General Clinical Comps Study Guide DONT LEAVE ANY ANSWERS BLANK MAKE AN EDUCATED GUESS IF YOURE STUCK

WRITE ANSWERS SHORT AND SWEET! MAKE SURE YOU ARE ANSWERING THE QUESTION! Approach 1. Make two copies so that you end up with 3 copies of the scenario set. Keep one set mark free in case you need to copy it. 2. On one copy: Read through each scenario. Note the areas you feel you know, Highlight the areas you feel your weak on. 3. Start at the top and look at each and every word of the scenario. a. Age, wt, ht, race: Compare this with the primary dxdo you see relevancy? Something specific to that age group or cultural group? b. Decipher all the acronyms: CPT, CMP, DTO, 3Hs, etc. 4. Allergies: If yes, check the meds and other orders for a conflict. 5. PMH: How does this impact the current situation? May depend on recency or severity. 6. PSH / SH: Smoking, drug use, etc. Surgeryimpact? How does this impact the current situation? 7. Check for MD orders, labs, diagnostics, procedures that are incorrect, missing or conflict with another order. This includes things like: Is the drug amount within the normal range? Is it contraindicated with another drug? Allergies? Does the patient need O2 and it isnt ordered? General Info 1. Note that: a. Nursing intervention = independent intervention b. Collaborative intervention = includes another discipline c. Intervention = means either an independent or a dependent intervention 2. Do not write a bookstay to simple and concise. If you feel your answer may be misunderstood, its okay to give a rationale, but dont get crazy and rationale every answer on the test! For each disease process 1. Understand the PATHO behind each of the diseases including anatomy. 2. Know the signs and symptoms of the disease as these are what your assessments are geared towards to determine if the treatments are effective 3. Know normal ranges of all labs and critical drugs. Highlight the ones that are out or normal range. Know which labs are indicative of which disease/ailment. Look for missing tests of a listed disease. Pending orders: This leaves the door open for the results to be given in the test. What will the results (high or low) mean when they come back.
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4. KNOW the PRIORITY NURSING INTERVENTIONS AND DIAGNOSIS FOR EACH PT. YOU MUST HAVE A RATIONALE FOR YOUR ANSWER. The points will range from 1 to 3: 1 for Nsg. Dx, 1 for related to and 1 for s/s a. Read the questionknow the PRIORITY nursing dx! But it may be worded so that it is directed toward a secondary diagnosis. b. When writing the Nsg Dxyou must use the s/s that are in the case studydo not make up your own or name other s/s that are not in the case study. 5. Use your MedSurg book to look up 2-3 Priority Nsg Dx and Interventions (What you can do for your patient independentlywithout calling the doctor first). 6. NOTE: a. nursing intervention means independent nursing action. This is action that a nurse does not need a MD order for which does NOT include any medication administration, oxygen only in emergencies and then written order must me obtained, hot/cold packs, embolic stockings, showers (pt walk to), ambulation, etc. Must get MD order unless, again, it is an emergency. b. intervention or collaborative both mean collaborative nursing interventions. These can include orders that a MD writes. 7. Know the usual medication info. a. Indication: why is med ordered for the pt? b. Check to see if the med is the right dose, given the right way, etc. c. Correspond each med to the pts disease/condition i. Are there any meds that cant be linked to a disease/condition? ii. Is a med ordered that is contraindicated to the pts condition? d. Know the common side effects excluding Nausea/Vomiting e. Know the major adverse reactions f. Is this med contraindicated for any reasonconflicts with other meds or other medical conditions. g. What are you going to teach the pt. about the medications (TEACHING IS A BIG THING ON THE COMPS) 8. Know patient teaching on disease processes, discharge, pre and post op, meds, etc. 9. Know how to do chest physiotherapy and patient positioning 10. Know all of Eriksons stages, what each development stage should be doing, how to promote activities for each stage (especially infants, children and teens), what stage the pt is currently in, etc. Calculations 11. Know weight conversion 12. Burns fluid resuscitation 13. Burns TBSA for adults and children
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14. Peds maintenance fluid calculation 0-10 kg 100 mL/kg/day (100 x kg) 11-20 kg 1000 mL (1st 10 kg) + 50 mL/kg/day for each additional kg from 10- 20 kg > 20 kg 1500 mL (1st 20 kg) + 20 mL/kg/day for each additional kg over 20 kg 15. Basic calcs: mL and gtt/min 16. Know how to calculate mEq / hr 17. How to weight infant output (diapers) 18. How to measure breast feeding 19. How to divide fluid up among all 3 shifts when pt is put on fluid restriction a. during the day (7-3) b. 2/3 of whats left on the evening c. The remainder for night d. EX: 1500mL 750 days, 500 eves, 250 night Basics 20. Rationale for daily weights (most sensitive indicator of fluid gain or loss) 21. VS ranges for adults, children and Peds 22. Blood pressure: a. What systolic and diastolic represent b. What is MAP? Why is it used? Know how to calculate MAP. c. Irregular heart rhythm? 23. Trach, chest tube, PICC line, ET care a. Pt preparation ? b. Know contraindications c. Know complications d. Know what to monitor for and how to troubleshoot i. E.g., what does bubbling mean in the chest tube drainage air chamber? ii. How much fluid do you put in the chest tube drainage air chamber? e. How to suction (a CNA can do oral suctioning)? 24. Pt preparation and post care for: a. Chest tube, paracentesis, thoracentesis, cardiac cath, b. S/s of poor outcome (what to assess for) c. PC for each 25. Seizure precautions a. Note time sz begins and ends b. Side rails padded/up c. 02 by mask d. Monitor pt assuring safety/watch for vomiting (what to do if pt vomits); (Prevent head from hitting anything hard) e. Cardiac monitor f. If sitting or standingease to floor g. Bite block (only if safe to insert)may not use any more
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26. Ventilator settings, know: a. Fi02 b. PEEP c. Mode: AC (assisted controlled), S: each inspiratory effort beyond the set sensitivity threshold triggers delivery of the fixed tidal volume. If the patient does not trigger the ventilator frequently enough, the ventilator initiates a breath, ensuring the desired minimum respiratory rate (delivers breaths at a set rate and volume that is synchronized to the patient's efforts), PCV (pressure controlled ventilation) d. TV total volume e. Rate f. When is the rate turned up? g. When is the Fi02 increased? 27. Types of oxygen administration (n/c, mask, venturi mask, etc.) a. RA = 21% oxygen Assignment and Delegation 28. Must know what a CNA, LVN can and cannot do (see handout)cranial 29. Know how to calculate Nursing Hour ratios a. What is the question asking: number of nursing hours for the shift or for the entire day (24 hours) b. Do not include Nurse Managers, ward clerks or Charge Nurse unless she/he is taking a patient assignment c. Nursing Hours for the ward are calculated by the Nursing Office and are given to you. This is a baseline which you compare your calcs to. d. FORMULA: (# of RNs + # of LVNs + # of CNAs) x # of hrs in a shift 30. Total # of patients on the ward You need to note if the staffing is over or under. Then state what to do about it. a. OVER: Notify nursing office of extra staff b. UNDER: Call nursing office for more staff, call sister wards, call nurses at home to see if they can come in. c. NOTE: You must name the type of nurse you needRN, LVN, CANand give the rationale i. Look at what skills are needed, scope of practice and which is most cost effective. Be able to complete an Acuity Sheet on any or all of the scenarios What is conflict resolution? a. Conflict can result in good outcomesnew ideas may come forth Know about team dynamics and how to manage them Know the Five Rights of Delegation including definitions/examples What patients can be put in the same room with each other
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31. 32. 33. 34. 35.

36. Know soft and hard restraint monitoring 37. Scope of practice for all staff: Be able to identify what each staff member may or may not do for each scenario (e.g. ward clerk: puts in orders, up dates assignment board, answer phones, etc. a. RNs: Pt education, interpretation of VS/lab/dx values, IV start, IVF, all medications, b. LVNs: VS, basic assessment (data gathering), IV starts, IVF without medications, PO/SQ/SD/PR meds, pain rating, F/C and NGT placement, oral suctioning, NO IVP, chart on tasks they do c. CNA: VS, feed pt, linen changes, distributes trays, takes critical labs to the lab, ambulate pts, I&Os, no invasive tasks (accu checks, F/C or NGT placement), chart VS/I&Os or tasks they do, 38. Types of managing (autocratic, democratic, authoritarian, laissez faire, etc.) 39. You may be given 4-8 patients and asked to prioritize the order in which you would see the pts. a. Use the ABCs of caredont let the pts age fool you! b. If a change in status is EXPECTEDthen its not priority Cardiac 40. What is Angina pain? Chest pain or discomfort due to coronary heart disease Types of Angina a. Stable Episodes of chest discomfort, usually predictable; occur on exertion or under mental or emotional stress. Normally the chest discomfort is relieved with rest, nitroglycerin or both. b. Unstable Chest pain is unexpected and usually occurs while at rest; discomfort may be more severe and prolonged. Most common cause is reduced blood flow to the heart muscle because the coronary arteries are narrowed by fatty buildups (atherosclerosis); an artery may be abnormally constricted or partially blocked by a blood clot. c. Variant (Prinzmetal's) Is due to transient coronary artery spasm occurs spontaneously, and unlike typical angina, it nearly always occurs when a person is at rest. It doesn't follow physical exertion or emotional stress, either. Attacks can be very painful and usually occur between midnight and 8 a.m. 41. Cardiac Patient Care a. Dont elevate the extremities of pt. w/ cardiac problems b. Know how to evaluate the complaints of chest pain (OLDCART) c. What should be ordered to give when pt c/o of CP. d. The role of each medication ordered for CP.

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42. Homans Sign, how to test/What not to do a. Passive dorsiflexion of the ankle by the examiner elicits sharp pain in the calf b. Flex the patient's knee slightly with one hand and, with the other, dorsiflex the foot. The complaint of calf pain with this procedure is a positive sign and often indicates venous thrombosis. Absence of Homans' sign does not preclude venous thrombosis c. No massage or ambulation d. Give anticoagulants as ordered by MD 43. MI: ischemic vs. infarct a. Appearance on an EKG b. How is it treated? i. ASA = what does it do? Why is it important to give asap in the field (r/t anti-platelet)? ii. Nitro = dosage, effects? iii. Metoprolol c. what do you do if pt c/o CP? d. Risk factors 44. CHF: what are the two types? The two categories? a. Systolic, diastolic b. Right sided, left sided c. Know clinical manifestations of each type. d. How is it treated? e. What to do if the pt c/o of CP? f. What medications are contraindicated? g. What patient teaching is necessary? 45. EKG changes with Hyperkalemia a. The first EKG sign of hyperkalemia is peaked T waves and usually appears around 6 mEq/L. Also seen are shortened QT interval and ST-segment depression (check your texts on this) b. 2nd sign is prolongation of PR interval can be seen around or above 7 mEq/L. c. Absent P wave with widen QRS complex is the third manifestation and is a very dangerous sign. It means that atrial activity is lost and stage is set for ventricular tachycardia/fibrillation. It is usually seen at level around 8-9 mEq/L. d. Ventricular tachycardia/fibrillation is the price you pay of ignoring above changes on monitor. 46. Know how to read and measure an EKG strip a. P wave, QRS wave, T wave (and what they represent) i. P and T waves are not usually measured, but just in case, know how to measure thembeginning of the upward stoke to the return of the downward stoke to the isometric line. b. Know how to measure PR interval, QT interval c. V-tach
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d. e. f. g.

V-fib Sinus bradycardia Sinus tachycardia What to do if Asystole occurs check leads, reposition pt.

47. What are the dangerous rhythms? (V-tach and V- fib) Note: A-fib can be a stable rhythmdepends on the pt status. Note the ventricular response (R waves). 48. SVT supraventricular tachycardia a. HR = 150-250 bpm b. Above the ventriclesoriginates in the atria c. Place pt on monitor, 2 IVs, oxygen, crash cart nearby d. Asymptomatic and symptomatic e. Asymptomatic i. Valsalva maneuvers, carotid rub to convert rhythm ii. IV meds: Adenosine x3, sometimes verapamil iii. Cardizem iv. Cardioversion if all else fails f. Symptomatic i. Immediate cardioversion 49. External pacemaker a. For brady rhythms b. Know pacer spike on EKGa very straight line up or down and before a P-wave (atrial paced rhythm) or the QRS complex (ventricular paced rhythm). c. Check MD orders for meds that contribute to brady rhythms 50. Stress test a. Preparation good shoes b. Thalium stress test what is it? DRUGS 51. Know about your insulin onset, peak, duration a. Regular (only one that can be given IV) b. NPH c. Lispro d. Lantus e. 70/30 (70 is regular - 30 is NPH) f. SSI 8. Why is ultram ordered instead of vicodin? 9. Know why your pt may be taking Colace, esp. your pt. w/ cardiac problems. a. Avoids constipation and straining 52. S/S of ASA toxicity 53. S/S of antilipidemics (Mevacor - Lovastatin). Rhabdomylolysis ; no alcohol
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54. Rhabdomyolysis (RDM) is a disorder causing injury to muscle, particularly the sarcolemma of skeletal muscle. The process may be precipitated by acute traumatic injury (burn, crush, and exertion), disease (alcoholism), disorders of lipid and carbohydrate metabolism, drugs, and other various muscle membrane and ion channel dysfunctions 55. Know the drugs that have toxicity levels and what s/s you see at toxic levels a. Lithium b. Vancomycin/Gentamycin c. Digoxin d. Coumadin 56. Know the antidotes for various meds w/ toxicity levels b. Benzos Flumazenil c. Opiates Narcan d. Tylenol Mucomyst (N-acetylcysteine) e. Heparin Protamine sulfate f. Iron - Deferoxamine mesylate g. Digoxin Digibind h. Aspirin - Salicylates stimulate the respiratory center, leading to hyperventilation and respiratory alkalosis i. activated charcoal ii. Whole bowel irrigation (WBI) with polyethylene glycol (alkaline diuresis) iii. hemodialysis include a serum level greater than 120 mg/dL 57. The liver breaks down medications. a. Medications and other substances that are broken down by the liver can release toxins into the blood stream. b. An impaired liver cannot effectively break down medications any longer. Therefore, the medications can build up in the body. 58. The kidney removes toxins and excretes medications from the blood. a. If the kidney is impaired, then toxins and medications are not effectively removed from the body and may build up to toxic levels. b. Ammonia is especially toxic and causes AMS. 59. OhVancocheck for corn allergies. 60. Propofolmonitor triglycerides 61. Amphotericin reactionno need to Stop infusion, just slow it down NEURO 48. Spinal precautions: Rationale for, what is required? a. C-spine collar, body board b. Cannot remove until the patient is cleared clinically and by X-ray c. R/o reason for patient complaint of neck pain
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49. Cranial nerves a. Know all 12 OOOTTAFAGVSG b. What they innervate: c. Clinical manifestations d. How to test each nerve e. Motor, sensory or both? 50. Know all the neuro case studies a. What the damaged neuro innervates, s/s that will manifest, nursing assessments, etc. i. Brocas, Wernickes ii. Hemiplesia iii. homopsia b. Know the rationales for all MD orders, including medications c. Are there any missing orders that you would expect to see? 51. Triple H therapy look this up a. Used to prevent and treat cerebral vasospasm after aneurysmal in subarachnoid hemorrhage. b. The condition can be treated with hypertensive hypervolemic hemodilution therapy commonly known as Triple H therapy. Triple H therapy combines intravenous medications and large volumes of intravenous fluids to elevate blood pressure, increase blood volume, and thin the blood, driving blood flow through and around affected vessels. c. Know: Hypervolemia, hypertension, and hemodilution d. Triple-H therapy carries significant medical morbidity, including pulmonary edema, myocardial ischemia, hyponatremia, renal medullary washout, indwelling catheter-related complications, cerebral hemorrhage, and cerebral edema Blood Transfusion 52. Study blood products and your responsibility as a nurse a. Consent, you must check that it is there! b. MD Order must be written to infuse x (number) units of PRBCs over period of time c. Double check w/RN (licensed person) d. One unit at a time, unless life threatening e. Over 2-4 hours (must be in MD order) f. Pre-meds: Tylenol and benadryl (not always ordered. Some docs dont use them) g. Serial VS h. Begin slow30cc/hr for about 15 min. i. Check vitals after 15 min, 30 min., then 2 hrs. (check this)
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53. Whole blood and PRBCs can cause a hemolytic reaction due to antigens 54. S/S of hemolytic reaction a. bloody urine, chills, fainting or dizziness, fever, flank pain or back pain, rash b. What the RN does: i. Stop infusion ii. Bag all the tubing, blood, etc. (returned to blood bank lab) iii. Start NS infusion (treat or prevent kidney failure and shock) iv. Antihistamine drugs (eg, diphenhydramine) can treat itching and rash v. Pain reliever, acetaminophen can reduce fever and discomfort. vi. Corticosteroids (such as prednisone or dexamethasone) can reduce the immune response vii. Take VS, continue to monitor pt LABS 55. Know your labs normal/abnormal ranges 56. What is the Sweat test> 57. CBC w/diff: Know this including RBCs, primary WBCs in normal infective process and in AIDS 58. What labs are ordered for SLE and why. (ESR, CBC, anticardiolipid, anti-DNA, what else?) 59. What med is used to distinguish MG from GB? How does it work? 60. Know all components of a test: CBC w/diff, RUA, etc. 61. C-Reactive Protein (CRP) check for inflammation a. Produced by liver b. Non-specific indicator of an inflammatory process in the body c. Used to determine risk for heart disease d. Not usually elevated in RH and lupus e. Normal = serum levels are zero 62. ABGs a. Know normal ranges and differentiate between respiratory/metabolic and acidotic/alkalotic states b. You may be required to interpret an ABG and name the acid/base pt is in i. Do you know if it is compensated or uncompensated. 63. Why you give a pillow to a splint Fx for stabilization and to prevent internal rotation of involved extremity. 64. Isolation precautions and what diseases need which ones? a. Contact Isolation = gown, gloves , wash hands (ORSA) i. Adenovirus, infectious diarrhea, group A step, MRSA, VRE, viral conjunctivitis, lice, scabies, RSV, varicella, zoser, SARS b. Respiratory now airborne (TB) c. Droplet adenovirus, group A step, H. influenza, mumps, rubella, meningococcal d. Airborne measles, TB, varicella, zoster, SARS
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65. Reynaudss Syndrome a. Arteries/arterioles constrict and spasm when exposed to cold or from emotional upset. Smoking or working with vibrating machinery also triggers the episodes. When there's a spasm in the small veins and blood is trapped in the capillaries, the fingers or toes turn blue as the blood loses its oxygen. The result is that the fingers or toes become pale, cold and numb. 66. Know the adverse rx to abx = pseudomembranous colitis a. an infection of the colon often, but not always, caused by the bacterium Clostridium difficile (C. diff colitis). Characterized by offensive-smelling diarrhea, fever, and abdominal pain. It can be severe, causing toxic megacolon, or even fatal. b. Clindamycin and cephalosporins 67. 6 ps for your pts that have extremity fractures (use the first 6the others are extras) o Pulse o Parathesesia, paralysis o Pallor o Poikelothermia o Perfusion o Progressive swelling/edema o Pain 68. Specific diets and be able to name the foods that are allowed/not allowed a. Cardiac diet i. Those on diureticsK+ wasting b. Diabetic diet (ADA) i. Complex carbs c. Renal diet d. Neutropenic (cook all foods) 69. Respiratory a. O2 can be placed by a RN in emergency, but an order must then be obtained. b. Emergent: Sit up, HOB up, give oxygen 70. Pt w/ foley and urine is <30 ml, what do you do? a. Check the foley, it maybe kinked b. Check placement 71. check vital signs while giving transfusion: 15 min, 30 min, 72. Foods are high in potassium Apples, Apricots, Bananas, Brown Rice, Cantaloupe, Figs, Legumes, Lima beans, Milk, Oranges, Peaches, Potatoes, Prunes, Raisins, Spinach, Vegetable Juices Tomatoes, Carrots, raisins, prunes, watermelon, Fish: Cod, flounder, sardines, salmon, poultry: chicken, turkey grains such as bran and wheat. Artichoke, Asparagus, Broccoli, Cabbage, Corn, Dates, Green Beans/Peppers Kidney Beans, Onions, Papayas, Parsley, Pumpkin, Peas, Romaine Lettuce, Strawberries, Sweet Potato, Tomato.
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73. EKG Lead Placement WHITE RA , just below the right clavicle BLACK LA, just below the left clavicle 74. RED LL, on the lower chest, just above and left of the umbilicus. 75. GREEN RL, on the lower chest, just above and to the right of the umbilicus 76. BROWN position at the fourth intercostal space, right sternal border 77. What do you do if you page the intern and he fails to call back. Please double check, but I believe you call the fellow...please double check this one 78. Five (5) things you need to do for a pt who's pre-op a. Assess pt./VS b. Meds on call to surgery c. All consents signed d. Pt. teaching re: procedure e. Cross & match done 79. Why K+ is given when IV insulin is given for a DKA pt. 80. Signs and symptoms of Vancoespecially the dangerous ones like red man syndrome 81. Rest pain (from peripheral d/o hand out) 82. How long on INH before pt is no longer contagious (2 weeks) 83. Know the difference between DKA and HHNK. 84. Know your psych meds.Geodon, lithium, etc. 85. A change in patient status (with new VS or lab results and ask you what you would do.first!) 86. Know signs and symptoms of hypo/hyperglycemia, hypo/hyperkalemia. Psych 87. 5150/5250 know the difference a. 5150 Involuntary hold for 72 hours b. 5250 14 day hold 88. S/S of Lithium toxicity pt teaching about this medication. a. Methyldopa (Aldomet) may increase the likelihood of lithium toxicity b. Caffeine appears to reduce serum lithium concentrations, and side effects of lithium have increased in frequency when caffeine is consumed. c. Both diltiazem and verapamil have been reported to have variable effects on lithium levels in blood. In some patients there may be decreased lithium blood levels and in others lithium toxicity. d. Various reactions have resulted when lithium is administered with phenothiazines, [for example, chlorpromazine (Thorazine), thioridazine (Mellaril), trifluoperazine (Stelazine) or with haloperidol (Haldol)]. Such reactions have included delirium, seizures, encephalopathy, high fever or certain neurologic reactions that affect movement of muscles, called extrapyramidal symptoms. e. Lithium can cause goiter or hypothyroidism. The use of lithium with potassium iodide can increase the likelihood of this adverse reaction.
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f. The beta blocker, propranolol (Inderal) can lead to a slow heart rate and dizziness. Other beta blockers, [metoprolol (Lopressor), atenolol (Tenormin)] may interact with lithium = a slow heart rate. g. Lithium crosses the placenta and has been associated with toxicity in the fetus. 89. Manic Bipolar sx (Hyperverbal, excitability) a. bipolar I disorder - episodes of extremely high moods (mania) and extremely low moods (depression). May have high and low moods at the same time-called mixed states or mixed mania. Some people may see or hear things that are not there. b. bipolar II disorder - severe periods of depression but milder form of mania = hypomania i. Nursing responsibility: provide finger foods, make sure pt. takes medication, safety measures remember they are too hype to eat, but nutrition is very important. When behaving inappropriately, tell them they are behaving inappropriately and remove them to another area. 90. Know what to do for your psych pt a. Creating a safe environment b. What to do if pt. refuses meds 91. Neuroleptic Malignant Syndrome what pt may be prone to this syndrome a. neurological disorder caused almost exclusively by antipsychotics b. Dopamine receptor blockage causing Parkinsons like sx OTHER PROCEDURES/DISEASES Parkinsons 92. Know the classic triad and other s/s 93. Know the treatments and rationale a. Levadopa b. Sinemet carbidopa fills up the dopamine receptors in the body. This leaves more dopamine available to cross the blood brain barrier. c. Megace???? 94. Know medications: how each functions in the body 95. Know how the nurse can promote pt activity 96. Know patient/family teaching 97. Know deep brain stimulation What does it do? Why is it used? a. Surgically implanted, battery-operated medical device called a neurostimulatorsimilar to a heart pacemaker and approximately the size of a stopwatchto deliver electrical stimulation to targeted areas in brain that control movement, blocking abnormal nerve signals that cause tremor & PD symptoms like tremor, rigidity, stiffness, slowed movement, & walking problems.

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98. 99.

100.

101.

102.

b. How to prepare the pt? i. 10 days prior: NO aspirin, aspirin-containing drugs, related drugs (e.g., ibuprofen or naproxen or Vitamin E.) These increase bleeding risk. PM before surgery, pt washes head, neck, & chest with hibiclens (or other soap containing chlorhexidine). AM of surgery, pt shouldnt take antiparkinsonian meds. However, pt should take any regular meds for other problems, such as HTN. Pt should inform surgeon of a cold, cough, or any type of infection in days prior to the surgery. Pt should hydrate (drink a lot of non-alcoholic, non-caffeinated drinks) prior to surgery. c. DBS system consists of three components: the lead, the extension, & neurostimulator. Lead (aka: electrode)thin, insulated wireis inserted through a small opening in skull & implanted in brain. Tip of the electrode is positioned within the targeted brain area. d. PC: hemorrhagic stroke Lithotripsy: Know pt preparation, how the treatment is done and post-procedure pt care including assessment for PCs. Shingles herpes zoster a. Chicken pox viruslatent b. Occurs along a dermadome c. Severe pain, itching and rash along the dermadome d. Occurs in older adults when under stress, disease, or immune system weakens e. ContagiousRN must have chicken pox vaccine prior or had virus f. Begins with HA, flu-like sx, the itchingclusters of blisters. g. Antiviral meds, pain meds, antidepressants Rheumatoid Arthritis a. Know how it differs from arthritis b. Tests done c. Tx d. Hot/cold applications DVT a. Elevate the affected legwhy? b. BRno walking c. Can move to PE d. Greenfield filter know where it is placed and what it does e. On heparin i. PTT ii. Monitor s/s of bleeding f. Goes home on coumadin HTN a. Risk factors b. Tx combination meds c. Pt education
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103. Esophageal varices a. 90% fatal know causes b. Monitor for active hemorrhaging c. HOB up d. Nursing care 104. Peripheral Vascular Disease (PVD) a. Contributing factors b. How to dx c. Tx and nsg care 105. Dialysis a. Know all 3 phases: Inflow, Dwell, Outflow i. How to trouble shoot each phase b. Tenckoff catheter: What it is and how it works. c. Hemo i. Know procedure ii. S/S of PCs iii. Medications to hold/give prior to procedure iv. How to assess a fistula, catheter d. Peritoneal i. Advantages/disadvantages ii. Procedure iii. PCs iv. Pt teaching

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