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139 Cards in this Set
- Front
- Back
Vincristine (Oncovin) Side Effects
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Hair loss, numbness and decreased reflexes
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Sigmoid Colostomy
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Solid Feces, can use irrigation to create regularity
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Stomatitis instructions
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Rinse mouth with baking soda, no hard toothbrush, no spici/hot foods, no mouthwash, no xylocaine.
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Adequate learning by parent with child with lymphoma
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limit visits from friend that is sick
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Food that decreases chance of colorectal cancer/ Food that increases chance of colorectal cancer
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Vegetables decrease, red meat (specially smoked) increase chance cause of nitrates
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Discourage patient with colostomy from eating
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Cucumbers and other gassy foods
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What foods decrease odors of colostomy
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Buttermilk and yogurt, spinach and parsley
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Food for pt that develops diarrhea as a side effect of chemo
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Eat bananas cause they create less bulk.
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Teaching about metastasis
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Cancer cells enter blood vessels and travel
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Child with Wilms tumor on Dactinomycin (Cosmegen) and Vinctristine (oncovin)
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Constipation and Leukopenia
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Patient with thrombocytopenia secondary to chemo, which clinical manifestation needs inmediate action?
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Excessive bleeding
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Intervention appropiate for patient with myeloma?
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Prepare for hemodyalisis, keep hydrated, restrict calcium
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Assessment findings indicate of leukemia
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fatigue, anemia, enlarged lived and slpeen
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Inmediately post op priority intervention
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ineffective breathing pattern related to pain
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Patient with glioma prone to developing which problem
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Seizure, glioma is a brain/spine tumor
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Action when patient is undergoing chemo and has nausea
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Antiemetic prior to chemo
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Intervention to promote apetite in patient undergoing chemo
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Rinse mouth before eating
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Finding that suggests bleeding in patient that underwend lobectomy 24hrs ago
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SOB and restlessness
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Patient with external radiation device that needs more teaching
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I will go swimming only once a week
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Discharge intervention for masectomy patient
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Apply lotion to cuticle of affected arm instead of cutting it
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Patient taking steropids should reduce the intake of and increase the intake of
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Need to reduce sodium and increase potassium
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Patient with actinic keratosis asks if she is at risk of developing skin cancer
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10-20% turn into cancer
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Nursing intervention for patient with lung cancer that develops superior vena cava syndrome
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Monitor neuro status cause of increased ICP and decreased O2
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Toddler with neuroblastoma that completed chemo, parents should report the following after discharge:
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Central venous access appears red, (fatigue, easy bruising normal as long as bruising is not excessive)
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Postop managment patient that underwent lower lobecotmy
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promote optimal ventilation: positioning, exercise, removal of secretions
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Outcome for patient with new colostomy
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Demonstrate colostomy care
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Clinical symptom most relevant of bladder cancer
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Hematuria without dysuria
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Nursing intervention to prevent dislodging of application in cervix with radioactive element
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Low residue diet to limit BM, also will have urinary catheter in place
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Child with leukemia is dischaged home with prednisone, teaching for parents
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Weight gain is temporary, given in the AM, limit sodium, increase potassium
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What does interlukin 2 do in treating cancer
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Increases inmune response
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What to do with a dislodged radioactive implant?
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Use long handled forceps and place implant in lead lined container
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important info on sickle cell
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Drink fluids, hypoxia can be caused if climbs stairs in high rise or second hand smoke
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Coumadin
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No green leafy vegetables cause it decreases level, cant take laxatives
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Why is it important to reduce anxiety in patient post MI
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Stress homrones increase cardiac workload which as a reult increases oxygen demand by heart
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Findings about chronic anemia
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Beefy smooth tongue, fatigue, brittle nails
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Pernicious anemia
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B12 deficiency cause of lack of intrinsic factor in intestine, will have to get b12 shots once a month
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10 month old with iron deficiency, increase which food?
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Cereal
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Nursing intervention in patient with cardiac failure
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HOB 30 degrees, support arms with pillows, report weight gains more than 2-3 weeks in a few days
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Coagulation disorder that formy tiny clots
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DIC
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Task that should not be delegated
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Instructing patient to avoid exercise after eating
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Anginal episode precipitated by which factor
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insufficient coronary blood flow
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Position to relieve pericarditis
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Fowler
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Initial nursing intervention when patient has adverse reaction to blood transfusion
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Stop infusion, start NS, call MD
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Lasix: electrolyte imbalance symptom
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Muscle weakness:hypokalemia
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Patient with heart failure, report what to MD?
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Increase in weight
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Therapeutic effect of nitroglycerin
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Smooth muscle relaxation
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Teaching for angina
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Avoid outdoor activities in extreme temperatures
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Teaching about nitroglyerin
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Sit down or lie down when taking pills in order toprevent hypotension/syncope episode
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Data that supports lack of pumping ability due to MI (Decreased cardiac output)
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Cyanotic nail beds, decreased urinary output, cool skin
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Pale diaphoretic, nonresponsive, pulseless, bizzare wide QRS complex at regular intervals
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Ventricular tachycardia
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Right Side hear failure sign
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Dependent edema
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Chest pain and dyspnea priority nursing intervention
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start 02 and call MD
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Side effect of inderall (propanolol)
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Side effects include insomia and depression, inderall can be sued to treat migranes
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Question to ask before starting thrombolytic therapy?
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Have you hurt yourself recently?
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Important info to discuss patient on antihypertensives
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May cause problems with sexual functioning
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Relationship betweek CAD and smoking
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Increased platelet agregation
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Med used to increased cardiac output
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Digoxin (Lanoxin) strengthens contrations, increased cardiac output.
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How to monitor effectiveness of plasma trnasfussion
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platelet and coagulation times
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Proper care and monitoring of a pacemaker
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pat down at airport, can swim, can be checked through telephone
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Priority intervention after cardiac surgery
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Potassium needs to be between 3.5-5.0, temp usually low, UOP need to be 25 ml/hr or above
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Pt on methyldopa (aldomet) for HTN complains of light headedness
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Moves slowly from position to another
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Purpose of pursed lip breathing
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to polong exhalation and increase airway pressure uring expiration
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What is necessary for CPAP to be effective on infant with respiration distress
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Infant needs to be able to breathe spontaneously without assistance
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Position for thoracentesis
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edge of bed with arms and head resting over the bed
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Patient with chronic respiratory disease reports decreased energy, suggestions to patient?
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Work on endurance through excercise routine
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Chest tube being transported to xray, how do you transfer the patietn?
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Place the unit below chest level and transport it with the patient
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In patient with COPD with oxygen therapy, include the follwing
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Monitor for bradypnea (cause of risk of supressing hypoxic drive with O2)
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Priority when administering thrombolyitic therapy to patient with pulmonary embolism
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D/C if uncontrolled bleeding occurs
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Pulmonary edema on Lasix and Digocin monito
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Hypokalemia
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Sign of patient experiencing hypoxia
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Mental confusion, restlessness first signs
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Nursing action in POC of patient with COPD
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Monitor cardiac status by assessing enzymes
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Best way for patient on vent to deal with anxiety
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Relaxation therapy
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Position for person with orthopnea
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High fowler, arms supported
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Action appropiate on suctioning tracheostomy
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Apply suction no longer than 10-15 seconds while withdrawing cathetersm rinse in normal saline, insert just far enough to stimulate cough reflex
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Knife like chest pain upon inspiration
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Pleuresy = knife like pain
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Chest tube not working well
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Continious bubbling =air leak
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Important assessment after tonsilectomy
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airway patency
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Indication chest tube working properly
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presence of fluid in chamber
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Patietn with cor pulmonae becomes agitated
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cor pulmonae = right side heart failure, irritability and agitation = air hunger
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Manatoux test
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If bigger than 10mm sensitivity to TB Bacillus
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Ater chest physiotherapy nurse noted diminished lung sounds what does she do?
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Document findings
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Expected outcome administered cromolyn sodium to patient with asthma
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Prevents allergic trigger
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Priority pneumococal vaccine
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patient with cystic fibrosis
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Astha associated with airway obstruction by which physiolodical factors:
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Swelling bronchial lining and mucous in bronchi
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Ventilatory support: which prevents alveolar collapse:
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positive and expiratory pressure: helps alveoli from collapsing
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Gentamycin affects which organ as a side effect
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Renal
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Indication of cardiac tamponade after surgery
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cessation of chest tube drainage, which may signal clotting which may dignal fluid buildup
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Need for further teaching with expiratory flow meter
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Patient sits straight --- needs to be done standing up
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Car accident, pt with paradoxymal movement of chest, dx?
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Fail chest due to broken ribs, paradoxical movement and difficulty breathing.
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Alert nurse need of further instruction on BSE
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"I dont need to examine my other breast"
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Patient on chemo develops tumor lysis syndrome, appropiate NI
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Increase fluids and watch for electrolyte imbalance
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Why do we use 2 chemo drugs combined?
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Target different phases so more cancer cells are destroyed
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Wilms tumor, dont perform?
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Palpation of abdomen, causes cells to migrate
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Leukemia patient that needs further teaching
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Can't have live plants
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4 y/o with abdominal neuroblastoma s/sx of distant metastasis
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Distant: periorbital edema en exopthalamus. Proximal: bone pain, weight loss
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Plan for chemo include which instruction
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Use appropiate entiemetic, increase fluids, use soft toothbrush, can take tylenol
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Pt recieving radiation in state of cachexia, what should be included in POC
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Cachexia = loss of weight unintentionally, 6 small meals
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What should be included in plan of care with multiple myeloma
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Hypercalcemia is a problem so increase fluids
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Why patient with neutropenia needs private room
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Minimize exposure to infection, other nursing interventions include administer ABT, asespsis, nutritional planning
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Inmmediate post op masectomy
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Maintain elevation of R arm and hand ina pillow, ice only if hematoma forms, exercises can be started on the second day postop
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Diet for Hodgkins
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Radiation diet: high protein, high carb, low residue so it does not irritate
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Patient with Illeal conduit needs teachings
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Change every 3-7 days, opening 1/8 inch, apply skin barrier, no tape on faceplate
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Child Stomatitis teaching
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Chocolate milk and mashed potatoes appropiate for child, xylocain decreases gag reflex
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How to cope with alopecia, cancer patient
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Select hairwig of matching color before hair falls out
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Important Assessment a day after masectomy
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Pulmonary complications (pain and fluid can affect patients ability to clear airway)
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Colostomy complication
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Dark red to black
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Prevent skin breaskdown in colostomy
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Empty when bag is 1/3 full, wash with mild soap and pat dry
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Family Resources
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Laryngectomy = los chord club. candelighters = cancer, Reach for recovery= breast cancer
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Sexual function after prostate surgery
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surgery may cause impotence prosthesis may be considered
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Foods that increase risk of cancer in children
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Smoked meats cause of nitrates
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Nursing Dx for patient with lung cancer, RR20, HR92, Circumoral cyanosis, small amount of pale yellos mucous coughed
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Impaired gas exchange
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Nursing measure for pt with thrombocytopenia
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Apply pressure after needle sticks for 5 minutes
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When cancer pateint has stomatitis, what other part of the body should the nurse check for lesions?
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Perineal area and IV sites
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What to report and what not to report after a bone marrow transplant
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Report: clauducation, constipation, rash Don't report: Alopecia
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Dietary interventions patient with stomatitis and colorectal cancer
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Avoid things that are hard to chew, not spicy or hot, increase fluids, fruits and veggies decrease chances of colorectal cancer
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Early detection method for prostate cancer
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Digital recal examination
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Rationale for sign on bedroom after masectomy "No BP or Venipuncures" on affected arm
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Increased risk of infection
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Which lab value determines if chemo should be held?
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Bone marrow supression
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Patient asks about complementary therapies, appropiate response by nurse
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"Describe the therapies you wish to explore"
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Child with osteogenic sarcoma on chemo. Early s/sx of myelosupression?
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Increased temperature and gingival bleeding
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Child on chemo hyperactive and with rash
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Anaphylactic reaction to chemo
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Visitors precautions during internal radiation therapy
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Maintain 6ft, visits limited to 30 minutes, no children, no pregnant women can visit.
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Important nursing intervention for patient after abdominal/ perineal resection of rectal cancer
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If want to sit use foam pad pillow, if in bed side lying
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Condition that increases chances of developing cancer
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Down Syndrome
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Complication of thrombolytic therapy after MI
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systemic bleeding
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Cardiac failure patient that feels powerlessness
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Allow them to have food choices
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Understanding pacemaker
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Stimulus to control HR
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Morphine sulfate goal after MI
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Decrease cardiac workload, can cause constipation
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Arterial vs Venous insufficiency
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Arterial = hair loss in legs, cool skin, decreased pulses, no granulation tissue, elevation causes pain Venous = Swelling, flaky dry skin, brownish discoloration.
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Phases of recovery after MI
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Phase 1: Begins once patient is stable
Phase 2: Convalescent period at home Phase 3: Activities return to normal Phase 3: Normal |
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Rheumatic fever
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Rheumatic fever is an inflammatory disease that may develop after an infection with Streptococcus bacteria (such as strep throat or scarlet fever). The disease can affect the heart, joints, skin, and brain. Need to take precautions for ever
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Instructions with ACE inhibitor
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Causes cough that will go away in some days, take 1 hr before meals
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Directions for patient undergoing Schilling test
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Shilling test: to see if body absorbs B12. Collect urine for 24 hrs
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Nitroglycerin instructions
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One pill every 5 minutes up to 3 total. If not relieved call emergency services. Do not use viagra with it.
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Patient outcome indicates reolution og congestive heart failure
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PWAP 8
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Common side effect of digoxin
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Hypokalemia, nausea and tachycardia if toxicity.
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Child with viral illness then has bruises on extremities
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Idiopathic thrombocytopenic purpura
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To whom do you give combination of nitro and dopamine?
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Cardiogenic shock patient
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Indicative of DIC
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Increased fibrin split products
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