Cold therapy should be used for only 15 to 20 minutes two or three times a day. The client needs to be instructed not to place ice directly between the skin and a firm surface. The weight of the body and the low temperature of the ice may produce ischemia. The skin should be checked for signs of injury. The frozen ice pack is taken from the freezer and should be wrapped in a warm towel to help the client adjust to the cold. There is no useful reason to check the pulse before applying ice.
TPN solution is a hyperosmotic solution and thus needs to be diluted as much as possible to prevent vein irritation. Large central veins are used because they are less likely to be affected by the high solute concentration.
Asian Americans, American Indians, and Alaskan Native infants often have a pseudostrabismus due to a flattened nasal bridge. It will need to be distinguished from a true strabismus in the assessment.
The legal definition of negligence is the failure to meet accepted standards of care.
After placement of a subclavian central catheter, a chest x-ray is the only method listed that will verify tip placement of the catheter. Flushing and blood return will help to determine that the catheter is in a vein but will not identify any information concerning exactly where the tip is located. Auscultation of lung sounds may be helpful in identifying a pneumothorax, but it will not provide information regarding actual catheter tip location.
Incentive spirometer devices use a concept of sustained maximal inspiration. Each device has a means of setting an inspiratory goal. Correct use requires a spontaneous, slow, voluntary, deep breath. When full inhalation is reached, the breath is held for at least 3 seconds. This sequence is repeated 10 to 20 times an hour. Incentive spirometer exercises are most effective when used every hour while the client is awake.
Electrolyte solutions such as lactated Ringer’s are used to replace fluid from gastrointestinal (GI) tract losses. Albumin is used for shock and protein replacement. Five percent dextrose in water contains only glucose and no electrolytes to replace gastrointestinal losses. Normal saline contains no glucose, and glucose is essential for calories when a client is NPO.
After nephrectomy the client may be in considerable pain. This is due to the size of the incision and its location near the diaphragm, which makes coughing and deep breathing so uncomfortable. For this reason, narcotics are used liberally, and may be most effective when provided as patient-controlled analgesia, or through epidural analgesia.
Both the kidney donor and recipient need thorough medical and psychological evaluation prior to transplant surgery. To avoid conflict of interest, evaluation of the donor is done by a team different from that caring for the donor. The psychosocial issues in living-related organ donation may be very complex, and conversations with the donor are held in strict confidence to preserve family relations.
Clients receiving total parenteral nutrition at home require client education and nurse supervision. Clients and caregivers need to follow prescribed protocols for management of the total parenteral nutrition. Clients should report concerns to the nurse before changing management methods. Total parenteral nutrition infusions should be maintained at a constant flow rate. Too rapid a flow of solution could result in hyperglycemia. Too slow a flow will not deliver the prescribed nutrients and fluids.
The correct procedure for performing the otoscopic exam is to pull the pinna up and back and to visualize the external canal while slowly inserting the speculum. The nurse tilts the client’s head slightly away and holds the otoscope upside down as if it were a large pen.
When communicating with a hearing-impaired client, the nurse should speak in a normal tone to the client and should not shout. The nurse should talk directly to the client while facing the client and speak clearly. If the client does not seem to understand what is said, the nurse should express the statement differently. Moving closer to the client and toward the better ear may facilitate communication, but the nurse needs to avoid talking directly into the impaired ear.
Nurses should have a basic knowledge of the care of a hearing aid to assist the client in its use. The client should be instructed to turn the hearing aid off prior to removing it from the ear to prevent squealing feedback. The hearing aid should be turned off when not in use, and the client should keep an extra battery available at all times. The client should wash the ear mold frequently with mild soap and water with the use of a pipe cleaner to cleanse the cannula. The client should not wear the hearing aid if an ear infection is present.
The Centers for Disease Control and Prevention recommends the wearing of gowns and gloves for close contact with a person infested with scabies. Masks are not necessary. Transmission via clothing and other inanimate objects is uncommon. Scabies is usually transmitted from person to person by direct skin contact. All contacts that the client has had should be treated at the same time.
For clients with AIDS who experience night fever and night sweats, it is useful to offer the client an antipyretic prior to bedtime. It is also helpful to keep a change of bed linens and nightclothes nearby for use. The pillow should have a plastic cover, and a towel may be placed over the pillowcase if there is profuse diaphoresis. The client should have liquids at the bedside to drink.
The AIDS client experiencing nausea should avoid fatty products, such as dairy products and red meat. Meals should be small and frequent to lessen the chance of vomiting. Spices and odorous foods should be avoided, since they aggravate nausea. Foods are best tolerated either cold or at room temperature.
When the nurse is handling and preparing chemotherapeutic agents, the nurse should wear disposable latex gloves, a mask to cover the nose and mouth, and eye protectors. The medication should also be prepared under a special vented hood.
Immune globulin is given prophylactically for hepatitis A. Hepatitis B immune globulin is indicated for persons exposed to the hepatitis B virus. Vaccination is effective for long-term prevention of hepatitis B in health care workers. Both the vaccine and hepatitis B immune globulin may be given at the same time. Since the employee was pricked by a needle from an unknown source, both vaccine and hepatitis B immune globulin will be administered.
The nurse teaches the client with TB to increase intake of protein, iron, and vitamin C. Foods rich in vitamin C include citrus fruits, berries, melons, pineapple, broccoli, cabbage, green peppers, tomatoes, potatoes, chard, kale, asparagus, and turnip greens. Food sources that are rich in iron include liver and other meats, from which 10% to 30% of available iron is absorbed. Less than 10% of iron is absorbed from eggs, and less than 5% is absorbed from grains and vegetables.
Dietary instructions to the client with a uric acid type of stone include increasing legumes, green vegetables, and fruits (except prunes, grapes, cranberries, and citrus fruits) to increase the alkalinity of the urine. The client should also be instructed to decrease purine sources such as organ meats, gravies, red wines, goose, venison, and seafood.
The goal of CPT is to mobilize secretions for improved respiratory function. The nurse must determine which areas of the lungs should be targeted for this technique. The client’s capability for lung expansion is secondary to the lung assessment. Deep breathing routines and oxygen use do not specifically relate to client positioning.
The urine has a normal pH range of 4.5 to 8, and a specific gravity ranging from 1.010 to 1.025. The urine is typically screened for protein, glucose, ketones, bilirubin, casts, crystals, red blood cells, and white blood cells, all of which should be negative.
The client with an endotracheal tube in place cannot speak. The nurse devises an alternative communication system with the client. Use of a picture or word board is the simplest method of communication, because it requires only pointing at the word or object. A pad and pencil is an acceptable alternative, but it requires more client effort and more time. The use of hand signals may not be a reliable method, because it may not meet all needs and is subject to misinterpretation. The family does not need to bear the burden of communicating the client’s needs, and they may not understand them either.
Pioglitazone (Actos) is an antidiabetic medication used for clients with type 2 diabetes mellitus; the medication reduces the plasma glucose. It is used as monotherapy or in combination with a sulfonylurea, metformin (Glucophage), or insulin as an adjunct to diet and exercise. It should be taken 15 to 30 minutes before a meal. A prescribed diet is an essential component of treatment in a diabetic client, but the client is not told to increase calorie intake unless this is specifically prescribed by the physician. The client is instructed in the signs of hypoglycemia because this effect can occur with the use of antidiabetic medications. The client is also instructed regarding the intervention necessary if hypoglycemia occurs. Anemia is not associated with the use of this medication.
Pantoprazole (Protonix) is a gastric acid pump inhibitor that increases the gastric pH and reduces gastric acid production. It is used to treat gastric and duodenal ulcers and gastroesophageal reflux disease. It is not used to treat cough, constipation, or migraine headaches.
Oseltamivir (Tamiflu) is an oral antiviral medication used to treat influenza A and B virus.
Propofol (Diprivan) is an anesthetic agent that is used to provide continuous sedation for a client receiving mechanical ventilation. It is diluted only with 5% dextrose.
Carbamazepine (Tegretol) is an anticonvulsant used to treat seizures. The maintenance daily dose is between 800 and 1200 mg. The goal of all therapy for clients with seizures is no seizure activity. Since this high dose of carbamazepine (Tegretol) is not controlling the seizures, the use of an additional anticonvulsant is warranted.
Patient-controlled analgesia (PCA) involves the use of a programmed syringe pump that delivers predetermined amounts of analgesia at preset intervals. PCA enables the client to titrate analgesics to maintain a consistent serum level of the narcotic rather than experience the peaks and troughs that occur with PRN injections. The pump is programmed by nursing staff as prescribed by the physician. The client will have IV fluids infusing to keep the vein open between analgesia infusions.
Aluminum hydroxide (Amphogel) lowers serum phosphate by binding with dietary phosphorus to form insoluble aluminum phosphate. The phosphate is then excreted in the feces. Aluminum hydroxide will not affect the renal system as much as other antacids.
A client with spinal cord injury is prescribed Dantrolene (Dantrium) for discomfort due to spasticity. The risk of hepatotoxicity can occur with dantrolene, and the liver function studies need to be monitored while the client is taking this medication. The sedimentation rate measures the presence of inflammation and infection. The white blood cell count measures the body’s immune defense system. The creatinine level measures renal function.
Naloxone is a short-term opiate antagonist. It reverses the respiratory depression that can be exhibited in newborn infants whose mothers have been treated with opiates for the pain of labor and delivery. Because it is short acting, and the newborn’s liver is immature, respiratory depression may recur after the duration of effects of naloxone.
Atenolol (Tenormin) is a beta-blocker causing a decreased heart rate and blood pressure and a decrease in cardiac output. Fatigue is the most common side effect. If this interferes with the client’s activity level, the dosage can be adjusted to eliminate this side effect. The defining characteristics of decreased cardiac output include complaints of fatigue or weakness.
A nurse caring for a client with Paget's disease. Doctor prescribed Calcitonin works in conjunction with parathyroid hormone (PTH) to regulate calcium by decreasing the rate of bone resorption and regulating bone metabolism.
Throughout a person’s life bone is constantly breaking down and growing back. With Paget’s disease the normal process of bone growth is changed. The bone breaks down more quickly, and when it grows again it is softer than normal bone.
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