STUDY NOTES Comprehensive Predictor A & B

Lithium toxicity

- coarse hand tremors

- confusion

- ECG changes

- sedation

Lithium adverse effects

- HA

- polyuria

- hyperglycemia

Cardiomyopathy

- heart muscle becomes enlarged, thick or rigid

- activity intolerance: a finding of left ventricular failure and is associated with

dilated cardiomyopathy

Left sided heart failure vs. right sided heart failure

- left: inadequate tissue perfusion

- right: systemic venous congestion (peripheral edema)

- left: dyspnea, orthopnea (shortness of breath while lying down), fatigue, displaced

apical pulse, s3 heart gallop, pulmonary congestion (dyspnea, cough, crackles),

frothy sputum, altered mental status, oliguria

- right: JVD, dependent edema (legs, ankles, sacrum), abdominal distention (ascites),

fatigue/weakness, nausea anorexia, polyuria, liver enlargement and tenderness,

weight gain

Cholesterol levels

- cholesterol: <200

- HDL: >40

- LDL: <100

Trochanter rolls for immobility

- used to prevent external rotation and abduction of the hips which will maintain

correct body alignment for a client who is immobile

- consume 2-3 L of fluid to prevent renal calculi and UTIs

- avoid massaging lower extremities to prevent dislodging thrombus

- no pillows under knees=impede venous return=thrombus formation

Macular degeneration

- decrease or loss in central vision due to bleeding in the macula or yellow spots

under the retina

- increase in intraocular pressure=glaucoma

- floating dark spots=retinal detachment

- double vision: cataracts

Neutrophils

- normal: 1800-7800 cells/mm3

- for low=administer granulocyte colony-stimulating factor to promote production of

granulocytes in the bone marrow to help fight infection

Raynaud's

- blanching of the fingers and toes

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Child organ donation

- the family may have the child in an open casket if they wish because organ

donation does not disfigure the child's body

- removal of organs does not damage body

- receiving antibiotics prior to death does not prevent donation of organs

- organs must remain viable and donor must remain alive until the retrieval process

is set to take place

- pathologist will perform an autopsy following an unattended death, a suspicious

death or at the request of the family following the death of the individual

- nurse should discuss organ donation with the parents separately from discussion

about child's impending death

Gestational constipation

- during the second and third trimesters, the size and weight of the growing uterus

cause bot displacement and compression of the intestines

- these changes cause a decrease in motility, leading to constipation

- estrogen and progesterone increase during pregnancy leading to decrease

peristalsis and relaxation of the smooth muscles of the intestine, which results in

constipation

- intestine absorbs more water from the stool during pregnancy leading to

constipation

- the small intestine absorbs iron more readily during pregnancy due to increase

material needs leading to constipation

McBurney's point

- right lower quadrant between the umbilicus and the anterior iliac crest

- appendicitis

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Enteral feedings

- keep HOB elevated to 45 degrees for 1 hour after feedings

- inject 10-30 mL of air into NG tube before checking residual to clear the tube of

any feeding

- 20 mL of tap water to flush the NG tube before and after each feeding (0.9% NaCl

can lead to hypernatremia)

- avoid adding dye

Tunneled central venous catheter education

- you should keep the catheter clamped when not in use to prevent blood back flow

- does not have a two-way valve

- instruct to flush daily with heparin when not using it regularly

- restrict physical activities until the tissue adheres to the cuff

- do not participate in water sports because of the risk of infection

- change dressing at least every 5-7 days

Listeriosis (listeria)

- avoid deli meats (salami)

- can harbor bacteria listeria monocytogenes which crosses the placental barrier

and is harmful to the developing fetus

- raw milk, soft cheese, raw veggies, and ice cream should also be avoided

- listeriosis during pregnancy can lead to spontaneous abortion or stillbirth

- newborns who survive the infection can have sepsis and meningitis

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Ovarian cancer

- abdominal bloating is an early indication of ovarian cancer

- other manifestations: increased abdominal girth, pelvic or abdominal pain, early

satiety, and urinary frequency or urgency

- cervical cancer: back pain and postcoital bleeding

Hemolytic transfusion reaction

- low back pain

- tachycardia

- hypotension

Hypokalemia

- decreased deep tendon reflexes

- muscle weakness

- hypoactive bowel sounds due to decrease GI mobility

- hypernatremia: dry, stick mucous membranes

- hypocalcemia: numbness and tingling of extremities and around the mouth

Delirium

- patients with delirium exhibit rapid, inappropriate, incoherent and rambling

speech patterns

- paranoid personality disorder=project blame

- dependent personality disorder=excessively clinging behavior

- schizotypal personality disorder=social awkwardness

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