MED SURG FOCUSED REVIEW

1. The nurse’s role in the informed consent process is to witness the client’s signature on the informed consent form and to ensure that the provider has obtained the informed consent responsibly. 2. If the client refuses a treatment or procedure, the client signs a document indicating that he understands the risk involved with refusing the treatment or procedure and that he has chosen to refuse it 3. .Tasks that RNs may delegate to PN: Monitoring findings, reinforcing client teaching from a standard care plan, performing tracheostomy care, Suctioning Checking ng tube patency, administering enteral feedings, inserting a urinary, and catheter administering medication 4. Tyramine foods that contain tyramine are avocados, figs, aged cheese, yeast extracts, beer, smoked meats concurrently taking monoamine oxidase inhibitors can lead to hypertensive crisis. Avoid these foods while taking MAIO. 5. Droplet precautions protect against droplets larger than 5 mcg and travel 3 to 6 ft from the client (streptococcal pharyngitis or pneumonia, Haemophilus influenzae type B, scarlet fever, rubella, pertussis, mumps, mycoplasma pneumonia, meningococcal pneumonia and sepsis, pneumonic plague). Droplet precautions require:A private room or a room with other clients who have the same infectious disease. Ensure that clients have their own equipment. Masks for providers and visitor. 6. To Prevent Migraine Headache: Limit foods with tyramine (pickles, caffeine, beer, wine, aged cheese, artificial sweeteners), MSG, or preservatives. Maintain adequate regular sleep patterns. Avoid light glare or flickering lights. Review menstrual cycle pattern and hormone fluctuations. Avoid intense environmental odors, perfumes, and tobacco smoke. 7. Concurrent use of heparin, aspirin, nonaspirin antiplatelet drugs (clopidogrel, dipyridamole, ticlopidine, abciximab), glucocorticoids, sulfonamides, acetaminophen, cimetidine, and parenteral cephalosporins increase the effects of warfarin, which increases the risk for bleeding. 8. Before Ear drop medication instilling warm the medication by gently rolling the container between the hands before instilling drops. Cold drops can cause dizziness. Gently shake medication that is in suspension form Place clients on the unaffected side. Keep clients in a side-lying position for 5 min with the affected ear up after instilling drops. Place a small piece of cotton in the ear. Avoid packing it tightly. Remove the cotton after 15 min 9. Sputum samples are needed every 2 to 4 weeks to Monitor TB therapy effectiveness. Clients are no longer considered infectious after three consecutive negative sputum cultures and can return to employment. 10. After Amputation surgery, monitor tissue perfusion of end of residual limb. Palpate residual limb for warmth. Heat can indicate Infection. Compare pulse most proximal to incision with pulse in other extremity. Amputation might not heal if performed below the level of adequate tissue perfusion. Position the affected extremity in dependent position This study source was downloaded by from CourseH on :03:48 GMT -05:00 MED SURG FOCUSED REVIEW to promote blood flow/oxygenation. Keep a tourniquet at the bedside in case of hemorrhage Next, please send me the answers to the module case study. Questions: 1. How should the nurse position this client and why?  Nurse should make the client sit in high fowler position so the client’s chest can expand and breath better. 2. List four signs and symptoms of respiratory distress the nurse may observe in a client with COPD.  Oxygen saturation 90%, use of accessory muscle, increased respiratory rate, diminished breath sound, wheezing and swelling in ankles and feet. 3. The client wants her nasal oxygen turned up because she is experiencing increased difficulty breathing. What should the nurse say to the client?  Usually Client who has COPD gets oxygen no more than 2-3 liter because their lungs are used to with more carbon dioxide than oxygen. Because oxygen is prescribed by the doctor, so I will let the client know that I have to get the doctor’s order first and go ahead and let the doctor know client’s situation. 4. Why is it important to address the client’s pain level?  Because pain will affect pt.’s breathing. The more pt. feel pain the more the client gets difficulty breathing which can cause him getting hypoxic. 5. List three non-pharmacologic interventions that the nurse could implement to help decrease the client’s difficulty breathing.  Encourage pursed lip breathing  Sit in upright or high fowler position  Encourage ambulation as tolerated to prevent buildup of secretion. This study source was downloaded by from CourseH on :03:48 GMT -05:00 6. What are the normal ranges for each of the ABG components in an adult: pH, partial pressure of carbon dioxide (PaCO2), bicarbonate (HCO3), partial pressure of oxygen (PaO2) and oxygen saturation (SaO2)?  PH=7.35 to 7.45  PaCO2=35 to 45mmhg  HCO3=22 to 26mEq/L  PaO2=80 to 100mmhg 7. What ABG results would the nurse expect in a client with COPD?  High side PH, increased PaCO2, HCO3 and low oxygen saturation. 8. Analyze each set of ABG results: 1. pH=7.32 PaCO2=58 mmHg HCO3=32 mEq/L PaO2=60 mmHg compensated respiratory acidosis 2. pH=7.22 PaCO2=35 mmHg HCO3=20 mEq/L PaO2=80 mmHg uncompensated respiratory acidosi 3. pH=7.52 pCO2=28 mmHg HCO3=24 mEq/L PaO2=70 mmHg Respiratory Alkalosis 9. List two nursing diagnoses for this client?  Impaired gas exchange  Activity intolerance Then, send me the answers to the review questions below. Review Questions: A nurse is caring for a client who has been prescribed a medication that is listed on his allergy list. What action should the nurse take?  The nurse should let the Dr. know that pt. has allergy to this medication, so he can change the prescription. A bed-bound client needs to be repositioned. What guidelines should the nurse follow to prevent personal injury? (Review the Fundamentals Review Module)  A bed bound pt. needs to be repositioned every 2 hours and keep the skin clean and dry. This study source was downloaded by from CourseH on :03:48 GMT -05:00 A nurse is preparing a client for a total hip arthroplasty. What preoperative education should be reinforced by the nurse? Suggested Medical Surgical Learning Activity: Joint Replacement  Obtain consent form  Reinforced teaching about after care A nurse is reinforcing teaching to the family of an older adult client with a visual impairment. What information regarding modifications for home safety should be included? (Review the Fundamentals Review Module)  Remove items that could cause the client to trip, such as throw rugs and loose carpets.  Place electrical cords and extension cords against a wall behind furniture.  Monitor gait and balance, and provide aids as needed.  Make sure that steps and sidewalks are in good repair.  Place grab bars near the toilet and in the tub or shower, and install a stool riser.  Use a nonskid mat in the tub or shower.  Place a shower chair in the shower and provide a bedside commode if needed.  Ensure that lighting is adequate inside and outside