NUR280 COMP 2 REVIEW LATEST UPDATED 2022 ALREADY GRADED A

NUR280 COMP 2 REVIEW  Prioritization- acute has a higher priority than chronic o Suddenly, new onset, just developed  Lab values!!! – don’t just know the ranges, but know how your patient is going to present if the ...

NUR280 COMP 2 REVIEW  Prioritization- acute has a higher priority than chronic o Suddenly, new onset, just developed  Lab values!!! – don’t just know the ranges, but know how your patient is going to present if they are high/low o Hypocalcemia-Decreased HR, hypotension, decreased peripheral pulses, hyperactive bowels, cramping causes by diet, parathyroid disease, anticonvulsants, renal failure. o Hypercalcemia- Increased HR, bounding pulses, muscle cramps, N&V, caused by TB or other respiratory issues, dehydration, diuretics and parathyroid disease. o Hypomagnesemia- Tetany and positive chop sticks signs, caused by chronic alcohol abuse and GI losses. o Hypermagnesemia decreased deep tendon reflexes(OB/GYN), hypotension, bradycardia, bradypnea, and asystole, caused by excessive intake of Mg but most commonly causes by renal failure. o Hypokalemia-Psychosis, muscle cramps, palpitations and uncontrolled diabetes, caused by diarrhea, vomiting, alcohol abuse, excessive laxative use, Cushing’s Disease diuretics and anything that relates to metabolic alkalosis. o Hyperkalemia- Arrhythmias, fatigue caused by DKA, metabolic acidosis, Addison’s disease, severe burns, ACE inhibitors. o Hyponatremia- headache, neuro changes, seizures caused by excess water; DI, or renal failure or drinking too much water. o Hypernatremia- Excessive thirst, dry mouth, neuro changes caused by loss of water through skin, heatstroke.  Also know dig toxicity s/s and lithium toxicity s/s o Digoxin toxicity- 0.5-2.0 is therapeutic level. Anything greater is toxicity!  Things to remember about dig: take apical pulse for 1 full minute before administering. Eat foods high in potassium. Digibind is antidote. Monitor renal efficiency and electrolytes  Digoxin is to increase contractility of the heart  Dig toxicity- tachycardia, anorexia, n/v, visual disturbances (halos), dysrhythmias! o Lithium toxicity- 1.0-1.5 is therapeutic level. Anything greater is toxicity!  Things to remember about lithium: blood levels must be monitored frequently, take with meals to reduced GI distress, takes 1-2 weeks to get in therapeutic level. Should have consistent fluid and sodium intake (2500-3000 mL/day)  Lithium is a mood stabilizer- used for bipolar  Toxicity- vomiting, diarrhea, drowsiness, muscular weakness, ataxia.  Newborn care prioritization o Heat loss is critical! o Respiratory distress- airway!!!!  Bulb suctioning- mouth first and then nose! o Apgar score  Heart rate, respiratory effort, muscle tone, reflexes, color.  0-3 poor, 4-6 fair, 7-10 excellent. o Bonding- how is mom reacting to baby? Watch for postpartum depression!!! o Shots and drops- vitamin K drops in eyes, and hep B shot o Umbilicus care- 2 arteries and 1 vein  Keep it dry, open to air, don’t submerge it.  Dab it dry- no alcohol or other substance use  IV solution is running late- don’t increase the rate! - fluid overload  Besides checking iV site, priority patient assessment is respiratory o Crackles!!!!  How are Thyroid storm, organ rejections, and infection alike- increase in temperature! o Tachycardia, o Hyperpyrexia (high fever)  Thyroidectomy- have emergency trach kit and ambu bag at bedside o Low or semi-fowler’s o Support head, neck, and shoulders to prevent flexion or hyperextension of suture line; elevate head of bed to 30 degrees o Trach set and suction supplies at bedside o Give fluids as tolerated. o Complications:  Laryngeal nerve injury- detected by hoarseness  Thyoidtoxicosis- increased temperature, increased pulse, hypertension, abdominal pain, diarrhea, confusion, agitation, seizures  Treatment- hypothermia blanket, oxygen, potassium iodine, PTU, propranolol, hydrocortisone, acetaminophen; also caused by trauma, infection, palpation, RAI therapy  Hemorrhage- check back of neck and upper chest for bleeding  Respiratory obstruction  Tetany (from decreased calcium from parathyroid involvement- Chvostek’s and Trousseau’s sign  Have IV calcium gluconate or IV calcium chloride available  Parathyroid gland removal along with thyroid- hypocalcemia- chovasetk and trousseau’s sign o CATS!!! - hypocalcemia  What do ACE inhibitors, Addison’s disease, and potassium sparing diureticshyperkalemia o ACE inhibitors- causes decreased BP, decreased aldosterone secretions- sodium and fluid loss  this causes high levels of potassium (end in –pril) o Addison’s disease- remember that you have to ADD cortisol. So, lethargic, dehydration, weight loss, etc. This causes high levels in potassium, but low levels of all other electrolytes. o Potassium sparing diuretics- cause potassium to stay in the system while fluids and electrolytes leave. Salt substitute is essentially potassium, so don’t use, and don’t eat a diet high in potassium.  Thoracentesis- removal of fluid from the thoracic cavity in the pleural space o Aspiration of fluid or air from the pleural space.  Used to obtain specimen for analysis, relieve lung compression, obtain lung tissue for biopsy, or instill medications into pleural space.  Prep/testing:  Explain procedure  Take vitals  Clip area around the needle insertion site  Position client is sitting with arms on pillows on over-bed table or lying on side in bed  Expect stinging sensation with injection of local anesthetic and feeling of pressure when needle inserted  Don’t remove more than 1000 mL fluid at one time  Post-nursing care  Auscultate breath sounds frequently  Monitor vital signs frequently  Check for leakage of fluid, location of puncture site, client tolerance  Sterile dressing after procedure!!!  Chest tube- expected drainage- 100 mL/hr o Anything higher contact the doctor o If more than 100- internal bleeding somewhere o Chest tube- intrapleural drainage system with one or more chest catheters held in pleural space by suture to chest wall, attached to drainage system. o Nursing care:  Fill water seal chamber  If suction is to be used, fill the suction control chamber with sterile water to the 20 mL  Encourage the client to change position and cough and deep breathe frequently  Put the drainage system below level of insertion and without kinks!  Chest tubes are only clamped momentarily to check air for leaks and to change the drainage apparatus  Observe for fluctuations of fluid in the water-seal chamber; stops fluctuating when:  Lung re-expands  Tubing is obstructed  Loop hangs below the rest of the tubing o Removal of the chest tube  Instruct the client to do the Valsalva maneuver  Chest tube is clamped and quickly removed by the health care provider