NUR 2502 Multidimensional Care III

Multidimensional III Exam 2 Review

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Which is not an assessment finding for neck cancer

- Obesity

Post-op care for a laryngectomy include

- Stress reduction

Diet modification

Alternative means of communication

Best diagnostic test for facial trauma

- CT Scan

Post rhinoplasty care education includes:

- You will have facial bruising

Pt has facial trauma and stridor. Priority intervention?

- Call provider and set up for intubation

Pt with facial and head trauma with pink drainage from nares. Intervention?

- Test drainage for CSF on filter paper

Emphysema symptoms include

- clubbing

barrel chest

dyspnea 

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Which education should not be included for sleep apnea?

- Avoid full meal before bed

Triggers for asthma include all except

- Obesity

Chronic bronchitis symptoms include

- Large amounts of thick mucous

Which symptom is most typical of an older adult with pneumonia?

- Confusion

Purpose of fluticasone

- Decreases airway inflammation

Before giving TB medications you want to check the pt chart for...

- liver disease

Pneumonia assessment

- Age, living, working, school environment.

Diet, exercise and sleep routines

Swallowing problems

Presence of NG tube

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Tobacco and alcohol use, past or current use of addiction to street drugs

Flushed cheeks, anxious expression, tachycardia, dyspnea, tachypnea,

hemoptysis, and sputum production. Severe chest muscle weakness may be

present due to severe cough.

Respiratory assessment, pain assessment

Sputum culture, ABGs, BUN (if increase may be dehydrated), Chest x-ray,

pulse ox 

Pneumonia Interventions

- Monitor for sepsis, O2 management, respiratory assessment, and lung sounds

before and after interventions as well as routinely.

Administer of medication and neb

Pneumonia pt education

- Vaccination for pneumonia and influenza routinely is important

Increase water intake, increase fluids, smoking cessation, rest, proper

cleaning of home equipment.

Handwashing, avoiding crowds (especially during the flu season).

Cough and deep breathing exercise.

Healthcare-associated pneumonia prevention

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- older adult, chronic lung disease, altered LOC, recent aspiration event,

tracheostomy, poor nutrition.

Anterior Epistaxis intervention

- Maintain standard precautions

Position the patient upright

Leaning forward to prevent blood being swallowed, reassure pt to reduce

anxiety.

Apply lateral pressure to the nose for 10 minutes and apply ice or cool

compress to nose and face if possible. If packing is necessary loosely pack

both nares with gauze or nasal tampons.

Posterior epistaxis interventions

- Emergency

Cannot be easily reached, pt may lose a lot of blood very quickly.

Epistaxis Post:

- Observe for resp distress

Tolerance of pacing tubes, humidity, O2 and possible antibiotics

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