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Registered Nurse (RN)
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NCLEX®
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NCLEX-RN® Test Plan: Client Needs
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Potential for Alterations in Body Systems

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NCLEX-RN® Test Plan: Client Needs | Registered Nurse (RN) School Study Aid

Potential for Alterations in Body Systems
14 Picmonics to Learn | 28 mins
Chest Tubes: Management and Care
Confirm suction order
Assessment
Crepitus
Kinking
Shortness of Breath (SOB)
Infection
Excessive bubbling
Quick Interventions
If tube dislodges from patient, use petroleum gauze taped 3 ways
If drainage system is damaged, place disconnected drainage tube in sterile water
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1 min
Dysphagia
Etiology
Neurological Disorders
Muscular Disorders
Structural Abnormalities
Gastroesophageal Reflux Disease (GERD)
Inflammatory Conditions
Signs & Symptoms
Difficulty Swallowing
Choking or Coughing
Regurgitation
Diagnosis
Clinical History and Physical Examination
Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
Videofluoroscopy (Modified Barium Swallow Study - MBSS)
Interventions
Treat Underlying Cause
Therapy
Dietary Modifications
Medications
Surgery
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3 mins
The National Dysphagia Diet
Drinks Levels 0 to 3
Level 0: Thin
Level 1: Slightly Thick
Level 2: Mildly Thick
Food – Levels 4 to 7
Level 3: Moderately Thick Food
Level 4: Pureed, Extremely Thick
Level 5: Minced, Moist
Level 6: Soft, Bite-sized
Level 7: Regular
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3 mins
Interventions for Impaired Skin Integrity
Assessment
Signs of Skin Breakdown
Pain
Redness
Decreased Skin Turgor
Bleeding
Bony Prominences
Intervention
Reposition Q2H
Pressure Relief
Maintain Clean and Dry Skin
Adequate Nutrition and Hydration
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2 mins
Pressure Ulcers
Risk Factors
Prolonged Immobilization
Neurologic Disease
Decreased Level of Consciousness
Classification
Stage 1: Intact Skin with Non-blanchable Erythema
Stage 2: Partial Thickness Skin Loss
Stage 3: Full-thickness Skin Loss without Fascial Involvement
Stage 4: Full-thickness Skin Loss with Fascial Involvement
Management
Wound Care
Surgery
Considerations
Septicemia
Osteomyelitis
Prevention
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3 mins
Immobility
Assessment
Mobility Continuum
Complications
Cardiovascular
Respiratory
Musculoskeletal
Integumentary
Gastrointestinal
Urinary
Considerations
Turn, Cough, Deep Breathe (TCDB)
Range of Motion (ROM)
Skin Care
Fluids
Balanced Diet
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2 mins
Marasmus
Deficiency of all Nutrients
Body Weight < 60% of Normal
Tissue and Muscle Wasting
Loss of Subcutaneous Fat (Buttocks and Thighs)
Variable Edema
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2 mins
Kwashiorkor
Protein Deficiency
Swollen Belly
MEALS
Malnutrition
Edema
Anemia
Liver Malfunction
Skin Lesions
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2 mins
Functional Incontinence
Symptoms
Increased Urinary Volume
Unable to Timely Urinate
Pathophysiology
Dementia
Excessive Alcohol Consumption
Immobility
Treatment
Scheduled Voiding
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1 min
Stress Incontinence
Symptoms
Urine Leak with Movement
Cough or Sneeze
Increased Intra-abdominal pressure
Pathophysiology
Laxity of Pelvic Floor Muscles
Urethral Sphincter Insufficiency
Treatment
Kegel Exercises
Pessaries
Alpha-adrenergic Agonists
Surgery
Associations
History of Vaginal Birth
Cystocele
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2 mins
Overflow Incontinence
Symptoms
Increased Residual Urine Volume
Involuntary Urine Dribble
Urinary Frequency
Pathophysiology
Nerve Lesions Cause Bladder Atony
Bladder Outlet Obstruction
Weak Detrusor Muscles
Treatment
Bethanechol
Catheterization
Sacral Neuromodulation
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2 mins
Diabetes Education
Self-Monitoring (Blood Glucose)
SubQ Injection Technique
Lifestyle Changes
Symptoms of Hyperglycemia and Hypoglycemia
Sick Day Care
Foot Care
Exercise Therapy
Medication
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1 min
Appendicitis Interventions
Treatment
Appendectomy
Preoperative Care
Antibiotics
IV Fluids
No Enema or Laxative
Postoperative Care
Semi-Fowler's Position
Nasogastric Tube
Diet as Tolerated
Pain Management
Early Ambulation
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2 mins
Diabetes Interventions
Early Diagnosis
Insulin
Oral Hypoglycemics
Glucose Monitoring
Routine Exercise
Diabetic Diet
Monitor for Complications
Insulin Therapy
Diabetic Ketoacidosis (DKA)
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2 mins

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