NCM 116 Prophylactic long term
Lesson 1 Chronic dehydration
CANCER OVERVIEW
Unusual bleeding or Administering a contrast
Discharge Medium to the client
- Elevated bp and glucose - 300 pounds
Level 90 mins.
Sanative STEP BY STEP
CHEMOTHERAPY -
Zyloprim LESSON 3
Decreased platelets Orthostatic hypotension
Antiemetic medication Claustrophobia
DRUGS Assess for an allergic
Alkylating agents Reaction
Oncovin POST SKILL & VARIATIONS
Alopecia No radiation exposure
RADIATION Nurse’s notes
Prevention Metallic objects
Assess vs COMMON ERRORS & CRITICAL
Purple colored ink THINKING
LESSON 2 Magnetic field
LEUKEMIA, NEPHROBLASTOMA, Radiation
NEUROBLASTOMA Electromagnet
Swelling mass w/in abdomen OVERVIEW
Hypercellular marrow LESSON 4
Purinethol Image structures or masses
HODGKIN’S LYMPHOMA & AMP; Cortical hypoplasia
EFFECTS OF TREATMENT Salty taste
Prior to chemotherapy STEP BY STEP
Client cooperation Peritoneal bleeding
Confirm identity of client Lesson 6
Start an I OVERVIEW
POST SKILL & VARIATIONS Client receiving
Lie on hard surface Anticoagulants.
Sedate the child - Clients who have had heart
MAR Failure
COMMON ERRORS & CRITICAL Pneumothorax
THINKING OUTCOMES
Check medical record Emphysema
Produce clear images Increase venous
HR ASSESSMENT & PREPARATION
LESSON 5 The unaffected side
OVERVIEW Decreased prothrombin time
2 hrs Diabetes
- Contaminate the biopsy PROCEDURES
Assess the client for massive Insert 14 gauge
STEP BY STEP Advance the catheter
Hold breaths Toward costodiaphragm
8th or 9th intercostal space Aspirate before injecting
Make a small incision POST PROCEDURE & VARIATIONS
POST SKILL & VARIATIONS Chest tube
Helping the client to assume Hyperpnea
6 hrs LESSON 7
Bleeding OVERVIEW
COMMON ERRORS & CRITICAL Diagnose the cause of sever
THINKING Bleeding
Spleen Flow cytometry
Bleeding Morphologic analysis
OUTCOMES Remove the stylet
- Nausea POST PROCEDURE & AMP;
Spicules VARIATIONS
ASSESSMENT & PREPARATION Assess incision site
Naloxone Thrombocytopenia
1 vial of heparin LESSON 9
Ventilator OVERVIEW
PROCEDURES Entering the dural venous
Chromosome analysis Access
Morphologic analysis Thrombocytopenia
POST PROCEDURE & AMP; Subarachnoid space
VARIATIONS OUTCOMES
Contraindication for the - Clubbings
Procedure Implantation of epidermal
24 hrs Tumors
ST segment ASSESSMENT & PREPARATION
LESSON 8 Cognitive status
OVERVIEW Flexion of the neck
To assess the status Lateral decubitus
Hemophilia PROCEDURES
OUTCOMES Elevated intracranial
Excessive pain Pressure
ASSESSMENT & PREPARATION Falsely elevated CSF pressure
Naloxone (opiate) Place his/her arm behind the
25 degrees Clients head
Flumazenil POST PROCEDURE & VARIATIONS
PROCEDURES Subarachnoid hemorrhage
5 mm Postdural puncture
Touch preparation Headache
Spinal nerve irritation STEP BY STEP
LESSON 10 Lateral tilt position
OVERVIEW Determine the fetus position
Glucose Tenderness distal
Suspected bleeding diathesis POST SKILL & VARIATIONS
CSF drainage in Prenatal resources available
Hydrocephalus Cramping
OUTCOMES Baby’s gestational age
Injury of the periosteum COMMON ERRORS & CRITICAL
Nonclosure of the durat THINKING
Hematoma Lightheadedness
ASSESSMENT & PREPARATION Use guided imagery
Myasthenia gravis Down’s syndrome
5-10 ml syringe LESSON 12
Fluoroscopy OVERVIEW
PROCEDURES Examination of
L3-L4 or L5-S1 Tracheobronchial
Conus medullaris Cannot tolerate interruption
22G needle Of high
POST PROCEDURE & AMP; Nasotracheal
VARIATIONS OUTCOMES
1-4 hrs Diaphoresis w/ slow,
24 hrs Unsteady pulse
Arrythmias Gradual shortness of breath
LESSON 11 Sudden, severe shortness of
OVERVIEW Breath
Mild cramping ASSESSMENT & PREPARATION
Ultrasound Mask & goggles
Baby’s gestational age 8 hrs
Level of dyspnea POST PROCEDURE & AMP;
PROCEDURES VARIATIONS
Tracheostomy 2 hrs
Lidocaine Fever
Instruct client not to swallow Increased flatus
POST PROCEDURE & AMP; LESSON 14
VARIATIONS OVERVIEW
Severe hemoptysis 24 hrs
2 hrs Measure many physiologic
Detect early sign of Components
Bronchial perforation Diuretics
LESSON 13 STEP BY STEP
OVERVIEW Glucose
Large aortic aneurysm Ask client to perform mental
Pancreas Exercise
Bronchoscopy - Encourage client to drink
OUTCOMES More fluids
Vomiting POST SKILL & VARIATIONS
Decreasing level of Physician
Consciousness Use straints
Vasovagal response MAR
ASSESSMENT & PREPARATION COMMON ERRORS & CRITICAL
2 days THINKING
Urine Start new IV
Midazolam Fold clean linen
PROCEDURES Specific names of
Left lateral sim’s position Medications
Atropine LESSON 15
Colonoscopies OVERVIEW
Colorectal cancer screening Medications given before
IV start equipment And after
Auscultate the abdomen How painless the procedure
STEP BY STEP Is
Prevent possible injury Reduced circulation
Knee-chest position COMMON ERRORS & CRITICAL
Cramping occurs THINKING
POST SKILL & VARIATIONS Subsequent assessments
Bowel mucosa Comfort
Sim’s position Apply direct pressure
Residual diarrhea LESSON 17
COMMON ERRORS & CRITICAL INTRODUCTION
THINKING - High BP
Speak w/ the client -Acute heart failure &
Unhurried Pulmonary edema
Can u describe the Low BP
Appearance SKIN
The procedure and bowel PATHOPHYSIOLOGY
Prep Stroke volume
LESSON 16 Myocardial infarction
OVERVIEW The heart cannot pump
Digital extremity circulation Enough bloods
Impaired renal function HEART FAILURE
Hypotension PULSE & BP
STEP BY STEP Increase amount of blood
Use a fluoroscope Reduced blood flow
Pseudoaneurysm formation Contractility
Assessment of the fexion 70 ml
POST SKILL & VARIATIONS ASSESSMENT
60 and 100 beats Acute tubular necrosis
Sympathetic nervous system Oliguria
HEART SOUNDS SIGNS & AMP; SYMPTOMS
- Reduced stoke volume
Enlarged ventricles prevent Left-sided & right-sided failure
AV valves from closing Pulmonary & peripheral
Properly Congestion
AV valves DIAGNOSTIC TESTS
Atrioventricular valves 25/0
SCHEMIA & AMP; DISTENTION Coronary artery blockage &
Jugular vein distention Abnormal pumping of the
Preload Left ventricle
Less oxygen-rich blood to Cardiac output & cardiac
Reach the myocardium Index
PERIPHERAL EDEMA TREATMENT
The renin-angiotensin- MEDICAL TREATMENT
Aldosterone Decreasing total peripheral
Sodium and water retention Resistance
And increases blood volume Blocking the enzyme
The renin-angiotensin- Deuterium oxide
Aldosterone system SURGICAL TREATMENT
RESPIRATORY SYSTEM Afterload
Crackles - Take over the pumping
Shortness of breath Action of the left ventricle
Lung congestion & Temporary counterpulsation
Hypoxemia PULMONARY EDEMA
GI SYSTEM & AMP; NEUROLOGIC PATHOPHYSIOLOGY
SIGNS Paraplegia
Bulimia - Fluid accumulation in the
Lungs Left side
Tachycardia Undress and put on gown
ASSESSMENT ANTERIOR CHEST
RESPIRATORY SYSTEM INSPECTION
Acute respiratory disease APICAL PULSE
Interstitial edema & Cardiac apex
Increased interstitial Less than 2.5 cm
Hydrostatic pressure Thrust during systole
Tachycardia OTHER PULSATION
VITAL SIGNS & AMP; NEUROLOGIC Breath out & hold expiration
SYSMPTOMS Aortic aneurysm
Fatigue Increased pulmonary artery
Release of catecholamines Blood flow
Rapid PR PALPATION
DIAGNOSTIC TEST FINDINGS APICAL IMPULSE
Respiratory acidosis Thrill
PCO2 above 45 millimeters Expand chest wall
Of mercury Light pressure
PCO2 below 45 millimeters of OTHER PULSATIONS
Mercury Right 2nd intercostal space
TREATMENT (aortic)
Increase fluid intake. Left 2nd intercostal space.
Afterload Left sternal 3rd, 4th, 5th
Inotropic agents & PERCUSSION
Vasodilators 5th intercostal space
LESSON 18 Left anterior axillary line
PREPARATION Heart may be enlarged or
30 degrees Displaced
Position herself at the client’s AUSCULTATION
NORMAL HEART SOUNDS Diminishes
Mitral & tricuspid valve HEART MURMURS – GRADE &
Closure LOCATION
Beginning of ventricular Stets diaphragm (high)
Diastole (12) Bell of stet
Beginning of ventricular Very faint and may not
Systole Heard
EXTRA HEART SOUNDS AUSCULTATION PROCEDURES
Ventricular gallop HEART SOUNDS
- Vibrations produce in late Rubbing it into her palm
Diastole (4) Place diaphragm of the stet.
Vibration that resolve when Firmly on the client’s chest in
Blood flows into a dilated The right 2nd intercostal close
Ventricle To the sternum
OTHER EXTRA SOUNDS Place the bell of the stet.
3rd intercostal space along Lightly on the client’s chest
The lower left sternal border HEART MURMURS
Stetonic mitral or tricuspid Around cardiac apex
Valves leaflets recoil abruptly 2nd & 3rd intercostal space
During ventricular diastole Near lower left
Inflammation forces the REVIEW
Pericardial visceral and Understanding of the client’s
Parietal surface rub together Fam. History
HEART MURMURS – TIMING & Heart’s left border
CONFIGURATION Cardiac apex
Between s2 & the next sl LESSON 19
(diastolic) SYSTEM IN FAILURE
Between s1 and $2 SYSTEM IN FAILURE
Loudly then gradually Maintain adequate bp
Hypovolemia NITROGLYCERIN
Hypotension (cardiovascular Headache & hypotension
Deficit) Suspension
BLOOD TEST Vasodilator
PT3 MYOCARDIAL INFARCTION
0-30 MANIFESTATIONS
Immature red cells Elevated ST segment
ENZYME TEST Encephalopathy
18 hrs - Inverted I wave
48 hrs INTERVENTTIONS – EARLY
GGT Administer fluids
CVP & AMP; EKG Morphine
0.12 -0.20 Semi-fowler position
Atrial depolarization INTERVENTIONS – LATER
5-10 cm of water Occupation
ANGIOGRAPHY & AMP; Diet
CATHETERIZARION Administer streptokinase
Injection of contrast medium CARDIAC SURGERY
Into the vascular system to - Hypertension
Outline an area of the body PTCA
Measuring CO2 Lidocaine
Concentration CONGESTIVE HEART FAILURE
Arteriography is done to the LEFT VENTRICULAR
Vessels around the heart Inadequate ejection of
ANGINA Blood into the systemic
Hips Circulation, usually
Medication is urgently Associated with MI,
Needed Hypertension
Arteriosclerosis churva Inability of the heart to meet
Tissue requirements for - Calcium agonists
Oxygen Central acting
Jaundice Propylene glycol
RIGHT VENTRICULAR THROMBOPHLEBITIS
Bradycardia Clot in the vein with
Congestion due to Inflammation of the wall
Inadequate pumping of Initiate the use of embolism
Blood from the systemic Stockings
System to lungs Weight loss
Tachycardia SCHOCK
AV HEART BLOCK -
Altered transmission of Dopamine
Impulse from SA node Failure of the heart to pump
Through AV node Adequately
Monitor K+ level Atropine
By firing constantly at a
Preset rate, regardless of the
Client’s own heart rate
VALVULAR DISORDERS
Administration of
Levothyroxine
Bradycardia
Stenosis
HYPERTENSION
Lethargy
Easily detected
Persistent bp above
140/systolic & 90/diastolic
ANTIHYPERTENSIVE DRUGS
NCM 117 Primary, secondary, & tertiary prevention
LESSON 1 Interdisciplinary approach
INTRODUCTION Primary prevention
therapist CRISIS INTERVENTION
learning more structured ways of behaving normative
Denver test marriage.
MEDICAL & PSYCHOANALYTICAL crisis intervention
Uncovering of childhood trauma & repressed GROUP THERAPY
feelings
individually focus on each group turn
memories and thoughts that do not enter
7-10 individuals interacting together w/ a
awareness
shared
uncover unconscious memories
purpose
INFANCY & EARLY & LATE CHILDHOOD
participants
infancy
FAMILY THERAPY
eric erikson
the family
autonomy vs shame & doubt
scapegoat
ADOLESCENCE, YOUNG ADULTHOOD,
undefined roles
ADULTHOOD & OLD-AGE
MILLIEU & ADJUNCTIVE THERAPIES
intimacy vs isolation
dance & art therapy
25-65 yrs old & giving back is important
environmental therapy
Young adulthood
client’s inner world
HIERARCHY OF NEEDS
MENTAL ILLNESS & MENTAL HEALTH
Basic psychological needs (bottom)
Successfully mask the problems & crises
Self-actualization
Different
Abraham Maslow
Respond to them appropriately
BEHAVIORIST
SUBLIMATION, ISOLATION, REACTION
Learning theory
FORMATION, ETC.
Positive reinforcement
Sport activities
Individuals w/ clinical disorders
Projection
COMMUNITY MENTAL HEALTH
Reaction formation (contradict inner feeling) Psychological threat resulting in feelings of
helplessness
SUPPRESSION, REPRESSION, DENIAL, ETC.
And uncertainty
Denial (ignoring)
Nervous system
Fixation (being stuck)
Anorexia
Denial (no prob. Drinking)
LEVELS
CHARACTERISTICS
Monitor client closely
Truth
Moderate
All encompassing
Difficulty concentrating
Social
PANIC
PREINTERACTION & ORIENTATION
Sudden onset of intense apprehension, fear or
Assessment
terror
Assessment of nurse
Fear that is out of proportion to external events
Preinteraction & orientation
Immobily
WORKING PHASE – COMMUNICATION TOOLS
PHOBIC
- Using specific, targeted questions
Agoraphobia
Deflecting statements back to the client
Lifestyle changes
Asking why questions
Gradual desensitization
WORKING PHASE – BLOCKS TO
OBSESSIVE-COMPULSIVE
COMMUNICATION
Recurring, irresistible impulse to perform an act
False reassurance
Anxiety reduction
Belittling
Anxiety
Agreeing & can block communication
POST TRAUMATIC STRESS
TERMINATION PHASE
Redirect away from manifestations
Evaluation phase
Significant, recognizable stressor or trauma
Acceptance
outside the
Orientation phase
Usual range of experience
LESSON 2
Distraction
OVERVIEW
HYSTERIA
Tension in response to a perceived physical or
Physical manifestations and complaints without Provide a safe & restrictive environment
organic
Confront the client
Impairment
Paranoid
Neurotic disorder
PARANOID PERSONALITY
Decrease the time spent
Serve food in open containers
HYPOCHONDRIASIS
Withdrawal
Exaggerated preoccupation with physical health,
Binging
not
AUTISM & ADHD
Based on real organic disorders
Lack of interest in human contact
Going on and on
Attempt regression therapy
Redirect the client on other activities
Children
STRESS RELATED DISORDERS
MEDICATIONS
Psychosocial factors
Antipsychotics
Hypotension
Increasing dopamine at the receptor site
Set limits on rumination
Disorganization
DISSOCIATIVE DISORDERS
EXTRAPYRAMIDAL EFFECTS
TYPES
Hand tremors
Splitting off an idea or emotion from one’s
consciousness Inability to sit still
Rule out organic pathology Overly sedative
Schizophrenia ANTICHOLINERGIC EFFECTS
ANTIANXIETY AGENTS Frequent urination
Oxazepam Increased likelihood of sunburn
Seizures Treat for hypotension.
Signs of drug dependence
LESSON 3
SCHIZOPHRENIA
Illusion (scarf snake)
Hallucination (covered with ants)
Delusion (I am God)