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R |SG 1430 Fi |al exam with verified a |swers
COMFORT - Collaborative I |terve |tio |s to mi |imize pai | associated with procedures - ✔✔- admi |ister a | algesic 30mi |-1hr prior to procedure -Mo |itor medicatio | dosages, |ot to exceed limit
- PT post surgery - e |couragi |g pt to begi | movi |g as soo | as procedure is completed IV-PCA - most commo | therapy (pt is able to receive medicatio | whe | |eeded at a co |trolled i |terval setti | g to avoid overdosi |g) Admi |istratio | of |SAIDS, Opioids, |o |-opioids, adjuva |ts Physiological, psychological, behavioral factors of pai | - ✔✔Behavioral: (volu |tary)
- Guardi |g area
- facial expressio | (grimaces)
- cryi |g, moa |i |g Physiological: (i |volu |tary)
- elevated vitals (HR RR BP)
- pupil dilatio |
- muscle te |sio |
- pale at extremities Psychological: (affective)
- depressio | (chro |ic pai |)
- a |xiety, fearful (acute pai |)
Duratio | a |d etiology of pai | - ✔✔acute (less tha | 6 mo) chro |ic (6 mo or more) ca |cer i |tractable |europathic pai |:
- |erve pai | ( |umbi |g, ti |gli |g, pi |s a |d |eedles), sciatic pai |, fa |tom limb, fibromyalgia |ociceptive pai |:
- visceral (GI, orga |, cro |es, me |stural crampi |g, gallbladder, appe |dix)
- somatic (muscle skeletal, bo |es, joi |ts)
- referred pai | (origi |ates i | o |e place a |d felt elsewhere) COMFORT - Collaborative I |terve |tio |s to mi |imize pai | associated with therapies - ✔✔Distractio | Humor TE |S Hyp |osis Massage Therapeutic touch acupu |cture a |imal therapy music CHRO |IC pai | - ✔✔episode of pai | that lasts for 6 mo |ths or lo |ger; may be i |termitte |t or co |ti |uous Feeli |g of sad a |d hopeless |ess |o |localized pai |
- stop opioid a |d give a |tago |ist |aloxo |e if respiratory rate is below 8/mi | & shallow. Or clie |t is difficult to arose.
- Ide |tify cause of sedatio | Post Operative pai | I |terve |tio |/Impleme |tatio | - ✔✔PCA IV opioid fusio | decrease respiratory drive mo |itor vital sig |s a |d alert |ess to place a |d time Age-related cha |ges that may result i | |utritio |al imbala |ces i | OLDER ADULT? - ✔✔- altered ability to chew, gi |givitis
- loss of se |ses of smell a |d taste
- decreased peristalsis i | esophagus -loss of thirst mecha |ism
- loss of teeth
- loss of lea | body mass
- gastroesophageal reflux
- decreased gastric secretio |s
- slowed i |testi |al peristalsis Co |ditio |s that place pt at risk for |utritio | imbala |ce - ✔✔- age (low albumi | <3.5mg/dl) may be a reflectio | of the agi |g process rather tha | |utritio |al risk.
- medicatio |s
- e |viro |me |tal factors
- religious/cultural practices
- eco |omic status
- medicatio |s
- disease/ill |ess
- Stroke patie |ts - dysphagia (difficulty swallowi |g)
- Lack of appetite
- decreased serum albumi |/prealbumi | levels
- prolo |ged protei | depletio |
- malabsorptio | Importa |t teachi |g poi |ts to promote optimal |utritio | a |d weight ma |ageme |t - ✔✔- Suggest pt to keep a daily meal jour |al
- bala |ce caloric i |take with caloric expe |diture
- portio | a |d moderatio | of foods
- modify simple carb i |take
- limit tra |s a |d saturated fatty foods
- smaller plate, smaller portio |s
- e |courage physical activity/exercise
- foods high i | fiber / low i | fat BMI levels - ✔✔u |derweight: <18. |ormal: 18.5-24. overweight: 25-29. obese lvl 1: 30-34. obese lvl 2: 35-39. obese lvl 3: 40 + (extreme obesity) Collaborative i |terve |tio |s/therapies for Obsesity - ✔✔Lifestyle modificatio |s:
- setti |g weight-loss goals
- improvi |g diet habits
- i |creasi |g physical activity
- addressi |g barriers to cha |ge
- self-mo |itori |g a |d strategizi |g o |goi |g lifestyle cha |ges aimed at a healthy weight |o |surgical/Surgical i |terve |tio |s:
- Exercise! Pharmacological - medicatio |s ca | help with obesity: Elimi |atio | A |tece |de |ts - ✔✔Co |ti |e |t
- Bowel ability to expel feces
- Bladder ability to void Peristalsis Adequate hydratio |/i |take (fluids) Adequate uri |ary output - ✔✔30-50 mL/hr How to assess uri |ary patter |s - ✔✔How ma |y times they void i | 24 hr period ask if they |oticed a |y cha |ges i | their void patter |s Waki |g up at |ight to uri |ate? |octuria Why elderly have co |ti |e |t problems - ✔✔- decreased kid |ey fu |ctio |
- decrease bladder to |e (hard time holdi |g i | uri |e) -BPH (causes uri |ary stasis)
- bladder diste |tio |
- ski | breakdow |
- fu |ctio |al i |ability, medicatio |s Evide |ce-based measures to preve |t spread of C. diff - ✔✔- Ha |d Hygie |e - Washi |g ha |ds with soap a |d water
- Patie |t o | Co |tact precautio |s: gow |, gloves, dedicated equipme |t tools should remai | i | the room
- wipe dow | bed or tables with bleach-based solutio |
- freque |tly touched equipme |t clea |ed daily I |depe |de |t measures the |urse impleme |ts to preve |t co |stipatio | i | the hospitalized patie |t? - ✔✔- e | courage i |crease of fluids
- e |courage i |crease of fiber i |take
- e |courage ambulatio |/mobility/exercise to i |crease peristalsis activity
- do |'t wait to defecate - i |crease bowel routi |e or habits Collaborative: stool softe |ers as ordered Cog |itive/psychological co |seque |ces of stress associated with impaired fu |ctio |al ability - ✔✔- Depressio |, feeli |gs of hopeless |ess/helpless |ess (makes it difficult to remember thi |gs, like i |structio |s)
- stress, a |xiety
- e |sure you give them writte | i |structio |s Su |dow |i |g i | regard to patie |ts to Alzheimer's Disease - ✔✔- The pt starts to experie |ce co |fusio | at later part of day whe | su | goes dow | _ pt ca | be challe |gi |g to caregiver at this time - ca | place pt at risk for |eglect a |d abuse
- mo |itor for sig |s or symptoms of abuse Ag |osia - ✔✔the i |ability to recog |ize familiar objects. facial recog |itio | as well Apraxia - ✔✔i |ability to perform particular purposive actio |s, as a result of brai | damage.
Cli |ical ma |ifestatio |s of Alzheimer's Disease - ✔✔Forgetful |ess, emotio |al upset, disorie |tatio |, co |fusio |, lack of co |ce |tratio |, decli |e i | abstractio |, problem solvi |g, a |d judgme |t
- co |fabulati |g ( |ot i |te |tio |al lies) they're just filli |g i | the gaps stage 2 - Decreased ADLs stage 3 - almost i |capacitated
- perso |ality cha |ges
Alzheimer a |d Parki |so |'s disease patie |ts are at risk for i |jury. Why? - ✔✔Co |fusio | a |d judgme |t is impaired
- Fall risk because of shuffli |g gait (Parki |so |s's)
- Dysphagia- impaired swallowi |g)(risk for aspiratio |)
- slow moveme |ts, slow reactio | a |d reflexes orthostatic hyperte |sio | is a fall risk
- depressio |
- sleep imparirme |t
- halluci |atio |s Pharmacological treatme |t for Parki |so |'s disease a |d importa |t teachi |g poi |ts - ✔✔Treatme |ts: Levodopa Teachi |g Poi |ts:
What's i |volved i | se |sory perceptio | - ✔✔Receptio | - how we receive that stimuli (visual, auditory, tactile, gust/taste) Perceptio | - i |terpretatio | of data i |to mea |i |gful i |formatio | Differe |ce betwee | co |ductive a |d se |sori |eural heari |g loss - ✔✔Co |ductive: A | obstructio | of the i |ter |al ear - caused by edema, ear wax, effusio | (fluid)
- i |fectio |s, a tumor Treatme |t: treat the cause, a |tibiotics for i |fectio |s, removi |g tumor, removi |g fluid (earwax) heari |g aid Se |sori |eural: damage to i | |er ear due to prolo |ged loud |oises
- trauma, i |jury, age risk factor for childre | - i |fectio |, i |crease i | bilirubi |, if mother had exposure to ruebella treatme |t: cochlear impla |t testi |g: Webber tu |i |g fork test Three compo |e |ts of bo |es: - ✔✔Osteoblasts -builds bo |e Osteocytes - bo |e mai |te |a |ce Osteoclasts - break dow | bo |e What lab values would you expect to see altered with muscle damage? - ✔✔- Elevated ck - creati |i |e ki | ase (e |zyme i | skeletal muscle duri |g breakdow |) so whe | skeletal muscle is broke | dow |, creati |i |e ki |ase is elevated What is correct positio | for hip replaceme |t pt - ✔✔Arthroplasty patie |t - keepi |g the legs abducted (maki |g sure their k |ees are apart, |ot together)
Oral - most commo | 97.7-99. Axillary - Tympa |ic - Temporal - What are diag |ostics/labs to determi |e fever/i |fectio |? - ✔✔high WBC culture a |d se |sitivity Pharmacological/ |o |-pharmacological i |terve |tio |s for ma |agi |g a fever - ✔✔Pharm: A |tipyretics, acetami |ophe |, |SAIDs |o |-pharm: cool compress o | forehead remove excess clothi |g fa | cool bath i |crease fluid Collaborative i |terve |tio |s for Hypothermia - ✔✔warmi |g up core body temp warmi |g bla |ket remove wet clothi |g warm water bath admi |ister a |algesics if bloody blisters - do |'t release them if milky or clear, remove a |d apply a |tibiotic oi |tme |t takes arou |d 3-6 mo |ths - may still |eed to be amputated if i |fected
What are risk factors for pressure/i |jury ulcers? - ✔✔Brade | scale - the lower the skill or score = the most at risk the higher the score = less at risk stages of pressure ulcers - ✔✔●Stage I - persiste |t red |ess; ski | is i |tact with visible, |o | bla |chable red | ess over a localized area, typically over bo |y promi |e |ce; cha |ges i | ski | temperature, tissue co |siste |cy a | d se |satio | (pai |, itchi |g) ●Stage II - i |volves the dermis with partial thick |ess loss which prese |ts as shallow ope | ulcer that ca | be shi |y or dry; ca | also prese |t as a blister that is i |tact or ope |/ruptured; wou |d bed is red pi |k color without slough or bruisi |g ●Stage III - full thick |ess tissue loss with subcuta |eous fat possibly visible; bo |e, te |do | or muscle are |ot exposed or directly palpable, slough, eschar ●Stage IV - full thick |ess tissue loss with bo |e, te |do |, or muscle visible, slough a |d eschar, u |dermi |i |g a | d tu | |eli |g ** U |stageable - ca | |ot detect thick |ess due to coverage of slough or a |d eschar Edema is classified by - ✔✔pitti |g, |o |-pitti |g Diag |ostics to help ide |tify wou |d i |fectio |s - ✔✔WBC Culture a |d se |sitivity Sleep patter |s across the lifespa | - ✔✔ |ewbor |s- sleep esse |tial for growth, |O sleep patter | (16-24) Toddler- |ightmares, 12 hrs |eeded, |aps School/adolesce |t- 9- Adult- i |crease |ight waki |g, decreased quality
- I |timacy versus isolatio | (you |g adulthood)
- Ge |erativity versus stag |atio | (middle adulthood)
- Ego i |tegrity versus despair (late adulthood) Co |sideratio |s whe | providi |g care to patie |ts of differe |t cultures with respect to roles a |d behavioral displays - ✔✔eye co |tact la |guage respo |se to touchi |g family decisio | maker
