Rasmussen University MDC I Final Exam Spring 2023 Latest Update!!

Rasmussen University MDC I Final Exam Spring 2023 Latest Update!! Infection signs and symptoms fever, BP drops, high respiratory rate, fast heart rate, altered mental status if wound gets infected it may be red and hot Hyperthermia temperature Above 99.5 antipyretics, ice packs under armpits, take off layers of clothing Hypothermia temperature Below 96.4 F blankets Normal body temperature 98.6 F or 37 C nursing interventions to decrease risk of pressure injury: positioning pad - pad hard surfaces with pressure redistribution properties do not elevate - do not elevate head of bed greater than 30 degrees suspend - suspend heels off the bed surface nursing interventions to decrease risk of pressure injury: nutrition encourage protein intake at each meal serve protein shakes between meals nursing interventions to decrease risk of pressure injury: skin care complete a daily skin inspection moisture dry skin with lotion do not massage bony prominences nursing interventions to decrease risk of pressure injury: skin cleaning clean - clean skin asap after soiling occurs pat - pat skin dry use - use tepid rather than hot water Dosage and Calc Basic Conversions 1 tsp = 5 mL 1 tbsp = 15 mL 1 oz = 30 mL 1 cup = 8 oz 16 oz = 1 lb 1 kg = 2.2 lbs 1 L = 1 kg 1 kg = 1000g 1 g = 1000 mg 1 mg = 1000 mcg 98.6 F = 37 C 1 cup = 0.5 pint 1 pint = 480 mL Signs and Symptoms of HIV/AIDS Wasting Syndrome - skinny and lost a lot of weight in a short period of time skin lesions malaise fever anorexia flu like symptoms night sweats non-hodgskins lymphoma risk Kaposi's Sarcoma - skin lesions that occur primarily in individuals with a compromised immune system HIV: CD4 and CD8 CD4 is decreased CD8 is normal AIDS: CD4 and CD8 CD4 is decreased CD8 is increased CD4 count less than 200 equals AIDS Antiretroviral drugs - combination drug therapy HIV patients on it for life It stops the virus from replicating already have HIV and exposed again progression to AIDS is faster HIV/AIDS Labs CD4 and CD8 counts HIV Viral Load testing - highest after infection Other Assessments -pulmonary function test -liver spleen scans -chest x-ray Priority of HIV patient is to prevent infection Prevent Infection Compromised Immunity avoid crowds bathe daily with antimicrobial soap wash hands thoroughly avoid raw fruits and vegetables avoid working in the garden or with houseplants monitor for signs and symptoms of infection -increase temperature -purulent drainage -foul smelling drainage -cloudy urine Prevent Infection when Hospitalized Compromised Immunity -private room -clean patient room and bathroom daily -vital signs every 4 hours -change gauze dressings daily -encourage cough and deep breathing exercises -strict aseptic technique for invasive procedures -no fresh flowers or potted plants in room -avoid undercooked meat steroids increase blood sugar delay bone healing mask infection manage pain pressure relieving mattress pads warms baths or hydrotherapy massage heat or cold packs lift sheets drug therapy enhance nutrition high calorie and high protein diet small frequent meals manage diarrhea no alcohol or caffein Restore skin integrity Lesions from kaposi sarcoma, herpes, and varicella keep lesions clean to avoid infection analgesic management dress to disguise the lesions Enhance cognition reorient x3 short simple directions maintain safe environment, bed alarms, side rails implement seizure precautions -padded side rails -padded tongue blade -side rails up -oxygen and suctioning equipment Glaucoma increased intraocular pressure in a hollow organ Glaucoma Primary open angle •Most common type •Affects both eyes •Gradual loss of vision •Signs and symptoms -Foggy vision -Mild eye aching -Headache •Late Signs and Symptoms after irreversible eye damage -Halos around lights -Losing peripheral vision -Decrease visual perception that does not improve with eyeglasses Secondary Glaucoma Related to another eye problem Associated Glaucoma Related to another disease process Primary Angle-Closure Glaucoma—Acute Onset Medical Emergency •Sudden sever pain around the eyes radiating over the face •Headache or brow pain •Nausea and vomiting •Seeing colored halos around lights •Sudden blurred vision •Reddened sclera •Foggy cornea •Moderately dilated pupil that does not react to light tonometry measures intraocular pressure. Intraocular pressure varies throughout the day10-21 mm Hg is normal gonioscopy used to determine if the glaucoma is open-angle or closed-angle. Allows for visualization of the angle where the iris meets the cornea Cataracts opacity of the lens of the eye that lies just behind the iris most are related to age Cataracts Signs and Symptoms -blurred vision -no pain -decreased color perception -may think that glasses are smudged -double vision -problems with ADL's -without surgical intervention, blindness follows -affects reading and driving prevention of increased intraocular pressure •Do not bend at the waist •Lift more than 10 pounds •Sneeze or cough •Blow your nose •Strain to move bowels •Have sexual intercourse •Vomit •Keep head in a dependent position •Wear tight shirt collars Maslow's Hierarchy of Needs physiological, safety, love/belonging, esteem, self-actualization Physiological Needs needs include those needs that are essential for maintenance of life. food, water, warmth, rest Love and belonging Needs met when the person seeks personal relationships with others. intimate relationships, friends Safety and security Needs freedom from physical harm and feelings of fear and anxiety. security and safety Esteem Needs met when a person feels a sense of accomplishment and are recognized by others for that achievement prestige and feeling of accomplishment Self-Actualization Needs met when the person reaches maximum potential and acts in an unselfish manner. achieving one's full potential, including creative activities HIV teaching nutritional support isolation precautions must take care of skin comfort measures medication must be taken for life higher risk for infections HIV is transmitted by: -blood -drug users (sharing needles) -fluids from intercourse -mom to baby SMART goals Specific, Measurable, Attainable, Realistic, Timely Clients at risk for compromised immunity