Cholecystitis and Cholelithiasis

      Cholecystitis and Cholelithiasis: Priority Finding for a Client Who Has Acute Cholecystitis (Active Learning Template - System Disorder) 1. Intense pain (increased heart rate, pallor, diaphoresis) with nausea and vomiting after ingestion of high-fat food caused by biliary colic. 2. Sharp pain in the right upper quadrant, often radiating to the right shoulder. 3. Pain with deep inspiration during right subcostal palpation (Murphy’s sign). Arthroplasty: Client Referral for Physical Therapy (Active Learning Template - Basic Concept) 1. Extensive physical therapy is required to regain mobility. Discharge can be to home or to an acute rehabilitation facility. 2. If discharged home, outpatient or in-home therapy must be provided. 3. Postoperative care includes incentive spirometry, transfusion, surgical drains, dressing, pain control, transfer, exercises, and activity limitations. Emergency Nursing Principles and Management: Expected Prescription for a Rattlesnake Bite (Active Learning Template - Basic Concept) 1. Administer opioid medications for pain due to snake or spider bite. 2. Generally, ice, tourniquets, heparin, and corticosteroids are contraindicated in the first 6 to 8 hr after the bite. 3. Antivenom based on the type and severity of a snake bite is most effective if administered within 4 to 12 hr. Preoperative Nursing Care: Assessing for a Latex Allergy (Active Learning Template - Basic Concept) 1. Allergies to banana or kiwi can indicate the client is at risk for a reaction to latex. 2. Allergy to eggs or soybean oil is a contraindication to the use of propofol for anesthesia. 3. Contrast media (iodine) may not always be a contraindication in clients who have a shellfish allergy. Further assessment may be needed. Stroke: Planning Discharge Teaching for a Client Who Has Hemianopsia (Active Learning Template - System Disorder) 1. If the client has homonymous hemianopsia (loss of the same visual field in both eyes), instruct them to use a scanning technique (turning head from the direction of the unaffected side to the affected side) when eating and ambulating. 2. Place personal supplies within reach on the unaffected side. 3. Provide frequent rest periods from sitting in the wheelchair by returning the client to bed after therapies and meals. (if experiencing decreased endurance) Cancer Treatment Options: Providing Teaching About Infection Prevention (Active Learning Template - System Disorder) 1. Avoid food sources that could contain bacteria (fresh fruits and vegetables; undercooked meat, fish, and eggs; pepper and paprika). 2. Avoid yard work, gardening, or changing a pet’s litter box. If necessary, wear disposable gloves when working with house plants or doing outdoor gardening. 3. Discard liquid beverages that have been sitting at room temperature for longer than 1 hr.       Meningitis: Instructions for Caring for a Client Who Has Bacterial Meningitis (Active Learning Template - System Disorder) 1. Isolate the client as soon as meningitis is suspected, and maintain droplet precautions per facility protocol. Initiate droplet precautions, which require a private room. 2. Continue droplet precautions until antibiotics have been administered for 24 hr and oral and nasal secretions are no longer infectious. 3. Clients who have bacterial meningitis might need to remain on droplet precautions continuously. Alzheimer's Disease: Measures for Reducing Agitation in an Older Adult Client (Active Learning Template - Basic Concept) 1. Use calm, redirecting statements. Provide a diversion. Use music therapy to calm or distract. 2. Promote self-care as long as possible. Assist with activities of daily living as needed. 3. Promote consistency by placing commonly used objects in the same location and using a routine schedule. Neurocognitive Disorders: Planning Care for a Client Who Has Dementia (Active Learning Template - Basic Concept) 1. Provide compensatory memory aids (clocks, calendars, photographs, memorabilia, seasonal decorations, familiar objects). Reorient as necessary. 2. Keep a consistent daily routine. 3. Maintain consistent caregivers. Complementary, Alternative, and Integrative Therapies: Medication Interaction With Feverfew (Active Learning Template - Medication) 1. Supplements (feverfew, garlic, ginger) can increase the risk for bleeding in clients who are taking NSAIDs. 2. The supplement ginkgo biloba can suppress coagulation and is used with caution in clients who are taking NSAIDs. 3. Tell the provider about any over-the-counter medications, vitamins, or herbal supplements before taking them. HIV/AIDS: Adverse Effects of Amphotericin B (Active Learning Template - Medication) 1. Nephrotoxicity: Obtain baseline kidney function (BUN and creatinine) and do weekly kidney function tests. 2. Electrolyte imbalance: Monitor electrolyte levels, especially potassium. Administer supplements for deficiencies. 3. Bone marrow suppression: Obtain baseline CBC and hematocrit and monitor weekly. Vitamins and Minerals: Adverse Effects of Magnesium Sulfate (Active Learning Template - Medication) 1. Monitor blood magnesium, calcium, and phosphorus. 2. Monitor blood pressure, heart rate, and respiratory rate when given intravenously. Assess for depressed or absent deep tendon reflexes as a manifestation of toxicity. Hematologic Diagnostic Procedures: Efficacy of Warfarin Therapy (Active Learning Template - Medication) 1. Depending on therapeutic intent, effectiveness can be evidenced by PT 1.5 to 2 times control. INR of 2 to 3 for treatment of acute myocardial infarction, atrial fibrillation, venous thrombosis, or tissue heart valves. 2. Depending on therapeutic intent, effectiveness can be evidenced by INR of 2.5 to 2.5 for treatment of a PE, INR of 3 to 4.5 for mechanical heart valve or recurrent systemic embolism 3. Depending on therapeutic intent, effectiveness can be evidenced by no development or no further development of venous thrombi Endocrine Disorders: Interaction with Levothyroxine (Active Learning Template Medication) 1. Inform the client that fiber supplements, calcium, iron, and antacids interfere with absorption. 2. Before taking any over-the-counter medications, the client must consult with the provider. 3. Monitor for cardiovascular compromise (chest pain, palpitations, rapid heart rate, shortness of breath). Gastrointestinal Disorders: Teaching About Psyllium (Active Learning Template Medication) 1. Obtain a complete history of laxative use, and provide teaching as appropriate. 2. Instruct clients to take bulk-forming and surfactant laxatives with 8 oz water. 3. Administer bisacodyl at bedtime for results in 6 to 12 hr. Bisacodyl suppositories are effective within an hour. Dosage Calculation: Calculating an Infusion Rate (Active Learning Template - Basic Concept) 1. If an electronic infusion pump is not available, regulate the IV flow rate using the roller clamp on the IV tubing. 2. When setting the flow rate, count the number of drops that fall into the drip chamber over 1 min. 3. Then calculate the flow rate using the drop factor on the manufacturer’s package containing the administration set. The drop factor is the number of drops per milliliter of solution. Pituitary Disorders: Expected Findings of Diabetes Insipidus (Active Learning Template System Disorder) 1. Decreased urine specific gravity (less than 1.005). 2. Decreased urine osmolality (less than 200 mOsm/L). 3. Decreased urine pH, sodium, potassium. Peptic Ulcer Disease: Identifying Manifestations of Pernicious Anemia (Active Learning Template - System Disorder) 1. Smooth, sore, bright-red tongue (vitamin B12 deficiency) 2. Pallor of the nail beds and mucous membranes 3.              3. Cold intolerance: skin is cool to the touch Burns: Discharge Teaching for Wound Management (Active Learning Template - System Disorder) 1. Maintain active and passive range of motion. 2. Assist with ambulation as soon as the client is stable. 3. Maintain correct body alignment, splint extremities, and facilitate position changes to prevent contractures. Growth Factors: Evaluating Understanding of Erythropoietin (Active Learning Template Medication) 1. Depending on therapeutic intent, effectiveness can be evidenced by Hgb level of 10 to 11 g/dL and maximum Hct of 33%. 2. Monitor iron levels, and implement measures to ensure an iron level that is within the expected reference range. 3. Monitor Hgb and Hct once weekly (darbepoetin) or at least twice per week (erythropoietin) until they reach the target range. Musculoskeletal Trauma: Manifestations of Compartment Syndrome (Active Learning Template - Therapeutic Procedure) 1. Pain that is unrelieved with elevation or analgesics; increases with passive movement. Paresthesia or numbness (early finding). 2. Pulselessness distal to the fracture (late finding). 3. Paralysis or an inability to move digits (nerve damage). Pale, cold skin and cyanosis to nail beds. Cancer Treatment Options: Teaching About Radiation Therapy (Active Learning Template - System Disorder) 1. Gently wash the skin over the irradiated area with mild soap and water. 2. Dry the area thoroughly using patting motions. 3. Use the hand to clean the skin rather than a washcloth. Hyperthyroidism: Priority Action Following a Parathyroidectomy (Active Learning Template - Therapeutic Procedure) 1. Keep a tracheostomy tray and suction equipment available at all times during the immediate recovery period. 2. Maintain the bed in a high-Fowler’s position to decrease edema and swelling of the neck. 3. Medicate as prescribed to reduce swelling. Tuberculosis: Discharge Instructions (Active Learning Template - System Disorder) 1. Sputum samples are needed every 2 to 4 weeks to monitor therapy effectiveness. 2. Clients are no longer considered infectious after three consecutive negative sputum cultures and can resume work and social interactions. 3. Continue medication therapy for its full duration of 6 to 12 months, even up to 2 years for multidrug-resistant TB. Failure to take the medications can lead to a resistant strain of TB. Heart Failure and Pulmonary Edema: Client Education (Active Learning Template Medication) Maintain an exercise routine to remain physically active, and consult with the provider before starting any exercise regimen. 2. Consume a diet low in sodium, along with fluid restrictions, and consult with the provider regarding diet specifications. 3. Refrain from smoking. Pacemakers and Implantable Cardioverter/Defibrillators: Rhythm Strip Interpretation (Active Learning Template - System Disorder) 1. When a pacing stimulus is delivered to the heart, a pacer spike (or pacemaker artifact) will be seen on a cardiac monitor or ECG strip. 2. The pacer spike, a vertical line, should be followed by a P wave (atrial pacing) or QRS complex (ventricular pacing). 3. An implantable cardioverter/defibrillator (ICD) monitors for life-threatening changes in cardiac rhythm and automatically delivers an electrical shock directly to the heart in an attempt to restore a normal rhythm. HIV/AIDS: Evaluating Effectiveness of Teaching (Active Learning Template - System Disorder) 1. Avoid raw foods (fruits, vegetables) and undercooked foods (meat, fish, eggs). 2. Avoid cleaning pet litter boxes to reduce the risk of toxoplasmosis. 3. Keep the home environment clean and avoid being exposed to family and friends who have colds or flu viruses. Respiratory Management and Mechanical Ventilation: Appropriate Mask Selection (Active Learning Template - System Disorder) 1. Non-rebreather mask delivers an FiO2 of 80% to 95% at flow rates of 10 to 15 L/min to keep the reservoir bag ⅔ full during inspiration and expiration. 2. Delivers the highest O2 concentration possible (except for intubation). 3. A one-way valve situated between the mask and reservoir allows the client to inhale maximum O2 from the reservoir bag. The two exhalation ports have flaps covering them that prevent room air from entering the mask. Complications of Diabetes Mellitus: Treatment Plan for Diabetic Ketoacidosis (Active Learning Template - System Disorder) 1. Administer regular insulin 0.1 to 0.15 unit/kg as an IV bolus dose and then follow with a continuous IV infusion of regular insulin at 0.1 unit/kg/hr. 2. Insulin is administered IV rather than subcutaneously to provide immediate treatment. 3. The client who has DKA will absorb subcutaneous insulin slowly and erratically, making it difficult to adjust dosages of insulin appropriately. Peptic Ulcer Disease: Priority Action for Shock (Active Learning Template - System Disorder) 1. Report findings, prepare the client for endoscopic or surgical intervention, replace fluid and blood losses to maintain blood pressure, insert nasogastric tube, and provide saline lavages. 2. Start two large-bore IV lines for replacement of blood and fluids. 3. Famotidine, cimetidine, and nizatidine suppress the secretion of gastric acid by selectively blocking H2 receptors in parietal cells lining the stomach. 1.             Hyperthyroidism: Dietary Teaching Following Thyroidectomy With Parathyroid Removal (Active Learning Template - Therapeutic Procedure) 1. Major Sources of calcium: Dairy, broccoli, kale, fortified grains 2. Major Sources of magnesium: Green leafy vegetables, nuts, whole grains, tuna, halibut, chocolate 3. Major Sources of phosphorus: Dairy, peas, meat, eggs, legumes Respiratory Management and Mechanical Ventilation: Responding to a High-Pressure Alarm (Active Learning Template - Basic Concept) 1. Pressure (high pressure) alarms indicate excess secretions, client biting the tubing, kinks in the tubing, client coughing, pulmonary edema, bronchospasm, or pneumothorax. 2. Explain the procedure to the client. 3. Establish a method for the client to communicate, such as asking yes/no questions, providing writing materials, using a dry-erase and/or picture communication board, or lip reading. Identifying Assessment Findings Associated With Respiratory Disorders 1. Chronic dyspnea- The respiratory rate can reach 40 to 50/min during acute exacerbations. 2. Clubbing of fingers and toes (late stages of the disease). 3. Pallor and cyanosis of nail beds and mucous membranes (late stages of the disease). Planning Care for Client Who Has an Acute Respiratory Infection 1. Administer oxygen therapy. 2. Obtain specimen before starting antibiotic therapy. 3. Encourage fluid intake of 2 to 3 L/day to promote hydration and thinning of secretions, unless contraindicated due to another condition. Actions to Take for Client Who Has History of Chron’s Disease 1. For an invasive procedure or surgery, the client must provide written consent. 2. Medications for cardiovascular disease, pulmonary disease, seizures, diabetes mellitus, some antihypertensive medications, and eye drops for glaucoma are usually allowed prior to surgery or a procedure. 3. Administer hypertonic IV fluids and broad-spectrum antibiotics as prescribed. Caring for a Client Who Has Abdominal Pain and Nausea 1. Opioid analgesics, such as morphine sulfate or hydromorphone, are preferred for acute biliary pain. 2. Rebound tenderness (Blumberg’s sign performed by the provider or advanced practice nurse). 3. Dyspepsia, eructation (belching), and flatulence. Evaluating Findings for a Client Who Has Pneumonia 1. The expected reference range is 95% to 100%. Acceptable levels range from 91% to 100%. Some illness states can allow for 85% to 89%. Readings less than 90% reflect hypoxemia. 2. The expected reference range for an adult client’s respiratory rate is 12 to 20/min. 3. The expected reference range for an adult client’s pulse is 60 to 100/min at rest.