Exam (elaborations)
UWORLD REVIEW 2024
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Exam of 66 pages for the course UWORLD at UWORLD (UWORLD REVIEW 2024)
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UWORLD REVIEW 2024• TB and all airborne transmission based precautions (chickenpox, measles)
• Use a surgical mask not an N95 for clients.
• This helps protect Health care workers and other clients from respiratory
secretions, and contain respiratory secretions
• The HCWs who transport the clients from a negative pressure room to
another location need to wear an N95 mask to protect themselves from
infection.
• Cirrhosis of the liver. These blood tests would be elevated in the lab results:
• Ammonia, bilirubin, prothrombin time
• Elevated bilirubin (jaundice) exists due to the decreased inability of the liver
toconjugate and excrete bilirubin
• Most coagulation factors are produced in the liver. A cirrhotic liver cannot
produce the factors essential for blood clotting. As a result, the PT, aPTT, and
INR levels areelevated.
• Total knee replacement
• A recent/current infection is a contraindication to total replacement surgery
as awound infection is more likely to occur in a client with a pre-existing
infection.
• Burning on urination should be investigated as it could indicate a UTI
• Severe knee pain is expected.
• Stop taking NSAIDS including selective COX-2 inhibitors (celecoxib) 7 days prior
tosurgery to decrease the risk of intra and post op bleeding.
• Transfusion reaction
• Chills, fever, low back pain, flushing, itching)
• Stop transfusion immediately, maintain IV line with NS, monitor VS, notify HCP
and blood bank, recheck tags numbers and client’s blood type, and return bag to
blood bank for further testing. Collect blood and urine sample to evaluate
hemolysis, and complete necessary facility paperwork to document the reaction.
• Chronic kidney disease with a large plural effusion. Findings :
• Decreased fremitus
• Diminished lung sounds
• A pleural effusion is an abnormal collection of fluid (>15-20ml) in the pleural
space between the parietal and visceral pleurae that prevents the lung from
expanding fully. This results in decreased lung volume, Atelectasis, and ineffective
gas exchange.
• Other s/s: dyspnea on exertion, non-productive cough, diminished breath
sounds, dullness to percussion, and decreased tactile fremitus. If the effusion is
large, thetrachea is deviated to the opposite side.
• Sounds travel faster in solids (consolidation) than in an aerated lung, resulting
inincreased fremitus in pneumonia. fluid or air outside the lung interrupts the
, transmission of sound, resulting in decreased fremitus in pleural effusion and
Pneumothorax.
• Cancer
• Unintentional weight loss of greater than 10 percent of usual weight (in
nonobese) clients require evaluation and could indicate underlying cancer. N,
anorexia, and dysgeusia (altered taste sensation) are also clinical features of
cancer and contributeto weight loss.
• CAUTION acronym of cancer
Change in bowel or bladder
habits A sore throat that does
not heal
Unusual bleeding or discharge from body
orificeThickening or lump in the breast or
elsewhere Indigestion or difficulty in
swallowing
Obvious change in wart or
moleNagging cough or
hoarseness
• Orange peel appearance of breast tissue, or retracted nipple
• Restrained client
• Position sideways or semi fowlers, because supine position can cause risk
ofaspiration
• Don’t tie the knot a square knot. Do a quick release knot.
• Tie to bed frame not bed rail
• Provide care to meet basic needs every 2 hours
• Gout
• To prevent future exacerbations
• Achieve and maintain a healthy weight
• Drink plenty of fluids
• Limit alcohol consumption and carbonated beverages containing high fructose
cornsyrup.
- You don’t need to eliminate all foods with protein. Just red meats and
seafoodintake
• Hip fractures
-external rotation, abduction, muscle spasm, and shortening of the affected extremity.
• Raynaud’s phenomenon
• An episodic vasospastic disorder of the small cutaneous arteries, mainly of the
fingersand toes.
• Occurs most often in young women age 15-40.
• Vasospasm induced color changes of the fingers, toes, ears, and nose.
, • Decreased perfusion initially causes pallor (white) followed by cyanotic (blue
purple) and last color change is red.
• Coldness numbness, followed by throbbing, aching, tingling, swelling
(hyperemicphase).
• Exposure to cold, emotional stress, and caffeine, and tobacco use may bring
onsymptoms.
• Don’t use substances with vasoconstrictive properties
• Perform stress management
• Emphysema
• Barrel chest, decreased activity tolerance, diminished breath sounds, distant
heart sounds
• Wheezing
• SOB that worsens over time
• tachypnea, prolonged expiratory phase
• Hyperresonance on percussion, pursed-lip breathing, use of accessory muscles
anduse of tripod position
• Hyperosmolar hyperglycemic state complications:
• Blood glucose levels are very high (>600)
• History of type 2 diabetes. Older age
• Neurological manifestations (blurry vision, lethargy, obtundation (decreased
LOC), progression to coma)
• Gradual onset of hyperglycemic symptoms (as some insulin is produced)
• Hyperventilation and abdominal pain less common
• Bicarb greater than 18 mEq/L
• Normal anion gap
• Serum osmolality >320 mOsm/kg
• Negative or small serum ketones
• Diabetes insipidus
• Insufficient production or suppression of ADH
• Polydipsia (increased thirst); polyuria (increased urine output) and can lead to
dehydration resulting in weight loss, hypernatremia, and high serum osmolality
(>295mmol/kg).
• Dilute and copious urine (2-20 L/day) with a low specific gravity (<1.005)
• Dilantin (Phenytoin)
• Anticonvulsant used to treat generalized tonic-clonic seizures.
• Therapeutic range: 10-20 mcg/ml, and it takes 3-12 months for steady state to
bereached.
, • Early toxicity signs: horizontal nystagmus and gait unsteadiness. Slurred speech,
lethargy, confusion, and even coma. Bradyarrhythmias and hypotension are
usuallyseen with IV Phenytoin
• Gingival hyperplasia is common expected side effect of Phenytoin and does not
indicate drug toxicity. Occurs more in those less than 23 y/o who are prescribed
>500mf/day. Good oral hygiene can limit symptoms.
• Other s/s: ataxia, decreased alertness
• Metronidazole
• Metallic taste in the mouth is common
• It’s an antibiotic
• Trisomy 18
• A genetic disorder with a short life expectancy (a few weeks after birth) .
It’s achromosome anomaly characterized by severe cardiac defects and
multiple musculoskeletal deformities.
• End of life issues should be discussed early after the diagnosis is confirmed.
Trisomy13 (patau syndrome) also results in death
• No treatment at this time available
• Warfarin
• Anticoagulant. Range: 2.3-3.5.
• Warfarin should only be administered after INR has been checked. Can be given
if it is less than 3.5 and should be held and HCP contacted if greater than 3.5.
• Antidote: Vitamin K
• Neutrophils
• Normal: >1500/mm3
• Neutropenic precautions: private room, strict Handwashing, avoid exposure to
people who are sick, avoid ALL fresh fruits, veggies, and flowers; ensure all
equipment usedwith the client has been disinfected.
• Infections in immunosuppressed clients are life threatening
• Avoid IM injections and minimize venipunctures when platelet count is below
50,000as these can cause prolonged bleeding
• Blood lead levels
• Common source is lead based paint found in houses built before 1978.
• Screenings are recommended at ages 1, 2, and up to 6, if not previously tested.
• Lead poisoning particularly affects the neurological system, due to immature
development of the brain and nervous system. This is more concerning than the
othereffects.
• Can cause neuro impairment, developmental delays, reading difficulties,
visual-motor issues; can lead to permanent cognitive impairment, seizures,
blindness, or even death.
• GI bleeding is for iron toxicity not lead poisoning.
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