ATI Exam Study Guide Fundamentals

     Fundamentals Ethics and Civil Law ● Reporting Act ○ Child and elderly abuse ○ Gunshot wounds ○ Communicable diseases ○ Ophthalmia Neonatorum ○ Phenylketonuria ○ Criminal acts ● Incident Reports ○ NEVER place in a patient's chart ○ If a patient wants to leave AMA, it is the provider's responsibility to advise the patient of any risks involved when they refuse care ● Advanced Directives ○ Two Types ■ Living will ■ Durable Power of Attorney: transfers all rights to the designated agent ○ Intended to allow patients to have more control over their healthcaredecisionsat the end of life ● Informed Consent ○ Not required in emergency situations ○ Capacity-age (adult), competence (can make choices and understand consequences) ○ Voluntary ■ Freedom of choice without force, fraud, duress, or coercion ○ Informed consent not to be made under the influence of a drug or alcohol ○ The nurse’s signature as a witness on a consent form indicates that the nurse observed the informed consent or the clientsauthorizedrepresentativevoluntarily signed the consent form ● When to Question Provider Orders ○ Ambiguous orders ○ Orders that the patient questions ○ Orders when the patient’s condition has changed ○ Orders which do not match with your experience ○ Verbal orders that the doctor has not yet co-signed ● How to Protect your License ○ Do not let anyone else borrow it ○ Do not copy it unless you write COPY on it ● ● ● ● ● ● ● ● ○ If you lose your license, report it immediately ○ Be sure that the Board of Nursing is notified of any changes of address or name ○ Practice nursing according to the scope and standards of the state you work in Torts ○ Civil wrongs ○ Intentional ■ Assault, battery, defamation, false imprisonment, outage,invasionofprivacy, wrongful disclosure of confidential information (can fax or email personal information if consent was given) ○ Unintentional (Negligence) ■ Failure of a nurse toperformanactthatareasonablepersonwouldorwould not perform in similar circumstances ■ Can be an act of omission or commission ■ Occurs when injury results from the failure of the wrongdoer to exercise care Malpractice ○ Professional misconduct that is an unreasonable lack of skill or fidelity in duties ○ Ex; not inserting a foley, not taking appropriate steps to decrease a patient’s temperature, notreportingworseningconditionsofthepatienttotheprovider,not preventing falls Libel ○ Written communication that injures a person’s reputation Slander ○ Oral communication that injures a person’s repudiation Assault ○ A threat or an attempt to make bodily contact with another person without the person's consent ○ Ex: threatening to give an injection to a psychotic patient if they do not behave properly Battery ○ Touching another person unlawfully or carrying out a threatened physical harm Good Samaritan law ○ Enacted by individual states to encourage healthcare providers to assist at the scene of accidents and emergencies ■ Care must be provided in good faith and must be gratuitous ■ The nurse must provide care at the level of their scope of practice Liability ○ Individual ■ Everybody is liable to his or her action/conduct ■ Liability must be shared by another person or group (ex; doctors and fellow nurses or a facility such as a hospital) ○ Vicarious ■ Liability under the nurse practice act, which defines the standard of care a nurse is expected to perform (ex; wrongfully administering a medication which would result in physical harm to the patient) ● Nursing Implications for breaches in Civil Law ○ Intervene when patient dignity or privacy is violated ○ Properly covering a physical body during procedures ○ Medical records must be released only with written patient consent ○ Clients belongings must be protected and may not be searched without specific authorization Admissions ● Admissions ○ Voluntary ■ When a patient is willingly taken to the hospital to be admitted ○ Involuntary ■ When oneisunwillingtogotothehospital,someoneelsemakesthedecision for that person ■ In this situation, the patient loses the right to make decisions for themselves ■ Ex; pediatric patients, adults with mental or cognitive impairment ● Discharges ○ Final or Absolute ■ Ex; when you give birth ○ Conditional or Incomplete ■ Ex; discharge to a halfway house, nursing home, group home, OT/PT ■ The patient has a contract with the hospital until final discharge ● Restraints ○ Physical restraints ■ Informed consent is needed ● If a client is unable to consent to the use of restraints, a consent of proxy must be obtained after full disclosure of risks and benefits ● If informed consent is not given, restraining a patient is considered false imprisonment ■ Restraints should be adequate and appropriate for the purpose, must have a doctor's order ■ In emergency situations, restraints may be applied without doctor's orders for a limited time ■ Restraints are only needed when a patient is harmful to self or others and alternative therapies have not worked ■ Check on restraints client every 10-15 minutes ● Documentation must include the time of each check and the neuromuscular status of the client's extremities ○ Chemical Restraints ■ Psychotropic drugs cannot be used to control behavior ■ Can be used only for diagnosis-related conditions ■ Inappropriate use of chemical restraints can cause deep sedation, agitation, combativeness, and possible injury to the patient Nursing Process ● Systemically a collection of data and clearly identifies  the patient's strengths and problems ○ The process offers improved quality of nursing care ○ Encourages client participation in care and decision-making ○ Always individualized ● ADPIE ○ Assessment, nursing diagnosis/analysis, planning, implementation, and evaluation ■ Always use the five steps in chronological order ○ Remember that assessment always comes before planning or implementation 1) Assessment ● Begins as soon as the patient walks in ○ Involves establishing the database of a client, collection and organization of physical and psychosocial assessment data ○ Collection of physical assessment data ● Verify the data ○ Whenever there is a doubt, verify the data ■ ex; if a patient wants to urinate,assessthesymphysispubisfordissensionor swelling. If this tension is present, it confirms the Dell ○ Always question orders you do not agree with ■ ex; ordering Demerol for head injury patient, needs questioning because Demerol depresses the respiratory center ○ Before the administration of any pain medication, ask the patient to rate the pain ■ If the pain is 0-4, try diversional therapies first ■ If the pain is 5-10, give pain meds ● Subjective Data ○ Information perceived only by patient, what they feel ○ Symptoms: patient is nauseous, with chills and pain ● Objective Data ○ Observed by nurse ○ Body temperature, blood pressure, cyanosis 2) Diagnosis & Analysis ● Formulated nursing diagnosis used NANDA ● Analysis ○ To identify the actual potential problems, the cause, or etiological factors ○ Analyzes lab results ○ Identifies immediate needs ○ Determine cause of symptoms, strengths, weaknesses ● Lab Results to Know RBC: 4.5-6.1 WBC: million 4,500-11,000 Hgb: 12-18 Hct: 38-54% Plt: 150-450,00 0 PTT: 35-45 sec INR: 2-3 Bleeding time: 1-10 min Na: 135-145 K: 3.5-5.1 PT: 10-15 sec aPTT: 25-35 sec Mg: 1.6-2.6 Ca: 8.5-10.5 BUN: 10-20 Creat: 0.5-1.5 Lithium: 0.5-1.5 Dig: 0.5-1.5 Cholesterol : 160-190 CKP: 25-175 AST: 8-20 Prostate antigen: 0.18-0.89 Glucose: 70-110 A1C: 4-6% pH: 7.35-7.45 CO2: 35-45 >45: acid <35: alkaline O2: 80-100 HCO3: 22-26 <22: acid >26: alkaline PaO2: 95-100%   ● Ability to Make Predictions ○ If a nurse administers Demerol, the nurse should expect it to start to relieve pain within 30 minutes ○ Regular insulin works within the first 30 minutes, therefore, if a nurse administers regular insulin, they should expect that the medicationwillstartworkingwithin30 minutes ■ Ability to synchronize meal times ○ If you remove CSF during a lumbar puncture, it will cause fluid loss and a headache ■ Remember, the positioning for this procedure is the fetal position/knee to chest position at the edge of the bed ■ The first four hours after the lumbar puncture, the nurse then places the patient in a prone position to allow the process of coagulation to take place ■ After this, the nurse places the patient in supine or flat position to apply pressure on the puncture site ○ When taking  care of a patient with rheumatoid  arthritis, a systemic and autoimmune disease that if left untreated, will affect the heart (carditis) ■ Therefore, the nurse can predict that bed rest will be needed 3) Planning ● Set priority first, short term goals before long term ones ● Consult with family and patient in developing plan of care ● Short-term goals ○ Immediate actions ○ Ex; f a patient is in a state of anxiety due to pain, the best solution is to relieve anxiety by relieving the pain ○ Ex; if a patient is bleeding from a surgical incision site, stop the bleeding by reinforcement of a wound dressing or apply pressure ● Long-term goals ○ Takes longer to achieve ○ Sets up priority or prioritizesthegoalsbyusingMaslow'shierarchyofneeds,ABCs, and safety 4) Implementation ● Carrying out the planning or accomplishing a defined goal, involves implementation of care, reporting significant changes in client's condition, documentation, communicating patient needs to others of the healthcare team ○ Ex; give me orange juice with iron for better absorption ○ Ex; Not giving diuretics at night 5) Evaluation ● Determining the extent at which the goals have been achieved ○ Comparing patient responses to the expected outcome ○ Revising the goal of care to accommodate patient values, Customs, culture, and beliefs ○ Gathering data to indicate effectiveness of each intervention ■ Ex; an evaluation of an anemic woman on iron medication after 3 months showed that her hemoglobin improved effectively Patient Needs ● Maslow's hierarchy of needs ○ Physical needs, physiological: oxygen, food, water, sex, shelter, rest ■ The highest needs that must be satisfied first ■ Airway, breathing, circulation ○ Psychological needs ■ Supporting patients in terms of their needs and problems suchasalleviating anxiety and pain ● Ex; placing a suicidal patient on a one-to-one unit ■ Using effective therapeutic communication techniques ■ Pain relief is considered psychosocial ○ Safety and Security ■ Reducing excessive stimulation in the environment ■ Modifying the environment to meet the needs of the patient example includes writing a confused elderly person's name on the dooroftheirroom and clearing the environment of clutter of a fall risk patient ■ Safe proof in the environment for childrentopreventfalls,accidentalpoison ingestion, and swallowing foreign bodies ○ Love and belonging ■ First loving yourself before you can love anybody else ○ Self-esteem ■ How you feel about yourself ○ Self-actualization ■ Very few people achieve this need, the need to become firm and resolute human being ● Therapeutic relationship ○ The nurse-patient relationship ■ The nurse maintains the prescribed relationship and sustains the trust built during the orientation phase, the longest phase ■ The nurse give the patient assistance needed to achieve the goals of the relationship ■ Termination phase begins on admission and during orientation phase when the patient is made aware of when to terminate the relationship ● Empathy ○ Putting oneself into somebody else’s world and seeing from anotherperson'spoint of view ○ Temporarily experiencing another person's feelings ○ NCLEX TIP: The answer is always “tell me about/how/why”, never assume ● Sympathy ○ Should never be used in medicine ○ Positive regards ■ Denotes respect or viewing a person as worthy of caring for ○ Non-judgemental ■ Refrain from judging clients based on behavior or their background Duties of Different Professionals ● RN Duties ○ Admission ○ Discharge teaching ○ Blood transfusions ○ Flushing lines and setting IVs ○ Decision making ○ Communication to the rest of the healthcare team ○ Developing the nursing care plan and implementation of teaching ○ Administering chemotherapy ○ Caring for a patient on mechanical ventilation ○ Transcribing physician orders ○ Analyzing assessment data and determining appropriate nursing diagnosis and actions ○ Caring for the critically ill or sickest client ● LPN Duties ○ Suctioning ○ Catheterization ○ Dressing changes ○ Blood transfusion after 1 hour ○ Medication administration ○ Taking vital signs ○ Ostomy care ● UAP Duties ○ Bed making and Grooming ○ Feeding, but not clients with dysphagia ○ Bathing and ambulating ○ Mouth care ○ Vital signs ○ Emptying ostomy bags ● Never delegate what you can eat: Evaluate, Assess, Teach Death and Dying ● Acronym: DABDA ○ Denial and Isolation ■ Usually defined as the refusal to accept loss ■ Tend to hospital jump to disprove initial diagnosis ○ Anger ■ Feeling of emptiness and anger ■ Reality has begun to penetrate their consciousness ○ Bargaining ■ Changing from “not me” to “yes me, but why now?” ■ Patient pleads for more time to live ■ Good for patients to help them set goals ○ Depression ■ Patient will turn inward, give simple answers and give up on those they love ■ Can be considered silent grief and Mourning period ○ Acceptance ■ Patient is ready and has accepted the death or loss ■ Will detach from family members as a normal reaction ● Pediatric Patients ○ Birth to 1 year ■ Has no meaning ○ 1-4 years ■ Regards death as a temporary separation ○ 5+ years ■ Regards death as permanent and irreversible Nursing Procedures ● Hand-washing ○ Single most important procedure for the prevention of nosocomial infections ● Wounds ○ Clean from inside to the outside ● Order of Donning ○ Gown, mask, cap, gloves ● Order of Doffing ○ Gloves, cap, mask, gown Standard Precautions ○ Contact with blood, bodily fluids, excretions, secretions, non-intact skin, and mucous membranes Important Considerations ● BP Cuffs ○ If it’s too small, can cause falsely high blood pressure readings ■ Should be two-thirds of the width of the limb where pressure pressure is being monitored ● Apical pulses ○ Diaphragm of the stethoscope placed at the left fifth intercostal space in the midclavicular line ● Carotid artery ○ Used for pulse in emergency situations ● Circulatory or respiratory problems ○ Vitals should be assessed before hot compresses are placed anywhere ● Risk for falls ○ Hx of falls, advanced age, sensory/motor impairment, urgent need forelimination, postural BP instability ● Wheelchair ○ When assisting the patient, place the chair on the unaffected side of the body ● Latex allergies ○ The patient may also be allergic to avocados, bananas, kiwi, or chestnuts ○ Signs of a reaction may include facial swelling, rhinitis, urticaria, and respiratory distress ● Iodine allergy ○ The patient may also be allergic to shellfish ● Mouth care ○ On an unconscious patient, ensure the patient is in a side-lying semi-Fowler’s position ● Fires ○ RACE ■ Rescue, alarm, contain. and extinguish ● Passive ROM ○ Contraindicated during the inflammatory phase of rheumatologic diseases as well as joints that are dislocated or fractured ○ During these exercises, never push a movement  beyond the point at which the client complains of discomfort or when you feel resistance ● Prone-Lying ○ Contraindicated for tracheostomies, cervical injuries, or breathing difficulties ○ GOOD for Covid-19 ● Crutches ○ Have the client Benz the elbows at 20- 30 degrees ● ● ● ● ● ● ● ● ● ● ● ● ● ○ The length of the crutch should be measured by placing two fingers between the axillary bars and 6-8 inches out from heel ○ When ambulating with a pt who is using crutches, stand on their affected sideand use a gait belt ○ When going up the stairs, good leg goes up first, bad leg follows Cane ○ Stand on their affected side and hold onto gait belt ○ Teach the patient to place the cane on their unaffected side so the cane and the weaker leg works together ○ Properly sized cane will extend from the greater trochanter to the floor allowing for 20- 30 degrees flexion Nitro patches/paste ○ Avoid direct contact to prevent headaches Cardiac Catheterization ○ First nursing priority is to assess for bleeding at the site Objective Examination ○ Inspection, auscultation, palpation, and percussion ■ Except in abdominal examination ○ To check for a pulse deficit, two nurses simultaneously auscultate the apical and palpate Radial pulse SIMs position ○ Preferred by pregnant women because of the Comfort it provides when lying down ○ Position of choice for an enema insertion Dorsal Recumbent position ○ Used for examination of the abdomen, breast, anterior chest Lateral position ○ Used for patients who have sensory or motor deficits on one side of the body Knee to chest position ○ Recommended for rectal examinations and patients with heart conditions that cause cyanosis Thoracentesis ○ Patient is in a sitting position bending over the bedside table ○ Ensure that the patient has voided before procedure Paracentesis ○ Patient is an upright position with the feet supported ○ Watch 4 complications such as hypotension and hypovolemic shock ○ Ensure that the patient has voided before procedure Liver biopsy ○ Patient is on their left side ○ After the procedure, place the patient on the right side to put pressure on the insertion site Lumbar puncture ● ● ● ● ● ● ● ● ● ● ● ○ Obtains CSF for examination, relieving pressure, or to introduce medication ○ Patient is in a lateral knee to chest position or a fetal position Enema ○ Always oil retention enemas before  cleansing ones ○ Hold the enema bucket at least 18 in above the level of the patient ○ If the patient complains of cramping, pinch the tubing and ask the patient to breathe slowly NG Tube ○ Measure from the tip of the nose, to the earlobe, to the tip of the xiphoid process ○ Advance the tube at the nasopharynx, at the pharynx, ask the patient to flex their head ○ Ensure proper placement by x-ray or test the acid in a gastric content Orthostatic Hypotension ○ Watch for complaints of vertigo, lightheadedness, fainting, nausea, or a sudden drop in blood pressure (25 systolicand19diastolic) whenmovingtheclientfroma horizontal to a vertical position Dependent edema ○ Most accurate area is the sacral area ○ Usually secondary to right sided heart failure Pap smear ○ First priority nursing action is to wipe the cells immediately across a clean glass slide and fix with spray Sigmoidoscopy ○ Client will receive a clear liquid diet for one day before the test and a warm tap water enema until returns are clear Colonoscopy ○ Patient is sedated and positioned on their left side Returning from procedures ○ Encourage early ambulation and provide oxygen support during ambulation Peritoneal dialysis ○ Involves the use of the peritoneal membrane across which excess waste and fluids move from the blood into the peritoneal vessels into a dialysate solution that has been instilled into the peritoneal cavity ○ Feeding, dwell time, draining ○ Monitor for signs of infection by observing for cloudy color of the dialysate effluent Ophthalmic ointment ○ Start at the inner canthus and extend the medication out word for the outer canthus Snellen chart ○ Used for visual acuity ○ 20/20 ■ The numerator is the distance in feet at which the letter is readable by the person who is normal eyesight ● Skin color changes ○ In dark-skinned individuals, these changes can best be seen in the lips, mucous membranes, earlobes, palms and soles of feet ○ Jaundice is best detected in the sclera of the eyes ○ Cyanosis is best detected in the oral mucosa, conjunctiva, and nail beds ○ Pallor is best detective in the conjunctiva and mucous membranes ● Surgical wounds ○ Compress Jackson-Pratt bulb/hemovac container every 4 hours to monitor drainage Common Clinical Signs ● Babinski reflex ○ Dorsiflexion of the big toe after stimulation of the lateral sole ○ Associated with corticospinal tract lesions ● Brudzinski's sign ○ Flexion of the hip and knee induced by flexion of the neck ○ Associated with meningeal irritation ● Chadwick's sign ○ Sign of vaginal and cervical mucosa ○ Associated with pregnancy ● Chovstek’s sign ○ Facial muscle spasms induced by tapping on the facial nerve branches ● Cheyne-Stokes respirations ○ Rhythmic cycles of deep and shallow respirations often with apneic periods ○ Associated with the central nervous system ● Cullen's sign ○ Bluish discoloration around the umbilicus ○ Indicative of acute pancreatitis ● Harlequin’s sign ○ In the newborn infant, reddening of the lower half of the laterally recumbentbody and blanching of the upper half ○ Due to temporary vasomotor disturbances ● Hegar’s sign ○ Softening of the fundus of the uterus ○ Associated with first trimester of pregnancy ● Homan's sign ○ Pain behind the knee induced by dorsiflexion of the foot ○ Associated with peripheral vascular disease, especially venous thrombosis in the calf ● Kernig’s sign ○ Inability to extend leg when sitting or lying with the thigh flexed on the abdomen ○ Associated with meningeal irritation Kussmaul's breathing ○ Paroxysmal air hunger, associated with acidosis, especially diabetic ketoacidosis ○ Characterized by deep sighing respiratory pattern ● Mcburney's sign ○ Tenderness at mcburney's point, two-thirds of the distance from the umbilicus to the anterior superior iliac spine ○ Associated with appendicitis ● Rovsing's sign ○ Pain in the right lower quadrant when the lower left quadrant is pressed ○ Associated with appendicitis Safety and Infection Control ● Local infection ○ Heat, redness, pain and tenderness, swelling, possible drainage (bloody, serous, purulent), abscess (localized collection of pus), cellulitis (involving cellular and connective tissue) ● Systemic infection ○ Fever, malaise, weakness ○ Will have an elevated WBC count above 11,000 ○ Will have an elevated erythrocyte sedimentation rate above 15-20, indicating the presence of inflammation ● Standard Precautions ○ Used with all patients as a primary strategy for nosocomial infection control ○ Applies to blood and all bodily fluids ● Patient Room Placement ○ Immunocompromised, then airborne, then droplet, then contact ○ Patient will be in private room if they have poor hygiene habits, contaminate the environment, or cannot assist in maintaining infection control ( infants, children, altered mental status in adults) Transmission-Based Precautions ● Airborne ○ Used with pathogens that are transmitted in the air ○ Private room with negative air pressure ○ Place a mask on the patient if they are being transported ○ Ex; Measles, tuberculosis, varicella, shingles (herpes zoster) ● Droplet ○ Used with pathogens transmitted by infectious droplets ○ Involves contact of conjunctiva or mucous membranes of the nose or mouth ■ Happens during coughing, sneezing, talking, or during procedures such as suctioning or bronchoscopy ○ Maintain 3ft distance between the infected patient and visitors ○ Place a mask on the patient when being transported ● ○ Ex; Streptococcus pharyngitis, pneumonia, meningitis from H. Influenza ● Tuberculosis ○ Airborne ○ Transmitted by aerosolization; bacillus multiplies in the bronchi and alveoli resulting in pneumonitis, may lie dormant for many years  and be reactivated in periods of stress ○ Signs and symptoms ■ Progressive fatigue, anorexia, nausea, weight loss ■ Irregular menses ■ Low-grade afternoon fevers, night sweats ■ Cough with mucopurulent sputum, occasionally streaked with blood ○ Diagnostic procedures ■ Skin test (mantoux/PPD): does not indicate an active disease is present, but indicates exposure to TB or the presence of an inactive dormant disease ■ Tinne test ■ Sputum smear for the acid-fast bacilli (most reliable) ■ Chest x-ray ● Hepatitis ○ Acute inflammatory disease of the liver resulting in cell damage from the liver cell degeneration and necrosis ○ Signs and symptoms ■ Jaundice (Icterus) ■ Clay-colored stools, tea colored urine ■ Anorexia and right upper quadrant pain ○ Patient teaching ■ Bed rest for severe symptoms ■ Avoid alcohol and hepatic toxic prescriptions (aspirin, Tylenol, sedatives) ○ Mode of transmission ■ A/E: enteric transmission ■ B/C/D: bloodborne transmission ● Lyme's disease ○ Multi-system infection transmitted to humans from ticks ○ Signs and symptoms (Stage 1) ■ Rash (papules that develop into lesions with a clear center), develops at the site of the bite within 2- 30 days, bullseye rash ■ Development of flu-like symptoms within 1 to several months ○ Signs and symptoms (Stage 2) ■ Cardiac conduction defects ■ Neurological disorders including Bell's palsy and paralysis that is  not permanent ○ Signs and symptoms (Stage 3) ■ Arthralgias, enlarged and inflamed joints that may persist for several years ● AIDS ○ Acquired immunodeficiency syndrome ○ Syndrome distinguished by serious deficits and cellular immune function associated with positive human immunodeficiency virus (HIV), evidence clinically by development of opportunistic infections, enteric pathogens, and malignancies ○ Special considerations ■ Monitor for HIV in the blood ■ AIDS syndrome has a CD4 cell count below 200 ■ Opportunistic infections such as pneumonia,stomatitis,andesophagitismay occur ■ CBC will reveal leukopenia with serious lymphopenia, anemia, and thrombocytopenia ● Chlamydia ○ Caused by chlamydia trachomatis, produces infections in men and women (Fallopian tubes, cervix, and urethra) and can also develop in PID ○ Incubation period is 5-10+ days ○ Special considerations ■ Observe for vaginal discharge, burning, bleeding or pain ○ Treatment ■ Doxycycline and erythromycin ■ Penicillin does not treat chlamydia ● Syphilis ○ Chronic infectious disease transmitted through physical contact with syphilitic lesionswhichareusuallyfoundontheskinorthemucousmembranesofthemouth and genitals ○ The first sign of disease is an open chancre (open sores) on the genitalia ○ Progression of the disease is marked by the primary, secondary, and tertiary stages ■ Primary: most infectious stage marked by an appearance of open sores, ulcerative lesions that are painless ■ Secondary: highly infectious stage morph by lesions that occuranywhereon the skin ■ Tertiary: spirochetes enter internal organs and cause permanent damage internal organs and cause permanent damage ○ Special considerations ■ Assess for symptoms related to nervous system Invasion such as meningitis, locomotor ataxia (foot slapping and broad-based gait), progressive mental deterioration leading to insanity ■ Assess for cardiovascular damage to the aorta and the valves ○ Diagnostic procedures ■ STS test (blood) ○ Treatment ■ Procaine penicillin G ● Gonorrhea ○ Infection that causes inflammation of the mucous membrane of the genitourinary tract ○ Transmission by sexual intercourse ○ Signs and symptoms (males) ■ Painful urination, pelvic pain, fever, epididymitis ○ Signs and symptoms (females) ■ Usually asymptomatic, but can have vaginal discharge, urinary frequency, and pain ■ PID can lead to sterility ○ Special considerations ■ Infection can be transmitted to babies eyes during delivery which can cause blindness, give prophylactic broad-spectrum antibiotics or 1% silver nitrate to newborns ■ Treat all sexual partners, as patient may become reinfected ● Herpes simplex virus (HSV) ○ Infects external genitalia, vaginal cervix, and penis ○ Develops into painful and draining vesicles ○ Virus is detrimental to fetus; usually C-section is preferred method of delivery ○ Special considerations ■ Maintain appropriate precautions during vaginal exams ■ Maintain isolation precautions during hospitalization ● Venereal Warts ○ Sexually transmitted infection caused by HPV, affect the cervix, urethra, penis, scrotum, anus ○ Warts appear 1-2 months after exposure through intimate sexual contact ○ Special considerations ■ No cure for HPV ■ Suggest and encourage pap smear every year due to high cancer risk Nutrition ● Overview ○ 1 gram of protein is 4 calories ○ Processed and canned foods are high in sodium ○ Fresh fruits and vegetables are low in sodium ○ The order of fuel use ■ Carbohydrates, fat, and then proteins ● Clear liquid diet ○ Gelatin, broth, apple juice, cranberry juice, tea ● Low-residue diet ○ Ordered to  reduce fiber for patients with crohn's disease, colon surgery,  esophagitis, and diarrhea ○ Clear liquids, fat, eggs, white potatoes ■ Avoid dairy products ● High-residue diet ○ Foods that contain skins, seeds, leaves ● High-fiber diet ○ Ordered to provide bulk in the stool and bring water into the colon for patients with constipation for diverticulitis ○ Raw fruits and vegetables and whole grains ● Sodium-restricted diet ○ Ordered for patients with kidney, cardiovascular disease, or hypertension in order to control the retention of sodium and water and lowering blood pressure ■ Avoid canned prepared foods, table salt, prepared seasoning ○ Used in patients with ascites, edema-associated advanced liver and renal disease, congestive heart failure, essential hypertension, and pts receiving adrenocorticoids ● Bland diet ○ Excludes foods that are chemicallyandmechanicallystimulatingorirritatingtothe GI tract ○ Small, frequent meals ○ Usually for patients with ulcers and post-op patients ■ Avoid fried foods, meat extracts, pepper, and chili powder ● Low-fat diet ○ Limits foods containing cholesterol and saturated fatty acid ○ Increases foods high in polyunsaturatedfattyacidsincludingskimmilk,eggwhites, lean meats, and fat-free soup ● Low-purine diet ○ Recommended for patients with gout ■ Avoid organ Meats, shellfish, oily fish ● Low-oxalate diet ○ Avoid leafy greens, nuts/seeds, beets, raspberries ○ For kidney stones, gout ● BRAT diet ○ Banana, rice, Apple, tea ● Gluten-free diet ○ Ordered for patients with malabsorption syndrome such a Celiac disease ● Cholesterol ○ Levels of 200+ associated with increased risk for CAD ○ Avoid foods with cheese and eggs ● Vitamin K ○ A deficiency in this may affect blood coagulation ○ Green leafy vegetables are high in vitamin K and should be avoided in patients on coumadin ○ Foods high in potassium also include baked potatoes, avocados, cantaloupe, tomatoes, and orange juice ● Gout ○ Avoid foods such as organ meats, sardines, beans, and lentils, foods high in protein ● Kidney stones ○ To reduce the risk of stone formation, increase intake of fluids ○ Maintain low oxalate diet ● 12 Amino acids ○ Non-essential ○ The liver is able to synthesize these acids ● 8 amino acids ○ Essential ○ The liver is unable to synthesize these ● Vitamin B12 ○ Found only in animal food ○ Needed after a gastrectomy in the form of injections because the intrinsic factor that is necessary for the absorption of B12 is founded a stomach ■ Strict vegetarians should include fortified breakfast cereal as their reliable source of vitamin B12 ■ Treatment of pernicious anemia also requires B12 injections for their life ● Vitamin D ○ Considered a nutrient of concern in elderly patients because they're synthesist is decreased ■ Deficiency includes osteomalacia, which is weakening and softening of the bones ● Calcium ○ Green leafy vegetables are a great source of calcium ○ Patients at risk for renal calculi should adhere to a low calcium diet ○ Pregnantmothersmustmaintainanadequatecalciumintaketopreventfromlosing stores of calcium ○ Cow’s milkisnotsuitableforinfantsunder1yearofagebecauseitishighinprotein and calcium that can lead to pediatric dehydration ● Iron ○ Must increase consumption of iron during pregnancy because of maternal red blood cell volume and iron storage in the fetus ○ Increase consumption of spinach, beef, liver, prunes, pork, broccoli, whole bread, and whole cereal ● MAOIs ○ Patient’s who consume foods high in tyramine may experience a hypertensive crisis, advise patients to avoid avocados,  figs, bananas, fermentedandagedMeats, pepperoni, salami, cheese, foods containing yeast (beer and wine) ● Older adults ○ Those who are bedridden or inactive need small meals with high fiber to prevent constipation ○ Dehydration often is missed because they have diminished sense of thirst ● Cancer and chemotherapy ○ May contribute to thedevelopmentofmalnutritionasaresultoftheeffectonbasal metabolism and symptoms such as nausea and decreased food intake ○ Recommendations include eggs and cottage cheese in place of meat ● Pulmonary disorders ○ Encourage rest periods before meals ● Dialysis patients ○ Routinely supplemented with calcium, vitamin B6, and folic acid ○ Nephrotic syndrome ■ Hypoalbuminemia, and hyperlipidemia ○ Chronic renal failure ■ Requires supplementation of water soluble vitamins ■ Low protein, low potassium diet ● Congestive heart failure ○ Offer smaller meals throughout the day due to the frequent fatigue ○ The goal is to minimize cardiac workload and reduce edema ○ Daily weights are the best indicator of fluid balance ● Type 2 diabetes mellitus ○ The more body fat that the client has, the more resistant to body cells are to insulin ● Islamic & Orthodox Judaism ○ Both exclude pork from the diet ○ Kosher ○ If meat is consumed, 3-6 hours must pass before dairy can be consumed                                          