NSG 320/ NSG320 Exam 1 Version 2 (NEW 2026/ 2027 Update) Adult Health Nursing I Complete Guide| Questions & Answers| Grade A| 100% Correct (Accurate Solutions)- GCU

1 …..DLDD NSG 320/ NSG320 Exam 1 Version 2 (NEW 2026/ 2027 Update) Adult Health Nursing I Complete Guide| Questions & Answers| Grade A| 100% Correct (Accurate Solutions)- GCU Q. What are the principles of health supervision? ANSWER -providing services proactively from birth to adolescents (not just intervening when sick, but intervening even when they are well) -the focus of health supervision is wellness (maximize health promotion for child, family, and community) 1. Developmental Surveillance and Screening 2. Injury and Disease Prevention 3. Health Promotion Q. What are 3 things that encompass wellness? ANSWER 1. the focus is wellness! -maximize health for the child, family, and community 2. build a medical home -long-term comprehensive relationship with families 3. partner with the family -focus on strengths -recognize parents are experts -use the child's behavior as your language Q. How do the PCP visits work within childhood? ANSWER 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, 2 years, 2.5 years, 3 years, then annually 2 Q. What screenings can occur at the PCP visits? ANSWER -hearing -vision -lead -oral health (every 6 months after the age of 1; some people say start after 3 years of age) -communicable diseases -iron deficiency -hypertension -hyperlipidemia Q. What vaccines are given SQ, PO, and IM? ANSWER -SQ: IPV, MMR, Varicella -PO: rotovirus ^I know this is silly but roto- reminds me of rotisserie chicken, and we eat that by mouth (lol) -IM: all the others Q. What are immunizations and why are they so important? ANSWER -immunizations stimulate the immune system to produce antibodies against a specific disease -when an antigen invades, the body is ready to send fighting antibodies ^passive immunity: immunoglobulins passed from one person to another (mother to baby; blood transfusions) ^active immunity: own immune system activates response -different types of immunizations: live, inactivated, toxoid, conjugate, and recombinant -immunizations are reviewed ANNUALLY 3 Q. What are contraindications for immunizations? ANSWER Permanently -anaphylaxis -encephalopathy within 7 days of pertussis immunization Temporary -immunocompromised -pregnant (cannot receive a LIVE vaccine) -children with intussusception should not receive the rotavirus vaccine -recently receiving blood products (passive immunity) -moderate to severe illness Q. What are immunizations starting in infancy and what is important to know about them? Hep B ANSWER - three doses starting at birth Diptheria, Tetanus, and Pertussis -Dtap: 7 years of age (start at 2 months) -Tdap: 7 years of age ^a good way to remember Tdap is the capital T stands for "tall" people, sooooo those who are 7 years of age Haemophilus influenza type B -start at 2 months Polio -only inactivated given starting at 2 months of age (IPV) Pneumococcal Vaccines -start at 2 months of age Rotovirus -live virus -given PO 4 Q. What are immunizations starting in toddlerhood and what is important to know about them? Varicella ANSWER -live: booster at 4 years of age; may be given with live OR 28 days apart -rash may occur -you need to be one year or older to get it Measles, Mumps, Rubella (MMR) -live: booster at 4 years; may be given with live OR 28 days apart -you need to be one year or older to get it Hep A -two dose series Q. What are immunizations for people 11 and older, and what is important to know about them? ANSWER Human Papillomavirus (HPV) -three shot series -boys and girls may receive -may get as early as 9 years of age Meningococcal -given at 11 years of age and booster at 16 years -high risk groups may be given earlier in life Q. What are barriers to immunizations? ANSWER 1. Multiple Injections -many combination vaccines are available (ex. ProQuad, Pediatrix DTaP, Hep B, IPV) 2. Maintaining a good record 3. Parental Concerns -be familiar with resources (ex. CDC) 5 Q. What are typical pediatric vitals? ANSWER Temperature -normal: 37.3 (99.9 F) -report immediately for a young infant with a temp 38.0 (typically younger than 6 months) - for an older infant/child, a fever is 38.5 (typically older than 6 months) Pulse -high in infants (slows as you grow) -normal: "100" ish -children under 12 years should always have a pulse greater than 60/minute (if under 60 bpm, start CPR) Respirations -normal: "20-30" ish in infants/toddlers -"20" ish for preschool and school age Blood Pressure -"60-80/40-50" in infants -"100ish/70-50" in children Q. What are some important things to remember about vitals? ANSWER -fevers in well children isn't too much of a concern, but a child with a chronic illness who has a fever needs to be taken care of immediately -if a fresh baby/infant 6 months has a fever, we need to act on it immediately -if your child has a HR less than 60 bpm, START CPR (emergency code situation) -most codes within the pediatric population are because of a respiratory distress issue Q. What are important things to know with hygiene? ANSWER -turn every 2 hours to maintain healthy skin -bathing -hair care should be performed 1-2 times per week -diaper changing needs to occur q 3hrs (typically done after feeds or temps) -oral hygiene 6 Q. What feeding issues can occur? ANSWER -feeding is WORK for an infant -refusal to eat is common in children (its a control issue; allow choices) -make eating interesting! ^ "What kinds of foods do you like?" ^ "Would you like pancakes or cinnamon toast?" Q. What are important things to know about feeding infants? ANSWER -DO NOT warm in the microwave, but use warm water instead ^microwaving can breakdown the good nutrients within the milk -1 to 3 months baby usually takes about 3-5 oz formula -3 to 6 months baby usually takes 5-6 oz formula -6 to 12 months baby usually takes 6-7 oz formula -normal feeding schedule is every 3-4 hours -DO NOT ALLOW feeding to extend longer 20-30 minutes (burning more calories than ingesting; remember that feeding is work for an infant) -DO NOT prop the bottle 7 Q. What are important things to know about skin level gastrostomy devices? ANSWER -they can fall out -we need to replace these periodically -if it falls out, we need to replace it as fast as possible because the insertion site will close if left unattended -typically, these associate with slow feeds (sometimes its good to provide non-nutritive sucking along with feeding because it helps with the digestive process) -we also want to warm up the formula before we put it through the tube -we only need to flush with about 5 cc of fluid because if we use 30 cc that is way too much for their small bellies Q. What are ways to improve absorption of feeds? ANSWER -use pacifier during alternative feeds (nonnutritive sucking improves digestion) -quiet, calm environment -consistent feeding techniques by caregivers/family members Q. What are important things to remember about TPN administration? ANSWER -administer through a central line -use an in line filter -check blood glucose -use aseptic technique -monitor VS -monitor for infection -monitor for electrolyte imbalances -keep system closed at all times (this avoids air embolus) -avoid administering medications through TPN line -we need to make sure we always check the order on the bag (never just pick a random bag up) -anything higher than 12% you probably shouldn't give through an IV -when you stop TPN, you need to check glucose (it is best to taper TPN so the child's sugar doesn't crash) 8 What are differences with pediatric medication administration? Medications are affected by... -high % of body water, decreased body fat, liver immunity, decreased plasma proteins available for binding, and limited renal excretion Oral Meds -slower gastric emptying, increased intestinal motility, high pH, decreased lipase/amylase Intramuscular -amount of muscle mass and tone ^faster absorption rate in an infant Topical -greater body surface area ^increased absorption/permeability What are important things to remember with oral medication administration for the pediatric population? -greater risk of aspiration in children less than 6 years of age ^use liquids or crush meds, and mix with a SMALL amount of liquid -use calibrated equipment such as an oral syringe -hold the child in an upright position and squirt the med into the side of their mouth (buccal) -Sodimier technique: have parents blow into their child's face while they take medication; it will startle them, causing them to swallow -use syringe/nipple -do not mix with formula (if the child doesn't finish formula, we are unsure about the amount of medication the child has received) -do not refer to as candy -may mix with small amounts of syrup, apple sauce, or ice cream -use popsicles to numb the tongue 9 -use a "chaser" if appropriate What is important to know about rectal and otic medication administration in the pediatric population? Rectal -less than three years of age, use the fifth finger -older child, use index finger -insert meds beyond both rectal sphincters (small child less than 0.5, older child 1 inch) Otic -3 years and younger: pinna down and back -older children: pinna up and back -allow refrigerated medications to warm to room temperature prior to administration -massage the out area for a few minutes following administration What is important to know about IM medication administration in the pediatric population? Preferred Site: Vastus Lateralis -important to recognize the amount being administered; if it is a lot, we need to place it in 2 separate syringes, give it in 2 legs, and administer at the same time -the deltoid can be used if the child is older than 3 years of age Needle Size -22-25 gauge, 5/8-1 inch needle in younger children -volume: 0.5-1 ml...for school age 1-5 ml EMLA -cream (put on site for injection/IV insertion) we put on 30 minutes before to help decrease pain and trauma of injections (this is a type of Atraumatic Care) What is important to know about IV medication administration within the pediatric population? Atraumatic Care -EMLA, parent participation, therapeutic hugging, adhesive remover Prevention of Fluid Overload -10 kilos: 100ml/kg/day -always use a a pump or Buretrol device (this device limits the size of boluses for the child b/c they can't take boluses like adults can) -maintenance fluids are much less in the pediatric population Prevent Complications -inspect site q 1-2 hrs -change dressing and tubing per institution protocol What are the different types of venous access? Heplock -1 to 3 cc saline I-Port -5cc saline-----5 cc 10 unit Heparin Broviac -3cc saline-----3cc 10 unit Heparin PICC -use at least a 5cc syringe! 10 -read Kardex for protocol What does OLD CART stand for? -O: onset -L: location -D: duration -C: characteristic -A: aggravating -R: relieving -T: timing What things can we look for to add to the pain assessment? -facial expressions -body movements (ex. guarding) -moaning/crying -decreased attention span -changes in VS Other Info -look how the patient is before an after pain management ^did things improve or were there no changes? -let parents come to their own conclusions What are common pain scales used within the pediatric population? Neonates -NIPS (Neonatal Infant Pain Scale); birth to 2 months ^facial expressions, cry, breathing pattern, arms, legs, and state of arousal 2 months-7 years -FLACC ^facial expression, position of legs, activity, crying, consolability 3 years and Older -FACES pain scale 11 7 years and Older -VAS (visual analog scale) What are behavioral-cognitive strategies to help with pain? -guided imagery (older children) -breathing and relaxation (older children) -distraction -thought stopping (substitute pleasurable thought for painful experience) -music -pet What are some biophysical interventions we can perform to help improve pain? -sucking and sucrose...breastfeeding -heat/cold -massage/acupressure -positioning What are nonpharmacologic pain interventions we can do for infants? -containment: swaddling -positioning -nonnutritive sucking (sucrose) -kangaroo holding What are non-opioid and opioid analgesics we can give to a patient? Non-Opioid -acetaminophen and NSAIDS (mild to moderate pain) Opioid -morphine, oxycodone, fentanyl (moderate to severe pain) What is the preferred site for medication administration? Oral (PO) Meds -however, if pain needs to be immediately resolved this probably isn't the best way to do that What are topical/transdermal ways to help improve pain in the pediatric population? EMLA -use before painful procedures -at east 1 hour before superficial procedures (IV or shots) -2 to 3 hours before more invasive procedures (ex. bone marrow or chest tube insertion) Fentanyl -for 12 years of age -provides continuous pain control -Narcan for respiratory depression 12 What are ways to help improve pain in the pediatric population through IVs? -method of choice for emergency, severe pain, and quick relief -morphine preferred opioid but hydromorphone may be used Torodol -may be used for moderate pain -stops prostaglandins that we want and don't want to stop ^want: pain, inflammation, menstrual cramps ^don't want: decreased platelet aggregation, GI distress What is the mechanism of action for PCAs? -Morphine is the drug of choice Basal Rate -purpose: consistent controlled pain mechanisms -you should also have fluids running during PCA administration Bolus Doses -patient administered -nurse or parent administered ^advantages: do not have to wait to receive pain medication and it also gives them control What is an epidural and what nursing care should we provide with it? -opioid + local (bupivacaine or ropivacaine) -instilled via single or intermittent bolus, continuous infusion, or patient controlled epidural analgesia (PCEA) Nursing Care -monitor for respiratory depression -monitor the skin around the surgical site ^make sure the site is not wet; if the site is wet, that tells us that it has dislodged 13 -assessment of pain What are side effects of pharmacological pain management? -respiratory depression -constipation (can give a stool softener, increase fiber, and increase fluid intake to help this side effect) -pruritis (not really a side effect) -N/V (avoid stimuli that causes increased nausea; possibly give an anti-emetic) -sedation -tolerance -physical dependence What patient and family education needs to occur in regards to pain management? DISCUSSION -safety in all ages with appropriate dosing -addiction/dependence -cause and effect of psychologic dependence -nursing statements to child/family and potential effects How often do check pain after administration? q 15 to 30 minutes What are factors affecting a child's reaction? -previous experiences -developmental level -recent life stressors -patients reaction to illness What nursing care can we provide in order to minimize stress? -describe/educate in terms child can understand ^helps in gaining feelings of control if they understand what's going on and what to expect ^ex. transitional objects: baby doll or stuffed animal (using them to demonstrate how medical procedures are done) -provide concrete information ^ex. temperature, lighting, sounds to expect -atraumatic care What nursing interventions can we perform for an infant (2 days-1 year) to decrease loss of control? Erikson Stage: Trust v Mistrust 14 -achieving this task is based on the quality of the caregiver-infant relationship and the care received by the infant -the infant begins to learn delayed gratification; failure to learn delayed gratification leads to mistrust -trust is developed by meeting comfort, feeding, stimulation, and caring needs -mistrust develops if needs are inadequately or inconsistently met, or if the needs are continuously met before being vocalized to the infant Techniques -use soother (suck, swaddle, swaying, shhh) -respond to crying quickly -use a schedule -use calm but confident approach What nursing interventions can we perform for a toddler (1 to 3 years) to decrease loss of control? Erickson Stage: Autonomy v Shame and Doubt -independence is the paramount for toddlers, who are attempting to do everything for themselves -toddlers often use negativism, or negative responses, as they begin their independence -ritualism, or maintaining routine and reliability, provides a sense of comfort for toddlers as they begin to explore the environment beyond those most familiar to them (love rituals at this stage) Regression -typical regression -ex. a toddler who has been off a pacifier is now a thumb sucker -ex. a toddler who drinks out of a cup now wants to drink out of a bottle Techniques -appropriate choices -encourage active play (gross motor development is huge during this stage) -approach SLOWLY -expect temper tantrums (this is a normal response) 15 -use transitional objects ^ask them about who they have with them (toy/stuffed animal), and let them share ^if the child doesn't want to talk, read a book to them (this helps to establish a relationship) What nursing interventions can we perform for a preschooler (3 to 6 years) to decrease loss of control? Erickson Stage: Initiative v Guilt -preschoolers become energetic learners, despite not having all of the physical abilities necessary to be successful at everything ^egocentric and magical thinking limits ability to understand events -guilt can occur when preschoolers believe they have misbehaved or when they are unable to accomplish a task -guiding preschoolers to attempt activities within their capabilities while setting limits is appropriate Techniques -appropriate choices -USE PLAY -simple concrete communication ^rather than saying, "I'm going to be taking your BP," say "I'm gonna give your arm a hug." -do not prepare to far in advance What nursing interventions can we perform for a school-age child (6 to 12 years) to decrease loss of control? Erickson Stage: Industry v Inferiority -a sense of industry is achieved through the development of skills and knowledge that allow the child to provide meaningful contributions to society ^striving for independence and productivity -a sense of accomplishment is gained through the ability to cooperate and compete with others -children should be challenged with tasks that need to be accomplished, and be allowed to work through individual differences in order to complete the tasks -creating systems that reward successful mastery of skills and tasks can create a sense of inferiority in children unable to complete the tasks or acquire the skills 16 -children should be taught that not everyone will master every skill Techniques -choices as appropriate -use book, videos, and diagrams ^ex. if they are getting something done to a specific bone, show them a skeleton and point to where the procedure is being done -allow time for questions -encourage schoolwork -encourage play What nursing interventions can we perform for an adolescent (12 to 20 years) to decrease loss of control? Erickson Stage: Identity v Role Confusion -adolescents often try different roles and experiences to develop a sense of personal identity, and come to view themselves as unique individuals -group identity: adolescents become part of a peer group that greatly influences behavior -struggling for independence, self-assertion, and liberation centers on the quest for personal identity -may react to dependency with rejection, uncooperativeness, anger, frustration, or withdrawal Techniques -appropriate choices ^ex. You need to walk around the unit 3x today. What times would be best for you? ^ex. So we have to get you in the chair today. Would you like to get in the chair now or when your breakfast comes? -do not scold -privacy -confidentiality -allow teens to interact -encourage visits from friends 17 How do we minimize the loss of control overall? Maintain Routine -gain an understanding of normal routine -use charts in room -nurse-to-nurse communication Promote Freedom of Movement -ex. thumbsucker: avoid placing IV in preferred arm SAFETY -in room and in play room -use treatment room for painful procedures Encourage Independence -limit restrictions if possible -take walks, go to the play room, outside Verbal Communication -speak in terms that children will understand and not fear -very concrete: avoid things like "a little stick", "feels like a bee sting", "coughing your head off" -instead say "I'm going to give to medicine under your skin" and "I can feel how warm you are." Nonverbal Communication -establish a rapport through PLAY -get on a child's eye level -use transition objects What things need to be addressed upon admission of a child? -previous experiences -knowledge base -developmental level -recent life stressors -parents reaction to the illness What are the three phases of separation anxiety? 1. Protest Phase 2. Despair Phase 3. Detachment Phase What occurs in the protest phase? -cry and scream -cling to parent -typically seen in the hospital setting What occurs in the despair phase? -crying stops -evidence of depression 18 What occurs during the detachment phase? -denial; resignation, not contentment -may seriously affect attachment to parent after separation -rarely seen within the hospital setting How do we prevent or minimize separation anxiety? Parent Participation -include parents in daily plan of care; rounds -assess parent ability to stay during procedures, encourage presence as appropriate ^assist parents in therapeutic hugging/ distraction Encourage Parents to Room In -help parents to make decisions regarding ability to stay -facilitate parents in being an advocate for child -parents do not substitute the nurse If parents cannot stay... -provide "presence" through spending time and being physically close while using a quiet tone -keep frequent updates with the parents (KEEP THEM INVOLVED) What are the 3 basic components of pediatric care? 1. focus on family centered care: you are not only caring for the patient, but you're taking care of everyone involved with that child 2. provide atraumatic care 3. use evidence-based practice During the family assessment, what considerations must we take as the nurse? -child and parent temperament ^easy going, slow to warm up (willing to change but it is hard for you), difficult (going shopping during nap time...BAD IDEA) -family structure (ex. nuclear; special family situation; view the next card to see family types) -lifestyle choices (inactivity, ETOH/drugs) 19 -socioeconomic status (poverty greatly increases the risk of poorer child health) -nutrition -environmental exposure (air pollution, smoke, water contaminants) -assess to healthcare (insurance, transportation, location, sociocultural barriers) -culture -community connections/support -spirituality What are the different types of family composition? (from ATI Ch 1) -traditional nuclear family: married couple and their biological children (only full brothers and sisters) -nuclear family: two parents and their children (biologic, adoptive, step, foster) -single parent family: one parent and one or more children -blended family: at least one step-parent, step-sibling, or half-sibling -extended family: at least one parent, one or more children, and other individuals (might not be related) -gay/lesbian family: two members of the same sex who have children and a legal or common-law tie -foster family: a child or children who have been placed in an approved living environment away from the family of origin -binuclear family: parents who have terminated spousal roles but continue their parenting roles -communal family: individuals who share common ownership of property and goods, and exchange services without monetary confusion What are the 4 parenting styles? 1. authoritarian 2. authoritative 3. permissive 4. uninvolved What are characteristics that encompass the authoritarian parenting style? -expects obedience, and discourages the child questioning family rules -low support & high control -child has little to no decision making 20 ex. the child is NEVER allowed to watch TV on school nights (ATI example) What are characteristics that encompass the authoritative parenting style? -expects child to adhere to rules -respects the child's opinion -promotes individualism ex 1. The child can watch TV for 1 hr on school nights after completing all homework and chores (ATI example) ex 2. Privileges can be taken away but later reinstated based on new guidelines (ATI example) What are characteristics that encompass the permissive parenting style? -little control over child's behavior -inconsistent, unclear rules -little discipline ex 1. The child assists with deciding whether they will watch TV (ATI example) ex 2. At one moment, jumping on the bed is ok and fun. Another moment, jumping on the bed is not acceptable and parents are disappointed (very confusing to the child) What are characteristics that encompass the uninvolved parenting style? -basic needs are not met ex. The child may watch television whenever they choose What is the difference between discipline and punishment? Discipline -increasing desirable behaviors and decreasing undesirable (kids love attention so when we give attention to desirable behaviors they will then be repeated by the child) -positive reinforcement: "time-in" -extinction: "time-out", ignoring Punishment -negative or unpleasant experience -verbal: scolding, disapproving statements -nonverbal: spanking What are recommendations to help parents with the distinction between discipline and punishment? -clear, consistent expectations 21 ^if you as the parent say it, you must up keep it ^ex. If you tell the child, "If you keep acting like this, we aren't going to the party," then you have to keep your word -avoid spanking -model desired behavior -GIVE ATTENTION and praise desired behavior -provide action of (positive or negative) behavior immediately When can an emancipated minor consent themselves? -in armed services -married -court appointed -financially independent and lives without parent support -college attendance -pregnancy -mother younger than 18 -runaway What is the mature minor doctrine? -very fuzzy area -healthcare provider determines what the parents need to know and what the parents don't need to know What services can a mature minor receive confidential/consent? -pregnancy -prenatal care -contraceptives -STI treatment -substance abuse -mental illness What do we need to assess for in regards to maltreatment? Assess for violence in and around the home -suicide -violence in the community -school violence (frequent absence, HAs, stomach aches) -violence in home Children Questions - "Do you feel safe in your home?" - "What happens to you when you get in trouble?" 22 Parent Questions - "Do you feel afraid in your home?" - "How do you discipline your children?" What are the 4 types of maltreatment? 1. physical 2. sexual 3. emotional 4. neglect ^ex. they don't have the necessary clothes to keep them warm What are the warning signs of maltreatment? -physical evidence -history is incompatible with injury ^does the injury match the story: if they say they got hurt yesterday but they have multiple bruises in different stages of healing, this is cause for concern -vague explanations -multiple fractures in different stages of healing and/or other injuries -delay in seeking care -caregiver reports What are possible contributing factors of maltreatment in regards to the parent? -young, single, isolated parents -low income and lack education -low self-esteem -substance abuse -history of being abused What are possible contributing factors of maltreatment in regards to the child? -infant, especially premature or requiring special care -unwanted children -hyperactive children What are possible contributing factors of maltreatment in regards to the environment? 23 -chronic stress -divorce, low support, addiction, poverty, inadequate housing/food What are assessment findings of physical neglect? -FTT (failure to thrive) -lack of hygiene -frequent injuries -dull affect -self stimulating What are assessment findings of physical abuse? -bruises, welts, and fractures in different stages of healing -aggression -lack of emotion What are assessment findings of emotional neglect/abuse? -FTT (failure to thrive) -enuresis -sleep disturbances -self stimulating -delayed development What are assessment findings of sexual abuse? -lacerations around the mouth, genital area, and anus -STI; UTI -regressive behaviors -personality changes What maltreatment assessment findings are particular for infants? -bruising -fractures -shaken baby syndrome/shaken impact syndrome ^vomiting, poor feeding, bulging fontanel, retinal hemorrhages, seizures, apnea, and brady What diagnostic procedures can be done with maltreatment cases? -XR -CT/MRI -Ophthalmology consult What nursing care needs to be issued for maltreatment? 24 -identify and report abuse early -priority is to keep the child safe -document clearly and objectively -photograph injuries -provide support for child and family What is the Muchausen syndrome by proxy? -type of abuse -parent (often health care provider) creates symptoms of illness -adult meeting his/her psychological need by having ill child What are susceptible s/sx of Muchausen syndrome by proxy? -1 or more illnesses that don't respond to treatment -symptoms that don't make sense or disappear when parent is not present (separation test) -physical/lab findings that do not correlate with history -repeated hospitalizations What should we assess with the skin of a child? -variations in skin color -temperature should be warm or slightly cool to touch -adequate skin turgor (brisk to return) -skin folds should be symetric What should we assess with the hair/scalp of a child? -hair should be evenly distributed, smooth, and strong ^manifestations of nutritional deficiencies include hair that is stringy, dull, brittle, and dry ^hair loss or balding spots on infants can indicate the child is spending too much time in the same position -scalp should be clean and absent from any scaliness, infestations, and trauma -assess children approaching adolescence for the presence of secondary hair growth (puberty) What should we assess with the lymph nodes of a child? -should be non-palpable -lymph nodes that are small, palpable, non-tender, and mobile can be an expected finding What should we assess with the head of a child? -the shape of the head should be symmetric -fontanels should be FLAT 25 -the posterior fontanel usually closes by 8 weeks of age (2-3 months) ^protects the head -the anterior fontanels usually closes between 12-18 months ^this allows the brain to grow -head circumference should be assessed on children 3 years old and younger When do we start assessing visual acuity in children? -typically older than the age of 3, because it is hard to assess children younger than 3 -visual acuity in infants can be assessed by holding an object in front of the eyes and checking to see whether the infant is able to see the object and follow it -older children should be tested using a Snellen chart or symbol chart -corneal light reflex: symmetrical by 4-6 months of age -permanent color manifests by 1 year of age What is important to assess with the ear of a child? External Ear -free of lesions and nontender -free of foreign bodies and discharge -cerumen is an expected finding Internal Ear -infants and toddlers: pull the ear down and back -children older than 3: pull the ear up and back -ear canal should be pink with fine hairs -the tympanic membrane should be pearly pink, or gray Hearing -newborns should have intact acoustic blink reflexes to sudden sounds -infants should turn toward sounds (ex. if you call a baby by their name) -older children can be screened by whispering a word from behind to see whether they can identify the word What is important to assess with the mouth of a child? -infants can have white coatings on their tongues which could indicate milk (it is easy to remove) ^if it is hard to remove and appears white, it could be candidiasis -infants should have 6-8 teeth by 1 year of age -visible tonsils is a common finding in children 26 What is important to assess with the thorax/lungs of a child? -infants chest shape is almost circular -if the child is less than 7 years old, abdominal movement is seen during respirations -its often hard to determine upper/lower respiratory sounds -assess for: retractions, increased rate, increased effort ^if this is noted, ACT QUICKLY (respiratory codes are most commonly seen within the pediatric population) What is important to assess with heart/pulses of a child? -sinus arrhythmia is associated with respirations (common) -innocent murmurs in children -listen upright and reclined -listen to all 4 valvular -we assess the brachial and femoral pulses in children PMI -Infant to 4 y.o.: 4 ICS medial left clavicular line -4 to 6 y.o.: 4 ICS left midclavicular line -Older than 7: 5 ICS midclavicular line What is important to assess with the abdomen in children? -without tenderness and no guarding -shape: symmetric, without protrusions around the umbilicus -infants and toddlers have rounded abdomens -children and adolescents have flat abdomens -bowel sounds should be heard every 5 to 10 seconds 27 What is important to assess with the male genitalia of a child? -locate testes -examine the scrotum -examine meatus -assess for lesions/adhesions What is important to assess with the female genitalia of a child? -assess for discharge, lesions, and adhesions What is important to assess with the musculoskeletal system of a child? -examine the spine for scoliosis and other spinal disorders -note the muscular tone -examine the joints for any redness, pain, or swelling -note gait ^toddler normally bowlegged -preschooler may appear knock knee -feet should face forward and shoes with even ear What is important to assess with neuro status of a child? -innate reflexes -DTR -language -cognition -fine and gross motor development ATI PRACTICE QUESTIONS these include Chapters 1, 2, 8, 9, & 10 A nurse manager on a pediatric unit is preparing an education program on working with families for a group of newly hired nurses. Which of the following should the nurse include when discussing the developmental theory? A. describe that stress in inevitable B. emphasizes that change with one family member affects the whole family C. provides guidance to assist families adapting to stress D. denies consistencies in how families change D A nurse is assisting a group of guardians of adolescents to develop skills that will improve 28 communication within the family. The nurse hears one guardian state, "My son knows he better do what I say." Which of the following parenting styles is this parent exhibiting? A. authoritarian B. authoritative C. permissive D. passive A: the parent controls the adolescent's behaviors and attitudes through unquestioned rules and expectations When performing family assessment, which of the following should the nurse include (select all that apply)? A. medical hx B. parent's education level C. child's physical growth D. support systems E. stressors A: include a medical hx on the parents, siblings, and grand parents when performing a family assessment B. include the family structure, which includes family members, family size, roles/position within the family, and occupation and education of the family D: include support systems to determine the availability of extended family work and peer relationships, and social systems and community resources to assist the family in meeting needs when performing the assessment E: include stressors, both expected and unexpected, when performing the assessment A nurse is preparing to assess a preschooler. Which of the following actions should the nurse take to prepare the child? A. allow the child to role-play using the equipment B. use medical terminology to describe what will happen C. separate the child from the caregiver during the examination D. keep medical equipment visible to the child A: allow the to role-play or manipulate actual or miniature equipment to reduce anxiety and fear related to the examination Explanation of Other Answers B: use neutral words and avoid over overestimating the child's understanding of words and describing what will happen C: encourage parental presence during the examination D: keep medical equipment out of sight unless showing or using it on the child A nurse is checking vitals on a 3 year old child during a well-child visit. Which of the following findings should the nurse report to the provider? A. Temperature of 37.2 (99.0) B. HR of 106/min C. Respirations of 30 D. BP of 88-54 C: this is outside the reference range for a 3 year old (remember its around 20 ish) 29 A nurse is assessing a child's ears. Which of the following findings should the nurse expect? A. light reflex is located at 2 o'clock position B. Tympanic membrane is red in color C. bony landmarks are not visible D. cerumen is present bilaterally D: this is an expected finding Explanation of Other Answers A: the light reflex should be located around 5 to 7 o'clock B: the tympanic membrane should be pearly pink, or gray in color C: bony landmarks should be present A nurse is assessing a 6 month old infant. Which of the following reflexes should the infant exhibit? A. moro B. plantar grasp C. stepping D. tonic neck B: exhibited from birth to 8 months Explanation of Other Answers A: from birth to 4 months C: birth to 4 weeks D: birth to 3-4 months A nurse is performing a neurological assessment on an adolescent. Which of the following response should the next expect the adolescent to exhibit when assessing the trigeminal nerve (select all that apply)? A. clenching teeth together slightly B. recognizing sour tastes on the back of the tongue C. identifying smells through each nostril D. detecting facial touches with the eyes closed E. looking down and in with the eyes A & D Explanation of Other Answers B: this would be checking the glossopharyngeal nerve C: this would be checking the olfactory nerve E: this would be checking the trochlear nerve A nurse is planning to administer the influenza vaccine to a toddler. Which of the following actions should the nurse take? A. administer SQ in the abdomen B. use a 20-gauge needle C. divide the medication in two injections D. place the child in a supine position D: the vastus laterals is recommended for administering IM medications. Placing the toddler in a supine position is the appropriate action the nurse should take 30 Explanation of Other Answers A: the influenza vaccine is administered IM B: a 22-25 gauge needle is recommenced C: the total volume of the vaccine is 0.5 ml A nurse is preparing to administer an IM injection to a child. Which of the following is contraindicated? A. deltoid B. ventrogluteal C. vastus lateralis D. dorsogluteal D The nurse is teaching a guardian of an infant about administration of oral medications. Which of the following should the nurse include in the teaching (select all that apply)? A. use a universal dropper for medication administration B. ask the pharmacy to add flavoring to the medication C. add the medication to a formula bottle before feeding D. use the nipple of the bottle to administer the medication E. hold the infant in an semi-reeling position B: multiple flavorings are available to add to medications and can assist in masking the taste D: administering medications through an emptying nipple can assist with successful administration of the medication E: for successful medication administration, the infant should be held in a semi-reeling position, similar to feeding Explanation of Other Answers A: medications have different viscosities, and droppers do not have a standard opening. C: because an infant might not finish their bottle, this practice not recommended A nurse is preparing to administer medication to a toddler. Which of the following actions should the nurse take (select all that apply)? A. identify the toddler by asking the caregiver B. tell the caregiver to administer the medication C. calculate the safe dosage D. ask the toddler to pick a toy to hold during the administration E. offer juice after the medication C: for safe administration, you should always calculate the safe dosage D: offering choices to the toddler is a practice of atraumatic care E: offering OJ is an example of offering atraumatic care Explanation of Other Answers A: confirm two identifiers B: assess the involvement of the caregiver A nurse os caring for an infant who needs otic medication. Which of the following is an appropriate action for the nurse to take? 31 A. hold the infant in an upright position B. pull the pinna down and back C. hyperextend the infant's neck D. ensure the medication is cool B: pulling the pinna down and back will straighten the ear canal to allow medication to flow into the ear Explanation of Other Answers A: infant should be placed supine or prone C: this can occlude the airway D: medications should be warmed up A nurse is completing a pain assessment of an infant. Which of the following pain scales should the nurse use? A. FACES B. FLACC C. Oucher D. Non-community children's pain checklist B: used between 2 months and 7 years of age Explanation of Other Answers A: 3 years or older C: used between 3 and 13 years D: used between 3 and 18 years for non-communicating children A nurse is planning care for a child following a surgical procedure. Which of the following interventions should the nurse include in the plan of care? A. administer NSAIDS for pain greater than 7 on a scale of 0 to 10 B. administer intranasal analgesics PRN C. administer IM analgesics for pain D. administer Iv analgesics on a schedule D A nurse is assessing an infant. Which of the following are finding of pain in an infant (elect all that apply)? A. pursed lips B. loud cry C. lowered eyebrows D. rigid body E. pushes away stimulus B, C, D Explanation of Other Answers A: infants who experience pain have their mouth open in a squarish shape E: infants who experience pain exhibit a local reflex to withdraw from the stimulus A nurse is planning care for an infant who is experiencing pain. Which of the following interventions should the nurse include in the plan of care (select all that apply)? 32 A. offer pacifier B. use guided imagery C. use swaddling D. initiate a behavioral contract E: encourage kangaroo care A, C, E Explanation of Other Answers B: this is a non-pharmacological strategy used for children D: this is a non-pharmacological strategy used for children A nurse is preparing a toddler for an intravenous catheter insertion using atraumatic care. Which of the following actions should the nurse take (select all that apply)? A. explain the procedure using the child's favorite toy B. ask the parents to leave during the procedure C. perform he procedure with the child in his bed D. allow the child one choice regarding the procedure E. apply lidocaine and prilocaine cream to three potential insertion sites A, D, E Explanation of Other Answers B: the parents should to remain for procedures to offer comfort to the child C: safe places like the child's bed should be avoided A nurse is caring for a preschooler. Which of the following is an expected behavior of a preschool-age child? A. describing manifestations of illness B. relating fears to magical thinking C. understanding cause of illness D. awareness of body functioning B: they are egocentric and magical thinkers Explanation of Other Answers A: limited ability to describe manifestation of illness C: have limited understanding of cause-and0effect relationship but understand what illness feels like D: this is behavior of an adolescent A nurse on a pediatric unit is caring for a toddler. Which following behaviors is an effect of hospitalization (select all that apply)? A. believes the experience is a punishment B. experiences seperation anxiety C. displays intense emotions D. exhibits regressive behaviors E. manifests disturbance in body image B, C, D Explanation of Other Answers A: preschool children believe hospitalization is punishment 33 E: this is seen within adolescents A nurse is teaching a guardian about parallel play in children. Which of the following should the nurse include in the teaching? A. "Children sit and observe others playing." B. "Children cubit organized pay when within a group." C. "The chid plays alone." D. "The child plays independently when in a group." D Explanation of Other Answers A: onlooker B: team play C: solitary play A nurse is teaching a group of caregivers about separation anxiety. Which of the following information should the nurse include in the teaching? A. it is often observed in the school-age children B. detachment is the stage exhibited in the hospital C. it results in prolonged issues of adaptability D. kicking a stranger is an example D: this is seen in the protest phase with separation anxiety Explanation of Other Answers A: typically observed in toddlers B: rarely seen in the hospital setting C: children are adaptable and permanent issues are rare Etiology of Autoimmune Disorders Genetic predisposition with environmental trigger (diet, radiation, chemicals, infections) Systemic autiommune disorders widespread inflammation: lupus, systemic sclerosis, rheumatoid arthritis, Sjogren's syndrome Organ-specific autoimmune disorders type 1 DM, grave's disease, myasthenia gravis, pernicious anemia, celiac disease, IBD, patient teaching: autoimmune diseases disease exacerbation can occur despite efforts. encourage patients to be realistic about what they can/can't control diagnostics: autoimmune diseases antinuclear antibody test: postive test confirms autoantibodies; rheumatoid factor; 34 inflammatory markers: ESR, C-reactive protein, ferritin The loss of which normal property results in the immune system producing antibodies against its own cells? self-tolerance Select all that apply: Which disorders are organ-specific autoimmune disorders? 1. Type 1 DM 2. Myasthenia gravis 3. Multiple sclerosis 4. Celiac disease 5. Lupus 6. Rheumatoid arthritis Answer: 1, 2, 3, 4, Even though not yet informed about which disorder is present, the nurse can expect the newly admitted patient to have which common clinical manifestations of autoimmune disorders? 1. complaints of fatigue 2. tachycardia 3. exacerbations 4. local inflammation 5. aching muscles 6. lung crackles Answer: 1, 3, 4, 5 **Practice Pearl Patients on immune suppressive therapies are at risk for infections; tell patients to report signs of infection Non-pharmacological therapy for autoimmune disease: plasmaphereis: blood is filtered apheresis: removes a larger volume of whole blood more rapidly than plasmapheresis what happens to blood before being returned to the patient who is undergoing plasmapheresis? filtered and exchanged with saline or plasma Which class of drugs prescribed to patients with autoimmune disorders, reduces inflammation by 35 neutralizing the activity of tumor necrosis factor? 1. NSAIDS 2. Monoclonal antibodies 3. Disease modifying antirheumatics 4. Calcineurin deterrent Answer: 3 Interventions for autoimmune diseases Rest during acute illness; after acute phase balance rest with exercise. Rest when fatigued!!! Identify and avoid triggers What is the difference between AIDS and HIV Trick question :) HIV is the virus that causes AIDS Transmission of HIV blood, semen, vaginal secretions, breast milk Patho for HIV HIV binds to CD4 T cells; allows its RNA to create a "new" DNA set for the CD4 T cells; As time passes CD4 T cells are destroyed, LEAVES PT AT INCREASED RISK FOR INFECTION Incubation Stage of HIV Incubation: last for weeks, up to 10 yrs; no detectable change in CD4T cell count; MOST INFECTIOUS; no noticeable symptoms Early Stage of HIV fever, sore throat, muscle aches, cervical lymph node enlargement, rash, headache, photophobia, normal CD4 T cell count Latent Stage of HIV asymptomatic; minor opportunistic infections; persistent generalized lymphadenopathy; virus dormant; normal CD4 T cell count Crisis Stage of HIV persistent fever, fatigue, weight loss, diarrhea, onset of opportunistic infections, cancers, neurologic disease, CD4 T cell count 500 cells/uL AIDS diagnostic criteria Lowered CD4 T Cell Count: 200 cells 36 Opportunistic infections; Caners; Wasting syndrome: loss of 10% of ideal body mass HIV Diagnosis 3 postive consecutive tests; Rapid HIV antibody screen test Standard antibody screen test Normal CD4 T cell count 800-1200 Normal WBC count 4,000-11,000 3 functions of immunity: defense, homeostasis: damaged cellular substances are digested and removed. surveillance innate immunity present at birth; nonspecific response; neutrophils and monocytes active aquired immunity natural contact with antigen through actual infection (chickenpox, measles, mumps) immunization with antigen. passive aquired immunity transplacental -transfer from mother to child; injection of antibodies from one person to another Anaphylaxis Severe allergic reaction; mediators are released systemically; reaction occurs within minutes and can be life threatening because of bronchial constriction and subsequent airway obstruction and vascular collapse. initial symptoms: edema and itching at the site; shock can occur rapidly and is manifested by rapid, weak pulse; hypotension; dilated pupils; dyspnea; and possibly cyanosis. HIV causes immunosuppression; transmitted through blood, semen, vaginal secretions, and breast milk What precautions are needed for HIV? 37 standard HIV infectious process 1. CD4+T cells become "HIV factory" 2. CD4+T cell count falls, viral load rises 3. Immune system weakens 4. Everyone with AIDS has HIV; not everyone with HIV has AIDS Prediabetes impaired glucose tolerance; impaired fasting glucose; precursor the client gets DM2.. check blood glucose and A1C regularly; monitor for signs of diabetes such as polyuria, polyphagia, and polydipsia Skin Cancer Assessment: ABCDE A: asymmetry B: uneven border C: multiple colors D: diameter larger than 1/4 in. E: evolving; changing Management of Skin Cancer Surgical -Cryosurgery -Curettage and electrodesiccation -Excision -Mohs' surgery -Wide excision Nonsurgical -Drug therapy -Radiation therapy which skin cancer causes the majority of skin cancer deaths? malignant melanoma; tumor arising in cells that produce melanin "If I look at the sun I burn!" Which Fitzpatrick classifications of skin type does this match? 1. Type I 2. Type II 3. Type III 4. Type IV Answer: 1 38 A patient with a new diagnosis of actinic keratosis is admitted to the unit. On assessment, which clinical manifestations would the nurse expect to find? 1. bluish plaque 2. tender lymph nodes 3. red, weeping skin patches 4. thickened papules on the skin answer: 4 The nurse is preparing to administer psoralen to a patient diagnosed with cutaneous T-cell lymphoma. Which action should the nurse teach the patient to perform while taking this medication? 1. Avoid sunlight 2. Increase fluid intake 3. Wear protective eyewear 4. Discontinue the use of emollients Answer: 3 Psoralen is a photosensitizing drug that should be used with extreme caution bc it may increase a patient's risk for developing cataracts. Normal intraocular pressure 10 to 20 mm Hg The nurse is caring for a patient diagnosed with melanoma. The nurse is aware that which areas are common sites for this CA? back, scalp, trunk, lower legs causes of cataracts age, blunt or penetrating trauma, congenital factors, radiation exposure or UV light exposure; corticosteroids; symptoms of cataracts decreased vision, abnormal color perception, and glare (worse at night) management of cataracts: change in glasses prescription; strong reading glasses or magnifiers; increased lighting; lifestyle adjustment; removal of lens; intraocular lens implantation basal cell carcinoma Most common and least severe type of skin cancer; often characterized by light or pearly nodules. occur 39 because of sun exposure. nodules are found on head/neck. Glaucoma increased intraocular pressure; optic nerve atrophy, resulting in peripheral visual field losses. Eye drop medications for glaucoma: b-adrenergic blockers, a-adrenergic agonists minimize vision loss Meniere's disease symptoms caused by inner ear disease: episodic vertigo, tinnitus, fluctuating sensorineural hearing loss; aural fullness. symptoms begin 30-60 yrs of age. "drop attacks" diagnostics: hearing tests, vestibular tests, electronystagmography. prior to acute episode of meniere's disease client's experience: ear fullness, increasing tinnitus, muffled hearing, feeling pulled to the ground/whirling nursing interventions for meniere's disease: ambulate with assistance only; no independent; antivertigo--meclizine verbal & tactile reassurance and support which action should the nurse take first when a patient's capillary blood glucose reading is 63 mg/dL 1. recheck the patient's blood glucose level 2. teach the patient to carry a source of carbs 3. obtain blood glucose sample drawn by the lab 4. give the patient a snack that equals 15 g of carbohydrates Answer: 4 SICK day rules: when a patient with diabetes becomes ill, it is important for the pt to monitor his/her diabetes even more closely---illness raises blood glucose level Continue taking OAs and/or insulin Check glucose every 4 hours Check urine for keytones every 3 to 4 hrs Increase overall fluid intake Call the HCP if unable to keep down any food or fluids should a patient with new-onset type 1 diabetes use the pad of their finger to obtain blood for a blood glucose level? no, they should use the side of the finger S/S of DM type 1 40 weight loss, weakness, fatigue, increase frequency of infection, rapid onset, insulin dependent, familial tendency 3 p's.. diagnostic studies of DM type 2 Hemoglobin A1C: 6.5% or higher FBG: higher than 126 microvascular complications of diabetes eye and vision changes; diabetic peripheral neuropathy, male erectile dysfunction, cognitive dysfunction Nursing interventions for diabetes: Premeal BG: 70-130 Aftermeal: less than 180 oral antidiabetic medications glipizide, metformin** (Glucophage) can cause kidney damage.. hold if patient has a CT with contrast. Pioglitazone (Actos) Rapid acting insulin lispro, aspart, glulisine (Apidra) onset: 10-30 mins peak: 30-3 hrs duration: 3-5 hr Short acting insulin Regular (Humulin R, Novolin R) onset: 30 mins-1 hr peak: 2-5 hr duration: 5-8 hrs Intermediate acting insulin NPH (Humulin N, Novolin N) onset: 1.5-4 hr peak: 4-12 hr duration: 12-18 hrs Long acting insulin glargine, detemir 41 onset: 0.8-4 hr peak: no pronounced peak duration: 16-24 hrs Hyperthyroidism clinical manifestations: enlarged thyroid: goiter; exophthalmos: eyelids are retracted--exposed corneal surfaces become dry and irritated. Early signs of hyperthyroidism Weight loss and nervousness teaching for exophthalmos elevate head of bed at night; eye drops; dark glasses; possible steroid therapy diagnostic studies of hyperthyroidism TSH: low or undetectable T4: elevated RAIU: used to differentiate Graves' disease from other forms of thyroiditis Hypervolemia S/S rapid/ bounding pulse; increased bp; S3 develops; distended neck veins; edema (tissues, lungs) sudden weight gain (1+ kg in 24 hrs) shortness of breath; crackles; pink frothy sputum; cough; cerebral edema purpose of potassium (3.5-5.0) transmit nerve impulse; cardiac contraction; skeletal contraction; acid-base; regulates insulin and storage Hypokalemia "A SIC WALT" Clinical Manifestations: -abdominal distention -hypoactive bowel sounds -shallow respirations -constipation -postural hypotension -flaccid paralysis -dysrhythmias -fatigue -weakness -confusion -PVCs -tachycardia 42 -lethargy -thready pulse -N/V Hyperkalemia 5.0 Caused by: CKD Acidosis; Blood transfusions Manifestations: -Weakness -Asystole -Resp Failure -Abdominal cramping -Diarrhea -Bilateral muscle weakness -Flaccid paralysis -Bradycardia -MI Anticipate diuretics, kayexalate, glucose/insulin; assess all patients with hyperkalemia for cardiac dysrhythmias; TALL T WAVES. conduction delays, v fib, and heart block. CARDIOVASCULAR CHANGES are the most common cause of death... treating hyperkalemia calcium chloride: reduces the risk of v fib caused by hyperkalemia; insulin admin with glucose: facilitates the uptake of glucose into the cell, which brings potassium with it magnesium sulfate: has been successfully used to treat acute overdose of slow-release oral potassium Sodium purpose (135-145) acid-base regulates CL influences renal excretion of H20 initiates neuromuscular reactions creates a charge in opposition to K+ Hyponatremia Caused by: fluid overload; psychogenic polydipsia; diuretics; edema; burns; poor Na intake manifestations: alt. LOC 43 confusion seizures weakness abd cramps ACTION ALERT: if muscle wks is present, check resp effectiveness... ventilation depends on adequate muscle strength. cerebral changes are the most obvious problems of hyponatremia. Hypernatremia Caused by: -suction -drains -fever -burns -diarrhea clinical manifestations: -thirst -agitation -decreased cardiac contract. -m/s twitching -decreased LOC -coma -lethargy T/F calcium and phosphate are always inversely related true Calcium purpose (8.5-10.5) structure for bones and teeth activates coagulation nerve and muscle impulses cardiac activation, excitation, and contraction Hypocalcemia Caused by: renal failure diuretics infections ETOH burns bone CA pancreatitis 44 s/s -hypotension -bradycardia -dyshythmias -increased RR -paresthesias* -chvostek's sign -trousseu's sign -INCREASED neuromuscular excitability -HYPERACTIVE reflexes -Extremity numbness and tingling -LARYNGOSPASM Hypercalcemia Caused by: renal failure dehydration metastatic CA HCTZ too much Ca++ intake Manifestations: -weakness -confusion -increased HR/BP -increased clotting times -decreased reflexes -anorexia -n/v -constipation -personality change -lethargy -stupor -coma -decreased muscle strength and tone Phosphorus 2.5-4.5 muscle contraction maintain heart rhythm kidney function nerve conduction regulates Ca+ acid base Hypophosphatemia caused by: vomiting 45 diarrhea burns etoh s/s: weak pulses weakness bradycardia bradypnea seizures decreased tendon reflexes anorexia confusion, stupor, coma shallow respirations respiratory failure Treated with: neutraPhos K+ phos Vitamin D Decreased Ca intake Magnesium purpose 1.5-2.5 heart rhythm nerves and muscle system function immune system balance electrolytes Hypomagnesemia caused by: ETOH diarrhea burns renal failure S/S: tachycardia HTN -increased neuromuscular excitability -chovstek's sign -trousseau sign -tremors -muscle cramps that can progress to tetany -seizures respiratory depression - confusion -lethargy torsades de pointes 46 Hypermagnesemia flushed appearance diaphoresis n/v decreased neuromuscular excitability drowsiness lethargy decreased muscle strength decreased deep tendon reflexes shallow respirations, respiratory arrest isotonic infusion solutions; same osmotic pressure as blood D5% Water 0.9% NS Lactated Ringers Hypertonic D5%.45NS D5%.9% NaCl D10W% Hypotonic 0.45% NS patho of asthma reversible airway obstruction; bronchial smooth muscle contaction; tenacious mucus; mucosal edema S/S of asthma labored breathing wheezing sleep problem chest pain frequent productive coughing allergies common cold feeling tired Asthma treatment use a SABA (albuterol) before using a LABA; Controller medications for asthma daily medications for all persistent asthma; long term control, anti-inflammatory 47 COPD: chronic airflow limitation "emphysema and chronic bronchitis" easily fatigued frequent respiratory infections use of accessory muscles to breathe orthopneic (tripod) cor pulmonale thin in appearance wheezing pursed-lip breathing chronic cough barrel chest dyspnea prolonged expiratory time bronchitis- increased sputum digital clubbing S/S of COPD chronic cough with sputum; cyanosis of mucosal membranes pneumonia: acute infection of lung parenchyma inflammatory response in the lungs; decreased gas exchange bacteria reside in alveoli; fluid accumulates in lungs INCREASED PRODUCTION OF MUCUS s/s of pneumonia cough fever, chills dyspnea, tachypnea pleuritic chest pain sputum: green, yellow, rust colored. change in mental status for older clients lung assessment of pneumonia fine or coarse crackles; dullness in percussion increased fremitus hypothermia rather than fever, may be noted with the older acute exacerbation of pneumonia increased resp rate use of accessory muscles decreasing LOC, restlessness 48 Complications of pneumonia atelectasis pleurisy pleural effusion bacteremia acute resp failure sepsis/septic shock empyema lung abscess pneumothorax meningitis TB airborne transmission night sweats productive cough weight loss crackles in the lungs diagnostics for TB 3 consecutive sputum samples on 3 different days chest x rays; cannot make diagnosis soley on x-ray first line drugs--TB ethambutol: adverse effects- headache, malaise, dizziness, confusion, optic neuritis, N/V, diarrhea, anorexia isoniazid: X 6 months if not active, X 12 if active. CONTRAINDICATED in hepatic dysfunction; adverse effects: hepatotoxicity, peripheral neuropathy, visual disturbances, hyperglycemia pyrazinamide N/V, diarrhea, anorexia, dysuria, itching, photosensitivity, anemia, hepatotoxicity rifamycin (Rifabutin) can turn body fluids red-orange-brown pH range 7.35-7.45 49 HCO3 range 22-28 CO2 range 35-45