Final Exam Soto Review
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 Gerontology, Delirium, Dementia
o How to assess cognitive status?
 Neurological assessment (time and place)
o Tools we can use = MMSE chart, to Assess the degree and severity of cognitive
decline
o MMSE categories: orientation, registration, attention and calculation, recall,
language (page 235 course manual)
 Delirium – acute onset and sudden confusion
o Look for infections (UTI, Pneumonia)
o Polypharmacy
o Problems with fluid (hyponatremia, electrolyte imbalance)
o If the route cause is treated we can REVERSE IT
 Dementia - Cannot be cured but can temporary stabilize it with Donepezil (Aricept)
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Elder Abuse
o Interview pt alone first
o Signs: hygiene, bruises, malnutrition
From the beginning
 Professional issues/ legal issues
o ANA – professional activities
o NLN – education monitoring in nursing school
o Negligence
 3 levels of prevention:
o Primary – prevention (teaching, vaccines, BP screening)
o Secondary – screening (pap smear, colonoscopy, mammogram)
o Tertiary – treating / rehabilitation (medications, activities , rehab)
 Immunity: passive, active, artificial
o Flu vaccine = artificial active immunity
o Active – your body develops the antibodies
o Passive – you give your body the antibodies
o Artificial
o Natural – you make your own antibodies (chicken pox party, be exposed and
your body would make its own antibodies)
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Principles of patient safety (what will you actively be doing to minimize pt injury)
o Bed in low position
o Wheelchair is locked when moving
o If pt is dizzy during movement – orthostatic hypotension (move pt slowly)
Mobility and Immobility
o Affects all major systems
o Restraints – physical and chemical
 Avoid usage
 If you need to use restraints be sure to check for circulation
 Assess for skin integrity, color of skin, capillary refill (check every 2hrs)
 Will offer the patient activity, nutrition and toileting
o Braden scale – check for risks of pressure ulcers
 Four stages
Tube feedings
o Biggest complication – ASPIRATION
o Key interventions: check for residuals and placement
 Check placement, first by x-ray then by auscultation
o Sit patient semi-flower
Primary IV therapy
o Hypotonic, isotonic, hypertonic
o Complications:
 Infiltration – cool upon palpation
 Phlebitis – warm upon palpation
Elimination
o GI
o GU common problems:
 Constipation - stool softeners, laxatives, enemas
 diarrhea – issues for electrolyte imbalances (hypovolemia)
Pharmacology
o ADME : absorption, distribution , metabolism , excretion
o Know lab values
o Be able to pick up kidney (nephrotoxicity) or liver (hepatotoxicity) failure by
looking at lab values
o Peak and Trough levels before receiving meds and during peak
Nutrition
o Macronutrients : carbs, proteins and fats
 Carbohydrates: complex (plus fiber) and simple
 Protein: check serum albumin , nonessential and essential
 Complete protein = animal proteins, diary
Hypoglycemia – low blood sugar
o In patients look for: rule of 15/15 (look at course manual page 191)
o A blood glucose (BG) of less than 70 mg/dl in general is considered low
blood glucose.
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o The symptoms of low blood glucose are:
 Sweaty and shaky, Weak, Headache, Confused, Irritable, Hungry, Pale,
Rapid heart rate and Uncoordinated movements
 There are times when someone may have low BG, but may not experience
symptoms. A low blood glucose can have severe health consequences and
needs immediate intervention.
 If the BG is low, follow the steps below to treat:
 Eat or drink something from the list below equal to 15 grams of
carbohydrate (carb).
 Rest for 15 minutes, and then re-check the BG. If it is still low,
(below 70), repeat step 1 above. Keep doing this every 15
minutes until the BG is > 80 without symptoms or > 100 with
symptoms. Sometimes symptoms last a while. Some health
facilities want the BG > 100. You must know the policy of the
health facility you are working in. Patients should always carry a
source of carbohydrate as below.
 Foods equal to One Carbohydrate Choice (15 grams of carb):
o 3 - 4 glucose tablets
o 4 ounces of fruit juice
o 5-6 ounces (about 1/2 can) of regular soda such as Coke or
Pepsi
o 7-8 gummy or regular Life Savers
o 1 Tbsp. of sugar or jelly
o These choices will give the best glycemic rise. Foods with
fat will delay the glycemic rise needed to treat
hypoglycemia. Therefore, a chocolate bar would not be
the best choices
o Discussion with the health care provider is needed because meal plan or
medications may need to be adjusted.
o For severe hypoglycemia, an injection of glucagon may be needed. Patients are
placed on their side due to possibility of vomiting and complication of aspiration.
Elimination
o Urinary retention: test by checking urinary output (30mL per hour)
o Be aware of Foley infections in patients
 Avoid by perineal care with regular soap and water
o How to collect samples for Urinary analysis
 Not sterile, can just be collected
o Collect sample C&S
 Sterile, collect directly from catheter using syringe (not from the bag)
Medication Administration (know needle sizes and amounts)
o Parental: intramuscular, sub Q
o Non parental
Teaching and Learning
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o Domains: cognitive, psychomotor
 Cognitive: knowledge acquisition. Teaching values are affected, attidue
and feelings
 Psychomotor: asking for demonstration of what they have been taught
Culture
o Be respectful
o Actively listen
Sterile asepsis – done during certain dressing changes and surgical procedures
Medical asepsis
Isolation / contact precaution
o Isolation for respiratory disease – turbuculosis
Standard precautions - AIDS (all patients are standard precautions UNTIL FURTHER
NOTICE)
Dosage calculations : I&O is included
o 1oz = 30mL
o IV amount, Fluid drainage devices, Urine output and diarrhea included
QUESTION: Patient is receiving IV fluids for the last 8 hours and it is now 9 am , normal
saline 1000mLinfusing at 15mL per hour, coffee, juice. Nurse walks into the room at
4pm, what is the patients total intake?
 DO NOT FORGET THE IV BEING INFUSED
Pay attention to be time and when to be given *** (be sure to look at the top of the
question**
Therapeutic communication
o Listening and communicating
o Sender and receiver
o Professional and healthy relationship
o Key difference between social and therapeutic relationship: therapeutic is
focused on the patient (how do you feel)
Defense mechanisms
o Coping mechanisms when facing a stressor: Denial, Regression, Repression
o Physiological stressor = surgery
o Stress:
 Levels: mild, moderate, severe, panic
 Treatments: for mild to moderate = guided imagery , for panic =
pharmacologically
o Antidepressants take a slower effect
o Benzodiazepines have a quicker onset
o SSRI
Fluid & Electrolytes
o Know signs and symptoms of intracellular and extracellular (SODIUM AND
POTASSIUM)
o Hypovolemic and hypervolemic S&S
Elderly
o Common problems:
 high risk for falls
 skin integrity
 incontinent
 malnutrition
 failure to thrive (manual page 177 – failure to thrive definition and
causes)
 dehydration – triggered in the elderly because they lose their sense of
thirst or cognitive decline
 Constipation due to decreased peristalsis and decreased gastric motility
leading to laxative dependence
 Presbyopia (loss in vision especially with focusing up close) and
Presbycusis (loss of hearing) are normal aging changes
o Health Literacy – to be able to understand and apply health information for
healthy positive outcomes
 Understanding their medication instructions
 Write out frequency of medications, no abbreviations
o ADL – activities of daily living: bathroom, eating
o IADL(instrumental activities of living) – shopping, driving, cleaning, cooking,
finances