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MED-SURG EXAM 1 REVIEW
You are assessing an older adult for malnutrition. What are appropriate nursing actions? โ monitor blood work (albumin, fats, cholesterol) โ Check oral mucosa SCALES โ Sadness or mood change โ Cholesterol is high โ Albumin is low โ Loss or gain in weight โ Eating problems โ Shopping and food preparation problems A Pt has inoperable lung cancer, prognosis is poor. the Pt says โI want to travel abroad for unfinished businessโฆ what type of anxiety is this pt exhibiting? โ Anxiety about unfinished business? Physiologic needs before psychosocial (Maslow's Hierarchy) โ assessing functional ability such as their own meal โ multiple meds for Cardiopulmonary diseaseโฆ For terminally ill Pt.. know their wishes, advance directives bc why? โ Look at the bottom for the table In an extended care facility, you are teaching a class about older adults about normal physiologic agingโฆ what should be included in your discussion? โ Decrease in bladder capacity due to elasticity & muscle support โ Difficulty seeing in low light environment โ Vital capacity of their lungs decline bc of structural changes An elderly Pt is scheduled for surgery.. what is this Pt at risk for? โ difficulty communicating after surgery โ skin elasticity decrease Chemotherapy to treat ovarian cancerโฆ Pt is vomiting on each previous dose of chemo.. What do you give to prevent vomiting? โ Antiemetics meds (Zofran) prophylactically before chemo and PRN
You are teaching a Pt about neutropenia after radiation therapyโฆ Know the types of food precautions *look at table at the bottom โ Remain in room, if needs to leave wear a mask, keep dedicated equipment in pt room, avoid invasive procedures causing breaks in the skin Hand washing โ minimize infection in the pt โ Water needs to be in water bottle bc risk for infection (No sharing of cup) โ Avoid uncooked foods, avoid fluids sitting out for 1 hr Focus assessment for elderly Pt receiving radiation therapy for lung cancer, what are the complications for radiation therapy? โ Most common reaction for chemo/radiation is bone marrow suppression= prone to infection A Pt is diagnosed with cancer, and is advised by HCP to get chemo STAT. Pt wants to try non traditional treatment first. Whats a good response? โ โTell me more about your concerns to chemo/radiation/surgeryโ You are caring for a palliative care Pt, what type of statements is said indicating they accept their prognosis? โ There no hope for cure so they're looking for limiting discomfort and making sure their comfort level is tolerable โ GOAL- prevent/relieve suffering, give them the best quality of life You are reinforcing teaching to a Pt with cancer. What are the clinical manifestation of cancer?
CAUTION
โ Change in bowel or bladder habits โ A sore that doesnโt heal โ Unusual bleeding/discharge โ Thickening/ lump in breast or elsewhere โ Indigestion or difficulty swallowing โ Obvious change in wart/mole โ Nagging cough/hoarseness Prevention & Early Detection of Cancer โ Limit alcohol, avoid alcohol/tobacco โ Get regular exercise โ Maintain normal body weight โ Obtain regular colorectal screening โ Mammogram & pap test โ Use sunscreen regularly; factor 15 or > โ Practice healthy dietary habits
A home health nurse is caring for an older Pt that is living alone. Pt is taking multiple meds for chronic health problems. How do you see if pt is compliant with meds? โ Used marked pillbox When assessing a Pt with UTI your first action is? โ Tell Pt to use the bathroom and empty their bladder before assessment An older adult with a broken arm has visible bruises that are healing at different times. You suspect abuse. โ assess pt alone โ PRIORITY is to keep them safe A Pt with stage 4 cancer is asking you about their prognosis. What do you tell them? โ poor prognosis Nursing intervention for a pt admitted in long-term facility. Pt may experience anxiety, depression, and disorientation when moving from one environment to a new one. โ Involve older adults in the decision to move and fully inform them about the location โ New residents can be greeted by staff members to provide orientation Splatic (?) treatment cancer โ Pt complaining of fatigue. Best nursing action is to? โ Assess CBC- blood level โ Anemia is one cause of fatigue A Pt is hospitalized for having a reaction to their cancer treatment. What are S&S for Neuropathy? โ pain, tingling, numbness (damaged nerves) Know how to calculate BMI Normal BMI is 18.5- 24. โ older adult normal level isโฆ โ weight (kg) / height (cm) 2 โ 1ft= 30. โ 1kg= 2.2 lbs Health promotion for older adults โ Reduction in diseases & problems โ Increased participation in health promotion activities (ex. water aerobics) โ Increased targeted services that reduce health hazards โ Health promotion activities can be used to increase self-care, personal responsibility for health, and independent functioning that will enhance the wellbeing of older adults
Older adult living alone tells nurse in the clinic that he is unable to drive to store, canโt cook in kitchen,etcโฆ โ refer them to community services to meals on wheels You are preparing an Pt for a physical exam by their HCP, your primary action is? โ Explain the procedure prior to assessment Nursing priority when performing discharge teaching to an older Pt is? โ limit distraction in the environment โ Closing doors, turning off TV An older Pt is A&O has metastatic cancer, in palliative care, and is ventilator dependent. The Pt says he wants the ventilator removed bc heโs tired. What do you do? โ Discontinue treatment bc it's the Pt wishes โ You donโt obey? Autonomy โ Actions done according to the pt choice or decision A hospice nurse is making visits to Pt with terminal cancer. Pt says he increased his pain med dosage. What is this called? โ Tolerance You are caring for a Pt who ask about preinvasive cervical cancer. Screening is called? โ Pap smear Group therapy for ptโs who are newly diagnosed of cancer. Therapeutic statements? โ Key is to listen actively to fears and concerns โ Can you tell me more of your concerns โ Are you afraid of having your breast removed? โ What do you mean? A cancer Pt is taking a new prescription called Zofran for Nausea. What do you administer? โ Analgesic โ Common adverse effects to monitor is headache (give tylenol), polyuria, lightheadedness, drowsiness, dizzy, photosensitivity Pt dx with colon cancer. Pt is asking the nurse what the provider will do about his cancer. What is the appropriate response?
- Write down all your Qโs/concerns and we will have the HCP answer them when the they get here o Nurse cannot answer the Q in behalf of the HCP. HCP will decide what treatment is best
โ S/e- bone pain, nausea, vomiting A Pt going into long term nursing care management. Which Pt is most appropriate to be transferred? โ Pt who weighs 350 lbs with osteoarthritis An older Pt who lives in a rural areaโฆ what would your intervention be for that pt? โ Transportation is the #1 barrier to health care โ Alternative service such as computer-based sources and chat rooms, DVDs, radios, community centers can help promote healthful practices. โ Other barriers are limited supply of health care workers and facilities, lack of quality health care, social isolation, and financial limitations Pancytopenia Pt (low WBC & RBC count)... UAP is assisting them, what type of actions can they do and cannot do? โ dental loss after eating? NO, at risk for infection/bleeding โ Can use saline rinses, toothpaste and toothbrush, baking soda Young old โ Ages 65-74 y/o Ageism โ^ Negative attitude based on age^ โ^ leads to discrimination and disparate care A nurse is taking care of a pt who is going into surgery what should you education? โ Choose answer that says bc type of surgery pt might not be able to communicate Pt with poor edacity turgor. Know why โ Pt with hypertension TIA is going to be educated on what โ S&S of a stroke call the doctor, longer than 24 hour symptoms is a stroke Elder pt suspect of taking UTI diuretics. What are nursing interventions? โ Assess! โ Inspect, auscultate, palpate An 85 y/o elderly pt. send home with different type of drugs. What are nursing interventions? โ Risk for adverse drug reactions because drug toxicity due to all symptoms Osteoarthritis affects the joints and knees. What is the major cause? โ Obesity
โ This pt would be sent to long term care Carcinoembryonic (CEA) โ CEA is a test that measures the amount of this protein that may appear in the blood of some people who have certain kinds of cancers If nurse is in a med surg and doctor suspect liver cancer what type of lab work would you check to confirm? โ a-fetorproten (FP) pt. with chemotherapy via IV, complains of itchy and pain. What is the intervention? โ Stop the chemotherapy; investigate A pt needs to increase their protein diet. What types of food are recommended? โ Soy, cottage cheese, yogurt, tuna fish, egg, ham, strawberries, banana Brachytherapy (internal radiation therapy) As a nurse, how do you know if the pt understands the treatment? โ Radioactive agent carried in the body such as the vagina or abdomen โ Pt states โI have a radioactive objectโ Pt states I can never go back to work bc of my disease. What is the best therapeutic communication to use? โ Restate pt statement Different types of cognitive fx โ Fluid intelligence โ Crystallized intelligence โ Vocabulary & verbal reasoning โ Spatial perception Nursing Management โ useful for obtaining assessment data in older adults to know if they need long term care or not
SPICES
โ sleep disorder โ problems with eating/ feeding โ incontinence โ confusion โ evidence of falls โ skin breakdown
