Antiretroviral AgentsMngmt of AIDSKetoconazole (Nizoral)Dermatitis, AIDS, topical or PO. May cause N/V, yellowing of skin and eyes.Enoxaparin (Lovenox)SubQ injection given in the belly -prevents blood clots -watch for bruising.Phenytoin (Dilantin)Anticonvulsant for seizures, don't give with Coumadin. Level 10-20 >30 toxic >60 lethalWarfarin (Coumadin)Blood thinner, no green leafy veggies, watch for bruisingBactrum-Antibiotics prevent infection -may treat whooping cough/ stomach flu may cause upset stomach, diarrheaFurosemide (Lasix)Loop Diuretic -watch K levelsDigoxinAntidysrthmic, may cause headache and dizziness, 0.5-2 ng/mLHyperaldosteronismPathophysiology- too much aldosterone is produced by the adrenal glands which leads low potassium. Manifestations: fatigue, headache, HTN, hyponatremia, muscle weakness. Nutrition- increase potassium and sodiumNursing management/care post transphenoidal resection of a pituitary adenomaAssess LOC; observe for nasal drainage- test for glucose (CSF), Ask about headaches or visual disturbancesDosing Schedule for Hep B vaccination3 vaccines; Give 1st dose, wait 1 month and then give 2nd dose, wait 2 months and give final doseAnaphylactic ReactionsAllergic response: rapid onset, maintain patent airway, swelling of mouth, hands, rashes, epi penLatex AllergyAsk all patient about latex allergySystemic Lupus ErythematousInflamed red "butterfly" rash on face, fever, fatigue, anorexia, joint inflammation. Teaching: cleanse with mild soap, dry by patting not rubbing, use SPF at least 30HIV/AIDS KarposisSmall, purplish brown raised lesions that are usually not painful or itchy can occur anywhere on the bodyAppendicitisAbdominal pain at McBurney's point, N/V, don't palpate, keep NPOCholecystitisManifestations: upper abdominal pain, radiates to the right shoulder, pain triggered by high fat foods, anorexia, N/V, dyspepsia, flatulenceHepatitis AContaminated food or water, fatigue, N/V, abdominal pain, low grade feverHepatitis BPreventable by vaccine, yellowing of eyes, abdominal pain, dark urine, clears up on its own.Hepatitis CSpread by contact with contaminated blood, needles, transfusions, fatigue, fever, loss of appetite, abdominal painHepatitis DOccurs only among people who are infected with Hep B, contact with infectious blood, needles, abdominal pain, nausea, fatigueCirrhosisCauses ascites, dietary mods: low Na dietOvarian CancerManifestations: abdl bloating, swelling, quickly feeling full when eating, weight loss, discomfort in pelvic area, constipation, frequent urination.Hodgkin's DiseaseEnlarged lymph nodes in the neck, groin and armpits, weight loss, chills, fatigue, fever, night sweats.Cervical Cancer-usually because of HPV -If multiple partners, early sexual activity, STDs, smoking -Bleeding after sex or menopause, watery foul bloody discharge, pain during sexChemotherapyhair does not grow back the same... infection, heart problems, infertility, N&V, decreased app, fatigue, fever, sores, and pain. -zofran beforeCervical Radiation Implant (Brachytherapy)pt is radioactive, use own bathroom toiletry... *know to use lead container and forceps *badge must be worn to monitor amnt of radiationExternal RadiationPt comes into facility/ under a machine, is not radioactive. * do not use lotion!!!Terminal CancerComfort pt with pain and nausea meds... with terminal cancer let pts. Do what they enjoy if able to. Allow person to express feelings and talk about memories.Pelvic Inflammation Diseasesexually transmitted bacteria spreads to uterus, ovaries, or tubes from vagina. -Gonorrhea or chlamydia -S/S: pain, discharge, irregular bleeding, pain during sex, painful urinationBreast CancerPerform self breast exam -dimpling of skin (peau de orange) -retraction of nippleHydrocelectomyHydrocele is a fluid filled sac surrounding a testicle causing scrotum swelling. Incision is made to remove it, may need a tube to drain fluid, and a dressing.Modified Radical MastectomyRemoval of all tissues... do not draw blood or BP from that side. -JP drains -arm elevated on pillow -dont raise that arm up (to ask question)Chronic Prostatitis-recurrent UTIs that's entered prostate gland -S/S: might not show at first and similar to a UTI. -Pt will have to have a rectal exam too, sitz bath, antibiotics (take full dose), avoid spicy foods and caffeine, avoid aggravating activity.Testicular Self-ExamPick a day out of the month (keep same day) feel your balls for lumps...we all know what a TSE is guys!!ProstatitisInflammation of the prostate glandProstatectomysurgical removal of all or part of the prostate gland. Do not drive for 1 week after your surgery, refrain for vigorous activity for 6 weeks, avoid climbing stairs as a form of exercise, and avoid bathtubs or swimming pools (infection)StrokeInsufficient blood supply to brain, drooping face, difficulty speaking, weakness R/F: obese, no exercise, drinking, drugs, smoking, high BP, high cholesterol, diabetes, heart problems, African Americans, age ... Do not give thin liquids *tilt head down!!Nitroglycerine-vasodilator -Opens up vessels to allow blood flow...Watch for sudden BP change SE: dizziness and headache - -1 tab every 5 min up to 3 tabs then ER -store in brown container (light sens)Raynaud'sBlood circulation narrowed vasospasms. Cannot stand cold temp, control stress, exercise. And keep pt warmICPS/S: headache, N&V, increased BP, SOB, LOC, seizure... Do not do lumbar puncture if IOP is high -Medication used to treat is an osmotic diuretic!!Spinal ShockAutonomic systolic is <90 due to lack of perfusion to spinal cord...bladder retentionAlzheimer's-Early, middle and late stages -cannot be fixed or reversed just relieved -Do not reorient pt.Guillain-Barre Syndrome-Priority: respiratory compromise, Manage airway, may require mechanical ventilationVisual Deficits-Safety: keep room well lit, keep floors clear of cords, rugs, pets to prevent falls, use guard rails and hand rails, wear nonskid shoes -Ambulation: walk in front of the person &let them hold on to your arm, keep walkways clear and well lit. Interventions- get eye exam every 6 months to every year, fall precautions Teaching: teach pt and fam importance of eye exams. If eye med is perscribed, teach how to apply it.Cataract Surgery-Complications: sharp, sudden pain in eye, bleeding or increased discharge from eye, lid swelling, decreased vision, flashes of light or floating shapes -Preventions: avoid acts that cz increased intraocular pressure; use eye drops as directed, get yearly eye examsGuilllian- Barre Syndromes/s occur distal to proximalGuillain-Barre Syndrome Complicationsrespiratory depression, motor weakness, sensory abnormalities.Ear Wick RFmultiple ear infections, swimmer's ear, allergic reactions to hairspray, earrings, hearing aidsEar Wick preventionwear earplugs when swimming, wash hands before handling ears, minimize ear canal moisture, limit exposure to materials that lead to local irritation or contact dermatitis.Meniere's Disease RFinfections, allergic reactions, fluid imbalances, long term stressMeniere's Disease Complicationshearing loss, vertigo, headaches, increasing tinnitus Patient safety-lay down when experiencing vertigo, move head slowly when standingPrevention of complications of Meniere's Diseasedistribute fluid intake throughout the day, avoid drinks and foods high in salt, avoid caffeine, use the meniett device which applies low pressure micro pulses to the inner ear for 5 minutes 3 times a day, placement of tympanostomy tubes in the eardrum of the affected ear, Dr. may prescribe mild diuretic to decrease endolymph volume, which reduces vertigo, hearing loss, and tinnitusGlaucomaOphthalmic medications-prostaglandin agonists, adrenergic agonists, cholinergic agonists, carbonic anhydrase inhibitors, and beta-adrenergic blockers. Beta blocking agents if absorbed systemically can cause an unsafe drop in heart rate, B/P, and can cause hypoglycemia.To administer glaucoma eye medplace a finger over the inner canthus and hold pressure while applying eye drops to prevent the medication from entering the blood stream.Proteinuria-RF: diabetes, high blood pressure, obesity, over age 65 -Etiology: nephrotic syndrome, diabetic nephropathy, urinary tract malignancies, glomerular diseaseCystoscopyA thin tube with a camera and a light is inserted through the urethra and into the bladder. Images from the camera are displayed on a screen where your dr can see them. It is done to diagnose blockages, enlarged prostate, noncancerous growths, stones, and bladder tumors. You may be prescribed an antibiotic before and after the procedure. You will be under general anesthesia so you will need a driver to take you home. Plan to take time to rest after procedure.UTI PreventionDrink plenty of water and cranberry juice, wipe front to back, empty bladder before and after intercourse, avoid douches and powdersAcute Glomerulonephritis RFlupus, diabetes, multiple kidney infections, high blood pressureAcute Glomerulonephritis Etiologyuntreated strep throat, bacterial endocarditis, viral infections such as HIV, Hep B and Hep C.Acute Glomerulonephritis ManifestationsSmoky, Dark , Brown colored urine, hematuria, foamy urine, proteinuria, high B/P, fluid retention, swelling in hands, feet, abdomen, and face, fatigue and anemiaLithotripsy Purposeto break up stones in kidneys so they are small enough to pass out of the body.Lithotripsy Complicationsinternal bleeding, infections in the kidneys, the kidneys may suffer damage and possible kidney failure may occurLithotripsy Nurse monitoringmonitor frequent vital signs, monitor amount, color, clarity of urine output. Maintain placement and patency of urinary catheter, control painRenal Surgery-Complications: HTN , hemorrhage, renal artery thrombosis, stenosis of renal artery, and kidney failure -Monitor post op: VS, color, amount, clarity of UO, hematuria, and turners sign (discoloration on sides)-sign of internal bleedingHemodialysisAV fistula post op-elevate arm, no B/P or sticks in that arm, use a rubber ball to squeeze in hand to strengthen the fistula before use, don't sleep with access arm under your head or pillow, check pulse daily in access arm, do not carry purses or children on that arm.Emergent Care Triageclassifies patients into priority levels according in severity of illness or injury.Emergent Care Prioritization-emergent (respiratory, chest pains, hemorrhage) -urgent (abdominal pain, fractures), -nonurgent (colds, sprains)Heat stroke-R/F: working in extreme heat, dehydration -Prevention: stop physical activity and move to a cooler place stay hydrated -Treatment: get body temp down, use cool wet washcloths, fluids, cool room temp, loose clothingBlack widow treatment-Monitor: VS, opioid medications, muscle relaxants, tetanus prophylaxis, antihypertensive agents -elevate arm, apply heatLightning prevention and treatment-Prevention: stay inside and away from windows when it's lightning -Treatment: immediate CPRAngina-physical and psychosocial responsesSudden, usually in response to exertion, emotion, or extreme in temperature, the pain is sub sternal and may spread across the chest and back and down the arms.Rheumatic Heart Disease Comp.valvular damage, thickening of the pericardium, pleural effusion may develop, can cause stenosis or regurgitation of the mitral and aortic valvesRheumatic Heart Disease Prev.go to the dr with s/s of streptococcal pharyngitis (high fever, sudden sore throat, reddened throat with exudate, enlarged tender lymph nodes), **Penicillin is drug of choice.Rheumatic Heart Disease Teachingteach patients to take all of their antibiotics, stay hydrated and get plenty of rest.Air Embolism RFair being introduced into the central venous system during catheter insertion, accidental disconnection of tubing, tubing changes, catheter rupture, catheter removalAir Embolism Prev.use luer-lok needleless caps, close side clamp on catheter extension when changing tubing, apply occlusive dressing with antiseptic ointment after removal of the catheterAir Embolism Txclamp catheter immediately, place patient left lateral trendelenburg position, call dr immediately, and apply oxygen therapy, ABG's and EKG stat12 lead EKG-Teaching: lay still during procedure and don't hold your breath -Safety: leads should have moist gel in the middle, do not wet monitor, do not use dry leads -Procedure: noninvasive procedure based on principles of ultrasound. Used to evaluate structural and functional changes inMRI- noninvasive diagnostic option to view organs through interaction of magnetic fields, radio waves, and atomic nuclei showing hydrogen density. Before an MRI, ensure the patient has removed all metallic objects, Patient's with pacemakers or implanted defibrillators may not be able to have an MRI. -Let patient know they will be in confined space so they may experience claustrophobia.Rheumatic Heart DiseaseA disease that can result from inadequately treated strep throat or scarlet fever. -most serious compl of Rheumatic FeverCardiac Cath.most definitive but most invasive test in the diagnosis of heart disease.Cardiac Cath.Assess patient's physical and psychosocial readiness & knowledge level about the procedure bc most pts have anxiety& fear about procedure. -Make sure inform consent is signedPost op Cardiac Cath.pt must remain in bed for 2-6 hours, assess insertion site, and peripheral pulses.Cardiac Cathpts may feel hot flash sensations &may have the desire to cough. These symptoms are normal.Atrial fibrillationMost common dysrhythmiaAtrial fibrillationPts have multiple rapid impulses from many atrial foci depolarize the atria in a totally disorganized manner at a rate of 12-200 beats per minute.Atrial fibrillation-Anticoagulants I.E.: heparin, enoxaparin (Lovenox), and warfarin (Coumadin) may be given for patients at high risk for emboli. -blood does not completely empty chambers so it has the potential to pool and clot.CADA broad term that includes chronic stable angina and acute coronary syndrome.CAD Nonmodifable RFage, gender, family history, and ethnic background.CAD Modifiable RFsmoking and obesity, uncontrolled BP, uncontrolled diabetes, uncontrolled cholesterol levelsHTNSystolic BP @ or above 140 and or Diastolic BP @ or above 90HTN Teachingsodium restriction, alcohol restriction, stress management, and exercise. If necessary teach the need to stop tobacco, especially if smoking. Eat more fruits, fiberLatex Allergy RFpts w spina bifida, ppl who routinely use latex condoms, healthcare workers who use latex glovesBurn Injury positioningno pillows, towel roll under neck, supine neutral position with minimal flexion.Burn Injury Pain Mngopioid analgesic, IV is best route, relaxation techniques and quiet environment.Response to fire-RACE -move patient firstEscharotomyincision through burn eschar relieves pressure caused by the constricting force of fluid.Rules of nineshead=9, arm=9, arm=9, anterior trunk=18, posterior trunk=18, upper right leg=9, upper left leg=9, lower right leg=9, lower left leg=9, perineal=1Burn Injury & Airway-direct injury to lung from contact with flames. -Maintain patent airwayBurn pt nutritional needsencourage as many calories as possibleResuscitation phase (Burn Inj)become hoarse, brassy cough, edema, blistersAcute Phase (Burn Inj)decrease in immune system, check for pneumonia, prevent contractures.HypothyroidismT3 & T4 low TSH elevatedGuillaine-Barre Nursing interventionsDRUG THERAPY: iv immunoglobulin (need to be started within 2 weeks of onset symptoms), plasmapheresis MANAGE PAIN: avoid stress (quiet room), massage, meditation, relaxationCirrhosisslowly progressing disease in which healthy liver tissue is replaced with scar tissue, eventually preventing the liver from functioning properlyMost Common Czs of CirrhosisHepatitis C, fatty liver, and alcohol abuseAddison's - Adrenal Insufficiency-not enough glucocorticoids & mineralocorticoids(aka not enough steroids) -Anemic Adam -low Na high K -bronze skin, wt loss, hypoglycemia, dehydrated, irreg HR (^K) -watch for adisonian crisis -TX: Cortisol 2/3 am 1/3 pmAddison's Disease MEDShydrocortisone -Florinef (replaces aldosterone)Nephrotic Syndromecond of increased glomerular permeability that allows larger molecules to pass thru the membraneGlomerulonephritiskidney disorders characterized by inflammatory injuries in the glomerulus, most of which are czd by immunological reaction, loss of kidney func develops. -2-3 weeks after strep infPulomonary embolidue to prolonged immobility, obesity, central venous catheters, hist of embolus. -INTERV: ROM for immobilized pts, TED hose, improve lung perfusion, antiplatlet therapy, O2 therapyNephrotic Syndrome-massive proteinuria -edema -decresase plasma albumin -hyperlypidemia -renal insufficiency -alt liver act may occur resulting n ^lipid production&hyperlipidemiaNephrotic Syndrome Tx-ACE Inhibitors dec protein loss in urine -Cholesterol lowering drugs improve blood lipid levels -Heparin reduce protein&renal isufficiencyGlomerulonephritis interventions-MONITOR: VS, wt, I/Os, charc's of urine, for compications -limit act high quality nutrient food(foods high in K restricted during per of oliguria, protein rest at times, moderate Na/fluid rest) -administer diuretics, antihypertensives,&antibiotics as Rx -seizure prec -pt report s/s of bloody urine, headache, edemaCADArteries fill w plaque &narrow, atherosclerosis occurs. -heart can't get enough O2 to funct properlys/s fluid vol overloadSOB, Edema, Crackles upon auscultation, increase bounding pulse, JVT, HTN, Ascites, 3rd heart sound, moist skin, dypsneas/s fluid vol defecitcold, clammy skin, paleness, rapid breathing and heart rate, weakness, decreased or absent urine output, sweating, anxiety, confusion, and unconsciousness low bpCholecystitisinflammation of the gallbladerHodgkins DiseaseCancer of the part of the immune system called the lymphatic system.Meniere's DiseaseAn inner ear disorder that causes episodes of vertigo (spinning).

NUR 107 FINAL EXAM REVIEW

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