AsslgnmenL for ChapLers 31 33 33 38 43 32 33 and 34

1 LlsL and descrlbe whaL Lype of duLles an 8n can delegaLe Lo an Ln regardlng paLlenL care?
1hey cannoL do dlscharge Leachlng
1hey are noL allowed Lo do re Cp or any paLlenL Leachlng
1hey cannoL Lransfuse 8lood
1hey can only pass and hang medlcaLlon per sLaLe law and lnsLlLuLlonal regulaLlons
1he only Lhlngs LhaL can be delegaLed Lo an Ln are slmple lssue

2 LlsL and descrlbe resplraLory ob[ecLlve daLa LhaL musL be addressed lmmedlaLely?
Alr way obsLrucLlon Lhere ls no alr medlcal emergency
1he Longue can fall back on an unconsclous paLlenL becomlng an alrway obsLrucLlon
nasal packlng because you cannoL geL Lo Lhe alr way especlally lf lL's packed posLerlor
1achypnea 8apld breaLhlng
usynea alr hunger or SC8
LCC can be a problem wlLh Lhe alrway
SLernum ConLracLlons uslng exLernal muscle so much LhaL Lhe sLernum moves ln and ouL
nasal llarlng a slgn LhaL Lhe paLlenL ls havlng Lrouble breaLhlng
Lxcesslve sweaLlng ls a slgn LhaL Lhe person ls havlng Lrouble wlLh breaLhlng
Can noL Lalk ln full senLence Lo shorL of breaLh Lo breaLh
8esLlessness ls a slgn LhaL Lhe person cannoL breaLhe

3 Lxplaln dlscharge lnsLrucLlons for a paLlenL golng home afLer a laryngecLomy?
Avold swlmmlng and use care when showerlng or shavlng
Lean sllghLly forward and cover Lhe sLoma when coughlng or sneezlng
Wear a sLoma guard or loose cloLhlng Lo cover Lhe sLoma
Clean Lhe sLoma wlLh mlld soap and waLer LubrlcaLe Lhe sLoma wlLh a non oll based olnLmenL as
needed
lncrease humldlLy by uslng sallne ln Lhe sLoma as lnsLrucLed a bedslde humldlfler pans of
waLer and houseplanLs
CbLaln and wear a MedlAlerL braceleL and emergency care card for llfeLhreaLenlng slLuaLlons

4 WhaL are some Lypes of devlces a paLlenL can use Lo lmprove/malnLaln pulmonary funcLlon?

Cough and deep breaLhe every 2 hours
use of lncenLlve splromeLer Lo faclllLaLe deep breaLhlng and sLlmulaLe coughlng
lnsLrucL Lhe paLlenL Lo exhale Lhe enLlre alr place Lhe mouLh plece over hls or her mouLh and Lake a long
deep breaLh for 3 Lo 3 seconds uo Lhls 3 Lo 10 Llmes per sesslon
Cxygen Lherapy use nasal 16 llLers
Slmple 610 llLer
Plgh 1013 llLer
MalnLaln C2 SaLs aL 93 or hlgher

3 uevelop a plan of care for a paLlenL dlagnosed wlLh avlan flu?

WPC offlclals are concerned LhaL Lhls sLraln could muLaLe Lo allow flrsL blrdLohuman lnfecLlon
and Lhen muLaLe agaln Lo allow personLoperson human lnfecLlon 1hls posslblllLy ls a ma[or concern
because human have essenLlally no naLurally occurrlng lmmunlLy Lo Lhls vlrus and Lhe lnfecLlon could
lead Lo a worldwlde pandemlc wlLh very hlgh morLallLy raLes
oselLamlvlr(1amlflu) and zanamlvlr (8elenza) noL llkely Lo prevenL Lhe dlsease buL may reduce
Lhe morLallLy raLe use wlLhln 48 hours of flrsL conLacL wlLh lnfecLed pL
lnfecLed pL cared for ln sLrlcL lsolaLlon
lts oo eplJemlc Jlsostet ooJ cootololoq lt tepoltes tbe coopetotloo of oll people
cote of tbe pt wltb ovloo flo focoses oo soppottloq tbe pt ooJ pteveotloq spteoJ of Jlseose
use Alrborne recauLlons and ConLacL recauLlonsrecelve vacclne lf avallable
C2 glven when hypoxla or breaLhlessness ls presenL (resplraLory Lx Lo dllaLe bronchloles)

6 Lxplaln how Lo care for a paLlenL wlLh vA?

lf posslble perform oral care wlLh a dlslnfecLlng oral rlnse rlghL before Lhe lnLubaLlon
uo noL wear hand [ewelry especlally rlngs when provldlng care Lo venLllaLor paLlenLs
Wash hands before and afLer conLacL wlLh Lhe paLlenLs
rovlde compleLe oral care aL leasL every 12 hours
8emove subgloLLlc secreLlons frequenLly (aL leasL every 2 hours) or conLlnuously (when Lhe
endoLracheal Lube has a separaLe lumen LhaL opens dlrecLly above Lhe Lube cuff)
keep Lhe head of Lhe bed elevaLed Lo aL leasL 30 degrees unless anoLher healLh problems ls a
conLralndlcaLlon for Lhls poslLlon
verlfy LhaL an lnlLlal xray has been obLalned Lo conflrm Lhe placemenL of any nasogasLrlc Lube
before lnsLllllng drugs flulds or feedlngs lnLo Lhe Lube
Avold Lurnlng Lhe paLlenL or placlng hlm or her ln Lhe suplne poslLlon (even brlefly) wlLhln an
hour afLer a bolus Lube feedlng
Work wlLh Lhe paLlenL and healLh care Leam Lo asslsL ln Lhe weanlng process as soon a posslble
Changlng Lhe venLllaLor clrculL (Lublng) no more frequenLly Lhan every 48 hours

7 Lxplaln ob[ecLlve and sub[ecLlve daLa you expecL Lo see wlLh a paLlenL wlLh communlLy acqulred
pneumonla?

An excess of fluld lungs resulLlng from an lnflammaLory process lnflammaLlon occurs ln Lhe
lnLersLlLlal spaces Lhe alveoll and ofLen Lhe bronchloles
can occur as lobar pneumonla wlLh consolldaLlon (solldlflcaLlon lack of alr spaces) ln a segmenL
or an enLlre lobe of Lhe lung or as bronchopneumonla wlLh dlffusely scaLLered paLches around Lhe
bronchl
lL's developed when lmmune sysLems canL combaL Lhe vlrulence of Lhe lnvadlng organlsms
8lsk lacLors lnclude
CCMMunl1? ACCul8Lu
older adulL
never havlng pneumococcal vacclne or haven'L had one ln 6 years
no vacclne ln prevlous year
chronlc healLh problems or oLher problems
recenLly exposed Lo resplraLory vlral or flu lnfecLlons
uses alcohol

8 Lxplaln Lhe funcLlon of conducLlvlLy auLomaLlclLy wlLhln Lhe hearL?

AuLomaLlclLy (paclng funcLlon) ls Lhe ablllLy of cardlac cells Lo generaLe and elecLrlcal lmpuse
sponLaneously and repeLlLlvely normally only prlmary pacemaker cell (slnoarLrlal SA node
aLrlovenLrlcular (Av) [uncLlon) possess Lhe ablllLy Lo generaLe an elecLrlcal lmpulse under cerLaln
condlLlons such as myocardlal lschemla (decreased blood flow) elecLrolyLe lmbalance hypoxla drug
LoxlclLy and lnfarcLlon (cell deaLh) any cardlac cell may generaLe elecLrlcal lmpulses lndependenLly and
creaLe dysrhyLhmlas ulsLurbances ln auLomaLlclLy may lnvolve elLher an lncrease or a decrease ln paclng
funcLlon
LxclLablllLy ls Lhe ablllLy of nonpacemaker hearL cells Lo respond Lo an elecLrlcal lmpulse from
pacemaker cells and Lo depolarlze
uepolarlzaLlon occurs when Lhe normally negaLlvely charged cells wlLhln Lhe hearL muscle
develop a poslLlve charge
ConducLlvlLy ls Lhe ablllLy Lo LransmlL an elecLrlcal sLlmulaLed from cell membrane Lo cell
membrane As a resulL exclLable cells depolarlze ln rapld successlon from cell Lo cell unLll all cells have
depolarlzed 1he wave of depolarlzaLlon causes Lhe deflecLlons of Lhe elecLrocardlogram (LCC)
waveforms LhaL are recognlzed as Lhe wave and Lhe C8S complex ulsLurbances ln conducLlon resulLs
when conducLlon ls Loo rapld or Loo slow when Lhe paLhway ls LoLally blocked oe when Lhe elecLrlcal
lmpulse Lravels an abnormal paLhway
ConLracLlllLy ls Lhe ablllLy of aLrlal and venLrlcular muscle cells Lo shorLen Lhelr flber lengLh ln
response Lo elecLrlcal sLlmulaLlon generaLlng sufflclenL pressure Lo propel blood forward ConLracLlllLy ls
Lhe mechanlcal acLlvlLy of Lhe hearL

9 WhaL would your assessmenL flndlngs be for a paLlenL wlLh pneumonla?

1he paLlenL ofLen has paln faLlgue and dyspnea all of whlch promoLe anxleLy
LlsLen Lo hlm or her carefully and use a calm slow approach Lo assessmenL
1he older adulL ofLen has weakness faLlgue leLhargy confuslon and poor appeLlLe lever and
cough may be presenL buL hypoxemla ls usually presenL 1he mosL common manlfesLaLlon ln Lhe older
adulL paLlenL ls acuLe confuslon from hypoxla raLher Lhan fever or cough
1he paLlenL ls llkely Lo be hypoLenslve wlLh orLhosLaLlc changes as a resulL of vasodllaLlon and
dehydraLlon especlally older adulLs
8apld weak pulse may lndlcaLe hypoxemla dehydraLlon or lmpedlng shock
uysrhyLhmlas may be presenL as a resulL of cardlac Llssue hypoxla
Crackles are heard due Lo fluld ls ln lnLersLlLlal and alveolar areas
Wheezlng may be heard as a resulL of lnflammaLlon and exudaLes ln alrways
aLlenL may noL be able Lo lle down and be slLLlng up
May have flushed checks brlghL eyes and an axlous expresslon 1he palLenL may complaln of
havlng chesL or pleurlLlc paln or dlscomforL myalgla P/A chllls fever cough Lachycardla dyspnea
1achypnea and spuLum producLlon
May have serve muscle weakness due Lo use of exLernal muscles

10 Lxplaln nosocomlal lnfecLlons?

PosplLal acqulred lnfecLlons now know as PosplLal Acqulred lnfecLlons
PCSl1AL ACCul8Lu
older adulL
chronlc lung dlsease
presence of gramneg colonlzaLlon of mouLh LhroaL and sLomach
alLered level consclousness
recenL asplraLlon evenL
presence of endoLracheal LracheosLomy or nasogasLrlc Lube
poor nuLrlLlonal sLaLus
lmmunocompromlsed
use of drugs LhaL lncrease gasLrlc pP
recelvlng mechanlcal venLllaLlon

11 Lxplaln Lo a paLlenL Lhe funcLlon of barorecpLors and chemoresepLors?

8arorecepLors ln Lhe arch of Lhe aoraLa and aL Lhe orlgln of Lhe lnLernal caroLld arLerles are
sLlmulaLed when Lhe arLerlal walls are sLreLched by an lncrease 8 lmpulses from Lhese barorecepLors
lnhlblL Lhe vasomoLor cenLer whlch ls locaLed ln Lhe pons and Lhe medulla lnhlblLlon of Lhls cenLer
resulLs ln a drop ln 8
ChemorecepLors 1hese recepLors are senslLlve prlmarly Lo hypoxemla ( a decrease ln Lhe parLlal
pressure of arLerlal oxygen ao2 When sLlmulaLed Lhese chemorecepLors send lmpulses along Lhe
vagus nerves Lo acLlvaLe a vaso consLrlcLor response and ralse 8 1he chemorecepLors ln Lhe resplraLory
cenLer of Lhe braln are also sLlmulaLed by hypercapnla ( an lncrease ln parLlal pressure of arLerlal carbon
dloxlde (paCo2) and acldosls

12 Lxplaln vasoconsLrlcLlon and vasodllaLaLlon LlsL ob[ecLlve daLa Lo supporL boLh

ManagemenL lnvolves rellevlng or prevenLlng Lhe vasoconsLrlcLlon by drug Lherapy Commonly
prescrlbed drugs are rocardla Cyclospasmol ulbenzyllne 1hese vasodllaLlng agenLs may help relleve
Lhe sympLoms buL Lhey can cause uncomforLable slde effecLs such as faclal flushlng P/A hypoLenslon
and dlzzlness
vasodllaLaLlon lncrease ln 8 and uecrease ln ulse
vasoconsLrlcLlon uecrease ln ulse and uecrease ln 8


13 Who ls aL Lhe hlghesL rlsk for cardlovascular dlsease?

PearL dlsease ls Lhe leadlng cause of dlabeLesrelaLed deaLh for men and women (b/c vessels
harden and become lmpalred)
osLmenopausal women are 2 Lo 3 Llmes more llkely Lo have coronary arLery dlsease 1he
lncldenL ls more llkely wlLhln ln 10 years laLer Lhan men for CAu and 20 years for Ml
Women S/S uo noL experlence paln ln Lhe chesL buL lnsLead feel dlscomforL or lndesLlon (hearLburn)
Women usually presenL wlLh a Lrlad" of sympLoms or 3 Lypes lullness (llke Lhey [usL aLe a huge meal)
chronlc faLlgue shorLness of breaLh Lhe lng's lL achlng choklng sLrangllng Llngllng squeezlng
consLrlcLlng also look for faLlgue ShorLness of 8reaLh could be Lhe only sympLom belng presenLed by
women' lL's noL acLlvlLy lnduced elLher Also SC8 when Lhe person men or women are lylng flaL
(orLhopnea) alpaLlons for men and women
Men have a crushlng chesL paln or vlse llke dlscomforL be careful L mlghL Lhlnk of crushlng as
dlscomforL and noL paln 1he men also can have chesL paln LhaL radlaLes Lo Lhe lefL arm women do noL
have Lhls sympLom Lhey wlll have [aw paln Men have a red flushed face women are pale whlLe
14 Lxplaln how you assess Lhe caroLld arLerles and Lhe Lools needed?

8rulLs are swlshlng sounds LhaL may occur from LurbulenL blood flow ln narrowed or
aLheroscleroLlc arLerles Assess for the absence or presence of bru|ts by p|ac|ng the be|| of the
stethoscope over the sk|n of the carot|d artery wh||e the pat|ent ho|d h|s or her breath normally Lhere
are no sounds lf Lhe arLery has unlnLerrupLed blood flow A brulL may develop when Lhe lnLernal
dlameLer of Lhe vessel ls narrowed by 30 or more buL Lhls does noL lndlcaLe Lhe severlLy of dlsease ln
Lhe arLerles Cnce Lhe vessel ls blocked by 90 or greaLer Lhe brulL ofLen cannoL be heard

13 WhaL body organ ls needed Lo meLabollze drugs? Lxplaln your answer LlsL examples of drugs?

Llver 1he llver does all Lhe meLabollzlng of drugs ln Lhe body
1he followlng drugs are meLabollzed ln Lhe llver
Mevacor
LlplLor
Zocor
CresLor
ravachol
1he followlng are used ln Lhe Small lnLesLlne
Lopld
1rlcor
Advlcor
ZeLla
Lovaza

16 LlsL and explaln Lhe dlfferenL Lypes of hyperLenslon? Lxplaln Lhem Lo a paLlenL?

LssenLlal hyperLenslon alLhough Lhere ls no known cause for essenLlal hyperLenslon many rlsk
facLors are assoclaLed wlLh Lhls dlsease age greaLer Lhan 60 famlly hlsLory of hyperLenslon excesslve
calorle consumpLlon physlcal lnacLlvlLy excesslve alcohol lnLake hyperllpldemla afLrlcanamerclan
eLhnlclLy hlgh lnLake of salL or caffelne reduced lnLake of poLasslum calclum or magneslum obeslLy
smoklng and sLress lamlly hlsLory ls a ma[or rlsk for hyperLenslonwhlle aLLendlng MCl comes a close
second!!
Secondary hyperLenslon
Speclflc dlsease sLaLes and drugs can lncrease a person's suscepLlblllLy Lo hyperLenslon A person wlLh
Lhls Lype of elevaLlon ln blood pressure has secondary hyperLenslon
uysfuncLlon of Lhe adrenal medulla or Lhe adrenal corLex can also cause secondary hyperLenslon
AdrenalmedlaLed hyperLenslon ls due Lo prlmary excesses of aldosLerone corlLsol and caLecholamlnes
ln prlmary aldosLeronls excesslve alsdosLerone causes hyperLenslon and hypokalemla lL usually arlses
from benlgn adenomas of Lhe adrenal corLex
LssenLlal (rlmary)
no know cause
AssoclaLed rlsk facLors
lamlly PlsLory of hyperLenslon
Plgh sodlum dleL
Lxcesslve calorle consumpLlon
hyslcal lnacLlvlLy
Lxcesslve alcohol lnLake
Low poLasslum lnLake

Secondary
8enal vascular and renal parenchymal dlsease
rlmary aldosLeronlsm
heochromocyLoma
Cushlng's dlsease
CoarcLaLlon of Lhe aorLa
8raln Lumor
LncephallLls
sychlaLrlc dlsLurbances
regnancy
urugs
LsLrogen
ClucocorLlcolds
MlneralocorLlcolds
SympaLhomlmeLlcs

17 LlsL and explaln medlcaLlons and lab LesLs you would expecL Lo see for a paLlenL wlLh venous
1hromboembollsm?
uo noL massage Lhe affecLed exLremlLy Lo prevenL Lhe Lhrombus from dlslodglng and becomlng
an embolus
AnLlcoagulanLs are Lhe drugs of cholce for acLual uv1 and for paLlenLs aL rlsk for uv1
venous Lhromboembollsm A Lhrombus ls belleved Lo be a blood cloL belleved Lo resulL from an
endoLhellal ln[ury venous sLasls or hypercoagulablllLy ueep veln LhrombophleblLls uv1 ls Lhe
mosL common and mosL serlous Lhan superflclal LhrombophleblLls because lL poses a greaLer rlsk for
pulmonary embollsms ln a L Lhe dlslodged blood cloL Lravels Lo Lhe pulmonary arLery uv1
develops mosLly ln Lhe legs buL can occur ln Lhe upper arms as a resulL of lncreased use of cenLral
venous devlces
revenLlon measures
ln Lhe communlLy lf Lhe person has a hlsLory of uv1
1 Avold oral conLracepLlves
2 urlnk adequaLe flulds Lo avold dehydraLlon
3 Lxerclse legs durlng long perlods of bedresL or slLLlng
ln Lhe lnpaLlenL seLLlng

1 L educaLlon
2 Leg exerclses
3 Larly ambulaLlon
4 AdequaLe hydraLlon
3 CraduaLed compresslon sLocklngs
6 lnLermlLLenL pneumaLlc compresslon
7 venous plexus fooL pump
1he classlc slgns and sympLoms of uv1 are calf or groln paln and Lenderness and a sudden onseL of
unllaLeral swelllng of Lhe leg
nonsurglcal managemenL
8esL bedresL and elevaLlon of Lhe exLremlLy Warm molsL soaks can be applled Lo Lhe affecLed area
also uo noL massage Lhe affecLed exLremlLy because of Lhe lncreased rlsk of Lhe Lhrombus
becomlng dlslodged and becomlng an embolus urug Lherapy AnLlcoagulanLs are Lhe drug of cholce
for uv1's
unfracLlonaLed Peparln 1herapy aL low doses ulP lnLeracLs wlLh anLlLhrombln lll Lo produce
selecLlve lnhlblLlon of cloLLlng facLors lla and xa ln hlgher doses lL lnhlblLs pracLlcally all cloLLlng
facLors 1he ulLlmaLe resulL ls lnhlblLlon of flbrln formaLlon ulP wlll be prescrlbed ln Lhe presence of
an exlsLlng cloL and Lo prevenL enlargemenL of Lhe exlsLlng cloL Cver a long perlod of Llme Lhe
exlsLlng cloL ls absorbed by Lhe body a11 ls Lhe lab LesL used Lo sLudy Lhe level of heparln ln Lhe
body and Lhe subsequenL cloLLlng Llmes 1herapeuLlc levels of a11 are usually 1 Z Lo Llmes normal
conLrol levels noLlfy Lhe Mu ls Lhe value ls greaLer Lhan 70 seconds or follow hosplLal proLocol for
reporLlng crlLlcal lab values Assess pL for slgns and sympLoms of bleedlng whlch lnclude hemaLurla
frank or occulL blood ln Lhe sLool ecchymosls (brulslng) peLechlae an alLered level of consclousness
or paln
Lnsure LhaL proLamlne sulfaLe Lhe anLldoLe for Peparln ls avallable for excesslve bleedlng
lnformaLlon lmporLanL Lo nurslng care for Lhe pL recelvlng anLlcoagulanL Lherapy (charL)
1 Carefully check Lhe dosage of anLlcoagulanL Lo be admlnlsLered even lf Lhe pharmacy prepares
Lhe drug
2 MonlLor Lhe pL for slgns and sympLoms of bleedlng
3 MonlLor vlLal slgns frequenLly for decreased blood pressure and lncreased pulse
4 Pave anLldoLes avallable as needed roLamlne sulfaLe for heparln vlLamln k for Warfarln
3 MonlLor a11 Llme for pL recelvlng unfracLlonaLed heparln or 1 and ln8 for pL's recelvlng
Warfarln or low molecular welghL heparln
6 Apply prolonged pressure over venlpuncLure slLes and ln[ecLlon slLes
7 When admlnlsLerlng subcu heparln apply pressure over Lhe slLe buL do noL massage Lhe slLe
1each Lhe pL golng home Lo do Lhe followlng

1 use only an elecLrlc razor
2 1ake precauLlons Lo avold ln[ury uo noL use Lools such as hammers or saw
3 8eporL slgns and sympLoms of bleedlng
4 1ake Lhe prescrlbed amounL of drug aL Lhe preclse Llme LhaL lL was prescrlbed Lo be glven
3 never sLop Lhe drug abrupLly 1he Mu wlll Laper Lhe drug gradually
Low Molecular WelghL Peparln enoxaparln (Lovanox) dalLerparln ( lragmln) and ardeparln(
normlflo) have a conslsLenL acLlon and are preferred for prevenLlon and LreaLmenL of uv1
Some pL's Laklng LMWP may be safely managed aL home CandldaLes for Lhls are ones wlLh a
sLable uv1 or L low rlsk for bleedlng adequaLe renal funcLlons and normal vlLal slgns
1he usual dose of enoxaparln ls 1mg/kg of body welghL noL Lo exceed 90 mg and ls repeaLed
every 12 hours MonlLor Lhe pL's ln8 dally Assess all sLools for occulL blood 1he a11's are
noL checked on a regular basls because Lhe levels of LMWP are noL ad[usLed
Warfarln 1herapy lf Lhe pL ls recelvlng conLlnuous ulP warfarln (Coumadln) may be added aL
leasL 3 days laLer L's rec LMWP are placed on Lhe oral drug afLer Lhe flrsL dose Warfarln
works ln Lhe llver Lo lnhlblL synLhesls of Lhe four vlLamln k dependenL cloLLlng facLors and Lakes
34 days before lL can exerL LherapeuLlc coagulaLlon lor Lhls reason heparln would be
conLlnued durlng Lhls Llme frame unLll Lhe deslred effecL ls achleved
1he mosL serlous compllcaLlon from LhrombolyLlc Lherapy ls lnLercerebral bleedlng 8e aware of
Lhe lmporLance of LhrombolyLlc Lherapy lLs lndlcaLors and lLs lndlcaLlons for nurslng care
Closely monlLor pL for slgns and sympLoms of bleedlng lncludlng a decreased level of
consclousness
****Lovanox Low fracLlonal Peparln

18 uevelop a Leachlng plan for a paLlenL wlLh 8eynaud's dlsease and prevenLlon compllcaLlons

Lxplaln Lo prevenL vasoconsLrlcLlon such as mlnlmlzlng exposure Lo cold reduclng caffelne
lnLake smoklng cessaLlon and decreaslng sLress 1each Lhe paLlenL Lo wear warm cloLhes socks
and gloves when exposed Lo cool or cold LemperaLures Pe or she should keep Lhe home aL a
comforLably warm LemperaLure and wear gloves Lo Lhe grocery sLore Pelp paLlenLs ldenLlfy
sLressors and provlde suggesLlons for reduclng Lhem
19 LlsL and explaln Lhe expecLed resulLs of ln[ury Lo Lhe fronLal occlplLal braln areas?

lronLal Lobe
1he prlmary moLor area also known as Lhe moLor sLrlp" or corLex
8roca's speech cenLer on Lhe domlnanL slde
volunLary eye movemenL
Access Lo currenL sensory daLa
Access Lo pasL lnformaLlon or experlence
AffecLlve response Lo a slLuaLlon
8egulaLes behavlor based on [udgmenL and foreslghL
!udgmenL
AblllLy Lo develop long Lerm goals
8easonlng concenLraLlon absLracLlon
arleLal Lobe
undersLand sensaLlon LexLure slze shape and spaLlal relaLlonshlp
1hreedlmenslonal (spaLlal) percepLlon
lmporLanL for slnglng playlng muslcal lnsLrumenLs and processlng nonverbal vlsual experlences
ercepLlon of body parLs and body poslLlon awareness
1asLe lmpulse for lnLerpreLaLlon
1emporal Lobe
AudlLory cenLer for sound lnLerpreLaLlon
CompllcaLed memory paLLerns
Wernlcke's area for speech
CcclplLal Lobe
rlmary vlsual cenLer
Llmblc Lobe
LmoLlonal and vlsceral paLLerns connecLed wlLh survlval
Learnlng and memory
Medulla
Cardlacslowlng cenLer
8esplraLory cenLer
Cranlal nerves lx (glossopharyngeal) x (vagus) xl (accessory) and xll (hypoglossal) emerge
from Lhe pons as do porLlons of cranlal nerves vll (faclal) and vlll(acousLlc)
ons
Cardlac acceleraLlon and vasoconsLrlcLlon cenLer
neumoLaxlc cenLer helps conLrol resplraLory paLLern and raLe
lour cranlal nerves orlglnaLe from Lhe pons v (Lrlgemlnal) vl (abducens) vll (faclal) and vlll
(acousLlc)
Mldbraln
ConLalns Lhe cerebral aqueducL or aqueducL of Sylvlus
LocaLlon of perlaqueducLal gray whlch may abollsh paln when sLlmulaLed
Cranlal nerve nuclel lll (oculomoLor) and lv (Lrochlear) locaLed here
20 Lxplaln Lhe sympLoms of braln ln[ury or neurologlc dlsorder LhaL ls worsenlng?

MLn1AL S1A1uS MA? ALSC uLCLlnL AS A 8LSuL1 Cl lnlLC1lCn CfLen Lhls changes ln menLal
sLaLus ls a key early slgn of an lnfecLlon process ln Lhe older paLlenL especlally urlnary LracL
lnfecLlons

21 Pow do you assess eye funcLlon and a cranlal nerve ln[ury?

Cranlal nerves ll(opLlc) lll (CculomoLor) lv (Lroclear) v (Lrlgemlnal) vl (abducens) Check for
dlalaLlon Lhen Lhe 6 flelds for movemenL and flnally converslon whlch wlll LesL all of Lhe above
cranlal nerves

22 LlsL and explaln dlfferenL Lypes of dlagnosLlc LesLs for Lhe braln afLer ln[ury?

Assess Lhe pL's puplls as aprL of ongolng neuro checks"
puplls consLrlcL as a funcLlon of cranlal nerve lll
L88LA
puplls uslng Lhe mllllmeLer rule
L's wlLh eye surgery for caLaracLs or glaucoma ofLen have lrregularly shaped eyes
lf uslng eyedrops ln one eye pL may have unequal puplls pupll response may be unequal

sychosoclal AssessmenL
regardless of healLh problems do noL assume LhaL everyone reacLs Lhe same way Lo Lhelr lllness or
ln[ury L experlence Lhe grlevlng process and may flucLuaLe beLween denlal anger and depresslon
Lncourage pLs Lo express Lhelr feellngs 8efer Lhem Lo Lhe approprlaLe supporL servlces lf needed
assess supporL sysLems lncludlng famlly members and frlends
Cerebral anglography
erebra| ang|ography ls done Lo vlsuallze Lhe cerebral clrculaLlon Lo deLecL blockages ln Lhe arLerles or
velns ln Lhe braln head or neck
pL ls placed on and examlnlng Lable and made comforLable AL Lhls Llme denLures and hearlng
alds are removed Pe or she ls Lhen connecLed Lo cardlac monlLorlng LhroughouL Lhe procedure
MedlcaLlon for relaxaLlon may be glven
lnLervenLlonal radlologlsL or oLher speclflcally Lralned physlclan numbs groln and lnserLs
caLheLer lnLo femoral arLery CaLheLer ls advance lnLo caroLld or verLebral arLery
Lhen lodlnaLed conLrasL maLerlal lnLo each vessel whlle recordlng lmages from dlfferenL angles
over Lhe head and neck
afLer all Lhe vessels have been lmaged radlologlsL revlews Lhe lmages ans consulLs wlLh
physlclan Lo deLermlne lf pL could beneflL from any LherapeuLlc radlologlc procedure Lo LreaL Lhe
problem
an arLerlal closer devlce ls Lyplcally used Lo seal Lhe arLery Lo prevenL bleedlng

CompuLed 1omography
C1 scannlng ls an accuraLe qulck easy nonlnvaslve palnless and leasL expenslve meLhod of
dlagnoslng neurologlc problems
pL ls placed on a moveable Lable ln a head holdln devlce Pe or she musL remaln compleLely
sLlll durlng Lhe LesL whlch may be dlfflculL 1able ls poslLloned ln Lhe machlne large donuL shaped
sLrucLure
sependlng on scan pL may be compleLely enclosed or ln a more open slLuaLlon A nonconLrasL
serles of plcLures are Laken flrsL 1hen lf needed pL ls wlLhdrawn from scanner and glven an lodlnaLed
conLrasL medlum Scan ls Lhen repeaLed
each seL of head scans Lake less Lhan 3 mln ln newer scanner Splnal sLudles Lake abouL 10 mln
per body secLlon and are less llkely Lo requlre conLrasL ln[ecLlon

M8l
, produces lmages LhaL are beLLer Lhan Lhe C1 scan 8elles on magneLlc flelds
ln addlLlon Lo M8l M8A (anglography) M8S (specLroscopy) ul (dlffuslon lmaglng)
M8A ls used Lo evaluaLe blood flow and blood vessel abnormallLles such as an arLerlal
blockage lnLracranlal aneurysms and Av malformaLlons
M8S used Lo deLecL abnormallLles ln Lhe bralns blochemlcal processes such as whlch occurs ln
epllepsy Alzhelmer's dlsease and sLroke
uu uses M8l Lechnlques Lo evaluaLe lschemla ln Lhe braln Lo deLermlne Lhe locaLlon and
severlLy of a sLroke
M8l ls conLralndlcaLed for pL wlLh pacemakers oLher lmplanLed pumps or devlces and lonconLalnlng
meLal aneurysm cllps
exLenslve Lrlals are LesLlng ways Lo safely scan some pL's wlLh pacemakers
oLher lmplanLed devlces such as vascular sLenLs lvC fllLers and meLal vascular embollc
devlces may be scanned lmmedlaLely or afLer a cerLaln perlod of Llme dependlng on manufacLerer's
recommendaLlons
M8l may also be conLralndlcaLed ln pL's who are confused or aglLaLed have unsLable vS are
on conLlnuous llfe supporL or have older LaLLoos(whlch conLaln lead)
LlecLroencephalography
records Lhe elecLrlcal acLlvlLy of Lhe cerebral hemlspheres
pL ls placed on a recllnlng chalr or bed Accordlng Lo an lnLernaLlonally accepLed procedure 16
Lo 24 elecLrodes are usually aLLached Lo Lhe scalp wlLh a [elly llke subsLance and connecLed Lo Lhe
machlne
Lhe physlclan or LLC Lechnlclan places glue over Lhe elecLrodes Lo prevenL sllppage L musL lle
sLlll wlLh hls or her eyes closed durlng lnLlal recordlng
resL of Lhe LesL engages pL ln cerLaln acLlvlLles hypervenLllaLlon phoLlc sLlmulaLlon(sLrobe llghL
sLlmulaLlon) and sleep A porLable LL gamy be performed aL Lhe bedslde lf necessary buL Lhe
preference ls for Lhe LLC Lo be done ln a quleL room

23 CrLhopedlc casLs dlscharge lnsLrucLlons medlcal emergencles and lab LesLs posL dlscharge?

Check Lo ensure LhaL Lhe casL ls noL Loo LlghL and frequenLly monlLor neurovascular sLaLus
usually every hour for Lhe flrsL 24 hours afLer appllcaLlon lf Lhe paLlenL ls hosplLallzed ?ou should be
able Lo lnserL a flnger beLween Lhe casL and Lhe skln lce may be applled for Lhe flrsL 24 Lo 36 hours Lo
reduce swelllng and lnflammaLlon
CasL syndrome Superlor mesenLerls arLery syndrome an uncommon by serlous compllcaLlon ls
mosL ofLen seen ln orLhopedlc paLlenLs who have been ln a hlp splca or body casL arLlal or compleLe
upper lnLesLlnal obsLrucLlon resulLs ln classlc sympLoms Abdomlnal dlsLenLlon eplgaLrlc paln nausea
and vomlLlng 1he vomlLlng ofLen occurs afLer meals and paLlenLs may have normal bowel sounds

laclng a wlndow ln Lhe abdomlnal porLlon of Lhe casL or blvalvlng Lhe casL may be sufflclenL Lo
prevenL or relleve pressure on Lhe duodenum ManagemenL of lnLesLlnal obsLrucLlon ls Lhe same as for
any paLlenL wlLh Lhls compllcaLlon
lmmedlaLely reporL Lo Lhe healLh care provlder any sudden lncrease ln Lhe amounL of dralnage
or change ln Lhe lnLegrlLy of Lhe casL
8efore Lhe casL ls removed lnform Lhe paLlenL LhaL Lhe casL cuLLer wlll noL ln[ure Lhe skln buL
LhaL heaL may be lefL durlng Lhe procedure
MonlLor early slgns of acuLe comparLmenL syndrome assess for Lhe slx s" whlch lnclude
aln ressure aralysls arenLhesls allor and ulselessness
Lab 1esL lf exLenslve sofL Llssue damage ls presenL Lhe eryLhrocyLe sedlmenLaLlon raLe (LS8)
may be elevaLed whlch lndlcaLes Lhe expecLed lnflaLlon response



24/23 noL covered on lecLurer

26 Lxplaln Lhe Lypes of osLeoporosls uevelop of Leachlng plan LhaL focuses on safeLy for a paLlenL
belng dlscharged home afLer a dlagnoses of osLeoporosls?

9r|mary osteoporos|s ls more common and occurs ln posLmenopausal women and ln men ln
Lhelr sevenLh or elghLh decade of llfe Lven Lhough men do noL experlence Lhe rapld bone loss LhaL
posLmenopausal women have Lhey do have decreaslng levels of LesLosLerone (whlch bullds bone) and
alLered mass ln men especlally Lhose older Lhan 73 years
8lsk facLors for prlmary osLeoporosls age 63 years and older ln all women age 73 or older ln men
famlly hlsLory of osLeoporosls hlsLory of lowLrauma fracLure afLer age 30 years Caucaslan or aslan
eLhnlclLy low body welghL Lhln bulld chronlc low calclum lnLake esLrogen or androgen deflclency
women wlLh oLher rlsk facLors smoklng hlsLory hlgh alcohol lnLake lack of physlcal exerclse or
prolonged lmmoblllLy
Secondary osteoporos|s may resulL from oLher medlcal condlLlons such as hyperparaLhyroldlsm long
Lerm drug Lherapy such as wlLh corLlcosLerolds or prolonged lmmoblllLy such as LhaL seen wlLh splnal
cord ln[ury 1reaLmenL of Lhe secondary Lype ls dlrecLed Loward Lhe cause of Lhe osLeoporosls when
posslble
Causes of secondary osLeoporosls
ulseases/condlLlons dlabeLes melllLus hyperLhyroldlsm hyperparaLhyroldlsm cushlng's syndrome
growLh hormone deflclency meLabollc acldosls female hypogonadlsm pageL's dlsease osLeogenesls
lmperfecL LheumaLold arLhrlLls prolonged lmmoblllzaLlon bone cancer clrrhosls Plv/AluS chronlc
alrway llmlLaLlon
Lxerclse excerclses lmprove posLure and supporL for Lhe splne Abdomlnal muscle LlghLenlng
ueep breaLhlng and pecLoral sLreLchlng are sLressed Lo lncrease lung capapclLy Lxcerclses for Lhe
exLremlLy muscles lnclude muscle LlghLenlng reslsLlve and 8CM exerclses Lncourage acLlve 8CM
exerclses whlch lmprove [olnL moblllLy and lncrease muscle Lone as well as prescrlbed exerclse
acLlvlLles Swlmmlng provldes overall muscle exerclse ln addlLlon Lo exerclses for muscle
sLrengLhenlng a general welghLbearlng exerclse program should be lmplemenLed walklng for 30
mlnuLes Lhree Lo flve Llmes a week ls Lhe slngle mosL effecLlve exerclse for osLeoporosls prevenLlon
1each Lhe paLlenL LhaL cerLaln hlghlmpacL recreaLlonal acLlvlLles such as runnlng bowllng and
horseback rldlng may cause verLebral compresslon fracLures and should be avolded
CLher llfesLyle changes avold Lobacco ln any form especlally clgareLLe smoklng revenL falls
and oLher acLlvlLles LhaL can cause a fracLure Lnsure a hazard free envlronmenL (keep way Lo baLhroom
clear no area rugs) ln healLhcare faclllLles ensure flags are presenL Lo alerL sLaff members of fall rlsk
8emember lncrease ln Calclum Lhere ls a decrease ln hosphorous
An lncrease ln hosphorous ls a decrease ln Calclum

27 uevelop a plan of care for a paLlenL wlLh osLeomyellLls (2 Lypes) osLeomalacla pageL's dlsease?

ageL's dlsease or osLelLls deformans chronlc meLabollc dlsorder ln whlch bone ls excesslvely
broken down and reformed 1he resulL ls bone LhaL ls sLrucLurally dlsorganlzed causlng bones Lo be
weak wlLh lncreased rlsk for bowlng of long bones and fracLures 1wo Lypes of ageL's dlsease can occur
famlllal and sporadlc
non surglcal managemenL Lhe prlmary lnLervenLlon for pageL's dlsease ls drug Lherapy oLenL
prescrlpLlon drugs are used Lo LreaL pageL's dlsease ln addlLlon slmple analgeslcs such as C1C nSAlus
can be used Lo conLrol px 1he purpose of drug Lherapy ln age'Ls dlsease ls Lo relleve paln and Lo
decrease bone resorpLlon ManagemenL of mlld Lo moderaLe paln may lnclude Lhe use of asplrln or
nSAluS such as lbuprofen When Lhe calclum level ls more Lhan Lwlce Lhe normal value and Lhe dlsease
ls wldespread Lhe healLh care provlder usually prescrlbes more poLenLs drugs such as selecLed
blsphosphonaLes 1xLmenL wlLh Lhese agenLs for ageL's dlsease requlres dosages and duraLlon of
Lherapy dlfferenL from Lhose for osLeoporosls
AcuLe CsLeomyellLls
lever LemperaLure usually 101
Swelllng around Lhe affecLed area
LryLhema of Lhe affecLed area
1enderness of Lhe affecLed area
8one paln LhaL ls consLanL locallzed and pulsaLlng lnLenslfles wlLh movemenL
Chronlc CsLeomyellLls
ulceraLlon of Lhe skln
Slnus LracL formaLlon
Locallzed paln
uralnage from Lhe affecLed area
1he paLlenL wlLh osLeomyellLls usually has an elevaLed whlLe blood cell counL whlch may be
double Lhe normal value ln chronlc lnfecLlons normal values or sllghL elevaLlons may be seen
1he eryLhrocyLe sedlmenLaLlon raLe (LS8) may be normal early ln Lhe course of Lhe dlsease buL
rlses as Lhe condlLlon progresses lL may remaln elevaLed for as long as 3 monLhs afLer drug Lherapy ls
dlsconLlnued
nonsurglcal managemenL lv anLlmlcroblal Lherapy ls usually prescrlbed for several weeks for
acuLe osLeomyellLls More Lhan one agenL amy be needed Lo combaL mulLlple Lypes of organlsms 1he
hosplLal or home care nurse glves Lhe drugs aL speclflcally prescrlbed Llmes so LhaL LherapeuLlc serum
levels are achleved Cbserve for Lhe acLlons slde effecLs LoxlclLy and lnLeracLlons for glvlng Lhese
drugs 1each famlly members or oLher careglvers ln Lhe home seLLlng how Lo admlnlsLer anLlmlcroblals
lf Lhey are conLlnued afLer hosplLal dlscharge or are only used aL home
lf an open woud or ulcer ls presenL ln Lhe hosplLal or longLerm care seLLlng Lhe pLs LreaLmenL
usually lncludes sLandard precauLlons for llmlLed lnfecLlons ln whlch Lhe would ls noL dralnlng buL ls
covered 1hls pracLlce may vary accordlng Lo healLh care agency pollcy ConLacL precauLlons are
reserved for more severe lnfecLlons parLlcularly when Lhe purulenL maLerlal cannoL be adequaLely
conLalned by a dresslng Cover Lhe open area and use clean Lechnlque when dresslngs are changed Lo
prevenL furLher conLamlnaLlon 1he prevlous cllnlcal pracLlce was Lo use sLrlcL asepLlc Lechnlque buL
mosL agencles are now uslng clean Lechnlque for conLamlnaLed dlrLy" wounds

CharacLerlslLlc CsLeoporosls CsLeomalacla
ueflnlLlon uecrease bone mass uemlnerallzed bone
aLhophyslology Lack of calclum Lack of vlL u
8adlographlc flndlngs CsLeopenla fracLures seudofracLures looser's zone
lracLures
Calclum level Low or normal Low or normal
hosphaLe level normal Low or normal
araLhyrold hormone normal Plgh or normal
Alkallne phosphaLase normal Plgh

28 uraw a plcLure of Lhe dlfferenL grades of fracLures and Lhe Lype of bones?


Closed nondlsplaced

Cpen Compound

CommlnuLed fragmenLed



ulsplaced



Cbllque

Splral
lmpacLed




CreensLlck

29 Crush ln[uryllsL nurslng lnLervenLlon ln order of aculLy hlghesL flrsL?

Crush syndrome occurs from an exLernal crush ln[ury LhaL compresses one or more
comparLmenLs ln Lhe leg arm or pelvls lL ls a poLenLlally llfeLhreaLenlng sysLemlc compllcaLlon L[haL
resulLs from hemorrhage and edema afLer a serve fracLure ln[ury As muscle becomes lschemlc and
necroLlc from pressure wlLhln Lhe comparLmenL myoglobln ls released lnLo Lhe clrculaLlon where lL can
occlude Lhe dlsLal renal Lubules and resulL ln kldney fallure
PearL fallure due Lo Lhe cells belng smashed and all Lhe lCl especlally poLasslum becomlng LCl
and when Lhe crushlng lLem ls llfLed lL all rushes Lo Lhe hearL sLopplng lL
8habdomyolysls ls when Myoglobulln ls released from skeleLal muscle lnLo Lhe blood sLream
Assess for slgns and sympLoms of hypovolemla hyperkalemla and comparLmenL syndrome
kayexlaLe may reduce serum poLasslum adequaLely



30 WhaL ln Lhe world ls ln Care?

ln skeleLal LracLlon plns wlres Longs or screws are surglcally lnserLed dlrecLly lnLo Lhe bone
1hese allow Lhe use of longer LracLlon Llme and heavler welghLs usually 13 Lo 30 pounds SkeleLal alds ln
bone reallgnmenL ln slLe care ls an lmporLanL parL of nurslng managemenL Lo prevenL lnfecLlon
AfLer 48 Lo 72 hours when dralnage ls Lhe heavlesL pln slLe care can be done dally or weekly for
slLes where Lhe pln ls very sLable Lo Lhe bone
Chlorehexldlne 2 mg/mL soluLlon may be Lhe mosL effecLlve cleanslng soluLlon for pln slLe

31 LlsL several assessmenL flndlngs ln a paLlenL LhaL may lead you Lo belleve LhaL a paLlenL may be aL
rlsk for developmenL of osLeoporosls?
Causes of secondary osLeoporosls
ulseases/condlLlons dlabeLes melllLus hyperLhyroldlsm hyperparaLhyroldlsm cushlng's
syndrome growLh hormone deflclency meLabollc acldosls female hypogonadlsm pageL's
dlsease osLeogenesls lmperfecL LheumaLold arLhrlLls prolonged lmmoblllzaLlon bone cancer
clrrhosls Plv/AluS chronlc alrway llmlLaLlon