BAH Fall 2023 Final Study Guide A+
Basic Adult Health Care
,
, BAH Fall 2023 Final Study Guide
Know reference ranges for use ATI Electrolytes, WBC, Platelets, H & H, albumin, RBC
Ch. 11 Delirium pg. 208
• Also called acute confusional state begins with disorientation, changes in level of consciousness,
irreversible brain damage, and sometimes death. Delirium patients may experience hypoalert-
hypoactive behavior or hyperalert-hyperactive behavior, even a mix of both at times. Hypoalert-
hypoactive can go unnoticed, which increases mortality rates and even poorer outcome of care.
• Delirium occurs secondary to physical illness, surgery, medication, or alcohol toxicity, dehydration,
fecal impaction, malnutrition, infection, head trauma, lack of environmental cues, and sensory
deprivation or overload.
• Most effective approach is prevention by providing therapeutic activities, reorienting patient, early
mobilization, controlling pain, preventing sleep deprivation, maintaining oxygen levels and fluid
and electrolyte balance.
• Once delirium occurs treating underlying disorder is important. Risk for falls must be monitored for
safety and behavioral problems, medication reconciliation should be maintained, to discontinue any
unnecessary drugs. As well as nutritional and fluid intake should be monitored. Ongoing mental
assessments using prior cognitive status should be used as baseline in evaluating response to
treatment.
Ch. 11 Alzheimer’s Disease / Nursing Management pg. 213
• AD is a progressive, irreversible, degenerative neurological disease that begins insidiously. AD is
characterized by gradual loss of cognitive function and disturbances in behavioral and affect. Not a
normal part of aging, can occur as early as 40 years of age, but generally in 65 years old.
• AD is caused by a combination of genetics, neurotransmitter changes, head trauma, and the
presence of seizures. Two types of AD familial/early onset is caused by genetics and sporadic/late
onset is unknown.
• In the early stages forgetfulness and subtle memory loss occur. As the disease progresses patients
loss their ability to recognize familiar faces, places, and objects. Conversations become repetitive,
difficult and word finding is difficult. Patients may become depressed, suspicious, paranoid, hostile,
and even combative.
• AD is diagnosed definitively by autopsy; however it can be clinical diagnosed by ruling out other
causes of dementia, depression, delirium, alcohol or drug abuse, or inappropriate drug dosage or
drug toxicity.
• Medical management no cure but several medications slow the progression of the disease such as
cholinesterase inhibitors Donepezil hydrochloride (Aricept) and rivastigmine tartrate (Exelon)
enhance acetylcholine uptake in the brain. Rivastigmine (Exelon patch) is indicated for severe
cases.
• Nursing Management promote patient function and independence for as long as possible, promote
physical safety, independence in self care activities, reducing anxiety and agitation, improve
communication, provide socialization and intimacy, promote adequate nutrition, balanced activity
and rest, and support and educate family caregivers.
Ch. 12 Opioid Analgesic Agents pg. 236
, • Legally controlled pain medication.
• Mu agonist opioids are morphine, hydromorphone, hydrocodone, fentanyl, oxycodone, and
methadone. Agonist- antagonist opioids are buprenorphine (Buprenex, Butrans), nalbuphine and
butorphanol.
• Adverse effects constipation, nausea, sedation, and respiratory depression. Antagonist (naloxone,
naltrexone) reverse adverse effects of respiratory depression.
• Administration is individualized by patient specific care and reevaluated and changed depending on
response to treatment and disease progression.
• Physical dependences normal response of withdrawal symptoms occur when opioids are suddenly
stopped or rapidly reduced or an antagonist is given.
• Tolerance is a normal response to opioid administration that consist of a decreased effect of pain
relief, sedation, or respiratory depression while treatment is ongoing resulting in an increase of
dosage.
• Addiction is a chronic relapsing treatable neurologic disease resulting in compulsive or impaired
drug use continued despite harm and waiting to take opioids for reasons other than pain relief.
• Pasero Opioid-Induced Sedation Scale
S = Sleep, easy to arouse
Acceptable
1 = Awake and Alert
Acceptable
2 = Slightly drowsy, easily aroused
Acceptable
3 = Frequently drowsy, arousable, drifts off to sleep during conversation
Unacceptable
4 = somnolent, minimal, or no response to verbal and physical stimulation
Unacceptable
Ch. 13 Table 13-7 Potassium Imbalances pg. 269
• Potassium is the major intracellular electrolyte, influences both skeletal and cardiac muscle activity.
Alterations in its concentration change myocardial irritability and rhythm.
• Normal K levels are 3.5-5 mEq/L
• Hypokalemia are K levels lower than 3.5
Caused by thiazides, loop diuretics, corticosteroids, sodium penicillin, and amphotericin B.
Vomiting, GI loos of K, gastric suctioning.
• Signs & symptoms
Fatigue, anorexia, nausea and vomiting, muscle weakness, polyuria, decreased bowel motility,
ventricular asystole or fibrillation, paresthesia(tingling sensation), leg cramps, hypotension,
abdominal distention, hypoactive reflexes, ECG: flattened T waves, prominent U waves, ST
depression, prolonged PR interval. Severe hypokalemia can cause death through cardiac arrest or
respiratory arrest.
Medical Management
Treated by diet intake or K supplements, even IV therapy very cautiously.
Foods high in K are fruits, vegetables, legumes, whole grains, milk, and meat.
Nursing Management
Monitor for early presence of S&S, patients at risk should be monitored closely, encourage patients
to eat foods high in K, educate patients about risk of hypokalemia by abuse of laxatives or diuretics.
Basic Adult Health Care
,
, BAH Fall 2023 Final Study Guide
Know reference ranges for use ATI Electrolytes, WBC, Platelets, H & H, albumin, RBC
Ch. 11 Delirium pg. 208
• Also called acute confusional state begins with disorientation, changes in level of consciousness,
irreversible brain damage, and sometimes death. Delirium patients may experience hypoalert-
hypoactive behavior or hyperalert-hyperactive behavior, even a mix of both at times. Hypoalert-
hypoactive can go unnoticed, which increases mortality rates and even poorer outcome of care.
• Delirium occurs secondary to physical illness, surgery, medication, or alcohol toxicity, dehydration,
fecal impaction, malnutrition, infection, head trauma, lack of environmental cues, and sensory
deprivation or overload.
• Most effective approach is prevention by providing therapeutic activities, reorienting patient, early
mobilization, controlling pain, preventing sleep deprivation, maintaining oxygen levels and fluid
and electrolyte balance.
• Once delirium occurs treating underlying disorder is important. Risk for falls must be monitored for
safety and behavioral problems, medication reconciliation should be maintained, to discontinue any
unnecessary drugs. As well as nutritional and fluid intake should be monitored. Ongoing mental
assessments using prior cognitive status should be used as baseline in evaluating response to
treatment.
Ch. 11 Alzheimer’s Disease / Nursing Management pg. 213
• AD is a progressive, irreversible, degenerative neurological disease that begins insidiously. AD is
characterized by gradual loss of cognitive function and disturbances in behavioral and affect. Not a
normal part of aging, can occur as early as 40 years of age, but generally in 65 years old.
• AD is caused by a combination of genetics, neurotransmitter changes, head trauma, and the
presence of seizures. Two types of AD familial/early onset is caused by genetics and sporadic/late
onset is unknown.
• In the early stages forgetfulness and subtle memory loss occur. As the disease progresses patients
loss their ability to recognize familiar faces, places, and objects. Conversations become repetitive,
difficult and word finding is difficult. Patients may become depressed, suspicious, paranoid, hostile,
and even combative.
• AD is diagnosed definitively by autopsy; however it can be clinical diagnosed by ruling out other
causes of dementia, depression, delirium, alcohol or drug abuse, or inappropriate drug dosage or
drug toxicity.
• Medical management no cure but several medications slow the progression of the disease such as
cholinesterase inhibitors Donepezil hydrochloride (Aricept) and rivastigmine tartrate (Exelon)
enhance acetylcholine uptake in the brain. Rivastigmine (Exelon patch) is indicated for severe
cases.
• Nursing Management promote patient function and independence for as long as possible, promote
physical safety, independence in self care activities, reducing anxiety and agitation, improve
communication, provide socialization and intimacy, promote adequate nutrition, balanced activity
and rest, and support and educate family caregivers.
Ch. 12 Opioid Analgesic Agents pg. 236
, • Legally controlled pain medication.
• Mu agonist opioids are morphine, hydromorphone, hydrocodone, fentanyl, oxycodone, and
methadone. Agonist- antagonist opioids are buprenorphine (Buprenex, Butrans), nalbuphine and
butorphanol.
• Adverse effects constipation, nausea, sedation, and respiratory depression. Antagonist (naloxone,
naltrexone) reverse adverse effects of respiratory depression.
• Administration is individualized by patient specific care and reevaluated and changed depending on
response to treatment and disease progression.
• Physical dependences normal response of withdrawal symptoms occur when opioids are suddenly
stopped or rapidly reduced or an antagonist is given.
• Tolerance is a normal response to opioid administration that consist of a decreased effect of pain
relief, sedation, or respiratory depression while treatment is ongoing resulting in an increase of
dosage.
• Addiction is a chronic relapsing treatable neurologic disease resulting in compulsive or impaired
drug use continued despite harm and waiting to take opioids for reasons other than pain relief.
• Pasero Opioid-Induced Sedation Scale
S = Sleep, easy to arouse
Acceptable
1 = Awake and Alert
Acceptable
2 = Slightly drowsy, easily aroused
Acceptable
3 = Frequently drowsy, arousable, drifts off to sleep during conversation
Unacceptable
4 = somnolent, minimal, or no response to verbal and physical stimulation
Unacceptable
Ch. 13 Table 13-7 Potassium Imbalances pg. 269
• Potassium is the major intracellular electrolyte, influences both skeletal and cardiac muscle activity.
Alterations in its concentration change myocardial irritability and rhythm.
• Normal K levels are 3.5-5 mEq/L
• Hypokalemia are K levels lower than 3.5
Caused by thiazides, loop diuretics, corticosteroids, sodium penicillin, and amphotericin B.
Vomiting, GI loos of K, gastric suctioning.
• Signs & symptoms
Fatigue, anorexia, nausea and vomiting, muscle weakness, polyuria, decreased bowel motility,
ventricular asystole or fibrillation, paresthesia(tingling sensation), leg cramps, hypotension,
abdominal distention, hypoactive reflexes, ECG: flattened T waves, prominent U waves, ST
depression, prolonged PR interval. Severe hypokalemia can cause death through cardiac arrest or
respiratory arrest.
Medical Management
Treated by diet intake or K supplements, even IV therapy very cautiously.
Foods high in K are fruits, vegetables, legumes, whole grains, milk, and meat.
Nursing Management
Monitor for early presence of S&S, patients at risk should be monitored closely, encourage patients
to eat foods high in K, educate patients about risk of hypokalemia by abuse of laxatives or diuretics.
