NURS 2230 UWORLD for NCLEX Notes for 2018,100% CORRECT

NURS 2230 UWORLD for NCLEX Notes for 2018 Refeeding syndrome • Serious complication of nutritional replenishment. phosphorus,  potassium, and/or magnesium (mnemonic PPM). Clients can also develop fluid overload. Low ...

NURS 2230 UWORLD for NCLEX Notes for 2018 Refeeding syndrome • Serious complication of nutritional replenishment. phosphorus,  potassium, and/or magnesium (mnemonic PPM). Clients can also develop fluid overload. Low-calorie feedings and a gradual increase in calories can prevent refeeding syndrome. Electrolytes should be monitored frequently Air Embolism • To prevent air embolism when discontinuing a central venous catheter, it is important for the nurse to pull the line cautiously, have the client in a supine position, have the client bear down or exhale, and apply an air-occlusive dressing Fat embolism syndrome (FES) • Respiratory problems (eg, dyspnea, tachypnea, hypoxemia)  to impaired gas exchange and acute respiratory failure. • Neurologic changes (eg, altered mental status, confusion, restlessness) • Petechial rash (eg, pin-sized purplish spots that do not blanch with pressure) around neck & chest. This defining characteristic differentiates a fat embolus from a PE • Fever (>101.4 F [38.6 C]) Thrombolytic agents • Thrombolytic agents (eg, alteplase, tenecteplase, reteplase) place clients at risk for bleeding. Contraindicated in active bleeding, recent trauma, aneurysm, arteriovenous malformation, hx of hemorrhagic stroke, and uncontrolled HTN. Stroke • A stroke is not considered stabilized until 48 hrs have passed without changes. The client's risk of losing the gag reflex is still high as the stroke could be evolving. Phenytoin (Dilantin) • An anticonvulsant drug used to treat generalized tonic-clonic seizures. The therapeutic is 10-20 mcg/mL. Early signs of toxicity include horizontal nystagmus and gait unsteadiness. These may be followed by slurred speech, lethargy, confusion, and even coma. Bradyarrhythmias and hypotension are usually seen with IV phenytoin. Gingival hyperplasia is a common expected S/E & does not indicate toxicity. • Stevens-Johnson syndrome is an immune-mediated reaction triggered by certain classes of drugs (eg, sulfonamide antibiotics, allopurinol, anticonvulsants”phenytoin”). It is characterized by blistered lesions on the face, trunk, and palms and may be fatal if left untreated. • least amount of time that the nurse can safely admin this med is 2 mins Digoxin • Improve cardiac output and efficiency in clients with HF. Sucralfate (Carafate) taken at the same time as digoxin can decrease absorption of the latter, thereby increasing symptoms of HF. Clients should take sucralfate at least 2 hrs after digoxin. • For infant, hold med if the apical pulse rate is <90 bpm. In adults hold if the apical pulse rate is <60 bpm. TNF (eg, etanercept, infliximab, adalimumab) • These drugs reduce the manifestations of (RA) and slow the progression of joint damage by inhibiting the inflammatory response. Causes immunosuppression and increased susceptibility for infection and malignancies. Major adverse effects include severe infections and bone marrow suppression. TB reactivation is a major concern. Therefore, all clients must receive a Tuberculin Skin Test(TST) to r/o latent TB. Mucositis • Measures to minimize oral mucositis from chemoradiotherapy include rinsing the mouth with normal saline, brushing with a soft-bristle toothbrush, using a water-soluble lubricating agent, avoidance of hot liquids and spicy/acidic foods, and application of prescribed viscous lidocaine. Ethics • Nonmaleficence is doing no harm, fidelity is loyalty and commitment. It exhibits loyalty and fulfilling commitments made to oneself and others. It includes meeting the expected responsibilities of professional nursing practice and provides the basis of accountability, justice is equal treatment for all, beneficence is doing good for the client's best interest, and autonomy is making decisions for oneself. RACE & PASS • RACE- Fires in inpatient settings (Rescue, Alarm, Confine, & Extinguish/Evacuate). • PASS- Using a fire extinguisher (Pull, Aim, Squeeze, and Sweep). Creatinine clearance • Measures GFR. Requires a 24-hour urine specimen & a blood specimen. The 1st urine specimen is discarded & the time is noted. Renal Calculi- • Provide adequate analgesia for pain, encourage increased fluid intake, and assist with ambulation as tolerated to promote clearance of calculi. All urine should be strained to retrieve any stones for analysis to determine preventive measures. Diabetic neuropathy • Autonomic neuropathy is nerve damage to the autonomic nervous system, the system responsible for involuntary body functions such as BP, HR & digestion. Magnetic resonance cholangiopancreatography • Uses MRI to visualize the biliary and hepatic ductal system. Contra , pregnancy, the presence of certain metal implants, and an allergy to gadolinium (ie, noniodine contrast agent) Sodium nitroprusside • is given as an infusion for the short-term treatment of acute decompensated heart failure, especially in clients with markedly elevated blood pressure. It is a potent vasodilator and reduces preload and afterload. The main adverse effect is symptomatic hypotension, necessitating close monitoring of blood pressure. Sequence of basic life support • Assessing responsiveness by tapping or gently shaking the client, activating the emergency response system (eg, calling a code), simultaneously assessing pulse and breathing for no more than 10 seconds, initiating chest compressions if no pulse is felt, and notifying the HCP. MRSA • Bathe with pre-moistened cloths or warm water containing chlorhexidine solution. Bathing clients in this way can significantly reduce MRSA infection. Status epilepticus • Serious condition that could result in brain damage and death. Quickly stopping the seizure is the first nursing priority as long as there is an adequate airway and the client is breathing. IV or rectal benzodiazepines (lorazepam or diazepam) are used to rapidly control seizures. Irritable bowel syndrome • Altered intestinal motility, causing abdominal discomfort w/diarrhea and/or constipation. Manage symptoms by avoiding gas-producing foods (eg, broccoli), caffeine, alcohol, and GI irritants (eg, high-fructose corn syrup, spices, dairy products) and by increasing fiber. Postoperative blood loss • >100 mL/hr should be reported to the HCP immediately Gestation: Neonate • By the end of 12 weeks gestation, fetal sex can often be determined by the appearance of the external genitalia on ultrasound, depending on the quality of the image • Fetal heart tones can be detected by 7 weeks gestation • Fetal movements are typically felt at around 16-20 weeks gestation. Cold Stress: Preemies • Premature infants are at high risk for cold stress due to decreased brown adipose tissue and inability to generate heat by shivering. The nurse should carefully assess for signs of cold stress, which include decreased temp, altered mental status, bradycardia, hypoxia, hypotonia, and a weak cry and/or suck. Separation anxiety • starts around age 6 months, peaks at age 10-18 months, and can last until age 3 years. It produces more stressthan any other factor (eg, pain, injury, change in surroundings) for children in this age range. However, separation anxiety is normal and resolves by age 3 years. Breast Feeding • Weaning is best achieved gradually to avoid breast engorgement and infant distress. Gradual weaning from breastfeeding may begin with the introduction of solid foods at age 6 months. Whole cow's milk may be given to children after age 12 months. • Premature infants require iron supplementation by age 2-3 months, which is when maternal iron stores are depleted. Appropriate sources include oral iron drops if breastfeeding or iron-fortified formula. Blood Transfusion • Normal saline (NS) is the only fluid that can be given with a blood transfusion. Dextrose solutions may lyse the red blood cells. Blood transfusions should be infused through a dedicated IV line. • A blood transfusion can result in fluid volume overload. Weight gain, HTN, & increased CVP are signs of fluid volume overload. If the client is experiencing fluid overload, stop the infusion and admin diuretics. Assess the response to tx and notify the HCP. Diuretics • Muscle cramps in the legs as a possible sign of hypokalemia in the client taking diuretics. Report to the HCP in anticipation of checking a potassium level, adding a potassium supplement, and instructing the client to eat potassium-rich foods. • Loop diuretics (eg, bumetanide, furosemide, torsemide) can cause hypokalemia (potassium <3.5 mEq/L [3.5 mmol/L]). Trisomy 18 (Edwards syndrome) • Severe cardiac defects and multiple musculoskeletal deformities. Life is a few weeks after birth, neonates rarely survive to their 1st birthday. End-of-life issues should be discussed early after the diagnosis is confirmed. Trisomy 13 (Patau syndrome) also results in early death. Hyperemesis gravidarum • (ie, excessive vomiting during pregnancy) leads to fluid and electrolyte imbalances (eg, hypokalemia), weight loss, nutritional deficiencies, and ketonuria. S/S of dehydration: poor skin turgor, decreased urine output (Urine is concentrated with dehydration, indicated by increased specific gravity (>1.030), tachycardia, low BP, & dry mucous membranes. 1st Stage Active Labor • The period of active labor from 8-10 cm dilation (ie, "transition") can be emotionally challenging for laboring clients. Signs of near-complete dilation include bloody show and the urge to push. Clients should be coached in breathing techniques and should avoid pushing until fully dilated to prevent cervical trauma. pudendal nerve block Burns • In a home setting, gently soak the area w/cool water; removing clothing or jewelry if not stuck to the skin; covering the affected area with clean, dry cloth/bandages; and avoiding application of med or substances to the wound. warfarin or heparin • Avoid using aspirin or NSAIDS, wear a MedicAlert device, avoid activities that increase the risk for bleeding, and limit alcohol intake. NSAIDS • NSAIDS (Ibuprofen), BB & Codeine, have the potential to cause problems like bronchospasms for clients with asthma. • may increase the occurrence of stomach and intestinal ulcers. This would increase the risk of GI bleeders. GI complaints and HA are two of the most common S/E. The client should stop taking celecoxib and get medical help right away if the client notices bloody or black/tarry stools. Abdominal aortic aneurysm (AAA) • Blood-filled bulge in the abdominal aorta caused by weakening in the vessel wall due to increased pressure. Risk factors include male sex, age >65, coronary artery and PVD, HTN, family & smoking hx. AAA dissection (blood leakage into a vessel tear) or rupture may manifest as acute-onset abdominal pain radiating to the back and is typically assoc wi/symptoms of hemorrhagic shock (eg, decreased systolic pressure; increased, weak pulses; pallor). It can lead to life-threatening vascular hemorrhage. o Stent Placement:  Signs of graft leakage that are important to monitor after repair of an abdominal aortic aneurysm include pain in the back, pelvis, or groin; ecchymosis of the groin, scrotum, or penis; tachycardia; weak or absent PAD peripheral pulses; decreasing Hct and Hgb; increased abdominal girth; & decreased urinary output.  Monitor Hypotension, dehydration, prolonged aortic clamping during surgery, blood loss, or embolization can lead to decreased renal perfusion and potential kidney injury. The nurse should routinely monitor the (BUN), creatinine & urine output. • Pts with intermittent claudication from PAD should assess the adequacy of circulation to the extremities by palpating and assessing the quality of posterior tibial and dorsalis pedis pulses. The quality of circulation will guide the tx plan including risk factor modification, drug therapy, and possible surgical revascularization. • Risk factors include HTN, DM, hyperlipidemia, and smoking. Pour bottles and IV bags with sterile solutions • Must be changed every 24hrs after being accessed. After 24 hours following opening a bottle of sterile saline, the solution is considered contaminated and must be discarded, even if there is still unused solution in the container. Bacterial meningitis • Inflammation of the meninges in the brain and spinal cord caused by bacterial infection. Key characteristics of bacterial meningitis in infants under age 2 include frequent seizures(Irritability), a high-pitched cry, poor feeding, nuchal rigidity, and possible bulging fontanelles. • Complications: increased ICP (eg, hearing loss, permanent brain damage, death), the priority of care is immediate abx therapy. Lumbar puncture (LP) with CSF culture is performed to determine the causative organism. Antibiotic choice may be adjusted later based on LP results. The client should remain on isolation precautions for a minimum of 24 hours following initiation of abx. INH • S/S: hepatotoxicity (eg, jaundice, vomiting, dark urine, fatigue) and peripheral neuropathy (eg, numbness, tingling of extremities). Clients should avoid alcohol use and aluminum-containing antacids, & report any experienced s/e to the HCP asap. UTI Prevention • Avoid use of feminine perineal products, vaginal douches, spermicidal contraceptive jelly and synthetic fabrics as these materials (eg, nylon, spandex). Protective factors include wearing cotton underwear, increasing water intake, and voiding immediately after sex. FTT • Defined as weight less than 80% of ideal for age and/or depressed weight for length, correcting for gestational age, sex, and special medical conditions. Observation of the child while being fed may provide info r/l to the cause of inadequate dietary intake, including disturbances in feeding behavior and psychosocial factors. Sepsis • In newborn is life-threatening. Newborns with fever, lethargy, and refusal to feed require a full septic workup. Broad-spectrum abx should be started asap after obtaining blood, urine, and CSF cultures. Rectal temperature >100.4 F (38.0 C) or <96.8 F (36.0 C) is a "red flag" in a neonate. Infants <30 days old have immature immune systems and a blunted response to infection. The 7-day-old infant is at high risk for bacteremia. • HR >90 beats/min, temp >100.9 F (38.3 C), systolic BP <90 mm Hg, altered mental status, and hyperglycemia (>140 mg/dL [7.8 mmol/L]) in the absence of DM. The assessment findings most important for the nurse to report to the HCP include: - Absent bowel sounds. Paralytic ileus occurs in the presence of sepsis and hypoxia as blood is shunted away from the GI tract to the vital organs. - Capillary refill 5 seconds. >3-4 seconds in an adult indicates inadequate blood flow to peripheral tissues. - Serum glucose >140 mg/dL (7.8 mmol/L). Gluconeogenesis occurs in response to the physiologic stress of infection. Insulin resistance is assoc w/anaerobic metabolism. Septic Arthritis • Can lead to irreversible joint damage if not treated promptly. Characteristic manifestations include severe pain of sudden onset, erythema, warmth, swelling, limited range of motion, and fever. Falls Reduction: Crutches • Look forward when walking, maintaining a clutter-free environment, resting crutches upside down on the axilla pads when not in use, using a small bag to hold personal items, wearing sturdy rubber-soled shoes, and keeping crutches in good repair. Rib fractures • often the result of blunt thoracic trauma (eg, motor vehicle collision). In the absence of significant internal injuries (eg, pneumothorax, pulmonary contusion, spleen laceration), interventions focus on pain management and pulmonary hygienetechniques (eg, coughing, deep breathing, incentive spirometry). • Breaths may become shallow as the client experiences pain with inspiration, which can result in a buildup of secretions, atelectasis, and pneumonia. (BIPAP) machine • Decreases CO2 levels in clients with hypercapnic respiratory failure e.g COPD pts Respiratory failure • Pts with asthma include hypercapnia, hypoxemia, paradoxical breathing, and mental status changes. Tracheostomy tube • Accidental dislodgment of a tracheostomy tube is a medical emergency. With a mature tracheostomy, an attempt to insert a new tracheostomy tube with the bedside obturator is indicated. If a tube cannot be reinserted, the stoma is covered with a sterile, occlusive dressing. Ventilation is provided with a bag-valve mask over the nose/mouth. Chest Tube Removal • Before removal, the client is given an analgesic and then asked to perform Valsalva during the procedure. The nurse should also bring sterile suture removal equipment and a sterile airtight occlusive dressing. Post-procedure chest x-ray is necessary within 2-24 hours. Chest Tube • An air leak is indicated by bubbling of fluid in the base of the water seal chamber of a chest tube drainage unit. The client with a known pneumothorax is expected to have an intermittent air leak, with bubbling in the water seal chamber. Continuous bubbling indicates an air leak somewhere in the chest tube system. MMRV vaccine • reactions that occur within 5-12 days after vaccination include mild fever and rash, irritability and restlessness, and swelling and erythema at the injection site. Febrile seizure is a rare but more serious reaction to the vaccine. So remember to find out about their temp. Pharyngitis • caused by group A β-hemolytic Streptococcus is a bacterial throat infection that can cause renal or cardiac complications if not treated. It is important to discard the child's toothbrush 24 hours after starting antibiotics, test siblings age <3 years, and complete the full course of prescribed antibiotics. Acute gastroenteritis • Associated with N/V diarrhea, and dehydration. An isotonic crystalloid (IV) solution (eg, 0.9% normal saline, lactated Ringer's) has the same tonicity as plasma and when infused remains in the vascular compartment, quickly increasing circulating volume. It is appropriate to correct the extracellular fluid volume deficit (dehydration) in this client. Normal saline • Fluid of choice for rapid correction of hypotension in most situations, including hypovolemic and septic shock. It can be administered in large quantities rather rapidly and is inexpensive. Hypovolemic shock • occurs when blood volume decreases via hemorrhage or third-spacing. Stopping the source of blood loss, increasing blood volume through IV fluids, and improving blood pressure with vasoactive medications are the first steps in treating this condition. Abruptly discontinuing vasoactive medications can cause hemodynamic instability; always be taper down slowly. Nurse offenses reportable to BON • Criminal acts (such as theft), practicing outside of the scope, falsification of records, and client abandonment. Any individual may file a complaint regarding an action that is potentially unethical, incompetent, impaired, or in violation of nursing law. Ulcerative Colitis (bloody diarrhea) • Inflammation and ulcerations in the large intestines resulting in urgent, frequent, bloody diarrhea; abdominal pain; anorexia; and anemia. Acute pain, altered nutritional status, hopelessness, and risk for deficient fluid volume are appropriate NDs for a client with UC. (ASA) toxicity • ASA poisoning (disorientation, vomiting, hyperpnea, diaphoresis, restlessness) as well as in those who are asymptomatic. Activated charcoal binds to available salicylates, thus limiting further absorption in the small intestine and enhancing elimination. Management of acute diverticulitis • focuses on bowel rest (NPO status, NG suction, bed rest), and drug therapy (IV abx, analgesics). Any procedure or tx that increases intraabdominal pressure or may cause rupture of the inflamed diverticula should be avoided. Avoid Barium Enema during acute stage. Myopia (nearsightedness) • Objects at a distance are difficult to visualize. S/S in children include HA & dizziness, as well as poor school performance, eye rubbing, and frequent blinking when viewing distant objects. IV Gauge • 14-gauge (large-bore) catheter is used to administer fluids and drugs in a prehospital or emergency setting, or for hypovolemic shock. • 18-gauge catheter is typically indicated for infusing blood or large amounts of fluid in adults. Mechanical Ventilator • Avoid suctioning or changing activity or O2 levels prior to drawing of ABGs. These actions can result in inaccurate ABG results. Fall Prevention • During ambulation: step slightly behind the client with feet wide apart and knees bent, place arms under the axillae or around the client's waist, place one leg behind the other and extend the front leg, and let the client slide down the extended leg to the floor. Epidural anesthesia • Contraindications: uncorrected maternal hypotension, coagulopathies (eg, low platelets), and infection at the epidural insertion site. Abdominal Exam • Sequence – stand on right side, inspect, auscultate, percuss, then palpate. Clonidine • Very potent antihypertensive. Abrupt discontinuation can result in serious rebound hypertensive crisis. Other common S/E of clonidine include dizziness, drowsiness, and dry mouth (the 3 Ds). BB, another class BP meds, can result in withdrawal symptoms if discontinued suddenly. Oral candidiasis • Immunosuppressed clients (eg, taking steroids, undergoing chemotherapy or radiation, with immunodeficient states) and those taking prolonged or high- dose abx are at increased risk of oral candidiasis. Elderly w/ dentures are also at high risk. Infection is tx w/antifungals (eg, nystatin) and proper oral hygiene. • The client should be directed to swish the solution within the mouth, making contact with all the mucous membranes, and then swallow the solution after several minutes. Swallowing would help to clear any unseen esophageal candidiasis. • Inhaled beta-2 agonists (eg, albuterol) do not increase the risk for fungal infections. However, individuals taking an are at increased risk for oral candidiasis. To reduce this risk, the client should rinse the mouth after each inhaled dose and maintain good oral hygiene. Reye syndrome • Is characterized by fever, acute encephalopathy, and altered hepatic function. It often develops following a viral infection, especially varicella or influenza. The risk of developing Reye syndrome increases if aspirin therapy is used to treat fever. Acetaminophen is an appropriate antipyretic choice von Willebrand disease, • Genetic bleeding disorder, deficient von Willebrand factor prevents effective coagulation. Clients can decrease bleeding risk by avoiding high-risk activities (eg, contact sports) and NSAIDS, keeping nasal mucosa moist, and maintaining gum integrity (eg, soft-bristled toothbrush). Pericardial effusion • Assess the client for pulsus paradoxus when cardiac tamponade is suspected. The amount of paradox is the difference between the pressure heard at the first Korotkoff sound during expiration and the Korotkoff sounds heard throughout inspiration and expiration. A difference of <10 mm Hg is normal, but if it is >10 mm Hg, this may indicate cardiac tamponade. Cardiac arrest, • therapeutic hypothermia should be implemented for 24 hours in clients who are comatose or do not follow commands. Therapeutic hypothermia has been shown to improve neurologic outcomes and decrease mortality in these clients. Monitor for seizures. Pacemaker • Assessing the function of a new permanent pacemaker is a priority after operative placement. The nurse should immediately attach the cardiac monitor before making other appropriate assessments. Catheter-related • infections from peripheral IV catheters, the nurse should clean the site with chlorhexidine in a back-and-forth motion using friction and allow it to dry completely. The catheter hub is secured with a sterile, semipermeable dressing, and access ports are cleaned with alcohol swabs prior to use. indwelling urinary catheter • To insert in a female perform hand hygiene; position; open the urinary catheter kit; place sterile drape under the hips; apply sterile gloves; empty lubricant into tray and place tip of catheter in lubricant; spread labia with the nondominant hand and cleanse front to back, outer to inner with meatus last using a new swab each time; insert catheter until urine is visualized and then advance 1-2"; and inflate balloon. Maintaining sterile technique throughout the procedure is imperative. Broca Aphasia • Damage to the frontal lobe of the brain may cause Broca (expressive) aphasia. Clients with this condition demonstrate effortful and sensible speech characterized by short, limited sentences, with retained ability to comprehend speech. This impairment often causes clients with Broca aphasia to be frustrated when speaking. cerebellum • involved in coordination of voluntary movements and maintenance of balance and posture. Balance is assessed with heel-to-toe gait testing. Coordination is assessed with finger tapping, rapid alternating movements, finger-to-nose testing, and heel-to-shin testing. Vaccinations • The measles, mumps and rubella (MMR) immunization should be administered 1 month or more before pregnancy. Teach the client that it is safe to receive immunizations right after giving birth, even if the client is breastfeeding. • The tetanus, diphtheria, and acellular pertussis (Tdap) and influenza immunizations are safe to administer during pregnancy, • Pertussis (whooping cough) and influenza vaccines can be deadly to a newborn. Additionally, depending on the client’s risk, the HCP may recommend that the client receive immunizations for hepatitis A, hepatitis B, and meningococcal disease. Frostbite • Tissue damaged by frostbite may appear pale, waxy, blue, or mottled due to frozen intracellular fluid. Affected extremities are thawed in a warm water bath (98.6-102.2 F [37-39 C]), and analgesics are administered. Manual friction (eg, massage, ambulation) is contraindicated as it may further damage the tissue. Rabies • Affects the CNS and is transmitted by the saliva of infected animals (eg, bat, dog) usually via a bite or scratch. Post-exposure prophylaxis includes immediate wound care with povidone-iodine or soap and water; vaccines for tetanus and rabies, or rabies immunoglobulin, may be given afterward. Tumor lysis syndrome, • An oncologic emergency, occurs when cancer tx successfully kills cancer cells, resulting in release of intracellular components into the bloodstream (eg, hyperkalemia, hyperphosphatemia). Released nucleic acids degrade into uric acid and cause hyperuricemia, leading to possible kidney injury. Hyperkalemia with ECG changes • The priority in treatment of hyperkalemia with ECG changes (eg, peaked T waves) is administration of intravenous calcium gluconate to prevent life-threatening dysrhythmias. Once calcium gluconate is administered, prescriptions to correct serum potassium (eg, intravenous regular insulin with dextrose, sodium polystyrene sulfonate, hemodialysis) may be implemented. Decorticate • Mental status may continue to decline in the first 24-48 hours following a CVA. Decorticate (flexion) posturing (arms rigidly flexed at the elbow, hands raised to the chest, and legs extended) is a sign of worsening neurological function that should be reported immediately to the HCP. Physiologic changes in pregnancy • Nasal stuffiness, ear fullness, and colostrum secretion (yellow-organge). Findings warranting further investigation and evaluation include dysuria; flank pain; headache with blurred vision; and copious amounts of watery, clear vaginal discharge. Pericarditis • Manifestations: pericardial friction rub; chest and neck pain worse with supine position, inspiration, and coughing; and ST-segment elevation. ST-segment elevation across multiple ECG leads (rather than in specific leads, as seen with myocardial infarction) is common in pericarditis The nurse should monitor the client with pericarditis for signs of cardiac tamponade (eg, narrowed pulse pressure, jugular venous distension, muffled heart tones). Restraints • Should not be in the supine position as it can cause aspiration. Clients in restraints should be placed in the side-lying, semi-Fowler, or high-Fowler position. epoetin alfa • Erythropoiesis-stimulating agents (eg, epoetin alfa, darbepoetin alfa) treat chronic anemia by stimulating RBC’s production. ESAs are held if hemoglobin exceeds 11 g/dL (110 g/L) due to an increased risk of thrombotic events (eg, myocardial infarction, stroke) • Hypertension is a major adverse effect of erythropoietin administration. Therefore, uncontrolled HTN is a contraindicationto recombinant erythropoietin therapy. Blood pressure should be well controlled prior to administering, so check BP first! Nonpharmacologic methods of birth control • The symptothermal method combines cervical mucus evaluation and basal body temperature evaluation. Any time a method of birth control can be used in combination with another, the rate of effectiveness increases. Therefore, this method is the most effective. Buccal administration • and becomes absorbed into the bloodstream. The cheek area has many capillaries that allow the medication to be absorbed quickly without having to pass through the digestive system. The degree of stinging experienced depends on the medication being administered. Some effects of certain medications can be lessened by digestive processes. Insulin Peak Cutaneous anthrax LPN UAP Cognitive Behavior Therapy Fentanyl Patch Acute cholecystitis wound dehiscence Tooth avulsion Oral iron Scleroderma SIADH Positive pressure ventilation (PPV) • causes increased intrathoracic pressure and reduced venous return and cardiac output, which can result in Gastrojejunostomy Child Physical Assessment cauda equina syndrome