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HESI Milestone 2 Study Guide Broca's Area - ✔Speech The cortical area that is responsible for integrating the myriad pathways required for the comprehension and formulation of language is called Broca area. It is located in a convolution adjoining the middle cerebral artery. This area is responsible for control of the combinations of muscular movements needed to speak each word. Chemo Side Effects - ✔Nausea Vomiting Myelosuppression SIADH, decrease renal perfusion, precipitate end products after cell lysis, and cause interstitial nephritis Cardiac Toxicity Testicular and ovarian function can be affected by chemotherapeutic agents, resulting in possible sterility. Chemotherapy-induced neurotoxicity, a potentially dose-limiting toxicity, can affect the central nervous system, peripheral nervous system, and/or the cranial nerves Chemo Brain: Many patients with cancer experience difficulty with remembering dates, multitasking, managing numbers and finances, organization, face or object recognition, inability to follow directions, feeling easily distracted, and motor and behavioral changes. Fatigue Expressive Aphasia - ✔Inability to express oneself Meningitis First Step - ✔Broad Spectrum Antibiotics Glaucoma Symptoms - ✔The patient may not seek health care until he or she experiences blurred vision or "halos" around lights, difficulty focusing, difficulty adjusting eyes in low lighting, loss of peripheral vision, aching or discomfort around the eyes, and headache.
Assessments for Guillain Barre - ✔The patient is monitored for life-threatening complications (respiratory failure, cardiac dysrhythmias, VTE [including DVT or PE]) so that appropriate intervention can be initiated. Because of the threat to the patient in this sudden, potentially life-threatening disease, the nurse must assess the patient's and family's ability to cope and their use of coping strategies. Maintain respiratory function Enhancing physical mobility Promote adequate nutrition Improving communication Decreasing fear and anxiety Managing potential complications Multiple Sclerosis & Urinary Retention - ✔A neurogenic bladder results in urinary retention or leakage. The patient may describe a sensation of bladder fullness or incomplete bladder emptying. The pharmacological treatment of urinary retention is administration of a cholinergic agonist From Google: Many multiple sclerosis (MS) patients are affected by urinary retention. Common causes include neurogenic underactive bladder and/or bladder outlet obstruction from detrusor sphincter dyssynergia Traction & Assessment (Blueprint- Fractured Femer Dim Pulses) - ✔After skin traction is applied, the nurse assesses circulation of the foot within 15 to 30 minutes and then every 1 to 2 hours. Circulatory assessment consists of: Peripheral pulses, color, capillary refill, and temperature of the fingers or toes. Manifestations of deep vein thrombosis (DVT), which include unilateral calf tenderness, warmth, redness, and swelling. Compartment Syndrome - ✔Diagnosis of compartment syndrome is based on clinical suspicion, assessment of the 6 P's (pain, poikilothermia, pallor, paresthesia, pulselessness, and paralysis) Normal Sinus Rhythm -
Advise mothers to nurse their infants at least eight to 12 times per day for the first several days Variable Decelerations - ✔Variable decelerations present as visually apparent abrupt decreases in FHR below baseline and have an unpredictable shape on the FHR baseline, possibly demonstrating no consistent relationship to uterine contractions. Variable decelerations are associated with cord compression Turn the client on her left or right lateral, knee-chest, or hands and knees to increase placental perfusion or relieve cord compression. Normal Fetal Heart Rate - ✔The normal baseline FHR ranges between 110 and 160 beats per minute (bpm) IUGR What is it? & What are NST Results? - ✔intrauterine growth restriction Currently, an NST is recommended twice weekly (after 28 weeks' gestation) for clients with diabetes and other high-risk conditions, such as intrauterine growth restriction (IUGR), preeclampsia, post-term pregnancy, renal disease, and multifetal pregnancies A nonreactive test has been correlated with a higher incidence of fetal distress during labor, fetal mortality, and IUGR. Additional testing, such as a biophysical profile, should be considered Methadone - ✔Methadone is an opioid Symptoms of opioid withdrawal cause significant distress, but do not require pharmacologic intervention to support life or bodily functions. Longer acting substances such as methadone may not produce significant withdrawal symptoms for 2 to 4 days, and the symptoms may take 2 weeks to subside. Also used to treat addiction & withdrawl Methadone can be used as a replacement for opioids, and the dosage is then decreased over 2 weeks. Substitution of methadone during detoxification reduces symptoms to no worse than a mild case of flu Client during Termination Phase - ✔Abandons old needs
Aspires to new goals Becomes independent of helping person Applies new problem-solving skills Maintains changes in style of communication and interaction Shows positive changes in view of self Integrates illness Exhibits ability to stand alone Nurse during Termination Phase - ✔Sustains relationship as long as client feels necessary Promotes family interaction to assist with goal planning Teaches preventive measures Uses community agencies Teaches self-care Terminates nurse-client relationship Maslow - ✔The most basic needs—the physiologic needs of food, water, sleep, shelter, sexual expression, and freedom from pain—must be met first. The second level involves safety and security needs, which include protection, security, and freedom from harm or threatened deprivation. The third level is love and belonging needs, which include enduring intimacy, friendship, and acceptance. The fourth level involves esteem needs, which include the need for self-respect and esteem from others. The highest level is self-actualization, the need for beauty, truth, and justice. Gout & Allupurinol - ✔Allopurinol is used to decrease the about of serum uric acid levels It is necessary to administer allopurinol after meals to ensure absorption. Osteoarthritis Exercise - ✔The goals of management are to decrease pain and stiffness and to maintain or, when possible, improve joint mobility. Exercise, especially in the form of cardiovascular aerobic exercise and lower extremity strength training, has been found to prevent OA progression and decrease symptoms of OA Hypertonic Fluids - ✔Hypertonic solutions exert an osmotic pressure greater than that of the ECF. When normal saline solution or lactated Ringer solution contains 5% dextrose, the total osmolality exceeds that of the ECF
Diabetes is a risk factor of PAD, Diabetes (speeds the atherosclerotic process by thickening the basement membranes of both large and small vessels) Thrombocytopenia Labs - ✔Thrombocytopenia: Low platelet count Bleeding and petechiae usually do not occur with platelet counts greater than 50,000/mm3, although excessive bleeding can follow surgery or other trauma. When the platelet count drops to less than 20,000/mm3, petechiae can appear, along with nasal and gingival bleeding, excessive menstrual bleeding, and excessive bleeding after surgery or dental extractions. When the platelet count is less than 5000/mm3, spontaneous, potentially fatal central nervous system or GI hemorrhage can occur Digoxin Clinical Manifestations of Toxicity - ✔Clinical manifestations of toxicity include anorexia, nausea, visual disturbances, confusion, and bradycardia. The serum potassium level is monitored because the effect of digoxin is enhanced in the presence of hypokalemia and digoxin toxicity may occur. A serum digoxin level is obtained if the patient's renal function changes or there are symptoms of toxicity. Digoxin Use & Concern - ✔Digoxin (Lanoxin) improves cardiac contractility and decreases signs and symptoms of HF. Patients with renal dysfunction and older patients should receive smaller doses of digoxin, as it is excreted through the kidneys. A key concern associated with digoxin therapy is digitalis toxicity. Congestion HF Symptoms - ✔Dyspnea Orthopnea Paroxysmal nocturnal dyspnea Cough (recumbent or exertional) Pulmonary crackles that do not clear with cough Weight gain (rapid) Dependent edema Abdominal bloating or discomfort Ascites Jugular venous distention Sleep disturbance (anxiety or air hunger) Fatigue
Poor Perfusion/Low Cardiac Output HF Symptoms - ✔Decreased exercise tolerance Muscle wasting or weakness Anorexia or nausea Unexplained weight loss Lightheadedness or dizziness Unexplained confusion or altered mental status Resting tachycardia Daytime oliguria with recumbent nocturia Cool or vasoconstricted extremities Pallor or cyanosis Diverticulitis Diet - ✔Rest, oral fluids, and analgesic medications are recommended. Initially, a clear liquid diet is consumed until the inflammation subsides; then, a high-fiber, low- fat diet is recommended. Stage 2-4 Diverticulitis on Hinchey Staging: Withholding oral intake, administering IV fluids, and instituting nasogastric (NG) suctioning if vomiting or distention occurs are used to rest the bowel Symptoms of Diverticulitis - ✔Most commonly, no problematic symptoms occur with diverticulosis. Some patients may have mild signs and symptoms that include bowel irregularity with intervals of alternating constipation and diarrhea, with nausea, anorexia, and bloating or abdominal distention. With diverticulitis, up to 70% of patients report an acute onset of mild to severe pain in the left lower quadrant. This may be accompanied by a change in bowel habits, most typically constipation, with nausea, fever, and leukocytosis PUD & NG Tube - ✔In PUD, during surgery and postoperatively, the stomach contents are drained by means of an NG tube. The nurse monitors fluid and electrolyte balance and assesses the patient for localized infection or peritonitis (increased temperature, abdominal pain, paralytic ileus, increased or absent bowel sounds, abdominal distention). Antibiotic therapy is given as prescribed. Small Bowel Obstruction Actions - ✔Decompression of the bowel through an NG tube is necessary for all patients with small bowel obstruction; this may be tried for up to 3 days for patients
COPD & Oxygen - ✔Long-term oxygen therapy (more than 15 hours per day) has also been shown to improve quality of life, reduce pulmonary arterial pressure and dyspnea, and improve survival. Long-term oxygen therapy is usually introduced in very severe COPD, and indications generally include a PaO2 of 55 mm Hg or less or evidence of tissue hypoxia and organ damage such as cor pulmonale, secondary polycythemia, edema from right-sided heart failure, or impaired mental status. Although the hypoxic drive is often cited as a concern in administering supplemental oxygen to patients with COPD, in actuality it is a very small part of the overall stimulus driving the respiratory system COPD Treatment - ✔Therapeutic strategies for the patient with COPD include promoting smoking cessation as appropriate, prescribing medications that typically include bronchodilators and may include corticosteroids, managing exacerbations, and providing supplemental oxygen therapy as indicated COPD Exacerbation Treatment - ✔When the patient arrives in an ED, the first line of treatment is supplemental oxygen therapy and rapid assessment to determine if the exacerbation is life-threatening. A short-acting inhaled bronchodilator may be used to assess response to treatment. Oral or intravenous (IV) corticosteroids, in addition to bronchodilators, are recommended in the hospital management of a COPD exacerbation. Antibiotics also benefit patients with COPD because bacterial infections often follow viral infections. Inflammatory Bowel Disease & Peritonitis - ✔From Google: Long-term inflammation and ulcers in the colon can weaken the intestinal wall. Over time, these weaknesses may develop into a perforation. A perforation can allow bacteria and other intestinal contents to leak out into the abdomen, causing a serious condition called peritonitis. Alcohol Withdrawl Symptoms - ✔Symptoms include coarse hand tremors, sweating, elevated pulse and blood pressure, insomnia, anxiety, and nausea or vomiting. Severe or untreated withdrawal may progress to transient hallucinations, seizures, or delirium, called delirium tremens.
Alcohol Withdrawl Timing - ✔Symptoms of withdrawal usually begin 4 to 12 hours after cessation or marked reduction of alcohol intake Alcohol withdrawal usually peaks on the second day and is over in about 5 days. This can vary, however, and withdrawal may take 1 to 2 weeks. Alcohol Withdrawl Medications - ✔Safe withdrawal is usually accomplished with the administration of benzodiazepines, such as lorazepam (Ativan), chlordiazepoxide (Librium), or diazepam (Valium), to suppress the withdrawal symptoms Placenta Abruption - ✔Separation of the placenta from the uterine wall Emergency measures include starting two large-bore IV lines with normal saline or lactated Ringer's solution to combat hypovolemia, obtaining blood specimens for evaluating hemodynamic status values and for typing and cross-matching, and frequently monitoring fetal and maternal well-being Classic manifestations of abruptio placentae include painful, dark-red vaginal bleeding (port-wine color) because the bleeding comes from the clot that was formed behind the placenta; "knife-like" abdominal pain; uterine tenderness; contractions; and decreased fetal movement. Rapid assessment is essential to ensure prompt, effective interventions to prevent maternal and fetal morbidity and mortality Depending on severity the women can be monitored through a vaginal birth but if it is a risk they will do c-section Shoulder Dystocia Action - ✔McRoberts Manuver and Superpubic Pressure From Google: The technique is performed by flexing the mother's thighs toward her shoulders while she is lying on her back. No specific degree of elevation or flexion of the patient's legs has been defined for the McRoberts maneuver. Umbilical Cord Prolaspe Action - ✔Umbilical cord prolapse is a rare obstetric emergency that occurs when the cord precedes the fetus out Typically, the examiner places a sterile gloved hand into the vagina and holds the presenting part off the umbilical cord until delivery. Changing the woman's position to a modified Sims, Trendelenburg, or knee-chest position also helps relieve cord
Diarrhea Diet - ✔Avoid fluids high in glucose, such as fruit juice, gelatin, and soda, which may worsen diarrhea Chronic diarrhea is often a result of excessive intake of formula, water, or fruit juice, so teach the parents about appropriate fluid intake. Google: Here's another bit of good advice from Mom for treating diarrhea - eat the BRAT diet: bananas, rice (white), applesauce and toast. When your health is good, physicians usually recommend whole-grain, high-fiber foods. But high-fiber foods could spell trouble when you have diarrhea First Sign Sickle Cell Crisis - ✔Sickling may be triggered by any stress or traumatic event, such as infection, fever, dehydration, physical exertion, excessive cold exposure, or hypoxia Immediately report symmetric swelling of the hands and feet in the infant or toddler Hemophilia Safety - ✔The primary goal of managing hemophilia is to prevent bleeding. This is best accomplished by instructing the child to avoid activities with a high potential for injury (e.g., football, riding motorcycles, skateboarding). Instead, encourage the child to participate in activities with the least amount of contact (e.g., swimming, running, tennis) Muscular Dystrophy: What is it - ✔Muscular dystrophy refers to a group of inherited conditions that result in progressive muscle weakness and wasting. The muscles affected are primarily the skeletal (voluntary) muscles Duchenne muscular dystrophy, the most common neuromuscular disorder of childhood, results in a shortened life expectancy. Nursing Management Muscular Dystrophy - ✔There is no cure for Duchenne muscular dystrophy. However, the use of corticosteroids may slow the progression of the disease. Calcium supplements and vitamin D are prescribed to prevent osteoporosis, and antidepressants may be helpful when depression occurs related to the chronicity of the disease and/or as an effect of corticosteroid use. Medications to decrease the workload of the heart, such as beta-blockers and ACE inhibitors may be prescribed.
Nursing focus on promoting mobility (Encourage at least minimal weight bearing in a standing position to promote improved circulation, healthier bones, and a straight spine) and cardiopulmonary function SCFE Surgery - ✔Surgical intervention may include in situ pinning, in which a pin or screw is inserted percutaneously into the femoral head to hold it in place. After in situ pinning, assist the child with crutch walking. Teach the family that weight bearing is usually resumed about a week after the surgery and that the pin will be removed later Slipped femoral capital epiphysis (SCFE) - ✔SCFE is a condition in which the femoral head dislocates from the neck and shaft of the femur at the level of the epiphyseal plate. The epiphysis slips downward and backward. The left hip is more often affected In acute SCFE, the pain is usually sudden in onset and results in inability to bear weight. Chronic SCFE may present with an insidious onset of pain and limp. Do not attempt to perform passive range of motion to determine the extent of limitation in the child with SCFE; this may cause worsening of the condition. Enforce bed rest and activity restriction. Febrile Seizure Teaching - ✔Provide parental support and education regarding febrile seizures. Reassure parents of the benign nature of febrile seizures. Counsel parents on controlling fever, discuss how to keep a child safe during a seizure, and provide instruction and demonstration in the administration of rectal diazepam at the onset of a seizure (if applicable). Instruct parents when to call their physician or nurse practitioner and when to take their child to the emergency room. Reinforce that any recurrent seizure activity will require prompt medical attention. What is Hydrocephalus: - ✔CSF is formed primarily in the ventricular system by the choroid plexus. It flows because of the pressure gradient that exists between the ventricular system and the venous channels. CSF is absorbed primarily by the arachnoid villi. Hydrocephalus results when there is an obstruction in the ventricular system or obliteration or malfunction of the arachnoid villi. Hydrocephalus Treatment -
difficult to localize. It is generally more severe after meals and is unrelieved by antacids. Alcoholic Hepatitis Teaching - ✔Stop drinking alcohol Sodium restriction What drug is used to treat ascites in cirrhosis? - ✔Spirolactone Acute Renal Failure Priority - ✔Fluid & Electrolyte Imbalances Chronic kidney disease & metabolic acidosis - ✔Metabolic acidosis occurs in ESKD because the kidneys are unable to excrete increased loads of acid. Decreased acid secretion results from the inability of the kidney tubules to excrete ammonia (NH3−) and to reabsorb sodium bicarbonate (HCO3−). There is also decreased excretion of phosphates and other organic acids. Dialysis & Hypertension & Edema - ✔Acute or urgent dialysis is indicated when there is a high and increasing level of serum potassium, fluid overload, or impending pulmonary edema, increasing acidosis, pericarditis, and advanced uremia. It may also be used to remove medications or toxins (poisoning or medication overdose) from the blood or for edema that does not respond to other treatment, hepatic coma, hyperkalemia, hypercalcemia, hypertension, and uremia. Addison's Disease & Blood Sugar - ✔Hypoglycemia Cushing's syndrome - ✔High Cortisol Causes: Taking lifelong steroids (prednisone) Pituitary Tumor (over production of ACTH by pituitary which stimulates adrenal gland to produce Cortisol) Signs/Symptoms: Moon Face & Buffalo Hump Central Obesity (thin extremities)
Thin Fragile Skin, Easily Bruised, Abdominal Stretch Marks Acne Hirsutism Hypertension & Hyperglycemia Infertility Diabetes Insipidus - ✔Causes: Insufficiency of ADH or loss of sensitivity in nephrons circulating ADH Head Trauma, Brain Tumor, Brain Surgery, CNS Infection Signs/Symptoms: Peeing non-stop, crystal clear, cannot have concentrated urine Low urine osmolarity (concentration) Serum Osmolality High Hypokalemia & Hypernatremia Polyuria & Polydipsia 1.001-1.005 Urine Specific Gravity (normal for them) Treatment: Desmopressin (replaces ADH) Testing: Fluid Deprivation Test (withhold fluid for
