MILESTONE 2 RETAKE NEW EXAM STUDY GUIDE SOLUTION
Continuous bladder irrigation - A three-way (lumen) irrigation is used to decrease bleeding and to keep
the bladder free from clots—one lumen is for inflating the balloon (30 mL); one lumen is for instillation
(inflow); one lumen is for outflow.
Continuous irrigation may be used with TURP.
The amount of fluid recovered in the drainage bag must equal the amount of fluid instilled -- secondary
hemorrhage may occur from overdistension
Urethritis - Common in postmenopausal women
Low estrogen levels decrease moisture and secretions in the perineal area, predisposing it to the
development of infection
Testing: STI, multiple dipstick, leukocyte esterase, nitrite testing, x-ray, CT, ultrasonography, kidney
scans
Renal Calculi Risk Factors - 1. Kidney diseases: Polycystic kidney disease, horseshoe kidneys, chronic
strictures, and medullary sponge disease
2. IBD, ileostomy, bowel resection
3. Medications: Antacids, acetazolamide (Diamox), vitamin D, laxatives, and high doses of aspirin
Calculi pain - Requires immediate attention
IV or IM opioids
IV NSAIDs
If pain increases, notify HCP
Imitrex contraindications - Ischemic heart disease
St. John's wort
Seizures - Assessment
· History, factors/precipitating events, alcohol, aura
,Planning and Goals
· Prevention of injury, control seizures, psychosocial adjustment, understanding, absence of
complications
Nursing Interventions
· Prevent injury, seizure precautions
Reducing Fear of Seizures
· Adhere to prescribed treatment, take on a regular basis, monitor for drug resistance
Precipitating factors:
· Emotional disturbances, new environmental stressors, onset of menstruation, fever, change in lifestyle
routine, bright flickering lights, stress, alcohol
Monitoring and Managing Potential Complications
· Status epilepticus
· Toxicity of meds
Hyperthyroidism signs/symptoms - Ophthalmopathy - exophthalmos (abnormal protrusion of one or
both eyeballs), (not always reversible)
Nervousness: Hyperexcitable, irritable, apprehensive, · cannot sit quietly, fine hand tremor
Cardiac: palpitations, rapid pulse, A-fib (new onset in adults), fatigability, weakness
Skin: tolerate heat poorly, perspire, flushed skin, dry skin, diffuse pruritus
GI: · amenorrhea, changes in bowel function, increased appetite, weight loss
Exophthalmos-POC - Assessment:
- Vision changes, trauma, visual acuity
, Treatments:
- Antibiotic eyedrops if infection is the underlying cause
- Antithyroid therapy (propylthiouracil, methimazole), if Graves' disease is the underlying cause
- Corticosteroids for optic neuropathy
- Eye lubricants (artificial tears)
- Surgery if vision is threatened
General:
- Cold/warm compresses (trauma)
- Eye protection (sunglasses)
Testing:
- CT, MRI, ultrasonography
Sensory perception peripheral neuropathy - The heels are particularly susceptible to breakdown because
of loss of sensation of pain and pressure associated with sensory neuropathy.
The skin is assessed for dryness, cracks, breakdown, and redness, especially at pressure points and on
the lower extremities. The patient is asked about symptoms of neuropathy, such as tingling and pain or
numbness of the feet. Deep tendon reflexes are assessed.
Teaching: Use a mirror to inspect feet daily.
Diabetes foot care - Feet should be cleaned, dried, lubricated with lotion (but not between the toes), and
inspected frequently
Supine position - alleviate pressure on the heels by elevating lower legs on a pillow, the heels positioned
over the edge of pillow
Seated in a chair - position feet so that no pressure on heels
Continuous bladder irrigation - A three-way (lumen) irrigation is used to decrease bleeding and to keep
the bladder free from clots—one lumen is for inflating the balloon (30 mL); one lumen is for instillation
(inflow); one lumen is for outflow.
Continuous irrigation may be used with TURP.
The amount of fluid recovered in the drainage bag must equal the amount of fluid instilled -- secondary
hemorrhage may occur from overdistension
Urethritis - Common in postmenopausal women
Low estrogen levels decrease moisture and secretions in the perineal area, predisposing it to the
development of infection
Testing: STI, multiple dipstick, leukocyte esterase, nitrite testing, x-ray, CT, ultrasonography, kidney
scans
Renal Calculi Risk Factors - 1. Kidney diseases: Polycystic kidney disease, horseshoe kidneys, chronic
strictures, and medullary sponge disease
2. IBD, ileostomy, bowel resection
3. Medications: Antacids, acetazolamide (Diamox), vitamin D, laxatives, and high doses of aspirin
Calculi pain - Requires immediate attention
IV or IM opioids
IV NSAIDs
If pain increases, notify HCP
Imitrex contraindications - Ischemic heart disease
St. John's wort
Seizures - Assessment
· History, factors/precipitating events, alcohol, aura
,Planning and Goals
· Prevention of injury, control seizures, psychosocial adjustment, understanding, absence of
complications
Nursing Interventions
· Prevent injury, seizure precautions
Reducing Fear of Seizures
· Adhere to prescribed treatment, take on a regular basis, monitor for drug resistance
Precipitating factors:
· Emotional disturbances, new environmental stressors, onset of menstruation, fever, change in lifestyle
routine, bright flickering lights, stress, alcohol
Monitoring and Managing Potential Complications
· Status epilepticus
· Toxicity of meds
Hyperthyroidism signs/symptoms - Ophthalmopathy - exophthalmos (abnormal protrusion of one or
both eyeballs), (not always reversible)
Nervousness: Hyperexcitable, irritable, apprehensive, · cannot sit quietly, fine hand tremor
Cardiac: palpitations, rapid pulse, A-fib (new onset in adults), fatigability, weakness
Skin: tolerate heat poorly, perspire, flushed skin, dry skin, diffuse pruritus
GI: · amenorrhea, changes in bowel function, increased appetite, weight loss
Exophthalmos-POC - Assessment:
- Vision changes, trauma, visual acuity
, Treatments:
- Antibiotic eyedrops if infection is the underlying cause
- Antithyroid therapy (propylthiouracil, methimazole), if Graves' disease is the underlying cause
- Corticosteroids for optic neuropathy
- Eye lubricants (artificial tears)
- Surgery if vision is threatened
General:
- Cold/warm compresses (trauma)
- Eye protection (sunglasses)
Testing:
- CT, MRI, ultrasonography
Sensory perception peripheral neuropathy - The heels are particularly susceptible to breakdown because
of loss of sensation of pain and pressure associated with sensory neuropathy.
The skin is assessed for dryness, cracks, breakdown, and redness, especially at pressure points and on
the lower extremities. The patient is asked about symptoms of neuropathy, such as tingling and pain or
numbness of the feet. Deep tendon reflexes are assessed.
Teaching: Use a mirror to inspect feet daily.
Diabetes foot care - Feet should be cleaned, dried, lubricated with lotion (but not between the toes), and
inspected frequently
Supine position - alleviate pressure on the heels by elevating lower legs on a pillow, the heels positioned
over the edge of pillow
Seated in a chair - position feet so that no pressure on heels
