INTERMEDIATE MED-SURG 201 Exam 1 MS2

INTERMEDIATE MED-SURG 201 Exam 1 MS2 MED-SURG EXAM 1 REVIEW You are assessing an older adult for malnutrition. What are appropriate nursing actions? ● monitor blood work (albumin, fats, cholesterol) ● Check ora ...

INTERMEDIATE MED-SURG 201 Exam 1 MS2 MED-SURG EXAM 1 REVIEW You are assessing an older adult for malnutrition. What are appropriate nursing actions? ● monitor blood work (albumin, fats, cholesterol) ● Check oral mucosa SCALES ● Sadness or mood change ● Cholesterol is high ● Albumin is low ● Loss or gain in weight ● Eating problems ● Shopping and food preparation problems A Pt has inoperable lung cancer, prognosis is poor. the Pt says “I want to travel abroad for unfinished business… what type of anxiety is this pt exhibiting? ● Anxiety about unfinished business? Physiologic needs before psychosocial (Maslow's Hierarchy) ● assessing functional ability such as their own meal ● multiple meds for Cardiopulmonary disease… For terminally ill Pt.. know their wishes, advance directives bc why? ● Look at the bottom for the table In an extended care facility, you are teaching a class about older adults about normal physiologic aging… what should be included in your discussion? ● Decrease in bladder capacity due to elasticity & muscle support ● Difficulty seeing in low light environment ● Vital capacity of their lungs decline bc of structural changes An elderly Pt is scheduled for surgery.. what is this Pt at risk for? ● difficulty communicating after surgery ● skin elasticity decrease Chemotherapy to treat ovarian cancer… Pt is vomiting on each previous dose of chemo.. What do you give to prevent vomiting? ● Antiemetics meds (Zofran) prophylactically before chemo and PRNYou are teaching a Pt about neutropenia after radiation therapy… Know the types of food precautions *look at table at the bottom ● Remain in room, if needs to leave wear a mask, keep dedicated equipment in pt room, avoid invasive procedures causing breaks in the skin Hand washing → minimize infection in the pt ● Water needs to be in water bottle bc risk for infection (No sharing of cup) ● Avoid uncooked foods, avoid fluids sitting out for 1 hr Focus assessment for elderly Pt receiving radiation therapy for lung cancer, what are the complications for radiation therapy? ● Most common reaction for chemo/radiation is bone marrow suppression= prone to infection A Pt is diagnosed with cancer, and is advised by HCP to get chemo STAT. Pt wants to try non traditional treatment first. Whats a good response? ● “Tell me more about your concerns to chemo/radiation/surgery” You are caring for a palliative care Pt, what type of statements is said indicating they accept their prognosis? ● There no hope for cure so they're looking for limiting discomfort and making sure their comfort level is tolerable ● GOAL- prevent/relieve suffering, give them the best quality of life You are reinforcing teaching to a Pt with cancer. What are the clinical manifestation of cancer? CAUTION ● Change in bowel or bladder habits ● A sore that doesn’t heal ● Unusual bleeding/discharge ● Thickening/ lump in breast or elsewhere ● Indigestion or difficulty swallowing ● Obvious change in wart/mole ● Nagging cough/hoarseness Prevention & Early Detection of Cancer ● Limit alcohol, avoid alcohol/tobacco ● Get regular exercise ● Maintain normal body weight ● Obtain regular colorectal screening ● Mammogram & pap test ● Use sunscreen regularly; factor 15 or > ● Practice healthy dietary habitsPt with metastatic bone cancer, tells you he wants to go home and die. But the family is concerned about meeting this Pt’s needs. What is your appropriate action? ● Refer them to hospice and home health You are providing dietary teaching for a Pt going through external beam therapy due to abdominal cancer. What is their diet? ● Eat several small meals a day, low fiber, low fat, no extreme temperature, high calorie & high protein diet ○ Use meal supplements PRN Pt has a debulking procedure. The outcome of the tumor? ● tumor size become smaller, and effects on other therapies are more effective Head and neck radiation for larynx cancer. A Pt has ulcerations of their oral mucosa and tongue (mucositis or Stomatitis) ● rinse mouth with a solution of half 0.9% sodium chloride and half peroxide TID ○ Use a soft-bristled toothbrush ● Avoid spicy, acidic, salty foods ○ Eat soft, bland foods & supplement ● Baking soda maybe used? Pt with stage 1 colon cancer, when assessing psychologic support, what is the most important Q to ask to get more information out of them? ● What were their previous coping skills to help them in stressful events Left sided lung cancer, what is lab value is important to report to a HCP? ● know lab for Na (135-145 mEq/L) ○ bc anything lower than 130 affects cardiac Neutropenia- teaching, precautions for foods Pt’s can have ● Food has to be completely cooked ● no public transportation, avoid crowds ● talk to oncologist before dental work ● Take temp daily ● Avoid fresh fruits/veggies, meats, eggs, fish, paprika, pepper A homeless Pt is A&O is being discharged with a foot infection. What is your main priority? ● Referrals ● Care for homeless older adults requires an interdisciplinary approach that links shelters with outreach, primary care clinics, Medicare and Medicaid offices, and pharmacies.A home health nurse is caring for an older Pt that is living alone. Pt is taking multiple meds for chronic health problems. How do you see if pt is compliant with meds? ● Used marked pillbox When assessing a Pt with UTI your first action is? ● Tell Pt to use the bathroom and empty their bladder before assessment An older adult with a broken arm has visible bruises that are healing at different times. You suspect abuse. ● assess pt alone ● PRIORITY is to keep them safe A Pt with stage 4 cancer is asking you about their prognosis. What do you tell them? ● poor prognosis Nursing intervention for a pt admitted in long-term facility. Pt may experience anxiety, depression, and disorientation when moving from one environment to a new one. ● Involve older adults in the decision to move and fully inform them about the location ● New residents can be greeted by staff members to provide orientation Splatic (?) treatment cancer – Pt complaining of fatigue. Best nursing action is to? ● Assess CBC- blood level ○ Anemia is one cause of fatigue A Pt is hospitalized for having a reaction to their cancer treatment. What are S&S for Neuropathy? ● pain, tingling, numbness (damaged nerves) Know how to calculate BMI Normal BMI is 18.5- 24.9 ● older adult normal level is… ● weight (kg) / height (cm) 2 ○ 1ft= 30.4 ○ 1kg= 2.2 lbs Health promotion for older adults ● Reduction in diseases & problems ● Increased participation in health promotion activities (ex. water aerobics) ● Increased targeted services that reduce health hazards ● Health promotion activities can be used to increase self-care, personal responsibility for health, and independent functioning that will enhance the wellbeing of older adultsOlder adult living alone tells nurse in the clinic that he is unable to drive to store, can’t cook in kitchen,etc… ● refer them to community services to meals on wheels You are preparing an Pt for a physical exam by their HCP, your primary action is? ● Explain the procedure prior to assessment Nursing priority when performing discharge teaching to an older Pt is? ● limit distraction in the environment ○ Closing doors, turning off TV An older Pt is A&O has metastatic cancer, in palliative care, and is ventilator dependent. The Pt says he wants the ventilator removed bc he’s tired. What do you do? ● Discontinue treatment bc it's the Pt wishes ● You don’t obey? Autonomy ○ Actions done according to the pt choice or decision A hospice nurse is making visits to Pt with terminal cancer. Pt says he increased his pain med dosage. What is this called? ● Tolerance You are caring for a Pt who ask about preinvasive cervical cancer. Screening is called? ● Pap smear Group therapy for pt’s who are newly diagnosed of cancer. Therapeutic statements? ● Key is to listen actively to fears and concerns ● Can you tell me more of your concerns ● Are you afraid of having your breast removed? ● What do you mean? A cancer Pt is taking a new prescription called Zofran for Nausea. What do you administer? ● Analgesic ● Common adverse effects to monitor is headache (give tylenol), polyuria, lightheadedness, drowsiness, dizzy, photosensitivity Pt dx with colon cancer. Pt is asking the nurse what the provider will do about his cancer. What is the appropriate response? • Write down all your Q’s/concerns and we will have the HCP answer them when the they get here o Nurse cannot answer the Q in behalf of the HCP. HCP will decide what treatment is bestfor the pt You are teaching a group of middle aged clients about early colorectal cancer detections. ● Screening- American cancer society recommendation that men and women ages 50 or above are at average risk ○ fecal occult blood test, and colonoscopy tests at age 50 then every 10 years A public health nurse employed in a facility is assessing an older Pt who lives with a family member. Who identify bruises in various stages of healing. You suspect abuse. ● Gather all information and report findings to Charge nurse and follow chain of command You are teaching staff about abuse assessment. Which of the following factors should the nurse include in the teaching? ● check suicide risk, previous coping strategies, support system, drug use A Pt with cancer is receiving TPN, what lab values indicate that treatment is effective? ● Albumin normal lvl 3.5- 5.5 Older adult admitted in assisted living • Assess functional abilities such as meal preparation or other ADL’s o check self-management • individual’s ability to manage his/her symptoms, treatment, physical and psychosocial consequences, and lifestyle changes in response to living with a long-term disorder Older adult taking multiple meds for cardiac disease. Patient lives with daughter. What is the priority diagnosis? ● Using Maslow’s Hierarchy of Needs, physiologic first before psychosocial Chemotherapy and alopecia- What nursing interventions used to increase self esteem? ● scarves, wigs, hats Filgrastim (Neupogen) ● A bone marrow stimulant that helps body make WBC after receiving cancer meds ● Neutrophil lvl 1.5- 8.0● S/e- bone pain, nausea, vomiting A Pt going into long term nursing care management. Which Pt is most appropriate to be transferred? ● Pt who weighs 350 lbs with osteoarthritis An older Pt who lives in a rural area… what would your intervention be for that pt? ● Transportation is the #1 barrier to health care ● Alternative service such as computer-based sources and chat rooms, DVDs, radios, community centers can help promote healthful practices. ● Other barriers are limited supply of health care workers and facilities, lack of quality health care, social isolation, and financial limitations Pancytopenia Pt (low WBC & RBC count)... UAP is assisting them, what type of actions can they do and cannot do? ● dental loss after eating? NO, at risk for infection/bleeding ● Can use saline rinses, toothpaste and toothbrush, baking soda Young old ● Ages 65-74 y/o Ageism ● Negative attitude based on age → leads to discrimination and disparate care A nurse is taking care of a pt who is going into surgery what should you education? ● Choose answer that says bc type of surgery pt might not be able to communicate Pt with poor edacity turgor. Know why ● Pt with hypertension TIA is going to be educated on what ● S&S of a stroke call the doctor, longer than 24 hour symptoms is a stroke Elder pt suspect of taking UTI diuretics. What are nursing interventions? ● Assess! ○ Inspect, auscultate, palpate An 85 y/o elderly pt. send home with different type of drugs. What are nursing interventions? ● Risk for adverse drug reactions because drug toxicity due to all symptoms Osteoarthritis affects the joints and knees. What is the major cause? ● Obesity○ This pt would be sent to long term care Carcinoembryonic (CEA) ● CEA is a test that measures the amount of this protein that may appear in the blood of some people who have certain kinds of cancers If nurse is in a med surg and doctor suspect liver cancer what type of lab work would you check to confirm? ● a-fetorproten (FP) pt. with chemotherapy via IV, complains of itchy and pain. What is the intervention? ● Stop the chemotherapy; investigate A pt needs to increase their protein diet. What types of food are recommended? ● Soy, cottage cheese, yogurt, tuna fish, egg, ham, strawberries, banana Brachytherapy (internal radiation therapy) As a nurse, how do you know if the pt understands the treatment? ● Radioactive agent carried in the body such as the vagina or abdomen ● Pt states “I have a radioactive object” Pt states I can never go back to work bc of my disease. What is the best therapeutic communication to use? ● Restate pt statement Different types of cognitive fx ● Fluid intelligence ● Crystallized intelligence ● Vocabulary & verbal reasoning ● Spatial perception Nursing Management – useful for obtaining assessment data in older adults to know if they need long term care or not SPICES ● sleep disorder ● problems with eating/ feeding ● incontinence ● confusion ● evidence of falls ● skin breakdownPt with HTN has transient ischemic attack, goes to the hospital and gets discharged. It is a prelim for what disease? ● CVA (Cerebrovascular accident) aka stroke ○ Go not give grapefruit Contact inhibition ● Cells have no boundaries, so they can grow wherever ● Cancer cells randomly produce 2 cells during mitosis= tumor mass Dysplasia ● When cell becomes abnormal but is not yet cancerous Tumor suppressor genes ● Normal cells that controls cell division ● BRCA 1 & 2, APCgene ○ Changes in these genes can increase risk of colorectal cancer Most common sites for cancers to metastasize? ● Liver, adrenal glands, lungs Goals of radiation? ● Cure, control, palliation Extravasation ● Drugs seep through the surrounding tissue= local tissue damage Pancytopenia ● Entire CBC is suppressed ○ # of WBC, RBC, platelet