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exams > Milestone 2-1 > Flashcards

Milestone 2-1 Flashcards

1
Q

Continuous bladder irrigation

A

A three-way (lumen) irrigation is used to decrease bleeding and to keep the bladder free from clots—one lumen is for inflating the balloon (30 mL); one lumen is for instillation (inflow); one lumen is for outflow.

Continuous irrigation may be used with TURP.

The amount of fluid recovered in the drainage bag must equal the amount of fluid instilled – secondary hemorrhage may occur from overdistension

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2
Q

Urethritis

A

Common in postmenopausal women

Low estrogen levels decrease moisture and secretions in the perineal area, predisposing it to the development of infection

Testing: STI, multiple dipstick, leukocyte esterase, nitrite testing, x-ray, CT, ultrasonography, kidney scans

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3
Q

Renal Calculi Risk Factors

A
  1. Kidney diseases: Polycystic kidney disease, horseshoe kidneys, chronic strictures, and medullary sponge disease
  2. IBD, ileostomy, bowel resection
  3. Medications: Antacids, acetazolamide (Diamox), vitamin D, laxatives, and high doses of aspirin
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4
Q

Calculi pain

A

Requires immediate attention

IV or IM opioids

IV NSAIDs

If pain increases, notify HCP

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5
Q

Imitrex contraindications

A

Ischemic heart disease

St. John’s wort

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6
Q

Seizures

A

Assessment

· History, factors/precipitating events, alcohol, aura

Planning and Goals

· Prevention of injury, control seizures, psychosocial adjustment, understanding, absence of complications

Nursing Interventions

· Prevent injury, seizure precautions

Reducing Fear of Seizures

· Adhere to prescribed treatment, take on a regular basis, monitor for drug resistance

Precipitating factors:

· Emotional disturbances, new environmental stressors, onset of menstruation, fever, change in lifestyle routine, bright flickering lights, stress, alcohol

Monitoring and Managing Potential Complications

· Status epilepticus

· Toxicity of meds

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7
Q

Hyperthyroidism signs/symptoms

A

Ophthalmopathy - exophthalmos (abnormal protrusion of one or both eyeballs), (not always reversible)

Nervousness: Hyperexcitable, irritable, apprehensive, · cannot sit quietly, fine hand tremor

Cardiac: palpitations, rapid pulse, A-fib (new onset in adults), fatigability, weakness

Skin: tolerate heat poorly, perspire, flushed skin, dry skin, diffuse pruritus

GI: · amenorrhea, changes in bowel function, increased appetite, weight loss

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8
Q

Exophthalmos-POC

A

Assessment:

  • Vision changes, trauma, visual acuity

Treatments:

  • Antibiotic eyedrops if infection is the underlying cause
  • Antithyroid therapy (propylthiouracil, methimazole), if Graves’ disease is the underlying cause
  • Corticosteroids for optic neuropathy
  • Eye lubricants (artificial tears)
  • Surgery if vision is threatened

General:

  • Cold/warm compresses (trauma)
  • Eye protection (sunglasses)

Testing:

  • CT, MRI, ultrasonography
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9
Q

Sensory perception peripheral neuropathy

A

The heels are particularly susceptible to breakdown because of loss of sensation of pain and pressure associated with sensory neuropathy.

The skin is assessed for dryness, cracks, breakdown, and redness, especially at pressure points and on the lower extremities. The patient is asked about symptoms of neuropathy, such as tingling and pain or numbness of the feet. Deep tendon reflexes are assessed.

Teaching: Use a mirror to inspect feet daily.

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10
Q

Diabetes foot care

A

Feet should be cleaned, dried, lubricated with lotion (but not between the toes), and inspected frequently

Supine position - alleviate pressure on the heels by elevating lower legs on a pillow, the heels positioned over the edge of pillow

Seated in a chair - position feet so that no pressure on heels

If ulcer on one foot - provide preventive care to the unaffected foot and special care to affected foot.

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11
Q

Preop labs

A

pH 7.35 – 7.45

pCO2 35 – 45

HCO3 22 – 26

Renal Lab Values

· BUN 10 – 20

· Creatinine 0.6 – 1.2

· Cholesterol Lab Value <200

CBC Lab Values

· HCT F:36 – 46 M:42 – 52

· HgB F:12 – 16 M:14 – 18

· Platelets 200,000 – 450,000, <40,000 be very concerned!

· WBC 4.5-11

Calcium 9-11

Sodium 135-145

Chloride 95-105

Phosphorus 2.5 – 4.5

Magnesium 1.5 - 2.5

Glucose 70 - 100

Potassium 3.5 - 5.0

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12
Q

Renal calculi risk factors

A

Polycystic kidney disease, horseshoe kidneys, chronic strictures, and medullary sponge disease

IBD, ileostomy, or bowel resection

Medications: antacids, acetazolamide (Diamox), vitamin D, laxatives, and high doses of aspirin

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13
Q

Seizure assessment

A
  1. Seizure history
  2. Precipitating factors
  3. Alcohol intake
  4. Aura (if present)
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14
Q

Seizure planning and goals

A

prevent injury

control seizures

psychosocial adjustment

understanding

prevent complications

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15
Q

Seizure interventions

A

Prevent injury

Seizure precautions

Reduce fear (adherence to prescribed treatment)

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16
Q

Hyperthyroid S/S

A

Nervousness

Rapid pulse

Tolerate heat poorly

Fine hand tremor

Exophthalmos

Weight loss

Amenorrhea

A-fib

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17
Q

Exophthalmos POC

A
  1. Conjunctivae should be moistened often with isotonic eye drops
  2. Elevate HOB
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18
Q

OR malignant hyperthermia

A
  • a rare inherited muscle disorder that is chemically induced by anesthetic agents
  • mortality at 70%
  • RF: bulky muscles, a history of muscle cramps or muscle weakness and unexplained temperature elevation, and an unexplained death of a family member during surgery that was accompanied by a febrile response
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19
Q

Malignant hyperthermia initial symptoms

A

Cardiovascular, respiratory, and abnormal musculoskeletal activity

Tachycardia, v-dysrhythmia, hypercapnia

Muscle rigidity

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20
Q

Malignant hyperthermia action

A

Identify patients at risk

Postpone anesthesia and surgery

Dantrolene (muscle relaxant)

Cold IV fluids, diuretics, treat arrhythmias & acid/base issues

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21
Q

Hydromorphone post-op pain

A

Assess BP, RR, & pulse before administration

Dilute with NS

Naloxone for overdose

Causes constipation - use stool softener

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22
Q

COPD and breathing

A

Improve breathing by inspiratory muscle training and

breathing retraining:

  1. Diaphragmatic breathing
  2. Pursed-lip breathing
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23
Q

TB diagnostic test

A
  1. Mantoux Skin Test - read in 48-72 hours, 5 mm warrants suspicion, 10+ mm is normal/mildly impaired immunity
  2. Blood test
  3. Quantiferon TB Gold test - can be done in 24 hours
  4. Sputum culture - for acid-fast bacilli
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24
Q

Perforated bowel first sign

A

Severe abdominal pain, an elevated white blood cell count (due to infection), fever, nausea, noticeable blood loss, and hemodynamic instability (septic shock)

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25
Q

NGT with decreased peristalsis

A

Turning side to side in bed

Ambulation

Bowel sounds

Full Fowler’s

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26
Q

Cholethiasis n/v

A

Indication of infection, leakage of bile into peritoneal cavity, and obstruction of bile drainage; acute pain

Note and report it

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27
Q

Diverticulitis WBC

A

Elevated WBC in labs for diagnosis

Stage I: Rest, oral fluids, analgesics, clear liquid diet

Stage II: NPO, IV fluids, NG suctioning, antibiotics, oxycodone for pain

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28
Q

Anemia labs

A

Fewer RBCs than normal, therefore, have lower hemoglobin (normal 12-18)

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29
Q

Plaquenil teaching

A

Manages symptoms of SLE (lupus)

Retinal damage is most serious toxicity

Discontinue at first sign of retinal injury

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30
Q

Blood administration - Overload

A
  • Hypervolemia can occur
  • Diuretics administered prior to infusion (at risk)
  • Signs: dysnpea, orthopnea, tachy, HTN, anxiety, JVD, crackles, hypoxemia, pulmonary edema, pink/frothy sputum
  • If mild, slow rate and give diuretics
  • Iron-chelation therapy for iron toxicity
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31
Q

Menopause risk of osteoporosis

A

Primary osteoporosis after menopause

Weight-bearing exercise, reduce caffeine, tobacco, alcohol, carbonated drinks

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32
Q

Osteoporosis goal

A

Knowledge of condition & treatment

Pain relief

Improved bowel elimination

Absence of fractures

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33
Q

Osteoarthritis pain assessment

A

Overweight

Sedentary lifestyle

Assistive devices - remove stigma

Give analgesic before exercise

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34
Q

Gout teaching

A

Severe dieting not necessary

Maintain normal weight

Avoid purine-rich foods (shellfish, organ meat)

Avoid trauma, stress, alcohol, red meat

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35
Q

ABG head injury

A

Respiratory acidosis causes hypercapnia (excess CO2) which causes vasodilation of cerebral arteries, increasing intracranial pressure

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36
Q

Celiac disease

A

Strict gluten-free diet for life (damages villi)

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37
Q

Prolapsed cord delivery

A

Modified Sims, Trendelenberg, knee-chest positions

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38
Q

If a patient has a positive 1 hour glucose tolerance test (which is administered at about 24-28 weeks), a 3 hour glucose tolerance test is ordered. If this test is abnormal, it is used to diagnose gestational diabetes.

A

Gestational diabetes lab

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39
Q

GBS positive

A

Presence of Group B streptococcus

Indicates treatment of the mother with antibiotics (Penicillin G 4 hours prior to delivery)

Women who at 36-37 weeks are screened

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40
Q

Placental abruption action

A

Maintain mom’s cardiovascular status

Deliver fetus quickly

If partial - C-section

If complete - vaginal, baby died

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41
Q

Variable deceleration actions

A

Reposition to left or right lateral, knee-chest, or hands and knees

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42
Q

Hemorrhage postpartum care

A

Oxytocin first - dilute in NS

If boggy uterus, fundal massage

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43
Q

Post-epidural headache

A
  • Can be an adverse reaction of spinal anesthesia
  • Semi-Fowler, IV hydration, O2
44
Q

Cryptorchidism

A

Undescended testes

Palpated in inguinal canal

Can be unilateral/bilateral

If can’t palpate, further investigation

45
Q

Acrocyanosis monitor

A

Persistent cyanosis of fingers, hands, toes, and feet with mottled blue or red discoloration and coldness

May be seen in newborns during the first few weeks of life in response to exposure to cold. Acrocyanosis is normal and intermittent.

46
Q

Vitamin K rationale

A

Vitamin K, a fat-soluble vitamin, promotes blood clotting by increasing the synthesis of prothrombin by the liver

Newborns are at risk for vitamin K deficiency and subsequent bleeding unless supplemented at birth

Vitamin K is not produced in the intestine until after microorganisms have been introduced, such as with the first feeding

47
Q

Sickle cell dehydration

A

Dehydration can trigger sickling

Other signs are elevated HR, pain, hyperthermia

Promote hydration, give IV fluids

48
Q

Hypoglycemia - milk

A

A hypoglycemic patient needs to be treated with sugar (i.e., milk, juice), followed by some form of protein intake

49
Q

Meningitis assessment

A

Nuchal rigidity-stiff neck

Kernig’s sign- hip flex causes pain in knee extension

Brudzinskis- neck flex causes knee and hip flex

50
Q

Congenital hypothyroid

A

Aka cretinism

Causes diminished physical and mental capacity

Measure & record growth

Measure thyroid levels

Assess for hypo- or hyperfunction

L-thyroxine (Synthroid) is treatment

51
Q

RSV: Synagis

what is the criteria to receive this vaccine?

A

Give IM to child < 2 yrs, once/month during RSV season

  • Prematurity
  • Chronic lung disease (bronchopulmonary dysplasia) requiring medication or oxygen
  • Certain congenital heart diseases
  • Certain neuromuscular disorders
52
Q

Hyperglycemia in DM

A

Assess for hypo- or hyperglycemia in hospitalized child every 2 hours

Child will need immediate access to rapid-acting insulin

53
Q

Biliary atresia

A
  • an absence of some or all of the major biliary ducts, resulting in obstruction of bile flow
  • causes cholestasis resulting in jaundice and eventual progressive fibrosis with end-stage cirrhosis of the liver
  • Assess: persistent jaundice, enlarged liver, chalky white stools
  • Management: vitamins ADEK, antibiotics, diuretics for ascites
54
Q

Main types of seizures in PEDs

A

Epilepsy

Febrile

Neonatal

55
Q

Seizure interventions for PEDs

A

Control and reduce frequency

Anticonvulsants

Neuro exam

Seizure precautions

Relieve anxiety

Monitor EEG changes in neonatal seizures

56
Q

Wilm’s tumor

A

Most common renal tumor

Occurs in kids 2-5 yrs

Affects only one kidney

Avoid palpating for initial pre-op assessment (metastasis)

57
Q

VSD fluid overload

A

“HOLE” in Ventricles

Heart Failure and pulmonary hypertension: clammy sweating and occurs with activity like crying, activity, feeding etc.

Often experiences lung infections (lung congestion)

Low growth rate and loss of weight (inability to eat and burns calories due to difficulty breathing and increased workload on the heart)

Extra heart sounds: holosystolic/pansystolic murmur (the mumur starts at S1 and goes into S2)…it may or may not be present at birth until pressure changes occur and is found at the lower left sternal border

58
Q

HF in Peds

A

Occurs most often in children with CHD

Assess: VS, fatigue, weight gain, heart/resp function, apical pulse for 1 min

Tests: Chest x-ray, ECG, echo

Promote: O2, cardiac, nutrition, rest

Tx: Digoxin, ACE, diuretics

59
Q

Intussusception stool

A

Currant-jelly, bloody

Palpate for sausage-shaped mass

Treat with barium enema

60
Q

Cystic fibrosis sweat test

A

Sweat chloride test: suspicious > 50 mEq/L, diagnostic if > 60 mEq/L

Sweat is thick with salty taste and has more chloride

61
Q

Hemophilia joint care

A

Recurrent bleeding into the joints can cause destruction

Promote physical activity

62
Q

Placental previa results

A

No pelvic exam

Painless, vaginal bleeding

Diagnosed with ultrasound

Treated with strict bedrest

Monitor VS, FHR, bleeding (risk for hemorrhage)

63
Q

Self harm in adolescence

A

Highest risk at ~2 weeks after starting antidepressant medication

Correlated with bullying

A form of PTSD

64
Q

Alzheimer hallucinations

A

Avoid direct confrontation

Instead, address environmental triggers

65
Q

Major depressive disorder therapeutic milieu

A

· electroconvulsive therapy (ECT)

· Psychotherapy:

o Interpersonal therapy - relationships, grief reactions, roles

o Behavior therapy – positive/negative interactions, social skills

o Cognitive therapy – how person thinks

66
Q

Aggression source

A

When predictability of meetings or groups and staff–client interactions is lacking, clients often feel frustrated and bored, and aggression is more common and intense

Triggering phase - the nurse should approach the client in a nonthreatening, calm manner in order to deescalate the client’s emotion and behavior

Escalation phase - nurse should provide directions to the client in a calm, firm voice. The client should be directed to take a time-out for cooling off in a quiet area or his or her room

Crisis phase – physically violent; staff must take charge of the situation for the safety of the client, staff, and other clients.

67
Q

Addiction & relapse

A

Family members and friends should be aware that clients who begin to revert to old behaviors, return to substance-using acquaintances, or believe they can “handle myself now” are at high risk for relapse, and loved ones need to take action.

68
Q

Heroin history

A
69
Q

Depression goal setting

A

To reverse negative views of the future

Improve self-image

Gain competence and self-mastery

70
Q

Bipolar impulsivity

A

Start multiple activities at once

People in the manic phase are easily angered and irritated and strike back at what they perceive as censorship

71
Q

Duty to warn

A

Mental health clinicians may have a duty to warn identifiable third parties of threats made by clients, even if these threats were discussed during therapy sessions

Must base his or her decision on the following:

Is the client dangerous to others?

Is the danger the result of serious mental illness?

Is the danger serious?

Are the means to carry out the threat available?

Is the danger targeted at identifiable victims?

Is the victim accessible?

72
Q

Borderline personality disorder – communication

A

Identify feelings that are related to self-mutilating or self-destructive behaviors

Focus on self-responsibility and active approaches

Identify strengths and successful coping behaviors

73
Q

Tangential speech in bipolar disorder

A
  • Pressured speech
  • a classic hallmark of mania

Interventions:

  • Decrease environmental stimuli
  • Use a firm yet calm, relaxed approach
  • Provide a consistent, structured environment
74
Q

Persecutory delusion

A

Belief that “others” are planning to harm him or her or are spying, following, ridiculing, or belittling (i.e., poisoned food)

Don’t support or challenge them

Ask them to explain their belief

75
Q

IPV action

A

Believe them, listen, affirm safety, respect their decision, encourage them to develop a plan

76
Q

Elder abuse nursing care

A

Gentle inquiry about the family’s usual approach to resolving interpersonal difficulties

77
Q

Maslow - esteem

A

The fourth level involves esteem needs, which include the need for self-respect and esteem from others; confidence, achievement

78
Q

School nurse – ADHD

A

· identified and diagnosed in preschool or school

· Symptoms interfere significantly with behavior and performance in school

o impulsivity, inability to share or take turns, tendency to interrupt, and failure to listen to and follow directions.

· The secondary complications of ADHD, such as low self-esteem and peer rejection

· Tx: 1st line are stimulants (methylphenidate), 2nd line antidepressants (SSRIs)

79
Q

ADHD early school age

A

A key feature of ADHD is the consistency of the child’s behavior

Strategies for Home and School:

· Medications, behavioral/environmental strategies

· Giving stimulants during daytime combats insomnia

80
Q

Water intoxication

A

a condition that occurs when a person drinks enough water to significantly lower the concentration of sodium in the blood (hyponatremia)

81
Q

PR interval

A

Consistent interval between 0.12 and 0.20 seconds

The PR Interval indicates atrioventricular conduction time. The interval is measured from where the P wave begins until the beginning of the QRS complex

82
Q

Atrial fib

A

Rate 120-200 bpm, irregular rhythm, no P-waves

Increased risk for stroke, HF, myocardial ischemia

83
Q

Unstable angina NTG

A

Unstable angina happens when a person still experiences pain even after stopping a stressful physical activity

ANOM - aspirin, nitrogen, oxygen, morphine

84
Q

MI plan of care

A

Relieve pain or ischemic S/S

Prevent further damage

Respiratory

Perfusion

Reduce anxiety

Self-care program

Recognize complications

85
Q

Valve surgery

A

Avoid strenuous activity

Alternate rest with activity

86
Q

Cardiomyopathy - HA onset

A

Chest pain, orthopnea, dyspnea on exertion, syncope

Pillows needed to sleep, weight change, limited ADLs

87
Q

ABGs – PE

A

With pulmonary edema, there is an extra layer of fluid in the alveoli that interferes with the lungs’ ability to get rid of CO2. This leads to a rise in pCO2.

88
Q

Pulmonary embolism signs and symptoms

A

Dyspnea - common symptom

Tachypnea - common sign

Chest Pain, anxiety, fever, tachycardia, apprehension, cough, diaphoresis, hemoptysis, and syncope

89
Q

ARDS – PaO2 level

A

Notify provider if PaO2 < 80

A rapid onset of severe dyspnea

Arterial hypoxemia that does not respond to supplemental oxygen

Respiratory acidosis can occur (PaCO2 > 45)

90
Q

Hepatitis C risk

A

Born from mothers w/Hep C

Health care and public safety workers

Exposure

Multiple sex partners, history of STIs

IV/injection drug use

Recipient of blood products or organ transplant before 1992 or clotting factor concentrates before 1987

91
Q

Hep C teaching

A

Avoid risky behavior

Avoid multi-dose vials

Monitor cleaning, disinfection, and sterilization

Barrier precautions with blood or body fluids.

Use needleless IV and injection systems

Standard precautions

92
Q

Acute pancreatitis - lipase

A

In most cases, serum amylase and lipase levels are elevated within 24 hours of the onset of the symptoms (diagnostic)

93
Q

Cirrhosis – hematemesis

A

Hematemesis is a key assessment for liver disease

Interventions: Semi-fowler’s, give albumin

94
Q

CKD/ARF diet

A

High-protein, high-calorie diet

High carb

Avoid potassium or phosphorus (e.g., bananas, citrus fruits and juices, coffee)

95
Q

Hemodialysis – low BP

A

Withhold antihypertensive meds before dialysis to avoid hypotension

96
Q

Addison’s disease - glucose

A

Severe hypoglycemia can result from Addison’s

Administer IV glucose

97
Q

Cushing’s findings

A

HTN, hyperglycemia

98
Q

Diabetes insipidus & hypernatremia

A

Hypokalemia & hypernatremia are signs

Tx: Desmopressin (replaces ADH)

Fluid deprivation test

99
Q

Fractured left hip

A

Circulatory assessment consists of:

Peripheral pulses, color, capillary refill, and temperature of the fingers or toes

100
Q

Multiple sclerosis teaching

A

Scheduled toileting

Continence management

Self-catheterization

101
Q

Guillain Barre - Swallowing

A

Bulbar weakness can impair ability to swallow

Suctioning may be needed to clear airway

Assess for gag reflex and bowel sounds if resume oral feeding

Gastrostomy/NG tube placed if can’t swallow

102
Q

Fibromyalgia pathophysiology

A

Amplified pain sensation

CNS’s ascending & descending pathways (that regulate and moderate pain processing) function abnormally, turning up the “volume control setting” for pain

103
Q

Pilocarpine ophthalmic evaluation

A

Administered for glaucoma as a miotic drug

To assess for therapeutic effect: Check the intraocular pressure

104
Q

Chemotherapy teaching

A

Causes thrombocytopenia - increases risk for bleeding, use a soft toothbrush

Bone marrow suppression causes anemia, leukopenia, and thrombocytopenia

Anemia - low hemoglobin and hematocrit

105
Q

Macular degeneration pathology

A

The outer layers of the retina slowly break down, causing drusen to appear within the macula –> blurred vision, straight lines appear crooked

Use Amsler grid several times a week

Loss of central vision

106
Q

CVA visual perception

A

Blurred vision

Diplopia

Ptosis

107
Q

Well-differentiated cells

A

Resemble the tissue of origin, most likely benign

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