8월 25일 강의 free

1.The nurse is caring for a newly admitted client in a hospital setting.

The client was recently diagnosed with cancer but is alert and oriented.

The client is Greek immigrant. but does speak English. During about advance directives with client.

The client tells the nurse."I do not want  to make any medical decisions.

I want my daughter to make these decisions for me"

The nurse should take which of the following actions?

①Make sure that the written advance directives document the client's wishes.#

②Tell the client that . being alert and oriented. the client should make his  own medical decisions

③Tell the client that due to  confidentiality . the daughter will not be informed of details fo the client's care

④Encourage both the daughter and the client to work together on making medical decisions

2.The nurse is assessing an irritable 6 month old infant during a well baby check up. The infant's weight is 19lb 6.4 oz(8.8kg).

The infatnt does not have an elevated temperature. the heart rate is 102.and the respiratory rate is 32. The mother states that the infant wakes every hour or two throughout the night. The infatnt wants a bottle. and falls asleep while eating. but doesn't stay asleep. Which of the following instructions should the nurse give the parents?

①Instruct the parents to offer acetaminophen(Tylenol) 325mg orally for comfort. and diphenylhydramint (Benadryl)25mg orally for sleep.

②Instruct the parents to offer high calorie solid foods during day time hours so the infant does not wake up hungry during the night.

③Instruct the parents to offer the last  feeding as late as possible. and put the infant to bed awake without a bottle.#

④Sugest using pacifiers. taking the infant to the parent's bed. or rocking the infant to sleep.

3.The nurse is taking care of a child after an open reduction for the radius and ulna of her right arm. The child is now immobilized in a plaster cast splinting reinforced with an Ace wrap. Which of the following non pharmacological nursing interventions will promote comfort for this child?

①Apply a heat pack to the appropriate area of the surgical incision

②Position the child so the cast is flat on the mattress for firm support

③Elevate the cast on a pillow. apply an ice pact to the approximate area of the surgical incision . and reposition the child every two hours.#

④Do not move any part fo the child's arm until the physician orders a specific position.

1.Malignant Melanoma risk factor?

african american

형제가 같은 암에 걸렸음

~ alopecia

dysplastic nevi

tinea~

ithcing rash 물어본다

sun expose hx asses

가족력 확인

화학물질 같은 거에 노출되는 환경에 있었니

2.피부암 risk

smoking

pollen

dysplastic nevi

tinea~

3. auscultation 시 맞는 것?

PMI 가 ICS 2-3번째이다(  point of maximal impulse (PMI)

carotid artery bell로 bilateral듣는다

BP cuff가 arm 둘레의 20%차지한다

jugular vein pressure check서 supine position 유지

the bell is placed at the apex.and lt lower sternal border during expiration CHF#

4. nifedifine 쓰는 환자 잘 이해 한 것?

일어날 때 천천히, bed에서~

Ca level을 체크 할 것이다

식이에 sodium 첨가해서 먹는다

체중을 줄이기위해 운동한다

5.Nifedipine side effect?

double vision

sinnitus

nystagmus

..Nifedipine의 side effect-foot edema, double vision. hypotension, pheripheral edema,

brady cardia, dizziness, pale

6.abd. cath irrigation 하는 환자 갑자기 통증호소하며 dark bloody ? 하게 나온다

즉시 해야할 액션은? NG tube 관련 (post op 24시간 커피색 배액)

saline flushing,

notify,

slowely drop

stop irrigation

7.parainfluenza 격리

standard.

droplet

contact

airborne

# 브루진스키 예시 그림

8. (그림문제) bruzinski sign?

누워서 neck flexion 하고 있는 그림

얼굴 찡그리고 있는 그림

팔에 bp 커프 감고 있는 그림

9. Doxycycline sata

물 많이 먹겠다

치아가 착색 될 수도 있음을 알고있다.

우유와 함께

아동 산모 피한다

Drink a full glass of water with each dose of tetracycline. Do not take tetracycline with food, especially dairy products such as milk, yogurt

10.doxycyclline S/E 줄이기 위해 해야 하는 것?

a full glass of water

empty stomach

take at bed time

with antacid

11.erythromycin side effect?

sgot sgpt

CBC

BUN CR

HB. HCT

12.SIADH 증상? all select

wt. gain

hypotension

u/o 증가

seizure

tremor

Confusion ,Nausea  Altered mood .Seizures .Loss of cons

headache, vomiting, diarrhea, abdominal cramps,abd distension. muscle tremors, twitching,  If severe, hyponatremia can cause confusion, seizures, and coma;

13.무릎관절경 환자 교육내용 SATA

동의서 받는다

시술 후 4시간까지 운전안하도록 -

시술 후 다리 올려둘게요

Ice, rest/ warm and ice bag alternative

Elevate the leg with a pillow

Patients are advised to resume driving after 6 weeks but should wait until they feel comfortable and confident enough to do so

14.오늘 TKR 수술 했는 환자 옳은 것(SATA)

한달 후에 jogging 가능하다.

오늘이나 내일 걸어봅시다.

pillow knee 밑에 넣으세요.

dislocation 이 common complication 입니다.

수술 부위 ice pack 되어주겠다.

#the AAOS (American Academy of Orthopaedic Surgeons) doesn't recommend jogging or running after a total knee replacement,”

15. UAP 한테 V/S 시킬 건데 어떤 환자 assign할래?(SATA)

Early onset 알츠하이머 복도에서 원더링중

client with 머리에 large, swelling ~ a few hours ago

1시간전 수술한 환자 vital sign

heart failure 환자

insulin self injection하는 환자 observation

6일전 수술한 사람

기립성 저혈압 측정

os op 후 몇시간됨 NRS 2점인 환자

16. iron deficiency anemia.ngn 무슨  anemia ?

Idiopathic thrombocytopenic purpura 원인 ? decrease platelet

Folic acid anemia 환자의 high risk vit b9 deficit

Megaloblastic anemia 는 cobalamin deficit (vit b 12)

pernicious anemia는 vit b 12 deficit after gasterectomy

IDA 는 low hb. hct lab이다

Aplastic anemia 는 bone marrow supression

17.NGN .preclampsia :

7. Ngn 어떤여자가 갑자기 epigastirc pain이랑 nausea vomiting 있는데 다른친구들은 멀쩡 진단명,

처치,우선적으로 줘야할 약물 (magnesium sulfate),

마그네슘 주는 목적 고르기(seizure 예방)

ngn 임신성 고혈압-

“손 다리 부어서 반지도 못껴”+headache(지문 이것뿐,,;)

자간전증인데 보기에는 없었음

18.High risk 8개중 2개 고르기:

간성뇌증,

renal failure

multi preg

Hx.of pre-eclampsia

obesity

twin gestation

age

smoking

GDM

19. 36주 산모 높은 BP 눈 앞이 잘 안보인다 -

문제 1.뭘 유의해야하는지?

Renal failure

eclampsia

20.문제 2.상태사정 뭘 가장 먼저

HA

U/O

21.severe preclampsia 고르기 .sata

Mg 준다.

1시간씩 운동시킨다.

조용환 환경 만든다.

assess placental separation

Complications of preeclampsia may include:

•Fetal growth restriction.

•Preterm birth.

•Placental abruption.

•HELLP syndrome.

•Eclampsia.

•Other organ damage..

•Cardiovascular disease

22.severe preeclampsia pt intervention ?

seizure precaution

monitoring placenta detachment monitor

prescribed mgso4

encourage ambulation

asses epigastric pain