1. Acid-Base Imbalances: Priority Interventions - ANS-Nursing Care
2. ◯ For all acid-base imbalances, it is imperative to treat the underlying cause.
3. ◯ Respiratory acidosis: Oxygen therapy, maintain patent airway, and enhance gas
exchange
4. (positioning and breathing techniques, ventilatory support, bronchodilators, mucolytics).
5. ◯ Respiratory alkalosis: Oxygen therapy, anxiety reduction interventions, and
6. rebreathing techniques.
7. ◯ Metabolic acidosis: Varies with causes (if DKA, administer insulin; if related to GI
losses,
8. administer antidiarrheals and provide rehydration; if serum bicarbonate is low, administer
sodium
9. bicarbonate [1 mEq/kg]).
10. ◯ Metabolic alkalosis: Varies with causes (if GI losses, administer antiemetics, fluids,
11. Acute Kidney Injury and Chronic Kidney Disease: Nephrostomy Tube Insertion -
ANS-Nephrostomy - a tube from the renal pelvis to the abdominal surface
12. Acute Kidney Injury and Chronic Kidney Disease: Over the counter medications -
ANS-Administer calcium channel blocker to prevent the movement of calcium into the
kidney
13. cells, maintain cell integrity, and increase glomerular filtration rate (GFR).Avoid
administering antimicrobial medications (e.g., aminoglycosides and amphotericin B),
14. NSAIDs, angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers,
and IV
15. contrast dye, which are nephrotoxic.
16. ◯ Digoxin (Lanoxin), a cardiac glycoside, increases contractility of the myocardium and
promotes
17. cardiac output.
18. ■ Monitor digoxin laboratory levels due to slow excretion of the medication with CKD.
19. ■ Administer digoxin (Lanoxin) after receiving dialysis.
20. ◯ Sodium polystyrene (Kayexalate) to increase elimination of life-threatening serum
potassium,
21. which may cause dangerous cardiac dysrhythmias and peaked T waves.
22. ■ Restrict sodium intake. Sodium polystyrene contains sodium and can cause fluid
retention and
23. hypertension, a complication of CKD.
24. ◯ Erythropoietin alfa (Epogen, Procrit) to stimulate production of red blood cells, given
for anemia
25. ◯ Ferrous sulfate (Feosol), an iron supplement to prevent severe iron deficiency.
26. ◯ Aluminum hydroxide gel (Amphojel)
27. ■ Taken with meals to bind phosphate in food and stop phosphate absorption.
, 28. ■ Take 2 hr before or after digoxin.
29. ◯ Furosemide (Lasix), a loop-diuretic administered to excrete excess fluids.
30. ■ Avoid administering to a client who has end-stage kidney disease.
31. ■ Clients may also receive thiazide diuretics, potassium-sparing diuretics, and osmotic
diuretics.
32. Arthroplasty: Assessing a Client Using a Continuous Passive Motion Machine - ANS-A
continuous passive motion (CPM) machine may be prescribed to promote motion in the
33. knee and prevent scar tissue formation. CPM is usually placed and initiated immediately
34. after surgery. CPM provides passive range of motion from full extension to the
prescribed
35. amount of flexion. The prescribed duration of its use should be followed, but it should be
36. turned off during meals.
37. Arthroplasty: Postoperative Care - ANS-After arthroplasty
38. Dos/Don'ts
39. › Use elevated seating/raised toilet set. › Avoid flexion of hip greater than 90º.
40. › Use straight chairs with arms. › Avoid low chairs.
41. › Use an abduction pillow, or a pillow, if prescribed,
42. between the client's legs while in bed (and with
43. turning, if restless, or is in an altered mental state).
44. › Do not cross a client's legs.
45. › Externally rotate a client's toes. › Do not internally rotate a client's toes.
46. Cancer treatment options: Safety precautions for a sealed radiation implant - ANS-◯
Nursing Actions
47. ■ Place the client in a private room away from other clients when possible.
48. ■ Place appropriate sign on the door warning of the radiation source.
49. ■ Wear a dosimeter film badge that records personal amount of radiation exposure.
50. ■ Limit visitors to 30-min visits, and have visitors maintain a distance of 6 ft from the
source.
51. ■ Visitors and health care personnel who are pregnant or under the age of 16 should not
come
52. into contact with the client or radiation source.
53. ■ Keep a lead container in the client's room if the delivery method could allow
spontaneous loss
54. of radioactive material. Tongs are available for placing radioactive material into this
container.
55. ■ Precautions listed above should be carried out at home if the client is discharged
56. during therapy.
57.
58. ◯ Client Education
59. ■ Inform client of the need to remain in an indicated position to prevent dislodgement of
the
60. radiation implant.
61. ■ Instruct the client to call the nurse for assistance with elimination.
62. ■ Instruct client and family about radiation precautions needed in the health care and
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