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Adult Health Final Exam Review
Advanced Adult Health Care
Keiser University
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Adult Health Exam 1 Review
If a patient has hypokalemia, what diuretic would most likely be appropriate? o Spironolactone (Aldactone) If a patient presents with hypermagnesemia, develops a drop in BP, the nurse needs to o call the MD and call for help immediately. Rapid Response Hypophosphatemia- o have + trousseau’s sign because calcium will be low. o Treat with a phosphate replacement but watch for elevated levels. If a patient is taking a lot of antacids and drinks a lot of milk, they are at risk for o low potassium and metabolic alkalosis Someone received a thyroidectomy, what electrolyte imbalance would you see? o Low calcium and treat it with calcium gluconate IV If a patient has hypernatremia, they need to o avoid processed foods. If a patient has hyperkalemia and is taking digoxin: o patient could develop digoxin toxicity- drops the heart rate lower than 60. Severe hypernatremia- o should be on seizure precautions If a patient is NPO, getting D5W IV, they will be at risk for o low sodium. Using Salt Substitutes could put patients at a greater risk for o hyperkalemia What group of people would be at a greater risk of low magnesium? o Alcoholics If a person has LOW Potassium, the EKG would show o inverted and flat T waves If a patient has HIGH Potassium, the EKG would show o tall tented T waves NG tube- loses o Na, K, Ca- put on monitor to watch for flat t waves Parathyroid regulates the o calcium levels Patient has high potassium- o will administer kayexalate enema for quick response If a patient has Metabolic Alkalosis - o they will likely have low potassium and low calcium- common with NG patients A patient receiving diuretics and laxatives is at a greater risk for
o losing potassium If a patient is taking thiazide diuretics, what electrolyte should be watched? o Loss of Potassium. Hyperventilation would result in respiratory alkalosis. o Calcium lowers, and may cause tetany If a patient has pneumonia and is afebrile- o respiratory acidosis If a patient has pneumonia and is febrile- o respiratory alkalosis Pancreatitis= o metabolic acidosis Cushing syndrome= o metabolic alkalosis- (retain sodium) Metabolic alkalosis causes o low potassium pH is regulated by the o kidneys and lungs Partial compensation- o all three levels are abnormal Bicarb 20 is o metabolic acidosis Kidney Failure= o metabolic acidosis Diabetic ketoacidosis= o metabolic acidosis COPD= o respiratory acidosis Retaining Bicarb= o metabolic alkalosis Trousseau’s sign- o blood pressure cuff- causes contraction Chvosteks sign- o stimulation of face
Hyperkalemia, a high potassium level, manifests as weakness, fatigue, and cardiac dysrhythmias. Cardiac – Peak or Tall T waves GI- hyperactive, nausea, diarrhea, intestinal colic
See on Test Questions
Hypocalcemia, a low calcium level, is associated with muscle spasms and tetany. Calcium-preserving drugs are:
This is the OPPOSITE in hypermagnesemia where everything system of the body is lethargic. T rouesseau’s (positive due to hypocalcemia) if see low Mag may also see low Ca++ and low K+ W eak respirations I rritability T orsades de pointes (abnormal heart rhythm that leads to sudden cardiac death.. in alcoholism), T etany (seizures) C ardiac EKG changes & Chvostek’s sign (positive which goes along with hypocalcemia) Flat T waves H ypertension, hyperreflexia I nvoluntary movements N ausea G I issues (decreased bowel sounds and mobility)
Foods rich in Magnesium “A lways G et P lenty O f F oods C ontaining L arge N umbers o f M agnesium” A vocado G reen leafy vegetables P eanut Butter, potatoes, pork O atmeal F ish (canned white tuna/mackerel) C auliflower, chocolate (dark) L egumes N uts O ranges M ilk
Adult Health Exam 2 Review
- Venturi mask uses provides the specific % of O2 that is ordered
- Viral and bacterial a. To determine viral/bacterial- must do a culture b. Systematic outcomes bacterial has a high temp and viral has low grade fever if none at all. c. Viral runs shorter duration and systems are less severe. i. Viral only care for systematically. Only symptoms.
- If a PPD reading is 5mm, they have been exposed to TB and you should administer BCG vaccine a. 15 mm means they TB
- When can you discharge a TB patient? a. 3 negative cultures (not about the x-rays)
- How many drugs do you use to treat TB? (4 – isoniazid, rifampin, ethambutol & pyrazinamide) a. Latent TB INH or rifampin
b. Active TB you are getting all 4 drugs 6. What is the blood test for TB called? a. QFT-G gold or T spot? 7. Isolation Precautions for TB: airborne, Neg. Pressure Room, N respirator 8. Isoniazid monitor for tingling, monitor liver function, decreases vitamin b6 levels. (peripheral neuropathy). Neurotoxicity can change mental status. 9. Rifampin turns body fluids orange, makes birth control less effective 10. Ethambutol Vision problems and risk for blindness. Monitor for color changes in vision. (peripheral neuropathy) 11. Pyrazinamide monitor uric acid levels, liver/kidney, take with food can cause GI problems. 12. Tx for atelectasis incentive spirometer 13. How do you empower the asthma patients to help recognize to know they’re getting worse? a. Pink flow meter and the daily symptom diary. 14. How do you educate them about home environment about asthma and allergies? a. You want them to wash linens in HOT water b. Don’t ask them to put air filters we don’t use this anymore. 15. Someone with asthma wants to exercise what do you tell them? a. Use rescue inhaler before 16. Wait 5 minutes between inhaler therapy for the same patient if they are getting multiple. a. Ex: bronchodilator inhaler, rescue inhaler, steroid inhaler (used for inflammation) b. Rinse mouth after steroid so you don’t get candida albicans infection 17. What is sign of cancer for larynx? a. Persistent hoarseness 18. Can a steroid medication increase your HR? YES a. Steroids decrease inflammation b. Steroids can also cause fungal infection known as Candida or candidiasis 19. Can albuterol increase your HR? YES 20. What is the main symptom of bronchitis? a. Cough and sputum 21. Main symptom of emphysema? a. Fast breathing and shortness of breath (Bc of the decrease exchange through the alveoli.) 22. With COPD when they can’t get the exhale out what advice do you give them? a. Pursed lip breathing. b. Rest periods if activity intolerance or SHOB during exertion. c. Respiratory Acidosis
Adult Health Exam 3 Review
Gastrointestinal System - Upper
Compare the etiology, clinical manifestations, and management of acute gastritis, chronic gastritis, and peptic ulcer. o Acute gastritis lasts for several days and is characterized by erosive or nonerosive based upon pathologic manifestations present in the gastric mucosa Erosive form caused by irritants such as aspirin or NSAIDS, alcohol consumption & gastric radiation therapy Nonerosive form caused by infection with H. Pylori More severe cases of acute gastritis is caused by the ingestion of strong acid or alkali which may cause the mucosa to become gangrenous or to perforate Clinical Manifestations Include: rapid onset of epigastric pain, dyspepsia, anorexia, hiccups or N/V which can last a few hours to several days. Erosive gastritis may cause bleeding Treatment includes: The gastric mucosa can repair itself after an acute episode, can also be managed by instructing the patient to avoid alcohol and food until symptoms subside o Chronic gastritis is classified according to the underlying causing mechanism which includes an infection with H. Pylori Clinical Manifestations include: fatigue, pyrosis (burning in the stomach & esophagus that moves up to the mouth; heartburn) Treatment Includes: modification of the patient’s diet, promoting rest, reducing stress and avoidance of alcohol & NSAIDS and initiating medications that may include antacids and H2 blockers or PPIs o Peptic Ulcer disease last for a few days, weeks or months. It is caused by the increased concentration or activity of acid-pepsin or by decreased resistance of the normally protective mucosal barrier Etiology: break in mucosal lining in the stomach or duodenum Clinical Manifestations Include: dull gnawing pain or burning sensation in the midepigastrum or the back. N/V and GI bleed w/ Hematemesis & Melena (bloody stool) Occurs immediately after eating Duodenal ulcers the pain begins about 2-3 hours post meals Diagnosed with EGD
Discuss the etiology, clinical manifestations, and management of tumors of the small intestine. o Etiology of tumors of the small intestine: they are rare, rates are higher amongst older Americans & higher amongst African American men. Malignant tumors are usually not detected until they have metastasized to different sites o Clinical manifestations include: tumors of the small intestine often present insidiously with vague, nonspecific symptoms. Most benign tumors are discovered incidentally on an xray study. Patient may also c/o pain, weakness, fatigue, N/V & intestinal obstruction o Management includes: Endoscopic excision/resection or electrocautery if the patient is symptomatic. Abdominal surgery may be required to remove rare tumors Use the nursing process as a framework for the care of patients with diverticular disease. o Assessment: Sac like herniations of the lining of the bowel that extends through a defect in the muscle layer. CT scan w/ contrast agent is the diagnostic test of choice, frank blood in stool o Diagnosis: Compare Crohn’s disease and ulcerative colitis with regard to pathophysiology; clinical manifestations; diagnostic evaluation, and medical, surgical, and nursing management.
Note: Both disorders have striking similarities but also several differences Crohn’s Disease Ulcerative Colitis The way to tell them apart:
Affects entire GI tract
Only affects large intestine or colon Pathophysiology Prolonged, variable Exacerbations, remissions Early Pathology: Transmural thickening
Early Pathology: Mucosal ulceration
Late Pathology: Deep, penetrating granulomas
Late Pathology: Minute, Mucosal Ulcerations Clinical Manifestations:
Ileum (Ascending Colon)
Rectum (Descending Colon) Perianal involvement
Common Rare
Bleeding Usually not, can be mild
Common - severe
Fistulas Common Rare
Diarrhea Less Severe Severe Abdominal Mass Common Rare
Diagnostic Study Findings: Barium Studies Regional, discontinuous skip lesions; narrowing colon; thickening of bowel cell; mucosal edema
Diffuse involvement; no narrowing of colon; no mucosal edema; stenosis rare
Sigmoidoscopy May be remarkable Abnormal inflamed mucosa Colonoscopy Distinct ulcerations separated by relatively normal mucosa
Friable mucosa with pseudo polyps or ulcers
Medical Surgical Management
Corticosteroids, immunomodulators, ABTs, Parenteral nutrition, Parietal or complete colectomy
Corticosteroids, amino salicylates, Immunomodulators, ABTs, Proctocolectomy with ileostomy
Use the nursing process as a framework for care of the patient with inflammatory bowel disease. o Assessment : obtain a health history to identify onset, duration & characteristics of abdominal pain o Diagnosis: Diarrhea, Acute pain, deficient fluid volume, imbalanced nutrition, activity intolerance, anxiety, risk for impaired skin integrity & deficient knowledge concerning the process o Planning: Attainment of normal bowel function and relief of abdominal pain o Interventions: Maintain normal elimination pattern, relieving pain, maintain fluid intake, maintaining optimal nutrition, promoting rest, reducing anxiety, preventing skin breakdown o Evaluation: Client reports decrease in the frequency of diarrhea stools, has reduced pain, maintains fluid volume balance, attains optimal nutrition, avoids fatigue, is less anxious and copes successfully with diagnosis Describe the responsibilities of the nurse in meeting the needs of the patient with an intestinal diversion. o Provide preoperative care and postoperative care
o Application of wet to dry dressings, how to control pain, sitz baths and medication management
Hematologic System
Discuss the significance of the health history to the assessment of hematologic health. o Provides important information related to a patient’s known or potential hematological diagnosis due to the condition being more prevalent in certain ethnic groups o Assessing the use of OTCs, herbal supplements & nutritional hx is important as well Describe the significance of physical assessment and diagnostic test findings of hematologic dysfunction. o Physical Assessment should be comprehensive and include careful detail to the skin, oral cavity, lymph nodes, respiratory, cardiovascular, genitourinary, musculoskeletal, abdominal, CNS and gynecological areas o Diagnostic Evaluation can be quantitative or qualitative and is important to look for trends to help the clinician decide whether the patient is responding appropriately to interventions Identify therapies for blood disorders, including nursing implications for the administration of blood components. o Therapies for blood disorders include: Splenectomy, therapeutic apheresis, hematopoietic stem cell transplantation, therapeutic phlebotomy o Nursing Implications include the following: Take baseline vital signs Verify order Obtain blood from blood bank Obtain a second a nurse to verify order & blood product Use the 5 rights of medication administration Use a 18-22 gauge needle and appropriate tubing per facility policy Begin transfusion slowly at 50cc/hr or per facility protocol Stay with patient for first 15 minutes and watching for reactions If reaction occurs, stop transfusion immediately and run 0% Normal saline through new tubing Continue to monitor client vital signs Differentiate between the hypoproliferative and the hemolytic anemias and compare and contrast the physiologic mechanisms,
clinical manifestations, management, and nursing interventions for each. o Hypoproliferative anemias : Iron deficiency anemia, aplastic anemia; anemia of inflammation; megaloblastic anemias are anemias that are most common especially iron deficiency anemia. It is due to decreased erythropoiesis, cancer, iron, B or folate deficiency – defective red blood cell production o Medical Management of Hypoproliferative anemias include: Iron supplements, Immunosuppressive therapy and in megaloblastic anemias, folic acid will be used o Hemolytic anemias : premature destruction of erythrocytes (hemolysis) results in the liberation of hemoglobin from the erythrocytes into the plasma caused by altered erythropoiesis, drug induced or autoimmune processes, mechanical heart valves & hypersplenism. May also be caused by blood loss Inherited anemia – passed down from parent to child Acquired hemolytic anemia – developed later in life o Medical Management of Hemolytic anemias include: medication such as hydroxyurea, transfusion therapy and corticosteroids in cases of immune hemolytic anemias o Clinical manifestations include : Varies depending on what type of anemia is present. Common manifestations include: fatigue, weakness, pallor or jaundice, cardiac & respiratory symptoms, tongue & nail changes, angular cheilosis (inflammation & small cracks in one or both corners of the mouth), Pica o Nursing Interventions : Education regarding the condition, Provide written information if needed. Inspect skin and monitor for worsening signs & symptoms. Assess gait, mouth and fingernails and promote home and community based and transitional care. Take health history, lab data and nutritional assessments. Obtain medication history and obtain a cardiac & GI assessment
Use the nursing process as a framework of care for patients with anemia, sickle cell crisis, and disseminated intravascular coagulation. - Anemia o Assessment: health hx & physical examination include medication hx, nutritional assessment and assess cardiac status o Diagnosis: Fatigue related to decreased hemoglobin; Imbalanced nutrition related to inadequate intake of essential nutrients; activity intolerance related to inadequate H&H o Planning: Decrease of fatigue, attainment or maintenance of adequate nutrition, maintenance of adequate tissue perfusion
o Medical Management of Neutropenia: varies depending on cause. Corticossteroids may be used; Reverse isolation precautions to protect patient; avoid infection, promote hygiene. Clients will not exhibit classic s/s of neutropenia. Fever is the most common indicator of infection but may not always be present o Lymphopenia: a lymphocyte count that is less than 1500/mm and results from ionizing radiation, long term use of corticosteroids, uremia, infections o Medical Management of Lymphopenia includes: Administration of antiviral agents, gamma globulin to help prevent infection, bone marrow stem cell transplant may be needed Describe the medical and nursing management of patients with bleeding and thrombotic disorders. o Medical & Nursing Management of bleeding disorders: Transfusion of blood products may be necessary. Nurse should monitor for reactions from transfusion. Administration of aminocaproic acid can be used to inhibit fibrinolysis o Medical & Nursing Management of Thrombotic Disorders: Provide information regarding condition to client, Medication to include anticoagulants
Lab Values:
Lab: CBC w/ diff Male Female Hematocrit 40-54% 37-47% Hemoglobin 14-18 g/dl 12-16 g/dl RBC’s 4.2-5 mill/mcl 3.9-5 mill/mcl WBC’s 3.8-10 thous/mcl 3.8-10 thous/mcl Platelets 130-400 thous/mcl Neutrophils 48-73% Eosinophils 0-5% Basophils 0-2% Monocytes 0-9% Lymphocytes 18-48%
Lab: PT Value Prothrombin Time (PT) 1-2.
Lab: Electrolytes Value Sodium (Na) 136- Potassium (K+) 3.5-5 (varies) Chloride (Cl) 95- Carbon Dioxide (CO2) 22-32% Calcium (Ca++) 8.5-10 meq/dl
Phosphorus (P) 2.5-4 meq/dl Anion Gap 4-
Lab: Liver Enzymes Value AST 0-42 U/dl ALT 0-48 U/dl Alkaline Phosphates 20-125 U/L GGT 0-45 U/L LDH 0-250 U/L Bilirubin 0-1 mg/dl
Adult Health Final Exam Review
Ch. 15 & 34 – Oncology
Chapter 15 – Cancer o #2 Leading cause of death in the US o 78% of cancers are people >55 years old o
What happens? Cancer cell can die Plus have our own immune system We are designed to not get cancer, but as we get older
Cells get tired and a couple of things can happen
Cell mutates enough that it doesn’t’ die Cell can grow, and push out healthy cells, and spreads. Eventually form a tumor and invade the tissues. Men leading cancer causes (not the type of questions that NCLEX will ever ask you, don’t focus on this) Prostate Older men, slow, not typically the cause of death. Lung Colorectal
T3N3M1 = locally enlarged, but bigger tumor, went to 3 different nodal areas and metastases to one other organ. N = Nodes # of nodes. The absence or presence and extent of regional lymph node metastasis. M = Metastases The absence or presence of distant metastases. # of organs CAUTION C = Change in bowel or bladder A = A sore that doesn’t heal U = Unusual bleeding or discharge T = Thickening or lump I = Indigestion or difficulty swallowing. Dysphagia (very true with GI cancers upper) O= Change in wart/mole N = Nagging cough or hoarseness 2 other ways to notice cancer signs: Extreme Fatigue B Symptoms Fever, fatigue, drenching sweat, unexplained weight loss, night sweats. NEED TO KNOW RELATED TO LEUKEMIA, LYMPHOMA, HODGINS AND NONHODGINS, CHRONIC LEUKEMIA (NOT ACUTE).
How to prevent cancer Primary Stop drinking Stop smoking Sunscreen Vaccinations - HPV - Hepatitis A and B Prophylactic surgeries Secondary Prevention Mammogram Colonoscopy Dermatology Prostate exam PSA -? controversy over whether to do this screening or not. Colon screening, hemoccult “cologard”
Diagnostic Imaging CT No metformin 49 hours before or after MRI
No metal Anxiety Pacemakers MRI safe oxygen tanks PET – Positron Emission tomography Radioactive agent If more activity it lights up on the PET scan. X-rays Ultrasound Depends where they are looking. Bone Scan Injection of contrast agent Biopsy Needle biopsy Bone biopsy – iliac crest, large needle it hurts. Fine needle Close to the skin Breast, lung, liver, kidney. Outpatient basis
Excisional Biopsy Lumpectomy – Take whole tumor and biopsy Get all of the margins Often done through endoscopy.
Cancer Treatment - 4 major ways for cancer treatment
Surgery Solid tumor – Primary way of treating Remove (cure) OR Debulk – cutting down on symptoms removing tumor (as much as you can surrounding tissue, and regional lymph nodes Reconstructive Redirection – Ostomy Concerns for surgery Infection Ambulation - Clots - Pneumonia O Pain Body Image and self esteem Education - Wound care
Adult Health Final Exam Review
Course: Advanced Adult Health Care
University: Keiser University
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