Chamberlain College of Nursing: NR 446 REVIEW NOTES PART 5,GRADED A
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Course
NR 446
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NR 446
Chamberlain College of Nursing: NR 446 REVIEW NOTES PART 5
Recognizing the need for a swallow evaluation (symptoms that indicate)
• Choking
• Drooling
• Coughing
• Difficulty swallowing solids, liquids and pills
• Painful swallowing
• Pocketing food
• Weight loss
• Hist...
chamberlain college of nursing nr 446 review notes part 5
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Chamberlain College of Nursing: NR 446 REVIEW NOTES PART 5
Recognizing the need for a swallow evaluation (symptoms that indicate)
Choking
Drooling
Coughing
Difficulty swallowing solids, liquids and pills
Painful swallowing
Pocketing food
Weight loss
History of aspiration pneumonia, CVA, Parkinson’s
Auscultation of heart sounds
,Nursing interventions and management for bacterial meningitis.
1) Health Promotion and Disease Prevention:
Haemophilus influenzae type b (Hib) vaccine – Ensure infants
receive vaccine for bacterial meningitis on schedule.
Pneumococcal polysaccharide vaccine (PPSV) – Vaccinate adults
who are immunocompromised, who have a chronic disease, who
smoke cigarettes, or who live in a long-term care facility. CDC
guidelines should be followed for revaccination. Give one dose to
adults older than 65 years of age who have not previously been
vaccinated nor have history of disease.
Meningococcal vaccine (MCV4) (Neisseria meningitidis) –
Ensure that adolescents receive the vaccine on schedule and
prior to living in a residential setting in college. Individuals in
other communal living conditions (military) also should be
immunized.
2) Client Education
Use an insect repellent when risk of being bitten by a mosquito exists.
3) Nursing Care
Isolate the client as soon as meningitis is suspected. Maintain
isolation precautions per hospital policy.
This should be droplet precautions, which require a private
room. Droplet precautions should continue until antibiotics have
been administered for 24 hr and when oral and nasal secretions
are no longer infectious.
Standard precautions are implemented for all clients who have
meningitis. Clients who have bacterial meningitis should remain
on droplet precautions continuously.
Implement fever-reduction measures, such as a cooling blanket, if necessary.
Report meningococcal infections to the public health department.
Decrease environmental stimuli.
Provide a quiet environment.
Minimize exposure to bright light (natural and electric).
Maintain bed rest with the head of the bed elevated to 30°.
Monitor the client for increased intracranial pressure (ICP). Tell
the client to avoid coughing and sneezing, which increase ICP.
Maintain client safety, such as seizure precautions.
Replace fluid and electrolytes as indicated by laboratory values.
Older adult clients are at an increased risk for secondary complications,
such as pneumonia.
4) Medications
Ceftriaxone (Rocephin) or cefotaxime (Claforan) in
combination with vancocin (Vancomycin)
Antibiotics given until culture and sensitivity results are
available. Effective for bacterial infections.
Phenytoin (Dilantin)
Anticonvulsants given if ICP increases or client experiences a seizure.
Decadron (dexamethasone)
, Corticosteroid, may improve outcome in adults if given before first dose of
antibiotic
Acetaminophen (Tylenol), ibuprofen (Motrin)
Analgesics for headache and/or fever – nonopioid to avoid masking changes
in the level
of consciousness.
Ciprofloxacin (Cipro), rifampin (Rifadin), or ceftriaxone (Rocephin)
Prophylactic antibiotics given to individuals in close contact with the client.
5) Potential Complications/Observe for these possible complications:
Increased ICP (possibly to the point of brain herniation)
Syndrome of inappropriate antidiuretic hormone (SIADH)
Septic emboli (leading to disseminated intravascular coagulation or
cardiovascular accident)
, Evaluating client understanding of SSRI:
Select Prototype Medication: Paroxetine (Paxil); Other
Medications: Sertraline (Zoloft),Escitalopram
(Lexapro),Fluoxetine (Prozac),Fluvoxamine (Luvox)
1) Therapeutic Uses:
Paroxetine: GAD<generalized anxiety disorder>, Panic
disorder<decreases both the frequency and intensity of panic
attacks and also prevents anticipatory anxiety about attacks>,
Obsessive-compulsive disorder (OCD) <reduces manifestations
by increasing serotonin>, Social anxiety disorder, Trauma- and
stressor-related disorders, & Depressive disorders
Sertraline: is indicated for panic disorder, OCD, social anxiety disorder, and
PTSD.
Escitalopram: is indicated for GAD and OCD.
Fluoxetine:is used for panic disorder and OCD.
Fluvoxamine: is used for OCD and social anxiety disorder.
2) Nursing Administration:
Advise clients that medications may be taken with food. Taking
medication in the morning minimizes sleep disturbances.
Instruct clients to take the medication on a daily basis to establish
therapeutic plasma levels.
Assist with medication regimen adherence by informing
clients that it may take up to 4 weeks to achieve therapeutic
effects from an SSRI.
3) Medication Effectiveness:
Maintaining normal sleep pattern
Verbalizing feeling less anxious and more relaxed
Greater ability to participate in social and occupational interactions
4) Expected Pharmacological Action:
Paroxetine selectively inhibits serotonin reuptake, allowing
more serotonin to stay at the junction of the neurons.
It does not block uptake of dopamine or norepinephrine.
Paroxetine produces CNS stimulation, which can cause insomnia.
The medication has a long effective half-life. A time frame of up
to 4 weeks is necessary to produce therapeutic medication
levels.
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