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7 Cards in this Set

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  • Back
What are the 3 categories of intervention activities for the patient with hypothyroidism?
respiratory monitoring
shock prevention
hypothermia treatment
When monitoring respiratory system, it is important to?
collect and analyze client data to ensure airway patency and adequate gas exchange
When monitoring for shock, it is important to?
detect and treat a patient at risk for impending shock
When monitoring for hypothermia, it is important to?
rewarm and observe a patient whose core body temperature is below 35 degrees Celcius
What 7 respiratory interventions should nurse monitor for?
rate, rhythm, depth, and effort of respirations

chest movement, watching for symmetry, use of accessory muscles, and supraclavicular and intercostal muscle refractions

breathing patterns for bradypnea

diaphragmatic muscle fatigue (paradoxical motion)

changes in SaO2 and Svo2, end tidal CO2 and ABG values, as appropriate

client's ability to cough effectively

dyspnea and events that decrease and worsen it
What 7 shock interventions should nurse monitor for?
temperature and respiratory status

circulatory status: BP, skin color, skin temperature, heart sounds, heart rate and rhythm, presence and quality of peripheral pulses, and capillary refill

signs of inadequate tissue oxygenation

apprehension, increased anxiety, and changes in mental status

intake and output

administer oxygen and/or mechanical ventilation, as appropriate

administer antiarrhythmic agents, as appropriate
What 11 hypothermia interventions should nurse monitor for?
client's temperature, using a low-recording thermometer if necessary

place on a cardiac monitor, as appropriate

cover with warmed blankets, as appropirate

administer heated oxygen, as appropriate

VS, as appropriate

skin color and temperature

intake and output

avoid giving IM or subcutaneous medications during hypothermic state

give client warm oral fluids, if alert and able to swallow

teach client to consume a caloric intake sufficient to maintain a normal body temperature

emphasize the importance of wearing warm, protective clothing when going into a cold environment