NO EXAM THURSDAY!!!!!!!!!

In Etudes under messages is a message from Mrs. Durston. It reads:

Message ID: #1
From: Instructor 10/31/2006 2:57 PM
Exam 1, Cancer/Death and Dying

Please don't shoot me.
I am sorry if there has been a misunderstanding.
You have not had all of the lecture material for the first exam, and it will be given November 9.
Please share this with your classmates.
Shelba Durston

N3 Exam 3 grades posted

now on RSevilla's docushare!

link to grades

#1

1. Review risk factors, screening procedures and warning signs of cancer.

RISK FACTORS
(Lewis pg 293-294) (more from Ill. Study Guide For NCLEX)
Chemical Agents: sun, smoke, dyes, asbestos – alter DNA; most often affect liver, lung, & kidneys
Physical Agents: radiation, sunlight, chronic irritation or infection, tobacco use
Viruses: incorporate into genetic cell structure (oncogenic) Ebstein Barr, AIDS
Genetic & familiar factors: DNA damage occurs in cells where chrom. patterns are abnormal - Wilms’ tumor, acute leukemias, etc
Dietary factors: long term ingestion of fats/oils from animal sources, alcoholic bevs., salt cured/smoked meat and nitrate containing foods (and from lecture… charred meats)
Hormonal Agents: disturbances in the body’s endogenous hormones or administration of exogenous hormones (diethylstilbestrol, prolonged ERT, oral contraceptives)
Idiopathic: arise from unknown causes


SCREENING PROCEDURES

Screening
(National Cancer Institute website)
http://www.cancer.gov/cancerinfo/pdq/screening/overview#Section_2

>Screening is a means of detecting disease early in asymptomatic people.
>Positive results of examinations, tests, or procedures used in screening are usually not diagnostic but identify persons at increased risk for the presence of cancer who warrant further evaluation.
>Diagnosis is confirmation of disease by biopsy or tissue examination in the work-up following positive screening tests. (Following a positive screening result, cancer can often be ruled out by procedures other than biopsy or tissue examination.)

Detection
>Direct or assisted visual observation is the most widely available examination for the detection of cancer. It is useful in identifying suspicious lesions in the skin, retina, lip, mouth, larynx, external genitalia, and cervix.
>The second most available detection procedure is palpation to detect lumps, nodules, or tumors in the breast, mouth, salivary glands, thyroid, subcutaneous tissues, anus, rectum, prostate, testes, ovaries, and uterus and enlarged lymph nodes in the neck, axilla, or groin.
>Internal cancers require procedures and tests such as endoscopy, x-rays, magnetic resonance imaging, or ultrasound. Laboratory tests, such as the Pap smear or the fecal occult blood test have been employed for detection of specific cancers.

See Lewis pg 300 Table 15-7
ACS Recommendations for Early Detection of Cancer in Asymptomatic People


WARNING SIGNS "CAUTION"

Change in bladder or bowel habits
A sore that does not heal
Unusual bleeding or discharge from any body orifice
Thickening or a lump in the breast or elsewhere
Indigestion or difficulty swallowing
Obvious change in a wart or mole
Nagging cough or hoarseness

#3.

3. Be Able to Identify Appropriate Nursing Diagnosis for Patient Experiencing Cancer Treatment:
Nursing Diagnosis for persons experiencing cancer surgery
Anxiety due to diagnosis and intervention
Knowledge deficit regarding cancer
Alteration in tissue perfusion
Potential for infection
Potential for injury due to decrease in Platelets
Nursing Diagnosis for persons experiencing chemotherapy
Alteration in Nutrition less than body requirements related to
Nausea/vomiting
Anorexia
Taste distortion
Diarrhea leads to
Fluid Volume deficit
Electrolyte deficit
Alteration in comfort
Altered bowel elimination
Rarely, constipation occurs related to dehydration and poor dietary intake
Alteration in comfort:
Pain due to dermatitis
Pain due to stomatitis
Pain due to perianal and vulvar ulcers
Due to pruritus
Due to liver enlargement
Disturbance in self-concept:
Due to alopecia
Due to skin pigmentation
Due to nail changes
Alterations in sensory-perceptual abilities
Due to impaired renal function
Kinesthetic due to paresthesia
Visual due to photosenstivity
Auditory due to ototoxicity
Impaired physical mobility due to cerebellar dysfunction
Alteration in Urinary Elimination Pattern due to hemorrhagic cystitis
Anxiety due to change in urine color
Sexual dysfunction and alteration of self-concept due to
Premature menopause
Amenorrhea
Decreased spermatogenesis
Altered cardiac output: decreased due to cardiotoxicity of specific antineoplastic agents.
Ineffective breathing pattern and ineffective airway clearance due to pulmonary toxicity
Nursing diagnoses for persons experiencing radiation therapy
Impaired skin integrity
Immediate skin reactions
Delayed skin reactions
Potential for infection related to bone marrow depression
Potential bleeding related to bone marrow depression
Activity intolerance related to anemia
Alteration in nutrition: less than body requirements
Alteration in oral mucous membrane due to irradation
Alteration in bowel elimination due to irradiation
Alteration in urinary elimination patterns
Alteration in comfort: nausea and vomiting
Alteration in comfort: headache
Disturbance of self concept related to alopecia

1/2 the answer for Question #2

I tried to do all of it but it's getting late and I have to get ready for tomorrow. So I did half of the question I covered Surgery and Radiation if someone else can do Chemo and Biological that would be great. Please feel free to put any input if something else can be added or you find an error. Good night ladies!

Treatment Modalities of CA: (Chemo, Radiation, Surgery, and Biologic Therapy) May be used alone or in combination in the initial treatment phase or retreatment phasesà two or more treatment modalities are used to cure or control the CA for a long period of time.
SURGICAL THERAPY: In order for surgical therapy to be applied the following priciples are applicable: **Cure, control and palliation **
i. Cancer that arises from a tissue c slow rate of cellular proliferation or replication is most amenable to surgical treatment
ii. A margin of normal tissue must surroung the tumeor at the time or resection
iii. Only as much tissue as necessary is removed, and adjuvant therapy is used
iv. Preventive measures are used to reduce the surgical seeding of cancer cells
v. The usual sites of regional spread may be surgically removed à a debulking procedure may be used if the tumor cannot be completely removed (i.e attched to a vital organ)
TYPES OF SURGICAL THERAPY
i. Diagnostic surgeries confirms or rules out malignancy. It establishes type, extent, and classification to tumor.Examples: needle biopsies, incisional or excisional biopsies. Samples of the tumor are taken if complete removal of a lesion or tumor is not possible or undesirable (location, etc) Removable tumors with excisional surgery are usually less than 3 cm in size. Size and location determine the best procedure to perform.
ii. Curative surgery is used to remove all of the tumor with minimal damage to structures surrounding the tumor and minimal functional impairment. Removal often means loss of an organ, resulting in an alteration in body image.The process of rehabilitation continues long after discharge, utilizing outpatient services. Groups of people who have experienced similar cancers often have formed support groups.
iii. Reconstructive Surgery helps restore form and function of whatever was removed (i.e breast reconstruction). It is possible for the reconstruction to occur at the same time as the curative surgery. The goal of reconstruction is to improve the person’s quality of life by restoring maximal funciton and appearance.**helps increase the quality of life**
iv. Palliative Surgery is used to retard the growth of the tumor. Removal of secreting glands to take away hormone source—Decrease the size of an existing tumor. Removal of all of the tumor may not be possible, so debulking the tumor reduces the “tumor burden” on the person, making it possible for other therapies, such as chemotherapy or radiation. Cryrosurgery or laser surgery may be used to remove obstructions, or ulcerations when a cure is no longer possible. This reduces pain. (Examples: colostomy for relief of a bowel obstruction, laminectomy for relief of a spinal cord compression.
v. Supportive Care are surgical procedures used throughout the DZ process of CA to provide support. They include insertion of feeding tubes, creation of a colostomy to allow healing of rectal abscess, suprapubic cysttostomy for the patient c advanced prostatic CA


RADIATION THERAPY: **Cure when therapy is used alone; control: palliation most often goalàcan be used to reduce tumor size to relieve symptoms such as pain and obstruction** local treatment modality for CA . Works by producing high energy ionization, taking a way the cells ability to reproduce. Works best on rapidly dividing cells thus cells in the GI tract, o;ral mucosa and bone marrow will die fast and exhibit early acute responses to radiation. The larger the treatment area, the greater the amount of side effects. Hair over treated area will likely fall out, and probably not grow back. The higher the number of rads the higher chance that they will have a reaction. Factors most commonly used to reduce side effects or radiation Fractionation give healthy cells time to repair themselves between doses and increases the chance that the tumor cells will be hit during a growth phase. Alternate sites allow for hitting the tumor from the front, back, and either side of the tumor. The area that all angles have in common is the tumor, but by alternating the directions normal cells contact with the radiation is minimized, thus normal cells will not be harmed as badly.
i. External Radiation (external beam radiation therapy): is the most common form of treatment delivery. Adm. By high radiation machines
ii. Internal Radiation (brachytherapy): is administered by an implantation or insertion fo radioactive material directly into the tumor or in close proximity. It may be temp or permanent. ** Nurses must be aware that the patient is radioactive. Nursing care should be organized so that limited time is spent with the patient. Sheilding if available should be used usually with a film badge.

iii. Side Effects: Nurse has an important role in helping patient deal with side effects.
1. Fatigue: Patient must be aware that fatigue is an expected side effect, and not a sign that treatment is not working. Encourage patient to rest when fatigued, to maintain usual lifestyle patterns a s closely as possible and to pace activities in accordance with energy level.
2. Anorexia: May develop as a general reaction to treatment. Monitor weight to make sure weigth loss is not excessive. Provide small frequent meals of high protein, gently encourage patient to eat but avoid nagging, serve food in a pleasant environment.
3. Bone Marrow Suppression: Monitor CBC (WBC are usually more affected). If anemia occurs and Hgb drops below 10g/dl the patient may require blood transfusion.
4. Skin Reactions: Protect skin from trauma, lubricate dry skin with nonirritating creams, avoid the use of harsh soaps.
5. Oral, Oropharynx, and esophageal reactions: Be aware that eating,swallowing, and talking ae difficult. Encourage patient to use artificial saliva, assess oral mucosa daily and teach patient to do this. Discourage use of irritatnts such as tobacco and ETOH.
6. Pulmonary Effects: effects may be include both acute and late reactions. For pneumonitis monitor for dry, hacking cough, fecre and exertional dyspnea.
7. GI effects: Monitor manifestataions such as urgency, frequency,a nd hematuria. For Nausea and vomiting: administer antiemetics, use diversional activities, teach to eat and drink when not nauseated, assess for s/sx of dehydration and alkolosis. For Diarhhea: Give anitdiarrheal agents as needed, assess volume, consistency and number of stools produced a day and encourage fluid intake.
8.Reproductive effects: Be sure to discuss these changes with patients àaspermia in males and potential infertility. Inform of the possibility of harvesting sperm

Nursing 2, Exam 1 Study Guide

I have moved it to the top of the list for discussion.


from SDurston's Docushare
link

Study Guide for Nursing 2, Exam 1
1. Review risk factors, screening procedures, and warning signs of cancer.

2. Review treatment modalities for cancer, including Chemotherapy, Radiation, Biological Mediators, and Surgery. Be aware of the variety of goals for each modality.

3. Be able to identify appropriate Nursing Diagnosis for patients experiencing cancer treatment. Using Nursing Diagnosis, be able to select the best intervention for a described circumstance experienced by a cancer patient

4. Be able to select the best responses to patient statements about their experiences and concerns about their cancer and related treatment.

5. Review information in your text about death and dying. Be able to identify responses to news of impending demise as they are described in the text and lecture material.

6. Develop an awareness of the effects of end-stage illness on family members, significant others, and care givers. Recognize appropriate responses vs. those that are less than optimal.

7. Review pain assessment, medication practices, and goals of pain treatments. Understand the World Health Organization’s schematic for pain control. Understand combinations of medications and therapies than have a synergistic effect to relieve pain.

8. Review the physiology of pain, as well as how complimentary and alternative therapies assist in relief of pain. Be able to select the best definition of pain. Study

Great Info. Resource

Hi Everyone !

Just wanted to let you all know about the great information resource we have available to us at the Evolve website that goes with our text..........there are NCLEX questions for every chapter, concept map maker for each chapter, case studies and even a printable glossary of key terms.

Happy Studying

http://evolve.elsevier.com/productPages/s_0323016103.html

Sorry.........the NCLEX questions are the same ones from the book.......oops!

Teaching aid - Neutropenia

From the Oncology Nursing Society website http://www.ons.org/patientEd/
a great resource for patient education....

Neutrophil Teaching Booklet
An educational guide developed to help patients understand neutropenia.
link to pt ed booklet

MEDICAL BLOOPERS!

xpost from another nursing site

1. A man comes into the ER and yells, "My wife's going to have her baby in the cab!" I grabbed my stuff, rushed out to the cab, lifted the lady's dress, and began to take off her underwear. Suddenly I noticed that there were several cabs - and I was in the wrong one.

Submitted by Dr. Mark MacDonald, San Antonio , TX .

2. At the beginning of my shift I placed a stethoscope on an elderly and slightly deaf female patient's anterior chest wall.
"Big breaths, "I instructed." "Yes, they used to be," replied the patient. Submitted by Dr.Richard Byrnes, Seattle , WA

3. One day I had to be the bearer of bad news when I told a wife that her husband had died of a massive myocardial infarct. Not more than five minutes later, I heard her reporting to the rest of the family that he had died of a "massive internal fart."
Submitted by Dr. Susan Steinberg, Manitoba

4. During a patient's two week follow-up appointment with his cardiologist, he informed me, his doctor, that he was having trouble with one of his medications. Which one?" I asked. "The patch. The nurse told me to put on a new one every six hours and now I'm running out of places to put it!" I had him quickly undress and discovered what I hoped I wouldn't see.
Yes, the man had over fifty patches on his body! Now, the instructions include removal of the old patch before applying
a new one.
Submitted by Dr. Rebecca St. Clair, Norfolk ,

5. While acquainting myself with a new elderly patient, I asked, "How long have you been bedridden?"
After a look of complete confusion she answered..."Why, not for about twenty years - when my husband was alive."
Submitted by Dr. Steven Swanson, Corvallis , OR

6. I was caring for a woman and asked, "So how's your breakfast this morning?" "It's very good, except for the Kentucky Jelly. I can't seem to get used to the taste", the patient replied. I then asked to see the jelly and the woman produced a foil packet labeled "KY Jelly."
Submitted by Dr. Leonard Kransdorf, Detroit , MI

7. A nurse was on duty in the Emergency Room when a young woman with purple hair styled into a punk rocker Mohawk, sporting a variety of tattoos, and wearing strange clothing entered. It was quickly determined that the patient had acute appendicitis, so she was scheduled for immediate surgery. When she was completely disrobed on the operating table, the staff noticed that her pubic hair had been dyed green, and above it there was a tattoo that read, "Keep off the grass."
Once the surgery was completed, the surgeon wrote a short note on the patient's dressing, which said, "Sorry, had to mow the lawn."
Submitted by RN.... no name

AND FINALLY!!!................
8. As a new, young MD doing his residency in OB , I was quite embarrassed when performing female pelvic exams. To cover my embarrassment, I had unconsciously formed a habit of whistling softly. The middle-aged lady upon whom I was performing this exam suddenly burst out laughing and further embarrassing me. I looked up from my work and sheepishly said, "I'm sorry. Was I tickling you?" She replied, "No doctor, but the song you were whistling was, "I wish I was an Oscar Meyer Wiener".
Dr. wouldn't submit his name

N2 Managing Chemotherapy Problems

Follow these guidelines to help your patient overcome adverse reactions.

Myelosuppression

* Monitor complete blood cell count before each treatment.

* Administer packed red blood cells (RBCs) as ordered.

* Administer growth factors as prescribed: granulocyte colony-stimulating factor, to decrease duration of nadir and epoetin alfa (Procrit) or darbepoetin alfa (Aranesp) to increase RBC production.

* Assess the patient for signs and symptoms of infection. Educate him about decreased absolute neutrophil count and infection risk.

* Monitor temperature daily. Call the oncologist/hematologist if the patient's oral temperature exceeds 100.5°F (38°C).

Pulmonary toxicity

* Obtain baseline pulmonary function tests.

* Assess the patient's pulmonary status before each infusion.

* Teach him to report cough, dyspnea, or shortness of breath.

* Hold bleomycin if he reports any symptoms of altered pulmonary status.

Cardiac toxicity

* Make sure that the patient undergoes a MUGA (multiple-gated acquisition) scan or an echocardiogram to determine adequate left ventricular ejection fraction before his first chemotherapy dose.

* Teach him to report shortness of breath or palpitations.

* Monitor his total doxorubicin dose.

* Perform ongoing assessments for signs and symptoms of heart failure, including dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, and fatigue.

Nausea and vomiting

* Administer antiemetics before administering chemotherapy.

* Assess the patient's level of nausea and vomiting with each treatment and modify his antiemetic regimen as indicated.

* Teach him how to use his prescribed antiemetic to prevent or treat delayed nausea and vomiting.

Extravasation

* Assess your patient's veins before and during each chemotherapy infusion.

* Teach him about the benefits of a central venous access device if peripheral access is poor.

* Assess blood return frequently during administration of vesicants such as doxorubicin, vinblastine, and dacarbazine.

* Treat extravasation promptly, according to facility policy.

Hypersensitivity reactions

* Assess your patient's baseline vital signs. Bleomycin in particular can cause fever.

* Administer premedications such as acetaminophen and steroids before therapy and have emergency equipment readily available in case of anaphylactic or anaphylactoid reaction.

* Teach him to promptly report any unusual symptoms such as dizziness, itching, or pain.

* Monitor his vital signs throughout the infusion. Increase the infusion rate every 30 minutes only if his vital signs remain stable and he doesn't develop signs of an adverse reaction.

* Stop the infusion if he develops a reaction.

Neuropathy

* Assess him for sensory and perceptual changes before each treatment.

* Notify the oncologist of any changes (peripheral, gastrointestinal) that develop after he receives vinca alkaloids.

Pain at injection site: ABVD

* Administer dacarbazine in 100 to 250 ml of I.V. fluid and infuse slowly over 1 hour.

* Apply heat or ice above the injection site.

Flulike syndrome

* Premedicate with acetaminophen.

* Encourage the patient to drink plenty of fluids.

Hyperglycemia

* Monitor his serum glucose level.

* Increase monitoring frequency if he has diabetes. The prescriber may need to modify his antihyperglycemic therapy.

Skilled care, teaching, emotional support

Anyone with lymphoma or leukemia requires skilled nursing care to cope with the diagnosis and to minimize adverse reactions to treatment. Remind your patient that most adverse effects of therapy can be managed and that many people continue working during treatment. To help him manage immediate and long-term problems, teach him about the following effects of his illness and therapy.

* Emotional issues. Encourage him to discuss his feelings; provide reassurance and support when he does. Teach him relaxation techniques and encourage him to seek help through a support group or counselor. If he's taking prednisone, advise him to take it with breakfast or lunch to prevent insomnia and to notify the oncologist/hematologist if he has mood changes, which can occur with prednisone therapy.

* Infection. Teach him about infection risk. Review the signs and symptoms and tell him to contact the oncologist/hematologist if he develops signs of infection.

* Hair loss and skin changes. Tell the patient about the potential for hair loss and explain that his hair will probably grow back after he finishes therapy. Encourage him to purchase a wig or hat before his first chemotherapy infusion. Tell him that his skin may dry and become more sensitive to sunlight so he may need to apply sunblock and wear protective clothing in the sunshine. He may also notice changes in his nails.

* Fatigue. Encourage your patient to pace his activities, rest frequently, and get help with activities of daily living.

* Reproductive issues. Discuss the potential for chemotherapy-induced sterility. For a male, review the need to prevent pregnancy in his partner because chromosome damage to sperm can negatively affect the fetus. Discuss sperm banking and provide resource information if he chooses this option. Teach a female patient that treatment can cause menstrual changes and menopause-like symptoms and make her susceptible to vaginal infections.

* Stomatitis. Encourage your patient to see a dentist before starting chemotherapy. Teach him to rinse his mouth with a solution of salt and baking soda in water to prevent infection and advise him to avoid drinking alcohol. Tell him to call the oncologist/hematologist if he develops mouth sores.

* Bladder and bowel changes. Advise your patient to drink plenty of fluids and to void frequently to prevent cystitis. Teach him to check his urine for blood and to call his health care provider if he develops frequency or discomfort with urination. Teach him to include fiber in his diet and encourage him to use a laxative if he can't move his bowels every 2 days. Tell him to call his health care provider if he develops diarrhea. Monitor his response to antidiarrheal medication and assess him for dehydration.

* Gastric irritation. If your patient takes prednisone, tell him to take it with food or milk. If he reports midepigastric distress, ask the oncologist/hematologist to prescribe medication to prevent gastrointestinal irritation.

Keeping current

N2 End of Life

Watch the video/tutorial at Medscape nurses on
The Last Hours of Living
Have Kleenex handy
There is a quiz in the comments
Also in the comments are signs and symptoms you would expect to see in the dying person.

N2 End of Life links

• Helping Yourself When You Are Dying
• A Dying Person's Guide to Dying
• http://www.hospicenet.org.
  
• National Cancer Institute. End of Life: Questions and Answers. http://www.cancer.gov//cancertopics/factsheet/Support.
  
• Palliative Care Resource Center.
• http://www.medscape.com/resource/hospice.

Wound Quiz

The chapter to read for the wound Quiz in skills is chapter 30 not 31.

Lindsey and Chrissy's walking club!!!!

for any of you nursing students out there... doesn't matter what semester... every thursday around 4:45 chrissy and i will be walking laps at delta's track... anyone who wants to come and beat those nursing pounds feel free!!
takes about an hour to walk 12 laps and thats 3 miles... we were done today around 5:45

Question of the week 10.23.06

A young adult male has been diagnosed with testicular cancer. Which of these statements by this client would need to be explored by the nurse to clarify his understanding?

1. "This surgical procedure involves removing one or both testicles through a cut in the groin. My lymph nodes in my lower belly also may be removed."
2. "I have a good chance to regain my fertility later. However if I am concerned, I can have my sperm frozen and preserved (cryopreserved) before chemotherapy."
3. "If I have cancer at stage 3 it means I have less involvement of the cancer."
4. "After the surgical removal of a testicle, I can have an artificial testicle (prosthesis) placed inside my scrotum. This artificial implant has the weight and feel of a normal testicle."

lab values

you will need to know lab values and what they mean as you progress further in the program. Here is a website that explains everything.

">www.dalesplace.net/lab_values.php

St. Joseph's Group 1

PHARM

PHARM TEST SCORES ARE POSTED

Congrats everyone on passing Nursing 1.

GRADES

GRADES ARE UP. THEY LOOK GOOD. CONGRATS!!!

Question of the week 10.16.06

(sorry for the late posting)


If the nurse notes cloudy drainage 2 days post insertion of a Tenckhoff catheter for peritoneal dialysis, what other data does the nurse need to collect before reporting this finding?

1. bowel sounds
2. breath sounds
3. temperaturey
4. urine output

Grades

Does anyone know anything about where our grades may be posted?!? I think I am confused, I thought she said they would be posted on Friday. I can't seem to find my grade.

Tea for incoming students

Hey everyone, I just wanted to update you guys. The tea is scheduled for Jan.8th. It will be from 9am-11am. We will have a meeting on Thursday before lecture (Oct.26th). The meeting will be at 11am. We will meet at the Lock Lounge.We would like everyone to get involved in the decision making, planning, and the actual event. This way you can also see and decide how your money is spent. I have left a message for the delta culinary program to see if they are available to cater the breakfast and also to find out how much it would cost if we decide to go this route. Some people talked about going with a theme of Mardi Gras Breakfast Bash. I went onto oriental trading company and found decorations for this theme to see what costs we are looking at. To decorate danner and the tables the cost will be approx. $175.00. We still need to provide food, goody bags, folders for info, raffle prizes, and anything else that we decide we need. It is important for everyone to contribute financially as well, as the money collected will determine how nice of a tea the incoming students will recieve. We can't get things rolling until we know how much money we have to work with. I will be collecting every Thursday at lecture. I have collected from 18 peole so far. Barbara will have forms with our tax ID# available on Thursday for anyone who is collecting donations from businesses. Thanks for all the support that you guys have already given Barbara and I. I think we can put on a wonderful tea, just as the class before us had done for us. Thanks again, Denise and Barbara

clinical worksheets

Hey everyone. If you haven't noticed yet, The care plans for the clinical site have been removed from Semillo's docushare site. They have not been added to Durston's site or anywhere else for that matter. I usually print them every week. My extra one I usually have , I used on our last week of N1. We all are going to need these next week. Does anyone have any saved to there computer. If so maybe we can email them. My email is dwilliams255@students.deltacollege.edu .

Congrats

Congratulations Ladies and Gentlemen!
I am On Cloud 9 Right Now, I Hope You Are On Cloud 9 Too!

final

final exam answers are posted on docushare!!!!!

Are we the only SNs without a life?

If you think that you are alone in your student nurse adventures at Delta, type the words student nurse into the search area on the blog and see just how many others are out there in the world blogging their lives through nursing school.
Here are a few examples;

http://runningwildly.blogspot.com/2006/09/losing-my-mind.html

http://saintmurse.blogspot.com/2006/10/great-day-as-nursing-student.html

http://unimum209.blogspot.com/

http://studentnursejack.blogspot.com/2006_09_01_studentnursejack_archive.html

Flu Shots... :)

Okay, so today our group (Dameron 1) was given the chance to give flu shots @ Kaiser and let me tell you ladies it was so much fun. Not only did we gain experience but we also had a great time doing it. We are now proficient in giving IM meds!!!YAY for us!!!

Thank You!

Thank You Ladies, You Brought Tears To My Eyes! (Yes I Am A Weenie)

No Really, We Are A Family. It Is Not "I", It Is "We and Us"! Let's Stick Together and Help Each Other Out. Keep Giving To Each Other Until You Can't Give Anymore, Because That Is What Families Do!

THANK U KELLY AND NURSE NICKEY!

THANK U FOR UR GREAT HELP AND KEEPING THIS THING GOING!! UR AN ENTHUSIASM IS AWESOME!

A "shout out" to the new admins

Nurse Nickey and Kelly have been added as admins for the blog. A huge "thank you gals" for steppin' up!!

Everyone did a great job this weekend knocking out the N1 final exam questions while some of us poor sods were neck deep in Pharmacology studies.

It was wonderful to see such exceptional teamwork!!

All Questions Answered

Okay, all questions have been answered, for those of you who are able, please add your comments/views/input on the questions that have been answered. The more input on these questions the better for all of us..........it's okay to have a different answer, share with us what it is in the comment area for that particular question.

Great Job Everyone !!

#24

24) Discuss the nursing interventions when an intramuscular medication is erroneously inserted.
Assess the client for allergies to the medication.
Conduct appropriate follow up, such as
*Desired effect (e.g., relief of pain or vomiting)
*Any adverse reactions or side effects
*Local skin or tissue reactions at injection site (e.g., redness, swelling, pain or other evidence
of tissue damage)
* Relate to previous findings, if available
* Report significant deviation from normal to physician.

Kozier pg 831

#12

12) Describe the procedure to prepare the client for surgery.
The nursing responsiblity immediately before surgery includes final preoperative teaching, assessment and communication of pertinent findings, and ensuring that all preoperative preparation orders have been completed and that records and reports are present and complete to accompany the patient to the OR. It is especially important to vertify the presence of a signed operative consent, laboratory data, a history and physical examination report, a record of any consultations, baseline vitals signs, and nurses' notes complete to that point. Nail polish should be removed to monitor oxygenation. An ID band is put on the client and allergy band if applicable. Client should void shortly before surgery and before the administration of any preoperative medication. The nurse should determine that all preoperative preparations have been completed and that the signed consent for surgery is present before giving any preoperative medications.
Lewis pg 371-372

Wow, Great Job!

Okay all, only two questions left #'s 12 and 24!!
I have been compiling all of the answers into one M.word document, please email me at k9nurse@sbcglobal.net if you would like a copy emailed to you after the last 2 questions have posted.

Great Teamwork!

#29

I didn't see this posted yet so here it is:



#29 Discuss the rationale of how weakness and fatigue is a risk factor
for pressure ulcers. Kozier p.857-8

Immobility due to paralysis, extreme weakness, pain, or any cause of decreased activity can hinder a person's ability to change positions independently and
relieve the pressure, even if the person can perceive the pressure.

This is one of several factors contributing to the development of pressure ulcers.

FYI - Other factors are:

Inadequate nutrition
Fecal and urinary incontinence
Decreased mental status
Diminished sensation
Excessive body heat
Advanced age
Presence of certain chronic conditions (i.e. diabetes, cardiovascular disease)

Thank You!

I Just Wanted To Say, "We Really Work Well Together To Get The Job Done"! I went to work this morning and there were a few questions done and I just got home and they are almost done. That says alot about us, as a Class. Thank you Classmates!

#13

13.) Describe the procedure of the surgical client when received in the PACU

Initial assessment includes a summary of the complete anesthesia report. Priority care includes monitoring and management of respiratory and circulatory function, pain, temperature, and surgical site.
Respiratory function
Patency, rate and quality of respirations with auscultation in all lung fields
O2 therapy used if ordered via nasal cannula or face mask – helps in elimination of anesthetic gases and meets increased O2 demand due to decreased blood volume or increased cellular metabolism. Monitor O2 sat.
Circulatory function
ECG Monitoring to determine cardiac rate and rhythm
BP monitored and compared with baseline data
Assess temp. and skin color and condition
Neuro. Assessment
Focused on levels of consciousness; orientation; sensory and motor status; size, equality, reactivity of pupils
Urinary Assessment
I & O and fluid balance
Note presence of IV lines, irrigation solutions and infusions
Output devices including catheters and wound drains
Surgical site assessment
Note condition of dressings and type and amount of any drainage
Institute post-op orders related to site care
Special considerations: Hearing is first sense to return in the unconscious patient so explain all activities from the moment of admission to PACU. Explain surgery is complete, patient is in recovery room and family has been notified. Also explain who nurse is caring for the patient, what is being done, and what time it is.
Common post-op problems that should be anticipated are airway compromise (obstruction), respiratory insufficiency (hypoxemia and hypercarbia), cardiac compromise (hypotension, hypertension, arrythymias), neurologic compromise (emergence delirium and delayed awakening), hypothermia, pain, nausea and vomiting.

SJDC ADN Class of 2008

#30 Discuss the theraputic communication needed for the immobile person.
Immobility is the reduction in the amount and control of movement taht a person has. Normally people change positions when they are uncomfortable, which reduces pressure to any given area. For those with mobility impairments such as paralysis, pain, weakness or any other problem that limits freedom of movement adjusting position to aleviate pressure or discomfort can be difficult or impossible.
Immobility can lead to disuse syndromes, contractures, stiffness in joints and pressure ulcers.
Nursing strategies are aimed at preventing the complications of immobility, at risk clients should be identified early to prevent complications before they arise. Braden scales are used as identifiers. Patients should have physcians orders that specify activity levels, "such as out of bed w/assist". Most clients require assistance, it is up to the nurse to determine how much assistance is required.
Theraputic communication promotes understanding and fosters a constructive relationship with the client that is goal directed. The nurse should gather data, determin limitations and assistance required. (preinteraction phase). Then clarify the desired task to the client with expectations for each. ( introductory phase) followed by the (working phase) exploring thoughts and feelings and implementing the task. lastly the (termination phase) where summarization occurs.
Clients should be involved in their own care if possible.

here's 2 and 3

2. Discuss the nursing interventions for the surgical client when ambulating. (fundamentals pg. 920)

Leg exercises
Encourage client to do leg exercises every 1-2 hours during waking hours. Muscle contractions compress veins, preventing stasis of blood in the veins, which can cause thrombus. Contractions also promote arterial blood flow. This will prepare the client for ambulation.

Moving and Ambulation
Encourage client to move from side to side, at least every 2 hours. This will make it easier for client to get up from bed.

Client should ambulate as soon as possible after surgery in accordance w/ surgeons orders. Usually the evening of the surgery. Early ambulation prevents respiratory, circulatory, urinary and gastro-intestinal complications. As well as general musclo-skeletal weakness. Offer pain medication or determine client comfort prior to scheduling ambulation. Start gradually , assisting the client to a sitting position at side of bed with feet dangling. Teach splinting techniques if necessary. Remember non-skid shoes!!!!

Remain at clients side for safety. Assess client needs IE walker, wheelchair nearby, level of assistance required. Monitor client for toleration IE Orthostatic reactions, increased pain, exertional shortness of breath… Document client participation and toleration.


3. Discuss the nursing implications for the surgical client when pain medication is administered. ( fundamentals pg. 919 ,1143)

Pain is described as a sensory and emotional experience. Pain can have detrimental effects in the post-surgical patient,leading to stimulation of the SNS, tachycardia, shallow breathing, atelectasis, altered gas exchange, immobility, and immunosupression.
Pain is greater 12-36 hours post-op, decreasing by second or third day. During initial post op period PCA’s are used via IV or epidural catheter. The nurse monitors the infusion or amount administered by PCA and assesses clients pain relief. If pain is uncontrolled then PRN medications or analgesics should be given routinely every 2 to 6 hours for the first 24-36 hours. Pre medication can be offered prior to scheduled activities ie wound care, ambulation… anti- inflammatories are also given w/ narcotic analgesics to enhance pain relief. Analgesics work best when taken on a regular basis, before pain becomes severe.
Non-pharmacological measures to aid in controlling pain include back rubs, repositioning, diversional activities, and guided imagery.
Remember pain is whatever the client says it is …
P-Provoked: What brought on your pain?
Q-Quality: What does your pain feel like?
R-Region/ Radiation: Where is your pain located? Does it travel?
S-Severity: On a scale of 1-10, 1 being no pain and 10 the worst, what is yours?
T-Timing: When did the pain start?

another med mistake from same hospital that gave lethal doses to premature babies

Hospital mistake paralyzes new mom
Sun Oct 15, 11:54 AM ET
A hospital that gave lethal doses of a drug to three premature babies has made another medication mistake, giving a new mother a painkiller 10 times faster than intended and making her temporarily unable to walk.
Amber Baise, 18, of Indianapolis, who received the painkiller during childbirth, has regained some movement in her legs as she recovers from what Methodist Hospital on Friday called a doctor's mistake.
"We remain hopeful that she will receive a full recovery. That is our hope. That is our commitment," said Bill Stephan, a spokesman for Clarian Health Partners, which operates Methodist and Indiana University's hospitals.
Baise entered Methodist on Oct. 8 to give birth to her first child and a doctor started her on an epidural. An improperly programmed pump gave her 10 hours worth of painkiller in just one hour.
Baise delivered a healthy girl.
The doctor who made the error works for an anesthesia practice that contracts with Methodist. The doctor has decades of experience and a good record, Stephan said. He did not release the doctor's name.
Baise's attorney, Nathaniel, said the physician's good record was irrelevant.
"There are certain mistakes that you can't make, that you shouldn't make, regardless of your education, regardless of your training, and this is the kind of mistake that you shouldn't make," Lee said.

Good Work Ladies!!

Just a few questions left out there: 2, 3, 12, 13, 24, 29, 30 Lets finish this tonight.......anybody new out there want to add to our study guide??

Great Teamwork!!!!

#20

#20 Discuss safety implications for insulin and heparin
Insulin- obtain FSBS to assess amount needed. Mix by rolling the vials not shaking, shaking can cause particules to foam up. Never drawl an insulin with a modify protein (cloudy insulin NPH or Lente) before the clear (regular insulin). The protein slows absorption, so inject air for the amount you will need into cloudy without touching the insulin inside the vial, and then inject and drawl out the amount of regular insulin you need. Next drawl up the cloudy, but be careful not to over drawl because you cannot put excess back, and be careful not to drawl up air bubbles. Inject at a 45 degree angle, and rotate injection sites to prevent skin break down.
Heparin- Do not aspirate when giving heparin by SC injection. Aspiration can possibly damage the surrounding tissue and cause bleeding as well as bruising. Do not massage the site after the injection. Massaging could cause bleeding and ecchymosis and hasten drug absorption. Alternate the sites of subsequent injections.

pharm practice questions

http://www.pharmacology2000.com/Autonomics/unit_practice_exam_index.htm

#17 Discuss assessment and interventions for IV therapy

# 17 Discuss the assessment and nursing interventions for the client
receiving IV therapy

Maintaining Infusions: (Kozier, skills bk.pg.549)

Once an intravenous infusion has been established, it is the nurse’s responsibility to maintain the prescribed flow rate and to prevent complications associated with IV therapy. (Fluid volume excess, electrolyte imbalance) Current research indicates that routine change of peripheral IV catherers/needles and IV tubing can be performed every 72 hours (or according to agency policy). Dressings should be changed on the IV site only when soiled, wet, or dislodged.

In maintaining the infusion, the nurse will examine the appearance of infusion site; patency of system; type of fluid being infused and rate of flow; and the response of the client. From physician’s order, determine the type and sequence of solutions to be infused. Determine the rate of flow and infusion schedule.

-Ensure that the correct solution is being infused.
-Observe the rate of flow every hour.
-Observe the position of the solution container. (should be 3 ft. above the IV site)
-If the rate is too fast, check agency policy, the physician may need to be notified.
-If the rate is too slow, adjust the IV to the prescribed rate. (check with facility policy)
-If prescribed rate of flow is 150mL/hr or more, check the rate of flow more frequently, for
example, every 30 min.
-Inspect the patency of the IV tubing and needle.(make appropriate changes/corrections when
nec.)
-Inspect the insertion site for fluid infiltration
-Inspect the insertion site for phelbitis
-Inspect the intravenous site for bleeding
-Teach the client ways to help maintain the infusion system(avoid twisting or turning the
arm/hand w/IV)


ATI book pg. 416-417 Says:

Monitor IV infusion at least every hour, count drip rate, check tubing for kinking/leaks, observe settings on pump, inspect site for swelling, pain, coolness, or pallor which may indicate infiltration.

-Inspect insertion site for redness, swelling, heat, and pain which may indicate phelbitis.
-Change tubing every 48-72 hours depending on policy
-Change tubing when hanging new solution container.
-Verify solution type and flow rate
-Peripheral IV dressings should be changed when damp or soiled or every 48-72 hours
depending on protocol.
-Label the dressing and secure the IV tubing

#28

28) List the nursing diagnoses for the client with impaired skin integrity.
Risk for Impaired Skin Integrity related to incontinence and immobility/At risk for skin being adversely altered.
Impaired Skin Integrity (stage II pressure ulcer)related to friction/Altered epidermis and/or dermis
Kozier pg 868
Impaired Skin Integrity
Related to:
mechanical factors (pressure, shear, friction, moisture)
altered circulation
altered sensation
radiation
medications
As evidenced by:
disruption of skin surface (incision, rash, excoriation, open wound(s) (specify type, location)

handout from Mary Lou

#26

26) Discuss why the elderly are at risk for impaired skin integrity.
The aging process brings about several changes in the skin and its supporting structures, making the older person more prone to impaired skin integrity. These changes include the following:
*Loss of lean body mass
*Generalized thinning of the epidermis
*Decreased strength and elasticity of the skin due to changes in the collagen fibers of the dermis
*Increased dryness due to a decrease in the amount of oil produced by the sebaceous glands
*Diminished pain perception due to a reduction in the number of cutaneous end organs responsible for the sensation of pressure and light touch.
Kozier pg 858

I'll take 17

#23

23) Explain the purpose of administering an intramuscular medication by the Z-track method.
Inserting an intramuscular needle at a 90-degreee angle using the Z-track method. (a) skin pulled to the side; (b) skin released. When the skin returns to its normal position after the needle is withdrawn, a seal is formed over the intramuscular site. This prevents seepage of the medication into the subcutaneous tissues and subsequent discomfort. Using a quick motion lessens the client's discomfort. Permits the medication to disperse into the muscle tissue, thus decreasing the client's discomfort.
skills book pg 558 and Kozier pg 831

#19

19) Discuss the various sites for insulin and heparin.
Among the many kinds of drugs administered subcutaneously (just below the skin) are vaccines, preoperative medications, narcotics, insulin, and heparin. Common sites for subcutaneous (SC or SQ) injections are the outer aspect of the thighs. These areas are conventient and normally have good blood circulation. Other areas that can be used are the abdomen, the scapular areas of the upper back, and the upper ventrogluteal and dorsogluteal areas. Only small doses (0.5 to 1.0 ml) of medication are usually injected via the subcutaneous route.
Insulin-The most important consideration is the depth of the subcutaneous tissue in the area to be injected. If the client has more than 1/2 inch of adipose tissue in the injection site, it would be safe to administer the injection at a 90-degree angle with the skin spread. If the client is thin or lean and lacks adipose tissue, the subcutaneous injection should be given with the skin pinched and at a 45- to 60-degree angle.
Heparin-the subcutaneous administration of heparin requires special precautions because of the drug's anticoagulant properties. Select a site on the abdomen away from the umbilicus and above the level of the iliac crests.

#21

#21 Discuss the assessment needed when administering oral medications; medications via NG tube

1. Always check with the pharmacist to see if the clients medications come in liquid form because these are less likely to cause tube obstruction.
2. If meds do not come in liquid form, check to see if they may be crushed (enteric-coated, sustained action, buccal, and sublingual meds should never be crushed).
3. Crush a tablet into a fine powder and dissolve in at least 30ml of warm water. Cold liquids may cause client discomfort. Use only water for mixing and flushing.
4. Read medication labels carefully before opening a capsule. Open capsules and mix the contents with water only with the pharmacists advice.
5. Do not administer whole or undissolved meds because they will clog the tube.
   Assess tube placement.
6. Before giving the med, aspirate all the stomach contents and measure the residual volume. Check Agency policy if residual volume is greater than 100ml.
7. When administering the meds
   

• remove the plunger from the syringe and connect the syringe to the pinched or kinked tube. Pinching or kinking the tube prevents excess air from entering the stomach and causing distention.
• Put 15-30ml (5-10ml for children) of water into the syringe barrel to flush the tube before administering the first med. Raise or lower the barrel of the syringe to adjust the flow as needed. Pinch or clamp the tubing before all the water is instilled to avoid excess air entering the stomach.
• Pour liquid or dissolved med into syringe barrel and allow to slow by gravity into the enteral tube.
• If you re giving several meds, administer each one separately and flush with at least 15-30ml (5-10ml for children) of tap water between each med
• When you have finished administering all meds, flush with another 15-30ml (5-10ml for children) of warm water to clear the tube.
• If the tube is connected to suction, disconnect the suction and keep the tube clamped for 20-30min after giving the med to enhance absorption.

Kozier pg 811

#22

#22 Discuss the aging process and medicaiton administration
· Altered memory- they may think they took their med, when they haven’t, or think they haven’t taken the med and take it again causing an overdose.
· Less acute vision- impaired vision may lead them to take the wrong med, or the wrong dose, or at the wrong times.
· Decrease in renal function, resulting in slower elimination of drugs and higher drug concentrations in the blood stream for longer peroids, so they may require smaller doses fo a drug because the drug and its metabolites may accumulate in the body.
· Less complete and slower absorption form the gastrointestinal tract
· Decreased liver funciton, which hinders biotransformation of drugs, creating a cumulative effect.
· Decreased organ sensitivity, which means theat the response to the same drug concentration in the vicinity of the target organ is less in older peole than in the young.
· Altered quality of organ responsiveness, resulting in dverse effects becoming pronounced before therapuetic eggects are achieved
· Decreased in manual dexterity due to arthitis and or decrease in felexibility makes it diffcult to open and adminster meds.
Kozier pg 805

# 14

List the relevant nursing diagnoses for the surgical client.

Preoperative Nursing Diagnoses: Deficient Knowledge.
Fear
Disturbed sleep pattern.
Anticipatory grieving.
Ineffective coping.

Intraoperative Nursing DX: Risk for aspiration.
Ineffective protection.
Impaired skin integrity.
Risk for perioperative-positioning Injury.
Risk for imbalanced temperature.
Ineffective tissue perfusion.
Risk for deficient fluid volume deficit.

Postoperative Nursing diagnoses: Acute pain.
Risk for infection.
Risk for injury.
Risk for deficient fluid volume.
Ineffective airway clearance.
Ineffective breathing pattern.
Self care deficit.
(Bathing/Hygiene, dressing, grooming, toileting)
Ineffective Health maintenance.
Disturbed Body image.

Fundamentals pgs: 901, 911, 914

#31 Legal implications of delegation

#31 Explain the legal implications of delegation.
(pwr.pt.notes 10/12, kozier 470-473)

Delegation: (definition) Transference of responsibility and authority for the
performance of an activity to a competent individual.


Delegate-assumes responsibility for the actual performance of the task or procedure.(LVN,practical nurses, LPT,UAP,C.NA,surg. Tech, pt.care tech.)

Delegator- retains accountability for the outcome.

Delegation-
 Is a tool that allows the manager to devote more time to tasks that cannot be delegated.
 Enhances the skills and abilities of the delegate which can build self-esteem, promotes morale, and enhances team work and attainment of organizational goals.
 In nursing, refers to indirect care.

5 “Rights” of Delegation
 Right task
 Right circumstances
 Right person
 Right direction/communication
 Right supervision/evaluation

You as the RN/delgator are legally responsible for the delegate and the task for which you have delegated. Know the scopes of practice for the LVN,C.NA’s, assistants and their limitations. Review the charts Fig 26-2 Kozier pg.471, Fig 26-1 pg.470, Delegation decision-making grid pg 472 Kozier.

#18 Explain health behaviors

#18 Explain health behaviors (Kozier, pg.125,1455, ATI pg. 7)

Health Behaviors: (definition) the actions a person takes to understand his or her
health state, maintain an optimal state of belief, prevent illness and injury and
reach his or her maximum physical and mental potential.

Cognitive-perceptual factors in health promoting behaviors:

These are considered the main motivators for engaging in healthy behaviors.

 Importance the person places on health
 How much control a person feels he/she has over own health
 Perceived self-efficacy (belief that he/she can be successful in carrying out the behavior)
 The person’s definition of health
 The person’s perception of his/her health status
 Whether the person perceives that there will be benefits from the healthy behaviors
 Perceived barriers (how difficult the person thinks the behaviors/activities will be)

Modifying factors: are those that affect the cognitive-perceptual factors.

 Demographic factors (sex, age, education, income)
 Biologic characteristics (body build)
 Interpersonal characteristics (expectations of significant others)
 Situational factors (ease/difficulty accessing healthy alternatives, balanced meals, etc.)
 Behavioral factors (previous experience knowledge and skill)
 Cues to action (things that make person aware of potential for growth)

#25

25. Signs and symptoms of an allergic reaction to medication:

*anaphylactic shock, which is avery severe reaction which can lead to death (hypostension, tachycardia, bronchospasm, and possibly pulmonary edema.
*Hives: which are multiple small, itchy, swollen areas on the skin
*wheezing
*palpitations: unusual heart beat of the chest
*skin rash
*swelling of one or more parts of the body
*acute situational anxiety: generalized anxiety disorder, anxiety disorder, panic disorder, post traumatic stress disorder, obsessive compulsive disorder, phobias

***I found this on the internet, if anyone can find it in the book that would help, i could only find anaphylactic shock in the book

#15

15. Lewis P.989-999 and Techniques P. 616

Assessment of TPN (Total Parenteral Nutrition)

*cHECK FOR ALLERGIES TO ANY OF THE CONTENTS IN THE SOLUTION. (water, protein, carbohydrates, electrolytes, minerals, and vitamins)
*Vital signs should be monitored ever 4-8 hrs (if fever or vital signs are abnormal, notify physician; an elevated temp is one of the earliest signs of catheter-related sepsis)
*Daily wts. give indication of hydration status
-Body wt. is considered the changes in protein, fat, and water.
-On a daily basis, body water fluctuates more that protein and fat.
-Analysis must be made of whether gains or losses in wt. are caused by fluid gained from edema, fluid loss through diuresis, or an increase or decrease in tissue wt.
*Measure daily fluid intake and output an calorie intake
*Blood levels of glucose, electrolytes, and BUN; a CBC; and a hepatic enzyme studies are followed 3x per week until stable and the weekly.
*Observe site under dressing for signs of inflammation and infection.
-Phlebitis can readily occur in the vein as a result of the hypertonic infusion, & area can become infected.
(FYI: Many patients on TPN are receiving chemotherapy, corticosteroids, or antibiotics, which can mask signs of infection)
*If sutures are used to anchor catheter, they may become infected
-If an infection is suspected a culture specimen of the site and drainage should be sent for analysis, and notify Physician
*Blood glucose levels should be checked every 4-6 hrs with a glucose testing meter (TPN patients are at RF Hyperglycemia)
*Check the amt. infused and the rate every 30 min-1 hr.
-too fast of an infusion can put a lrg. amt. of glucose into blood causing hyperglycemia and too slow an infusion rate can cause hypoglycemia.
- An infusion pump must be used during admin. of TPN
*Before setting up and administering TPN, the nurse must check the label and ingredients in the solution to see that they are what the health care provider ordered.
*Examine solutions for contamination, such as cloudy appearance.
*Discontinue TPN and replace with a new solution bag every 24 hr.
*Catheter-related infection and septicemia can occur.

#11

11) Discuss the complications of surgery.
Unanticipated intraoperative events occasionally occur. Although some might be anticipated (e.g., cardiac arrest in an unstable patient, massive blood loss during trauma surgery), others may occur without warning, demanding immediate intervention by all members of the OR team. Two such events are anaphylactic reactions and malignant hyperthermia.
Anaphylaxis is the most severe form of an allergic reaction, manifesting with life-threatening pulmonary and circulatory complications. An anaphylactic reaction causes hypotension, tachycardia, bronchospasm, and possibly pulmonary edema. Antibiotics and latex are responsible for many perioperative allergic reactions.
Malignant hyperthermia is a rare metabolic disease characterized by hyperthermia with rigidity of skeletal muscles that can result in death. It occurs in affected people exposed to certain anesthetic agents. Succinylcholine (Anectine), especially in conjunction with the volatile inhalation agents, appears to be as stress, trauma, and heat, have been implicated. Other complications are: pain, respiratory, mobility, bowel, urinary, death.
Lewis pg 390 and powerpoint

#16

16. Kozier p. 1157-1158

PCA- Patient Controlled Analgesia

PCA is an interactive method of pain management that permits clients to treat their pain by self administering doses of analgesics. With parenteral routes the client administers a predetermined dose of narcotic by an electronic infusion pump. This allows the client to maintain a more constant level of relief yet need less medication for pain relief.

PCA can be effectively used for clients with acute pain related to surgical incision, traumatic injury, or for labor and delivery, and for chronic pain as with cancer.

The physician prescribes the analgesic dose, route, and frequency, w/ the client administering the med. Clients pain must be assessed at regular intervals and analgesic use is documented in the clients record.

PCA's are designed with built-in safety mechanisms to prevent client overdose, abusive use, or narcotic theft. After pushing the button and the preset dose is delivered a programmable lockout interval (usually 10-15 mins) follows the dose, when an additional dose cannot be given even if the client presses the button

#10

10) Discuss the purpose of the pre-op checklist. Give examples of when the nurse would need to call the physician.
The overall goal of the preoperative assessment is to gather data in order to identify risk factors and plan care to ensure patient safety throughout the surgical experience. Goals of the assessment are to
1. Determine the psychologic status of the patient in order to reinforce coping strategies to undergo the proposed surgery.
2. Determine physiologic factors related and unrelated to the surgical procedure that may contribute to operative risk factors.
3. Establish baseline data for comparison in the intraoperative and postoperative period.
4. Identify prescription medications and over-the-counter drugs and herbs that have been taken by the client that may affect the surgical outcome.
5. Identify if the results of all preoperative laboratory and diagnostic tests are documented and communicated to appropriate personnel.
6. Identify cultural and ethnic factors that may affect the surgical experience.
7. Determine if the client has received adequate information from the surgeon to make an informed decision to have surgery and that the consent form is signed.
Examples: fear of death, excessive anxiety, fear of pain and discomfort
Lewis pg 361-362

#8

I am just trying to get us started so if you have more info please add it. The more people who discuss the info the better everyone will be able to understand. If we all do a little it makes the load easier.
8) Discuss the assessment needed for the surgical client in pain.
The client should be observed for indications of pain (e.g., restlessness) and questioned about the degree and characteristics of the pain. Identifying the location of the pain is important. Incisional pain is to expected, but other causes of pain, such as a full bladder, may be present. Research has shown that many clients are undermedicated for pain. Pain assessment may be difficult in the early postoperative period. The client may not be able to verbalize the presence or severity of pain. The nurse should observe for behavioral clues of pain such as a wrinkling face or brow, a clenched fist, moaning, diaphoresis, and an increased pulse rate.
Lewis pg 399 and 409

#9

9. Lewis P.393-395 and Parts of all of Chap. 17

Initial assessment: ACP gives report to admitting PACU nurse
Priority care includes: Monitoring and management of respiratory, and circulatory function, pain, temp, an surgical site.

Assessment should begin with evaluation of the airway, breathing, and circulation (ABCs) status of the patient.e

Assess patients airway patency and rate and quality or resp. made. Breath sounds are ascultated through out all fields.

O2 therapy should be used if patient has had general anesthesia or if ACP orders it. (By nasal cannula or face mask)

Pulse oximetry monitoring is intitiated.

Electrocardiographic (ECG) monitoring is initiated to determine cardiac rate and rhythm.

BP measured and compared to baseline readings.

Invasive monotoring (e.g.arterial BP monitoring) will be initiated if needed.

Body temp, skin color and condition noted

Neurologic: level of consciousness, orientation, sensory and motor status, and size, equality, and reactivity of pupils.

Urinary system: intake and output and fluid balance
* note presence of all IV lines, irrigation sloutions and infusions, and all output devices. Including catheters and wound drains.

Assess surgical site: noting condition of dressing and amt. of any drainage

GOAL: identify actual and potential problems that may occur as a result of anesthetic admin. and surgical intervention and intervene appropriately.

ANTICIPATE: airway compromise (obstruction), resp. insufficiency, cardiac compromise (hypo or hypertension, arrythmias), neurlogic compromise (emergence delirium, and delayed awakening), hyperthermia, pain, and nausea and vomiting.

ONGOING ASSESSMENT:
1. Airway patency (resp. rate, patterns, and breath sounds)
2. Vital Signs every 15 mins. (Inc: BP. HR, P, skin temp)
3. Observe indications of pain (restlessness, behavioral clues)
4.Temperature (oral,tympanic, axilla)
5.Question about feelings of nausea
6. examine urine for quantity and quality (atleast 0.5mL/kg/hr., and most urinated 6-8 hours post-surgery)
7.Ascultate all 4 quads for frequency, pitch of bowel sounds
8.Assess wound (drainage is expected to change for sanguiness (red) to serosanguiness (pink) to serous (clear yellow)
*check for dehiscence

#7

Please fill free to add more.
Explain the purpose of administering preoperative medication.
*Provide analgesia
*Prevent nausea and vomiting
*Promote sedation and amnesia
*Decrease anesthetic requirements
*Facilitate induction of anesthesia
* Relieve apprehension and anxiety
*Prevent autonomic reflex response
*Decrease respiratory and gastrointestinal secretions
Lewis pg 372

#6

Add info will be appreciated
Explain the types of prevention and their purposes; Give examples.
Prevention, in a narrow sense, means avoiding the development of disease in the future, and in the broader sense, consists of all interventions to limit progression of a disease. The levels of prevention occur at various points of a course of disease progression. There are three levels of prevention: primary, secondary, and tertiary. Five steps describe these levels: Primary prevention focuses on (a) health promotion and (b) protection against specific health problems (e.g., immunization against hepatitis B). The purpose of primary prevention is to decrease the risk of exposure of the individual or community to disease. Secondary prevention focuses on (a) early identification of health problems and (b) prompt intervention to alleviate health problems. Its goal is to identify individuals in an early stage of a disease process and to limit future disability. Tertiary prevention focuses on restoration and rehabilitation with the goal of returning the individual to an optimal level of functioning. Table 8-1 provides examples of activities for each level of prevention.
Kozier pg 120

Need Supplemental Help?

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Medical Learning Links

The Student Nurse's Prayer

Dear Lord: I know we go through this every day but please give me the knowledge
as to why I actually wanted to go to nursing school.
Lord, give me the strength to make it through
those boring three hour lectures without falling asleep.
Lord, please give me the patience to make it through twelve hour clinicals
with instructors that can't just give you the right answer
and on the same note, give the nurses the ability to remember
what it was like to be a student and give us just a little more respect.
Lord, give me the endurance to read all the assigned readings
and be able to remember it when I am taking a test with four right answers.
Lord, give my family and friends the ability to realize
I really am on the edge of insanity.
Finally, Lord, give me the vision to see that one day I will be a real nurse
and I will never have to wear this ugly uniform again.

by Meredith Joyner
Inspirational Page

number 5

risk factors for the surgical client:

• age: very young and elderly clients are at greater risk
• general health: the presence of infections or other pathophysiology increases risks.
• malnutrition or dehydration (complications: delayed wound healing)
• infection of any kind
• obesity(complications: hypertension, cardiac problems, respiratory problems,delayed wound healing, wound infection)
• cardiac conditions (complications: decreased cardiac output, poor tolerance ofanasthesia)
• respiratory disorders such as asthma (complications: post-op lung infections,poor tolerance of general anasthesia)
• renal disease (complications: fluid and electrolyte imbalance, inadequateexcretion of drugs)
• bleeding disorders (complications: hemorrhage, shock)
• diabetes mellitus (complications: delayed healing, infection)
• liver disease (complications: inability to detoxify medications, hemorrhage,delayed healing)
• neurologic disease (complications: seizures)
• mental status: mental illness, mental retardation, anxiety, and dementia affect the clientsability to cope with surgery. dementia may cause unpredictable response to anasthesia as well.

FOUND IN ATI BOOK PAGE 437

#4 study guide

#4 Discuss nursing interventions to promote oxygenation in the
surgical client.


 Positioning of client to allow for maxium chest expansion.
 Encourage/provide frequent changes in position when possible.
 Encourage ambulation when possible.
 Implement measures that promote comfort such as giving pain meds, good pain
control.
 Encourage deep breathing (abdominal, pursed lips) and coughing excercises.
 Educate/encourage use of incentive spirometer
 Keeping airways clear/suctioned when necessary.
 Monitor oxygen saturation levels, watch trend.
 Maintain proper application/levels of oxygen therapy when in use.

Kozier skills book pg.425

post-op practice problems

http://deltarns2007.blogspot.com/2005/10/postop-test-here-is-link-to-read.html

Study Guide Question #1

1. Describe the correct documentation of a surgical wound. (Kozier Pg. 925)

• Apperance- Inspect the color of the wound and surrounding area approximation of wound edges.
• Size- Note size and location of dehiscence, if present.
• Drainage- Observe location, color, consistency, odor, and degree of saturation of dressings. Note number of gauzes saturated or diameter of drainage on guaze.
• Swelling- Observe the amount of swelling; minimal to moderate swellig is normal in early stages of wound healing.
• Pain- Expect severe to moderate postoperative pain for 3 to 5 days; persistent severe pain or sudden onset of severe pain may indicate internal hemorrhaging or infection.
• Drains or Tubes- Inspect drain security and placement, amount and character of drainage, and functioning of collecting apparatus, if present.

Pharm Exam 2 Study Questions

Posted by Richard Sevilla on Docushare

Link to Exam 2 Study Questions

Math Test!?!

OK, I am on the "Short Bus" NOW! I sucked on the math test. I calculated just fine, but I screwed up on the "Insulin Syringe" (I thought it was 1ml). I am sure I pased with greater than 72%. No way did I score Greater than 90%! For those, that may not have not done very well. Take a deep breathe, we will Conquer this.

helpful website

Hey..if you go to nursewise.com there is some helpful tips and practice T/F tests.

Car Show on Sunday @ Delta!!!

Okay ladies, now I know this isn't Nursing related, but I just wanted to inform you all that on Sunday Oct. 15 my dance group Tamari'i Matairea (you know the polynesian dance group who performed at our Welcoming Tea) will be having a car show to raise funds to bring our main instructor down from Tahiti. All proceeds will go towards the group (i.e. costumes), so if you have the time ( come on now you know you want take a break from our chaotic lives) come on by. And if you know anyone who may want to put their car in just have them contact Alex @209-969-6102. The car show will be at the Cunningham 1 parking lot from 10am-4pm. Come on by!!

Question of the week 10.09.06

The registered nurse has just admitted a client with severe depression. What domain should be the priority focus as the nurse identifies the nursing diagnoses?

1. Nutrition
2. Elimination
3. Activity
4. Safety

Updated Grades

There are updated grades on Ms. Semillo's Docushare site.

link to grades updated 10/11

Lodi Memorial, We Are Official NOW!

SJDC ADN Class of 2008

Spring 2007 Class Schedule is posted on the SJDC website. 2nd semester here we come!

Job Fair

The job fair is a manditory event. Please come to it and sign in. It is from 9-12 Thrusday 10/12/2006.

This is per Mary Neville for all nursing students.

Thanks Caralee

Regarding study sessions for the test...

Ms Semillo is having session on Monday from 2:30-4:30 and Tuesday from 1-3. This takes up the time for Fern's and my session. If there are specific questions, email me the question and I will post them answer on the blogg for everyone to see.

Things to know for the skills check off:

Do a focused assessment to the patient's compliant and identify a priority nursing diagnosis.
Use PQRST when completing a pain assessment.
How to measure Input and output.
Sterile gloving and foley cath.
Trach sucting, vital signs, o2 placement

The mobility list is the same except for no more crutches, canes or picking a person off the floor. No vest restraints. Be able to Dangle a client at the bedside.

The list will be posted by Ms. Semillo.

See you tomorrow at the health fair.

Caralee

Cultural Projects!

Hi everyone, I just wanted to congratulate all of you on such wonderful presentations today. I learned a lot of valueable info that I will take with me on my career. I hope everyone enjoyed all the food and time away from clinical ;)....see you ladies and gents tomorrow!

Grossology

Anyone want to celebrate passing Nursing 1 with a little trip?

Grossology

Grossology: The (Impolite) Science of the Human Body—a “science in disguise” exhibit that turns the disgusting into the fascinating!

September 30, 2006 – January 7, 2007

DISGUSTING!" "YUCK!" "TOTALLY GROSS!"Slimy, oozy, crusty, stinky secretions like snot, barf, pus, and body odor-what's the cool science behind this "gross" stuff?

Enter Grossology and discover the anatomy, biology, chemistry and physics of why we sneeze, vomit, belch, and even stink.

Hands-on and feet-on activities, giant animatronics, and computer games let visitors explore how the human body fights germs, breaks down food, gets rid of trapped air, removes waste products, and performs other critical functions.

Visitors can:

Enter a giant nostril and get "blown away" by a humongous sneeze!
Perform organ removal in a delicate surgical "operation."
Walk, climb, slide, and crawl through a 3-D model of the human digestive system.
Get a whiff of four body odors, and match them to the body areas they come from.
Clamber up a "human skin" climbing wall with warts, zits, and wounds.
Play pinball, and bounce around foods that give you the most gas.
Shoot "dirt balls" into a giant nose.
Hear how air, vibration, and pressure lead to noisy, bodily surprises.
Take out the "trash" by removing waste elements from the bloodstream.
GROSSOLOGY Exhibit is produced by Advanced Animations LLC. in collaboration with Science World British Columbia.

GROSSOLOGY is a registered trademark of Penguin Group (USA), Inc.

September 30, 2006-
January 7, 2007

ATI EXAMS

The ATI results are up on their website. I did way better than I thought I did. I am happy with the results.

N3/HS3 Charts

For bonus receptor and drug charts, supplemental powerpoint lecture slides from your book, practice quizzes and more, check out this site.
Pharmacology Help

Study Guide for Final Exam

Posted by Mrs Semillo on Course Compass in "Assignments"

Study Guide for Final Exam
Introduction to Community Health Nursing, Health Promotion/Prevention, Introduction to Leadership/Management, Nursing Care of the Client Undergoing Surgery, Nursing Care of the Client with Altered Skin Integrity, Wound Care and Introduction to IV Therapy


Peri-operative Nursing Care

1. Describe the correct documentation of a surgical wound.

2. Discuss the nursing interventions for the surgical client when ambulating.

3. Discuss the nursing implications for the surgical client when pain medication is administered.

4. Discuss the nursing interventions to promote oxygenation in the surgical client.

5. Discuss the risk factors of the surgical client.

6. Explain the types of prevention and their purposes; Give examples.

7. Explain the purpose of administering preoperative medication.

8. Discuss the assessment needed for the surgical client in pain.

9. Discuss the assessment of the surgical client post-operatively.

10. Discuss the purpose of the pre-op checklist. Give examples of when the nurse would need to call the physician.

11. Discuss the complications of surgery.

12. Describe the procedure to prepare the client for surgery.

13. Describe the procedure of the surgical client when received in the PACU.

14. List the relevant nursing diagnoses for the surgical client.

IV Therapy

15. Discuss the assessment needed for the client receiving TPN.

16. Discuss the purpose of PCA.

17. Discuss the assessment and nursing interventions for the client receiving IV therapy.

Health Promotion/Prevention

18. Explain health behaviors.







Medication Administration

19. Discuss the various sites for insulin and heparin.

20. Discuss the safety implications for insulin and heparin.

21. Discuss the assessment needed when administering oral medications; medications via NG tube.

22. Discuss the aging process and medication administration.

23. Explain the purpose of administering an intramuscular medication by the Z-track method.

24. Discuss the nursing interventions when an intramuscular medication is erroneously inserted.

25. Describe the signs and symptoms of an allergic response to medication.

Skin Integrity

26. Discuss why the elderly are at risk for impaired skin integrity.

27. Discuss the etiology of ischemia.

28. List the nursing diagnoses for the client with impaired skin integrity.

29. Discuss the rationale of how weakness and fatigue is a risk factor for pressure ulcers.

Immobility

30. Discuss the therapeutic communication needed for the immobile patient.

Delegation

31. Explain the legal implications of delegation.

N1 Corrected grades posted

Posted by Mrs Semillo on Docushare

corrected grades

OUCH!!

Michelle and Amie develop empathy for their future patients.

Skills Check Off

Posted by Mrs Semillo in Docushare

Skills Check Off

SJDC ADN Class of 2008

SJDC ADN Class of 2008
Mistakes in Posting

There seems to be some mistakes in the latest grade posting. Lines 76-92 are a repeat of 40-56. Lines 123 and 125 have the same ID. Some ID's (including mine) are not listed.

test

if anyone did not do well on the second test, please go talk to mrs. flanders in room locke 309.

Grades are Posted

New grades are posted in docushare...they're scary! 12 are not passing now!!! That test sucked and really hurt a lot of people.

WoW!?!

I thought I did better, than I did on that test! I passed by the "SKIN ON MY TEETH", and I thought I did hella good. I can't wait to go over the answers!!!

Answers are up!

I know everybody has gotten tired of looking for the answers for Test #2, well....they're officially up. Felicia posted them on Docushare. Good luck!

Question of the week of 10.02.06

A client who is to have antineoplastic chemotherapy tells the nurses of a fear of being sick all the time and indicates a wish to try acupuncture. Which of these beliefs stated by the client would be incorrect about acupuncture?

1. "Some needles go as deep as 3 inches, depending on where they're placed in the body and what the treatment is for. The needles usually are left in for 15 to 30 minutes."
2. "In traditional Chinese medicine, imbalances in the basic energetic flow of life — known as qi or chi — are thought to cause illness."
3. "The flow of life is believed to flow through major pathways called nerve clusters in your body."
4. "By inserting extremely fine needles into some of the over 400 acupuncture points in various combinations it is believed that energy flow will rebalance to allow the body's natural healing mechanisms to take over."

Nursing2006 ANS eNews -- October 2006

Quick Quiz: Match game

For some types of drug administration, the location where you'd administer the drug is self-explanatory; for example, intrathecal administration refers to administering the drug in the intrathecal space of the spinal canal. However, other terms used to describe administration routes aren't so apparent. Can you match the drug administration route below with its correct definition?

Clues	Choices
___1. intra-articular	a. into the skin
___2. dermal	b. under the tongue
___3. buccal	c. into a vein
___4. ophthalmic	d. in the ear
___5. intradermal	e. between the cheek and gum
___6. otic	f. into a joint
___7. sublingual	g. onto the skin
___8. intravenous	h. into the eye