Monday, November 28, 2005

SNA meeting-ya'll come now.


Our next SNA meeting will be on
 December 5th @ 1300
in Locke 313
 Let's get in the holiday spirit together
 and celebrate the end of the semester
by bringing a treat to share.

Sunday, November 27, 2005

N6/N7 books

Can anyone tell me what books with ISBN's are required for N6 and N7? Thanks.

Tuesday, November 22, 2005

Male problems

Ignatavicius & Workman: Medical-Surgical Nursing: Critical Thinking for Collaborative Care, 4th Edition

Self-Assessment Questions

Chapter 76: Interventions for Male Clients with Reproductive Problems


1.     Which clinical manifestation in an older male client is associated with benign prostatic hyperplasia (BPH)?

A.     Chronic low back pain extending down the legs
B.     Difficulty maintaining an erection
C.     Difficulty initiating urination
D.     Thinning pubic hair

Correct Answer: C

2.     Which statement made by a client with benign prostatic hyperplasia indicates a need for clarification regarding nonsurgical management of this problem? “I will:

A.     drink at least a liter of fluid at every meal.”
B.     avoid drinking alcohol and caffeinated beverages.”
C.     try to urinate as soon as I am aware of the urge.”
D.     check with my doctor before taking any over-the-counter medications for colds.”

Correct Answer: A


3.     The client is returned to the nursing unit after a transurethral resection prostatectomy (TURP). You observe the Foley catheter to be draining blood-tinged urine containing small clots. What is your best action?

A.     Notify the physician.
B.     Increase the IV flow rate.
C.     Release the traction on the catheter.
D.     Document the observation as the only action.

Correct Answer: D


4.     Which client should have follow-up testing for possible prostate cancer?

A.     55-year-old man with a PSA of 3.5 ng/mL
B.     75-year-old man with a PSA of 3.5 ng/mL
C.     55-year-old man with a PSA of 4.5 ng/mL
D.     75-year-old man with a PSA of 4.5 ng/mL

Correct Answer: C


5.     The client who is taking estrogen for prostate cancer tells you he is experiencing all of the following symptoms. Which one alerts you to the possibility of complications?

A.     Bilateral breast tenderness and swelling
B.     Swelling of the right leg
C.     Decreased facial hair
D.     Mood swings

Correct Answer: B


6.     For which clients experiencing impotence is the drug Viagra contraindicated? Those clients:

A.     with erectile dysfunction
B.     with diabetes mellitus
C.     taking nitroglycerin
D.     over age 70 years

Correct Answer: C


7.     Which group of men has the highest risk for prostate cancer?

A.     Asian-American men
B.     African-American men
C.     Native American men
D.     Caucasian-American men

Correct Answer: B


8.     Which client with testicular cancer is considered a poor candidate for sperm banking? The client who:

A.     is gay.
B.     is 46 years old.
C.     has a seminoma.
D.     has started radiation therapy.

Correct Answer: D


9.     What is the priority nursing diagnosis/collaborative problem during the first 24 hours for the client who has had an orchiectomy and radical retroperitoneal lymph node dissection?

A.     Acute pain
B.     Risk for infection
C.     Risk for metastasis
D.     Body image disturbance

Correct Answer: A


10.     Which statement from the client who is going home after a unilateral orchiectomy for testicular cancer indicates a need for further teaching during the first two postoperative weeks? “I:

A.     am going to lift weights to regain my strength faster.”
B.     am going to perform TSE on the other side monthly.”
C.     will check the incision at least twice each day for drainage.”
D.     will limit stair-climbing to once per day until my doctor says it is okay.”

Correct Answer: A


11.     Which clinical manifestation in a client with testicular discomfort indicates a possible varicocele?

A.     The skin of the scrotum is wrinkled.
B.     The left testicle is about an inch lower than the right testicle.
C.     The client has noticed an increase in the size of the scrotal contents.
D.     Spongy, cord-like or worm-like structures are palpated through the scrotum.


Correct Answer: D


12.     The client is a 28-year-old man diagnosed with testicular cancer who is two days postoperative from a bilateral orchiectomy. Every time a young female nurse enters his room, the client makes remarks about how he would like to have sex with her. What is your best action?

A.     Explain to the client that the nurse is already married.
B.     Report the behavior to the head nurse and request that the nurse’s assignment be changed.
C.     Ask the client if he is worried about how the disease and surgery might affect his future sexual activity.
D.     Tell the client that if the behavior continues the nurse will note his inappropriate behavior in his chart.

Correct Answer: C

Chronic/Acute Renal Failure

Ignatavicius & Workman: Medical-Surgical Nursing: Critical Thinking for Collaborative Care, 4th Edition

Self-Assessment Questions

Chapter 72: Interventions for Clients with Chronic and Acute Renal Failure


1.     Which statement regarding the pathophysiology of acute renal failure is true?

A.     Acute renal failure is the result of a slow, steady decline in renal function.
B.     Rising intratubular pressure causes the BUN and creatinine levels to decrease.
C.     Inflammatory changes from drugs result in immune-mediated changes in renal tissue.
D.     With acute hypoperfusion, renal compensatory mechanisms work to increase urine output.

Correct Answer: C


2.     With which of the following clients should you remain alert for the possible development of acute renal failure?

A.     60-year-old woman with a wound infection treated with penicillin
B.     40-year-old woman with community-acquired pneumonia
C.     75-year-old man with a unilateral bladder obstruction
D.     68-year-old woman with severe heart failure

Correct Answer: D


3.     Which of the flowing clients is most at risk for the development of chronic renal failure?

A.     77-year-old female with a history of renal calculi
B.     65-year-old male with diabetes and hypertension
C.     24-year-old female who is taking oral contraceptives
D.     42-year-old male who is taking an H2 receptor antagonist

Correct Answer: B


4.     The client has been admitted with renal insufficiency. Which of the following alterations of laboratory values should you expect?

A.     A rise in BUN and creatinine only
B.     Increasing levels of BUN, creatinine, uric acid, and phosphorus
C.     Decreased renal reserve without measurable wastes present in the serum
D.     Excessive levels of BUN, creatinine, uric acid, and phosphorus incompatible with sustaining life

Correct Answer: B


5.     The family of a client with acute renal failure asks how damage to the kidneys can be avoided in the future. What is your best response?

A.     Consult with your health care provider before taking any over-the-counter medications.
B.     Take vitamin C whenever you have symptoms of a cold.
C.     Consume a diet high in protein, potassium, and sodium.
D.     Use ibuprofen instead of acetaminophen for pain.

Correct Answer: A


6.     A client admitted with acute renal failure develops an infection and spikes a temperature of 100.8° F. What initial action by the nurse will help preserve renal function?

A.     Carefully measuring and recording the intake and output
B.     Ensuring adequate hydration
C.     Administering diuretics as ordered
D.     Monitoring vital signs every four hours

Correct Answer: B


7.     Which of the following clinical manifestations is characteristic of stage III: end-stage renal disease (ESRD)?

A.     The ability to concentrate urine is decreased.
B.     The kidneys are unable to maintain homeostasis.
C.     Metabolic wastes are beginning to accumulate in the blood.
D.     The healthier kidney compensates for the diseased kidney.

Correct Answer: B


8.     In teaching a client who has progressed to ESRD treated with hemodialysis three times weekly about her medications, the client wonders why she is no longer taking diuretics. What is your best response?

A.     “Diuretics are no longer appropriate as they can cause harmful side effects now.”
B.     “The dialysis treatments will remove all excess fluid, so diuretics are not necessary.”
C.     “Your high blood pressure will be controlled with dialysis, so they are no longer needed.”
D.     “Your kidney failure is causing you to make a large quantity of dilute urine, so diuretics are no longer needed.”

Correct Answer: A


9.     In caring for a client immediately following hemodialysis, what priority nursing intervention should you implement at this time?

A.     Insert a Foley catheter.
B.     Monitor for signs of hemorrhage.
C.     Administer antipyretics for fever.
D.     Place the client in a high-Fowler position.

Correct Answer: B


10.     You are preparing a client receiving continuous ambulatory peritoneal dialysis (CAPD). What discharge instructions should you include in a teaching plan for this client?

A.     “Weigh yourself every day.”
B.     “The effluent should be a cloudy, opaque color.”
C.     “You need only use a “clean” procedure to care for your catheter at home.”
D.     “Clean the catheter insertion site going from the abdomen toward the insertion site.”

Correct Answer: A


11.     Which statement made by the client indicates an understanding of permanent vascular access for hemodialysis? “I:

A.     will not have my blood pressure measured in the arm with the vascular access.”
B.     should have my blood drawn only from the arm with the vascular access.”
C.     will not need to take any more medication for my kidney disease.”
D.     should avoid ROM exercise in the arm with the vascular access.”

Correct Answer: A


12.     The client who is on hemodialysis three times weekly asks why he is receiving more protein than prior to his dialysis treatments. What is your best response?

A.     “You must be getting the wrong tray, I’ll have to check on this.”
B.     “You need more protein now, as protein is lost during dialysis.”
C.     “The increase in protein is due to the improvement in your kidney function from dialysis treatments.”
D.     “Dialysis removes wastes from the body, so it does not matter how much protein you eat.”

Correct Answer: B


13.     You are preparing to perform a dressing change on a client with a peritoneal catheter for dialysis. Which dressing change technique should you employ?

A.     Aseptic technique
B.     Clean technique
C.     Clean technique, unless peritonitis is present
D.     Aseptic technique for the first two weeks, until the catheter site matures

Correct Answer: A


14.     Which of the following clients would be a candidate for kidney donation?

A.     50-year-old male with COPD
B.     72-year-old male with peptic ulcer disease
C.     38-year-old female with irritable bowel disease
D.     45-year-old female with advanced cardiac disease

Correct Answer: C


15.     Following renal transplantation, the client’s urinary output has decreased suddenly. What is your best course of action?

A.     Remove the Foley catheter.
B.     Notify the physician.
C.     Document the finding.
D.     Apply pressure over the area of the bladder to facilitate emptying.

Correct Answer: B

Urinary problems

Ignatavicius & Workman: Medical-Surgical Nursing: Critical Thinking for Collaborative Care, 4th Edition

Self-Assessment Questions

Chapter 70: Interventions for Clients with Urinary Problems


1.     Which clinical manifestation alerts you to the possibility of cystitis? The client has:

A.     frequent, painless voiding of large amounts of urine.
B.     infrequent, painless voiding of dark-colored urine.
C.     infrequent voiding of large amounts of urine, and difficulty starting the urine stream.
D.     frequent, painful urination and feelings of an immediate need to urinate.

Correct Answer: D


2.     The 25-year-old woman has had three episodes of cystitis with coliform bacteria in the past six months. Which intervention should you teach this client to prevent future urinary tract infections?

A.     “After using the toilet, always clean yourself from front to back.”
B.     “Avoid wearing tight clothing, especially slacks or jeans.”
C.     “Try to drink at least 3 liters of fluids each day.”
D.     “Avoid carbonated or caffeinated beverages.”

Correct Answer: A


3.     Which client condition suggests to you a problem with urge incontinence?

A.     A lack of awareness of the need to void
B.     The continuous “dribbling” of urine even when bladder volume is low
C.     The inability to control the act of urination when the need is perceived
D.     The loss of small amounts of urine whenever intra-abdominal pressure is increased

Correct Answer: C


4.     The client with a urinary tract infection is prescribed to take a trimethoprim/sulfamethoxazole combination antibiotic (Septra, Bactrim). Which precaution should you teach this client?

A.     “Avoid drinking coffee and other caffeinated beverages.”
B.     “Avoid aluminum or magnesium-containing antacids.”
C.     “Drink at least 3 liters of fluid each day.”
D.     “Take this medication with food.”

Correct Answer: C


5.     Which method should you use to evaluate pelvic muscle strength for the client who has a problem “leaking” urine?

A.     Observe for urine leakage when the client coughs or bears down in the standing position.
B.     Ask the client to stop the stream of urine during the middle of urination.
C.     Percuss the lower abdomen for dull sounds indicating a distended bladder.
D.     Ask the client if fullness is perceived immediately after urination.

Correct Answer: B


6.     Which description by the client indicates correct understanding of the nature and performance of exercises to strengthen pelvic floor muscles?

A.     “Tighten the muscles of my pelvis and buttocks, then attempt to urinate while maintaining a strong contraction of these muscles.”
B.     “Sit on the toilet and start my stream of urine. Try to stop the stream of urine by tightening my pelvic muscles without squeezing my legs together.”
C.     “Get down on my hands and knees. Take a deep breath and hold it. Rock or tilt my pelvis first in an upward motion then in a downward motion. Repeat this movement 10 times.”
D.     “Lie on the floor. Bring my knees up to my chest. Squeeze my buttocks together and hold my breath. Attempt to rock forward while maintaining my muscles in a contracted state.”

Correct Answer: B


7.     The client with urinary incontinence has been prescribed to take the anticholinergic agent oxybutynin (Ditropan) for this problem. She asks you how this drug decreases incontinence. What is your best response?

A.     “This drug improves muscle tone in the bladder neck and urethra, enabling you to hold the urine in your bladder longer.”
B.     “This drug reduces the rate that the kidneys make urine so your bladder does not fill as rapidly with normal fluid intake.”
C.     “This drug relaxes the bladder muscle, allowing the bladder to hold more without stimulating the sensation of needing to urinate.”
D.     “This drug works at the level of your brain, increasing your awareness of bladder filling and making the timing of urination more predictable.”

Correct Answer: C


8.     What is the priority nursing diagnosis for a client with renal colic?

A.     Acute pain
B.     Risk for infection
C.     Fluid volume excess
D.     Knowledge deficit

Correct Answer: A


9.     The 60-year-old male client has gross hematuria. What is your best next response?

A.     “Have you noticed any other change in the urine or urine patterns?”
B.     “Have any other members of your family ever had bladder cancer?”
C.     “Are you ever incontinent of urine?”
D.     “How often do you have sex?”

Correct Answer: A


10.     Which instruction should you teach the male client who has had a Kock pouch urinary diversion for bladder cancer? “You will need to:

A.     sit to urinate.”
B.     learn how to drain the urine from the pouch with a catheter.”
C.     adjust your diet and fluid intake to prevent frequent dehydration.”
D.     use special precautions to prevent skin breakdown from the adhesives used to hold the pouch to the skin.”

Correct Answer: B

Renal Disorders

Ignatavicius & Workman: Medical-Surgical Nursing: Critical Thinking for Collaborative Care, 4th Edition

Self-Assessment Questions

Chapter 71: Interventions for Clients with Renal Disorders


1.     What is the priority nursing diagnosis or collaborative problem for a client who has polycystic kidney disease?

A.     Acute pain
B.     Hypertension
C.     Risk for infection
D.     Fluid volume excess

Correct Answer: B


2.     Which clinical manifestation alerts you to the possibility of hydronephrosis?

A.     Flank asymmetry
B.     Pain and burning on urination
C.     Dull sounds present on bladder percussion
D.     Decreased blood urea nitrogen (BUN) level

Correct Answer: A


3.     What health problem or condition is most frequently associated with development of acute pyelonephritis?

A.     Tuberculosis
B.     Prolonged hypovolemia
C.     Prolonged indwelling catheterization
D.     Chronic exposure to aminoglycoside antibiotics

Correct Answer: C


4.     Which clinical manifestations indicate that the therapy for the client with acute pyelonephritis is effective?

A.     White blood cell count differential demonstrates a “left shift.”
B.     Urine output increases; urine specific gravity decreases.
C.     Serum albumin level increases; serum sodium increases.
D.     Flank pain decreases; urine specific gravity increases.

Correct Answer: D


5.     Which assessment area should you explore to distinguish between acute glomerular nephritis and nephrotic syndrome in a client with clinical manifestations of renal impairment?

A.     Serum sodium levels
B.     Serum albumin levels
C.     Family history of renal disorders
D.     Presence/absence of pitting edema

Correct Answer: B


6.     On the first postoperative day after a left transthoracic nephrectomy, the client tells you he is having a lot of pain on the right side and is worried that now something is wrong with the right kidney. What is your best response?

A.     “The right kidney now has to do the work of two kidneys and the increased function is causing the pain.”
B.     “I’m sorry you are having so much pain. I’ll get your pain medication right away.”
C.     “The pain on the right side is because of how you were positioned during surgery.”
D.     “You may have an infection in the right kidney causing this pain.”

Correct Answer: C


7.     The client with type 1 diabetes mellitus now has diabetic nephropathy. What specific complication should you remain alert to with this client? Increased risk for:

A.     hypoglycemia
B.     hyperglycemia
C.     ketoacidosis
D.     hyperosmolar, hyperglycemic, nonketotic syndrome

Correct Answer: A


8.     The client is being discharged after a nephrectomy for renal cell carcinoma. Which instruction or precaution should you include in a teaching plan for this client?

A.     Avoiding all contact sports
B.     Measuring abdominal girth daily
C.     Increasing intake of dietary fiber
D.     Avoiding aspirin or aspirin-containing drugs

Correct Answer: A

Renal Assessment

Ignatavicius & Workman: Medical-Surgical Nursing: Critical Thinking for Collaborative Care, 4th Edition

Self-Assessment Questions

Chapter 69: Assessment of the Renal/Urinary System


1.     Why does urine from a healthy person normally contain few, if any, protein or albumin molecules? These substances:

A.     are rapidly reabsorbed from the proximal convoluted tubule.
B.     break down into amino acids in the renal tubules and are excreted as nitrogen.
C.     are too large, with high molecular weights and do not pass through the glomerular capillaries.
D.     make up a very small percentage of whole blood so that their concentration in urine is relatively low.

Correct Answer: C


2.     What would be the effect on urine filtration and output if the afferent arterioles of all the nephrons in the kidney were dilated and the efferent arterioles were all constricted? _______ filtration pressure; _______ urine output.

A.     Increased; increased
B.     Increased; decreased
C.     Decreased; increased
D.     Decreased; decreased

Correct Answer: A


3.     How does antidiuretic hormone influence the distal convoluted tubule? _______ membrane permeability to water; _______ urine output.

A.     Increases; increases
B.     Increases; decreases
C.     Decreases; increases
D.     Decreases; decreases

Correct Answer: B


4.     Which change in renal function increases the older client’s risk for dehydration?

A.     Decreased renal blood flow
B.     Decreased activation of vitamin D
C.     Decreased glomerular filtration rate
D.     Decreased ability to concentrate urine

Correct Answer: D


5.     What does the BUN/creatinine ratio indicate for a female client given the following parameters?  BUN 28 mg/dL serum creatinine 1.55 mg/dL

A.     Ratio normal; renal impairment
B.     Ratio normal; dehydration
C.     Ratio elevated; renal impairment
D.     Ratio elevated; dehydration

Correct Answer: A


6.     The client with an indwelling Foley catheter requires a urine specimen for culture and sensitivity. Which technique should you use to obtain the specimen?

A.     Wipe the distal end of the catheter with an alcohol sponge. Separate the distal end of the catheter from the drainage collection tube and allow 5 to 10 mL of fresh urine to drain into a sterile container.
B.     Clamp the catheter close to the distal end for 15 minutes. Cleanse the aspiration site on the catheter with iodine. Draw up a 2 mL specimen with a sterile needle and syringe.
C.     Clamp the catheter close to the distal end for 2 hours. Have the client void around the catheter into a sterile specimen container.
D.     Empty the residual urine in the collection bag completely and discard. Collect the urine that drains into the bag during the next hour.

Correct Answer: B


7.     Which statement made by the client indicates the need for clarification with regard to the instructions for collecting a 24-hour urine specimen for assessment of renal function? “I will:

A.     continue to take my prescribed heart medicine.”
B.     add the preservative to the container at the beginning of the test.”
C.     begin the collection with the urine I excrete when I first get up in the morning and note the time.”
D.     end the collection by urinating the last specimen exactly 24 hours after the time the test was started.”

Correct Answer: C


8.     Which statement made by the female client indicates a need for clarification regarding how to provide a “clean catch” urine specimen?

A.     “First, I will clean my bottom from the back to the front with three swipes made with a separate clean sponge wetted with the solution.”
B.     “I will start the stream of urine after I have cleaned myself and urinate into the toilet.”
C.     “After I have urinated a few ounces, I will stop the stream and then urinate into the specimen cup provided.”
D.     “After I have urinated about an ounce into the container, I will empty my bladder into the toilet as usual.”

Correct Answer: A


9.     What technique should you use to determine whether the client’s bladder is full?

A.     Observe the urethra for dribbling while the client performs the Valsalva maneuver.
B.     Place the client on his or her right side and observe for a low abdominal outpouching.
C.     Beginning at the lowest edge of the abdomen, percuss upward toward the umbilicus and note where a dull versus a flat sound is elicited.
D.     Place the client on his or her back, ask a colleague to place the side of his or her hand in the midline of the client’s abdomen, gently tap the right side of the client’s abdomen, and palpate for a fluid wave on the left side of the client’s abdomen.

Correct Answer: C


10.     The client who had a renal arteriogram performed two hours ago now has an absent pedal pulse on the side the catheter was placed. What is your best first action?

A.     Place a sandbag on the catheter insertion site.
B.     Document the finding as the only action.
C.     Elevate the affected leg.
D.     Notify the physician.

Correct Answer: D

Calling All Student Mentors!

Next semester students would like to talk to you about your clinical experience. I do not have the answers to give them about anything but my experience. They request your help, please.
Questions about the hospital, instructors, study skills, coping, organization, directions, etc.

Invitation

It’s a celebration in honor of . . .
completion of the second semester of the ADN Program!
Come and celebrate with us!



The Nursing Department invites you to attend a celebration of your accomplishment of completing the second semester of the ADN Program.

Date: Friday, December 16, 2005 Time: 11:30 am Location: Radisson Hotel, 2323 Grand Canal Boulevard, Stockton
All meals will be served with a house salad, fresh seasonal vegetables, roll, butter and dessert. You have a choice of one of the following:
Beef Stroganoff - Tender beef braised in a sour cream mushroom sauce, served over fluffy egg noodles
Wine Country Chicken - Roasted boneless herbed chicken breast topped with a garlic- chardonnay wine sauce served with garden blend rice.
Vegetarian Lasagna - Layers of pasta, vegetables and cheese with a creamy Alfredo sauce served with fresh steamed vegetables.
Please R.S.V.P. with your menu choice to Kim Thompson by Monday, December 12 954-5461, Locke 307, kthompson@deltacollege.edu

AMSA Knowledge Bowl

AMSA Knowledge Bowl
When: Friday, December 9th, 2005
Time: 1600 (4 p.m.)
Where: Danner Hall
What: A competition against other clubs on campus in multiple academic and fun categories for points and a prize. Teams are 5 people with 2 alternates.
Cost: $5
Club: Student Nurses Association (that is what you belong to even if you never attend meetings)
Who: Mandy Parker 495-7807 or aparker892@students.deltacollege.edu
Deadline for registration is November 23rd, 2005
Anyone that wants to participate can contact me for the details. I am working that day and will not be able to do this. Is anyone interested?

Monday, November 21, 2005

More N7 News

I just received another email from Mary Neville saying to take N6 First (for those still waiting for an N7 spot) and an N7 will open up scheduled for evenings in the second half of the semester. I'll let you know more info if I hear any!

N7 Panic

For those of you have been unable to register for N7 due to lack of openings, I received an email from Mary Neville today. She is aware of the problem and is in the process of tyring to add another section.

Friday, November 18, 2005

Futurenurses2007

Hi all, it is almost the end of the semester and time to register for the next one. So you don't have to shoot in the dark or you have made the leap and want to know more about what you are facing, I will share some of my own experiances. Remember that these may not reflect all of my classmates or yours next semester.

I started in N4 with Karen. I had a great time! Once again there is a lot of material and not enough time to get indepth on anything. Karen put up practice questions NCLEX style that really helped. Also, part of the class was on line and I felt that we under-utilized it. The virtual classroom could be a way to learn more and share experiances and ask questions. The time in clinical started out scary, "crazy" people you know. It turned out to not be bad at all. The patients were very helpful and sharing for the most part. You do have to keep in mind that their reality is not always the same as yours. Travel in pairs, be polite and remember that above all else they are fellows humans and they are hurting.

N4 is still in progress and I am with Gloria Prieto at County. Gloria is a great instructor. She has a very dry sense of humor, can be sarcastic and demands the highest levels of performance. The nurses at County are very willing to help. They even tolerate a certain level of fumbling. Of course, they are used to students of all kinds and none of the ones I have worked with have objected to teaching. Be on time for clinical, work hard and you will learn, become more comfortable with the skills and will find it begining to smooth out toward the end. You will still make mistakes, we all do, but remember to be honest about them and learn from them. I have been a paramedic for twenty plus years and I still make mistakes and learn from them. I take the precautions for protecting the patients from errors very seriously and I hope you do too!

And last, but not least, have fun. No job is worth doing if you can not have fun while doing it. Taking care of people can be rewarding and fun, so enjoy yourself.

It does get better!!

Tuesday, November 15, 2005

Men in Nursing

Hey all of you male type nurses! Lipincott Williams & Wilkins is starting a brand new magazine for male nurses and offering charter subscriptions (this means 1st mag. free) the rest of the bimonthly issues will cost you. I just saw a card for it in my AJN mag.
If you are interested in the new Men in Nursing mag, here is a link to fill you in on what it is all about.
http://www.nursingcenter.com/library/Journals.asp?Journal_ID=606912

Genitourinary system

If anyone has forgotten their pathophysiology for the Renal and Urologic Systems, I have posted a short review from a Pathophysiology text on docushare under the Nursing 101 Success. I have also posted practice Case studies.

I will be reviewing the Genitoruinrary system on November 22, 2005, Tuesday from 10:30-11:30 which is one week before the N4 Genitourinary test. Please come with questions.

Have a great day and keep up the excellent work.

Fernisa Sison
954-5492
L214

Monday, November 14, 2005

Test Taking strategies powerpoint

Caralee has made and posted this powerpoint.

Test Taking Stratagies for Nursing Students

Nursing 101 Success Courseshttp://docushare.deltacollege.edu/dscgi/ds.py/View/Collection-5038

HEAR YE HEAR YE

HEAR YE! HEAR YE!
THE NEXT MEETING OF THE
STUDENT NURSE’S ASSOCIATION
WILL be ON
November 21, 2005
At
1330 hrs (130 Pm)
In
Locke 118

  Please join us for conversation and pizza

Sunday, November 13, 2005

And again, nervous system

Ignatavicius & Workman: Medical-Surgical Nursing: Critical Thinking for Collaborative Care, 4th Edition

Self-Assessment Questions

Chapter 44: Interventions for Clients with Problems of the Peripheral Nervous System


1.     Which statement regarding the pathophysiology of Guillain-Barré syndrome is true?

A.     The immune system destroys the myelin sheath.
B.     The axon cell body is attacked by white blood cells.
C.     Nerve impulses are not transmitted to the skeletal muscle.
D.     Chronic inflammatory demyelinating neuropathy is common.

Correct Answer: A


2.     The client has some clinical manifestations of Guillain-Barré syndrome. What question should you include in the collection of data for the history?

A.     “Do you can your own food?”
B.     “How long have you worn glasses or contact lenses?”
C.     “Have you traveled out of the country in the past month?”
D.     “Have you had any type of illness in the past two months?”

Correct Answer: D

3.     During an hourly assessment of a client with Guillain-Barré syndrome, you note the following changes. Which indicates a worsening of the client’s condition?

A.     Pulse rate decreases from 82 to 70
B.     Pulse pressure narrowed by 6 mm Hg
C.     Temperature elevation 0.5° C
D.     Increased confusion

Correct Answer: D

4.     The client with Guillain-Barré syndrome is receiving adrenocorticotropic hormone and intravenous immunoglobulin as drug therapy. Which of the following clinical manifestations indicates the therapy is effective?

A.     Positive Homan’s sign
B.     Mild fever and headache
C.     Increased handgrasp strength
D.     Increased blood immunoglobulin levels

Correct Answer: C


5.     Which of the following statements regarding myasthenia gravis is true? Paralysis or weakness results from:

A.     progressive deterioration of voluntary muscle fibers.
B.     an inability of motor nerves to generate an action potential.
C.     failure of nerve impulses to be transmitted to voluntary muscles.
D.     loss of upper motor neuron function while lower motor neuron function remains intact.

Correct Answer: C


6.     A client with myasthenia gravis is experiencing a cholinergic crisis. What clinical manifestations would you expect to be present in this client?

A.     Absence of swallow reflex
B.     Decreased urinary output
C.     Facial muscle twitching
D.     Increased pulse

Correct Answer: C


7.     Which of the following discharge instructions assists in preventing injury in the client with myasthenia gravis?

A.     Applying artificial tears
B.     Keeping a padded tongue blade at the bedside
C.     Using a picture or word board for communication
D.     Providing high-calorie, high-protein liquid snacks

Correct Answer: A


8.     The client has permanent polyneuropathy from exposure to neurotoxic chemotherapeutic agents. Which of the following lifestyle behaviors should the nurse teach this client to avoid?

A.     Wearing polyester clothing
B.     Drinking wine twice per week
C.     Exercising three times per week
D.     Smoking one pack of cigarettes per day

Correct Answer: D


9.     Which of the following interventions after surgical restoration of a transected nerve in the arm is recommended during the first postoperative week?

A.     Range-of-motion exercises to preserve function and prevent contractures
B.     Application of electrical stimulation to initiate Schwann cell production of myelin
C.     Casting in continuous joint flexion to avoid tension on the suture line
D.     Casting in continuous joint extension to avoid tension on the suture line

Correct Answer: C


10.     What is the priority nursing diagnosis for a client with trigeminal neuralgia?

A.     Risk for injury related to diminished sensation
B.     Pain related to paroxysmal nerve stimulation
C.     Risk for aspiration related to difficulty swallowing
D.     Body image disturbance related to weakened facial muscles

Correct Answer: B


11.     You are caring for a client with trigeminal neuralgia. Which medication should you be prepared to administer?

A.     Carbamazepine
B.     Midazolam
C.     Accupril
D.     Versed

Correct Answer: A


12.     The client with trigeminal neuralgia is scheduled for a Jannetta procedure. The client asks the purpose of this procedure. What is your best response? “This procedure will:

A.     prevent the spread of neuralgia to nearby nerves.”
B.     relieve pain without loss of facial sensation.”
C.     prevent involuntary facial movements.”
D.     prevent attacks of neuralgia.”

Correct Answer: B

Another one for the nervous system

Ignatavicius & Workman: Medical-Surgical Nursing: Critical Thinking for Collaborative Care, 4th Edition

Self-Assessment Questions

Chapter 42: Interventions for Clients with Problems of the Central Nervous
System: The Brain


1.     Which of the following clients is most likely to experience migraine headaches?

A.     30-year-old woman
B.     30-year-old man
C.     70-year-old woman
D.     70-year-old man

Correct Answer: A


2.     You are caring for a client recently diagnosed with migraine headaches. Which statement made by the client demonstrates an understanding of the treatment plan? “I will

A.     avoid caffeine.”
B.     drink red wine if I desire an alcoholic beverage.”
C.     sleep using two pillows for elevation of the neck.”
D.     sit by the window wearing sunglasses during an attack.”

Correct Answer: A


3.     Which of the following clinical manifestations best describes an absence seizure? A seizure:

A.     that begins with automatisms
B.     that begins with muscle stiffening or rigidity
C.     characterized by clonic jerking of the extremities
D.     characterized by brief periods of loss of consciousness

Correct Answer: D


4.     Which of the following nursing measures is most likely to prevent injury for the client with a seizure disorder?

A.     Keeping a padded tongue blade at the bedside
B.     Keeping the bed in the lowest possible position
C.     Placing the client in a vest-style restraint
D.     Assisting the client with all ambulation

Correct Answer: B


5.     During a generalized tonic-clonic seizure, the nurse observes the client to be cyanotic. What is the best nursing action for this situation?

A.     Document the observation.
B.     Tilt the client’s head back.
C.     Administer oxygen by mask during the seizure.
D.     Insert an oral airway between the client’s teeth.

Correct Answer: A


6.     Which of the following statements made by the client with epilepsy who has started taking a new antiepilepsy drug indicates correct understanding of the drug regimen?

A.     “I will take my medication one hour before or two hours after eating.”
B.     “If I have nausea or vomiting, I will not take my medication.”
C.     “If I have a seizure, I will double the drug the next day.”
D.     “I will always take my medication on time.”

Correct Answer: D


7.     You are caring for a client with bacterial meningitis. Which nursing intervention is aimed at preventing complications associated with this illness?

A.     Performing neurologic checks every two hours
B.     Elevating the head of the bed to 30 degrees
C.     Administering pain medication as ordered
D.     Maintaining isolation precautions

Correct Answer: A


8.     Which of the following statements regarding Parkinson’s disease is true?

A.     It has a cyclic pattern of periods of exacerbation followed by periods of remission.
B.     It has a pattern of progressive changes in voluntary muscle movement.
C.     It is characterized by severe muscle flaccidity.
D.     It is inherited as an x-linked recessive trait.

Correct Answer: B


9.     Which of the following nursing actions fosters independence in feeding for the client with Parkinson’s disease?

A.     Weighing the client weekly
B.     Providing soft, cold foods that are easy to chew and swallow
C.     Scheduling medication administration so that peak action occurs at mealtimes
D.     Ensuring that the amount of calories derived from protein is at least 30% of the total diet

Correct Answer: C


10.     Which of the following outcomes would be considered appropriate for a client with late-stage Alzheimer’s disease? The client will:

A.     be independent in toileting.
B.     have no episodes of memory loss.
C.     have decreased periods of agitation.
D.     not have speech or language difficulties.

Correct Answer: C


11.     Which of the following statements made by a family member of the client with Alzheimer’s disease indicates correct understanding of the usefulness of sertraline (Zoloft) as therapy for Alzheimer’s disease? “This drug will:

A.     improve my relative’s depression.”
B.     increase my relative’s memory.”
C.     decrease my relative’s aggressive behavior.”
D.     improve my relative’s ability to bathe and feed himself.”

Correct Answer: A


12.     Which instructions should you include in a teaching plan for a caregiver of a client with Alzheimer’s disease?

A.     Avoid using night lights in the client’s bedroom.
B.     Minimize physical activity to avoid overexertion.
C.     Prepare soft foods that are easy to chew and swallow.
D.     Maintain an unstructured environment and schedule to prevent boredom.

Correct Answer: C


13.     Which statement concerning the legal or ethical concerns of genetic testing for Huntington’s disease is true?

A.     Genetic testing can identify susceptible individuals early enough to cure the disease.
B.     There are no accurate genetic tests for the detection of Huntington’s disease.
C.     Genetic testing localizes the chromosomal abnormality and stabilizes it.
D.     Clients should consider the effect of the results of genetic testing on themselves and families.

Correct Answer: D

Another from the disk

Ignatavicius & Workman: Medical-Surgical Nursing: Critical Thinking for Collaborative Care, 4th Edition

Self-Assessment Questions

Chapter 41: Assessment of the Nervous System


1.     What function would be altered if a person’s ability to synthesize or maintain oligodendrocytes within the central nervous system was disrupted?

A.     Initiation of impulse transmission
B.     Production of myelin sheath
C.     Nutrition and support of neurons
D.     Formation of the blood-brain barrier

Correct Answer: B


2.     Which of the following modifications should the nurse suggest to an elderly client whose irises no longer fully dilate?

A.     Wear dark glasses whenever you are outside.
B.     Use eye drops on a regular basis to prevent dryness.
C.     Avoid rubbing your eyes to prevent corneal abrasions.
D.     Increase room lights when reading or doing close work.

Correct Answer: D


3.     Which of the following client responses during the history-taking alerts you to the possibility of a neurologic problem? The client:

A.     asks you to repeat a question.
B.     requires a long time to answer a question correctly.
C.     has a difficult time forming his or her words.
D.     does not remember your name at the end of the interview.

Correct Answer: C


4.     In performing an initial assessment of the client, which of the following behaviors or skills should you expect to be impaired in a client who has experienced an injury to the Wernicke’s area of the brain?

A.     Pronouncing words correctly
B.     Planning activities for a week
C.     Recognizing his or her spouse
D.     Processing words into coherent thoughts

Correct Answer: D


5.     A client who has been admitted for a neurological disorder has been assigned a Glasgow Coma Scale score of 2. What is your interpretation of this finding? The client:

A.     is in a deep coma.
B.     is alert, but disoriented.
C.     can obey commands, but lacks speech.
D.     is alert and oriented to time, place, and person.

Correct Answer: A


6.     The client returns to the unit for recovery immediately after digital subtraction angiography. Which of the following actions should you perform first?

A.     Assess pedal pulses
B.     Assess neurological signs
C.     Compare blood pressure in both arms
D.     Apply a sandbag to the injection site

Correct Answer: B

From the disk

Ignatavicius & Workman: Medical-Surgical Nursing: Critical Thinking for Collaborative Care, 4th Edition

Self-Assessment Questions

Chapter 45: Interventions for Critically Ill Clients with Neurologic Problems


1.     What are the major pathophysiologic processes causing neurologic deficits with hemorrhagic stroke?

A.     Meningeal scar tissue formation and atrophy
B.     Cerebrovascular inflammation and fibrosis
C.     Ischemia and cell death of glial cells
D.     Interruption of blood vessel integrity

Correct Answer: D


2.     Which of the following health problems related by the client alerts the nurse to the risk for an embolic stroke?

A.     Insulin independent diabetes mellitus
B.     Mitral valve replaced one year ago
C.     Use of oral contraceptives
D.     Degenerative joint disease

Correct Answer: B


3.     The client has experienced a lacunar infarct of the thalamus. Which of the following deficits should the nurse expect this client to manifest?

A.     Bilateral motor weakness
B.     Loss of sensory perception
C.     Poorly coordinated eye movement
D.     Difficulty with receptive and expressive speech

Correct Answer: B


4.     Which nursing diagnosis would be appropriate for a client who has amaurosis fugax as the result of a stroke?

A.     Disturbed sensory perception
B.     Total urinary incontinence
C.     Impaired physical mobility
D.     Unilateral neglect

Correct Answer: A


5.     A client with a hemorrhagic stroke becomes increasingly restless and complains of a headache. Which action should you take?

A.     Lower the head of the bed to a flat position.
B.     Notify the health care provider.
C.     Medicate the client for pain.
D.     Increase the IV fluid rate.

Correct Answer: B


6.     The sibling of a client with a hemorrhagic stroke asks you when the client will be treated with tPA, just like the sibling was after a stoke one year ago. What is your best response?

A.     “tPA may be of some benefit in strokes caused by blood clots, but it can make strokes caused by hemorrhage worse.”
B.     “tPA is most beneficial as therapy for strokes when given at least 72 hours after the onset of stroke symptoms.”
C.     “The use of tPA as treatment for stroke is controversial.”
D.     “This risk for an allergic reaction is too great.”

Correct Answer: A


7.     The nurse is admitting a client with a possible brain attack. Which of the following data first alerts the nurse to the probability of a thrombotic event causing the brain attack? The:

A.     client was treated for bacterial meningitis with seizures two years ago.
B.     client has experienced three episodes of right-sided weakness in one week.
C.     client’s onset of symptoms of neurologic problems is in the daytime.
D.     client has adult onset diabetes mellitus.

Correct Answer: B


8.     The family of a client who has suffered a stroke asks you why the client is being discharged to a rehabilitation facility rather than directly home. What is your best response? To:
A.     insure that your family member will be able to function independently when discharged home
B.     relieve you and your family of caregiving responsibilities as long as possible
C.     provide ongoing therapy and care in order to maximize function
D.     treat the depression that most people with a stroke experience

Correct Answer: C


9.     Which statement made by the client with a stroke indicates a need for further discharge teaching? “I will

A.     call for assistance to climb the stairs.”
B.     have my family install handrails in the bathtub.”
C.     continue my physical therapy after my discharge.”
D.     take my antihypertensives only if my blood pressure is elevated.”

Correct Answer: D


10.     Which of the following clinical manifestations in a client following head trauma alerts the nurse to the possibility of a basilar skull fracture? The:

A.     client is lethargic and disoriented.
B.     client has clear fluid draining from the ear.
C.     scalp is lacerated at the site of injury.
D.     skull is depressed at the site of injury.

Correct Answer: B


11.     Which statement regarding the pathophysiology of closed head injury is true?

A.     The impacted area of the bone bends inward.
B.     Damage occurs to the gray matter of the cerebral cortex.
C.     The scalp is lacerated creating an opening to the brain tissue.
D.     The primary cause of closed head injuries is the penetration of an object.

Correct Answer: B


12.     A client with a major head injury is about to be discharged home. The client’s family expresses concern over the possible psychosocial or behavioral manifestations associated with traumatic brain injury. What is your best response?

A.     “Your family member may not recognize you, as long-term memory may be most affected.”
B.     “Your family member may become more outgoing, as depression is rare.”
C.     “Personality changes, such as temper outbursts, can be expected.”
D.     “Most people have few difficulties with learning and concentration.”

Correct Answer: C


13.     When taking the hourly vital signs of a client with a severe head injury, you note the client’s urine output has decreased from 50 mL/hour to 4 mL/hour. What is your best first action?

A.     Check to see if a diuretic is ordered.
B.     Increase the IV flow rate.
C.     Notify the physician.
D.     Document the finding.

Correct Answer: C


14.     You are caring for a client who has undergone a craniotomy for treatment of a primary brain tumor. Over the past three hours, the client’s urine output decreases dramatically to <20 mL/hr and serum sodium levels are decreased. What complication of the surgery is suspected?

A.     SIADH
B.     Hydrocephalus
C.     Subdural hematoma
D.     Neurogenic pulmonary edema

Correct Answer: A


15.     A client who has undergone a craniotomy for a primary brain tumor has just returned to the unit. In which position should this client be placed for maximum comfort and safety?

A.     High Fowler’s position
B.     Trendelenburg position
C.     Supine, with the head of the bed elevated to 30°
D.     Prone, with the head of the bed elevated to 45°

Correct Answer: C

Tuesday, November 08, 2005

Monday, November 07, 2005

Nerves

This is a nice link to look over if you have the time.

http://www.innerbody.com/image/nervov.html

I'm doing it again with the link attached.

Sunday, November 06, 2005

Nursing Blogs

This blog has lots of practice tests and more. Check it out.
Practice tests and more
I found the above blog link, on the following blog, so check this one out too. Whatever you find helpful, post it for the rest of us! There is too much information and helps for one person to sort through, but as a team, we can help each other.
Mediblogopathy

Saturday, November 05, 2005

New tool

Hey everyone, I found a new program that may help people post on the blog easier. It is a utility for your Word program that allows you to type into Word and post directly to the blog. I am using it now. The link, if you want to download and install it is:  http://buzz.blogger.com/bloggerforword.html

Friday, November 04, 2005

SJDeltaRNstudents12/06

Just thougth I would let everyone know that our spring registration appointments are up on the delta website under our accounts! (more money out of our pockets)

test #1

Hi! Did anyone happen to look at the posted grades for exam 1 today and see the distribution of the scores? (I couldn't make it down to look-live too far away but was curious anyway)

Wednesday, November 02, 2005

TO ALL N4 STUDENTS--CALCULATOR FOR THE EXAM!

Per Gloria we will need a calculator for the test on Monday. Please pass is on to those who may not read the blog every day.

Blood and blood disorders stuff

BLOOD

Serum = plasma minus fibrinogen

Albumin- provides osmotic pressure
(low albumin----edema)
-binds hormones and drugs

γ-globulin-antibodies (=humoral immunity)


BLOOD CELLS

Erythrocytosis -lack of oxygen: high altitude, COPD
Leukocytosis -infections
-leukemia

Neutrophils -infection, acute stress
Eosinophils -allergies, parasites
Lymphocytes –viral infections, TBC

Leucopenia -radiation
-bone marrow suppression

Thrombocytopenia -DIC
-bone marrow suppression


RED BLOOD CELLS

Hematocrit -percentage of RBCs in blood volume
-male adult: 40-50%
-female adult: 35-45%

Hemoglobin -oxygen carrying protein in red blood cells
-male adult: 14-16 g/dl
-female adult: 12-15 g/dl

Hematocrit may be false low if blood is obtained with capillary fingerstick (“milking”)

Direct Coombs’ test -test for antibodies on patient’s erythrocytes
Positive if: -hemolytic transfusion reaction (mismatch)
-autoimmune hemolytic` anemia
-erythroblastosis fetalis (maternal antibodies bind to fetal RBCs→hemolysis)

Indirect Coombs’ test -test for antibodies in patient’s serum
Positive if: -sensitization from previous transfusion
-Rh sensitization from previous pregnancy




ANEMIAS

Acute blood loss -hematocrit remains normal in acute phase!

Chronic blood loss -may lead to iron deficiency

Iron deficiency -search for occult bleeding, especially in elderly

Vit. B12 or folate deficiency -required for RBC maturation in bone marrow


-Alcoholics:
B12 and folate deficiency common

-Pregnancy:
Folate deficiency common (supplementation!)

Pernicious anemia -chronic gastritis type A (autoimmune disease)
-antibodies against intrinsic factor from stomach→reduced vit. B12 absorption in small bowels

Sickle cell anemia -abnormal hemoglobin (electrophoresis)
-“sickle cells” seen on blood smear
-painful crises, leg ulcers

Thalassemias -abnormal hemoglobin (electrophoresis)
-“target cells” on blood smear

Hemolysis -antibodies against RBCs
-fragile RBCs

Blood hemolysis→increased serum bilirubin!

ASSESSMENT
Fatigue
Pale skin and mucosa
ALL ANEMIAS:
-Check CBC, blood smear, hematocrit, hemoglobin and iron.
APLASTIC ANEMIA:
-Low reticulocyte count indicates decreased production of RBCs.
THALSSEMIA, SICKLE CELL ANEMIA:
-Hemoglobin electrophoresis shows abnormal hemoglobins
PERNICIOUS ANEMIA:
-Schilling test: to evaluate vitamin B12 absorption

ANALYSIS
-Skin integrity?
-Delayed wound healing?
-Effective gas exchange



IMPLEMENTATION
-Provide rest periods to avoid fatigue
-Assist with blood transfusions
-Monitor for transfusion reactions: pruritus, chills, fever, shock


BLOOD PRODUCTS
USED FOR:
Whole blood -active bleeding, massive transfusions (packed RBC are preferred; less volume load)
Fresh frozen plasma -bleeding patient with coagulation deficiency:
-chronic lever disease
-alcoholics
-DIC
Cryoprecipitate -DIC (to replace fibrinogen)

Factor VIII or IX concentrate -hemophilia (to replace missing factors)

TRANSFUSION RISKS:

ABO incompatibility 1:33,000
Febrile reaction 1:200
HIV 1:500,000
Hepatitis B or C 1:60,000

Most fatal transfusion reactions are due to a mismatch caused by clerical error!!!!


TRANSFUSION REACTIONS

ASSESSMENT
HEMOLYTIC REACTION (10-20 minutes):
-chills, headache
-lower back pain
-flushing, “head feels full”
-signs of shock
-acute renal failure (oliguria)
FEBRILE REACTION (30 minutes):
-chills headache
-elevated temperature
ALLERGIC REACTION:
-Pruritus
-Hives, wheezes
-Anaphylaxis


IMPLEMENTATION
HEMOLYTIC OR FEBRILE REACTION:
-immediately stop transfusion
-keep IV access-replace transfusion with normal saline
-call physician
ALLERGIC REACTION:
-if hives are the only sign: proceed at slower rate (check institutional guidelines!)
-prepare epinephrine if signs of anaphylaxis occur

Start infusion slowly (2ml/min) to observe for early reaction. Stay at bedside.

ACUTE LEUKEMIA

ALL-acute lymphoblastic leukemia (3-7 years)
(prognosis is fair)
-fatigue, weakness, anorexia
-fever
-petechiae (numerous tiny bruises (size of pinheads)
-ecchymoses (large area bruises)

AML-acute myeloblasic leukemia (all ages)
(prognosis is poor)
-fatigue, weakness, anorexia
-fever
-petechiae
-ecchymoses
-lymphadenopathy, splenomegaly
-Auer rods in myeloblasts

ANALYSIS
-risk of injury and infections
-effective coping?

IMPLEMENTATION
-monitor vital signs
-watch for bleeding
-watch for signs of infection
-minimize side effects of chemotherapy

Bleeding and infection are the major causes of death.


CHRONIC LEUKEMIA
CML-chronic myelocytic leukemia (50 years)
(prognosis is poor)
-fatigue, weakness, anorexia
-fever
-night sweats
-splenomegaly
-Philadelphia chromosome

CLL-chronic lymphocytic leukemia (70 years)
(prognosis is fair)
-insidious onset
-few symptoms
-low Ig levels
-infections



ANALYSIS
-risk of injury and infections
-effective coping?

IMPLEMENTATION
-monitor vital signs
-watch for bleeding
-watch for signs of infection
-minimize side effects of chemotherapy

BLEEDING DISORDERS
Platelet defect -bleeding into skin and mucous membranes
-males and females
Coagulation defect -bleeding into joints, muscle, viscera
-mainly males
Vascular defect -purpura (bleeding into skin)
-gastrointestinal bleeding
-mainly females

Prolonged use of a tourniquet before drawing blood sample may falsely increase PTT and PT!


THROMBOCYTOPENIA

Platelets<100,000/μL increased bleeding risk
Platelets<20,000/ μL spontaneous bleeding
Platelets<10,000/ μL CNS bleeding

CAUSES
Bone marrow failure -viral infections
-drugs
-radiation
Platelet destruction -ITP
Platelet consumption -TTP
-DIC
Platelet sequestration -splenomegaly

ASSESSMENT
-history of drugs/medication intake
-fatigue
-easy bruising: petechiae, ecchymoses
-bleeding from mucosal surfaces

IMPLEMENTATION
-prevent avoidable injury
-avoid invasive procedures if possible
-apply pressure to venipuncture site until bleeding stops

CLIENT EDUCATION
-avoid aspirin (suppresses platelet activity)
-avoid coughing and straining (increased BP increases risk of CNS bleeding)

HEMOPHILIA

Hemophilia A -factor VIII deficiency
-X-linked recessive
Hemophilia B -factor IX deficiency
-X-linked recessive
von Willebrand’s -deficiency of von Willebrand Factor
-autosomal recessive or dominant

ASSESSMENT
• Excessive bruising
• Prolonged bleeding after minor injuries
• Nosebleeds
• Hemarthrosis (bleeding into joints: elbows, knees, ankles)
IMPLEMENTATION
• When bleeding: Elevate and apply pressure for 10-20 minutes
• Avoid taking rectal temperatures
• Treat hemarthroses early to preserve mobility of joint (elevation, ice packs, may require splinting)
MEDICATIONS:
• Replace coagulation factors VIII or IX (heat-treated to inactivate viruses, or recombinant)
CLIENT EDUCATION
• Avoid trauma whenever possible
• Never use aspirin (inhibits platelets and worsens bleeding)
GENETIC COUNSELING:
• X-linked recessive disease: -transmitted by asymptomatic female carriers
-50% of male offspring will have disease
-50% of female offspring are carriers

DIC
(Disseminated Intravascular Coagulation)

Intravascular activation of coagulation causes consumption of coagulation factors. This results in thrombosis or bleeding tendency or both and is a very serious condition.

CAUSES OF DIC:
Gram negative sepsis
Adenocarcinomas
Crash injury
Amniotic fluid embolism

ASSESSMENT
LAB:
• PT and PTT prolonged
• Thrombocytopenia
• Decreased fibrinogen
• Increased fibrin split products
IMPLEMENTATION
• Identify and treat underlying disorder!
• Observe fro bleeding
• Monitor platelet count
• Assist with platelet transfusion (increases platelet count)
cryopreciptate (increases fibrinogen)
fresh frozen plasma(increases clotting factors)


LEUKEMIA

Leukemia is a general term used to describe a group of malignant disorders affecting the blood and blood-forming tissues of the bone marrow, lymph system, and spleen. It results in an accumulation of dysfunctional cells because of a loss of regulation in cell division. Although often thought of as a disease of children, the number of adults affected with leukemia is 10 times that of children.
Regardless of the specific type, there is generally no single causative agent in the development of leukemia. Most leukemias result from a combination of factors including genetic and environmental influences.

Acute lymphocytic leukemia (ALL) is the most common type of leukemia in children and accounts for 15% of acute leukemia in adults. In ALL< immature lymphocytes proliferate in the bone marrow. Fever is present in the majority of patients at time of diagnosis. Signs and symptoms may appear abruptly with bleeding or fever, or they may be insidious with progressive weakness, fatigue, and bleeding tendencies.

Acute myelogenous leukemia (AML) represents only one fourth of all leukemias, but it makes up approximately 85% of the acute leukemias in adults. Its onset is often abrupt and dramatic. A patient may have serious infections and abnormal bleeding from the onset of the disease.

Chronic lymphocytic leukemia (CLL) is characterized by the production and accumulation of functionally inactive but long-lived, mature-appearing lymphocytes. The lymphocyte involved is usually the B cell. Lymph node enlargement (lymphadenopathy) throughout the body is present and there is an increased incidence of infection. Because CLL is usually a disease of older adults, treatment decisions must be made by considering disease progression and treatment of side effects. Many individuals in the early stages of CLL require no treatment.

Chronic myelogenous leukemia (CML) is a clonal stem cell disorder characterized by excessive neoplastic granulocytes in the bone marrow and the presence of the Philadelphia chromosome (a cytogenetic abnormality). The chronic phase of CML can last for several years and can usually be well controlled with treatment.

Hodgkin’s disease, which makes up 15% of all lymphomas, is a malignant condition characterized by proliferation of abnormal, giant, multinucleated cells called Reed-Sternberg cells, which are located in the lymph nodes. The disease has a bimodal age-specific incidence, occurring most frequently in persons from 15-35 years old and over 50 years old. In adults, it is twice as prevalent in men as in women.

Non-Hodgkin’s lymphomas are a heterogeneous group of malignant neoplasms of the immune system that affect all ages. They are classified according to the different cellular and lymph node characteristics. NHLs can originate outside the lymph nodes, and the method of spread can be unpredictable. The majority of patients have widely disseminated disease at the time of diagnosis. (AKA; Burkitt’s lymphoma, reticulum cell sarcoma and lymphosarcoma.)

Human immunodeficiency virus (HIV) infection follows a highly individualized course from the time of infection to the clinical manifestations of acquired immunodeficiency syndrome (AIDS). More than 34 million people worldwide are infected with HIV; AIDS is the final phase of a chronic, progressive immune function disorder caused by HIV. HIV is an RNA virus. It is called a retrovirus because it replicates in a “backward” manner, going from RNA to DNA. Like all viruses, HIV cannot replicate unless it is in a living cell. HIV infects human cells that have CD4 receptors on their surfaces. These include lymphocytes, monocytes/macrophages, astrocytes, and oligodendrocytes. Immune dysfunction in HIV disease is caused predominantly by destruction of CD4+Tcells (known as T-helper cells or CD4+lymphocytes). The major concern related to immune suppression is the development of opportunistic diseases (infections and cancers that occur in immunosuppressed patients that can lead to disability, disease, and death).










NCLEX Study tip Link

This is from the nursing studio. Sound familiar?
http://www.nursingstudio.net/2005/10/28/nclex-study-tips/

Smile!

Top Ten Reasons (and more) Why I Want Star Trek’s© Medical Beds In My Unit!
http://deltarns2007.blogspot.com/2005/11/top-ten-reasons-and-more-why-i-want.html
http://www.nursingstudio.net/

WOW!

Did we just have a makeover, or what?
Looks good Debbie!

YOU MIGHT BE AN E.R. NURSE IF.....

I found this on the nursing studio blog

You believe that 90% of people are a poor excuse for protoplasm…
Discussing dismemberment over a gourmet meal seems perfectly normal to you..
You believe a good tape job will fix anything…
You have the bladder capacity of five people…
You can identify the positive teeth to tattoo ratio…
Your idea of a good time is a full arrest at shift change…
You find humor in other people’s stupidity…
You believe in aerial spraying of Prozac…
You disbelieve 90% of what you are told and 75% of what you see…
You have your weekends off planned for a year in advance…
You automatically assume the patient is a drug seeker when presented with the complaint of migraine, lower back pain, chronic myalgia (choose one of the above), a list of numerous allergies to meds (except Demerol), and the statement that the family doctor is from out of town…
Your idea of comforting a child includes placing them in a papoose restraint
* You encourage an obnoxious patient to sign out AMA so you don’t have to deal with them any longer…
You believe that “shallow gene pool” should be a recognized diagnosis…
You have discovered a new condition that you call “hypo-xanax-emia”…
You believe that the government should require a permit to reproduce…
You debate which is worse, spaghetti and meatballs or pizza and beer, while performing gastric lavage…
You plan your dinner break while lavaging an overdose patient…
You believe that “ask-a-nurse” is an evil plot thought up by Satan…
You believe that unspeakable evils will befall you if the phrase “wow, it’s really quiet” is uttered…
You threaten to strangle anyone who even starts to say the “Q” word when the ER is even remotely calm…
You refer to Friday as NH Dump Day and you don’t mean New Hampshire…
Your diet consists of food that has gone through more processing than most computers…
You believe chocolate is a food group…
You take it as a compliment when someone calls you a dirty name…
You say to yourself “great veins” when looking at complete strangers …
You have ever referred to someone’s death as a transfer to the eternal care unit…
You don’t think a referral to Dr. Kevorkian is inappropriate…
You have ever referred to someone’s death as a celestial transfer…
You have ever answered a “lost condom” phone call…
You refer to someone in severe respiratory distress as a “smurf”…
Your idea of a good time is dueling shock rooms…
You have ever wanted to hold a seminar entitled “Suicide…Doing It Right!”..
You feel that most suicide attempts should be given a free subscription to “Guns and Ammo” magazine…
You believe that “too stupid to live” should be a diagnosis…
You have ever had to leave a patient’s room before you begin to laugh uncontrollably…
You have ever wanted to reply “yes” when someone calls and asks “Is my (husband, wife, mother, brother, friend, etc.) there?”…
You have ever issued a “dead head” alert…
You have ever referred to the E.R. Doc or triage nurse as a “shit magnet”…
Your favorite hallucinogenic is exhaustion…
You think that caffeine should be available in I.V. form…
You have ever restrained someone and it was not a sexual experience…
Your most common assessment question is “what changed, — tonight ,to make it an emergency after 6 (hours, days, weeks, months, years)?”…
You have witnessed the charge nurse muttering down the hallway “who’s in charge of this mess anyway?”…
You refer to vegetables and are not talking about a food group…
You have ever used the phrase “health care reform” to instill fear into your coworkers’ hearts…
You believe the waiting room should be equipped with a valium fountain…
You play poker by betting ectopics on EKG strips…
You believe a “supreme being consult” is your patient.s only hope…
You want lab to order a “dumb shit profile”…
You are totally astounded when someone from a NH is understandable…
You have been exposed to so many x-rays that you consider radiation a form of birth control…
You believe your patient is demonically possessed…
You have ever had a patient look you straight in the eye and say “I have no idea how that got stuck in there !”…
You believe that waiting room time should be proportional to length of time from symptom onset (”you’ve had the pain for three weeks…well have a seat in the waiting room and we’ll get to you in three days”)…
You know the phone number to the local Detox Center by heart…
You have ever had a patient say, “. . .—-But, I’m not pregnant; I can’t be pregnant; how can I be having a baby?”…
You have ever had a patient control his seizures when offered some food…
You carry your own set of keys to the “leathers”…
Your idea of gambling is an ETOH level pool instead of a football pool…
Your bladder expands to the same size as a Winnebago’s water tank…
Your feet are slightly flatter and tougher than Fred Flintstone’s…
Your immune system is so well developed that it has been known to attack squirrels in the backyard…
You get an almost irresistible urge to stand and wolf your food even in the nicest restaurants…
Your idea of fine dining is anywhere you can sit down to eat…
You have a special shrine in your home to the inventor of Haldol…
Your idea of an x-ray prep is a second dose of Haldol…
Your idea of a CT prep includes Norcuron and a vent…
You have recurring nightmares about being knocked to the floor and run over by a portable x-ray machine…
Your nursing shoes have been seized and quarantined by either the Centers for Disease Control in Atlanta, OSHA, the EPA, or the Nuclear Regulatory Commission…
You’re able to tell the difference between a medical order and the ground around a poultry farm…
You’ve been chipping away at your BSN for longer than most people take for a doctorate…
Your idea of thawing the holiday turkey consists of an IV and warmed saline … (and if the holiday turkey you usually see has arms instead of wings and is sauced instead basted)…
You have every referred to subcutaneous air as “Rice Krispies”…
You have thought OD instead of BBQ when asked to get the Charcoal…
You believe that a large part of your daily calorie requirement is provided by Tylenol, Advil, or Excedrin…
AND FINALLY….===YOU MIGHT BE AN E.R. NURSE IF…—-YOU FIND HUMOR IN ANY OF THIS!!!

New Pharm Comuter program

Check this out. They are having the 1st semester students check out a new pharm program for the computer lab. Check it out. It can help break down the meds into a manageable amount to learn. It gives you rationale on how it works and what to look for too.

http://deltarns2007.blogspot.com/2005/10/dear-sjdc-future-nurses-we-are-in.html

http://online.medspub.com/medsonline/sec-support.html