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NCLEX Review on Hepatitis

Today we will be talking about one of the most common diseases that you might encounter in the NCLEX which is that of Hepatitis.

Hepatitis is inflammation of the liver tissue its as plain and simple as that
And believe it or not a good portion of the people who has the less severe type of hepatitis will show no symptoms whereas others develop the some of the more common symptoms such as yellow discoloration of the skin and eyes, which what we call jaundice
and this is due to the liver not being able to breakdown and get rid of Bilirubin which as a a yellow pigment that is formed when our bodies breakdown our red blood cells in the liver.

now also other most common symptoms can include:
poor appetite, vomiting, tiredness, abdominal pain, and diarrhea.

Now as we all know Hepatitis may be temporary (acute) or long term (chronic) depending on whether it lasts for less than or more than six months.

Acute hepatitis can sometimes resolve on its own, or progress chronic hepatitis, or if not treated can lead to acute liver failure.

Over time the chronic form may progress to scarring of the liver, liver failure, or liver cancer.

 

CLASSIFICATIONS of Hepatitis Virus and its way of TRANSMISSION:

Now there are actually 5 types which are hepatitis a b c d and e
but on this quick review we will only be looking at the first three.

(If we look at the transmission: HEPATITIS B AND C are the only ones transmitted through blood and sexual contact).

Hepatitis A (transmitted through oral/fecal/water route)
Hepatitis B (transmitted through blood/drug use/sexual contact/childbirth)
Hepatitis C (transmitted through blood/drug use/sexual contact/childbirth)

 

HEPATITIS A

– Incubation period usually lasts from 15-45 days.
– Transmitted primarily through fecal/ oral route.
– Prevention includes sanitation and handwashing.
– There is a vaccine available for Hepatitis A.
– Prevention against Hepatitis A includes:

PROPER HANDWASHING
AVOIDANCE OF CONTAMINATED FOOD AND WATER
RECIEVING THE HAV VACCINE

 

HEPATITIS B
– transmitted through blood to blood contact sexual contact or drug use (needles, razors).

– There is a vaccine available for Hepatitis B.

 

 

HEPATITIS C

– Hepatitis C is transmitted through blood to blood contact sexual contact or drug use (needles, razors)

– The patient can be asymptomatic and others are only diagnosed once abnormality is detected in the liver enzymes.

SYMPTOMS OF ACUTE HEPATITIS C

FEVER
FATIGUE
LOSS OF APPETITE
NAUSEA
VOMITING
ABDOMINAL PAIN
DARK URINE
CLAY-COLORED BOWEL MOVEMENTS
JAUNDICE (YELLOW COLOR IN THE SKIN OR EYES)
SOME OF THESE SYMPTOMS CAN ALSO BE PRESENT ON OTHER CLASSIFICATIONS OF HEPATITIS* .

NCLEX Review on Hepatitis

HEPATITIS B AND HEPATITIS C is connected with cirrhosis and liver cancer.

ENZYME-LINKED IMMUNOSORBENT ASSAY (ELISA) is the initial screening test for clients suspected of infected of the Hepatitis C (HCV) Virus.
LIVER BIOPSY can also be used to confirm the diagnosis of Hepatitis.
Treatment most often used for Hepatitis C is a combination of two medicines, INTERFERON AND RIBAVIRIN.

 

 

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NCLEX Review on ARDS

Hello everyone today we will be talking about Acute Respiratory Distress Syndrome (ARDS)

An Acute respiratory distress syndrome (ARDS) what occurs is that there is fluid that builds up in the tiny, elastic air sacs called (alveoli) in your lungs.

And what occurs is that the fluid keeps your lungs from filling with enough air, which means less oxygen reaches your bloodstream.

And in turn this deprives your organs of the oxygen they need to function.

Now understand that ARDS typically occurs in people who are already critically ill or who have significant injuries.

Now lets look at a few of the symptoms

NCLEX Review Notes on ARDS

Symptoms

The signs and symptoms of ARDS can vary in intensity and basically depending on the cause and severity:

So the patient would be hypoxic and would show signs of
Severe shortness of breath
Labored and rapid breathing
and there would be
– Presence of crackles or (rhonci)
when we assess the patient

The patient would also have a Low blood pressure
and also be somewhat lethargic and confused

 

Lets look at a few of the Complications with ARDS

If you have ARDS, you can develop other medical problems while in the hospital. The most common problems are:

Blood clots. This is very dangerous because it can cause a (pulmonary embolism).
Collapsed lung (pneumothorax). there fore In most ARDS cases, a ventilator is used to increase oxygenation.
Infections. Because the ventilator is attached directly to a tube inserted in your windpipe, this makes it much easier for germs to infect and further injure your lungs.

Diagnosis
There’s no specific test to identify ARDS. The diagnosis is based on the physical exam, chest X-ray and oxygen levels.

– Diagnosed through the X- Ray (Ground Glass) Appearance within the lungs and this is due to the fluid buildup.

– A noncardiogenic Pulmonary Edema.
excess fluid in the lungs

Lab tests

The lab test will also show a decrease in the oxygen level throughout the body.

Treatment

The first goal in treating ARDS is to improve the levels of oxygen in your blood. Without oxygen, your organs can’t function properly.

NCLEX Review

Oxygen

So there are various ways that we can give supplemental oxygen
and that includes Mechanical ventilation.
The mechanical ventilator pushes air into your lungs and forces some of the fluid out of the air sacs.

The common Mechanical Ventillation includes PEEP or positive end-expiratory pressure.
basically its A method of ventilation in which airway pressure is maintained above atmospheric pressure

Another method is the CPAP or Continuous positive airway pressure
Now with CPAP, it basically applies mild air pressure on a continuous basis to keep the airways continuously open.

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NCLEX Review Infection Control

NCLEX Review on Safety and Infection Control

NCLEX Review:  Infection Control

When we are talking about Safety and Infection Control we need to simplify things and really understand what is safety and infection control and what the NCLEX wants us to focus on with this topic.  It is very important to realize that  The “Safety and Infection Control” now makes up about 10 -14% of the questions in the entire NCLEX Exam  This is a huge part of the exam, which means that it can be a factor for us either passing or failing the NCLEX exam.

So lets simplify the SAFETY AND INFECTION CONTROL information that we need to know for this NCLEX Review.  So the first thing that we need to learn is to understand and simplify each category and correlate  which particular disease belongs to each particular category.  We have to know this by heart, and to do this we really need to know the basics of each diseases.

So first lets go over the STANDARD PRECAUTIONS

Standard precautions simply are the basic level of infection control that should be used in the care of all patients all of the time.  Basically we use standard precautions in the care of all patients, in order to reduce the risk of transmission of microorganisms.

It is also called UNIVERSAL Precaution.

NCLEX Review:  Review on Safety and Infection Control

Personal protective equipment (PPE) that we need  includes: Gowns, Mask and Eye protection

Now lets go over the meat and potatoes of Safety and Infection Control in the NCLEX Exam which is knowing all the necessary precautions.  And obviously  in order to be successful in the NCLEX, you have to know this by heart.

The three main transmission based precautions aree Contact precautions– Droplet precautions and Airborne precaution

Lets begin with Contact Precaution.  It is pretty much self explanatory in a sense that it is transmitted through usually skin to skin contact. Now the major diseases that exist that enables the organism to be transferred through contact precaution that you will most likely encounter in your NCLEX exam includes mostly skin infections.  Since the skin is the number one barrier during a contact.

  • Varicella zoster

  • Herpes simplex

  • Impetigo

  • Scabies, Staphylococcus

Now lets take a look at Droplet precaution which can occur from a source such as a person during coughing, or sneezing or  talking,  Now these Droplets that contain the microorganisms can generally travel no more than 3 feet from the patient.

What Diseases can we usually see that involves droplet precuations in the NCLEX?

These disease can include

* Diptheria

* Streptococcal pharyngitis/tonsillitis

* Meningitis

* Mumps

* Pertussis

* Scarlet fever

 

Lastly, lets go over the AIRBORNE PRECAUTIONS

NCLEX DISEASES: AIRBORNE PRECAUTIONS

DISEASES that you will most likely encounter in the NCLEX.

* TB (m. Tuberculosis) 

* Measles (rubeola)

* Chicken Pox (varicella)

* Shingles (disseminated zoster)

 

Remember that with TB – Tuberculosis you will need a:

  • PRIVATE ROOM

  • NEGATIVE PRESSURE WITH 6-12 AIR EXCHANGES PER HOUR

So its basically a negative pressurized room.  What this does is that it enables a ventillation system that generates negative pressure to allow air to flow into the room and not allow the pathogens to escape.

  • MASK

NCLEX Priority: Make sure to wear our speacial mask which is the N95 MASK FOR TB.

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NCLEX Review Shownotes:

I have mentioned before that pharmacology plays a big role and a big factor with the NCLEX exam. If we encounter the mid level which are basically the competent questions which is exactly what we need to know and what the NCSBN or Board of Nursing wants us to answer correctly in order to pass the NCLEX exam. Then it is expected from us to understand the management and prioritization aspects of certain medications that we have to know for the NCLEX.  That simply means to know and understand side effects or adverse reactions for certain medications and also how management and prioritization would be applied towards Pharmacology in correlation to the impact of the side effects or adverse reactions towards the patient. What it means is basically as a nurse or as a nurse graduate taking the NCLEX exam,  it is our job and our duty to be conscious and aware of certain side effects and how that impacts our client.  Also implications that we need to know for certain medications such as interactions or interventions that will become a priority for us as the nurse, in taking take care of our patient.  This entails knowing the specifics factors such as the ABG’s, vital signs and lab values and all of the symptomatic signs. Now let’s look at a few important examples of the most important pharmacological categories of medications that we will most likely encounter in the NCLEX exam.

NCLEX Review Cardiac Medications

Now let’s begin with the important medications that is used for hypertension, which is diuretics. Lets talk about diuretics, which helps get rid of sodium and fluid in the body. Diuretics is used to lower the blood pressure and therefore promotes excretion of sodium and water. Now with this in mind we can understand that diuretics interferes with the patient’s blood pressure (which means it can significantly drop) as a result: decrease in the preload and afterload in the body.   Therefore, a priority would be giving IV fluids to that patient.   And since there would be sodium absorption in the kidneys, it causes an increases the urine output.

Now let’s go over a specific type of diuretics and start with a potassium sparing diuretics. With a potassium sparing diuretic, it basically promotes the excretion of sodium and water while the retention of potassium (Important to know for NCLEX Review).  And basically is used usually for hypertension and edema and for a patient with hypokalemia or hypokalemic symptoms.   An example of a potassium sparing diuretics would include Spir0nolactone, which will usually be very common in the NCLEX exam. So what is the prioritization for this particular patient:  Obviously the patient could end up having too much potassium and that would cause hyperkalemia, so therefore then we would have to know the symptoms of  hypokalemia (now we all know that Potassium is needed for cells, especially nerve and muscle cells, to function properly) as a result the person can have symptoms that can include irregular heartbeat, nervousness, tingling in the hands, shortness of breath and nausea and vomiting.

Let’s talk about another category of cardiovascular medications which is beta-adrenergic blockers or beta blockers and basically beta blockers helps lower blood pressure and pulse rate.   It is also used to treat headaches, glaucoma and prevent MI or myocardial infartions by blocking the sympathetic motor response of the body.  Always try to remember that the beta blocker medications would usually end in syllables “lol” .  Common Beta Blockers that you can encounter in the NCLEX includes (Metoprolol, Carvedilol, Acebutolol).   Beta blockers block the action of catecholamines such as epinephrine (adrenaline) and as we all know this causes the fight-or-flight response of the body therefore the opposite effect can be manifested as the adverse reaction.  So, Side effects for patients taking  Beta blockers would include orthostatic hypotension, bradycardia, nausea and vomiting and diarrhea. We need to know that some of the symptoms may mask signs of hypoglycemia in the patient and is manifested as hypoglycemic symptoms.  This is due to the fact that beta blockers normally stimulate hepatic glycogen breakdown in the pancreas and causes the release of glucagon. So we need to take note of that for the NCLEX

Nursing interventions for clients with beta blockers would include interventions such as making sure that we monitor the clients blood pressure, and heart rate.  We also need to monitor the client for signs of edema.  So as the nurse, we should assess the lung sounds for the signs of rales and rhonchi which can be due to obviously fluid overload. When patients are taking beta blockers, it is also very important to monitor the changes in lab values such as protein, B UN and creatinine which can indicate nephrotic syndrome in the kidneys and that can be a problem. Nursing teaching for these patients would include teaching the client to rise slowly because the cause orthostatic hypotension which can become a safety issue and we also need to tell the patients to  report any signs of bradycardia, dizziness and confusion.

Focus on this Topic:

  • Potassium Sparing Diuretics
  • Beta Blockers

♣ Pharmacology Drugs for Hypertension:

DIURETICS

– HELPS GET RID OF THE SODIUM AND FLUID IN THE BODY.
– USED TO LOWER THE BLOOD PRESSURE.
– PROMOTES THE EXCRETION OF SODIUM AND WATER
– DIURETICS INTERFERES WITH THE SODIUM ABSORPTION IN THE KIDNEY.
– INCREASES THE URINE OUTPUT. DECREASES THE PRELOAD AND AFTERLOAD..
If the patients blood pressure drop to low, it is important to give IV FLUIDS to pt.

LETS GO OVER THE CATEGORIES OF DIURETICS ♠

♦ TYPES OF DIURETICS

♣ POTTASIUM SPARING DIURETICS

It promotes the excretion of soduium and water, while the retention of pottasium

Used for:

HYPERTENSION
EDEMA
HYPERALDOSTERONISM
HYPOKALEMIA
MEDICATION:

SPIRONOLACTON (ALDACTONE)
AMILORIDE (MIDAMOR)
TRIAMTERENE
Now lets go to the SIDE EFFECTS:

First, of course the person can have too much potassium or HYPERKALEMIA:

Signs of HYPERKALEMIA

IRREGULAR HEARTBEAT
NERVOUSNESS
TINGLING IN HANDS AND FEET
SHORTNESS OF BREATH
TIREDNESS OR WEAKNESS
OTHER SIDE EFFECTS:

NAUSEA AND VOMITING
CRAMPING AND DIARRHEA
DIZZINESS & HEADACHE

BETA (ADRENERGIC) BLOCKERS

– Helps lower blood pressure, puls rate and cardiac output.
– Can be used to treat headaches.
– Can be used to treat glacauma and prevent myocardial infarctions.
– Acts on the system, by blocking the symathetic vasomotor response.

For the NCLEX, try to remember that the syllable for beta blockers is usally (olol).

SIDE EFFECTS:

ORTHOSTATIC HYPOTENSION
BRADYCARDIA
NAUSEA AND VOMITING
DIARRHEA
NOTE: Some of the symptoms may MASK signs of Hypoglycemia

♠ HYPOGLYCEMIC SYMPTOMS

NURSING INTERVENTIONS FOR CLIENTS TAKING BETA BLOCKERS:

Make sure that you monitor the client’s blood pressure, heart rate and rhythm, before administering the beta blocker. Monitor the client for signs of edema. The nurse should also assess the lungs sounds for signs of rales and ronchi. When patient are taking beta blockers, it is also very important to monitor the changes in lab values such as (protein, BUN and creatinine) which can indicate nephrotic syndrome. Nursing teaching for the NCLEX would include: Teaching the Client to rise slowly (ORTHOSTATIC HYPOTENSION) * (A SAFETY ISSUE), report any signs of bradycardia, dizziness, confusion depression or fever. It is also very important to taper off the medication properly.

CARDIAC PHARMACOLOGY

♣ NCLEX Review Notes:.

♣ NCLEX REVIEW PHARMACOLOGY

Drugs Used for treating Hypertension:

BETA BLOCKERS
– REDUCES THE CARDIAC OUTPUT AND DECREASES THE SYMPATHETIC NERVOUS SYSTEM RESPONSE.
– BLOCKS THE BETA RECEPTOR, CAUSING A DECREASE IN BLOOD PRESSURE.
– MEDICATIONS INCLUDE THE “OLOL’S”: METROPOLOL, PROPANALOL, ACEBUTOLOL, NADOLOL.
– USED FOR HYPERTENSION, MYOCARDIAL INFARCTION AND ANGINA.
ADVERSE EFFECTS CAN INCLUDE: BRADYCARDIA, HYPOTENSION AND HYPOGLYCEMIA (DISTRUPTS THE LIVER’S ABILITY TO CONVERT GLYCOGEN TO GLUCOSE).

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