fluid and electrolytes
symptoms of hypernatremia vs. hyponatremia
hypernatremia: seizures, coma, sticky mucous membranes, postural hypotension, weight loss, increased pulse, agitation, increased BP, increased CVP, weight gain, peripheral and pulmonary edema, twitching
hyponatremia: confusion, irritability, headache, seizure, coma
difference between cure, palliation, and prevention?
cure: eliminating or repairing pathology (ex. removing ruptured appendix)
palliation: alleviating symptoms without cure (ex. cutting a nerve root to remove symptoms of pain)
prevention: removing a mole before it becomes malignant or removing the colon in a patient with familial polyposis to prevent cancer
what is the ABCDE assessment?
skin assessment including: asymmetry, border irregularity, color change and variation, diameter of 6 mm+, and evolving in appearance
pain management with cancer pts.
Drug therapy, including NSAIDs (e.g., ibuprofen), opioids (e.g., morphine), and adjuvant pain medications, should be used and selected based on the character and cause of the pain.
Analgesics should be given on a regular schedule
Opioids normally are prescribed for the treatment of moderate to severe cancer pain. Corticosteroids are part of many drug regimens. They are anti-inflammatory, reducing swelling and inflammation, which may contribute to cancer pain.
RBC, Hgb, HCT are all included in what type of test?
complete blood count
nursing management/implementation of fluid excess or deficit
-I&O
-monitor cardiovascular changes
-assess respiratory changes
-neurological changes
-daily weights
-skin assessment
nurses responsibilities pre-op
-review results of pre-op diagnostic studies and share with HCP
-identify cultural and ethnic factors that may affect surgical experience
-the nurse is NOT responsible for obtaining consent but is responsible for making sure consent form is completed!
-identify and document surgical site
-identify prescription drugs, OTC meds, & herbs taken at home
A patient comes in with spots on his head and neck. the spots have raised borders, depressed center, and an opaque appearance. Which skin disorder does the nurse suspect this patient has, and what treatment does the nurse anticipate?
basal cell carcinoma
tissue biopsy to confirm diagnosis; treatment depends on location, histologic type, size, and characteristics
The nurse is caring for a female who had surgery 1 day ago to remove a breast mass. The patient is awaiting the pathology report. She is tearful and says that she is scared to die. The most effective nursing intervention at this point is to use this opportunity to
a. review the importance of advanced directives.
b. provide reassurance that everything will be fine.
c. discuss healthy stress relief and coping practices.
d. let her communicate about the meaning of this experience.
ANS: D
what is included in a comprehensive metabolic panel?
glucose, calcium, sodium, potassium, carbon dioxide, chloride, albumin
A patient presents with cardiac dysrhythmias, dysphagia, tingling around mouth, and a positive Trousseau's sign. Is this hyper or hypocalcemia?
hypocalcemia
post-op nursing considerations
check neurological status, check VS, mobilize pt. asap, pain management (PCA education?), monitor temperature, n/v?, surgical site monitoring (if bleeding, hold pressure with gloved hand over dressing), positioning (q 1-2 hr, HOB 30 degrees)
infestation presenting with severe itching especially at night, presence of burrows, and red papules
treatment?
scabies
5% permethrin topical lotion, 1 overnight application with second application 1 week later. treat all family members! (cover environment with plastic covering for 5 days, launder all clothes and linen with bleach). possible antibiotics if secondary infections present
chemo considerations? side effects (most common?)
-use proper protective equipment when handling chemo to avoid exposure risks
-encourage relaxation techniques, monitor neurological status, pain assessment
-give antiemetics 30-60 minutes before going to chemo to prevent n/v
-myelosuppression is the most common! malnutrition, alopecia, anemia, anorexia, leukopenia, infection, reproductive problems
coagulation
A patient comes in with weak/paralyzed skeletal muscles, abdominal cramping, and cardiac dysrhythmias. Which fluid imbalance is the nurse suspecting?
hyperkalemia
A severe reaction to certain drugs used for anesthesia. This severe reaction typically includes a dangerously high body temperature, rigid muscles or spasms, a rapid heart rate, and other symptoms. Without prompt treatment, the complications caused by malignant hyperthermia can be fatal.
malignant hyperthermia
A patient comes into the clinic presenting with several; lesions that are irregular in color, surface, and borders on the back. what skin disorder does the nurse suspect and how does the nurse anticipate it to be treated?
melanoma
surgical excision and possible lymph node evaluation; possible adjuvant therapy
The most effective method of administering a chemotherapy agent that is a vesicant is to...
a. give it orally
b. give it intraarterially
c. use a central venous access device
d. use the smallest gauge needle through a peripheral line
ANS: C
what is included in a lipid profile? why is a lipid profile used?
cholesterol, triglycerides, HDL (good), LDL (bad), VLDL
lipid profile is used as an accurate predictor of heart disease.
difference in QRS complex with hyperkalemia and hypokalemia 📈
what is the nursing management for hyper vs. hypo?
hyperkalemia: flattened Q wave, wide QRS, narrow/peaked T wave
nursing management: KCL supplements, always dilute IV KCL! never give KCL via IV push or as a bolus! should not exceed 10 mEq/hr (slower rate prevents hyperkalemia & cardiac arrest); always on a pump - never let drip freely!
hypokalemia: flattened T wave, prominent U wave, dysrhythmias
increase elimination of K (diuretics, dialysis, kayexalte), force K+ from ECF to ICF!
post-op coughing and deep breathing education
educate patient to cough to mobilize fluid and deep breathe to prevent pneumonia and atelectasis. if the pt. had an abdominal surgery or if pain is exacerbated with coughing, teach the patient to splint when they cough.
contagious bacterial infection presenting with vesiculopustular lesions that develop thick, honey-colored crust surrounded by redness, itchiness, commonly on the face.
what is the treatment?
impetigo
wound care with warm saline or aluminum acetate soaks. topical antibiotic cream or ointment & good personal hygiene; systemic antibiotics
A patient on chemotherapy and radiation for head and neck cancer has a WBC count of 1.9 × 103/μL, hemoglobin of 10.8 g/dL, and a platelet count of 99 × 103/μL. Based on the CBC results, which are the most serious clinical findings?
a. anorexia and nausea
b. headache, mucositis, and constipation
c. fatigue and skin redness at site of radiation
d. temperature of 101.9, fatigue, and shortness of breath
ANS: D
what is a PSA used for?
Used as a screening tool for early detection of prostatic cancer. Used in combination with rectal examination. Also used to monitor the disease after treatment.