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.