NURSING 2349 EXAM 2 STUDY GUIDE WITH LATEST QUESTION 2021

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NURSING 2349 EXAM 2 STUDY GUIDE WITH LATEST QUESTION 2021 Module 3 - Elimination: • UTI: o Causes  Most due to Escherichia Coli  Use of indwelling catheters (Foley)  Uncircumcised... clients  Menopause  Frequent sexual intercourse  Females gender close proximity of urethral meatus to anus o Symptoms:  Urinary frequency  Urgency  Nocturia  Flank pain  Hematuria  Cloudy  Foul-smelling urine  Fever  Leukocytes in urine o Management/Medication  Antibiotics • Gentamicin, cephalexin, trimethoprim/sulfamethoxazole, and ciprofloxacin for infections. • Phenazopyridine: treats the manifestation of UTIs o Doesn’t treat infection but relieves bladder discomfort. • Fluconazole is the drug of choice to treat for candida infections o Preventions:  Drink fluids liberally as much as 2-3 liters daily.  Clean your perineum from front to back  Avoid douches, scented lubes, bubble baths, tight fitting underwear’s, and scented toilet tissue.  Empty bladder before and after sex  Cranberry juice decrease risk of UTIs • Urinary incontinence: a significant contributing factor to skin breakdown and falls, especially in older adults. o Types:  Stress: Loss of small amounts of urine form increased abdominal pressure without bladder muscles contraction. • Most common type • Cannot tighten the urethra enough to overcome the increase bladder pressure caused by contraction of the detrusor muscle. • Causes: o Sneezing/coughing o Laughing o Jogging o Lifting  Urge: loss of urine for no apparent reason after suddenly feeling the need or urge to urinate. • Continent adults override the signal and relaxes the detrusor muscle for the time it takes to locate a toilet • People who suffer from urge incontinence cannot suppress the signal and have a sudden strong urge to void and can leak a large amount of urine at a time. • Most common in women • Does not have known causes or may result from; strokes, other urinary tract problems, irritation form concentrated urine, artificial sweeteners, caffeine, alcohol, and critic intake.  Overflow: urinary retention form bladder overdistention and frequent loss of small amounts of urine due to obstruction of the urinary outlet or an impaired detrusor muscle.  Reflex: Involuntary loss of a moderate amount of urine usually without warning due to hyperreflexia of the detrusor muscle, usually from spinal cord dysfunction.  Functional: loss of urine due to factors that interfere with responding to urinate, such as cognitive, mobility, and environmental barriers.  Total: unpredictable, involuntary loss of urine that generally does not respond to treatment. o Preventions  Maintain a toileting schedule: gradually increased unration intervals after  Kegel exercises  Reduce caffeine, alcohol intake  Viginal cone therapy for stress incontinence  Weight reduction program for stress incontinence. o Managing/ medications  Nortriptyline has anticholinergic effects that help relieve urinary incontinent.  Oxybutynin and dicyclomine decrease urgency and help alleviate pain for neurogenic or overactive bladder. • Ask patient about history of glaucoma. Medication increase intraocular pressure. • Indwelling catheters: Urine is collected from an indwelling catheter or tubing when patients have catheters for continence or long-term urinary drainage. o Types:  Straight • Pyelonephritis: It is a bacterial infection in the kidney and renal pelvis. o Causes:  Escherichia coli  Enterococcus faecalis o Symptoms • Acute pyelonephritis • Fever • • Chills • • Tachycardia and tachypnea • • Flank, back, or loin pain • • Tenderness at the costovertebral angle (CVA) • • Abdominal, often colicky, discomfort • • Nausea and vomiting • • General malaise or fatigue • • Burning, urgency, or frequency of urination • • Nocturia • • Recent cystitis or treatment for urinary tract infection (UTI) • Chronic Pyelonephritis • ________________________________________ • • Hypertension • • Inability to conserve sodium • • Decreased urine-concentrating ability, resulting in nocturia • • Tendency to develop hyperkalemia and acidosis Management: Glomerulonephritis: immunologic kidney disorder that can start in the kidneys. Ca lead to end stage kidney disease,  Risk factors o Infection particularly of the skin or upper resp tract o Travel or other possible exposure to bacteria, viruses, fungi or parasites o Systemic diseases o Recent surgery or illness  Symptoms o Anorexia o Nausea o Dysuria o Oliguria o Fatigue o Hypertension o Difficult breathing o Crackles o S3 heart sound o Weight gain o Reddish brown or cola urine o Old ppl can be confused w/ congested heart failure  Management: o Penicillin, erythromycin, or azithromycin for infection due to streptococcal o Dialysis or plasmapheresis Bowel obstruction: • Constipation: is a bowel pattern of difficult and infrequent evacuation of hard, dry feces. o Complications:  Fecal impaction  Hemorrhoids and rectal fissures  Bradycardia, hypotension, syncope Indwelling catheters: known as a Foley or retention catheter, is used for continuous bladder drainage (e.g., when the bladder must be kept empty or when continuous urine measurement is needed). It is usually a double-lumen tube: one lumen is used for urine drainage, and the second lumen is used to inflate a balloon near the tip of the catheter.  Care: soap and water  Washcloth  Gloves  Use soap and water at the insertion sit  Cleanse the catheter at least 3xs a day and after defecation  Monitor the patency of the catheter o Check fullness in the bladder o Kinks o Sediment in the tubing o Make sure bag is below bladder level. 24 hr urine collection With outFoley  Discard first void, collect all urine for 24 hrs  Do not allow contamination with stool  Keep urine on ice Indwelling Apply a clamp to the drainage tubing, distal to the injection port. Clamping allows urine to collect in the tubing at the location where the specimen is obtained. • Clean the injection port cap of the catheter drainage tubing with an appropriate antiseptic and allow to dry. Povidone-iodine solution or alcohol is acceptable. Surface contamination is prevented by following the cleaning procedures. • Attach a sterile 5-mL syringe into the port and aspirate the quantity of urine required. A minimum of 5 mL is needed for culture and sensitivity (C&S) testing. • Inject the urine sample into a sterile specimen container. A sterile container is used for C&S specimens. • Remove the clamp to resume drainage. • Properly dispose of the syringe. Kidney stones: Module 4 – Law and Ethics • Informed consent: a legal process by which a client or the client’s legally pointed designee has given written permission for a treatment or procedure o Most nursing care implied consent is adequate. o Written consent is not necessary in an emergency if experts would agree that there was immediate threat to life o If the person is confused and disoriented, you should contact the case manager or your supervisor for guidance. State law identifies the order of individuals who can make decisions for individuals who are judged incompetent. It is usually the spouse, then parents, then sisters and brothers, and so on. If the person does not have relatives, the court will appoint a legal guardian to make healthcare decisions. o Elements of consent  Completeness  Clarity and comprehension  Voluntariness  Competence o A court sometimes will authorize treatment of a child against his parents’ wishes. In some states, a minor who is married or living independently is considered emancipated and can make his/her own healthcare decisions. • Ethical principles: are standards of what is right or wrong with regard to important social values and norms. o Autonomy: patient has the right to make his/her own decision, even if it is not his/her best interest. o Beneficence: do what is best for the patient; positive actions to help others o Fidelity: keep your promise o Justice: provide fairness in café and allocation of resources o Nonmaleficence: do no harm o Veracity: tell the truth • EMTALA: The emergency medical treatment and active labor act o Requires healthcare facilities to provide emergency medical treatment to patients who seek healthcare in emergency department, regarding of their ability to pay, legal status or citizenship status. • Mandatory reporting: legal obligation to report their finding in accordance with state law in the following situation: o Suspicion of abuse: child, elderly, and domestic violence o Communicable diseases to local/state department (mandates by state) o Immunization o Gunshot or stab wounds o Rapes and sexual assaults • Advanced directives: it is to communicate a client’s wishes regarding end of life care should the client become unable to do so. o Living will: communicates patient’s wishes regarding medical treatment is patient becomes incapacitated. o Durable power of attorney for health care: patient designates health care proxy to make medical decisions for them if they become incapacitated o Providers order: prescription for DNR (do not resuscitate) or AND Allow natural death.) • HIPPA: Ensures the confidentiality of health information o Only those responsible for patient’s care may have access the patients record. o Do not use patients’ names on public display boards o Communication about the patient should happen in a private place or at nursing station o Password protect electronic records. Do not share passwords. o Do not share patient info with unauthorized people. (code systems can be used) • Patient self-determination act stipulates that staff must inform clients they admit to health care facility of their right to accept or refuse care. Competent adults have the right to refuse treatment, including the right to leave a facility without a discharge prescription from the provider. o If client refuses treatment or procedure, they must sign a document indication understand of risks. o If client decides to leave facility patient must sign a document (Against medical leave) , the nurse must notify the provider and discuss the clients risk to expect when leaving the facility prior discharge. • Palliative care: Interventions focus on symptom relief. Can be given at the same time as treatments to cure disease, or end of life. o Palliative care is aggressively planned comfort care. o General issues for most end-of-life care include the following:  Supporting families and caregivers  Ensuring continuity of care  Ensuring respect for persons  Ensuring informed decision making  Attending to emotional and spiritual concerns  Supporting duration of function and survival  Managing symptoms (e.g., pain, dyspnea, depression)  Examples – Morphine for pain and antibiotics- We don’t just let you die!!!!!!!! o A patient does not necessarily have to be “actively dying” to receive palliative care. It is also provided over a long period of time for those who have slowly progressive diseases. Palliative care should not be seen as merely limiting life-sustaining treatment or allowing death. It should result in increased patient satisfaction, improved symptom control, and cost savings for hospitals • Mandatory licensing o When you observe violations of the state’s licensing regulations, you have a professional and legal responsibility to report them to the appropriate authority. • Malpractice: a nurse admins a large dose of medication due to a calculation error. The client has cardiac has a cardiac arrest and does. • Negligence: a nurse fails to implement safety measure for a client at risk for fall. • Ethical responsibility of nurses: o Caring for several patients and seeing that their physical and spiritual needs are met o Performing patient and family teaching and preparing them for patient discharge o Noticing changes in patient condition and notifying appropriate health-care professional • Regulatory agencies o U.S. department of health and human services o U.S, food and drug admin o State and local public health o State licensing boards to ensure that health care providers and agencies comply w/ state regulations o The joint commission to set quality standards for accreditation of health care facilities o Professional standards review organizations to monitor health care services provided o Utilization review committees to monitor for appropriate diagnosis and treatment of hospital clients Module 5 • Palliative Types of surgery • Elective: planned for correction of nonacute problem o Cataract removal o Hernia removal o Hemorrhoidectomy o Total joint replacement • Emergent: requires immediate intervention because of life-threating consequences o Gunshot or stab wound o Severe bleeding o Abdominal aortic aneurysm o Compound fracture o Appendectomy • Urgent: requires prompt intervention; may be life threating if treatment is delayed more than 24- hrs. o Intestinal obstruction o Bladder obstruction o Kidney or ureteral stones o Bone fracture o Eye injury o Acute cholecystic o • Preoperative care o Informed consent  It is the providers responsibility to obtain consent after discussing the risk and benefit of the procedure  Nurse cannot provide any new or additional info not previously given by the provider.  Two witness can be required if the client is able to only sign with an ‘X’, has vision or hearing. o Site marking  Break in the skin increase risk for infection  Patient may be asked to shower using antiseptic solution (chlorhexidine)  Hair removal by electric clippers, depilatories  Shaving if hair creates risk for infections o Main nursing diagnosis  Anxiety related to new or unknown experience, possible of pain and possible surgical outcomes  Knowledge deficit related to unfamiliarity with surgical procedures and preparation • Intraoperative care o Scrubbing for surgery  Broad-spectrum surgical antimicrobial solution  Vigorous running that creates friction used from fingertips to elbow  Scrub continues for 3-5 mins o Position o o o o o o • Precautions o The use of patient-transfer and personal protective equipment (gowns, non-powdered gloves, masks, and eye protection), ongoing monitoring of the environment for trace anesthetic gases, and monitoring of radiation badges worn by personnel (for exposure levels to radiation) and lead shielding are basic safety precautions that are used in the OR to manage personnel safety and minimize known risk factors. • Universal protocol o The Joint Commission (TJC) has developed a Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery; and the Association of periOperative Registered Nurses has developed recommendations based on this protocol (AORN, 2015b). The nurse asks the patient about any allergies and determines whether autologous blood was donated. A special allergy bracelet on the patient's wrist and the medical record must be verified with what has been communicated. • Assessment done by nurse o Anesthesia care and complications (malignant hyperthermia, treatment)  Care • Positioning the patient comfortably and safely • Offering information and reassurance • Staying with the patient and providing emotional support • Observing for breaks in sterile technique • Recognizing and responding to signs and symptoms of possible reactions to the anesthetics  Complications (malignant hyperthermia, treatment) • Malignant hyperthermia is inherited muscle disorder, acute, life-threatening complication of certain drugs used for general anesthesia. Reaction starts in skeletal muscle causing increased calcium levels in muscle cells and increased muscle metabolism. This leads to acidosis, cardiac dysrhythmias, and high body temperatures o Treatment: dantrolene (bring buckets of ice to lower temperature • Overdose • Unrecognized hypoventilation • Intubation problems  Complications from general anesthesia • Malignant hyperthermia • Overdose • Unrecognized hypoventilation • Problems with specific anesthetic agents • Intubation problems  Complications of local or reginal anesthesia • Anaphylaxis • Incorrect delivery technique • Systemic absorption • Overdose • Local complications o Safety concerns inside the OR  Fall risk  Potential for infection related to invasive procedures  Compromised gas exchange related to anesthesia, pain, reduced respiratory effort  Instrument count o Medical Asepsis vs. Sterility  Medical asepsis: practices performed to prevent the spread of infection • Also known as “clean technique”  Surgical Asepsis: ensures sterility and alert for breaks • Postoperative care o Dressing changes  surgeon usually performs the first dressing change to assess the wound, remove any packing, and advance (pull partially out) or remove drains. Before the first dressing change, reinforce the dressing (add more dressing material to the existing dressing) if it becomes wet from drainage. Document the added material and the color, type, amount, and odor of drainage fluid and time of observation. Assess the surgical site at least every shift and report any unexpected findings to the surgeon.  After removal of the dressing, the surgeon may leave the suture or staple line open to the air, which allows easy assessment of the wound and early detection of poor wound edge adherence, drainage, swelling, or redness. Some surgeons believe that air-drying promotes healing. However, a draining wound is always covered with a dressing.  Dressing changes are prescribed by the surgeon; however, the facility or unit may have standards or policies that dictate specific protocols for dressing changes and incision care. An unchanged wet or damp dressing is a source of infection. Change dressings using aseptic technique until the sutures or staples are removed.  Dressings vary with the surgical procedure and the surgeon's preference. Common dressings for large incisions consist of gauze or nonadherent pads covered with a larger absorbent pad held in place by tape, a tubular stretchy net, or Montgomery straps (see Fig. 16-3). Some incisions may be covered with a transparent plastic surgical dressing (e.g., OpSite) or a spray in the OR. This type of dressing stays intact for 3 to 6 days, allows direct observation of the wound, prevents contamination, and eliminates the need for dressing changes. • Preventing wound infections o Nursing assessment of surgical area is critical o Dressings—First change usually done by surgeon o Drains—Provide exit route for air, blood, bile; help prevent deep infections, abscess formation during healing o Interventions o Drug therapy, irrigation to treat wound infection o Débridement o Surgical management required for wound opening • What promotes wound healing? o A diet high in protein, calories, and vitamin C promotes wound healing. Supplemental vitamin C, iron, zinc, and other vitamins are often prescribed after surgery to aid in wound healing and red blood cell formation. Instruct the patient who needs dietary restrictions about the importance of following the prescribed diet while recovering from surgery. Encourage the older adult or weakened patient to continue using dietary supplements, if prescribed, between meals until the wound is completely healed and the energy levels are restored. o Surgery stresses the body, and time and rest are needed for healing. Teach the patient to increase activity level slowly, rest often, and avoid straining the wound or the surrounding area. The surgeon decides when the patient may climb stairs, return to work, drive, and resume other usual ADLs (e.g., housekeeping, gardening, and sexual activity). The surgeon will determine the amount of weight that the patient can lift safely after surgery (i.e., in pounds or kilograms). Instruct the patient in the use of proper lifting techniques and remind him or her about weights of frequently used items such as grocery bags, handbags, and common household items. A patient whose work involves a moderate amount of physical labor may return to work about 6 weeks after abdominal surgery. Stress the importance of adherence to prevent complications or disability. • Postop complications o Respiratory- atelectasis, pulmonary embolism (PE) o Cardiovascular- venous thrombosis (DVT) o Gastrointestinal- N/V, abdominal distention, paralytic ileus, stress ulcer o GU- urinary retention o Hemorrhage-slipping of a ligature (suture) o Wound infection o Wound dehiscence or evisceration o Paralytic ileus o Hypovolemic shock: result from a massive loss of circulating blood volume o Hypoxia: decrease of I oxygen saturation o Airway obstruction • Postop monitoring o ATI page 1108-1109 (med surg) [Show More]

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