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Future RN 2015

Abnormal Platelets?: High at risk for clotting Low at risk for bleeding
Abnormal WBC numbers mean? Patient either has an infection if its high and at risk for infection if low
African Americans are more at risk for? hypertension
After surgery you should?: Assess surgical incision, respiratory and signs of bleeding.
ALS Respiratory complications, respiratory complications A progressive neurologial degeneration, short life expectancy after diagnosis. Palliative care for quality of life
Alzheimer's disease: Toilet them often. Reorient often. Be aware of symptoms of infection if they are unable to tell you, Be aware of sundowning, keep environment consistent and free of unnecessary distractions.
Antibiotics take the whole course
Appendicitis REBOUND TENDERNESS!!! Usually in younger people Right lower quadrant pain
Arterial Insufficiency Color changes, pale skin, decreased pulses, hair absence, poor tissue perfusion, usually have pain with exercise and the pain is relieved by rest Dry wounds, like black toe (I think this is the question
Assess for risks for hepatitis: A & E: Traveling BC: Unprotected sex, needle drug use
Braden score: 15-16 mild risk 12-14 moderate risk <11 severe risk
Cardiac landmarks aortic pulmonic, Erb's (S1 and S2), tricuspid, mitral
Catheter considerations: really good care for catheter and skin. Take it out as soon as you can
Catheterization: Lean in as short of a time as possible because it is a portal for infection;Usually long term only for people who are sedated or paralyzed
Caucasian Women are more at risk for??? Coronary Artery disease? I think? indigestion, heart burn as symptoms
Check temp every day with Chemo, also check left shift often
Colon cancer Genetic risk Dietary risk, lots of processed foods, diets high in meat; Psychosocial with cancer
Community acquired Pneumonia: People with underlying issues in the community, like substance abuse. What does this even mean? that people with substance abuse issues are more likely to get pneumonia? I have no idea. Maybe ignore this one.
COPD Hyper inflated lungs Increased CO2 Hypoxia O2 sats Elevated heart rate Elevated hemoglobin
COPD Patients Often on inhalers and steroids, more at risk for infection. Thrush Need to use inhaler correctly,
Crush injuries Compare sides for vascular compromise, check the 5 p's
Cushings Disease: Diets, high calorie, lots of protein and nourishment
Cystic Fibrosis Lots of mucous, Physiotherapy, Percussion. Focus is to prevents respiratory complications. nutritional issues, supplement pancreatic enzymes.
Delegation ONLY RNS CAN: Assess, educate. LPNS can: Reinforce education and give meds; Make sure you do things first for a patient: feeding a person who just had a stroke.
Duchennes Muscular Dystrophy: Genetic, mother is the carrier, sons get the disease. Usually wheelchair bound(she said this multiple times) Short life expectancy weakness
Dignostics for GI EGD Colonoscopy Occult Blood
Esophageal Cancer: Increased risk: Smoking and drinking, barrets esophagus: chronic acid causes cellular changes
. food Poisoning don't take antidiarrheal Don't become dehydrates, get enough fluids, seek medical attention if it is severe
Food Poisoning assessment questions: Have you traveled anywhere out of country? Have you eaten something you do not normally eat?
Gal Bladder Affects females more, obese, older pregnancy.
Hearing Difficulties: Minimize distractions face them directly focus on visual Modify alarms and phones for flashing lights
Heart Failure Left: Lung issues Right: Edemas Lasix Pillow under the arms Dietary modifications: Avoid salt, canned foods, processed foods, usually on fluid restriction. DAILY WEIGHTS!!!!! Sate time, same scale, same clothes
Heart Failure 2 Make sure they take their meds as prescribes Be aware of potassium ACE inhibitors increase potassium low Na+ diet, check labs K+
Hepatitis B& C: Blood or body fluids A & E are fecal oral D only can exist with b
hypersensitivity reactions anaphylactic reactions usually are: peanuts, latex, bees
hip replacement precautions do not cross legs, elevated toilet seat
How can you tell the difference between cardiac friction rum and pulmonary friction rub? have the person hold their breath and if you still hear the rub its cardiac if it stops its pulmonary.
How is HIV Spread Using dirty needles or unprotected sex. Healthcare workers are at minimal risk. Treat everyone with precaution, carry gloves all the time
how to diagnose leukemia bone marrow biopsy
How to take samples from catheters you know this so i am not putting it
Hyperthyroid assessment warm, energetic, lost weight
Hypothyroid less calories due to less metabolic demand
Hypothyroidism assessment fatigue, gaining weight, constipation
patient is fatigued rest and space out care
dark skin/check for jaundice? mucous membranes
Intrarenal failure inside the kidney, causes: medications, antibiotics, diabetes, hypertension
Kidney biopsy usually done with ultrasound. In the hospital. kidneys are highly vascular so watch for bleeding. 14 gauge needle
kidneys filter, manage blood pressure, and stimulate red blood cell production.
Lab matching CBC WBC:5000 to 10000 Hgb F:12-16 Hgb M: 14-18 HCT: F35-45% HVT M: 42 to 52% PLT: 150000-400000 BUN: 10-20 Creatinine: 0.5-1.1
Labs Potassium: 3.5 to 5 be aware of cardiac issues Sodium: 135-145 if its super really low can cause coma seizure and death
Labs Electrolytes k: 3.5 to 5 MG+: 1.1-2.1 CL-: 90-106 Ca+: 9-10.5 Sodium: 135-145
Lactulose concerns Hypokalemia, losing sodium, skincare
Left shift body is putting out white blood cells that are immature (neutrophil bands). Due to infection or cancer. find out the cause, check temps, do a urinalysis, look for wounds
Left shift 2 Immature white blood cells increased, infection wounds and temp, left shift with sepsis TX: antibiotics
Liver Assessment Cirrhosis Skin tone, check for jaundice yellowing eyes, ascites, peripheral edema, malnutrition
Liver Failure Cirrhosis Stop drinking alcohol or doing drugs. Take lactulose to keep ammonia levels down
Liver Labs AST 5-40 ALT: 3-35 Albumin: 3.5-5.0 Amonia: 15 to 110
Low hemoglobin Anemia
Lumbar Puncture side lying, not agitated or restless. Be aware of the site for clear fluid draining which could be cerebral spinal fluid. Remember the yellow ring when it dries means it is CSF and not just normal fluid.
Matching Question Peripheral artery disease VS Peripheral Venous Disease PAD: Less hair, reduced pedal pulses, cool temp PVD Discoloration Edema
Native Americans Are More at risk for Diabetes
Neurological Assessment PERRLA Pupils Equal, Round, Reactive to Light and Accommodating, LOC
NG tube check placement; pH etc. Med admin need to flush before and after and between
NG tube feeding sit high fowlers; check residuals before each feeing to ensure digestion.
Obstructive sleep apnea: Obesity, Excessive Daytime Sleepiness, fall asleep a lot, neck circumference
Occult Blood Test people should avoid: aspirin, vitamin C, and red meat for 48 hours before giving a stool specimen
Oxygen Education No smoking Precaution
Paget's disease a chronic disorder where bone is broken down by osteoclasts. reformed by osteoblasts and results in bone deformation. More common in people with a family history
Pancreatitis Lots of pain, lots and lots of pain, give pain meds NPO because eating stimulates the pancreas At risk for shock because enzymes go places they shouldn't and eat things they shouldn't Sometimes they get an nj tube to decompress the stomach
postsurgical complications risks Obese, smokers, previous complications from other surgeries
kidney failure poorly controlled; anemic due to not enough red blood cells
High risk for Latex allergies spinabifida and healthcare workers, people with fruit allergies
thyroid issues usually assessed for infertility issues
Pericarditis inflammation, very painful. You can hear pericardial friction rub.
Polycystic kidney disease Genetic Edema Peri-orbital Edema Pulmonary Edema Usually kidney transplant- Medication compliance important
Postoperative considerations RESPIRATORY Slow Gi: hypo-active bowel sounds Sleepy groggy,
Postrenal failure urine cannot get out, stone, obstruction; usually in ureter; after kidney
Preop Planning identity,Consent, Bathroom, VS, Assess for food/ med allergies and administer Preop Meds time out
Preoperative consent signed inform consent; bilateral surgeries correct marking
Prerenal failure Shock, CHF, Stricture in renal artery, Dehydration (dessert walkers) causes also inadequate blood perfusions
Reglan helps with what postop? induce bowel movement after surgery
Respiratory Assessment: auscultate to lungs; inspect chest diameter; assess Clubbing fingernails; inquire about occupational exposure assess if SOB
SIADH Syndrome of inappropriate antidiuretic syndrome Low serum sodium. Fluid restriction, sodium restriction
Sinus Rhythm look at pic
Skin issues in the hospital can be caused by: bedrest, immobility
Spinal Cord injury autonomic dysreflexia (From urine retention) can result in hypertensive crisis put them on a catheterization schedule. Psychosocial considerations SKIN INTEGRITY!!!
Suctioning Have to be hyper oxygenated before Only suction on the way out intermittent assess before and after: O2 sats, lung sounds
Cardiac symptoms Chest pain, fatigue, tachycardia, hypertension, shortness of breath
Thyroidectomy assessment low calcium, check airway, check calcium reflexes. Chvostek's and Trousseau's sign
Thyroidectomy Intervention Usually take it out for cancer, hyperthyroidism and need to control symptoms. supplementation synthroid. Interacts with a lot of meds, given early in the morning to avoid interactions w/ food or meds. interacts w/ Ca+, soybean flour
total hip replacement Post surgical DVT, leg-leg comparison; edema, pulses. Anticoagulant, mobilize, Coumadin, implement bleeding precautions.
Traction pin site for infection, check order and weights, educate pts. and family to leave weights alone. Weights cannot be on floor
abdominal trauma Do not palpate, check for distention, guarding, rigid abdomen Seatbelts are a common cause of abdominal trauma
Urinalysis Check for infection Also checks for other issues GLUCOSE AND PROTEIN MEAN DIABETES
UTI prevention education, front-back, voiding post-sex, estrogen changes, increase fluids.
Venous insufficiency Edema, discolorations. Wounds are wet and oozy
skin Interventions repositioning q 2 hrs or more, mobilizing patient and high protein diet
thrush medication Nystatin
GI concern Hypoactive bowel sounds Rebound tenderness
Paget's disease Intervention Priority Control pain; usually severe bone pain
Confusion demonstrated by pt. find cause; infection, UTI, electrolyte imbalance; neurological issue or medication. Reorient pt.
GI emergency symptom rigid board like abdomen
Fluid overload risks Heart failure, kidney failure, trauma, too much iv fluids
Pressure Ulcers Stages I-V I-redness skin, intact skin II- not intact skin, blister open/close III-sore invades sub q tissues, IV- full skin loss muscle, tendon or bone V-unstageable
Pressure ulcer risks change in mental status, immobility, malnutrition, incontinence
Pressure ulcer Interventions repositioning q 2 hr or more, nutrition (high protein), skin care, skin cleaning and barrier protection
Complication of fractures issues with tissue perfusion, check pedal pulses at same time for comparison and 5 P's, Pain, Pulse, Pallor, Paresthesia, Paralysis
postoperative complications respiratory distress or other issues, cardiac issues due to advanced age, previous hx of complications, comorbidities
postoperative assessment respiratory, incision, bleeding, gag reflex, bowel sounds
total hip precautions don't cross legs, don't allow more than 90 degree elevation with affected leg. use accommodation devices elevated toilet seat, reaching arm etc.
Created by: Future RN 2015