Student- NU 216 topic overview (1)

Topics NU 216 Adult Health One Final exam is 80 questions. Who should you see first questions: Make a check mark for each correct in each answer. Which answer has the most check marks? Unit1- Introduction to medical surgical nursing  Culturally competent care: o Acknowledgement of other options and decisions o Ask questions about preferences (fasting rituals) o Prayer schedules or prayer preferences  Terminally ill patient: Include the family and talk to them as well. o Focus on meeting expectations of patient and family. o Advance directives o Patient wishes.  Culture-define. o Beliefs and customs of a certain group of people o Traditions and values o Main and subgroups of cultures o Ask patient about their beliefs and values.  Visual o Accommodation  Assessment? Pupils constrict when an object is brought toward the nose. Pupils will dilate when an object is pulled away from the nose.  What is normal? Pupillary constriction and dilation.  Why are you doing this? Ensure eyes are converging correctly. Determines if there is an issue with the eyes. Determines if there is damage to the brain.  Cataract-define. Cloudiness of the lens of the eye. Blurred vision and light sensitivity. o Assessment Dilation of pupils. Ophthalmoscope to view the back of the eye.  Cheyne stokes respirations-define. o End of the life breathing patterns o Labored and abnormal breathing o “death rattle” due to secretions  Insomnia-define. How is it determined or diagnosed? o Disturbance of the circadian rhythm o Data is subjective. o Educate pt to keep diary/journal of sleep patterns o Acute or chronic o Influenced by mental health (stress, anxiety, depression) 1

Unit 2- End of life care, pain, STI  Chlamydial infections-define Bacterial infection from unprotected sex, presents like strep throat orally. o Patient teaching everyone should be tested (patient and patterns), do not have sex during treatment, take full course of antibiotics, finish antibiotics completely even if feeling better (antibiotic resistance could occur)  How to avoid recurrence  Reported to health department, use condoms or protection, treatment as prescribed.  Pain-define. o SUBJECTIVE o Facial expression, dementia, verbal, numeric scales o Pain is what the patient tells you it is. o Determine what is the patient’s pain goal (functional goal)  Keep pain at a manageable level. o Acute pain: pain lasting up to 3 months. o Chronic: pain lasting 3-6 months or longer o Functional medicine  Nonpharmacological pain management  Keep the patient at a manageable pain level.  STI o All sexual contacts need to be informed and provided treatment  Functional medicine o Pain- get the patient to their best QOL. Unit 3- alterations in sensory function, integumentary disorders  Atopic dermatitis-define. Patient teaching o Eczema o Topical corticosteroids o Chronic inflammation of the skin o Itchy skin o Flat, plaque raised skin lesion of 0.5 cm Unit 4 Immunity  Acquired immunity-define o Body develops antibodies from infections o Infections or immunizations  Active acquired immunity-define o Natural infection of the antibodies (chicken pox parties)  Passive acquired immunity. 2

o Large scar forms or develops o Secondary wounds o Fibroblasts produce collagen  Maturation phase-define o Maturation: collagen synthesis, scarring, last stage in wound healing.  Delayed wound healing—comorbidities? o Malnutrition o Diabetes o Alcoholics o Autoimmune patients  **Dehiscence-define: wound splits open, edges of a wound are not well approximated  **Evisceration-define – Occurs when wound edges separate (intestines protruding) o Patient will place knees to chest, normal saline gauze and hold pressure until patient is able to get in surgery Unit 6- alterations in Endocrine health, Fluid and Electrolytes  Severe hyponatremia-define. Manifestations o Low sodium o Severe: serum sodium under 126 o Nausea, vomiting, confusion, seizures o Keep patient close to nurses station for safety since they are risk for falls  Mild hyponatremia-define. Manifestations o Serum sodium 130-135 o Headache, irritability  Hypomagnesemia-define. o Normal range: 1.7-2.2 o Low magnesium levels o Anorexia, nausea, vomiting, personality changes, irritability o Dx: Chvostek sign o Maalox  Normal levels and hypo/ hyper of: o magnesium, 1.7-2.2 o Calcium 8.6-10.2  linked to parathyroid o potassium, 3.5-5.0 o sodium levels 135-145  Hyperaldosteronism o Describe: excessive aldosterone secretion  Sodium and water retention  Excretion of potassium and hydrogen o Assessment findings:  S/Sx: shortness of breath, chest pain, headaches, vision problems, hypertension, hypernatremia, hypokalemia. 4

 Cushing syndrome o Describe: happens when you use corticosteroids for a long period of time o Assessment findings? Buffalo hump, striae on abdomen, truncal obesity, weight gain  Thyroid o Assessment patient should drink water through a straw while palpating the thyroid  Findings o Labs  TSH - Considered the most sensitive diagnostic test for evaluating thyroid dysfunction.  T3 - Used to diagnose hyperthyroidism if T 4 levels are normal.  T4 - Used to evaluate thyroid function and monitor thyroid therapy.  TRH - The test is used in the differential diagnosis of secondary and tertiary hypothyroidism.  Hyperthyroidism- over-secretion of thyroid hormones. o TSH- LOW (<0.4 mU/L) o T4- elevated  Hypothyroidism- under-secretion of thyroid hormones. o TSH- ELEVATED o T4- LOW o What lab work- TSH and FREE T4  Anterior pituitary gland- secretes excessive TSH  Thyroid gland- Serum TSH is high when the defect is in the thyroid and low when it is in the pituitary or the hypothalamus.  Parathyroid hormone-define Regulate calcium levels and increases bone resorption (movement of calcium out of bones.) Also increases GI absorption of calcium and increases tublue reabsorption of calcium.  Hypovolemic shock-define Occurs after a loss of intravascular fluid volume. Caused by hemorrhage, GI loss such as vomiting/diarrhea.  Hypovolemia o What may you see with assessment? o Decreased capillary refill, tachypnea, decreased urine output, pallor, cool clammy skin, anxiety, confusion, agitation, absent bowel sounds Unit 7- Diabetes and Diabetic Ketoacidosis  Co-morbidities? o Wound healing? Delayed wound healing Unit 8 – alterations in respiratory health  Severe respiratory distress Provide oxygen, elevate the head of the bed (High-Fowler's)  Lung sounds- know how to describe o Crackles- Low pitch, bubbling sound during inspiration 5

 DASH diet-define – low salt, less red meat, increase calcium  Myocardial ischemia-define: lack of blood to the heart o Pain caused by? Buildup of Lactic acid Unit 11- Alteration in Nutritional Status and UGI health  Gastritis risk factors- Inflammation of the gastric mucosa.  Risk factors: Aspirin, NSAIDS, H. Pylori, Smokin, Alcohol, Large quantities of spicy, irritating foods.  Obesity- An excessively high amount of body fat or adipose tissue o Assessment  What factors led to your obesity/ malnutrition?  Full assessment needed o Body mass index – height and weight greater than or equal to 30. o Risk factors  Bowel assessment o What is the correct order? Inspection, Auscultation, Percussion, Palpation o When will you do a more focused abdominal assessment? If there is an absence of bowel sounds (bowel sounds not heard after 1 minute of auscultation)  Percussion of abdomen reveals tympany --> fluid, air, or fecal matter present in the bowels, sensation of incomplete evacuation. Unit 12 alterations in lower GI health  Irritable bowel syndrome-define. Abdominal pain, alteration of bowel patterns, abdominal distention, nausea, flatulence, bloating, urgency, mucus in the stool, o Patient teaching- Increase fiber intake, avoid caffeine, alcohol. Drink adequate fluids.  Constipation o Teaching – ambulation (activity) and adequate hydration  Diarrhea o Stool sample  C-Diff  Patient placed on contact isolation  Patient may have runny stool, incontinence  E-coli  Bleed Unit 13 Alterations in Renal and urologic health  Urinary system-upper and lower-define. o Upper – Kidneys and ureters o Lower – Bladder and urethra  Dysuria-define – difficulty urinating pain or burning  Decreased renal function-what are some of the causes? o Decreased blood flow to the kidneys, heart attack, liver failure, dehydration, sepsis  Assessment 7

o Kidney assessment- may not be able to palpate o Bladder- may be able to palpate for distention  Diagnostic testing o UA with culture and sensitivity  What to do if it is a weird color? Red-orange urine may be due to medications that patient is taking (Pyridum)  Costovertebral angle (CVA)- An assessment for kidney complications (kidney infections or polycystic kidney disease) Percuss on lower back for pain (11 th rib or 12 th rib)  What are the findings of a normal physical urinary assessment? Kidneys and bladder are not palpable (bladder may be palpable if full or distended)  Urinary tract infection-define Upper UTI –define inflammation of the renal parenchyma and collecting system.  Symptoms – flank pain, dysuria, pain, burning o Lower UTI define Inflammation of bladder and/or the urethra.  Symptoms – burning and pain : burning, pain o Acute pyelonephritis- An inflammation of the renal parenchyma and collecting system (including the renal pelvis) o Risk factors- Catherization, Benign Prostatic Hyperplasia (BPH), Vesicoureteral reflux (retrograde (backward) movement of urine from lower to upper urinary tract. o Nursing assessment- CVA tenderness, percuss on back for pain o Patient education-  what is important for a patient with a UTI?  Finish medications  Proper hygiene  Drink fluids  Wipe front to back  How to prevent recurrent UTI?  Hygiene  Safe sex practices  Recurrent UTI may require long course antibiotics (stronger)  Cranberry juice o UTI risk factors-define  Older age, female, diabetics o Health care – associated infections (HAI)  Avoid unnecessary urinary catheterizations  Patients with indwelling foley catheters put patients most at risk for HAI o Escherichia coli (E coli)-define – most common cause of UTI  Benign prostatic hyperplasia (BPH)- define. o Symptoms – delayed urination, frequency, inability to completely go o Characteristics – difficulty starting a stream of urine, frequent or urgent need to urinate, nocturia. 8

 Do not forget about the significant others- they need to understand the plan of care and learn to cope- they should not overly do things for the patient so the patient can relearn tasks.  Promote independence of patient  May need bladder training  Teach patient to utilize extremities that are not affected by stroke  Speech therapy, occupational therapy, physical therapy o Non-Modifiable risk factors-define: Risk factors that cannot be changed. This includes genetic predisposition, family history, age, or gender. o Modifiable risk factors-define: Risk factors that can be changed in order to enhance a person's health. This includes diet, exercise, smoking cessation, use of aspirin o When would tPA infusion be used? 4 hours after CT scan confirms stroke  R-sided stroke- o Patient manifestations- Paralyzed left side, left-sided neglect, Spatial-perceptual deficits, tends to deny or minimize problems, rapid performance, short attention span, impulsive, safety problems, impaired judgement, and impaired time concepts.  L-sided stroke- o Patient manifestations- Paralyzed ride side, Impaired speech/language aphasias, slow performance, aware of deficits, depression/anxiety, impaired comprehension r/t to language, math.  Expressive aphasia- Inability to produce language. o How can you help with communication? Ask yes or no questions.  Fluent aphasia- Speech is present but contains little meaningful communication.  Non fluent aphasia- Minimal speech activity with slow speech that requires obvious effort.  Transient ischemic attack (TIA)-define. o Patient teaching Considered a mini or warning stroke for patients; risk for future strokes  Daily aspirin- why? Prevention of strokes through anticoagulation  Meningococcal meningitis o Isolation- Respiratory isolation. Wear a mask.  Bacterial meningitis- Acute inflammation of the meningeal tissues surrounding the brain and spinal cord. o Manifestations- Fever, severe headache, seizures, changes in mental status and level of consciousness, skin rash, petchiae on trunk, lower extremities and mucous membranes o Nursing plan of care? Wear a mask!  Viral meningitis- Common causes are enteroviruses, arboviruses, HIV and Herpes simplex virus (HSV) o Health promotion- Get pneumococcal pneumonia and influenza vaccinations.  Meningitis o Who should be immunized? College students and adolescents  Osteoarthritis- Cartilage destruction. May begin between ages 20 and 30 and the majority of adults are affected by age 40. o Nursing assessment- 10

o Manifestations- Early morning stiffness that resolves within 30 mins, crepitation, Heberden’s nodes and Bouchard’s nodes ofetn red, swollen, and tender.  Rheumatoid arthritis (RA)- Inflammation of connective tissues in the diarthrodial (synovial) joints. o Patient education- Teach pt. About need for balance or rest and activity, with use of joint protective strategies. o How to manage activities of daily life?- maintain upper extremity function and encourage use of splint or other assistive devices for joint protection.  Lyme’s disease o Describe Inflammatory characterized at first by a bullseye rash, headache, fever, chills, What causes it – deer ticks o Progression later possible arthritis, neurological and cardiac disorders  Systemic lupus erythematosus (SLE)-define  Discoid (effects skin),  Systemic (effects connective tissue of multiple organs, can lead to major organ failure.). o Manifestations – “Butterfly” Rash on face, fatigue, depression, joint pain, swelling, anorexia, alopecia, sun sensitivity. o Nursing diagnosis  At risk for Social isolation o Patient education  NSAIDS, corticosteroids, immunosuppressants, avoid fatigue by balancing exercise and rest periods, contraceptives exacerbates lupus.  Rheumatoid nodules Bumps that if removed are likely to reappear o Nursing actions? - assess the skin for infections Pharmacology/ dosage calculation What is a major side effect of ACE inhibitors? Cough, headaches, increased potassium, and angioedema What is the action of spironolactone (Aldactone)? Potassium-sparing diuretic  Monitor for? Low potassium Patient teaching for ramipril (Altace)- possible adverse effects angioedema, Lightheaded feeling, jaundice, little urination, (high potassium) nausea, weakness, irregular heartbeats, fever, cough What is the action of bumetanide? Loop diuretic works on the loop of Henle to increase the salt and water you urinate. Bumetanide - possible adverse effects? Dry mouth, feeling thirsty, headaches, confusion, dizziness, muscle cramps/weakness. Action of Plavix and heparin-define blocking platelets from sticking together and prevents them from forming clots, it’s an anticoagulant. 11