COMPREHENSION

• Group and Family Therapy

  • Helping individuals develop more functional and satisfying relations within a group setting
  • Goals vary depending on type of group, but clients generally: Discover that members share some common feelings, experiences, and thoughts
  • Experience positive behavior changes as a result of group interaction and feedback
• Expected Findings of Dementia


  • Impairments in memory, judgment, speech (aphasia), ability to recognize familiar objects (agnosia), executive functioning (managing daily tasks), and movement (apraxia); impairments do not change throughout the day
  • Level of consciousness is usually unchanged
  • Restlessness and agitation are common; sundowning can occur
  • Personality change is gradual
  • Vital signs are stable unless other illness is present
• Expected Family Responses to a Child's Terminal Illness- Complicated Grief


  • extensive or prolonged grief -
  • Intense thoughts
  • Distressing yearning
  • Feelings of loneliness
  • Distressing emotions & feelings
  • Disturbances in personal activities (sleep)
  • Can require referral to an expert in grief counseling
• Rest & Sleep: Reducing Environmental Stressors in an Acute Care Facility


  1. Provide a quiet hospital environment and limit waking the client during the night to reduce interruptions in the client's sleep

  2. A soothing back rub and assisting the client in following their regular bedtime routine, such as taking a bath in the evening, might promote relaxation and sleep in the acute care facility

  3. Complete exercise 3 hr before bedtime

  4. Establish bedtime routine & a regular sleep pattern

  5. Arrange the sleep environment for comfort

  6. Limit alcohol, caffeine, & nicotine at least 4 hr before bedtime

  7. Limit fluids 2 to 4 hr before bedtime

  8. Engage in muscle relaxation if anxious or stressed
• Priority Action for a Client Who Has a Bleeding Peptic Ulcer


  • Perform frequent checks of pain and vital signs to detect subtle changes that can indicate perforation or bleeding
  • Provide oxygen and assist with ventilator support as needed
  • Ensure two large-bore IV lines are in place for replacement of blood and fluids
  • Report findings, prepare the client for endoscopic or surgical intervention, assist with blood and fluid replacement to maintain blood pressure, insert nasogastric tube, and assist with saline lavages
• Rheumatoid Arthritis: Manifestations of Joint Disease


  • Female Sex
  • Age 30 to 50 years
  • Genetic predisposition
  • Bacterial or viral infection
  • Environmental factors
  • Older age
  • Fatigue
  • Joint Discomfort
• Tuberculosis: Evaluating Client Manifestations


  • Persistent cough lasting longer than 3 weeks
  • Fatigue and lethargy
  • Weight loss and anorexia
  • Night sweats and low-grade fever in the afternoon
• Pancreatitis: Recognizing Manifestations to Report to the Provider Immediately


  • Sudden onset of severe, boring pain (goes through the body) - Epigastric, radiating to back, left flank, or left shoulder, Worse when lying down, Eating may worsen discomfort (acute)
  • Pain relieved somewhat by fetal position or sitting upright, bending forward
  • Nausea and vomiting
  • Weight loss
  • Seepage of blood-stained exudates into tissue as a result of pancreatic enzyme actions - Ecchymoses on the flanks, Bluish-gray periumbilical discoloration: Cullen's sign
  • Abdominal distension and rigidity (peritonitis)
  • Generalized jaundice
  • Absent or decreased bowel sounds (possible paralytic ileus)
  • Warm, moist skin; fruity breath (evidence of hyperglycemia)
  • Tetany due to hypocalcemia - Trousseau's sign: hand spasm when blood pressure cuff is inflated, Chvostek's sign: facial twitching when facial nerve is tapped
• Middle & Inner Ear Disorders: Caring for a Client Following a Stapedectomy


  1. Avoid air travel for 2 to 3 weeks

  2. Avoid straining or coughing, and blow nose gently with the mouth open for 2 to 3 weeks following surgery

  3. Keep ear canal clean and dry. Avoid washing hair or showering for several days to 1 week

  4. When able to shower, loosely place a cotton ball with petroleum jelly into the ear canal to prevent water from entering

  5. Expect some temporary hearing loss in the affected ear due to presence of fluid or packing

  6. Drainage from the ear canal should be reported to the provider
• Ulcerative colitis: Identifying Manifestation


  • Abdominal pain/cramping: often left-lower quadrant pain relieved with defecation, Anorexia and weight loss, Fever, Diarrhea: up to 15 to 30 liquid stools/day, Stools containing mucus or blood, Abdominal distention, tenderness, and/or firmness upon palpation, Rectal bleeding
• Fractures: Identifying Complications of a Femur Fracture


  • Pain
  • Crepitus
  • Deformity
  • Edema
  • Ecchymosis
  • Decreased use of affected area
• Tuberculosis: Anticipating Client Need


  1. Administer humidified oxygen therapy as prescribed

  2. Prevent infection transmission - Wear a N95 HEPA filter or powered air purifying respirator when caring for clients who are hospitalized with TB, Place the client in a negative airflow room and implement airborne precautions, Use barrier protection when the risk of hand or clothing contamination exists, Have the client wear a surgical mask if transportation to another department is necessary, Instruct the client to cough and expectorate sputum into tissues that are disposed of by the client into provided plastic bags or no-touch receptacles

  3. Administer prescribed medications

  4. Promote adequate nutrition - Encourage fluid intake and a well-balanced diet for adequate caloric intake, Encourage foods that are rich in protein, iron, and vitamins C and B

  5. Provide emotional support

  6. Test exposed family members for TB
• Gastrointestinal Structural & Inflammatory Disorders: Identifying Postop Complications

  • Examine operative sites for manifestations of crusting, bleeding, and infection
  • Cleft Palate - Close observation for manifestations of airway obstruction, hemorrhage, and laryngeal spasm
  • Pyloromyotomy - Check for manifestations of infection
  • Hirschsprung's disease - Observe for manifestations of dehydration
  • Appendicitis - Non ruptured Laparoscopic - Monitor surgical site for bleeding or any other abnormalities, Ruptured Laparoscopic or Open Surgery - Check for peritonitis (Fever, Sudden relief from pain after perforation, followed by a diffuse increase in pain, Irritability, Rigid abdomen, Abdominal distention, Tachycardia, Rapid shallow breathing, Pallor, Chills)
  • Meckel's diverticulum - Surgical removal of the diverticulum - Examine surgical site for bleeding or any other abnormalities
• Monitoring Complications Following General Anesthesia

  • Respiratory Arrest
  • Atracurium - Hypotension
  • Succinylcholine - Prolonged Apnea, Malignant Hyperthermia, Muscle Pain, Hyperkalemia
• Heart Failure & Pulmonary Edema: Evaluating Medication Effectiveness


  • Diuretics: decrease preload - Loop-diuretics: furosemide bumetanide, Thiazide diuretics: hydrochlorothiazide, Potassium-sparing diuretics: spironolactone
  • Afterload-reducing agents: help the heart pump more easily by altering the resistance to contraction - Angiotensin-converting enzyme (ACE) inhibitors: enalapril, captopril, Angiotensin receptor II blockers: losartan, Calcium channel blockers: diltiazem, nifedipine, Phosphodiesterase-3 inhibitors: milrinone
  • Inotropic agents: increase contractility and thereby improve cardiac output - digoxin, dopamine, dobutamine, milrinone
  • Beta adrenergic blockers (beta blockers): improve the condition of the client who has sustained increased levels of sympathetic stimulation and catecholamines - carvedilol and metoprolol
  • Vasodilators: prevent coronary artery vasospasm and reduce preload and afterload, decreasing myocardial oxygen demand - Nitroglycerin and isosorbide mononitrate
  • Hyperpolarization-activated cyclic nucleotide-gated channel blocker (HCN channel blocker): Slows heart rate by inhibiting sinus node channel, used for clients who are unable to take beta blockers or are receiving the maximum dose - Ivabradine
  • Anticoagulants: if the client has a history of thrombus formation - Warfarin
• Tuberculosis: Evaluating Effectiveness of Discharge Teaching

  • TB is often treated in the home setting
  • Airborne precautions are not needed in the home setting because family members have already been exposed
  • Exposed family members should be tested for TB
  • Continue medication therapy for its full duration of 6 to 12 months, even up to 2 years for multidrug-resistant TB. Failure to take the medications can lead to a resistant strain of TB
  • Continue with follow-up care for 1 full year
  • Sputum samples are needed every 2 to 4 weeks to monitor therapy effectiveness. Clients are no longer considered infectious after three consecutive negative sputum cultures and can resume work and social interactions
  • Practice proper hand hygiene
  • Cover mouth and nose when coughing or sneezing
  • Contaminated tissues should be disposed of in plastic bags
  • While TB is active, wear a mask when in public places or in contact with crowds
• Osteoarthritis & Low Back Pain: Reinforcing Teaching with a Client about Joint Disease


  1. Balance activity with rest

  2. Heat can help with joint tenderness and muscle stiffness. Use hot baths and showers, or hot packs and moist heating pads to promote comfort but avoid high temperatures to prevent burns

  3. Achieve and maintain a healthy weight to reduce stress on the joints

  4. Follow the prescribed exercise regime consistently. Active exercises are more beneficial than passive

  5. On days when pain is increased, attempt exercise, but reduce the number of repetitions and avoid resistance exercises

  6. Use non-pharmacological measures for pain relief such as relaxation, meditation, and distraction which can promote comfort and reduce muscle tension
• TB Interactions:

  
  

  Practice proper hand hygiene, Cover mouth and nose when coughing or sneezing, Contaminated tissues should be disposed of in plastic bags, While TB is active, wear a mask when in public places or in contact with crowds
• Osteoarthritis & Low Back Pain:

  Balance activity with rest, Heat can help with joint tenderness and muscle stiffness, Achieve and maintain a healthy weight to reduce stress on the joints, Follow the prescribed exercise regime consistently, On days when pain is increased, attempt exercise, but reduce the number of repetitions and avoid resistance exercises,

  Use non-pharmacological measures for pain relief such as relaxation, meditation, and distraction which can promote comfort and reduce muscle tension
• Isoniazid (INH)


  Bactericidal, inhibits growth of mycobacteria by preventing synthesis of mycolic acid in the cell wall
• Adverse Reaction to Isoniazid (INH)


  Monitor for hepatotoxicity (jaundice, anorexia, malaise, fatigue, and nausea) and neurotoxicity (such as tingling of the hands and feet)
• Rifampin (RIF)


  Bacteriostatic and bactericidal antibiotic that inhibits DNA-dependent RNA polymerase activity in susceptible cells
• Adverse Reaction to Rifampin (RIF)


  Observe for hepatotoxicity, Immediately report pain or swelling of joints, loss of appetite, jaundice, or malaise, Can interfere with the efficacy of oral contraceptives
• Pyrazinamide (PZA)


  Bacteriostatic and bactericidal, exact mechanism of action is unknown
• Adverse Reaction to Pyrazinamide (PZA)


  non-gouty polyarthralgia, Immediately report yellowing of the skin or eyes, pain or swelling of joints, loss of appetite, or malaise
• Ethambutol (EMB)


  Bacteriostatic, works by suppressing RNA synthesis, subsequently inhibiting protein synthesis
• Adverse Reaction to Ethambutol (EMB)

  Ocular toxicity, changes in vision, Should not be given to children younger than 8 years of age
• Streptomycin sulfate


  Aminoglycoside antibiotic, potentiates the efficacy of macrophages during phagocytosis
• Adverse Reaction to Streptomycin sulfate

  Ototoxicity
• Postoperative Nursing Care:

  
  

  Provide catheter care and administer bladder antispasmodics as prescribed, If the suprapubic approach was used, monitor suprapubic catheter output, Provide information regarding availability of a sex therapist or intimacy counselor if needed
• Blood & Blood Product Transfusions: Ensure the procedure has been explained to the client, Check vital signs and the client's temperature prior to transfusion, Remain with the client during the initial 15 to 30 min of the transfusion, Review laboratory values to ensure the client requires transfusion and to compare to post-transfusion values, Verify the prescription for a specific blood product, Ensure that the client has given consent for procedure if required, Ensure that blood samples have been obtained for compatibility determination, such as type and cross-match, Check for a history of blood-transfusion reactions, Ensure that the client has a large-bore IV access, Assist with obtaining blood products from the blood bank, Prior to transfusion, two RNs (or an RN and a PN, depending on facility policy) must identify the correct blood product and client, The nurse completing the blood product verification must be one of the nurses who administers the blood product, Ensure that the blood administration set has been primed with 0.9% sodium chloride only, Use a blood warmer if indicated, The transfusion should be started by the RN within 30 min of obtaining the blood product to reduce the risk of bacterial growth
• Blood & Blood Product Transfusions: Remain with the client for the first 15 to 30 min of the infusion and monitor vital signs and rate of infusion per facility policy, Older adult clients: Check vital signs every 15 min throughout the transfusion, Notify the provider immediately if indications of a reaction occur
• Blood & Blood Product Transfusions: Obtain vital signs upon completion of the transfusion, Dispose of the blood-administration set according to facility policy, Complete paperwork, and file in the appropriate places, Document the client's response
• Intravenous Therapy: For Infiltration or Extravasation -

  
  

  Stop the infusion and remove the catheter, Elevate the extremity, Encourage active range of motion, Apply a warm or cold compress depending on the solution infusing, Restart the infusion proximal to the site or in another extremity
• Intravenous Therapy: For Phlebitis or Thrombophlebitis -

  
  

  Promptly discontinue the infusion and remove the catheter, Elevate the extremity, Apply warm compresses 3 to 4 times/day, Restart the infusion in a different vein proximal to the site or in another extremity, Obtain a specimen for culture at the site and prepare the catheter for culture if drainage is present
• Intravenous Therapy: For Fluid Overload -

  
  

  Decrease the IV flow rate and notify the provider of the change, Raise the head of the bed, Measure vital signs and oxygen saturation, Adjust the rate after correcting fluid overload, Administer diuretics
• Intravenous Therapy: For Cellulitis -

  
  

  Discontinue the infusion and remove the catheter, Elevate the extremity, Apply warm compresses 3 to 4 times/day, Obtain a specimen for culture at the site and prepare the catheter for culture if drainage is present, Administer antibiotics, analgesics, and antipyretics
• Intravenous Therapy: For Catheter Embolus -

  
  

  Place a tourniquet high on the extremity to limit venous flow, Prepare for removal under x-ray or via surgery, Save the catheter after removal to determine the cause
• Family & Community Violence:

  
  

  Provide phone numbers for 24-hr hotlines for sexual assault survivors, Promote self-care activities, Initiate referrals for needed resources and support services, Schedule follow-up calls or visits at prescribed intervals after the assault, Emphasize importance of after care, as sexual assault clients historically have a poor compliance rate with follow-up visits
• Coordinating Client Care:

  An interprofessional team is a group of health care professionals from various disciplines, Collaboration involves discussion of client care issues in making health care decisions, Nurses should recognize that the collaborative efforts of the interprofessional team allow the achievement of results that a team member would be incapable of accomplishing alone