient with outflow peripheral arterial disease in the lower extremities will encourage which of the following positions for the patient to be in?
c. Sitting, with legs lower than hips
The new WCU graduate nurse realizes what is most likely the first sign of PAD?
c. Diminished pedal pulses
A patient that has been diagnosed with Parkinson's disease tells the nurse that he has had started to have trouble with his balance and walking. The nurse knows that the symptoms of Parkinson's disease stem from a decreased amount of which neurotransmitter?
c. Dopamine
The nursing student should know that which individual is the most at risk of developing Parkinson's disease?
c. A healthy 66 year old white male.
Which statement indicates that the patient needs further teaching on Parkinson's disease?d. The goal of my therapy is to cure the disease.What behavior will limit risk of Clostridium difficile infection (CDI)? (Select all that apply)b. If prescribed clindamycin, asking for a different antibiotic c. Thorough, frequent handwashing with soap & water d. Avoiding unnecessary antibiotic treatmentsWhat are typical risk factors for developing C. difficile infection? (Select all that apply)a. Older than 65 years old b. Current or recent hospitalization c. Recent use of antibiotic therapy d. Immunocompromised e. History of C. difficileWhich statement would indicate that further teaching is needed for a patient and their family regarding C. difficile management?c. "As long as I wash my hands with soap and water as directed, my family shouldn't catch this and that's all I need to do."The nurse is providing postoperative teaching for a client who had an abdominal surgery and has a Jackson Pratt drainage tube. Which of the following indicates the patient needs further teaching?c. "After removing the old dressing, I will clean around the drain insertion site with hydrogen peroxide."When providing preoperative teaching for abdominal surgery, the nurse will inform the patient that they should immediately notify someone of which of the following?b. Feeling as though "something gave way" in the incisional siteA nurse is providing preoperative teaching to a client who will undergo an abdominal surgery. Which should the nurse include in the preoperative teaching plan?a. Sit up for coughing while splinting the incision with a pillowA patient recently prescribed medication for hypertension asks the nurse, "Why do I have to be on medication, I feel fine!" What is the nurse's best response?D. Even though most people with hypertension do not have symptoms, it is very damaging to your blood vessels and organs.A patient is newly diagnosed with hypertension and asks about diet modifications she can make to her diet to help lower her blood pressure. The nurse would suggest which of the following? (Select all that apply)B. Use spices instead of salt for seasoning food D. Choose fresh foods over processed foodsYou are providing education on hypertension to new nurses. Which response indicates a correct understanding of the teaching?A. Morning headaches, blurred vision, dyspnea, and a systolic blood pressure greater than 200 mmHg are signs of malignant hypertension.Which focused neurological assessment would be the most appropriate for the nurse to use when assessing a patient for Alzheimer's Disease:D. Mini-Mental State ExamIn order to make a diagnosis of dementia, two of the following criteria must be present: (choose two)B. Significant impairment of memory E. Significant impairment of visual perceptionWhich of the following statements made by the caregiver of an Alzheimer's patient indicates a need for further teaching:A. "I should change our routine daily so that she doesn't get bored."Peri-op Respiratory IssuesPost surgery assess airway and check for adequate gas exchange Monitor O2 sats, skin color, breathing pattern, admin O2, position in semi-fowlers - Breathing exercises - Turn, cough, deep breathe - IS - Splint incision when coughing - Pain management to prevent breathing problemsPost op resp. other issues- Respiratory depression - Atelectasis - Pneumonia - PE - Laryngeal edema - Ventilator dependence - Pulmonary edemaExpected findings after bowel resection- Catheter remains until patient is able to void on their own - Ambulation early - Pain (Splint incision) - May have drains - Monitor bowel sounds, passage of flatus, BMs (monitoring for paralytic ileus) - May have abdominal binderPre-op teaching with older adults- Greater incidence of chronic illness - Greater incidence of malnutrition - More allergies - Impaired self care abilities - Inadequate support systems - Stress of surgery or anesthesia - Cardiopulmonary complications post surgery - Risk for change in mental status when admitted (related to unfamiliar surroundings, change in routine, drugs) - Fall and resultant injuryPhases of peri-op process*Pre-op* - Begins when pt is scheduled for surgery and ends when transferred to surgery site *Intra-op* - Begins when in OR and ends when pt leaves recovery *Post-op* - begins when leaving recovery and ends when healedCategories of Surgery*Elective*-correction of a nonacute problem (cataract removal, hernia repair, total joint replacement) *Urgent*- requires prompt intervention. Life threatening if tx delayed >24-48 hrs. (intestinal obstruction, bowel obstruction, bone fracture, eye injury, acute cholecystitis) *Emergent*-requires immediate intervention, life threatening consequences (gunshot or stab wound, severe bleeding, abdominal aortic aneurysm, compound fracture, appendectomy)Pathophysiology of BronchitisBlue Bloater (VENTILATORY problem) - Peripheral Edema, Thickened bronchial walls, Excessive mucous - Anatomic change is BRONCHIOLARPathophysiology of Emphysema- Pink Puffer (Barrel Chest leads to Impaired OXYGENATION) - Hyperinflation of the lungs + Loss of elasticity = Less surface area for GAS EXCHANGE - Anatomic change is ALVEOLARCOPD s/sx-Orthopnic posture, wheezes, reduces BS w/ emphysema, cyanosis, sluggish cap refill, finger clubbing - 60/60 club: 60 - PaO2, 60 - Pa CO2Pathophysiology of Asthma- Obstruction D/T: Inflammation & Bronchospasm - Triggers: Antigens & Irritants (air pollution, chemicals, smoke), ASA & NSAIDS (increase leukotrienes), GERD, Genetic predisposition, exercise, cold air, MSG *Poorly controlled asthma → BRONCHIAL HYPERPLASIA and fibrosis (scarring) (CHRONIC AIRWAY CHANGES)*Asthma Control*Controlled* : No more than 2 episodes / inhaler use per week; No activity limitations or nocturnal episodes *Partially Controlled*: > 2 episodes/inhaler/wk; Activity limitations or nocturnal episodes (< 80%) *Uncontrolled*: ≥ 3 Partially Controlled criteria (leads to hyperplasia)Asthma tx1. PRN Bronchodilators (Inhalers) (beta2 agonists / cholinergic antagonist) 2. Inhaled corticosteroid (Low dose) 3. Inhaled corticosteroid (Med to High dose) 4. Leukotriene modifier 5. Theophylline SR (complex bronchodilator with anti-inflammatory effects)Treatment for status asthmaticus1. Apply O2 per NP 1-3 lpm; high Fowlers 2. Frequent/Continuous aerosolized albuterol 3. Ipratropium nebulizer 4. Epinephrine SQ or IM 5. Establish IV -- Methylprenisolone (corticosteroid), Theophylline (loading dose & maintenance infusion), IV fluidsS/Sx of Pneumonia-TACHYPNEA and DYSPNEA - d/t decreased pulm compliance and narrowed bronchioles - Cough - purulent if productive - Sputum is thich, creamlike (WBCs) (color characteristic of specific bacteria) - SOB - HYPOXEMIA - d/t impaired oxygenation from alveolar fluid and compromised ventilation - Can also cause decreased LOC - Acute CONFUSION in older patients - Facial flushing and glassy eyes - May progress to CV collapse and systemic infection (sepsis) - Crackles from alveoli - Increased Fremitus (vibration) d/t fluid/purulent matter in lungs - Dull percussion - Bronchial breath sounds over areas of consolidation - Possible absent breath soundsABG Analysis- *Crackles*: Pneumonia, atelectasis, empyema, lung abscess, PE - *Wheezes*: Asthma, edema, inflammation, secretions - *Rhonchi*: tumors/obstruction, thick, tenacious sputum - *Pleural friction rub*: TB, pneumonia, lung cancer, pleurisy, PEABG Analysis1. pH (7.35-7.45) 2. PaO2 (80-100) 3. PaCO2 (35-45) 4. HCO3 (21-28) 5. SaO2 (95-100) *Respiratory Acidosis* hypoventilation (d/t meds, respiratory disease)) pH: < 7.35 PaCo2: > 45 HCO3: increased or normal *Respiratory Alkalosis* (Hyperventilation) pH: >7.45 PaCO2: <35 HCO3: decreased or normal *Metabolic Acidosis* (Diabetic Ketoacidosis) pH: < 7.35 PaCO2: Normal or down HCO3: < 21 *Metabolic Alkalosis* (Vomiting, Alkaline drugs) pH:> 7.45 PaCO2: Normal or high HCO3: > 28Beta Blockers- Assessing response- Beta 1: Heart - Beta 2: Lungs - Bronchoconstriction: caution for COPD pts, assess for wheezes - Bradycardia - HR >60 - BP: systolic >90 - Glucose: Mask s/ hypogycemia - assess orthostatic hypotension and never stop abruptly (assess diabetics)Risk factors mod. for HTN*Risks*: Family Hx, Blacks, hyperlipidemia, smoking > 60 yo, excessive sodium/caffeine intake, obesity, physical inactivity, excessive alcohol, low K+, Ca, Mg intake, excessive/chronic stress *Interventions*: 1. decreased Na intake (DASH diet) Max = 2400 mg/day. Target = 1500 mg/day 2. decreased weight 3. decreased ETOH use; 'sparingly' 4. Exercise 5x/wk 5. Avoid tobacco & caffeine 6. Relaxation techniquesRisk factor mod for CV Dx- No smoking - Diet - watch sodium saturated fat - Monitor or lower cholesterol levels - Keep BP WNL - Manage DM - Decrease weight or keep weight within healthy range - Increase physical activity - Lower Stress - Drink ETOH in moderation - Avoid excess caffeineCHF pt teaching- Inadequate CO to meet metabolic needs, kidneys (holds onto more fluid = increased preload) and brain (bumps up rate to increase preload) - *Left Sided HF* : 1. Increased preload; episodic 'overshoot' (Starling's Law!) 2. Gradual onset 3. initiating pathology: impaired contractility *2˚ CAD* Other left-sided pathologies: Valvular disease, cardiomyopathy, septal defects - begins with failure of LEFT then RIGHT *Left Sided*: - DECREASED CO - Fatigue - Weakness - oliguria during the day (nocturia at night) - angina - confusion, restlessness - dizziness - tachycardia - palpitations - pallor - weak peripheral pulses - cool extremities *PULMONARY CONGESTION* - hacking cough, worse at night - dyspnea, breathlessness - crackles or wheezes in lungs - frothy pink-tinged sputum (Pulmonary edema!!) - Pulmonary Edema - Crackles, Dyspnea at rest, Acute confusion, tachycardia, HTN or hypotension, reduced urinary output, PVCs, Anxiety, Restlessness, Lethargy - tachypnea - s3/s4 summation gallopLab Findings for HF- BNP (> 100) - Troponin (maybe CPK-MB) - BMP - CBC - 12 Lead EKG (looking for evidence of MI) - Chest X-ray - Echocardiogram (looks at CO, and pressure in LV)• - Stress testing when stabilized *Laboratory assessment* - Cardiac enzymes, Electrolytes (potassium), renal function (creatinine), LFTsRaynauds s/sx- Painful vasospasms of arteries and arterioles in extremities, esp. digits - red-white-blue skin color changes on exposure to cold or stress - Numbness, tinglingAnemia in elderly- Anemia of chronic disease: bone marrow is unable to incorporate iron into RBCs - Iron deficiency - blood is BMDiagnoses by type of anemia*Glucose 6 Phophate Dehydrogenase deficiency anemia* Diagnosis: Genetic, lack of G6PD enzyme *Immunohemolytic Anemia* Diagnosis: Excess immunoglobulin G and Complement protein fixation on immunoglobulin M *Iron deficiency anemia* Diagnosis - S/sx: weakness, pallor, fatigue, reduced exercise tolerance, fissures at the corners of the mouth - Serum ferritin values less than 10ng/mL - RBCs are microcytic *Vitamin B12 Deficiency Anemia* - Diagnosis: Deficiency in B12 S/sx: pallor, jaundice, glossitis, fatigue and weight loss *Pernicious anemia* - may also have paresthesias in hands and feet and poor balance - Macrocytic RBCs *Folic Acid Deficiency - Diagnosis: S/sx similar to B12 deficiency anemia, except NO effect on nerve function - Decreased levels of folic acid *Aplastic anemia* - Diagnosis - CBC: severe macrocytic anemia, leukopenia, and thrombocytopenia Bone marrow biopsy may show replacement of cell forming marrow with fatCataract post op care- Abx given subconjunctivally - Eye is unpatched, discharge usually occurs within 1 hr - Dark glasses required - Instill abx-steroid eyedrops - Mild itching normal - Pain indicates complications - Reduce IOP - Prevent infection - Assess for bleeding * NO Coumadin or ASA* -Post-op: use different types of drops for as long as 4 weeks. Final best vision - 4 to 6 weeks. Wear dark glasses outdoors and in brightly lit settings until the pupil responds to light.Glaucoma PathoNormal IOP: 10-12 mm HgDetached Retina- Medical Emergency !!! - prompt tx preserves vision *Presentation*: 1. Sudden and Painless 2. Partial to complete blackout of visual field 3. Photopsia (flashes of light) or floating dark spots Provide information and reassurance *Treatment*: Surgery