Chronic Exam 2 Case studies
Terms in this set (48)
A patient with ALS is admitted to your floor from the ED. He is on a ventilator and newly diagnosed with pneumonia. What will the nurse include in her nursing care plan?
Set up suction equipment at bedside, reposition ever two hours to prevent skin breakdown.
You're a charge nurse on a neuro floor. You understand that some of the following patients have an increased risk for respiratory complications: MG, ALS, GBS. Is it appropriate to assign an agency nurse to care for these patients?
Not really. Would want to assign a nurse who is familiar with the floor with complicated patients.
Of the patients with MG, ALS, GBS, which patient under what condition should have the greatest assessment priority?
Descending GBS. Respiratory insufficiency develops quickly.
What type of clinical pattern occurs most commonly in patients with GBS?
Ascending motor weakness and paralysis
You find out this patient (with GBS) had an upper respiratory infection that triggered the GBS. Why?
Viral infection or immunization often precedes GBS by 1-3 weeks.
Once the GBS patient is ready to go home, what is the goal for this patient?
Evaluate ability to perform ADLs.
A patient's son that has Huntington's asks you about genetic testing. How do you respond?
The patient's son is at risk. 50/50 chance of getting it. Show compassion and concern. Recommend counseling before testing.
What is a major nursing assessment of importance in patients with HD?
Your newly diagnosed MS patient is asking about MS. How can you guide her?
Tell her that motor weakness is common; notify her doctors immediately if fever develops. Why?
There are injectable medications that can prevent exacerbations, which are they?
During remissions, staying active is important. What is the best exercise you can recommend?
Your patient with MG is unable to keep her eyes open while talking to you, what is this finding called?
Your MG patient suddenly develops increased muscle weakness and trouble breathing. What is the medication of choice?
Tensilon, then increase doses of anticholinesterase meds. Probably myasthenic crisis
After Tensilon (edrophonium) is administered, you monitor your MG patient's heart rate for what?
Bradycardia. Also monitor RR and be prepared to intubate.
Your MG patient develops a fever, elevated BP and HR is 120 bpm and is incontinent of urine and stool. What is occuring?
What is the nurse's priority after this assessment?
If a MG patient recieved too much pyridostigmine, what is the first action?
Check HR. Cholinergic crisis can cause profound bradycardia
Once your patient is stabilized and ready for discharge, what are you going to tell her about the MG meds?
1. Dosing is adjusted and timed to control symptoms. May need to dose to improve chewing.
2. Make sure MG patient only uses one pharmacy to ensure that all prescriptions are safe. Some drugs may increase weakness or precipitate a crisis
You're assigned a patient with Parkinson's. What is the first think you will notice when he walks?
Shuffle and propulsion.
The patient is started on Carbidopa/Levidopa, what do you assess for prior to ambulating him?
Check BP. Can cause orthostatic hypotension.
Teach pt med should be taken with meals.
You are assigned a patient with possible Alzheimer's dementia. What is the best method of diagnosing dementia?
History. Cognitive assessment.
As you are getting ready to discharge a patient with HF, what is something to keep in mind about chronic illnesses?
Most have the potential of an acute exacerbation of symptoms. Adjusting to changes in course of life of disease.
How would you engage a patient in controlling his care?
Readiness to learn, Have patient be in charge or health/empower them.
As a charge nurse on rounds, a patient with chronic pain complains to you that he's ignored when he requests pain medication. What is the first thing you would do?
Assess the MAR and nurse's notes.
After reviewing the EMR you also learn that the patient has depression. What is something that would most concern you when in a patient with unrelieved pain and depression?
The patient is referred to a pain clinic and the discharge nurse cautions the patient to avoid alcohol when taking acetaminophen. Why?
An elderly patient with chronic dementia is admitted to your unit with abdominal pain. Overnight he develops fluctuating levels of consciousness and mood swings. Is this a normal finding?
No. Ensure patient safety. Then call doctor.
You just started working on a Hospice/Palliative unit at your hospital. On orientation you learn about the client self-determination act (PSDA). What is the importance of this information?
Advanced directives. Hospital needs to know this stuff.
You are assigned to a patient with end stage HF. What is the importance of palliative care with this patient?
A terminally ill cancer patient is on palliative care and her intermittent pain is 7/10. How would you administer her pain meds?
What if her pain becomes constant and more severe? What is the best way to administer analgesics then?
Put patient on schedule
You are assigned a patient who is dying of cancer. Is it appropriate to discuss past life events and their meanings? WHy?
Yes. Help them cope.
Your patient expires. Can you delegate post-mortem care to an LPN?
You have a patient with possible Crohn's Disease. What type of study can diagnose it?
Colonoscopy, double contrast
How do you know if the patient understands what a barium enema study entails?
The patient is diagnosed with Crohn's, what is important for the patient to understand about the illness?
Symptoms may vary depending on what part of the GI system is affected
Your ulcerative colitis patient has low blood count and is diagnosed with anemia. Is this common with UC patients?
Yes. Common for bloody diarrhea.
Your IBD patient is getting a colostomy. What is included in your pre-op teaching?
After surgery the colostomy bag is empty, no feces yet. Should this concern you?
Normal. Takes time for bowel to start going.
On POD#2 a pt with colostomy bag is getting full. Can the nurse delegate a UAP to empty it?
Only if it's not a new colostomy.
Your assignment for today is taking care of a patient with SLE. Her kidney function comes back with elevated creatinine. What do you do?
The patient is started on high dose prednisone for four days but on day five there's an order to stop it. What should you do?
Notify doctor. Would want to taper the amount.
As you get ready to discharge her home, what are some of the patient teachings for her to understand?
She should pace her activities and use sunscreen. Why?
You are taking care of a patient with acute RA. What type of medications are used in the acute phase?
meds to decrease inflammation
The patient is placed on prednisone. How do you know its working?
Decreased pain levels, blood values: decreased wbc
What blood values do you closely monitor?
What do you instruct the patient to prevent in order to manage her RA at home?
Avoid repetitive motion activities.
A month later, your same RA patient comes to the hospital. She is now on autoimmune medications. Her WBC is 15000. What do you do? Why?