Periop
What nursing tasks should be performed in the preoperative stage?
What lab is used to determine a client's average glucose level over a 2-3 month period? Expected range for a diabetic?
Hgb A1C. Expected range < 7% for diabetics.
What are the 6 Ps of circulation?
Pain, pallor, paralysis, paresthesia, pulselessness, and poikilothermia.
Describe the clinical manifestations of sleep apnea
Loud snoring, multiple apnea episodes throughout night, daytime sleepiness, morning headaches, poor concentration, 10 seconds or longer of breathing cessation, loud snort after breathing cessation
Describe coronary artery disease
Involves the buildup of plaque within the coronary arteries, causing narrowing or occlusion that limits or blocks blood, oxygen, and nutrient flow to the heart muscles.
Chronic autoimmune disease where the immune system attacks the synovial membrane and joint tissue.
Clinical manifestations include joint pain, swelling stiffness, and systemic symptoms like fever and fatigue.
Think about the medications used to slow the progression of this disease.
Describe the following disorders: macular degeneration, cataracts, retinal detachment, glaucoma
Macular degeneration: degeneration of the macula that leads to loss of central vision. Blurred vision, impaired night vision, difficulty reading.
Cataracts: cloudy or opaque areas found on the eye lens that alter the passage of light through the eye lens, causing painless blurred/hazy vision.
Retinal detachment: retinal tissue is pulled away or detached from blood vessels that provide oxygen and nourishment to the retina. Sudden onset of vision changes, loss of peripheral vision, dark spots.
Glaucoma: Progressive optic neuropathy. Elevated pressure causes damage to the optic nerve. Progressive blurry vision, seeing halos around lights, and loss of peripheral vision. Severe nearsightedness is a risk factor.
What medication is given to treat hypothyroidism?
Levothyroxine (Synthroid)
Diagnostic: colonoscopy, endoscopy
Ablative: colectomy, fallopian tube removal
Constructive: repair of cleft lip or palate
Cosmetic: rhinoplasty
What are clinical manifestations of hypothyroidism? What medication is given for this disorder?
Fatigue, weakness, weight gain, cold intolerance, dry skin, constipation, slow heart rate.
Synthroid
Describe the difference between osteoporosis and osteoarthritis
Osteoporosis: A softening of the bones often associated with aging. Bone loss occurs in both cortical and cancellous bones and can lead to fractures with minimal to no trauma.
Osteoarthritis: A chronic degenerative disease characterized by loss of joint cartilage leading to bone-on-bone contact.
Describe the clinical manifestations of pulmonary edema
Early signs: Dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, cough.
Late signs: increased work of breathing, tachypnea, use of accessory muscles, intermittent or persistent hypoxemia, crackles, wheezing, pink frothy sputum, jugular vein distension.
What are clinical manifestations of pericarditis?
Sharp pleuritic chest pain that is positional, radiates and worsens with deep inspiration or coughing. Pericardial friction rub.
Describe active and passive immunity
Active: body creates its own antibodies after exposure to pathogens (natural infection or vaccines).
Passive: body receives pre-formed antibodies from external source (maternal antibodies via placenta/breast milk)
Describe Meniere's Disease
A progressive disorder that develops from an excessive buildup of endolymphatic fluid in the inner ear which disrupts normal balance and hearing functions.
Tylenol, NSAIDs, Corticosteroids
Describe the signs of hemorrhaging in a postoperative client.
Hypovolemia: hypotension, tachypnea, decreased O2 saturation. Visible bleeding from surgical wounds, excessive bleeding that soaks through dressings.
Describe the clinical manifestations of HHS. More common in T1DM or T2DM?
Hyperglycemic Hyperosmolar State: more common in T2DM.
Severe hyperglycemia, extreme dehydration, no ketones in urine, altered mental status.
Describe the effects of immobility in the cardiovascular, pulmonary, and GI system
Cardiac: decreased cardiac output, venous stasis, orthostatic hypotension, DVT
Pulmonary: pneumonia, decreased cough reflex, hypoventilation, atelectasis, decreased lung expansion, stasis of secretions.
GI: swallowing difficulties, incontinence, constipation, aspiration risk, malnutrition, anorexia.
Describe the clinical manifestations of COPD.
Progressive dyspnea, chronic cough, sputum production, barrel chest, pursed-lip breathing, use of accessory muscles, weight loss.
Describe peripheral arterial disease and peripheral vascular disease
PAD: a progressive disorder that affects blood flow to the arteries in the lower extremities. Plaque builds up in the artery walls and causes decreased flow, blockage, or spasms, which affects the ability of the body to supply tissues with oxygen-rich blood.
PVD: describe progressive conditions characterized by altered blood flow through vessels in areas outside of the heart. It involves the veins that carry deoxygenated blood back from the lower extremities to the heart.
Describe the clinical manifestations of meningitis
Fever, severe headache, nuchal rigidity, photosensitivity, altered mental status, N/V, seizures, petechial rash.
What is the general management for burns?
Fluid resuscitation, infection prevention, pain management, nutritional support.
A client who is experiencing an asthma attack should use what medication in what order?
1st: Bronchodilator (albuterol)
2nd: Inhaled Corticosteroid (fluticasone)
What interventions are done for a client who is hemorrhaging postoperatively?
Monitor vital signs, assess surgical sites for bleeding, replace fluid volume loss with sodium chloride and/or PRBCs.
List interventions/education for a client who may experience a hypoglycemic event.
15-15 rule, recognize early signs, carry glucose tabs, wear a medical bracelet, know how to administer glucagon, call 911 if unconscious or unable to swallow, should always have a glucagon kit.
Describe the nursing interventions for a client who has had a total joint replacement
Monitor dressings for drainage, monitor effected limb's neurovascular status, pain management, early mobilization, support of limb when repositioning, anticoagulant therapy.
Describe the following types of pneumothoraxes: spontaneous, traumatic, tension
Spontaneous: air in pleural space without external trauma. Sudden pleuritic chest pain.
Traumatic: pleural air from blunt or penetrating chest injury or procedures. Acute pleuritic chest pain, dyspnea.
Tension: life threatening one-way valve effect causing rising intrathoracic pressure, mediastinal shift and cardiovascular compromise. Rapid progressive respiratory distress, severe dyspnea, hypotension, tachycardia, tracheal deviation
Describe pericardial effusion and the procedure performed to relieve symptoms
Complication associated with pericarditis that triggers and increased accumulation of fluid in the pericardial sac.
A pericardiocentesis is a procedure performed to drain the accumulation of fluid from the pericardial sac.
Describe fibromyalgia including its clinical manifestations
Chronic pain disorder with widespread musculoskeletal pain and heightened pain sensitivity.
Clinical manifestations: chronic widespread pain, tender points, severe fatigue, sleep disturbances, cognitive difficulties, mood changes.
Think about nursing interventions for these clients.
What causes the following chronic wounds: venous ulcers, arterial ulcers, diabetic ulcers
Venous ulcers: caused by venous insufficiency causing poor venous return.
Arterial ulcers: caused by decreased blood flow to the extremities.
Diabetic ulcers: caused by neuropathy, poor perfusion, altered wound healing.
What medication could be used to decrease serum uric acid levels in a client who has chronic gout?
Allopurinol
What is the priority assessment for a client who is postoperative?
Airway management
Describe T1DM and T2DM
T1DM: autoimmune destruction of beta cells, usually juvenile onset, requires insulin for life.
T2DM: insulin resistance and/or insufficient insulin production, usually adult onset. Risk factors: obesity, sedentary lifestyle.
When caring for a client with a fracture what are the nursing considerations?
Fall prevention, infection prevention (open), weight baring restrictions, immobilization, circulation, skin integrity.
Describe the possible nursing considerations for a client with pulmonary edema
Which type of cardiomyopathy is frequently found to have a genetic predisposition?
Hypertrophic cardiomyopathy
What causes lymphadenopathy?
bacterial, viral or local infections, autoimmune disorders, malignancies, medications, allergic reactions.
List common skin conditions caused by inflammation
Atopic Dermatitis
Contact Dermatitis (allergic and irritant)
Psoriasis
Rosacea
Urticaria
Seborrheic Dermatitis
A client has been diagnosed with peripheral arterial disease. The cause is atherosclerosis. What drug classification should the client be placed on to reduce the production of cholesterol?
HMG-CoA reductase inhibitors, which are commonly referred to as statins.