Comp exam #1

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Sickle cell crisiso Fever, pain, signs of infection, dehydration, chills, don't live in low O2 states o Red blood cells are sickling/clumping; Vaso-occlusive crisis which causes painLPNDelegation- who? § Stable patients § Cannot assess patient right out of surgery (initial assessment/change of status)PCT- patient care techDelegation- who? § Can't take pt to bathroom on first time out of bed (need the initial assessment)Public health departmentReporting to who? o STIs o Highly contagious/Rare- anthrax, botulism o covidglomerulonephritis· Signs and symptoms of what? o Caused by strep o High BP, generalized edema, s/s of fluid overloadKidney transplanto Main concern is rejection § s/s- pain over the site, feverSubjective/objective data (as evidenced by)Developing plan of care- what is importantIncident reportWhat do you do for this? o Med errors o Patient has injury o Patient harm or patient propertydate and timeCorrect documentationinfectious/contagiouso Which patient do you remove from an outpatient clinica? Anyone that is showing ? symptomsRestraintso Try distraction first, least invasive, music, TV o Make sure they are safe- check circulation and make sure your fingers can fit under o Make sure they are retied correctlyCircumcision/belly cord careo Wash with warm water o Don't put diaper over belly button o Cord take 7-10 days to fall off o Circumcision- wash with warm water o No Vaseline if vastabell?Lung soundso Adult- vesicular breath sounds heard over most lung fields Newborn baby- Bronchial sounds over the trachea6 monthsInfant skills o Baby sits with support2-3 monthsInfant skills- smiling4-5 monthsInfant skills- grab stuff20· blood transfusions o ?G IVtransfusion reactionso fever o back/flank pain, fever, restlessness o stop, run normal saline, sent a tube of blood and bag to lab and call the doctor o start infusion within 30 minutes of getting it o return the bag if there are cryoprecipitate in it o secondary check with another nurse stay with the patient for 15 minutes from when the blood hits the veinRhogamo Mother gets the shot o Antibodies can form that could potentially attack the fetus or future pregnanciesvictimo Characteristics of ? § Powerless, helplessness, takes blame, dependent, needs someone to validate themselvesabusero Characteristics of ? § Narcissist, impaired self esteemstay with patientAbused patient comes in. what do you do?suicideDanger in terms of ? o Giving away stuff, writing out a living will, act like they are getting better (eps after starting an anti-depressant) § Do they have a plan, do they have a way to carry it out, have they done it in the past, do they live aloneManicFlight of ideas, sexually active, wreck-less, spending a lot of moneyDepressionDecreased activity, lethargy, social isolation, weight lossStrokeFAST- facial droop, arms (stick out palms up), slurred speech, timeExpressive aphasiaknow what you are saying but can't respond/express; with strokeReceptive aphasiathey can't understand what you are saying; with strokeAnti-embolism stockingso Measure- circumference of calf, widest part of the calf o Don't fold down if too long o Lack of circulation, pain in the toes o Leave off 3-4 hours a day or at bedtimeskin breakdownthese help with ? with incontinence -Turn every 2 hours, barrier cream, keep them dry, don't keep them in diapersTransurethral resection of the prostate (TURP)o Expect- § 3 way foley with continuous bladder irrigation (CBI) § pink tinged urine o output stops- clotting § irrigate the foley manually o no fluid restrictionSeizure medicationsside effects- nose bleeds, bleeding gums, low platelet count and WBC count, sleepy, take with food to decrease GI upsetHypoglycemiaGive simple sugar now give amp of D50 (one time shot)Digoxino Heart failure o Increase contractions o Check HR, watch potassium o S/S of toxicity- GI disturbances, visual disturbances § Patient exhibits these things- take vital signsPenicillin drugsAvoid cephalosporin'sHeparino APTT o Therapeutic range 60-80 o Heparin + warfarin = Bridge therapy § Trying to get person off heparin, stop heparin when they are in therapeutic range for warfarin -> INR · INR should be 2-3 o Don't have monitor APTT with lovenoxHypovolemiao S/S- tachycardia (trying to get more fluid through the body bc cardiac output has dropped)Ace inhibitorso Block angiotensin converting enzyme from 1-2 § Angiotensin 2 is vasoconstrictor § Aldosterone- conserves salt, naturally makes you retain sodium and water, excrete potassium o Inhibit aldosterone release § Release sodium and water which causes BP decrease § Hold onto potassium o Hyperkalemia- read abovenaloxoneoverdose: Morphineflucanoziloverdose: BenzoDiabetes/Insulino 15g of simple sugar, check sugar again in 15 minutes, if still low, give 15g more of simple sure and if that doesn't work give amp of D50 o preventative foot care, check feet all the time o Exercise- decreases the BG level § Check blood sugar before you, during and after exercise and keep a simple sugar on you o Don't massage site after giving, Rotate the sites o Can stay at room temp for 28 daysdiabetic neuropathyelevate glucose damages the nerves so they don't feel stuffHypoglycemiao Cold and clammy, eat some candy o Lethargy, headache, sweaty o Beta-blockers reduce the HR, can mask signs of ?External radiation§ patient does not omit radiation · Can hold your baby · Avoid sun in the area where you are getting radiationinternal radiation§ can omit radiation, radioactive · IV chemoThrombocytopeniao platelets Bleeding precautions, use electric razorNeutropeniao neutrophils § High risk for infection § Avoid large crowds, no fresh fruits or flowers, wear a mask, wash your handsPeritoneal dialysiso Biggest risk- infection, peritonitis (s/s- cloudy output) § Brown output- bowel perforation § Urine color- bladder perforation § Red output- vascular compromise o Normal output is clearBurnso First things we want to do § Airway, fluid resuscitation § Find out what kind of burn it is (fluid, chemical, electrical) · Fire- airway, lungs o Monitor fluid resuscitation efforts § Output § Need a foleyFHR monitoringo Cord compression- variable o Late deceleration- placental problems o Early deceleration- head compressionNon-maleficenceno harm to the patientFidelitydoing what you sayVeracitytelling the truthJusticetreating everybody equallyBeneficencedoing good, benefits the patientadvanced directiveCan witness a consent but not an ?