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- CONTRAINDICATED- SEIZURES
Which of the following ECG chages should the nuse expect i a client with hyperkalemia?
Tall, tented T waves
Elevated potassium levels act as a mycardial depressant. Tall, tended or peaked T waves are an early sign of hyperkalemia. Other ECG changes include a prolonged PR interval, a loss of P waves and a wideing of the QRS complex. Flat T waves, depressed ST segments, and inverted T waves are ECG changes associated with hypokalemia.
pigmented macular lesions on the skin
white patches in mouth and esophagus
- CD4+ lymphosite count below 200/microliter
- Oportunistic infections
test and Diagnosis HIV
- Elisa, Western bolt (test)
- CD4+ greater than 200 microliters
Hiatal hernia sleep postion
upper body elevated
Burn victim IV infusion rate guided by which parameter?
Client weight in kilograms
2 to 4 ml of IV fuid x kg body weight x percentage of burn
Lab value concern when taking acetaminophen (Tylenol)
- Aspartat aminotransferase (Liver Enzyme levels)
- 12-31 units/L
Pancretic Enzyme Lab
elevated in a client with acute pancreatitis
- LAbs- Serum Amylase
- Serum Lipase
Late S/S of Carbon Monoxide Poisoning
Cherry red lips and skin
caused by rapid reduciton in urea, sodium, and other solutes from the blood.
may lead to ICP S/S
Tumor growing form a nerve in the auditory canal
s/s: Unilateral hearing loss and tinnitus
Examples of oxalate-rich foods (avoided in oxalate renal calculi)
spinach, rhubard, and asparagus, tomatoes, beets, choclate, cocoa, nuts, celery and parsley
how to administer DIDANOSINE (VIDEX)
chew tablets thoroughly before swallowing, may be crusehd and mixed in water...should not add to fruit jices other acidic liquid
ian antiretroviral drug
-Intra-aortic balloon pump (IABP)
-Pulmonary Artery (PA) catheter
-A temporary transvenous pacemaker
-Implantable cardioverter-defibrillator (ICD)
Intra-aortic balloon pump (IABP) = Used to treat cardigenic shock, uses internal compression to augment the pumping action of the heart.
Pulmonary Artery (PA) catheter = measures pulmonary artery pressure, which helps guide treatment.
A temporary transvenous pacemaker = used to treat symptomatic bradycardia and heart block.
Implantable cardioverter-defibrillator (ICD) = used to treat lethal ventricular arrhythmias and prevent suddent cardiac death. It isn't a specific treatment for cardiogenic shock.
Morphine route for MI severe chest pain?
IV to ensure adequate and prompt delivery of the medication and to prevent muscle damage, which can elevate cardiac enzyme levels. Morphine isn't given orally because the onset and duration of action is more variable. Morphine isn't given IM because muscle damage can increase cardiac enzyme levels, confusing the diagnosis. Moreover, if circulation is poor, the medcaiton could pool in the tissues, resulting in inadequate pain relief and possibly a drug overdose when circulation improves. If the client receives thrombolytic theraphy, a hematoma could occur at the site of an IM injection. Morphone given by lumbar epidural wouldn't relieve the chest pain.
Nitroglycerin ointment delay next application if:
Nitroglycerin is a vaodialator and can lower arterial blood pressure. As a rule, when the client's systolic blood pressure is below 90 mm Hg, the nurse should delay the dose and notify he physician. Nitroglycerin isn't contraindicated in a client with atrial fibrillaion. Headache, a common occurence with nitroglycerin, can be treated with an analgesic an isnt a cause for withholding a dose. Sites should be changed with each dose, especialy if skin irritation occurs.
Peripheral pulses location:
Dorsalis pedis pulse = betwen first and second metatarsal bones on the top of the foot
Popliteal pulse is located in the popliteal fossa lateral to the midline
Femoral pulse = found in the crease of the groin
Posterior Tibial pulse = inner aspect of the ankle just behind and below the medial malleolus
Central Venous Pressure
A CVP reading can be used to ascertain right ventricular function and intravascualr volume. As intravascular volume increases, CVP increases. Normal CVP values ranges from 4-10 cm H2O. In right-sided heart failure, flud overload causes blood to back up into the right atrium and venous circulation, resulting in an elevated CVP. In dehydration, CVP reading are low because intravascualr volume is low. CVP monitors don't measure blood pressure or cardiac output.
Electrocardiogram (ECG) with hyperkalemia:
Tall, tented T waves
- Elevated potassium act as a myocardial depressant.
- -Tall, tented or peaked T waves are an early sign of hyperkalemia. Other ECG chagnes include a prolonged PR interval, a loss of P waves, and a widening of the QRS complex. Flat T waves, depressed ST segments, and inverted T waves are ECG changes associated with hypokalemia.
S/S Dissecting aortic aneurysm
Abrupt, tearing or ripping pain; syncope; and diminished peripheral pulses
Severe tearing or ripping pain in the anterior chest extending to the shoulders, epigastric area, or abdomen.The client's blood pressure may be elevated in one arm, and the pain is severe. Distended jugular veins indicate heart failure. Hoarseness and respiratory stridor aren't typically seen.
Arterial occlusive disease contraindication:
May experience assocated neuropthy, imparing their ability to feel local temperature extrmes. Therefore, prolonged ehat or cold application is contraindicated. Stopping smoking, excerciseing, and keeping legs lower than the heart are all appropriate treatment measures for arterial occlusive disease.
Restrictive cardiomyopathy diagnosis priority
Restrictive cardiomyopathy lowers cardiac output and leads to heart failure, it produces fatigue and weakness.
Factor detects risk developing cardiogenic shock?
Decreased cardiac index
Cardiac Index, a figure derived by dividing the cardiac output by the client's body surface, helps identify whether cardiac output i sufficient or meeting a client's need. Decreased heart rate, blood pressure, and cerebral blood flow are less useful for detecting the risk fr cardiogenic shock.
After percutaneous transluminal coronary angioplasty (PTCA) complications alert for:
Chest pain and activity intolerance
Chest pain and activity intolerance suggest that the artery has become reoccluded, which may occur after angoplasty. Left-sided heart failure and decreased sensitivity to pain aren't related to PTCA. Increased shortness of breath indicates a respiratory problem or other heart condition.
12-lead electrocardiogram (ECG) experiencing inferior wall myocardial infraction (MI)
ECG changes involving MI?
- Inverted T wave
- Elevated ST segment
- Pathologic Q wave
An inverted T wave, an elevated ST segment, and a pathologic Q wave are signs of tissue hypoxia that occur during an MI. Ischemia results from inadequate blood supply to the myocardial tissue and is reflected by T-wave inversion. Injury from prolonged ischemia and is reflected by ST-segment elevation. Q waves may become evident when the injury progressess to infarction. A notched T wave may indicate pericarditis in an adult client. The presence of a U wave may or may not be apparent on a normal ECG; it represents repolarization of the Purkinje fibers. A prolonged PR interval is associated with first-degree atrioventricular block.
Assessment finding with ischemic ulcer casued by chronic peripheral arterial vasculr disease
An arterial or ischemic ulcer cased by chronic peripheral arterial vascualr disease occurs over the dorsum of the toes and foot. Venous ulcers occur around the ankle. Although venous ulvers produce little or no pain, ischemic ulcer are painful. Granulation tissue typically occurs at the base of a venous uler; however, little granulation tissue is seen with an ischemic ulcer. An ischemic uler tends to be deep, with circular, even edges. A venous ulcer is shallow and has irregular edges.
Thyroidectomy discharge instructions:
- Take thyroid rplacement medication as ordered
- Report changes-such as letharghy, sensitivity to cold, and dry skin-to the physician
After removal of the thyroid gland, he client needs to take thyroid replacement medicaiton. The client also needs to report such changes as lethargy, restlessmess, cold sensivitity, and dry skin, which my indicate the need for a higher dosage of medication. The thyroid gland soesn't regualte blood glucose level; therefore, signs and symptoms of hypoglycemia aren't relevant for this client. Dehydration is seen in diabetes insipidus. Injectable dexamethasone isn'tneeded for this client.
Hyperthyroidism exhibits manifistations similar to:
Hyperthyroidism is a hypermetabolic state characterized by signs as tachycardia, systolic hypertension, and anxiety, all of which are seen in adrenergic (sympathetic stimulation. Manifestation of hypovolemic shock, benzodiazepien overdose, and Addison's disease are simliary to those of a hypometabolic sate.
Levothyroxine (Synthroid) theraphy effectiveness:
Bacause a reduced metabolism, a person with hypothyroidism tends to gain weight. Levothyroxine increases the clients metabolic rate and results in weight loss. Excitability, anxiety, and irritability are signs of an overdose of levothyroxine. Depression and a reduced pulse are signs of hypothyroidism and indicate that the drug was ineffective.
Desmopressin acetate (DDAVP) route instruction
Instill the drug intranasally
The intranasal route of administration is used when lifelong theraphy with desmopressin is required. The drug isnt' available in oral or transdemal forms. Although a subcutaneous injection of desmopressin may be given, it isn't the preferred route for long-term theraphy.
Hyperglycemic nonketototic syndrom (HHNS) which DM client/patient greater risk?
20yr old type 1 DM
20yr old type 2 DM
60yr old type 2 DM
60yr old type 1 DM
A 60 yr old with type 2 diabetes
HHNS, a syndrome marked by severe hyperglycemia, commonly occurs in olde adults with type 2 DM. Diabetes ketoacidosis, marked by hyperglycemia and ketones in the urin, commonly occurs in client with type 1 DM
IV solution fluid theraphy for Diabetic ketoacidosis
Intially, a large volume of an isotonic solution, such as normal saline solution, is inflused to increase the client's fluid volume. When the client has stabilized, half-normal saline solution is used. As blood glucose levels drop to 250 mg/dl, the IV solution may be changed to 5% dextrose in half-normal saline. A 10% dextrose solution isn't infused to replace fluids in diabetic ketoacidosis
Subtotal thyroidectomy complication to assess:
Damage or removal of te parathyroid glands during surgery on the thyroid gland may lead to reduced levels of parathyroid hormone, which in turn leads to hypocalcemia. Hypokalemia, hypophosphatemia, and hyponatremia aren't electrolyte imbalances generally assocated with thyroidectomy.
Inappropriate antidiuretic hormone (SIADH) assessment finding
Decreased urine output
In SIADH, excess release of antidiuretic horme increases the reabsorption of water and reduces the production of urine. As a result, urine osmolality incrases, serum sodium levels and serum osmolality decrease, and blood urea nitrogen level remains normal.
Diagnosis of hypotension, hypoventilation, temperature of 94F
Imparied gas exchange
Hypothermia, hypotension, and hypoventilation are manifistations of myxedema coma, a potentialy life threatning complication of hypothyroidism. Impraied gas exchange is the most significiant nursing diagnosis becaue the client with myexedema coma may suffer from hypoventilation, bradypnea and respiratory failure casued byrespiratory muscle weakness and coma. Ensuring and maintaining a patent airway always takes precedence. Hypothermia occurs in the client in myexedema coma because of decrased metabolism. Disturbed though processes may result from reduced cerebral perfusion secondary to reduced cardiac output. Deficient fluid volume may result from impaired free water clearance.
Shortest to longest peak of insulins
- Humulin N
- Humulin L
Humalog peaks in 1/2 to 1 1/2 hours. Novolog peaks in 1-3 hrs. The peak action of Humulin N is in 4-12 hrs. Lantus peaks in 5 hrs. Humulin L peaks 7-15 hrs, and Ultralente peaks in 10-30hrs
Room best for a client with Hyperactive Goiter - alert and oriented but anxious with fine hand tremors and rapid speech
-Temperature 65-68 degrees F (18.3 - 20 degrees C)
-Temperature 75-78 degrees F (23.9 - 25.6 degrees C)
The client's symptoms indicate hyperthyroidism. Clients with hyperthyroidism have heat intolerance and need a room cooler than average, as weel as an environment with decreased stimulation. A room near the nurses' station doesn't meet the requirements. A temperature 75-78 degrees F (23.9 - 25.6 degrees C) would be too warm for the client with hyperthyroidism. A private bathroom may be desireable, but its more important to have a room with a suitable temperature.
A client with labyrinthitis started on Meclizine (Antivert) priority diagnosis
Risk for imbalanced fluid volume related t nausea and vomiting
Labyrinthitis is characterized by acute onset nausea, vomiting, and vertigo. The condition is painless and doesn't affect hearing. Although the anticholinergic affect of the medication may cause drowsiness, physical mobility wouldn't be impaired.
Difficulty reading small prints
Presbyopia is a loss of visual acuity for close objects. Its's commonly called farsightedness and occurs with advantage age. With retinl detachment, the client may initally complain of floating spots and recurrent flashes of light. As the detachment progresses, gradual vision loss occurs. Myopia is nearsightedness and can occur at any age. Refraction refers to the bending of light.
Acoustic neuroma s/s
Unilateral hearing loss and tinnitus
An acoustic neuroma is a tumor growing from a nerve in the auditory canal. Classic sign of acoustic neuroma include unilateral hearing loss that occurs oer an extended period of time and tinnitus (ringing in the ears). Severe vertigo, sensorineural hearing loss, and tinnitus are symptoms of Meniere's disease, which involves inner ear dysfunction. Presbycusis, an otologic effect of aging, results from a loss of hair cells in the organ of Corti and can cause an inability to hear high-pitched sounds. Sudden deafness may occur in a person with no previous hearing impairment. It may stem from acute infection, an metabolic disorder, head trauma, or ototoxic drugs.
Acute Otitis Externa assessment finding
Acute otitis externa is characterized by inflammation or infection of the extenal auditory canal. It has various causes, including bacterial infection caused by water retention after swimming. Though P. aerunginosa and Staphylococcus aureus are the most common pathogens, cultures are usually unnecessary unless the client is refactory to tratment. The client's tympanic membrane would remain intact. Fever and chills are unlikely findings with acute otitis externa.