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S2 1533 > 1533 Final > Flashcards

1533 Final Flashcards

1
Q

Delirium Assessment

A

Confusion Assessment Model tool
CAM
Can be done without an order

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2
Q

Delirium can lead to

A

Changes in level of consciousness
Irreversible brain damage
Death

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3
Q

Delirium symptoms

A 
Stupor - hypoactive
Excessive activity - hyperactive
Disorganized thinking
Short attention
Hallucinations, delusion, fear, anxiety, paranoia
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4
Q

Dementia symptoms are -

Where as delirium symptoms are -

A

Long term onset

Acute onset

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5
Q

Because of unknown underlying causes, delirium is considered a

A

Medical emergency

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6
Q

Delirium prevention

A 
Reorienting
Early mobilization
Pain control
Good sleep
Enhance communication methods (hearing aids, glasses)
O2 levels 
Hydration
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7
Q

Delirium treatment

A

Fall prevention
Discontinue none essential meds
Monitor nutrition and fluids
Familiar environment ques like fam interaction

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8
Q

Haldol does NOT work for

A

Elderly with dementia

Has opposite effect

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9
Q

Dementia is -

Most common dementia is -

A

General decline in higher brain function

AD

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10
Q

3 Stages of AD

A

Preclinical - Minor forgetfulness, small difficulties
Mild Cognitive - Noticeable mild changes that can be measured, limitations in independent living start
Severe - Significant impairment of thinking, behavior and functioning independently

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11
Q

Medications for Alzheimer’s

A

Donepezil
Rivastigmine
Galantamine
(Anticholinesterase inhibitors)

Memantine
(Preserves memory)

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12
Q

Risk factors for Dementia/delirium

A 
Aging
Low education
Down syndrome
Family history
Smoking x2 to x4 fold increase
Obesity
Insulin resistance
Dyslipidemia - high level of lipids
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13
Q

Dyslipidemia

A

High level of lipids

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14
Q

Med good for hyperactive delirium

A

Haldol

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15
Q

Assessment for Alzheimers

A

Mini COG

Can be done without orders

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16
Q

Assessment for cognitive performance of the elderly

A

Mini Mental State Examination

MMSE

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17
Q

In elderly, cognition may be effected by

A 
Sensory impairment
Physiologic health
Environment
Sleep 
Psychosocial influence
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18
Q

Delirium

A

Acute confused state

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19
Q

Alzheimer Disease

AD

A

6th leading cause of death

Progressive degenerative neurologic disease

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20
Q

AD is most common in people over

A

65y/o

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21
Q

AD Patho

A

Neurofibrillary tangles - nonfunctional neurons

Neurotic plaque - deposits of amyloid protein in the brain

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22
Q

Reality orientation with AD

A

Who and where a person is in a time continuum, this will only WORSER mental/emotional state of AD patient due to increased anxiety

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23
Q

Nursing roles in AD

Supporting cognitive function

A 
Calm predictable routine
Simple explanations
Memory aids
Physical and verbal stimulation
Clock/calendar display
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24
Q

Therapies for Phobias

A

Cognitive Behavioral Therapy CBT
Group Therapy
Guided Mastery Therapy

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25
Q

Meds for phobias

A

Antidepressants SSRI
Paroxetine, fluoxetine

Tricyclic antidepressants imipramine

Monoamine oxidase inhibitors MOAIs

Benzodiazepines
Alprazolam
Clonazepam

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26
Q

SSRIs can increased suicidal thinking in patients age-

A

18-24

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27
Q

Benzos can lead to

A

Dependence

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28
Q

Anorexia Nursing interventions

A 
Establish trust and expression
Periodic weight
Encourage small frequent meals
PN/TPN
Assess bowels
Supervise patient during meal and 1 hour after
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29
Q

When anorexic patients eat they can develop refeeding syndrome
S/S are

A

Hypophosphatemia, hypokalemia, hypomagnesemia, fluid overload, edema.

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30
Q

Assess anorexic patients

A

electrolytes for refeeding syndrome

for suicidal ideations

for good sleep and energy

Weight

I&O

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31
Q

Selye’s General Adaptation Syndrome

GAS ARE

A

Alarm stage
Resistance stage
Exhaustion stage

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32
Q

Fetal alcohol spectrum disorder characteristics

A 
Small head
Short eye openings
Flat midface (cheeks)
Smooth philtrum (space under nose)
Underdeveloped jaw
Low nasal bridge
Epicanthal folds
Short nose
Thin upper lip
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33
Q

Fetal alcohol spectrum disorder characteristics

A 
Small head
Short eye openings
Flat midface (cheeks)
Smooth philtrum (space under nose)
Underdeveloped jaw
Low nasal bridge
Epicanthal folds
Short nose
Thin upper lip
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34
Q

Neonatal abstinence syndrome
NAS

occurs when mother takes

A 
Amphetamines
Barbituates 
Benzos
Cocaine
Marijuana
Opiates
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35
Q

NAS treatment is for drug dependence

A

Methadone

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36
Q

Antabuse

A

Disulfiram

Creates negative reaction to alcohol

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37
Q

NAS baby clinical manifestations

A 
Fussy/hard to calm 
Excessive sucking BUT poor feeding
High pitched cry
D/V
Trembling or jittery

Full withdrawal symptoms - muscle tone increase, seizures, breathing problems

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38
Q

Peripheral neuropathy
Alcohol myopathy
GI-itis

A

Complications of alcoholism

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39
Q

Wernicke’s encephalopathy
Korsakoff’s psychosis
Alcohol cardiomyopathy

A

Complications of alcoholism

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40
Q

Cirrhosis
Blood dyscrasia
Fetal alcohol syndrome

A

Complications of alcoholism

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41
Q

Legal intoxication level

A

Alcohol level over 0.08

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42
Q

Alcohol dependence is 4 times more likely in patients with

A

Mental illness

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43
Q

SIADH

A

Syndrome of inappropriate ADH (antidiuretic hormone)

TOO MUCH ADH

RETAIN WATER

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44
Q

SIADH lab values

A

Hypoosmolality
Urine concentration greater than 100
Natriuresis - NA in urine greater than 30

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45
Q

SIADH Symptoms

A

Fluid in lungs
Early - Cramps, N/V
Late - Confusion, seizers, coma

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46
Q

Hallmark of SIADH

A

Hyponatremia blood serum

Hypernatremia in urine

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47
Q

Hypernatremia symptoms

FRIED

A 
Fever
Restlessness
Increased fluids
Edema
Decreased urine, dry mouth
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48
Q

Hypernatremia can be treated with diuretics but diuretics an lead to

A

Hypokalemia

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49
Q

Potassium wasting diuretics

A

Furosemide

Hydrochlorothiazide

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50
Q

Potassium sparing diuretics

A

Spironolactone

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51
Q

is dehydration FVD

A

NO, dehydration is loss of water alone

INCREASE in electrolytes

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52
Q

in FVD unlike dehydration

A

Fluids AND electrolytes are lost and need replacement

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53
Q

Dehydration symptoms

A 
Dry mouth
Poor skin turgor
Low BP
High Na
High HR
Weight loss
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54
Q

Urine specific gravity

A

1.005-1.030

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55
Q

Creatinine and BUN normal

AND with dehydration

A

Creatinine 0.6-1.2 will be over 1.2

BUN 10-20 will be over 20

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56
Q

DI causes

A

Head injury
Pituitary tumor
Craniotomy

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57
Q

DI MOA

A

Pituitary gland shuts off ADH supply to kidneys

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58
Q

In DI, patients bodies cant stop peeing, as a result the symptoms will be

A 
BP decrease
Thirst Increase
Hypovolemia
Hypernatremia
Tachycardia
Urine Specific gravity low
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59
Q

Nursing care for DI

A

Monitor and replace fluids

Check neuro status, vitals, mucous membrane

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60
Q

DI water movement

A

Polydipsia
Polyuria
Nocturia

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61
Q

Meds for DI

A

Desmopressin ddAVP

Vasopressin

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62
Q

Because of incontinence, the elderly are reluctant to

best way to tell if a pt is dehydrated is

A

Drink enough water

Filling of veins in hands

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63
Q

COPD MOA

A

Chronic inflammation damages lung tissue causing scarring that narrows the airway

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64
Q

COPD associated complications

A

Chronic Bronchitis

Emphysema

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65
Q

COPD symptoms

A

Chronic cough
Sputum production
Dyspnea

Weight loss

Barrel Chest

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66
Q

COPD management

A 
Smoking cessation
Exacerbation management 
O2 therapy
Pneumococcal/influenza vaccines
Pulmonary rehab
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67
Q

Meds for COPD

A

Bronchodilators and Corticosteroids

Antibiotics
Mucolytics
Antitussives

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68
Q

Nursing management for COPD

A

Airway clearance
Breathing patterns
Activity tolerance

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69
Q

Asthma MOA

A

Chronic inflammation or mucous membrane and edema due to hyperresponsiveness

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70
Q

Asthma symptoms

A

Cough
Chest tightness
Wheezing
Dyspnea

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71
Q

Manifestations of asthma

A

Diaphoresis
Tachycardia
Hypoxemia
Cyanosis

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72
Q

Fast acting and long acting meds for asthma

A

Fast - fast beta 2 agonists
Anticholinergics

Long - long beta 2 agonists
Corticosteroids

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73
Q

Teach asthma patients to

A

Avoid triggers
Use inhaler
Monitor peak flow
When to seek aid

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74
Q

Gas exchange corticosteroid

A

Triamcinolone

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75
Q

Use bronchodilator _

Use Corticosteroid _

A

First

Second

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76
Q

Use mouth wash after

A

Corticosteroids

WILL cause thrush

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77
Q

Anticholinergics

A

Will decrease acetylcholine relaxing breathing

Ipratropium bromide

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78
Q

RSV children should be placed on what precaution

A

Droplet

Can be cohorted

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79
Q

To prevent RSV

A

Wash hands at day care and after exposure to individuals with cold symptoms

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80
Q

Hospitalize RSV child with what symptoms

A

Tachypnea
Retraction
Poor oral intake
Lethargy

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81
Q

Severe, continuous asthma that is unresponsive to meds

A

Status Asthmaticus

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82
Q

Diagnosing Asthma

A

Episodic symptoms of airflow obstruction
Airflow it at least partially reversible,
Other causes are excluded

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83
Q

Blood pH
PaCO2
HCO3

A

7.35-7.45
45-35
22-26

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84
Q

Metabolic acidosis

A

Bicarbonate less than 22
DKA
Kidney failure
Diarrhea

HYPERkalemia

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85
Q

Kusmaul breathing

A

Metabolic acidosis

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86
Q

Diamox

A

Decreases bicarb reabsorption
Treats metabolic alkalosis
Can cause metabolic acidosis

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87
Q

A/B of vomiting

A

Metabolic alkalosis

loss of H

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88
Q

Treat metabolic alkalosis with

A

Antiemetic
Stop suction
Stop diuretics “loop and thiazide especially”
Monitor ABGs

Give diamox

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89
Q

Flu symptoms
Hyperactive reflex
Confusion

A/B

A

Metabolic Alkalosis

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90
Q

Metabolic alkalosis S/S

A

Bradypnea Hypoventilation
under 12

HYPOkalemia
EKG changes

Tetany
Tremors
Muscle weakness
Fatigue

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91
Q

Metabolic acidosis s/s

A

Kusmaul breathing
Confusion
Weakness

Lob BP

N/V

HYPERkalemia

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92
Q

Respiratory acidosis S/S

A 
Neuro drop
Drowsiness, confusion, fatigue
Headaches
RR less than 12
Hypotension
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93
Q

Resp Acidosis interventions

A

Admin O2
Encourage cough
Deep breathing
Watch K

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94
Q

Respirator alkalosis s/s

A

Resp rate over 20
Confusion
Fatigue
Tachycardia

Tetany
EKG changes
Muscle cramps
Positive Chauvstics

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95
Q

Resp alkalosis interventions

A

Monitor lytes
Paper bag
Hold breath
Calcium gluconate for tetany

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96
Q

3Ps of Diabetes

A

Polyuria
Polydipsia
Polyphagia

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97
Q

Type 2 diab

A

Patient becomes insulin resistant due to high blood glucose over time

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98
Q

T2 diab risk factors

A

Diet
Lifestyle
Medication

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99
Q

A1C

A

Checks blood sugar for past 3-4 months

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100
Q

Brown thick skin on neck and armpits

A

Acanthosis nigricans

T2 Diab sign

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101
Q

Normal unfasted glucose value
Pre diabetic value
Diabetics value

A

70-115
NA
200+

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102
Q

Fasting glucose value
Fasted pre diabetic value
Fasted diabetic value

A

Less than 100
100-125
126+

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103
Q

A1C normal value
Pre diabetic value
Diabetic value

A

less than 5.7
5.7-6.4
Over 6.5

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104
Q

Sugar under 70 hypogly

A

Brain will die

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105
Q

Diabetic complications of kidneys

A

Nephropathy
Kidneys will DIE
creatinine over 1.2

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106
Q

Diabetic complications of nerves

A 
Loss of sensation
Sugar foot
Slow healing 
Retinopathy 
Blindness
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107
Q

Diabetic complications of heart and brain

A

HTN
Atherosclerosis

CVA
Stroke

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108
Q

Oral agents only work for _ diab

A

T2

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109
Q

PO drugs for t2 diab

Toxic to

A

Metformin
Glipizide Glyburide
Pioglitazone
Acarbose

Toxic to liver

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110
Q

for diabetics, avoid FOOT

A

Flipflops, high heels, nylon

OTC corn removal

Overly hot baths, use thermometer

Toe injuries, daily inspection, use mirror

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111
Q

NOs of diabetic foot care

A

NO callous removal
NO heavy powder
NO rubbing with hands
NO hot baths

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112
Q

Diabetic diet good

A

High fiber
Complex carbs

BROWN beans, rice, bread, peanut butter

Whole wheat/grain/milk

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113
Q

Diabetic diet bad

A 
Simple sugars
Soda 
Candy
White bread/rice
Juice #1 offender
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114
Q

Antithyroid meds

A

Methimazole
Propylthiouracil

Can cause hypothyroidism

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115
Q

Hypothyroidism symptoms

Low and Slow

A 
Weight gain, shot metabolism
Unable to tolerate cold
Goiter
Tiredness
Fatigue
Slow HR
Depression
Memory loss
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116
Q

Hypothyroidism

Skin

GI

Hair

A

Dry, rough, cold

Constipation

Thin brittle

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117
Q

Myxedema

A

Swelling of face and eyes

Hypothyroidism

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118
Q

Hypothyroidism risk factors

A

Women
middle to older age

Hashimotos
Iodine deficiency
Pituitary tumor

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119
Q

Hypothyroidism monitor

A

HR BP RR
Blood glucose
Weight

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120
Q

Meds for hypothyroidism

A

Levothyroxine
Liothyroinine
Lotrix

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121
Q

Hypothyroidism

how it is diagnosed

A

Under secretion of T3 and T4

Blood test for t3 t4 and TSH

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122
Q

INsulin

A

protein hormone made in pancreas

Puts sugar and potassium INto cells

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123
Q

In t2 diab pt becomes insulin _

A

resistant

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124
Q

Best t2 diab treatment

A

Diet Lifestyle Exercise

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125
Q

Insulin peaks =

A

plates

Give food

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126
Q

IV only insulin

A

REGULAR

Right in the vein

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127
Q

Clear days before cloudy days

A

Regular Clear insulin first

NPH Cloudy insulin second

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128
Q

RN of insulin

A

Regular first

NPH iNtermediate second

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129
Q

Best location for insulin injection

A

Abdomen
rotate daily

NEVER aspirate fat tissue

NEVER massage or hot compress

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130
Q

Insulin on sick days

A

Still give

Monitor closely

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131
Q

LONG Acting insulin

‘Old guys”

A 
NO peak
NO mix
SEPARATE syringes
Duration 24+h
NO risk of hypoglycemia
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132
Q

Detemir

gLARGine

A

Last all year
LARGe lasting

Long lasting insulins

133
Q

NPH insulin
Cloudy dudes
Always mixed up

A

iNtermediate
NEVER IV
Mix Clear to Cloudy
Duration 14+h

134
Q

NPH Insulin peak

A

4-12h

5-6 most dangerous

135
Q

Regular insulin

A

Goes right in
Ready to go IV
ONLY iv insulin
Duration 5-8h

136
Q

Regular insulin peaks

A

2-4h

137
Q

Rapid insulin

A

MOST DEADLY PRIORITY

15min onset

138
Q

Rapid insulin peak

A

30-90 min

139
Q

ASSpart
Lispro
Glulisine

A

Move you ASS
Lis time
Go Limosine

RAPID acting insulins

140
Q

Rapid acting insulin is given

A

DURING a meal
PT is eating

DONT give until food is delivered

141
Q

CSII

A

Continuous subcutaneous insulin infusion

Fewer swings

Nice even basal rate

142
Q

NPH insulin names have an _

A

N

Humulin N
Novolin N

143
Q

Regular insulin names have an _

A

R
Humulin R
Novolin R

144
Q

T1 diabetes

A

Body kills own pancreas cells
Body has no insulin
Autoimmune
Can be passed down genetically

PTs are insulin dependent FOR LIFE

145
Q

3Ms of metformin side efects

A

Minicam chance of hypoglycemia
Massive weight gain
Major liver and kidney toxicity

NOT for liver serosis or hypatitis patients

146
Q

Hold metformin for _ before_

because

A

48h
Cath lab

Contrast due and metformin will KILL kidneys

147
Q

GlipizIDE GlyburIDE

A

G heart may DIE
bad for heart

Hypoglycemia

Weight gain

Sun burn

Toxic for elderly

148
Q

Pioglitazone side effects

A

HF
Liver failure

edema

crackles

weight gain

149
Q

Acarbose side effects

A

Carb blocker

Flatus and diarrhea

Don’t give to IBS patients

150
Q

TPN complications

A

Hyperglycemia, may need insulin
GI atrophy
Dumping syndrome

151
Q

Sites to run TPN

A

Peripheral or Central line

152
Q

For TPN patients check blood glucose _ because is at risk of hyperglycemia.
May need to be put on _

A

q6h

insulin

153
Q

For home health TPN monitor

A

Lytes Daily

154
Q

TPN is a _ procedue

A

Sterile

155
Q

Parenteral nutrition indications

A 
Come
Preop
GI problems
Pancreatitis
Paralytic ileus
156
Q

Peripheral TPN site guidelines

A

Less preferred
No dextrose above 10
Less than 2 weeks

157
Q

Central TPN site guidelines

A

Preferred method
PICC
Percutaneous
Triple lumen

158
Q

TPN feeding rate

A

50ml/hr to start

100-125ml/hr as tolerated

159
Q

TPN too rapid symptoms

A

Hyperosmolarity

Headache
Nausea
Fever
Chills
Malaise
160
Q

TPN too slow symptoms

A

Rebound hypoglycemia

Confusion
Tremors
Hypotension
Tachycardia
Cool clammy skin
161
Q

TPN nutrition IVs always use _ to infuse at a _

change tubing _

A

Pumps
Constant

24h

162
Q

Nutrition maintenance

A

Keep refrigerated

Warm to room temp when giving

163
Q

With TPN monitor daily

A

Weight
Glucose
Temp
I&O

164
Q

With TPN monitor every other day

A

BUN
Ca
Mg

165
Q

With TPN monitor weekly

A 
CBC
Platelets
Prothrombin
AST ALT liver
Serum albumin
166
Q

Before starting TPN perform

A

Chest x-ray to verify placement

167
Q

What irritates peptic ulcers

A

NSAIDs
Acidic foods
Sodas

168
Q

Where can peptic ulcers happen

what is it

A

Anywhere in the digestive tract

Erosion of mucous membrane creating an excavation

169
Q

Peptic ulcer bacteria

A

H Pylori

170
Q

Peptic ulcer is caused by

A

NSAIDs
H Pylori

Alcohol, smoking, fam hist,

Zolinger-ellison too much stomach acid

171
Q

Peptic ulcer pain management

A

Tylenol
Antacids

NO NSAIDs

172
Q

With peptic ulcers monitor for

A

Anemia

Bleeding

173
Q

Keep a _ with peptic ulcers

A

Food diary

At least 72 hr

174
Q

Care for peptic ulcer pts in order

A

PAIN
ANXIETY
Nutritional imbalance
Knowledge deficit

175
Q

Best indicator of malabsorption

A

Low albumin

176
Q

Older adult nutrition requires

A

Fewer calories and more nutrient rich foods

177
Q

Excessive fluid intake tan lead to patient

A

Not eating enough

178
Q

Steotorrhea

A

Fat in stool malnutrition

179
Q

Transferrin level

A

Less than 100

Severe protein depletion

Malnutrition

180
Q

Low prealbumin and nutrition

A

Malnutrition

181
Q

Low BUN and nutrition

A

Malnutrition

182
Q

Normal albumin level

A

3.5-5.0

Less means malnutrition

183
Q

Most common complication of pregnancy

A

Gestational hypertension

184
Q

First question to ask hypertension PT

A

Fam history

185
Q

Gestational hypertension characteristics

A

No proteinuria

Systolic bp over 140 or diastolic over 90 after 20 weeks gestation

186
Q

In preeclampsia patient will have

A

Proteinuria AND hypertension symptoms

187
Q

Preeclampsia symtpoms

A 
Headache
Oliguria
Blurred vision
Edema
Thrombocytopenia
Rena failure
Cerebral disturbances
188
Q

How to cure preeclampsia

A

Give birth

189
Q

S3 heart sound indicates

A

Mitral regurgitation

Left side HF

190
Q

Murmur

A

Skip in pulse
do pulse for the full 60 sec for these patients

INDICATES MVP

191
Q

Mitral valve prolapse symptoms

A 
Atypical chest pain 
Palpitations
SOB
Dizziness
Syncope
192
Q

Mitral valve prolaps meds

A

Antiarrhythmics

CCB BB for pain

193
Q

Antiarrhythmics

A

Amiodarone
Flecainide

Help with MVP

194
Q

MVP consumables to avoid

A

Caffeine
Alcohol
Tobacco

195
Q

Meds containing these products can worsen MVP

A

Alcohol
Caffeine
Ephedrine
Epinephrine

196
Q

Mid systolic click

A

Indicates Mitral Valve Prolapse

197
Q

Calcium channel blocker med endings

A

ZemAmilDipine

198
Q

Calcium channel blockers calm the heart by

A

Dropping both HR and BP
Zem and Amil

Dropping only BP
Dipine

199
Q

CCB or calcium channel blocers

A

Count HR and BP, hold if HR below 60 or BP below 100 sys

Change positions slowly

Bad headaches

200
Q

Beta Blockers LOL endings

A

Atenolol

Block Beats

for LOw HR
and Low BP

201
Q

Beta Blockers are contraindicated in patients with

A

Resp distress

202
Q

BBBB of beta blockers

A

HR less than 60, BP less than 100, DO NOT GIVE

Breathing problems

Bad for HF- new edema, worsening crackles, rapid weight gain, new JVD

Blood sugar masking

203
Q

Digoxin

A

DIGs for deeper contractions
Does not affect BP
ONLY decreases HR

204
Q

ACE and ARBs

A

Act to lower BP only NOT HR

205
Q

ACE and ARB ending

A

ACE pril

ARB sartan

206
Q

ACE and ARBs side effects

A

Avoid Pregos
Angioedema Airaway risk ACE only
Cough Ace only
Elevated K

207
Q

Angioedema

A

Risk with ACEs only
Airway closure
Face and mucosa swelling

208
Q

AAA of ARBs and ACEs

A

Antihypertensive (lowers BP, NOT HR)
AVOID pregos and breastfeeding
ADDS Potassium, hyperkalemia

209
Q

Digoxin is a

A

TOXIN
Toxicity over 2.0 serum

K bellow 3.5 increases Dig toxicity

210
Q

1 Drug for acute or worsening HF

A

Diuretics
Lower BP

Furosemide
Spironolactone

211
Q

Post op Abdominal surgery non pharmacological pain management

A

Pillow splinting

212
Q

Wong-baker FACES scale

A

Pain scale

Adults and children as young as 3

213
Q

FLACC

A

Pain scale for young children

Face Leg Activity Crying Consolability

214
Q

CPOT

A

Modeled after FLACC

Used for PTs who can not self report in critical care

215
Q

When is pain worst after surgery

A

24-48h

216
Q

Post op pain is accompanied by

A

N/V

give Phenargan Reglan or Compazine

217
Q

Sickle cell pain symptoms

A 
Fussy
Crying
Pain
Fever
Swelling
218
Q

Sickle cell anemia symptoms occur at

A

6m, this is when fetal hemoglobin diminishes

219
Q

Tests for Sickle Cell Anemia

A

Dithionite - not precise

Hemoglobin Electrophoresis - PRECISE

220
Q

Sickle cell anemia pain management

A

Elevate hands and feet to promote blood flow
Warm compress
Remove restrictive clothing

Opioids Around The Clock

221
Q

Dactylitis

A

Inflammation of hands and feet with SCA

222
Q

Hydroxyurea

A

Used to treat SCA and cancer

Creates fetal hemoglobin

223
Q

Kidneys and SCA

A

Unable to concentrate urine

Hydration is a HIGH PRIORITY

224
Q

Renal Calculi Treatment

A

PAIN
1st intervention
Relieve pain

2 flush stones

3 strain all urine for stones

4 use ambulation to facilitate passage

NO BEDREST, WALK
NO MASSAGE, more damage

225
Q

Shockwave lithotripsy

A

Breaks up calculi

Blood and stones will be present

Bruising and pain normal

226
Q

PVD pain type

A

Neuropathic

227
Q

PVD meds

A

Gabapentin
Venlafaxine
Vicodin
Percocet

228
Q

PVD affects

A

ANYWHERE outside the heart

229
Q

PVD patient legs should be

A

eleVated

230
Q

PAD patient legs should be

A

hAnged

231
Q

Claudication

A

Calf pain
Sign of low O2
PAD

232
Q

PVD VEINY

A 
Voluptuous pulses
Edema
Irregular shaped sores
No sharp pain DULL pain only
Yellow and brown ankles
233
Q

PVD Risk factors

A

Smoking
Diabetes
Cholesterol
HTN

234
Q

Diagnosing PVD and PAD

A

Doppler ultrasound

Arterial Brachial Index

235
Q

For PAD you can apply a

A

Warm pad under the legs

236
Q

Antibiotics for diverticulitis

A

Broad spectrum

Flagyl
Cipro

237
Q

Diagnosing diverticulosis

A

Colonoscopy
Barium enema
CT scan W/contrast

238
Q

Diverticulitis

A

Inflammation of the diverticula

239
Q

If ruptured, diverticulitis can become

A

Peritonitis and sepsis

240
Q

Diverticulitis S/S

POUCH

A 
Pain LLQ
Observe bloating and blood
Unrelenting cramps
Constipation
High temp
241
Q

Diverticulitis nursing care focus

A

GI assessment

Diet regiment

242
Q

Initial phase of diverticulitis nursing care

A

NPO

Assess for peritonitis

Hydrate

Pain meds

243
Q

Diet for diverticulitis

A

HIGH FIBER

Fresh fruit and veg, oats, grains and beans

drink 2-3L a day

244
Q

Psyllium

Probiotics

A

Fiber supplement for diverticulitis

gut flora for diverticulitis

245
Q

Palpable mass
Lack of motility
NV
Backing up

A

Diverticulitis

EMERGENCY

246
Q

Peritonitis s/s

A 
Rebound tenderness
Muscle rigidity
Fast shallow breaths at rest
Distended abdomen
Ascites
Fever
247
Q

Neurogenic bladder

A

Nerve disfunction leading to incontinence

248
Q

Neuro bladder can lead to

A

Infection MOST COMMON
Renal calculi
Impaired skin
Urinary incontinence

249
Q

Neuro bladder edu

A

bladder retraining program

250
Q

Neuro bladder med

A

Bethanechol to help pee

Anticholinergics
Oxybutinine

251
Q

Neuro bladder eval

A

I&O
Residual volume
Urinalysis

252
Q

Neuro bladder intervnetions

A 
Emptying regularly
Intermittent cath
Low calcium diet
Ambulation
Increase fluid intake
253
Q

ID bowel obstruction with

A

Sigmoidoscopy

Colonoscopy

254
Q

Nursing treatment for bowel obstruction

A

Ambulate
Monitor I&O
Ensure tube placement
Auscultate

255
Q

IV fluids for bowel obstruction

A

Water
Sodium
Chloride
Potassium

256
Q

Large bowel obstruction assessment methods

A

X ray
CT
MRI

257
Q

Hyperresonance on percussion

A

mechanical obstruction finding

258
Q

Due to frequent vomiting with small bowel obstruction, the pt is at risk of metabolic

A

Alkalosis

Loss of H

259
Q

IV fluids for bowel obstruction

A

NS or LR with K

260
Q

With bowel obstruction check NG tube for

A

Coffee grounds or bright red color indicating blood

261
Q

Non surgical bowel obstruction treatment

A 
Fluid and lytes
NG suction
Antibiotics
TPN
Analgesics 
NO OPIOIDS
262
Q

To encourage return of peristalsis have the pt

A

Ambulate

263
Q

Most bowel obstruction occurs in the

A

small intestine

264
Q

Hyperactive bowel sounds

borborigmi indicates

A

Small bowel obstruction

265
Q

Since liquids can not go through digestive tract, small bowel obstruction will lead to

A

dehydration

lyte imbalance

266
Q

Nursing treatment for large bowel obstruction

A

Admin fluids/lytes
Auscultate
Maintain interventions like NG decomp

267
Q

BUN with bowel obstruction

A

HIGH dehydration

268
Q

Bowel obstruction pts are at risk of

A

Shock
Peritonitis
Venous thromboembolism

269
Q

WBC in bowel obstruction

A

Will be high

270
Q

DVT s/s

A 
Edema/swelling
warmth
cyanosis
pain
tenderness
increase in circumference
271
Q

DVT Diagnostics

A

Duplex venous ultrasonography

Plethysmography

MRI

Ascending contrast venography

272
Q

Prophylaxis for DVT

A

Heparin

Oral anticoagulants

Early mobilization

273
Q

DVT pulses

Skin

A

Weak, bounding

Warm, red, swollen, pain, parasthesia, cyanosis

274
Q

Prevention of blood clots and DVT

A

Walk
Compression stockings
Hydrate

275
Q

If DVT is suspected to become PE do this test

A

VQ scan

Lung perfusion ventilation scan

276
Q

DVT extremity should be

A

Elevated 10-20 degrees ABOVE heart

Have a warm, moist compress

277
Q

Measure DVT limb to check for

A

Compartment syndrome

278
Q

With DVT, clothing should be

A

Lose

279
Q

Injectables for DVT

A

Heparin

lmw heparin
Enoxaparin

280
Q

Oral meds for DVT

A

Warfarin

281
Q

What is used to disolve existing VTEs

A

Thrombolytics

t-PA

282
Q

Anticoagulants

A 
Aspirin
Clopidgorel
Warfarin
Heparin
Lovenox
283
Q

Antithrombotics

A

Activase

284
Q

for DVT heparin should be given in _ form

A

DRIP

285
Q

PT INR normal

PT INR with warfarin therapeutic

A

0.75-1.25 seconds

Therapeutic 2-3 seconds

286
Q

aPPT time normal

aPPT time on heparin

A

30-40 sec

1.5-2 TIMES the normal

287
Q

D-dimer test

A

Checks activity of thrombin and plasmin

Normal plasma does NOT have D dimers

288
Q

Heparin precaution

A

Give Calcium and D

289
Q

Normal clotting time

Clotting time on anticoagulant therapy

A

70-120 sec

150-600 sec

290
Q

Platelet count
Adult

Child

A

150,000-400,000

200,000-475,000

291
Q

Fibrinogen values

A

200-400

292
Q

To reverse warfarin give

A

Vit K

293
Q

To reverse heparin give

A

Protamine sulfate

294
Q

Warfarin onset

A

3-5 days

295
Q

Otitis media risk factors

A

Young age
Day care
History
Recurring upper resp infections

296
Q

tympanosclerosis

A

hardening of eardrum

result of Otitis media

297
Q

Diagnosing otitis media

A

Sign of fluid
Tympanic bulging
Ear pain
Inflammation

Otoscopy
Tympanometry

298
Q

Otitis media fam education

A

Waiting for symptoms to resolve on own
FINISH antibiotics
Follow up

Explain OME impact on hearing and speech

299
Q

Preventing Otitis Media

A

Breastfeeding for 6 to 12 m
No second hand smoke
Prevnar influenza vaccine

300
Q

Itching
Pain
Drainage
Fullness in ear canal

A

Otitis

301
Q

Pain management with otitis media

A

Acetaminophen
Ibuprofen
Sever - narcotics

Lie on affected side and place warm or cold compress

302
Q

Nursing goals for UTI

A

Eradicate infection
Promote comfort
Prevent recurrence

303
Q

Risk factors for UTI

A 
Female
Diabetic
Pregnant
Neuro disorder 
Gout
Calculi
304
Q

UTI in elderly 1st sign

A

Delirium

305
Q

Most common UTI bacteria

A

E.coli

306
Q

UTI can lead to

A

Pyelonephritis

307
Q

UTI prevention for women

A

Cranberry juice
Cotton underwear
Void after sex
Avoid tight pants

308
Q

Comp vs Uncomp UTIs

A

Comp - hospital acquired

Uncomp - community acquired

309
Q

Cellulitis

A

Bacteria enter SUBCUTANEOUS tissue

310
Q

Most common cellulitis bacteria

A

Streptococcus

Staphylococcus

311
Q

Cellutlitis s/s

A

Swelling
Localized redness
Warmth
Pain

Fever
Chills
Sweating
Tender lymph nodes

312
Q

Redness with cellulitis is

A

NOT uniform
Skips areas

Eventually becomes pitting range peal

313
Q

Nursing management of cellulitis

A

Elevate affected are 6 in above heart
Apply cool moist packs

Once inflammation is resolved use warm moist packs

314
Q

Osteomyelitis

A

Infection of bone

315
Q

Osteomyelitis types

A

Hematogenous - blood infection

Contiguous - contamination due to surgery

Vascular insufficiency - PVD, diab feet, most common

316
Q

Risks for osteomyelitis

A

Old age
Poor nourishment
Obesity

317
Q

Most common osteomyelitis bacteria

A

Staphylococcus aureus

318
Q

Osteomyelitis progression

A

Inflamation puss vascularity edema

as blood vessels lead infection to marrow

in 2-3 days
thrombosis ischemia and necrosis will occur

319
Q

Sequestrum

A

Dead bone tissue

Osteomyelitis

320
Q

Involucrum

A

Forms around sequestrum

Chronic osteomyelitis

321
Q

Osteomyelitis

Blood borne-

Adjacent -

Chronic -

Diabetic -

A

Will have sepsis that may mask symptoms
site will be painful swollen tender

Cross contamination, no sepsis
site will be painful swollen tender

involucrum/sequestrum
Non healing ulcer that drains pus

poor glycemic control and vascular problems lead to infection

322
Q

Diagnosing osteomyelitis

A

Xray
MRI
WBC
ESR

323
Q

Antibiotics for osteomyelitis are given

Supportive measures include

infected area should be

A

for a longer period of time 3 to 6 weeks

hydration, diet high in vit protein

immobilized

324
Q

Sprain

A

Injury to ligament and tendon that surrounds a joint

Twisting or hyperextension

325
Q

1st, 2nd, 3rd degree sprains

A

1st - mild
local hematoma
mild pain edema tenderness

2nd - moderate
edema tenderness pain with motion, joint instability

3rd - severe
avulsion of bone
severe pain, increased edema, abnormal joint motion

326
Q

Sprain treatment

A

PRICE (protection, rest, ice, compression, elevation)

Elastic compression bandages

If 3rd splint brace or cast

327
Q

For sprains cold packs are good for first

apply for no longer than

A

24-72 h

20 min

328
Q

with sprains monitor for increase in pain and decrease in motion/sensation may indicate

A

compartment syndrome

329
Q

With sprains monitor every
for first

then every

A

15m
1-2h

30min

S2 1533 (3 decks)

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