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Alterations in Body Systems

by Diana Shenefield, PhD
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    00:01 Welcome! Today’s NCLEX review subject is Alterations in Body Systems, and we are going to get started right now. You want to read through the overview of what we are going to talk about today, and some of the things we are going to talk about are under the physiological part of NCLEX exam. Each part of the exam has different sections, and so today we are going to talk about, we are going to start here, we are going to talk about patients with chronic or with life threatening physical conditions. And we are going to just review a little bit on what you’ve probably already learnt in nursing school, but we are going to bring it down to just a real fine topic. So you want to make sure you read through the learning objectives. If after we are all done, if there's are topics that you aren’t clear about, you want to make sure you go back and review those topics, you want to make sure you go back and look at your nursing text books on areas that you might not be as familiar with, or maybe you have forgotten. So let’s start off with a question, to kind of get us in the mode of what we are talking about today. So we have a nurse that needs to assess for a patient with hyperkalemia, which if you remember is an increase in potassium.

    01:08 Which of these patients which she'd be watching for? A, a patient with renal failure. B, a patient with nausea and vomiting. C, a patient that has excessive laxative use or D, a patient with loop diuretic use. So, think back to potassium, and which of these patients would she need to be watching for? Hopefully you picked A, renal failure, because we know the other, B, C, and D will be hypokalemia. So again, if you can’t remember your lab values, you are going to want to go back and review those.

    01:42 Here is another question, so you have a nurse caring for which of the following patients.

    01:47 Again read through what question is asking you, and this one specifically asking you about a nursing diagnosis, and this nursing diagnosis is going to relate to one of the following answers. Is it a newly admitted 32 year old with myasthenia gravis? Again myasthenia gravis is not a real common disease, but it is an important disease that has a lot of life threatening effects, so you want to make sure you review that. Or is it a post-op patient, who had just have a Fem-Pop bypass surgery. Again, if that isn’t familiar to you, you are going to want to go back and review that. A 56-year-old patient admitted with an appendectomy or D, an 83-year-old patient that has had prostate cancer.

    02:37 So again, you are looking at the nursing diagnosis. Now, a lot of these patients are patients you are going to take care of, but you want to make sure you are addressing the nursing diagnosis that the question is asking about, and this question is asking about breathing difficulties, so we are going to pick question, or answer A, with a patient with myasthenia gravis. Patients with myasthenia gravis a lot of times have problems with the respiratory system. So again, as we are going through some of these topics, make sure that you understand or have an understanding of what part of the body we are dealing with, so that you can use your critical thinking to be able to narrow down your answers. So, we are going to start out with the general.

    03:19 Patients can experience alterations in body systems whenever they are suffering from any kind of illness. And again, sometimes we get focused on what they came to the hospital for, or what they came the physician’s office for, but remember a lot of our patients have co-morbidities, and so how one patient reacts to an illness might be different than the way another patient react to their illness. So, we need to look at how is this disease process affecting your patient. The nurse should be able to monitor and assess for changes.

    03:48 One of the biggest things as for nurses, is we kind of know how the pathway should go, but our patients surprise us at times. And so we need to be watching for those changes so that we can prevent complications. The nurse should be able to implement appropriate interventions. Not waiting necessarily for physician orders, but should be able to critically think through about what’s happening with the patient, and be able to intervene in a timely manner. The nurse is assessing proper patient education.

    04:19 We know as nurses that what we tell the patients is very important. They don’t get a lot of education from physicians, because the physicians know that nurses are with the patients longer. We need to make sure that we are thoroughly educating our patients. We need to make sure that they understand what’s happening before, during, and once they go home, giving them a little written paper, and sending them out the door does not do it. We need to make sure that they totally understand what could happen to them, and what their disease process is going to entail, what medicine. So we really need to focus a lot on patient education.

    04:55 And then, the nurse should be educated in pathophysiology. When you are going through nursing school, I’m sure you had a huge pathophysiology book, and you are thinking to yourself "There is no way I can know about every disease," and that’s true. But you do need to know about the major diseases, and then you are responsible that when you have the patient that comes in with a disease process that you are not familiar with, to go back and educate yourself so that you can have the best care of your patient. Just not knowing is not an excuse. So again, as you are going through and you're looking at NCLEX questions, if there's disease processes that maybe you are not as familiar with, you should at least be able to pick out what body system, and go from there. When you are out on the floor, you need to know, you need to look those things up for the safety of your patient. So, what are some of the common therapeutic procedures we do as nurses. Think back to nursing school, all the things that you've learned.

    05:50 We did things like assessing tube drainage, not just saying we 'assessed' it, but looking at what’s the color? What’s the drainage coming from? How much is there? Documenting all of that. Being able to understand what does it mean, if it's just sanguineous? What does it mean if it's serosanguineous? What does it mean if it's yellow? And being able to critically think through on whether it’s an expected outcome, or whether something else is going on. What about monitoring a patient on a ventilator.

    06:21 We don’t just leave ventilators just to respiratory therapy but we have to watch those ventilators, and make sure that the respiratory rate is correct, to make sure that our patient isn’t getting too much oxygen. So what would you need to be watching for, for your patient on a ventilator? How about using temperatures? We take temperatures all the time, but what does that mean for your patient? And, are you able to watch trending? Even if they are in a normal parameter? Are they trending too high or too low? Sometimes we take temperature and heart rate kind of for granted because we do that all the time. But sometimes that is the fastest way to figure out what’s going on with your patient before things get too bad. So don’t forget about that. What about monitoring phototherapy on an infant.

    07:09 If it has been a long time since you have been in an OB or in pediatrics, review phototherapy.

    07:14 We know that phototherapy can cause damage to the retinas. So do you understand that? And then what about the blood draw? What are they looking for in the blood draw? And what is a normal bilirubin level? So you want to make sure that you are reviewing that.

    07:28 Ostomy care. Nobody gets thrilled about doing ostomy care, but what are we looking for? Not only the stoma, and what it looks like, but the skin around it, and what are kinds of complications that can happen with that skin, from yeast infection to breakdown, and are we monitoring that, and are we documenting that? And then, postictal care. You know you have a patient that has had a seizure, what are you watching for afterwards? Do they have a good respiratory rate? What is their neurological status? And are they safe in the environment that they are in? Those are all things that you need to run through your mind and again if there's topics that maybe you don’t feel strong at, you want to go back and review those.

    08:07 What about suctioning, orally or from a trach. If you haven’t done that for a while, you are going to want to review that procedure, and look at how would you know if you are suctioning too hard? How would you know if you are going down too far? Is bleeding normal? Are you watching the heart rate? Are you causing the patient to vagal down? Again, what are the complications that can happen? How often should you be doing these procedures and then what are you documenting? Monitoring ICP, Intracranial Pressure. What are you looking for? What patients are going to be more prone to have increased intracranial pressure? What kind of symptoms are going to tell you that the pressure is going up? What do you need to watch for before maybe the patient is getting ready to herniate, things that you should have been watching for. So, you want to review the sign and symptoms of increased intracranial pressure. Monitoring cardiopulmonary systems. Again, it’s more than just heart rate. It’s blood pressure. It’s perfusion. It’s capillary refill. So again, making sure you that understand how to keep your patient safe, and how to watch for complications before they happen. Assisting a physician with invasive procedures.

    09:19 Do they need a consent? Making sure that consent is signed. Making sure the physician has the equipment that they need. Making sure that you have the safety equipment that you need, or safety medications that you need. And then what are you monitoring for? Are you making sure that they are breathing. Are you making sure that they are not compromised? Are you watching the positioning that they are in, especially if it is an elderly person.

    09:40 So make sure you review all that. And then wound care, making sure that you know how to document a wound. Do you know how to measure it? How you assess depth? How you assess pressure ulcers? Pressure ulcers are a big problem, again with our patients that are immobile or our diabetic patients. So it’s important that you understand how to prevent, and then how to treat, and how to assess, and how to document. So you are going to want to make sure you go back and review that.

    10:09 Complications. How do we know what complications? We use our critical thinking, but we start with assessment, you have to assess and reassess, assess and reassess, and when you go in and you do an assessment, and you might be really good at assessment, but if you are not going back and reassessing, things happen in the meantime, things that maybe we thought could happen, or maybe things that just kind of surprised us. So don’t forget about assess, reassess, and how important that is that you are doing that constantly through your shift.

    10:44 Nursing process, NCLEX will drill you, and drill you on the nursing process, and it is so important that you understand that assessment is the first thing that you do. And a lot of times in nursing school we get focused on interventions and what do I need to do, but don’t forget you can’t do anything with a patient, until you’ve assessed.

    11:04 Then you are going to plan a nursing diagnosis, and that doesn’t mean that you are always writing it down, or going to the computer, but in your mind you should be thinking through a nursing diagnosis that fits the assessment that you just did.

    11:17 And then planning. What’s the plan? How are you going to know that what you do is making the patient any better? There has to be goals, so that you can mark the goals off when they’ve met them, or reevaluate if they are not meeting them.

    11:30 Then we get to intervention, then we get to the fun part when we get to do something.

    11:35 But again, we can’t do until we’ve met the other criteria.

    11:40 And then don’t forget the fifth step, evaluation, that’s our reassessment. We go through this whole process. We cannot know how we are affecting our patient. We can’t know if the patient is getting any better if we don’t go back and evaluate, and start back at the top and make sure that they are meeting the goals that we've set for them.

    12:00 So, in closing on this section, assessing, assessing, assessing is so important, and reassessing. Looking for alterations in body systems. Remembering that our patients come as individuals. And even though we have a general idea of what a disease process does to the body, don’t forget that everybody comes with something else, either genetics, culture, age, that adds to that, so make sure that you are reading those questions but making sure that you are taking care of your patients. Being able to assess, diagnose, plan, intervene, and evaluate. Knowing that nursing process forward and backwards. And then remembering that you have the responsibility to identify changes in your patients, to catch when a heart rate is going too high or too low, and not waiting until a complication is full blown, but making sure that you are catching that beforehand, and intervening, assessing, and doing your nursing process. So that’s all for this topic. Go and study for NCLEX, and good luck.


    About the Lecture

    The lecture Alterations in Body Systems by Diana Shenefield, PhD is from the course Physiological Integrity. It contains the following chapters:

    • Alterations in Body Systems
    • Common Therapeutic Procedures
    • Complications and Nursing Process

    Included Quiz Questions

    1. Assess a patient’s progress toward a desired outcome
    2. Ambulate a patient 20 feet down the hallway
    3. Question a patient about family medical history
    4. Assign a nursing diagnosis to an identified need
    1. Improving airway clearance
    2. Removing allergens from the environment
    3. Eliminating foods that are known to cause intolerance
    4. Preparing patient for the CF-specific sweat test
    1. Tracheal deviation
    2. Tachypnea
    3. Hypotension
    4. Unilateral wheezing
    1. The presence or absence of bilateral wheezing
    2. The presence or absence of a cough
    3. The presence or absence of unilateral wheezing
    4. The duration of the expiratory phase
    5. The rate of the respirations

    Author of lecture Alterations in Body Systems

     Diana Shenefield, PhD

    Diana Shenefield, PhD


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