NURS 133 Final Exam Part 2

jasmine's version from 2016-06-16 06:30

Section 1

Question Answer
Hyperthyroidism interventions Monitor cardiac output-keep cool, decrease stress; Monitor vision- tinted glasses, cool compress, tape eyes shut at night, elevate HOB; Nutrition- increase carb and protein, snacks, may need 4000 cal/day; Support positive body image; Thyrotoxic storm- cooling, fluids, glucose, electrolytes, iodide solutions, propylthiouricil, beta blockers, sedation; Remove/destroy thyroid or suppress with meds
Hypothyroidism interventions Thyroid hormone replacement; Surgery to remove goiter; Assess if secondary/tertiary; Monitor Cardiac output-keep warm, allow rest; Prevent constipation- fiber, fluids, activity; Maintain skin integrity- reposition, ROM, lotion
Levothyroxine action Replace endogenous Thyroid hormone
Levothyroxine side effects Headache, insomnia, angina, arrhythmia, tachycardia, abd cramping, diarrhea, vomiting, sweating, hyperthyroid, menstrual irregularity, heat intolerance, weight loss, accelerated bone maturation
Levothyroxine interventions Assess pulse, BP, arrhythmia, chest pain. Monitor TSH and thyroid levels, monitor BG in diabetic patients, assess for hyperthyroidism, Peds- monitor growth and development. Monitor for overdose- treat with beta blockers, oxygen, gastric lavage, charcoal; Instruct to take with water on empty stomach before breakfast, IV, IM

Section 2

Question Answer
Seizure interventions Medication, surgery, ketogenic diet; Monitor electrolytes, glucose, ABG, fever, BP; Monitor O2 and administer; Prevent injury; Psychosocial support
Phenytoin action Alter ion transport to decrease synapse transmission
Phenytoin side effects Suicidality, ataxia, diplopia, nystagmus, hypotension, tachycardia, hepatic failure, gingival hyperplasia, nausea, steven Johnson, hypertrichosis, agranulosytosis, anemia, “DRESS”
Phenytoin interventions Monitor suicidality/depression, assess and support oral hygiene, assess for hypersensitivity- may begin up to 12 weeks, monitor for rash- d/c if present, test for HLA-B*1502 gene esp. in Asian clients, assess mental status, assess seizure activity, Monitor BP, respirations, CBC, serum calcium, albumin, hepatic function, Monitor serum drug levels, monitor for toxicity; Instruct to take with meals, avoid contact with mucosa. IV-
Valproic Acid action Increase GABA levels to inhibit CNS activity
Valproic side effects Suicidality, agitation, headache, insomnia, sedation, peripheral edema, visual disturbance, hepatotoxicity, pancreatitis, abd pain, anorexia, diarrhea, n/v, DRESS, thrombocytopenia, hyperammonemia, hypothemnia, tremor
Valproic interventions Assess seizure activity, mood/behavior, pacreatitis, DRESS. Monitor CBC, platelets, bleeding time, hepatic function, serum drug levels; Instruct to take with meals- not with milk for carbonated drinks, IV- slow infusion
Concussion Patho Bruising, bleeding, tearing of nerve fiber, edema->increase brain volume, vasoconstriction, ischemia
Concussion manifestations Amnesia, confusion, headache, dizzy, tinittus, n/v, slurred speech, sensitive to light/noise, mood/cognition change, sleep disturbance; Resolve within 38-72 hours
Second impact concussion syndrome Repeat injury before first is fully healed. Increased swelling, bleeding, permanent brain damage/death
Concussion interventions Assess q 2 hours- PERRLA, eye movement, motor function, balance, coordination, reflexes, memory and concentration; NPO until fully alert; Awaken at set intervals to assess; Use cold compresses, clear liquids, rest. Avoid aspirin and NSAID; Monitor for- clear or bloody drainage from ears/nose, blurred vision, weakness, incoordination, difficulty waking, slurred speech, altered behavior, increased confusion/amnesia, and vomiting
Lorazepam action Potentiate GABA to depress CNS
Lorazepam side effects Dizzy, drowsy, blurred vision, resp depression, apnea, cardiac arrest, bradycardia, hypotension, constipation, diarrhea, n/v, rash, tolerance/dependence
Lorazepam interventions Assess anxiety/need for med, assess CNS depression, esp resp., monitor renal/hepatic/hematologic function. V push- 2 to 5 minutes
Lorazepam overdose antidote Lumazenil

Section 3

Question Answer
Paroxetine action Potentiate serotonin activity, SSRI
Paroxetine side effects Neuroleptic malignant syndrome, suicidal thoughts, anxiety, dizzy, drowsy, headache, insomnia, dry mouth, nausea, ejaculatory disturbance, decreased libido, steven Johnson, sweating, serotonin syndrome,
Paroxetine interventions Monitor appetite/eating and weight changes, assess mental status/depression/suicide risk, assess for serotonin syndrome/autonomic instability/neuromuscular aberrations, monitor for neuroleptic malignant syndrome and rash. Monitor CBC; Instruct to take in morning with food
Phenelzine (MAOI) action Inhibit MAO, causes accumulation of neurotransmitters
Phenelzine side effects Seizure, dizzy, drowsy, headache, hyperreflexia, insomnia, tremor, twitching, weakness, hypertensive crisis (with tyramine or stimulant drugs), edema, orthostatic hypotension, constipation, dry mouth, sexual dysfunction, hypernatrmia, weight gain
Phenelzine interventions Assess mood/mental illness/suicide risk, monitor BP and pulse, monitor I and O/ weight/edema/ urinary retention, monitor hepatic function, monitor BG in diabetics, monitor for overdose/hypertensive crisis- treat with phentolamine/vomiting/gastric lavage; Instruct to not in the evening
Doxepin (TCA) action Prevent uptake of norepinephrine and serotonin- potentiate their activity
Doxepin side effects Fatigue, sedation, blurred vision, hypotension, constipation, dry mouth, decreased libido, photosensitivity, blood dyscrasia
Doxepin interventions Monitor BP/pulse/EKG, assess sexual dysfunction, assess weight gain, monitor blood lipids, assess mental status/mood, assess serotonin syndrome, assess anxiety, pain, prurirtis, monitor WBC, hepatic function, serum glucose; Instruct to take with food-or topical (antihistamine)
Sertraline (SSRI) action Potentiate serotonin activity
Sertraline side effects Neuroleptic malignant syndrome, suicidal throughts, dizzy, drowsy, headache, insomnia, diarrhea, dry mouth, nausea, sexual dysfunction, sweating, tremor
Sertraline interventions assess suicide risk/mood, monitor weight/intake, assess for serotonin syndrome

Section 4

Question Answer
Hearing loss manifestations Mild 26-40 bd; Moderate 41-60 db; Severe 61-80 db; Profound 81-90; Deaf >90
Hearing loss interventions Maintain and use hearing aids; Surgery, decongestants, steroids, antibiotics; Good communication techniques; Prevent social isolation
Gabapentin action Unknown, stabilize neuronal membranes
Gabapentin side effects Suicidal thoughts, depression, confusion, dizzy, drowsy, abnormal vision, hypertension, weight gain, anorexia, rhabdomyolysis, ataxia, multiorgan hypersensitivity
Gabapentin interventions Monitor for suicidality, assess seizure/neuralgia/restless leg syndrome; Discontinue gradually
Atropine action Block muscarinic receptors of iris and ciliary muscle to paralyze and dilate the eye
Atropine side effects Blurred vision, photophobia, angle closure glaucoma, eye irritation. Systemic- anticholinergic- confusion, flushing, hallucination, slurred speech, drowsiness, tachycardia, constipation, dry mouth
Atropine interventions Protect eyes from light, assess for anti-cholinergic effects
Travoprost action Relax ciliary muscle to promote acqueous humor outflow
Travoprost side effects Irritation, foreign body sensation, increase eyelash growth, browning of iris and eyelid, blurred vision, keratitis
Travoprost interventions Keep bottle clean during administration, educate client about brown pigmentation; eye drop daily in evening, 5 minutes apart from other eye drops
Timolol action Decrease production of acqueous humor
Timolol side effects stinging, dry eyes, conjunctivitis, blurred vision, photophobia. Systemic- bradycardia, AV heart block, bronchospasm
Timolol interventions Prevent contamination of bottle, monitor pulse and respiratory status