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Term 4 (PN) > 195 exam 2 > Flashcards

195 exam 2 Flashcards

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1
Q

What diet should a person w/ burns be on?

A

High calorie & high protein

Increased fluids

Increased vit. & minerals

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2
Q

What diet should a person Dx w/ hyperlipemia be on?

A

Low cholesterol & saturated trans fats

High fibers

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3
Q

What diet should a person w/ wounds be on?

A

High protien

Increased carbohydrates & fat

Increased fluid intake

Increase Vit (C) & minerals (Zinc/Iron)

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4
Q

What is the healing process of a wound based on?

A

Pattern

Type of wound

Severity of wound

Overall condition

Time it takes to heal

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5
Q

Begins as soon as wound / injury occurs

Blood platelets adhere to the walls of the injured vessel, a clot begins to form

Fibrin in the clot begins to hold wounds together & bleeding subsides

A

hemostasis (Termination of bleeding)

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6
Q

Initial increase in the flow of blood elements (antibodies, electrolytes, plasma protein) & water out of the blood vessel into the vascular space

Repair cells to move toward the wound site & causes cardinal

S/s of inflammation
* erythema (redness)
* Heat
* Edema (swelling)
* Pain
* Tissue dysfunction

Cells in injured tissue migrate, divide, & form new cells w/in 24-48 hours

As this ends, new cells & capillaries refill in the wound from the underlying tissue to the skin surface

A

Inflammitory Phase of wounds

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7
Q

Myofibroblasts produce collagen (glue like protein strengthening wound tissue)

Collagen formation increases rapidly between postoperative days 5-25

Wound fills w/ granulation tissue & takes on the appearance of an irregular, raised, purplish, immature scar
* wound dehiscence most frequent in this pase

A

Reconstruction / proliferation phase of wounds

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8
Q

Wounds in which skin edges are closed together and little tissue is lost
* minimal scarring

Begins during inflammatory phase of healing in surgery
* usually in closure of wound

A

Primary Intention of wounds

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9
Q

When a wound must gradulate during healing

Occurs when skin edges are not close together (approximated), or when pus is formed

Some wounds develope purluent exudate (fluid, cells, or other that have been excreted from cells or blood through small pores/breaks in skin)

Slowly necrotized tissue decomposes & escapes , & the cavity begins to fill w/ granulation tissue, or soft, pink, fleshy projections that consist of capillaries surrounding by fibrous collagen

A

Secondary intention

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10
Q

Practitioner leaves contaminated wounds open & closes it later, after infection is controlled, by suturing two layers of granulation tissue together in the wound
* occurs when a wond becomes infected , opened, allowed to granulate, & and then sutured

A

Tertiary intention

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11
Q

What nutritional needs should be monitored in a pt w/ wounds?

A

Protein

Carbs

Fats

Vitamins

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12
Q

What can you do for a client who is unable to tolerate large meals or solid foods?

A

Eat small frequent meals

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13
Q

What food class helps promote wound repair?

A

Protein
* Meats
* Peanut butter
* Legumes

Vit A
* Dark leafy veg.
* Yellow/orange fruits & veg.

Vit C
* Strawberries
* Tomatoes
* Spinach
* Broccoli, califlower, cabbage

Zinc
* Fortified cereals
* Red meat
* sea food

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14
Q

What are some interventions for a pt w/ a wound?

A

Encourage fluid intake of 2000-2400mL in 24hrs

Monitor I/Os
* until stable (48-72hrs)

Balance rest & activity

Encourage to move one body part at a time
* To sit up, pt should roll to the side, use elbow as lever, & push into sitting position

If coughing occurs, apply pillow, rolled blanket, or palms of hands to incision area and apply pressure (Splinting)

Monitor for malnutrition, & chronic disease (HTN, DM, arthritis)
* these add stress to body & need ongoing monitoring

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15
Q

Watery plasma that is mostly clear, but may have some pink/yellow tinge to it

Thin, composed of serum portion of blood

A

Serous drainage

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16
Q

Thick

Yellow/green/tan/brown drainage

Indicates infection

A

Purulent drainage

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17
Q

Pale

Red, watery

Mixture of serous & sanguineous drainage

Thin

Can occur on the day of surgery

A

Serosanguineous

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18
Q

Bright red

Indicates active bleeding

Can occurs on day of surgery

A

Sanguineous

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19
Q

Closed drainage system that uses a bulb to provide the needed vacuum

Have wide, flat areas that must be brought through stab wound w/ great foce

A

Jackson-Pratt drainage device

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20
Q

Used after removal of gallbladder (via open cholecystectomy), the bile duct often is inflamed & edematous
* Drainage tube goes into duct to maintain free flow of bile until edema subsides

Long end of tube inserted through abdominal incision or through seperate surgical wound

Tube drains by gravity into closed drainage system

Collection bag emptied & measure Q shift

A

T-Tube drainage system

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21
Q

Used to treat acute wounds (traumatic wounds, flaps, & grafts) & chronic wounds
* Functions by applying negative pressure to wounds

Healing of wounds if facilitated by increased blood flow, improved/ increased fluid drainage, & enhance wound closure as pressure draws wounds together

Accelerated wound healing by promoting granulation tissue, collagen, fibroblasts, & inflammatory cells to close completely/ improve confition for skin graft

Negative pressure removes fluid from surrounding areas, thus reducing local edema & improving circulation
* After 3-4 days bacteria count drops

A

Wound-Vacuum-Assisted Closure (Wound vac)

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22
Q

Heart is not as effiecient as it should be

Ventricle is loaded with blood to the point where the heart muscle contraction becomes less efficient

Labs:
* CBC, MP
* Cardiac enzymes
* T3/T4, TSH
* C-reactive protein (If infection is suspected)
* B-type natrietic peptide (BNP)
* N-terminal pro b-type natiuretic peptide (NT-proBNP

A

Heart Failure

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23
Q

Often the choice for management of a wound w/ little exudate or drainage, such as abrasions and nondraining postoperative incisions

Keeps initial bleeding to a minimum & protects wounds from injury

Prevents introduction of bacteria, reduces discomfort, & speed healing

Prevents deeper tissues fromm drying out by keeping the wound surface moist

If dressing adheres to a wound, moisten dressing w/ sterile normal saline solution or sterile water before removing the gauze

A

Dry Dressing

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24
Q

Most appropriate for wounds that do not have significant amounts of ischemic or necrotic tissue or large amounts of drainage or exudate

Purpose is to keep wound bed moist or provide mechanical debridement
* Used NS & LR (Isotonic solutions)

A

Wet-to-dry dressing

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25
Q

Gentle washing of an area with a stream of solution delivered through an irrigating syringe

Benefits include cleansing & medication

Soulutions include topical cleansers, antibiodics, antifungals, antiseptics, & anesthetics
* Most common is NS solution

Promotes wound healing by removing debris from the wound surface, decreasing bacterial counts,
& loosening/removing eschar

A

Irrigation

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26
Q

What does the principles of basic wound irrigation include?

A

Cleansing in direction from least contaminated area to most contaminated

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27
Q

What are some complications of wound healing?

A

Abscess: contains pus & surrounds inflammed tissue

Adhesion: Scar tissue that binds 2 anatomic surfaces
* Most commonly found in the abdomen

Cellulitis: Infection of skin characterized by heat, pain, erythema, & edema

Dehiscence: Seperation/rupture of surgical incision or wound
* Sometimes preceded by serosanguineous drainage

Evisceration: Protrusion of internal organ through a surgical incision or wound

Extravasation Passage/escape into tissues
* Usually blood, serum, or lymph

Hematoma: Collection of extravasated blood trapped in the tissues or organ that results from incomplete hemostasis after surgery/injury

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28
Q

What are nursing interventions for Evisceration (Medical emergency)?

A

Remain w/ pt & notify HCP

Place pt in low fowlers position w/ knees slightly flexed
* Relieves pressure wounds, prevents dehiscence of the wound edges, & reduces the risk of further evisceration

Cover protruding organ w/. saline dressing moistened w/ sterile NS

Monitor closely & assess vitals
* Pulse ox readings determine if the pt is showing signs of shock

Keep NPO for surgery

Reassure the pt & family because occurance if frightening

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29
Q

Interventions for dehiscence

A

Bed rest

NPO

Encourage pt not to cough

Place warm, moist, sterile dressing over area until seen by surgeon

Provide reassurance

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30
Q

What are some cardiovascular changes w/ aging & their results?

A

Decreased cardiac o/p:
* Increased risk of HF
* Decreased peripheral circulation

Decreased elasticity of heart muscle & blood vessles:
* Decreased venous return
* Increased dependent edema
* Increased risk of orthostatic hypotension
* Increased risk of varicosities & hemorrhoids

Increased atherosclerosis:
* Increased BP
* Increased MI

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31
Q

What other Dx does HTN contribute too?

A

CAD

Stroke

HF

PVD

Renal failure

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32
Q

What are nursing interventions for a pt having dysrhythmias?

A

Monitor vitals

Note rate, regurality, & strength of pulse

Monitor I/O

Observe & report reaction to meds

Keep stress to a minimum
* Balance rest & activity

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33
Q

What interventions would you provide a pt w/ CAD?

A

Assess knowledge & understanding of disease process
* Discuss Dx, s/s, & potential complications

Explain purpose, dosage, side effects, & special effects of meds

Assess modifiable cardiac risk factors

Assess diet:
* Intake, intake of processed/canned foods
* Salt intake

Exercise:
* 150 min/week

Obesity:
* Manage caloric intake

Smoking:
* Avoid tobacco
* Avoid second hand smoke

Identify source of stress & sleeping habits

DM

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34
Q

What interventions would you provide a pt w/ COPD?

A

Ask if smoker
* if so, how many packs a day

Assess lung sounds
* Diminished
* Crackles, wheezes
* Barrek chest d/t increased anteroposterior diameter

Pulmonary hygiene, breath retraining

Meds, exercise

chest physiotherapy (CPT)

Smoking cessation

Encourage fluids, deep breathing exercises, & pured -lip breathing

Education on lifestyle changes

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35
Q

What lab should you draw if an Infection is suspected in a post-op pt?

A

Culture of any drainage taken before antibiodics

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36
Q

What interventions would you perform for a pt w/ inadequate oxygenation?

A

Prevent pneumonia & atelectasis by frequent position changes & deep breathing

Instruct pt to breath through the nose & gradually blow out of the mouth

Use incentive spirometer 10x/hr
* Ball rises w/ inhale

Splint when coughing

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37
Q

What are some S/s of diverticulitis?

A

Often asymptomatic

Changes in bowel habits
* Constipation
* Diarrhea
* Periodic bouts of each

Rectal bleeding

Pain in left lower abdomen

N/V

Urinary problems

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38
Q

Elevated BP
* Confirmed by repeat BP findings averaging 140/90mm Hg or higher

Most serious complications include MI, HF, stroke, kidney disease & blindness
* Assess more frequently

S/s:
* Occipital headaches (more severe when arising)
* Lightheadedness, blurred vision
* Epistaxis (nosebleeds), “Silent killer”

emergency crisis: 180/100

Tx:
* Monitor vital (esp. BP)
* EKG
* Blood studies: Glucose, Hct, K, Ca, Cr, Liped profile
(Elevated Cr = kidney damage, abnorm serum lipids & lipoprotein may indicate artheroscleosis)
* CXR (May show enlargment of heart/pulmonary blood vessels)
* Education on weight reduction, smoking cessation, Na & alcohol reduction, exercise, & relaxation techs.
* Education on Dietary Approaches to Stop HTN (DASH diet - Fruit/veg, whole grains, low fat dairy)
* Medications (Beta-blocker, ACE inhibit., Thiazide/Diuretics, ect)

A

HTN

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39
Q

protein hormone synthesized in the pancreas that regulates blood sugar levels by facilitating the uptake of glucose into tissues

Rotate injection site to prevent lipohypertrophy & lipoatrophy
- DO NOT massage
- Heat & exercise increase absorption rate

lowers blood glucose

AKA “beta cells”
- acts as key that allows sugar into the cell

A

Insulin

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40
Q

Elevated BS (>100)
- occurs in type 2 DM
​
Can result from:
- Insufficient insulin production / secretions
- Deficient hormone signaling
- Excessive counterregulatory hormone secretion
​
S/s: (Think “FLUSHED”)
- F: Flushed skin/ fruit like breath (acetone)
- L: Listless/ lethargic
- U: Unusual thirst, hunger,urine o/p (3 p’s)
- S: Skin warm/ dry, poor wound healing
- H: hyperventilation (kussmaul RR - deep/rapid breathing)
- E: Emesis, increased N/V ( late findings)
- D: Drowsiness, decreased appetite (N/V)

A

Hyperglycemia

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41
Q

BS less than normal (<70)
- occurs in type 1 & 2

S/s:
- Tremors, tachycardia
- Clammy skin, cold
- Alt consciousness, irritability
- Hunger
- seizure/ stroke like s/s
- diaphoresis
- Apathy (severe lethargy)

Can result from:
- Insufficient intake
- Adverse reaction to meds
- Excessive exercise

A

Hypoglycemia

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42
Q

What are some diagnostic testing for diabetes?

A

Glucose screening:
- Fasting (> 100 and < 126 = prediabetes)
- GTT (Detects early Diabetes)
- Glycosylated hemoglobin (HgbA1c; below 7%)

Antibody testing:
- Glutamic acid decarboxylase (GAD ; most common)
- C-peptide

lipid analysis:
- Triglycerides, HDL, LDL

Renal function tests:
- BUN/Cr, albumin in urine,

C-reactive peptide

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43
Q

What is the lab value for cholesterol?

A

< 200 mg/dL

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44
Q

What is the lab value for HDL?

A

Males: > 45mg/dl

Females: > 55mg/dl

(want high)

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45
Q

T/F: When glucose levels are high, triglyceride levels will also be high

A

True
- Triglycerides are general reflection of glycemic control

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46
Q

What is the lab value for LDL?

A

< 70 mg/dL

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47
Q

What is the lab value for triglycerides?

A

<150 mg/dL

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48
Q

What is the lab value for C-reactive protein?

A

< 1.0 mg/L

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49
Q

Lispro (Humalog)
Aspart (Novolog) - Given AC

Clear insulin; most common

Given before pt eats

Onset: 10-30 minutes
Peak: 2hrs
Duration 3-5hrs

A

Rapid insulin

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50
Q

Humulin R
Novolin R

Clear

Only insulin able to be administered by IV
- Takes longer to kick in

Onset: 30min-1hr
Peak: 2-3hrs
Duration: 5-8hrs

A

Short/ Regular insulin

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51
Q

Humilin N
Novolin N

Cloudy; roll to mix

Onset: 2-4hrs
Peak: 4-12hrs
Duration: 12-16hrs

A

Intermediate Insulin/ NPH

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52
Q

Glargine (lantus) - give seperatly
Detemir (levemir)

Clear; given in AM/PM

Onset: 1hr
Peak: N/A
Duration: up to 24hrs

A

Long acting insulin

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53
Q

T/F - You should not mix short and rapid insulin together

A

True

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54
Q

Anticoagulant (blood thinner)
- PO
- vitamin K antidote

action:
- interferes with blood clotting

side effects:
- nausea, rash, anemia, ect

adverse effects:
- hematuria and hemorrhage

Lab: INR 2-3 (Give if below 2, hold if above 3)

BBW: monitor for bleeding

A

Warfarin (Coumadin)

55
Q

The nurse educates a client with diabetes on proper use of insulin glargine. The nurse determines further education is needed after which client statement?

A.) “I will rotate injection sites on my abdomen.”

B.) “I will use a sliding scale to determine my dose.”

C.) “I will throw out an opened vial after 28 days.”

D.) “I will keep my opened pen at room temperature.”

A

B.) “I will use a sliding scale to determine my dose.”

Explanation: Sliding scale doses of insulin are for short- or rapid-acting insulins only. Long-acting insulins like glargine are not dosed using a sliding scale

56
Q

The nurse triages a client with a history of type 1 diabetes who reports abdominal pain, nausea, weakness, and thirst. Fruity odor on the client’s breath is noted. A bedside glucose check shows the client’s blood sugar is 323 mg/dL (17.9 mmol/L). The nurse prepares for which drug therapy?

A.) Insulin detemir

B.) Insulin degludec

C.) Regular insulin

A

C.) Regular insulin

57
Q

A patient has impaired glucose tolerance, high serum insulin hypertension elevated triglycerides low high density cholesterol and altered size and density of low density lipoproteins (LDL) cholesterol’s. Which disorder is associated with these characters?

A.) Retinopathy
B.) Neuropathy
C.) metabolic syndrome
D.) macrovascular syndrome

A

C.) metabolic syndrome

58
Q

a medical condition associated with a group of metabolic risk factors
- obesity, diabetes (T2) , high cholesterol, hypertension, heart disease, and stroke

Precursor to Diabetes

Pts often have:
- Impaired glucose tolerance
- insulin resistance, hyperglycemia
- HTN
- Low HDLs, elevated triglycerides
- Altered size (large waist) & density of LDL

Treatment :
-weight loss, dietary & lifestyle changes
-reduce sugar & refined grains

A

metabolic syndrome

59
Q

What is the lab value BUN an indicater for?

A

Kidneys ability to excrete urea (end product of protein metabilism)
* Nephrotoxic drugs, high protein diet, GI bleed, dehydration, MI, shock, burns, & sepsis

Lab value: 10-20

60
Q

Waste product of skeletal muscle breakdown
* Renal function test

Not influenced by diet, hydration, nutritional status, or liver function

Lab value: 0.6-1.2

A

Cr

61
Q

How will electrolytes be effected for a pt Dx w/ renal failure?

A

Na & K levels are elevated & Ca levels are decreased

62
Q

What is the normal Hemoglobin level?

A

12-18 combined

M : 14-18

F : 12-16

63
Q

Build up of waste in blood makes it hard for kidneys to keep correct fluid balance

Arteries in renal parenchyma become narrowed d/t artherosclerosis, HTN, nephrosclerosis, or blood components (sickled RBC,Hgb or myoglobin)

S/s:
* fluid retention/ hypovolemia
* SOB, cp or pressure
* Irregular heartbeat
* edema lower extremities
* Change in urine o/p
* systolic bp > 70mm Hg

Labs/ Tests:
* UA, BUN/Cr
* CBC
* Kidney biopsy
* GFR
* Ultrasound, CT/MRI, X-ray

A

Acute Renal Failure

64
Q

What nursing interventions/ treatements will you anticipate for renal failure?

A

Fluid restriction, direct restriction
* IV fluids w/ dopamine, furosmide, or both (loop diuretics)

Restore electrolyte imbalance
* restrict Na, K & phos intake (give kayaxelate)
* Place on cardiac monitor
* Hemodialysis
* Diet individualized by electrolyte imbalance

Avoid nephrotoxic drugs

Prevent FVO
* monitor for crackles, cyanosis, increased RR, ect.

Continuous Renal Replacement Therapy

Daily weight
* Same time, same scale, same clothing types, ect.

Monitor s/s related to immobility (constipation, skin breakdown)

65
Q

Kidneys damaged & cannot propperly filter blood
* progressive destruction of nephrons of both kidneys that is describes in stages 1-5
* Develops slowly

Excess fluids and waste from blood remain in body causing other problems (heart disease, stroke)

Cr clearance is important
* < 15 = stage 4, severe funtion loss

S/s:
* Elevated BUN/Cr
* Elevated serum K (hyperkalemia, hypocalcemia, high phosphate)
* Decreased GFR
* increased BP
* High LDL
* Polyuria leading to oliguria
* Change ins Sp. Grvty d/t decreased ability to concentrate urine
* hypernatremia
* Hypervolemia

Labs:
* BUN/Cr
* UA
* ultrasound, CT/MRI, X-ray
* CBC
* Metabolic panel

A

Chronic Kidney disease

66
Q

What are the most common causes of Chronic Kidney disease?

A

HTN

DM

Artherosclerosis

67
Q

loop diuretic - po, IV,IM

potassium wasting
* Give if K is high
* Inhibits reapsorption of Na

used for worsening crackles, new edema in the legs, edema w/ HF, rapid weight gain, pulmonary edema, hepatic disease, renal failure, & cirrhosis of the liver

monitor BUN & Cr

only give if K+ is in range

Adverse reactions:
* hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia
* thrombocytopenia
* orthostatic hypotension
* rash
* ototoxicity and deafness
* dehydration

A

furosemide (lasix)

68
Q

opioid analgesic and vasodilator - PO/IV/IM

used to treat severe pain, sedation, & cancer pts
* narcotic drug derived from opium

Monitor for resp. depression

Controlled substance

A

morphine

69
Q

anticoagulant - SubQ

used to prevent the extension and formation of clots by inhibiting factors in the clotting cascade and decreasing blood coagulability
* Prevents DVT, PE in hip/knee replacements

monitor for hemorrhage

side effects & adverse effects:
* hemorrhage
* hematuria
* epistaxis
* ecchymosis, bleeding gums
* thrombocytopenia
* hypotension

A

Enoxaparin (Lovenox)

70
Q

How can you dx HTN?

A

CXR

EKG

71
Q

What are some tests you could run to determine the level of HF?

A

BUN

Cr

Electrolytes
* sodium (Na)
* calcium (C)
* magnesium (Mg)

EKG

CXR (Chest X-ray)

72
Q

Chronic pulmonary disease/ disorder

pressure from fluid buildup and causes backflow of fluids to the right ventricle
fluid backs into venous system/ rest or body

S/s:
* coughing, wheezing
* SOB when lying flat
* dizziness
* fluid retention
* hepatomegaly
* peripheral edema

A

right sided heart failure

73
Q

occurs when the heart loses its ability to pump blood
* prevents organs from receiving enough oxygen
* affects pulmonary (edema)

S/s: (pulmonary symptoms)
* Decreased cardiac output
* Dyspnea, orthopnea
* Wheezing
* pink sputum
* Crackles
* SOB when exercising or sleeping

A

Left sided heart failure

74
Q

Anemia caused by inadequate iron intake (most common)
* take vitamin C to help absorb iron

S/s:
* brittle nails
* pallor
* dyspnea
* tachycardia
* glossitis (inflammation/ burning tongue)
* Cheilitis (inflammation of lips)

Dx/Tx:
* CBC (decreased Hgb & O2)
* Bone marrow aspiration
* Stool sample, colonoscopy, endoscopy (check for blood)
* *treat cause/ iron supplements *
* increase fluids (use straw to prevent staining)

A

iron deficiency anemia

75
Q

Vitamin B12 deficiency
* treatment: B12 injections

causes:
* hypoparathyroidism
* graves disease
* crohn’s disease
* celiac disease
* medications

S/s:
* weight loss
* fatigue, weakness
* loss of balance

A

pernicious anemia

76
Q

What happens if you put on a BP cuff that is too big &/or too small?

A

BP cuff that is too small = false high BP

BP cuff that is too big = false low BP

77
Q

T/F - If a patient has been in atrial fibrillation for more than 48 hours, anticoagulation is needed prior to a cardioversion due to blood clot risks.

A

True

78
Q

Rapidly progressive hypertension that can cause life-threatening damage to small arteries in major organs

Diastolic pressure is usually >140 mm Hg

life-threatening organ damage
- treatment based on severity

S/s usually don’t occur until vascular changes occur in the heart, brain, eyes, or kidneys

A

malignant hypertension

79
Q

chaotic, rapid electrical impulses in the atria
* irregular/no P wave - has QRST wave
* 100-150 BPM
* Increases stroke risk
* most common

causes:
* HTN, MI, HF
* CHD, COPD

s/s:
* Palpitations, pulse deficit
* hypotension
* SOB, CP
* fatigue
* tachycardia
* possible stroke

treatment:
* prevent thrombi (warfarin/ anticoagulants - bleeding precaution)
* restore normal rhythm
* synchronized cardioversion/ D-fib
* Count apical pulse for 1 min

A

arterial fibrillation (AFib)

80
Q

What labs should you monitor for a patient who has anemia?

A

Hgb

81
Q

Your patient has a potassium level of 6, what do you do?

A

Give spironolactone (Aldactone)

82
Q

What do you monitor for while taking lovenox?

A

Bleeding

D-dimer

83
Q

What type of precautions is C- Diff and what type of PPE do you need?

A

Contact

gown & gloves

84
Q

genetic disorder that causes abnormal hemoglobin, resulting in some red blood cells assuming an abnormal sickle shape

interventions:
* Hydration
* Oxygen
* Pain management (opioids)

A

sickle cell anemia

85
Q

What diet should a patient with pernicious anemia be on?

A

high protein diet
* meat
* eggs
* dairy

86
Q

what do you suspect is the problem with your pt complaining of being tired, weak, their skin is itchy and they have a dusky gray color to their skin?

A

Chronic Renal Failure

87
Q

which protein choice would align with Dietary Approaches to Stop Hypertension (DASH) eating plan?

A) 12 oz ribeye steak, grilled
B) 3 oz wild salmon, grilled
C) 8 Oz hamburger w/ cheese
D) 12 hot wings w/ skin and hot sause

A

B) 3 oz wild salmon, grilled

Explaination: DASH diet emphasizes lean sources of protein including poultry, fish, nuts, low-fat dairy, & lean red meats.

88
Q

What can cause hypercalcemia?

A

Malignancy

Hyperparathyroidism

Excessive calcium intake

89
Q

low potassium
* Below 3.5

Causes:
* GI loss, renal loss, diuretics
* Increased perspirations, NG suctioning
* V/D/laxatives
* Excessive use of glucocorticoids, poor dietary intake

S/s:
* Fatigue
* Metabolic alkalosis
* N/V/A, increased sensitivity to digitalis
* ECG changes (ventricular tachycardia and ventricular fibrillation/ can lead to death)

Treatment:
* Salt substitutes
* Dysthymia monitoring
* Increase perspiration (mild loss)

A

Hypokalemia

90
Q

high potassium
* Above 5

rare in patients with normal renal function

causes:
* Decreased urinary excretion of potassium (renal failure/disease)
* Movement of potassium from the cells (ICF) to the ECF (burns/ crushing injuries)

S/s:
* cardiac rhythm issues (asystole)
* muscle weakness, flaccid paralysis
* N/D

treatment:
* treat underlying cause
* discontinue potassium supplements
* IV calcium gluconate, IV sodium bicarb
* Albuterol/ salbutamol, kayexalate (NG/ retention enema/ PO)
* regular insulin
* hypertonic dextrose IV
* dialysis

A

Hyperkalemia

91
Q

excessive calcium in the blood
* above 10

may be due to malignancy, hyperparathyroidism, or excessive calcium intake

treat pt by handling the pt gently to prevent fractures, avoid high calcium foods, and drink more water

A

Hypercalcemia

92
Q

What are some Causes of Metabolic Alkalosis?

A

Vomiting

Suctioning

hypokalemia

93
Q

What are some Causes of Metabolic Acidosis?

A

diarrhea

renal failure

Diabetic Ketoacidosis

Shock

Sepsis

94
Q

What are some Causes of Respiratory Acidosis?

A

sleep apnea

head trauma

opioid overdose

COPD

pneumonia

95
Q

Antibiotic; fluoroquinolone (bacterial infections)

BBW: Tendon rupture, Increased risdk when used w/ corticosteroids

can cause prolonged Q-T intervals
- danger of prolonged Q-T interval can put heart at an increased risk for cardiac dysrhythmeias (even deadly ones)

A

Ciprofloxacin (Cipro)

96
Q

Solution of choice for dehydration
- used frequently in surgery

Check compatibility - has many substances in it:
- dextrose, Na, Cl, K, & Ca
- does not have enough Na or Ca to correct deficiencies in these electrolytes

Do not use if lactate levels are elevated

A

Lactated Ringers (LR)

97
Q

Are the following Isotonic, hypotonic or hypertonic solutions?

0.225% NaCl

0.455 NaCl

0.35 NaCl

Dextrose 2.5% in water

A

Hypotonic solutions

98
Q

an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof

Do not always occur because of an error
- Not all error result

Reported to joint commision

Most frequent sentinel events:
- falls
- wrong patient, site, or procedure
- unintended retention of foreign body
- delay in treatment
- suicide
- operative/ post-op complications

A

Sentinel events

99
Q

What are the PN IV therapy Can Do’s?

A

Initiate/ maintain fluids

Hang initial bag IVPM antibiotics

Hang 2nd bag of vitamins/ electrolyte solutions

Prepare & reconstitute IV antibiotics with normal saline/ heparin

Can maintain/ regulate as IV infusion according to prescribed flow rate

Change tubing used

Place peripheral IV on adults, Can care for adults (18+)

100
Q

What is the most serious symptom of hypocalcemia?

A

laryngospasm
- treat with oral/ IV supplements

101
Q

Ph 7.1 PCO2 49 HCO3 26 PO2 70

Example: Pt has pneumonia

A

respiratory acidosis

102
Q

Ph 7.0 PCO2 50 HCO3 28 PO2 67

Pt has an acute exacerbation COPD

A

respiratory acidosis

103
Q

A patient is post-op from knee surgery. The patient has been receiving Morphine 4 mg IV every 2 hours. You notice the patient is exhibiting a respiratory rate of 8 and is extremely drowsy. Which of the following conditions is the patient at risk for?

A. Respiratory acidosis
B. Respiratory alkalosis
C. Hypokalemia
D. Metabolic acidosis

A

A. Respiratory acidosis

104
Q

Ph 7.49 PCO2 46 HCO3 30 PO2 90

Example: Pt has been vomiting for 2 days

A

metabolic alkalosis

105
Q

Ph 6.9 PCO2 30 HCO3 19 PO2 98

Example: Pt has a bs of 503, ketones in the urine

A

metabolic acidosis

106
Q

Respiratory alkalosis can affect other electrolyte levels in the body. Which of the following electrolyte levels can also be affected in this condition?

A. Calcium and sodium levels
B. Potassium and sodium levels
C. Calcium and potassium levels
D. Potassium and phosphate levels

A

C. Calcium and potassium levels

107
Q

A patient is experiencing respiratory alkalosis. What is the most classic sign and symptom of this condition?

A. Bradypnea
B. Tachypnea
C. Bradycardia
D. None of the options are correct

A

B. Tachypnea

108
Q

Which of the following is not a cause of respiratory acidosis?

A. Pulmonary edema
B. Asthma
C. Chronic obstructive pulmonary disease (COPD)
D. Hyperventilation

A

D. Hyperventilation

109
Q

low level of calcium in the blood (below 8)

hypoalbuminemia is the most common

S/s:
* Tenany, muscle cramps
* + trousseau and + chvostek signs
* cardiac dysrhythmias, seizures
* laryngospasm (most dangerous symptom)

treat with oral or IV supplements

A

hypocalcemia

110
Q

Are the following Isotonic, Hypotonic, or Hypertonic solutions?

Normal sodium chloride(0.9% NaCI)
D5W ( Dextrose 5% & water
LR (Lactated ringers)
Dextrose 5% and 0.225% NaCI
Albumin 5%

A

Isotonic

111
Q

Are the following Isotonic, hypotonic or hypertonic solutions?

Dextrose / sodium chloride (D5/NS)
Dextrose 5% and LR (D5/LR)
Dextrose and 0.45% NaCI (D5 & 1/2 NS)
TPN (Total Paternal Nutrition)
Albumin 25%

A

Hypertonic

112
Q

LPN can administer what solutions?

A

D5W
D5/LR
D5/NS
NS
LR
1/2 NS
1/4 NS

113
Q

What are some Causes of Respiratory Alkalosis?

A

panic attack

fast resp rate

114
Q

When can an LPN change a PICC/CVC dressing?

A

If the patient is 18 or older

115
Q

Solution of choice for trauma (except burns)

Compatible with most solutions/ meds

Used to hang blood products & flush CVCs and PICC lines

Can lead to circulatory overload

A

Normal Saline (NS)

116
Q

Prolonged _______________ can lead to the development of acute renal failure.

A) hypervolemia
B) hypokalemia
C) hypovolemia
D) hyperkalemia

A

C) hypovolemia

117
Q

pH 7.28 , PCO2 54, HCO3 34

A) Respiratory acidosis, partially compensated
B) Metabolic acidosis, fully compensated
C) Respiratory alkalosis, compensated
D) Metabolic alkalosis, uncompensated

A

A) Respiratory acidosis, partially compensated

118
Q

pH is abnormal and either CO2 or HCO3 is abnormal

A

Uncompensated

119
Q

pH, CO2 & HCO3 values will be abnormal

A

Partially compensated

120
Q

pH is normal PaCO2 & HCO3 abnormal

A

Fully compensated

121
Q

pH 7.22 , PCO2 44 , HCO3 17

A) Respiratory acidosis, compensated
B) Metabolic acidosis, uncompensated
C) Respiratory alkalosis, partially compensated
D) Metabolic alkalosis, fully compensated

A

B) Metabolic acidosis, uncompensated

122
Q

pH 7.49 , PCO2 30 , HCO3 17

A) Respiratory acidosis, compensated
B) Metabolic acidosis, uncompensated
C) Respiratory alkalosis, partially compensated
D) Metabolic alkalosis, fully compensated

A

C) Respiratory alkalosis, partially compensated

123
Q

pH 7.36 , PCO2 49 , HCO3 28

A) Respiratory acidosis, fully compensated
B) Metabolic acidosis, uncompensated
C) Respiratory alkalosis, partially compensated
D) Metabolic alkalosis, compensated

A

A) Respiratory acidosis, fully compensated

124
Q

pH 7.44 , PCO2 50, HCO3 31

A) Respiratory acidosis, compensated
B) Metabolic acidosis, uncompensated
C) Respiratory alkalosis, partially compensated
D) Metabolic alkalosis, fully compensated

A

D) Metabolic alkalosis, fully compensated

125
Q

pH 7.46 , PCO2 44, HCO3 29

A) Respiratory acidosis, compensated
B) Metabolic acidosis, fully compensated
C) Respiratory alkalosis, partially compensated
D) Metabolic alkalosis, uncompensated

A

D) Metabolic alkalosis, uncompensated

126
Q

pH 7.25 , PCO2 30, HCO3 15

A) Respiratory acidosis, fully compensated
B) Metabolic acidosis, partially compensated
C) Respiratory alkalosis, compensated
D) Metabolic alkalosis, uncompensated

A

B) Metabolic acidosis, partially compensated

127
Q

pH 7.3 , PCO2 50, HCO3 24

A) Respiratory acidosis, uncompensated
B) Metabolic acidosis, partially compensated
C) Respiratory alkalosis, compensated
D) Metabolic alkalosis, fully compensated

A

A) Respiratory acidosis, uncompensated

128
Q

pH 7.48 , PCO2 29, HCO3 23

A) Respiratory alkalosis, uncompensated
B) Metabolic acidosis, partially compensated
C) Respiratory acidosis, compensated
D) Metabolic alkalosis, fully compensated

A

A) Respiratory alkalosis, uncompensated

129
Q

pH 7.36 , PCO2 30, HCO3 20

A) Respiratory acidosis, uncompensated
B) Metabolic acidosis, fully compensated
C) Respiratory alkalosis, compensated
D) Metabolic alkalosis, partially compensated

A

B) Metabolic acidosis, fully compensated

130
Q

NSAID (non-steroidal anti inflammatory)
- IM, IV, nasal spray

Used for mild-moderate pain
- check BUN/Cr (Toxic to liver)

Black box warning: nephrotoxic, hepatotoxic, can cause stroke & MI, GI bleeding, Steven-Johnson’s syndrome

Do not use for pain associated with CABG
- coronary artery bypass graft

Antidote: Narcan, Mucomyst

A

Toradol (ketorolac)

131
Q

Organisms include: TB, varicella and measles, Covid
- Think MTV

best practice for precaution:
- isolation room
- negative pressure room
- N-95 or HEPA mask applied before entering room or home

A

Airborne precautions

132
Q

Organisms include: VRE, C-Diff, Noroviruses, RSV

PPE: gown, gloves
- DON before entering
- DOFF before exiting

A

contact precaustions

133
Q

What are S/s of an overdose?

A

decreased respirations, resp. depression

decreased SpO2

lethargy

change in LOC

134
Q

masks and goggles, or a mask with a face shield, to prevent exposure of mucosal surfaces to respiratory secretions
* flu.
* meningococcal disease.
* rubella

A

Droplet precaution

Term 4 (PN) (13 decks)

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