- Keep legs ABDUCTED with a PILLOW between

- Do not cross legs

*Protect the hip- want to avoid injury

-Portal hypertension -> esaphageal varaceses (Can rupture and cause bleeding)

med: Propanolol

-Hepatic encephalopathy 

med: Lactulose (agitated and confused, end stage liver cancer *gives pt diarrhea)

-Weakness

-Monitor vitamin b12 levels, hematocrit, hemoglobin

-Neurological systems = monitor

Teach to decrease insulin need ->exercise, decrease sugar intake

Raise insulin need -> when get sick, still need insulin. Stress raises the need for insulin -> can cause hyperglycemia

Dilantin -> long term seizure med

Ativan -> short term use, for active seizure

*Teach patient not to stop taking the med. 

Teach patient to go to the bathroom every 2 hours on a schedule.

*this is not for urge 

Blood pressure decreases

Heart rate increases

The heart is overcompensating to get more blood circulated

Decreased platelets.

-Teach the patient to be careful not to hurt himself/herself, can get a hematoma

Clotting time is decreased

-Monitor for bleeding gums, nose bleed = could mean that platelets are even lower

Stop the infusion immediately. 

Complications usually happen within the first 15 minutes. 

Patient usually gets 2 doses of lasix before and in the middle of the transfusion.

Transfusion can last for maximum up to 4 hours.

Assess respirations! (AIRWAY!!)

*Do this before checking pupils etc.

Document it. Do not to anything.

As long as it is under 180 it is fine. Sugar will drop too low if give insulin because patient is usually NPO and could result in more complications.

Look at pH to tell if acid/base.

Resp - acidosis/ alkalosis = look at CO2 -> high= acidotic, low= alkalotic

Metabolic - look at HCO3

Comp/Uncomp -> look at pH, normal pH = Fully compensated

Confusion, agitation, cyanosis

*Act immediately!!

Infused in IV (central line)

If blood surgar is really high, give insulin.

Never want to stop because it is a set dose. It is based on weight and nutrition dose. (only made once a day)

Look at prealbumin levels. 

Watch to see if levels are increasing/improving.

Prealbumin  = nutrition, anorexia, bulemia 

Albumin = liver disease, protein

Collapsed lung.

Expect absent lung sounds, pain, and stats dropping.

Chronic COPD patients can collapse the lung by coughing. Treatment is a chest tube.

DO FIRST: Troponin- Usually order 3 (want to see if the levels increase, if they do = MI)

Check CKMB - checks muscle breakdown of the heart

EKG - Also tells if patient is having an MI.

You should not check blood pressure/ sticks on the arm.

You should check for bruits/ thrills.

"super vein" = artery/vein

graph = artificial fistula (not patients own vein/artery)

Have a high fiber, high fluid intake (to prevent constipation). Increase activity (exercise) as tolerated.

Patient can still take an aspirin.

It is used for suctioning, decompress stomach. Can give meds, nutrition through it.

For bowel obstruction, nausea, vomiting.

Elevate the head of the bed>45 degrees (dont want them to aspirate)

Confirm tube in the right place with an x-ray.

Hook up the NG tube on low intermittent.

Aortic regurg ("back up") - symptoms?

(LOOK UP- Didnt give answer)

Goes back into the ventricle, left sided heart failure.

Back up in the lungs.

Plavix is anti platelet.

adverse effects (not given - look up!)

patient teaching- monitor for low platelets, bruising.

Impaired cardiac tissue profusion

Pain

Medication - Lasix (diuretic - waste potassium)

If you have kidney disease - you will have elevated potassium.

Ask patient to swallow/ check gag reflex.

Throat is numbed and want to make sure won't aspirate.

Inflammed gall bladder = Cholecystitis

Patient states she has pain in her right shoulder, what type of pain is this? 

Warm, tender, pus.

The WBC level will be elevated.

They can receive all. They are a universal recipient.

AB = universal recipient.

O = universal donor.

Need to wear a mask 1st 24 hours.

Viral = let run it's course.

Decreased LOC.

(She said on the exam there was a disagree btwn headache and LOC- she said to go with LOC and she will confirm with Mrs. Davis)

Patient can donate their own blood before the procedure. Can give patient IV fluids, iron.

Don't want to give patient false hope that they will not need blood so need to give the patient other options.

Have the patient wear an eye patch. 

Have patient lay flat.

Refer them to a community agency. 

(not a cane lol)

1 hour.

Try to arouse the patient to see if they easily awaken before administering Narcan.

ALWAYS assess first!!! 

Give Narcan only if patient is difficult to arouse.

Tinnitus

GI bleed

Check to make sure right blood type, right name/DOB, how much fluid is in the blood, when it expires.

One nurse looks at the bag and one nurse looks at the paper. 

Patient's ID needs to match the bag, send the bag back ASAP if incorrect. Dont just assume its correct.

Bag expires after 3 days.

Population

Intervention

Compared to

Outcome

Type I: Patient will be DKA.

Type II: Patient will be HHNS. 

-The ratio of fat-muscle tissue is decrease

-Decrease in GI mobility

Decreased sensation in fingers/toes. Seen typically in diabetics.

Tell patient to check their feet, shoes

Surgery, any invasive procedure.

Have patient sign before meds are given.

If patient is getting meds, make sure sign the form before meds are given.

"TIME OUT FORM" -if done by the bedside, need to make sure have consent, if cant get a signature from the patient then ask family.

Antibiotics.

Ask the patient- do you have any allergies? what is the reaction?

What do you teach a patient who has COPD?

(ANSWER NOT GIVEN)