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Thursday, January 15, 2009

Notes For Your Nclex / CGFNS Examination : Rationale

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Nursing care after bone biopsy includes monitoring the site for swelling, bleeding, or hematoma formation. The biopsy site is elevated for 24 hours to reduce edema. The vital signs are monitored every 4 hours for 24 hours. The client usually requires mild analgesics; more severe pain usually indicates that complications are arising.

Triamterene is a potassium-sparing diuretic, and the client should avoid foods high in potassium. Fruits that are naturally higher in potassium include avocado, bananas, fresh oranges, mangoes, nectarines, papayas, and dried prunes.

Breathing exercises are recommended for children with cystic fibrosis, even for those with minimal pulmonary involvement. The exercises are usually performed twice daily, and they are preceded with postural drainage. The postural drainage will mobilize secretions, and the breathing exercises will then assist with expectoration. Exercises to assist with posture and to mobilize the thorax are included, such as swinging the arms and bending and twisting the trunk. The ultimate aim of these exercises is to establish a good habitual breathing pattern.

Urine specific gravity measures the concentration of the urine. During the first stage of labor, the renal system has a tendency to concentrate urine. Labor and birth require hydration and caloric intake to replenish energy expenditure and promote efficient uterine function. An elevated blood pressure and ketones in the urine are not expected outcomes related to labor and hydration. Once membranes are ruptured, it is expected that amniotic fluid may continue to leak.

The most accurate measurement of the effectiveness of nutritional management of the client is through monitoring of daily weight. This should be done at the same time (preferably early morning), in the same clothes, and using the same scale.

An NG tube connected to suction is used postoperatively to decompress and rest the bowel. The gastrointestinal tract lacks peristaltic activity because of manipulation during surgery. Although the nurse makes pertinent observations of the tube to ensure that it is secure and connected to suction properly, the client is assessed for the effect. The client should not experience symptoms of ileus (nausea and vomiting) if the tube is functioning properly. A pain indicator of 3 is an expected finding in a postoperative client.

Graves’ disease causes a state of chronic nutritional and caloric deficiency caused by the metabolic effects of excessive T3 and T4. Clinical manifestations are weight loss and increased appetite. It is therefore a nutritional goal that the client will not lose additional weight and will gradually return to ideal body weight if necessary. To accomplish this, the client must be encouraged to eat frequent high-calorie, high-protein, and high-carbohydrate meals and snacks.

Ignoring a negative attention-seeking behavior is considered the best way to extinguish it, provided the child is safe from injury.

Oral intake after laryngectomy is started with semi-solid foods. Once the client can manage this type of food, liquids may be introduced. Thin liquids are not given until the risk of aspiration is negligible.

Watery diarrhea is a frequent clinical manifestation of celiac disease. The absence of diarrhea indicates effective treatment. Bloody stools is not associated with this disease. The grains of wheat and rye contain gluten and are not allowed. A balance in fluids and electrolytes does not necessarily demonstrate improved status of celiac disease.

Clients receiving amphotericin B (Fungizone) may develop hypokalemia, which can be severe and lead to extreme muscle weakness and electrocardiogram (ECG) changes. Distal renal tubular acidosis commonly occurs, contributing to the development of hypokalemia.

Conjunctivitis is highly contagious. Antibiotic drops are usually administered four times a day. When purulent discharge is present, saline eye irrigations or eye applications of warm compresses may be necessary before instilling the medication. Ophthalmic analgesic ointment or drops may be instilled, especially at bedtime, because discomfort becomes more noticeable when the eyelids are closed.

The goal of therapy in nephrotic syndrome is to heal the leaking glomerular membrane. This would then control edema by stopping the loss of protein in the urine. Fluid balance and albumin levels are monitored to determine effectiveness of therapy.

A plaster cast must remain dry to keep its strength. The cast should be handled using the palms of the hands, not the fingertips, until fully dry. Air should circulate freely around the cast to help it dry. Additionally, the cast also gives off heat as it dries. The client should never scratch under the cast. A cool hair dryer may be used to relieve an itch.

Most of the excretion of potassium and the control of potassium balance are normal functions of the kidneys. In the client with renal failure, potassium intake must be restricted as much as possible (30 to 50 mEq/day). The primary mechanism of potassium removal during ARF is dialysis.

Condoms should be used to minimize the spread of genital tract infections. Wearing tight clothes irritates the genital area and does not allow for air circulation. Douching is to be avoided. Wearing items with a cotton panel liner allows for air movement in and around the genital area.

Nitroglycerin may be self-administered sublingually 5 to 10 minutes before an activity that triggers chest pain. Tablets should be discarded 6 to 9 months after opening the bottle, and a new bottle of pills should be obtained from the pharmacy. Nitroglycerin is unstable and is affected by heat and cold, so it should not be kept close to the body (warmth) in a shirt pocket, but rather it should be kept in a jacket pocket or purse. Headache often occurs with early use and diminishes in time. Acetaminophen (Tylenol) may be used to treat headache.

The client with Parkinson’s disease has a tendency to become withdrawn and depressed, which can be limited by encouraging the client to be an active participant in his or her own care. The family should also give the client encouragement and praise for perseverance in these efforts. The family should plan activities intermittently throughout the day to inhibit daytime sleeping and boredom.

The potential effects of alcohol abuse during pregnancy for both the mother and fetus have been well documented. The nurse who expresses genuine concern with suspected abusers may motivate positive behavioral changes during the prenatal period. The maternal behaviors of lack of concentration and agitation are frequently seen in childbearing women abusing alcohol.

Whenever the abused client remains in the abusive environment, priority must be placed on ascertaining whether the person is in any immediate danger. If so, emergency action must be taken to remove the person from the abusing situation.

The establishment of a therapeutic relationship with the suicidal client increases feelings of acceptance. While the suicidal behavior and thinking of the client is unacceptable, the use of unconditional positive regard acknowledges the client in a human-to-human context and increases the client’s sense of self-worth.

An autopsy is required by state law in certain circumstances, including the sudden death of a client and a death that occurs under suspicious circumstances. It is not a requirement by federal law. It is not mandatory that every client who is DOA have an autopsy. If a family requests not to have an autopsy performed on a family member, then the nurse should contact the medical examiner about the request.

With earlier hospital discharge, clients are returning home with greater acuity of problems than was previously true, and they may require support from a home health agency until they are independent in functioning.

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