Explore every episode of the podcast Nursing School - Audio Review

Understand the etiology and pathophysiology of ChronicKidney Disease (CKD)           

•             What is CKD?

•             High risk groups

•             Stages of CKD

9.           Recognize the clinical manifestations associated with CKD    

•             Clinical manifestations of chronic uremia affecting bodily systems.

10. Describe the diagnostic studies related to CKD.

•             Renal ultrasound, scan and biopsy

•             Serum urea, Cr, BUN, eGFR, Ca, electrolytes, albumin, para-thyroid hormone

•             Urinalysis including 24-hour urine test.

•             Urine cultures

•             Serum hemoglobin and iron indices

11. Understand the different treatment modalities in the management of CKD.           

•             Nonpharmacological therapy

•             Pharmacological therapy

•             Nutritional therapy

•             Supportive care

•             Dialysis

•             Kidney Transplant

12. Apply the nursing process in patients with CKD.     

•             Nursing assessment (including nursing diagnoses)

•             Planning/goals

•             Implementation

•             Evaluation

13. Understand the principles of dialysis.         

•             Peritoneal dialysis

•             Hemodialysis

14. Identify the complications associated with dialysis.

•             Peritoneal dialysis

•             Hemodialysis

•             Vascular accesses

15. Understand Continuous Renal Replacement Therapy (CRRT) as an alternative or adjunctive method for treating AKI.      

•             Types of CRRT

•             Features of CRRT that differ from HD

16. Understand the principles of Kidney Transplant.

•             Features of kidney transplant

•             Postoperative care

•             Complications of transplantation

1.                      Review the structures and functions of thekidney.              

•             Functionsof the nephron

•             Functionsof the kidneys

2.                      Understand the etiology and pathophysiology ofAcute Kidney Injury (AKI).       

Common causes of AKI

•             Prerenal

•             Intrarenal

•             Postrenal

3.           Describethe clinical manifestations associated with AKI.

Manifestations associated with:

•             Prerenal

•             Intrarenal

•             Postrenal

Manifestations associated with the phases of acute tubularnecrosis (ATN):

•             Initiationphase

•             Maintenancephase

•             Recoveryphase

4.           Understandthe diagnostic studies associated with AKI.

•             Urinalysis

•             Renalultrasound

•             Renalscan

•             Computedtomography (CT)

•             Retrogradepyelogram

•             Bloodwork (serum Cr, BUN, electrolytes)

5.           Understandthe treatment modalities and interventions in AKI.             

•             Treatmentof precipitating cause

•             Fluidrestrictions

•             Crystalloids

•             Nutritiontherapy

•             Treatmentsof hyperkalemia (including pharmacotherapy)

•             Calciumsupplements or phosphate-binding agents

•             Totalparenteral nutrition (if indicated)

•             Enteralnutrition (if indicated)

•             Renalreplacement therapy (RRT) (if indicated)

6.           Understandpharmacological interventions in AKI.      

•             Antihypertensives

•             Diuretics

•             Treatmentsof hyperkalemia

•             Calciumsupplements or phosphate-binding agents

7.           Apply thenursing process in patients with AKI.

•             Nursingassessment (including nursing diagnoses)

•             Planning/goals

•             Nursingintervention

•             Evaluation

1. Understand the function of the Pituitary gland &adrenal system.

               AnteriorPituitary:

•             Thyroidstimulating hormone.

•             Adrenocorticotropichormone (ACTH)

Posterior Pituitary:

•             Antidiuretichormone (ADH)

Adrenals:

•             Adrenalmedulla

•             Adrenalcortex

Regulation of hormone secretion:

•             Negativefeedback

•             Positivefeedback

2. Understand the pathophysiology related to the Pituitarygland.

               Pituitarytumors:

•             Acromegaly

•             Hypopituitarism

•             Tumors

•             DiabetesInsipidus (DI)

•             Syndromeof Inappropriate Antidiuretic Hormone Secretion (SIADH)

3. Understand the pathophysiology related to the Adrenalglands.

               Adrenalmedulla:

•             Norepinephrine

•             Epinephrine

Adrenal Cortex

•             Cortisol

•             Cushing’sdisease

•             Addison’sdisease

             Hyperaldosteronism

4. Understand the assessment abnormalities related to thePituitary.

•             DiabetesInsipidus (DI)

•             Syndromeof Inappropriate Antidiuretic Hormone Secretion (SIADH)

•             Tumors

5. Understand the assessment abnormalities related to theAdrenal glands.  

•             Cushing’sdisease

•             Addison’sdisease

6. Describe the diagnostic studies related to the pituitary& adrenal glands.

•             Bloodstudies

•             Radiology

•             Urinestudies

7.  Describe themedical & pharmacological management of the pituitary and Adrenal glands.

               Medical:

•             Pituitarysurgery

Pharmacological:

•             Corticosteroids

•             ACTH

•             Dexamethasone

8. Apply nursing interventions for the patient experiencingAdrenal and pituitary insufficiency.

•             DiabetesInspidius

•             SIADH

•             Addison’sdisease

•             Cushingsyndrome

1.       Understand the mechanism of breathing.         

Pressure relationships in the thoracic cavity:

•             intrapulmonarypressure

•             intrapleuralpressure

•             importanceof negative pressure in intrapleural space

2.       Understand the rationale for insertion of chesttubes in specific medical-surgical conditions.

•             Thoracotomy

•             Lobectomy

•             Pneumothorax

•             Empyema

3.       Understand the rationale of a water-seal system.         

•      Preventreentry of air into the lung

4.       Understand three mechanisms to drain fluid andair from the pleural cavity.  

•             Positiveexpiratory pressure, deep breathing, and coughing

•             Gravity

•             Suction

5.       Understand four types of pleural drainagesystems.     

Pleura-evac:

•             wetsuction control chamber

•             drysuction control chamber

•             Heimlichvalves

•             pigtailcatheters

6. Understand nursing responsibilities in caring for aclient with chest tubes.

                Assessment of client

•             vitalsigns

•             lungsounds

•             clinicalsigns of complications

•             respiratorystatus

•             dressing

•             discomfort

Maintaining chest tubes and closed chest drainage:

•             ensuringthat the system is airtight.

•             assessmentof drainage in the collection container

•             assessmentof fluctuation of fluid level in the water-seal chamber of the Pleura-evac unit

•             assessmentfor intermittent bubbling in the water of the water-seal chamber

•             assessmentfor gentle bubbling in the suction control chamber

•             inspectionof the air vent

•             inspectionof the drainage tubing for kinks or loops

•             Chesttube dressing changes as per hospital protocol.

1.  Define chest trauma.            

2.  Identify the causes of chest injury.  

•             Planned-Surgical

•             Unplanned accidents

3. Identify the common types of planned chest surgery.            

•             Thoracotomy

•             Pneumonectomy

•             Lobectomy

•             Wide resection

•             Segmental resection

4. Describe classifications of chest trauma.    

             Penetrating

             Non-penetrating

5. Understand the methods of assessing chest trauma.            

             Initial Assessment ABCs

             History

             Physical Examination

             Chest x-ray

             Laboratory tests

               ABGs

               ECG

6.  Understand the complications of severe chest trauma.      

             Pneumothorax

             Open pneumothorax    

             Mediastinal flutter

             Tension Pneumothorax and mediastinal shift

             Hemothorax

             Fractured ribs

             Flail chest

7. Understand the therapies used in treating chest traumaand complications of chest injury.

•             Oxygenation

•             Pharmacotherapy

•             Medical therapy

•             Surgery

8. Identify the physiological issues related to chest injury.        

•             Hypoxia

•             Inadequate Gas Exchange

•             Ventilatory Impairment

•             Immobility

•             Activity Intolerance

•             Anxiety

9. Identify the nursing interventions relate to chestinjuries.     

•             Assessment

•             Nursing management of chest tubes

•             Recording assessment findings

•             Trouble shooting

1.    Describe airway obstruction.

a.    Complete airway obstruction

b.    Partial airway obstruction

c.    Symptoms of airway obstruction

d.    Interventions to re-establish apatent airway

2.    Understand the relevantterminologies.

a.    Tracheotomy

b.    Tracheostomy

c.    Cuffed and uncuffed tubes

3.    Recognize the purposes and advantagesof a tracheostomy.

a.    Bypass airway obstruction.

b.    Facilitate removal of secretions.

c.    Long-term mechanical ventilation.

d.    Permit oral intake and speech inpatients on long-term Mechanical ventilation.

4.    Describe the different types oftracheostomy tubes

a.    Tracheostomy tube with cuff and pilotballoon

b.    Fenestrated tracheostomy tube(Shiley, Portex) with cuff, inner cannula, decannulation plug, and pilotballoon

c.    Speaking tracheostomy tube (Portex,National)) with cuff, two external tubing

d.    Tracheostomy tube (Bivona Fome-cuf)foam-filled cuff

5.    Describe the different parts of atracheostomy tube

a.    Flange

b.    Outer cannula

c.    Inner cannula

d.    Obturator

e.    Pilot balloon

f.     Cuff

g.    Inflation tube

h.    15-mm adapter

i.     Tracheostomy tie strings

6.    Understand how certain medical healthproblems may benefit from a tracheostomy.

a.    Head, neck or chest illnesses,injuries, or surgeries

b.    Respiratory failure

c.    Neurological trauma or disorders

d.    Severe pulmonary edema or pulmonaryinfections with copious sputum production

7.    Identify complications and interveneappropriately.

a.    Abnormal bleeding/hemorrhage

b.    Tube dislodgement

c.    Tube Obstruction

d.    Tube dislodgement/Decannulation

e.    Cuff leak

f.     Inflammation of tracheostomy stoma orpressure area around the TT

g.    Subcutaneous emphysema

h.    Tracheal stenosis

i.     Tracheoesophageal fistula

j.     Hypoxemia/hypoxia/ hypercapnia

8.    Identify actual and/or potentialnursing diagnoses in patients with tracheostomy

a.    Ineffective airway clearance

b.    Impaired verbal communication

c.    Potential for aspiration

d.    Potential for infection

e.    Knowledge deficit

f.     Anxiety

g.    Altered body image

9.    Identify nursing management inpatients with tracheostomy.

a.    Assessment

b.    Suctioning

c.    Tracheostomy care

d.    Delegation

e.    Role of hydration and humidity

Learning Outcomes:

1.   Reviewand distinguish between the different ulcer types - pressure, diabetic, andvascular (venous, arterial) including assessments and assessment tools.

2.   WoundBed Preparation Algorithm

3.   Identifyfactors that affect the ability to heal and explain what needs to be consideredwhen correcting or modifying treatable causes of tissue damage (ulcer specific)

4.   Masterassessing a wound. Explain the types of debridement and identify thedebridement to use. Identify when to use a non-cytotoxic vs an antisepticsolution. Recall the principles of bacterial balance vs increased bacterialload. Identify S&S of infection and when to culture a wound. Explain whatto consider in treating an infection

a.   Providelocal wound care

                                      i.    Wound Assessment - MEASURE mnemonic

                                     ii.    Types of debridement (surgical sharp, conservativesharp, mechanical, autolytic, enzymatic, biologic)

                                    iii.    Selection of debridement based on wound

                                    iv.    Solutions to cleanse the wound (non-cytotoxic vsantiseptics)

                                     v.    Bacterial balance vs increased bacterial load

                                    vi.    S&S of infection (NERDS vs STONES)

                                  vii.    Culturing a wound

                                 viii.    Treating an infection

5.   Explainthe factors to consider when selecting a dressing. Identify the benefits of amoist environment. Know the various types of dressings for the treatment ofwounds.

a.    Provide local wound care

                                      i.    Dressings:

                                     ii.    Factors to consider when selecting a dressing(patient, wound, bacterial profile & product)

                                    iii.    Benefits of a moist environment

                                    iv.    Helpful tips for dressings

                                     v.    Various types of dressings

                                    vi.    Negative Pressure Wound Therapy

6.   Describehow to care for the peri-wound

a.   Methodsto protect the peri-wound skin and prevent maceration from minimal, moderate tolarge amount of exudate

7.   Identifycriteria involved in in the evaluation of wound healing

8.   Identifyinterdisciplinary teams in caring for a patient with a wound

Outline the nursing role in medication therapy for a patient with Dementia.

Classifications:

·       Cholinergic

o  Aricept, Reminyl, Exelon

·       NMDA Antagonists

o  Memantine

·       Others

o  SSRIs

o  Benzodiazepines

o  Antipsychotics

o  Antiepileptics

1.    Administration practices: Conditions for drug administration

2.    Assessment: Baseline Patient Status

3.    Monitoring/Evaluation: Therapeutic and adverse effects

4.     Patient and Caregiver Teaching

1.     Describe pathophysiology of Delirium and Alzheimer’s Dementia (AD).

Neuritic plaques, neurofibrillary tangles

Deposits of B-amyloid protein

Neuronal degeneration/loss

Vascular Dementia

2.     Describe diagnostic testing and nursing assessment required for the patient with Delirium and AD.

Medical history, cognitive status, physical exam.

Lab tests, CT, Pet Scans

3.     Assess and differentiate between delirium and dementia.

Confusion

Assessment Method CAM or RADAR

Cognitive assessment

4.    Recognize and name symptoms of Delirium and AD.

Cognitive changes

Behavior and emotional responses.

Changes in ADL and IADL Function

Progression of symptoms

Caregiver strain/burnout

5.    Determine a nursing diagnosis in a patient with Delirium and AD in a case study.

Determine underlying cause of delirium

Altered thought processes

Risk for injury

Wandering

Social isolation

Alteration in nutrition

Self-Care deficits

Catastrophic Reaction

6.     Apply appropriate nursing interventions to respond to specific patient problems related to AD.

RNAO best practice guidelines

Communication techniques

Environmental modifications

Safety techniques

ADLs

Caregiver education and support

1.     Describe relevant terminology.

Hospice, Palliative care, Integrated hospice palliative care approach, End-of-life (EOL) care, Continuous palliative sedation.

2.     Contrast the approach of palliative care with disease modification therapy.

Illness trajectory, Goals, Focus of care, Presentation/Diagnosis.

3.     Recognize physical manifestations of the end of life and determine patient priority nursing problems (diagnoses).

Sensory, Cardiovascular, Respiratory, Genitourinary, Gastrointestinal,Musculoskeletal, Integumentary.

4.     Recognize psychosocial manifestations of the end of life and determine patient priority nursing problems (diagnoses).

Withdrawal, Communication, Vision-like experiences, Anxiety/Depression, Anger, Hopelessness, Powerlessness, and All types of fear.

5.     Outline the nurse’s responsibilities for assessment in the person at end of life.

Determining priorities in assessment.

Physical, Symptom (OPQRST), Social, Spiritual, Cultural.

6.     Implement appropriate nursing interventions and pharmacological treatment based on patient’s needs at end of life.

Psychosocial support of patient, family and caregivers.

Physical care: Pain, delirium, dysphagia, weakness, fatigue, dehydration, dyspnea, myoclonus, skin breakdown, bowel and urinary changes, anorexia, nausea and vomiting, candidiasis.

Analgesia, antiemetics, anticholinergic (glycopyrrolate), bronchodilators, oxygen, anxiolytics, antidepressants, topical treatments.

7.     Describe steps in post-mortem care. 

Pronouncement of death, Certification of death, Preparing the body.

8.     Identify special needs of nurses who provide end of life care.

Rewarding.

Challenging: Feelings of loss and grief manifested in physical and emotional ways. Must utilize interventions for coping to maintain well-being.

Cataracts

1. Describe the pathophysiology of cataracts. 

Stages 

Opacity of the lens 

2. Describe the signs and symptoms of persons experiencing cataracts 

Blurred vision 

Decreased color perception 

Photophobia 

Glare in bright light 

Cloudy lens 

3. Describe the causes of cataracts.  

Aging 

Trauma 

Toxic substance exposure including ultraviolet light 

Diabetes 

Smoking 

4. Describe common medical interventions for cataracts. 

ECCE 

ICCE 

Touch ups 

5. Describe nursing interventions for a patient undergoing cataract surgery. 

Pre- and post-operative care 

Home care instructions 

Glaucoma 6. Describe the pathophysiology of glaucoma. 

Open Angle 

Closed Angle 

7. Describe the surgical intervention, preoperative and postoperative care for patients undergoing ophthalmological surgery.

Glaucoma

Post-op complications

8. Summarize the action and uses of drug therapy for treating problems of the eyes and ears.

Glaucoma: β-Adrenergic Blockers, α-Adrenergic Agonists, Carbonic Anhydrase Inhibitors

9. Discuss factors affecting adherence to medication regimen.

Physiological 

Psychosocial 

10. Identify potential problems/nursing diagnoses related to visual impairment. 

Decreased mobility 

Loss of vision 

Injury 

Self-care deficit 

Sleep pattern disturbance 

Social isolation 

Decreased self-esteem 

Powerlessness 

Body image disturbance 

11. Describe nursing interventions to assist patients with impaired vision. 

Prevention 

Care of Eyes 

Referral to community resources: MAB  and CNIB 

Hearing Impairment12. Describe signs and symptoms associated with hearing loss in the elderly. 

 Faulty speech 

Inattentiveness, withdrawal 

Tinnitus 

Noise intolerance 

Vertigo 

Decreased speech perception 

High tone hearing loss 

13. Discuss contributing causes to hearing impairment.  

Aging process 

Diseases 

Infection 

Foreign objects 

Prolonged exposure to noise 

Medications 

14.. Discuss potential problems related to hearing impairment. 

Altered communication 

Isolation 

Safety issues 

Dependency 

15. Describe nursing interventions to assist the hearing impaired. 

Quiet environment, good lighting 

Position, speak slowly, voice tone/pitch 

Health teaching re: hearing aids,  including use of and maintenance 

Refer to community resources 

1. Understand the concepts related to loss, death, and grief/bereavement

Loss, Death, Grief, Bereavement, Mourning

2. Understand and recognize the grieving process and the types of grief and loss

Types of loss (objects, environment, etc.)

Types of grief

Factors influencing the grieving process

3.Recognize the common needs of the elderly person and the family experiencing bereavement or loss.

The 6 Cs Approach

Needs of the family

4. Apply interventions that can assist/support the patient/family experiencing grief, bereavement, or loss.

Assessment

Nursing diagnosis

Planning (goals and outcomes)

Intervention

Evaluation

 5. Identify emotional consequences of nursing patients in the final stages of the life 

Nurse’s experience with grief

Professional burnout

Own experience

5. Identify emotional consequences of nursing patients in the final stages of the life

1. Outline the nursing role in drug therapy for a patient with Parkinson’s Disease.

Administration practices: Conditions for drug administration

Assessment: Baseline patient status

Monitoring/Evaluation: Therapeutic and adverse effects

Patient and Caregiver Teaching

2. Describe the drug classification, mechanism of action, precautions, therapeutic and adverse effects of drug therapy in the management of PD.

Drug therapy includes:

·       Anticholinergics

·       Antivirals

·       Carbidopa/Levodopa

·       Dopamine Agonists

·       Monoamine B inhibitors

·       COMT inhibitors

·       Antihistamines

3. Identify drugs used to manage the other signs and symptoms associated with PD.

AntidepressantsCholinesterase inhibitors

LaxativesMeds to treat N/V, urinary retention, sleep disturbances, anxiety, gastrointestinal distress, pain

1.  Define Parkinson’s disease.

Chronic, slow, progressive neurodegenerative disorder caused by loss of dopaminergic neurons in the substantia nigra of the basal ganglia characterized by tremors at rest, rigidity, bradykinesia, and postural instability.

2.  Describe the pathophysiology of Parkinson’s disease.

Role of DA producing neurons in the substantia nigra.

Imbalance of two neurotransmitters dopamine (DA) and acetylcholine (ACh).

3.  Identify the etiology of Parkinson’s disease.

Possible causative factors of PD.

Other medical conditions with Parkinson-like symptoms.

4.  State the incidence of Parkinson’s disease.

Age group most affected

Gender

5. Describe the clinical manifestations (motor and non-motor features) of Parkinson’s disease.

Primary:

Tremors

Rigidity

Akinesia/bradykinesia

Postural instability

Secondary:

Fine motor function problems

DysarthriaHypophonia

Masklike face

Fatigue and weakness

Autonomic manifestations

Cognitive impairments

Emotional lability

Sleep disturbance

6. Describe the stages of Parkinson’s disease.

Stages I-V

7.  Understand the diagnosis of Parkinson’s disease.

History and clinical findings

Rule out other disorders

Conventional diagnosis

8.  Identify health problems in patients with Parkinson’s disease.

Worsening of motor and nonmotor symptoms as the disease process progresses.

9. Describe nursing interventions used to promote adaptation in patients with Parkinson’s disease.

General principles and specific interventions

Team approach

Referrals

Education

Discharge planning

Community care and involvement

Nurse’s role

10. Understand nonpharmacological strategies to manage the signs and symptoms associated with Parkinson’s disease.

Exercise therapy

Speech therapy

Relaxation techniques

Self-care management

Balance nutrition

Strategies to prevent constipation, anxiety, pain, sleep disorders, and activities to improve cognition

Use of complementary therapies

11. Identify surgical procedures that may be implemented to alleviate the symptoms of Parkinson’s disease.

Thalamotomy

Pallidotomy

Deep brain stimulation (DBS)

Fetal-adrenal transplants

Stem cell transplants

1.     Identify and describe nursing care related to seizures.

• Obtaining history from patient/family

- Type of seizure

- Manifestations

- Duration

- Management

• Maintaining safety

- Seizure precautions

- Ensuring compliance with drug therapy

• Observations and nursing care during a seizure

• Health promotion for families

2.     Define “status epilepticus” and describe related problems.

1.     Describe classification of seizures.

Focal, generalized, and unknown onset

2.     Describe how seizures are diagnosed.

• Patient/family history
• Complete physical and neurological examination
• Electroencephalogram (EEG)
• Laboratory and neuroimaging tests

3.     Describe the treatment of seizures.

• Holistic approach

• Medications

• Ketogenic diet

• Vagal nerve stimulation

• Surgery

1.     Differentiate between the terms “seizure” and “epilepsy”.

• Paroxysmal behavior caused by abnormal discharge

of neurons.

• Relation to acute illness

2.     Describe the etiology and pathophysiology of seizures.

• Genetic

• Structural/metabolic

• Neuronal discharges

• Unknown

• Phases of seizure

3.     Identify contributing factors to febrile and neonatal seizures.

• Illness

• Infection

• Asphyxia

• Electrolyte imbalances

4. Identify nursing interventions relative to the child with ASD and his/her family.

• Offering family support

• Identifying signs of anxiety or depression in family members

• Encourage family to seek assistance or servicesrelated to respite care or support groups
• Interdisciplinary approach and collaboration

• Involve family in care planning during hospitalization

• Individualize care

• Adapt physical environment as needed

• Communication approaches

• Medications that can be used to manage the behaviors associated with ASD

1.     Identify treatment goals for ASD.

• Reducing disruptive behaviors

• Teaching the child how to accomplish purposeful activities

• Improving communication skills

• Providing opportunities for socialization

• Improving self-care skills

• Alleviating family distress

1.     Describe the etiology of autism spectrum disorder (ASD).

• Developmental disorder

• Risk factors

• Diagnosis

2.     Identify signs and symptoms associated with ASD.

• Impaired social functioning

• Impaired language development

• Stereotypical behaviors

• Self-mutilation

• Increased aggression in adolescence

3/3

7. Describe the nursing interventions for dehydration.

• Rehydration (oral & IV)

• Strict monitoring of intake & output

• Accurate weight of child

• Health teaching to prevent gastroenteritis

2/3

4. Describe how to determine the severity of dehydration.

• Weight change (in % or in mL/kg)
• Signs and symptoms

5. Relate the extent of dehydration to thetherapy.

Fluid and electrolyte replacement

6. Describe the nursing problems most oftenseen in dehydrated children.

• Fluid and Electrolytes:

-Fluid Volume Deficit

-Fluid and electrolytes imbalances

• Nutrition: less than body requirements
• Impaired skin integrity

1/2

1.     Describe the pathophysiology of dehydration in a child.

• Risk factors for dehydration
• Consequences of dehydration
• Compensatory mechanism
• Types of dehydration

2. Compare and contrast the fluid and electrolyte requirements of children in various age groups.

• Pediatric differences

• Fluid requirements and minimum output

3. Identify common tests related to GI dysfunctionand dehydration

• Urine specific gravity
• Hematocrit
• Serum electrolytes

1. Identify how nutritional challenges are related to certain health conditions in children and adolescents.

• Inflammatory bowel disease (IBD)

• Ulcerative colitis (UC)

• Crohn’s disease (CD)

• Malabsorption disorders

• Celiac disease

• Diabetes mellitus type 2 (DM II)

• Obesity

• Failure to thrive (FTT)

• Anorexia nervosa and bulimia nervosa

2. Identify health promotion strategies to optimizenutritional status in the presence of certain health conditions.

• May include medical, surgical, nutritional and psychosocial approaches

1.     Recall the nutritional requirements of children and adolescents.

• toddler and preschool
• school age
• adolescent

2.     Identify factors that can influence nutritional intake for children and adolescents.

• Weight and height progression
• Growth and developmental stage
• Illness and disease
• Physical activity level
• Media influences

6/6

6. Describe the nurse’s role in preventing childhood injuries.

Model safety practices • Educate parents and children •Support legislative efforts that advocate prevention • Collaborate with other health care providers to promote safety and injury prevention

5/6

 5. Define Sudden Infant Death Syndrome (SIDS) and list the possible risk factors related to its occurrence.

Risk factors related to sleeping position • Parental smoking, avoiding overheating, encouraging breastfeeding, etc.

4/6

4. Define Shaken Baby Syndrome (SBS) and list the possible signs associated with SBS.

Definition, signs of SBS and strategies to prevent SBS •Strategies to reduce incidences of SBS (e.g. Period of Purple Crying program)

3/6

 3. Apply strategies that can be applied to prevent childhood injuries and identify the teaching needs for children and/or their families that promote safety.

•Anticipatory safety guidance

• Passive vs. active strategies

• Three Es: • Education • Engineering • Enforcement (legislation)

2/6

2. Identify the leading causes or trends associated with unintentional pediatric injuries.

Epidemiological approach to unintentional injuries.

• Injury trends and causes related to growth & development (host), season, environment and physical and social agents (e.g. may include choking & suffocation, falls (I.e. crib safety), accidental poisoning, motor vehicle incidents (I.e. pedestrian &car safety), drowning, incidents related to sports & recreation; head injuries; burns and scalds

1/6

Understand the connection between the developmental stage of a child and the type of injury they have.

2/2

1.    Describe age-appropriate non- pharmacological interventions for controlling pain in children.

a.      Trusting relationship • Distraction-Play • Massage • Application of heat/cold • Music •Visualization • Positive self-talk • Role of Child Life Therapist in hospitals

2.    Describe documentation of nursing assessments and interventions for pain.

a.      Document nursing assessment and pain management

1/2

1.    Describe pain assessment for pain in children (the 5th vital sign)

a.     Pediatric pain assessment tools • Obtain a pain experience history •

2.    Describe pharmacologic interventions, management modalities and administration routes (and/or delivery devices) for controlling pain in children.

a.     • Opioids/patient-controlled analgesia • NSAIDS • Non-opioids • Adjuvants

4/4

3.     Identify the therapeutic and adverse effects of medications used in high-risk pregnancies.

Medications:  -Antihypertensives in pregnancy -IV Magnesium Sulfate (drug of choice, the monitoring & the antidote)

Other medications(Hyperemesis Gravidarum):  -Ginger (non-pharmacological)-Diclectin™  -Gravol™  -Maxeran™  -Zofran™

3/4

1.     Describe the pathophysiology, clinical manifestations and nursing care of gestational problems.

Pre-eclampsia/Eclampsia ♦ HELLP syndrome ♦ Gestational Diabetes ♦ Hyperemesis Gravidarum ♦ Hemorrhagic conditions

2. Describe the care of the pregnant woman with a pre-existing condition.

Obesity ♦ Diabetes ♦ Thyroid disorder ♦Cardiovascular/Pulmonary

2/4

 4. Describe diagnostic tests used to assess maternal and fetal well-being.

Antepartum/Prenatal testing: • 1st trimester • 2nd trimester • 3rd trimester

5. Describe the care of the pregnant woman with a pre-existing condition.

RH/ABO Incompatibility - RhoGAM/WinRho

 Group B streptococcal (GBS) - Penicillin

6. Discuss the role of the nurse in a pregnancy at risk.

Antenatal risk assessment ♦ Educator ♦ Support

1/4

 2. Discuss determinants of health as risk factors and their implications for pregnancy.

• Biology & Genetic Factors • Demographic Characteristics • Personal Health Practices & Coping Skills

3. Explore Canadian maternal health problems.

• Causes of maternal death • Mental health issue •Intimate partner violence

6/6

9. Identify danger signs during pregnancy

Table 11-2 Signs of Potential Complications during the 1st, 2nd & 3rd Trimesters

• vaginal bleeding /vaginal discharge • rupture of membranes (ROM and PROM) • uterine contractions • swelling of fingers or face •continuous headache • visual disturbances • persistent or severe abdominal pain• chills/fever • painful urination • diarrhea • persistent vomiting • change infrequency or strength of fetal movement • glycosuria

5/6

 7. Describe health teaching to promote adaptation during pregnancy

Teaching Health Behaviors: • recognizing potential complications • breast care • exercise, Kegel exercises • rest and sleep • employment • exposure to teratogens • travel• over-the-counter drugs, herbal preparations • tobacco, alcohol, caffeine • immunizations• transition to the parenting role – prenatal classes

4/6

Identify factors that will influence the process of maternal role transition.

Psychosocial and Cultural Assessment:

·      psychological response to pregnancy

·      availability of resources

·      communication style

·       health beliefs

·       language

·      culture

6. Describe common discomforts of pregnancy, causes and measures that prevent or give relief.

Table 11-4Discomforts Related to Pregnancy

·       nausea and vomiting

·       heartburn

·       backache

·       urinary frequency

·       constipation

·       varicosities

·       hemorrhoids

·       leg cramps

·       ankle edema

3/6

Describe the psychological responses to pregnancy.

- maternal responses during pregnancy:

• 1st trimester

• 2nd trimester

• 3rd trimester

- maternal adaptation

- accepting the pregnancy

- identifying with the mother role

- reordering personal relationships

- establishing a relationship with the fetus

- preparing for childbirth

- paternal adaptation

- sibling adaptation

2/6

Common Lab Tests

·      Blood grouping

·      CBC, Hemoglobin (Hgb)

·      RH factor and antibody screen

·       Rubella

·      Hepatitis B screen

·      STD’s

·       Urinalysis

·       Maternal blood glucose

·       GBS (Group B Strep)

- Ongoing Assessment

·      vital signs

·      weight

·       urinalysis – protein, glucose, ketones

·       fundal height

·      Leopold’s maneuvers

·       fetal heart rate

·       fetal activity

1/6

1.     Describe maternal physiological and psychosocial changes that occurduring pregnancy.

2.     Identify signs of pregnancy

a.     Presumptive

b.     Probable

c.     Positive

3. Describe antepartum assessment.

Initial Assessment

- History:

·       calculate (GPAL = gravida, para, abortions, living children) and length of gestation

·       any maternal or infant complications/multiple gestation

·       calculate Estimated Date of Birth (EDB)

8. Describe perinatal care choices.

• Physician care • Midwives • Doulas • Birth plan

3/3

1.    Relate the pathology to therapy; describe pharmacological and nursing interventions associated with an acute respiratory illness in the pediatric population.

a.     Epinephrine, dexamethasone, bronchodilators, corticosteroids, nebulized normal or hypertonic saline, etc.

b. Oxygen therapy, cold humidity, corticosteroid therapy, inhalation therapy, positioning, maintaining a calm environment, Croup score, hydration, prevention and health teaching

2/3

1.    Describe the diagnostic tests used in respiratory illnesses.

a.      Arterial blood gases

b. Nasopharyngeal aspirations and cultures

c. Chest x-rays

d. Bronchoscopy

2.    Describe the signs and symptoms indicating a potential respiratory emergency.

a.     Respiratory assessment, chest auscultation, changes in mental status

b. Maintain a patent airway, manage infection, manage inflammation

1/3

1.    Describe the differences in the anatomy and physiology of the pediatric respiratory system that increase the risk for respiratory illness.

2.    Assess signs and symptoms, analyze causative and contributing factors, formulate nursing diagnoses, set goals, determine nursing interventions and evaluate interventions in the different respiratory challenges for children and adolescents.

• Upper airway infections: Croup and epiglottitis

• Lower airway infections: Bronchitis and bronchiolitis

• Respiratory syncytial virus (RSV)

3/3

1.    Describe the use of various medications in the management of intrapartum and postpartum complications.

a.     Tocolytics

b. Glucocorticoids

c. Anti-inflammatories

d. Electrolytes

e. Anticoagulants

f. Uterine stimulants

2/3

1.    Describe the etiology, nursing care and therapeutic management of various postpartum complications.

a.     Rupture of uterus

b. Amniotic fluid embolism (anaphylactoid syndrome)

c. Inversion of uterus

d. Abnormal adherence of placenta (placenta accreta)

e. Trauma (injuries)

f. Postpartum hemorrhage

g. Venous thromboembolic disorders

1/3

1.     Describe the etiology, nursing care and therapeutic management of various intrapartum complications.

a.      Spontaneous preterm labor

b. Premature rupture of membranes (PROM)

c. Chorioamnionitis •Dystocia

d. Precipitous labor

e. Prolapsed umbilical cord

3/3

1.     Formulate guidelines for preparing children of different age groups for procedures.

a.      Before the procedure

b.      During the procedure

c.       After the procedure