176 Exam 2 Flashcards by Alayna Johnson

what are some terms associated with impaired urinary elimination?

anuria (absence of urine)

dysuria (painful urination)

polyuria (frequency of urination)

Oliguria (Low o/p)

Nocturia (Night time urination)

Hematuria (Blood in urine)

hesitancy (has urge to pee but difficulty starting stream)

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What are the main parts of the digestive tract?

Mouth
* Amylase initeates breakdown of carbs
* Tongue mixes food w/ saliva & presses it against teeth
* When bolus is swallowed, tongue forces food into pharynx

Pharynx
* Shared by resp. and digestive tract
* Joins mouth and nasal passage
* When swallowing, epiglottis covers airway preventing food from entering resp. tract

esophagus
* Long muscular tube that passes through diaphram into stomach
* Wave like contractures propel food down digestive tract (peristalsis)

stomach
* 3 sections: Fundus, body, & pylorus
* Gastric secretions: Rennin (breaks down milk proteins), lipase ( breaks down fats), Pepsin/hydrochloric acid (digest protiens)

small intestines
* 3 sections: duodenum, jejunum, & illeum
* Liver and pancreas secretions leak into duodenum

large intestines
* 5 sections: cecum (appendix location), ascending colon (right side of abd.), transverse colon (across abd.),descending colon (down left side of abd.), Sigmoid colon ( between iliac crest & rectum)

anus
* Last part of large intestine
* Where waste leaves the body

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What is the function of the large intestine?

Absorb water from chyme & eliminate remaining solid waste in form of feces

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What are the main parts of the urinary tract?

Kidney
* Cortex receives large blood supply & is very sensitive to changes in BP and blood volume
* Medulla collects urine and drains it into calyces, which drain into renal pelvis
* Uriters carry urine from renal pelvis to bladder

Bladder
* Made of smooth mucles that strech to store urine, rests on floor of pelvic cavity behind peritoneum
* Upper portion of bladder called apex, base of bladder called fundus

Urethra
* Muscular tube lined with mucous membranes that carry urine from bladder out of body
* functions as sphincter (contracts to hold urine & relaxes to release flow)

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Loss of urine during physical exertion
* Ex: coughing, sneezing, laughing

Causes
* increased abd. pressure under stress (weak pelvic floor muscle)
* urethreal trauma, sphincter injury

Nursing interventions:
* Teach kegel exercises
* Advise patient to void frequently
* Administer drugs as ordered to stimulate sphincter

Stress incontinence

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Involuntary contraction of bladder muscles
* Usually follows a strong desire to void

Causes:
* Nervous system disorders
* UTI
* Bladder obstruction

Nursing interventions:
* Toilet scheduling
* Limit fluid intake 2 hrs before bed
* Admin drugs as ordered

Urge incontinence

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Untimely urination d/t issues
* Ex: Cognition, obsticles, unsteadiness

Causes:
* Dementia
* Head injury
* Stroke (CVA)

Nursing interventions:
* Scheduled toileting
* Reinforce appropriate behavior
* Remove enviornmet barriers

Functional incontinence

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Loss of urine associated w/ a full bladder
* Blockage of urethra
* Frequent voiding

Causes:
* urethral obstruction
* Disorders of bladder, nerves, or muscles
* Spinal cord injuries

Nursing intervention:
* Cath.
* Admin drugs as ordered
* Cutaneous triggers (teach stimulation tech.)

Overflow incontinence
(Urinary)

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urine leakage that is caused by a temporary situation such as an infection or new medicine
* Temporary
* Resolves self

Transient incontinence

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Uncontrolled, frequent passage of small, semi-soft stool

Cause:
* Constipation
* entire colon full of fecal matter

Nursing interventions:
* Admin laxitives & enemas as ordered
* increase fluids and fibers

Overflow bowel incontinence

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Uncontrolled passage of stool several times a day

Cause:
* Weak pelvic muscles
* Loss of anal reflexes
* poor rectal sphincter
* Rectal prolapse

Nursing interventions:
* Teach kegel exercises
* Prepare for surgery if planned

Anorectal bowel incontinence

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Formed stools passed after meals
* usually seen in dementia patients

Causes:
* Gastrocolic reflex stimulates defecation
* Patient does not delay until apropriate time

Nursing Interventions:
* Ensure toilet scheduling

Neurogenic bowel incontinence

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Incontinet stools (usually diarrhea)
* Not related to other fecal incontinence types

Causes:
* Colon or rectal disease

Nursing Interventions:
* Provide comfort
* Proper skin care
* prepare for dx tests/ procedures

Symptomatic bowel incontinence

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What is the correct order of an abdominal assessment?

Inspect
Ausculate
Percuss
Palptate

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What is the lab value BUN an indicater for?

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

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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

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Elevated primarily in renal disorders and is a better measurement of kidney function

Normal functioning kidneys = very low levels & high urine levels

Serum Creatinine

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Monitored in pts w/ renal issues d/t the serious consequences that occur w/ electrolytes

Renal failure = Na & K levels are elevated & Ca levels are decreased

Serum Electrolytes

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Identifies microorganisms in urine

Collect specimen first voide of the day
Clean catch tech
Collect before antibiodic therapy
If cath, collect specimen after disregarding small urine amount

Nursing intervention:
* Cap specimen & refrigerate or send to lab (unless specimen has preservative)

Urine cultuer & sensitivity

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Measures glomerular filtration rate; decreases w/ renal disease
* Provide specimen container
* Document first void for next 12-24hrs as ordered
* Keep specimen refrigerated
* If foley cath, place drainage bag in basin of ice & empty into refrigerated container hourly

Nursing intervention:
* No special care needed

Urine Creatinine Clearance

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Detects GI bleeding when blood is not readily seen
* Advice need of stool sample
* If test is done at home, explain the procedure

Nursing intervention:
* No special care required

Occult Blood Test

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Provides radiographic view of kidneys, uterus, & bladder
* No special prep
* Schedule test before studies that use contract

Nursing intervention:
* No special care required

KUB
(Kidney, urterer, bladder)

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Uses radiographics and fluoroscope to outline kidneys
* Tell pt contrast will be injected & radiographs taken to study urinary tract
* Give laxitives & enemas as ordered before tests
* NPO status 8-10hrs before test

Nursing interventions:
* Encourage fluids to flush contrast
* Monitor signs of iodine allergy (urticaria, rash, n/, swollen parotid gland)
* Check injection site for inflammation

Intravenous Pyelogram

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Detects abnormalities of large intestine
* Contrast admined. by enema & radiographs take w/ pt in various positions
* Radiographs taken initially & repeated 6hrs later to see how much barium has passed through the stomach
* clear liquid
* NPO after midnight
* Fluid given on morning of procedure

Nursing intervention:
* Monitor stool up to 2 days for white stool showing barium being eliminated (normal stool after 3 days)
* Laxities may be ordered to promote elimination
* Provide food, extra fluids, & rest

Barium enema

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**Uses lit scope inserted through the urethra, bladder, & ureteral openings * obtain consent** * NPO if anesthesia usage * *Give laxities/enemas as ordered* * Give sedative as ordered for anxiety * **Antibiotics given 2-3 days before & continued after** Nursing intervention: * **Safety precaution d/t orthostatic hypotension** * *Monitor I/O's, vitals, urine color (may be pink)* * Report severe pain & give pain meds * Sitz bath * Drink 2-3 L of fluids

Cystoscopy

**Visualizes esophagus, stomach, & Duodenum** * Inform pt *scope will not interfere with breathing* * *NPO 6-8hrs; give sedative before test if ordered* * Remove dentures Nursing interventions: * **NPO until return of gag reflex** * **Monitior for signs of trauma (bleeding), perforatium (distension/cramping)** * *Warn of sore throat* * *Contact PCP if severe pain, fever, dyspnea, or hematesis*

Esophagogastroduodenoscopy (EGD)

Visualizes anus, rectum, & entire colon * **NPO 6-8hrs before test** * *Restricted to only liquids on previous day/evening* * Bowel cleansing done w/ cathartics, suppositories & enemas Nursing intervention: * *Tell pt to report blood in stool (bleeding suggests perforation of colon)* * **Monitor BP & HR** * *Inspect abd. for distention* * Encourage fluids when fully alert to replace loss

Colonoscopy

What labs would you run in relation to elimination?

**Urinalysis** Renal function test (**BUN/Cr,Cr clearance**) Cultures (**specific gravity, stool/urine**) **Occult blood culture**(done when expected GI bleed)

What radiographic tests would you run in relation to elimination?

X-ray, KUB ultrasound CT, MRI

What direct observation tests would you run in relation to elimination?

Colonoscopy Cystoscopy Esophagogastroduodenoscopy (EGD) Bladder scanner

inflammation of bladder * **bacteria travels up urethra, infects urine & inflames the bladded lining** * Women more than men S/s: * *low grade fever* * *Pain, pelvic/abd. discomfort* * **Bacteria in urine** * **Urgency/frequency/dysuria/nocturia/bladder spasms/incontinence** * **Dark, tea colored,cloudy urine** Dx: * **Urinalysis** * **Culture & sensitivity** Tx: * **Oxybutynin chloride (Ditropan)** - Antispasmotic * **Antibiodics**, continuous prohylactic antibiodics * Mild analgesics (acetaminophine) * **Teaching on peri care, avoid scents/perfumes on genitlas** * Shower instead of bath, sitz bath * *Void after sex & void frequently* * Increase fluids

Cystitis

What are risk factors for Cystitis?

**Prolonged immobility** Renal calculi, urinary diverson **Indwelling cath** Radiation therapy, chemo **Gender (women more than men affected)**

How would you educate a pt with Cystitis?

Teach to avoid risk of furure infection: * **Wear cotton undergarments** * **Avoid tight fitting clothes in perineal area** * **Avoid carbonated caffeine, tea/coffee, apple/orange/grapefruit, & tomato juice (irritated bladder)** * **Drink cranberry juice** * Wipe front to back for females * Complete entire first course of antimicrobial therapy

**Inflammation of renal pelvis that may affect one or both kidneys** * Most often results from inadequate closure of ureterovesical junction during voiding **Acute**: Ascending bacterial infection, may be blood born **Chronic**: Persistant/recurrent; results in damage to parenchyma (functional tissue) S/s: * **Decreased activity & urine o/p** * *slight aches over kidney(s)* * Bladder irritation * *High fever, chills, n/v* * *Dysuria* * **Severe pain, constant, dull aches in flank area** Labs: * **BUN/Cr** * **UA, culter & sensitivity**

Pyelonephritis

How would you treat Pyelonephritis?

*Hospitilization* **IV antibiodics**, UT antiseptics, analgesics (NSAIDS), **antispasmotic** **HTN medications** *IV fluids w/ n/v* * *Monitor I/O* Dietary salt & protein restriction Assist w/ ADLs

What are risk factors for Pyelonephritis?

Long term UTIs ESRD Fluid and electrolyte imbalance Dialysis

Enlarged prostate gland (men over 50) * **Cells arent malignant** Glands press against & pinch urethra *Bladder walls become thicker & may weaken to lose ability to empty completly* S/s: * **Difficulty starting urination** * **Straining**/ pushing out urine * **Weak/slow urine flow** * Frequency, urgency, nocturia * Dribbling, incomplete emptying of bladder Treatment: * **Finasteride (proscar) - Hormone** * **Tamsulosin (Flomax) - BPH agent/ alpha blocker** * **Transurethral resection of prostate (TURP; most recommended)** * Fluid intake of 1500-2000mL/day * Fluid restriction 2hrs before bed * **Avoid caffeine & alco.** * *Prostatectomy*

Benign Prostatic Hyperplasia (BPH)

What are some Dx tests & labs that would be obtained for BPH?

Dx: * Digital rectal exam * Ultrasound * Prostate-specific antigen (PSA) Labs: * UA, Culture & sensitivity

What are risk factors for BPH?

Men age 40 and up Family Hx Obestity T2DM Heart & circulatory disease

**used after removal of prostate to maintain continous irrigation & bladder drainage** * AKA "*standard cath*" **continous irrigation** intended to clear bladder of blood & debris **If cath o/p is less than irrigating fluid delivered, catheter may be obstructed** * Manual irrigation is needed as ordered to clear colts & restore drainage * Notify Dr ASAP if drainage is not restored

Triple-lumen urinary catheter

What is the normal Hemoglobin level?

12-18 combined M : 14-18 F : 12-16

What is a normal WBC level?

5000-10,000

What is the normal platelet level?

150,000-400,000

What is the normal urine Specific Gravity level?

1.001-1.035

What is the normal PTT range?

25-35 seconds

Hormone - PO * **Used to treat BPH** reduces hyperplastic cell growth, treats male pattered baldness **CAUTION: DONT TOUCH PILL IF PREG** Adverse reactions: * Impotence * Decreased libido * Decreased ejaculation

Finasteride (Proscar)

Which type of tx may be used for neurogenic incontinence? A) Fluid restriction B) Pelvic exercises C) Toilet scheduling D) Consumption of mineral oil

C) Toilet scheduling

How would you perform care after a transurethral resection of the prostate (TURP)?

Continuous/intermittent bladder irrigation Close observation of drainage system * Increased bladder distension causes pain & bleeding Manage bladder spasms Pain control w/ analgesics & decreased activity first 24hrs Avoid straining w/ BM

How does a UTI spread?

urethra to the bladder, then ascends into kidneys

**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**

Acute Renal Failure

What medications will you anticipate for acute renal failure?

Oliguria: * treat w/ diuretics Hyperkalemia: * **Kayaxelate (PO/recal; sodium polystyrene)** * *IV Insulin/glucose* * Calcium gluconate *IV fluids w/ dopamine, furosmide, or both (loop diuretics)* Amino acid supplements **TPN if GI tract not functioning**

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

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)

What are the causes of AKI?

Prerenal: * **Decreased blood flow to glomeruli** * need to **sustain systolic Bp 70mm Hg or >** to sustain glomeruli function Intrarenal: * Nephrotoxic meds (**antibiodics**) * Kidney infection (**pyelonephritis, polycystic kidney disease**) * DM, trauma (**bleeding/bruising**) Postrenal: * Obstruction (**kidney stones**) * *BPH* * *Prostate cancer*

What are s/s of AKI?

Oliguric phase: * **Oliguria** (*urine o/p < 400mL/ day; occurs w/in 1-7 days of kideny injury*) * UA (***casts, RBC/WBC, Sp. grvty fixed at 1.010***) * **Metabolic acidosis, hyperkalemia, hyponatremia** * **Elevated BUN/Cr** Diuretic phase: * *Gradual increase in urine o/p* ( 1-3L/day) * ***Hypovolemia/ dehydration, hypotension*** * *BUN/Cr normalize* (**indicate working** - Dont need hospital) Recovery phase: * **Begins when glomerular filtration rate (GRF) increases** * *BUN/Cr level plateau then decrease*

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*

Chronic Kidney disease

What are the most common causes of Chronic Kidney disease?

HTN DM Artherosclerosis

What labs & tests are expected to be ordered for Chronic Kidney disease?

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

What are S/s of ESRD?

*electrolyte imbalance* *FVO* **increased BP** alt. mental status * depression, confusion, w/drawn behavior **Dry, flaky, yellow/gray/ecchymosis skin** **Purpura** (small blood vessels leak blood under the skin) *Anemia*

What nursing interventions/ treatments would you anticipate for Chronic Kidney disease?

**Diuretics, ACE inhibitors ("*-pril*"), Calcium- channel blockers (decrease HTN)** Water souble vitamins **"-statin" drugs in early stages** Promote elimination of waste & maintanance of fluid balance * **Fluid restriction** * **Na, K restriction** **Iron supplements** **Dialysis** *IV insulin & glucose* *Erythropoetin* **Monitor for s/s of infection, BM status, nutrition, and any sign of skin trauma**

**Blood leaves body** and goes through device to filter out toxins in blood, **then blood is returned** Done at hospital, clinic, or home performed **3-5x/week** for 3 or more hours Requires access to circulatory system to route blood: * *Fistula* ( **joins artery & vein; lowers risk of infection**) * *AV Graft* (**synthetic graft betwen artery & vein; increases risk for infection; needs more heparin**) **For pts w/ acute/ irriversible (chronic) renal failure & fluid & electrolyte imbalance** **Hold BP meds until after dialysis Monitor for hypotension - check BP q15min**

Hemodialysis

**Blood doesnt leave body**. Body fluid intrills into peritoneal cavity. Filter then pulls out waste from blood vessles * Not everyone qualifies Done at home **4x/day** for 40 min Pt **uses own peritoneum** as a semipermeable dialyzing membrane * Peritoneal cath *Use Aseptic tech. (sterile, everyone wears mask)* CANNOT be used on pts w/: * recent abd. surgery * extensive trauma * open abd. wound

Peritoneal dialysis

What are advantages & disadvantages of hemodialysis?

**Advantages**: * useful in emergent situations (femoral/jugular site) * Rapid waste, electrolyte, & fluid removal **Disadvantages**: * Need vascular space * Use of anticoagulent (heparin) * Potential hemorrhage/ anemia

How do you asses a dialysis site?

Assess fistula/graft for infection Assess circulation in distal extremities **Ausculate Bruit, Palpate Thrill** **No IV, Bp, or blood draws in arm** * If dialysis site on both arms, take bp on thigh

What are advantages & disadvantages of peritoneal dialysis?

**Advantages**: * Less anemia * Decreased cost * Fewer dietary & fluid restrictions * "Norm" kidney function **Disadvantages:** * **Risk peritonitis** * **Cath. site infection** * hyperglycemia * Increased serum lipid levels

What are some complications associated with hemodialysis?

**Cardiovascular disease** **Anemia** *Air embolism* **Disequalibrium syndrome** (rapid change in fluid & electrolytes) *Hypotension* *Irregular heart rhythem*

What are some nursing interventions for a patient attending dialysis?

**Daily weight before and after** Maintaine dialysis site *Prevent/manage infections* *Monitor for S/s of electrolyte imbalance*

What are some complications associated with peritoneal dialysis?

**Peritonitis** (most serious) Infections at cath. site or where it is tunneled under the skin **Encapsulating peritoneal sclerosis** (thick membrane developes around bowel) Abd. pain Hernia Lower back pain

**Intolerance of gluten (wheat, barley, rye, & oats)** * AKA "gluten enteropathy" or "celiac spur" Results in accumulation of amino acid glutamine (toxic to intestinal mucosal cells) S/s: * **Abd. pain/ distention** * **Large, bulky, foamy, & foul smelling stool** * **Steatorrhea** (execive fat in stool) * Irritability * **Acute or insidious diarrhea** (watery stool w/ pale color & foul oder) Risk factors: * **T1DM** * Addisons disease * Down syndrome * *Fam hx*

Celiac disease

What are some labs & tests that will be ordered for Celiac disease?

**Endoscopy** w/ small bowel biopsy Lactose deficiency based off **lactose tolerance test** **Breath test** for abnormal hydrogen levels **Biopsy** of internal mucosa

What are some nursing interventions/ treatments anticipated with Celiac disease?

Nontropical celiac disease: * Avoid gluten products (**B**arley, **R**eye,**O**ats, **W**heat) Tropical Spur: * *Antibiodics* * Oral folate * *Vit B12 injections* **Lactose deficiency** can be treated by eliminating milk & milk products **Endoscopy** **Read food lables**

**Inflammatory bowel disease that** ***can occur anywhere in the GI tract*** * **Increases risk for colon cancer** * *most often found in the ileum and in the colon* Most often affects the terminal ileum & leads thickening & scarring, a narrowed lumen, fistulas, abscesses & ulcerations S/s: * Dehydration * **Electrolyte imbalance** * **Malnutrition**, anemia * Abd. distention, flatus * cramp like/ colicky pain after meals * **Diarrhea (semisolid - containes mucus and pus)** * weight loss * N/V/A * bleeding uncommon **5-6 soft, loose stools / day**

Crohn's Disease

What labs & tests will be ordered for Crohn's Disease?

**CBC, CT, Ultrasound** *Abd. radiography* **Colonoscopy** *w/ biopsy* **Barium enema** *exam w/ air contrast* Cell studies

What nursing interventions/ treatments will you anticipate for Crohn's Disease?

Monitor I/o Measure & count diarrhea stools Sitz bath Easy toilet access **Administer antidiarrheals, antispasmodies, anticholinergics, antibiodics & corticosteroids** **Admin TPN**

**Ulcerative & inflammatory disease of bowels resulting in poor absorption of nutrients** * *Begins in rectum and ascends towards cecum* * **Increased risk of cancer in large intestine** **Affects large intestine ONLY** **Colon becomes edematous & may develope ulcers which lead to perforation** * Scar tissue developes = loss of elasticity & ability to absorb nutrients S/s: (bleeding common) * Weight loss * Abd tenderness & cramping * Fever * **Severe diarrhea (w/ blood & mucus)** * **Malnutrition, dehydration, electrolyte imbalance** * Muscle hypertrophy * Vit K deficiency * Hemorrhage * **15-20 liquid, bloody stools/ day**

Ulcerative Colitis

What labs & tests will be ordered for ulcerative Colitis?

CBC Abd. radiography Colonoscopy w/ biopsy Barium enema exam w/ air contrast Ultrasound CT Cell studies

**antianemic (IV, SUBQ)** * ***used to treat anemia in patients with chronic renal failure*** to those receiving chemotherapy. **erythropoietin is a factor controlling the rates of RBC production** * product is developed by recombinant DNA technology Side effects: * seizures * **hypertension** * rash * encephalopathy * **DVT** * **stroke** * **MI** * Decreased endogenerous erythropoietin **Monitor the BP and CBC with differentials & Maintain serum iron at normal level - watch platelets**

epoetin alfa (epogen)

what should you monitor for with epoetin alfa?

CNS symptoms seizures pure cell aphasias BP CBC

**loop diuretic - po, IV,IM** **potassium wasting** * **Inhibits reapsorption of Na** used for worsening crackles, new edema in the legs, edema w/ HF, rapid weight gain, pulmonary edema, & hepatic disease **monitor BUN & Cr** **only give if K+ is in range**

furosemide

what are side and adverse effects of furosemide?

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

**antianginal, vasodilator - IV** produce vasodilation, **decrease preload and afterload** and reduce myocardial oxygen consumption * *Check expiration date* **do not use with erectile dysfunction drugs (viagra)** **5 min between each tab, only give 3** *LIGHT SENSITIVE - Dont take if Preg* side effects & adverse effects: * *headache* * **orthostatic hypotension** * dizziness, weakness * faintness * nausea, vomiting * *flushing or pallor*

nitroglycerin

**beta blocker, antihypertensive - PO/IV** * **Used for Mild-mod HTN/ acute MI** **decreasing cardiac output, decrease heart rate and decrease blood pressure, decrease workload of the heart, stable angina** *do not give with asthma* **DO NOT STOP ABRUPTLY** side effects & adverse effects: * bronchospasm * **bradycardia** * **hypotension** * weakness, fatigue * N/V * **hyperglycemia** * **agranulocytosis** * behavior or psychotic response, depression

metoprolol

**Antiarrhythmic, Antihypertensive - IV, PO** *helps heart contract, slows heart rate, increases cardiac output , decreases preload, fluid retention decreased* * Inhibits Na K pump **DONT use w/ renal disease** * *Hold when the apical pulse is lower than 60 bpm* Therapeutic range: 0.5-2.0 side effects & adverse effects: * **diplopia, blurred vision, yellow-green halos, photophobia** (visual disturbances) * drowsiness, fatigue, weakness * **bradycardia** * n/v/d/ headache/ anorexia

digoxin

*Reduces serum level of cholesterol, triglycerides, or low density lipoprotein* - PO **report unexplained muscular pain** **lower risk of coronary disease** side effects & adverse effects: * constipation * **GI disturbances** * *heartburn, nausea, belching, bloating*

simvastatin

**opioid analgesic** and vasodilator - PO/IV used to treat **severe pain, sedation**, & cancer pts * narcotic drug derived from opium **Monitor for resp. depression**

morphine

antihypertensive, **ace inhibitor** - PO **used for mild-moderate hypertension** *Monitor for vertigo, dizziness, hypotension* *Report dry cough*

lisinopril

NSAID used for mild to moderate pain or fever * Relieves muscle aches, toothaches, common cold, and headaches.

aspirin

Vitamin B12 - PO needed for adequate nerve functioning, RBC development

cyanocobalamin

**opiate analgesic** - PO * **Mild to severe pain** *inhibits ascending pain pathways in the CNS, increases pain threshold, alters pain perception* **Monitor for respiratory depression & substance abuse**

hydromorphone

**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**

Enoxaparin (Lovenox)

**anti-infective - PO, IV** *used in the treatment of anaerobic infections, Bone/joint pain, Resp tract infection, **C-Diff*** Nursing interventions: * assess IV site, compatibility, CBC * **Toxic to the liver. Need to check liver functions before given** **Monitor for reactions, seizures, aseptic (Viral) meningitis, bone marrow depression, metallic taste, & secondary malignancy** **Patient teaching**: eat with food, no alcohol, urine may be dark

Metronidazole (Flagyl)

**Immunosuppressive drug, antianemic - SubQ** *It can treat mod-severe arthritis*, plaque psoriasis, ankylosing spondylitis, **Crohn's disease, and ulcerative colitis** Monitor for: * **serious infection (BLACK BOX WARNING)** * *severe renal disease* * *impaired hepatic function* * *leukopenia* * *thrombocytopenia* * bronchitis

Adalimumab (humira)

**Immunosuppressive drug - IV** It **can treat** *rheumatoid arthritis*, psoriatic arthritis, ankylosing spondylitis, **Crohn's disease**, plaque psoriasis, and **ulcerative colitis** Monitor for: * s/s of infection - contact MD * seizures - implement seizures precautions *Don't give with a live virus*

Infliximab (Remicade)

They say to avoid alcohol products while taking METRONIDAZOLE (FLAGYL), besides an alcoholic beverage, what does that include?

mouthwash aftershave deodorant bath splashes

What drugs would you use for HTN?

ACE inhibitors **("-pril")** Beta-blocker **("-olol)** Calcium- channel blockers **("-pine" or "-amil")** Digoxin Diuretics

How can you dx HTN?

CXR EKG

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

BUN/Cr electrolytes * sodium (Na) * calcium (C) * magnesium (Mg) EKG, CXR

An adult patient is being discharged home on Digoxin. Which statements below verbalized by the patient demonstrates they understand how to properly take this medication? **Select all that apply**: A. "I will limit by intake of foods high in potassium." B. "I will not take this medication and notify the physician if my heart rate is less than 70 bpm." C. "I will measure my pulse rate before every dose I take." D. "It is important that I immediately report any vision changes I may experience while taking this medication."

C. "I will measure my pulse rate before every dose I take." D. "It is important that I immediately report any vision changes I may experience while taking this medication." The patient should **always measure their pulse rate before taking each dose of Digoxin and hold the dose if it is less than 60 bpm (this is for adults)**. The patient **should not restrict foods high in potassium because this could lead to hypokalemia, which can lead to Digoxin toxicity.** **Vision changes should be reported** because this could indicate Digoxin toxicity.

What type of education would you give a patient with HTN?

limit Na and alcohol monitor BP stop smoking increase exercise

**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

right sided heart failure

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

Left sided heart failure

**sickles become stuck** together causing severe pain cause: - infection - dehydration - overexertion - cold weather - excessive alcohol/ smoking Tx: - IV fluids (expands vascular space - NS/ bolus) - pain meds, PQRST - RBC transfusion - Oxygen

sickle cell crisis

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**)

iron deficiency anemia

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

pernicious anemia

abnormal activation of the proteins involved in blood coagulation, causing **small blood clots to form in vessels and cutting off the supply of oxygen to distal tissues** * can lead to organ ischemia (*not a disease*) S/s: * petechiae & purpura * hematuria * **melena** (black tarry stool) * **nosebleeds** * **Stroke, DVT, PE** * **heart attack** Dx: * Labs: **D-dimer, Hgb, CBC, platelets** (**decreased platelet and fibrinogen**) * Prolonged clotting time (**increased PT & PTT**) * **Increased D-Dimer** (indicated clots) Tx: * treat cause * **transfusion (packed RBC, FFP, platelets)**

Disseminated Intravascular Coagulation (DIC)

**condition where a build-up of fat deposits in the arteries restricting blood supply** * *Common sites are femoral/ popliteal/ distal arteries* * **increased risk or developing CAD** Narrow arteries (**atherosclerosis**) prevent oxygenated blood from getting to hands/feet * ischemia & necrosis of extremity S/s: * **Shape pain** worse at night ("rest pain"), intermittent claudication * **Poor pulse**, numbness/tingling * **Cool temp d/t no blood in extremities** * **color: pale, hairless, dry, scaly, thin skin** * Wound: red sores w/ regular shape/round, "punched-out" appearance * **Gangrene** d/t tissue death from lack of blood flow treatment: * **CBC** * **Angiography** * Doppler **ultrasound** * **Ankle-brachial index (ABI)** (lower the number = greater risk) * Vasodilators/ antiplatelets * **Assess pulses, insicion site, & extremity** * Avoid vasoconstriction * **Dangle extremity** * **rest in dependent position** * *education on foot care & skin integrity*

peripheral arterial disease (PAD)

A patient is taking Digoxin. What medication on the patient's med list increases the patient's risk of experiencing Digoxin toxicity? A. Furosemide B. Metformin C. Nitroglycerin D. Coumadin

A. Furosemide Furosemide is a loop-diuretic and this medication wastes potassium. Remember hypokalemia (low potassium level) increases the risk of a patient developing Digoxin toxicity. Hypercalcemia and hypomagnesemia also increases Digoxin toxicity.

a surgical operation that creates an opening from the colon to the surface of the body to function as an anus * **includes the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum**

Colostomy

Bringing end or loop of small intestines (ileum) out onto the surface of the skin - Bowel cancer - Growth Liquid stool, irritating to skin

Ileostomy

Creates a stoma for the urinary system * After extensive surgery * Obstruction

Urostomy

Your patient is experiencing extreme fatigue, hypotension, palpations, and shortness of breath. You obtain an ECG and discover a rhythm of sinus bradycardia with a rate of 40 bpm. What finding below could be causing this condition? A. Potassium level of 3.9 meq/L B. Lisinopril 10 mg BID PO C. Blood glucose 84 D. Digoxin 0.125 mg PO daily

D. Digoxin 0.125 mg PO daily Digoxin slows down the heart rate and can lead to bradycardia.

Your patient, who is 55-years-old, is prescribed to take Digoxin. What patient finding requires that the nurse hold the dose of Digoxin and notify the physician? A. Digoxin level of 1.2 ng/mL B. Blood glucose 82 C. Heart rate 61 bpm D. Potassium 2.8 mEq/L

D. Potassium 2.8 mEq/L The patient's potassium level is low (<3.5 mEq/L). Remember **hypokalemia increases the chances of Digoxin toxicity developing**. The nurse should notify the MD and hold the ordered dose until further instructions are given by the doctor

What EARLY signs and symptoms should the nurse assess for in a patient taking Digoxin that could indicate toxicity of this drug? **Select all that apply**: A. Dysrhythmias B. Anorexia C. Drowsiness D. Nausea E. Vomiting

B. Anorexia D. Nausea E. Vomiting GI-related signs and symptoms are the earliest indications that the patient may be having Digoxin toxicity. The other signs and symptoms occur later, especially dysrhythmias.

How does blood flow through the heart

Blood comes from **superior/inferior ven cava** into the **right atrium** from the body, moves **into the right ventricle**, through a **valve** and is **pushed into the pulmonary arteries in the lungs**. After picking up oxygen, the **blood travels back to the heart through the pulmonary veins** into the **left atrium**, to the **left ventricle**, through a**valve** and out to the body's tissues through the **aorta**.

high blood pressure 2 types: - primary HTN - secondary HTN *BP cuff that is too small = false high BP* *BP cuff that is too big = false low BP* *emergency crisis: 180/100* normal: 120/ 80 S/s: * asymptomatic "silent killer" * *blurred vision*, headache * CP, nosebleeds

hypertension (HTN)

Abnormally high BP not caused by a medical condition Causes * Arterial changes * Genetic factors * sedentary lifestyle, obesity, smoking

essential hypertension (primary)

**Caused by a medical condition** *& subsides when disease is treated or corrected* Renal artery stenosis, increase in plasma renin and unilateral atrophy of kidney (*Fibromuscular dysplasia in young women*)

Secondary hypertension

**Chest pain** caused by reduced blood flow to the heart **Warning sign of potential HA or stroke** * *Monitor pain, echocardiogram, nitroglycerin, angioplasty* if untreated pt will be at higher risk for infection

Angina

**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.

True

Which medication below should not be used for the treatment of sinus bradycardia in a patient with a transplanted heart? A. Isoproterenol B. Atropine C. Epinephrine D. Glucagon

B. Atropine

What medication below is NOT a treatment for Sinus Tachycardia? A. Verapamil B. Metoprolol C. Antipyretics D. Dopamine

D. Dopamine **Dopamine increases the heart rate along with the blood pressure. It is used in Sinus Bradycardia.** Verapamil is a calcium channel blocker and can slow down the heart. In addition, Metoprolol is a beta blocker that can slow down the heart rate as well. Antipyretics reduce a patient's fever which can slow down the heart rate (if a fever is causing the sinus tachycardia).

A condition in which the blood is deficient in RBC's, in hemoglobin, or in total volume resulting in pallor skin effects perfusion * **HGB may fall to low & reduce the amount of O2 delivered to the tissue** effects gas exchange: * **decrease in RBC transporting O2 and CO2, impairs the body's ability for gas exchange**

Anemia

**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**

malignant hypertension

**A rapid heart rhythm in which the electrical impulse begins in the ventricle** (instead of the atrium) * *may result in inadequate blood flow and eventually deteriorate into cardiac arrest* * **>100 BPM** * **QRS wide/ bizarre** * *leads to v-fib* cause: * **MI** * *hypokalemia* * **digoxin toxicity** S/s: * *CP, decreased cardiac output* * lightheadedness, SOB * dizziness, *syncope* treatment: * **Antiarrhythmics (amiodarone**) * *Replace electrolytes* * Restore to normal rhythm * **CPR, ACLS, code blue** * **synchronized cardioversion**

Ventricular tachycardia (V-tach)

**Disorganized, ineffective twitching of the ventricles, resulting in no blood flow and a state of cardiac arrest** * **rapid/ undetectable** * *fatal if not treated in 3-5 mins* * **No P wave but has QRST complex** Causes: * CP, SOB * N/V * MI, cardiac injury * **electrolyte imbalance** * **untreated V tach** s/s: * decreased LOC * no pulse, RR, or BP treatment: * O2 * **Defib, CPR/ ACLS** * **Epinephrine, amiodarone, lidocaine**

ventricular fibrillation

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**

arterial fibrillation (AFib)

**>100 bpm** * **has PQRST complex** s/s: * **palpitations** * **anxiety** * **CP** * dizziness causes: * *dehydration* * *fever* * **stress/anxiety/hyperventilation** * excessive caffeine treatment: * *treat underlying cause* * *slow HR* - **Metropolol IV** * **can lead to stroke, HF, or death**

Sinus Tachycardia

**< 60 bpm** * **Has PQRST complex** * slow rhythm cause: * Meds (**digoxin, beta blockers**) * **hyperkalemia** * vagal stimuli * athletes s/s: * dizziness, syncope * hypotension, orthostatic hypotension * CP *Not treated unless symptomatic - Pt may need pacemaker*

Sinus Bradycardia

**slow and progressive** circulation disorder * *narrowing, blockage, or spasms in a blood vessel, arteries or veins* Cause: * *smoking* * **diabetes** * **high cholesterol** * **HTN** S/S: * **Dull, constant, achy pain** * **Pulse may not be palpable d/t edema** * **warm temp (blood in extremities)** * yellow/ brown in color * Wounds: venous stasis ulcer, shallow/ irregular shaped wounds * **No gangrene** treatment: * **control DM** * decrease cholesterol (**"-statin"**) * **reduce BP** * **antiplatelet medications, *aspirin, clopidogrel*** * control diet * stop smoking

Peripheral Venous Disease (PVD)

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

Hgb

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

give spironolactone (Aldactone)

What are labs used for MI?

troponin and creatine kinase

What do you monitor for while taking lovenox?

Bleeding D-dimer

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

Contact gown & gloves

genetic disorder that causes abnormal hemoglobin, resulting in some red blood cells assuming an abnormal sickle shape interventions: * **H**ydration * **O**xygen * **P**ain management (opioids)

sickle cell anemia

Pt complains of the following symptoms associated with urinating; hesitancy, intermittent stream, frequency, urgency and nocturia what do you suspect is wrong?

BPH

What diet should a patient with pernicious anemia be on?

high protein diet * meat * eggs * dairy

5-6 soft stools daily, pain in abdomen and joints, mucous in stool, loss of appetite, fever, fatigue, cramping are all S/S of what GI condition?

Crohn's

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?

Chronic Renal Failure

Beta Blocker Lopressor is used for what, and what do you do before administering?

HTN, take B/P before you give

How do you control bleeding in someone with hemophilia?

blood transfusion factor VIII & IX bed rest apply pressure and ice

Pts with UC (Inflammatory Bowel Disease) are at risk for what?

fluid and electrolyte imbalance and poor nutrition

Pt education on ostomy in ascending colon

stools will be liquid

Atherosclerosis, HTN, DM, obesity, smoking, family history, high fat diet, sedentary lifestyle are all contributing factors to what?

Coronary Artery Disease

which protein choice would align with **D**ietary **A**pproaches to **S**top **H**ypertension **(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

B) 3 oz wild salmon, grilled Explaination: DASH diet emphasizes lean sources of protein including poultry, fish, nuts, low-fat dairy, & lean red meats.

176 Exam 2 Flashcards

Weeks 5-8 (144 cards)