Exam 4: NSG123/ NSG 123 (Latest 2024/ 2025 Update) Med Surg 1| Review with Questions and Verified Answers| 100% Correct- Herzing
Exam 4: NSG123/ NSG 123 (Latest 2024/
2025 Update) Med Surg 1| Review with
Questions and Verified Answers| 100%
Correct- Herzing
Q: Diagnostic Test for Parkinson’s
Answer:
Use of Levodopa for one week
Q: Nursing Interventions for Parkinson’s
Answer:
Safety
Aspiration
Dietary consult for weight loss
Supplemental feedings
Weight weekly
Help with meals
Q: What type of exercise can a patient with Parkinson’s not do?
Answer:
Treadmill
Q: 3 Keys to Communication with Parkinson’s Patient
Answer:
Speak slow
Short Sentances
Face Client
Q: Why do we give levodopa/carbidopa together?
Answer:
Carbidopa prevents premature absorption of levodopa
Q: Risk Factors for Seizures
Answer:
CNS infection
Alcohol
Head injury
Q: What do interventions for seizures focus on?
Answer:
Safety
Q: How is an aura with a seizure beneficial
Answer:
help us determine what part of the brain is initiating the seizure
Q: First thing to do for a patient with history of seizures
Answer:
Implement seizure precautions
Q: What medications may be given during Status Epilepticus
Answer:
Ativan or Valium
Q: What is the goal of vagus nerve stimulation?
Answer:
Decrease length of seizure
Q: What medications can affect thyroid lab values?
Answer:
Contraceptives
Anything with iodine
Q: Two teaching aspects about Phenytoin (Dilantin)
Answer:
Can cause osteoporosis so increase calcium intake
Can cause gingivitis so good oral care is necessary
Q: Teaching to prevent constipation in hypothyroidism
Answer:
Increase fiber
Exercise
Drink water
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Delirium: State of temporary acute mental confusion. Usually develops over a 2-3 day person. It is life-threatening & possibly preventable syndrome. Most frequent complication of hospitalization in older adults. Priority of safety and treating underlying cause. Delirium, often called acute confusional state, begins with disorientation and, if not recognized and treated, can progress to changes in level of consciousness, irreversible brain damage, and sometimes death
Dementia Initial symptoms are related to changes in cognitive function. The cognitive, functional, and behavioral changes that characterize dementia eventually destroy a person’s ability to function. The symptoms are usually subtle in onset and often progress slowly until they are obvious and devastating. Family members often report to doctor: Memory loss, Mild disorientation, Trouble with words and/or numbers
Early vs. Later Signs of Alzheimer’s Early: Patients still have the ability do things for themselvesLate: patient cant swallow, incontinence, skin break down, ADLs
What can you delegate to a UAP with a dementia patient? Communicate with dementia patientUse ques to avoid confusionLet them do what they can do for themselvesRepositioningToileting
Signs/Symptoms of Abuse in Dementia Patients BruisePressure UlcerContinue to assess for any other signs to report as abuse
Diagnostic Test for Parkinson’s Use of Levodopa for one week
Nursing Interventions for Parkinson’s SafetyAspirationDietary consult for weight lossSupplemental feedingsWeight weeklyHelp with meals
What type of exercise can a patient with Parkinson’s not do? Treadmill
3 Keys to Communication with Parkinson’s Patient Speak slow Short SentancesFace Client
Why do we give levodopa/carbidopa together? Carbidopa prevents premature absorption of levodopa
Risk Factors for Seizures CNS infectionAlcoholHead injury
What do interventions for seizures focus on? Safety
How is an aura with a seizure beneficial help us determine what part of the brain is initiating the seizure
First thing to do for a patient with history of seizures Implement seizure precautions
What medications may be given during Status Epilepticus Ativan or Valium
What is the goal of vagus nerve stimulation? Decrease length of seizure
What medications can affect thyroid lab values? ContraceptivesAnything with iodine
Two teaching aspects about Phenytoin (Dilantin) Can cause osteoporosis so increase calcium intakeCan cause gingivitis so good oral care is necessary
Teaching to prevent constipation in hypothyroidism Increase fiberExerciseDrink water
2 Things to Teach Patients about Thyroid Replacement Hormone Cannot stop taking, lifelongUp to 6months for results/improvement
What is contraindicated when taking Levothyroxine? Antacids
When is levothyroxine best absorbed atleast 2 hours before meals
What medication cannot be given to someone who has a severe fever due to thyroid storm? Aspirin
Who is at highest risk for thyroid cancer Anyone who has had radiation therapy
What medication can we give a patient with hyperthyroidism with tachycardia and hypertension Beta-Blocker (Propranolol)
2 Things to Know about After Insulin Administration Do not massage siteDo not wrap injection site
What do you do in a hypoglycemic emergency when patient cannot swallow Injection of Glucagon
Complication associated with increased urination Electrolyte Imbalance
Metformin and IV Contrast Stop Metformin 48 hours prior to an IV contrast injection
If a diabetes patient is sick, do they discontinue insulin? No
Mixing NPH and Regular Clear then CloudyRegular then NPH
Nursing Safety Priorities for Dementia Provide calm and predictable environment to help minimize confusion and maintain safetyAvoid changing surroundings and care giversPromote physical activityo Provide cues and clear, simple instructionsAssess for signs of neglect and abuse Bed alarm, chair alarm, call light, bed in low position
Nursing Priority for Delirium Safety-fall riskAssess the cause of delirium
S/S Parkinson’s Tremor, rigidity, bradykinesia, postural instabilityThe effect of PD on the basal ganglia often produces autonomic symptoms that include excessive and uncontrolled sweating, drooling, paroxysmal flushing, orthostatic hypotension, gastric and urinary retention, constipation, dysphagia, and sexual dysfunction.
Stages of Parkinson: Mild In the mild stage, motor symptoms are inconvenient but the activities of daily living are not affected; symptoms are unilateral; medications are effective in controlling motor symptoms.
Stages of Parkinson: Moderate “In the moderate stage, symptoms are bilateral; movement is slow; “”freezing”” can occur; balance and coordination is impaired; medications to control motor symptoms may “”wear off””; medications may cause side effects such as dyskinesia.”
Stages of Parkinson’s: Advanced In the advanced stage, patients may be in a wheelchair or be in bed most of the day because of difficulties walking; they need help with activities of daily living and are unable to live alone; they may have significant cognitive problems; medication benefits and side effects may be difficult to balance.
Why do we use deep brain stimulation Parkinson’s? Surgery and deep brain stimulation (DBS) can help severe cases. With DBS, electrodes are surgically implanted in the brain. They send electrical pulses to stimulate the parts of the brain that control movement. Patients eligible for DBS are those who have responded to levodopa but are impaired by dyskinesias, have had the disease for at least 5 years, and are disabled by tremor.
What medication can cause a hypertensive crisis in Parkinson’s? MAOI Phenelzine (Nardil)Concurrent administration of nonselective monoamine oxidase (MAO) inhibitors (used in the treatment of depression) and levodopa can result in extreme elevations in blood pressure or hypertensive crisis.
Aura in Migraines An aura is characterized by focal neurologic symptoms. Visual disturbances (i.e., light flashes and bright spots) are most common and may be hemianopic (affecting only half of the visual field). Other symptoms that may follow include numbness and tingling of the lips, face, or hands; mild confusion; slight weakness of an extremity; drowsiness; and dizziness.
Nursing Treatment for General Headache Acute therapy for tension headaches entails the use of nonpharmacologic methods, such as rest, relaxation techniques, or stress-reduction strategies as well as medication. Pharmacologic treatment of tension headaches includes acetaminophen, aspirin, and nonsteroidal anti-inflammatory agents
Naproxen and Pregnancy Contraindications to naproxen or naproxen sodium include a known allergy to aspirin or other nonsteroidal anti-inflammatory drugs as well as pregnancy and lactation.
Naproxen Side Effects The most severe adverse effects of naproxen sodium include bronchospasm and anaphylaxis. Gastrointestinal (GI) adverse effects include GI bleeding, nausea, dyspepsia, and GI pain. BLACK BOX WARNING stating that naproxen sodium may put patients at increased risk for cardiovascular events and GI bleeding.
Pregnancy & Epilepsy Women of childbearing age who have epilepsy require special care and guidance before, during, and after pregnancy. Many women note a change in the pattern of seizure activity during pregnancy. The risk of congenital fetal anomaly is two to three times higher in women with epilepsy. Maternal seizures, anticonvulsant medications, and genetic predisposition all contribute to possible malformations.
Hyperthyroidism Lab Levels TSH decreases, antibodies stimulate release of T3/ T4 so T3 T4 increase
Hypothyroidism Lab Levels TSH increases, T3 T4 decrease
Complication of Hypothyroidism Any patient who has had hypothyroidism for a long period usually has associated elevated serum cholesterol, atherosclerosis, and coronary artery disease.
Treatment of Myxedema Give thyroid hormone- if they get chest pain you must stopUse warm blanket (passive warming to avoid an increased O2 demand)
Seizure Precautions Assist them to the floor and move objectsDocument time of seizurePlace in recovery positionSeizure precautions are maintained, including having available functioning suction equipment with a suction catheter and oral airway. The bed is placed in a low position with two to three side rails up and padded, if necessary, to prevent injury to the patient. The patient may be drowsy and may wish to sleep after the seizure; they may not remember events leading up to the seizure and for a short time thereafter
Diagnostic Data for Thyroid Cancer o Lesions that are single, hard, and fixed on palpation or associated with cervical lymphadenopathy suggest malignancy. Thyroid function tests may be helpful in evaluating thyroid nodules and masses; however, results are rarely conclusive. Needle biopsy of the thyroid gland is used as an outpatient procedure to make a diagnosis of thyroid cancer, to differentiate cancerous thyroid nodules from noncancerous nodules, and to stage the cancer if detected. Additional diagnostic studies include ultrasound, MRI, CT, thyroid scans, radioactive iodine uptake studies, and thyroid suppression tests.
Patient Teaching Biopsy Thyroid Cancer The procedure is safe and usually requires only a local anesthetic agent. However, patients who undergo the procedure are monitored closely because cancerous tissues may be missed during the procedure. A second type of aspiration or biopsy uses a large-bore needle rather than the fine needle used in standard biopsy; it may be used when the results of the standard biopsy are inconclusive or with rapidly growing tumors.
PTU Major Side Effects/Black Box Warning The FDA has issued BLACK BOX WARNING for propylthiouracil. Severe liver injury resulting in death or acute liver failure may occur within 6 months of treatment. All patients should receive instruction about the signs and symptoms of acute liver failure. Routine liver function testing is necessary to assess for liver failure.
What is the med Propylthiouracil given for? Treat Hyperthyroidism
What is the glycemic index? o One of the main goals of diet therapy in diabetes is to avoid sharp, rapid increases in blood glucose levels after food is eaten. The term glycemic index is used to describe how much a given food increases the blood glucose level compared with an equivalent amount of glucose. The effects of the use of the glycemic index on blood glucose levels and on long-term patient outcomes are unclear, but it may be beneficial. Patients can create their own glycemic index by monitoring their blood glucose level after ingestion of a particular food. This can help improve blood glucose control through individualized manipulation of the diet
Is DKA more common in type 1 or type 2? Type 1
A1C level that indicated diabetes A1C ≥6.5%Greater than 6.5%
What food group affects the glycemic index? Carbohydrates
Signs/Symptoms of HHS & Treatment The clinical picture of HHS is one of hypotension, profound dehydration (dry mucous membranes, poor skin turgor), tachycardia, and variable neurologic signs.The overall approach to the treatment of HHS is similar to that of DKA: fluid replacement, correction of electrolyte imbalances, and insulin administrationGlucose in urineNo ketones
What is HHS? Hyperglycemic Hyperosmolar SyndromeHHS is a metabolic disorder of Type 2 diabetes resulting from a relative insulin deficiency initiated by an illness that raises the demand for insulin. This is a serious condition in which hyperosmolarity and hyperglycemia predominate, with alterations of the sensorium (sense of awareness). At the same time, ketosis is usually minimal or absent.
10 Steps of Taking Blood Sugar 1. Hand hygeine & PPE2. Identify patient using two identifiers3. Choose site for blood sample4. Use alcohol swab to clean and let dry5. Insert test strip into monitor 6. Use single-use lancet to draw blood 7. Apply blood to test strip 8. Piece of gauze over the site and apply pressure 9. Read & record the result, reporting any abnormal values 10. Dispose of all equiptment safely
Onset, Peak, and Duration of Regular Insulin Short ActingOnset: 30-60minPeak: 2-3 hrDuration: 4-6hr
Onset, Peak, and Duration of Glargine (Lantus) Insulin Onset 70 minPeak N/ADuration 24 hour
When to give Glargine (Lantus) insulin: o It was originally approved to be given once a day at bedtime; however, it has now been approved to be given once a day at any time of the day but must be given at the same time each day to prevent overlap of action. Many patients fall asleep, forgetting to take their bedtime insulin, or may be wary of taking insulin before going to sleep. Having these patients take their insulin in the morning ensures that the dose is taken.
Onset, Peak, and Duration of Lispro (Humalog) Insulin Rapid ActingOnset 10-15 minPeak 1 hrDuration 2-4 hr
Complication of Insulin Pump o The most common risk of insulin pump therapy is ketoacidosis, which can occur if there is an occlusion in the infusion set or tubing. Because only rapid-acting insulin is used in the pump, any interruption in the flow of insulin may rapidly cause the patient to be without insulin
Contraindication of Lantus Hypoglycemia
When can regular insulin cause patients to experience hypoglycemia? At the peak
Iodine Teaching o Give solutions of iodine and iodine compounds with milk or fruit juice and administer through straw to prevent staining of the teeth
Sumatriptan Indication Health care providers use sumatriptan to treat acute migraine headache pain with or without an aura. They also use it to treat cluster headaches. Older adults should not take sumatriptan and other triptans
Sumatriptan Administration It is important to administer sumatriptan at the onset of migraine symptoms. Although it is appropriate to administer a second dose of the oral preparation when symptoms return, this should not occur earlier than 2 hours after the first tablet is taken.