195 exam 2 Flashcards by Alayna Johnson

What diet should a person w/ burns be on?

High calorie & high protein

Increased fluids

Increased vit. & minerals

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

Low cholesterol & saturated trans fats

High fibers

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What diet should a person w/ wounds be on?

High protien

Increased carbohydrates & fat

Increased fluid intake

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

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What is the healing process of a wound based on?

Pattern

Type of wound

Severity of wound

Overall condition

Time it takes to heal

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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

hemostasis (Termination of bleeding)

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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

Inflammitory Phase of wounds

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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

Reconstruction / proliferation phase of wounds

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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

Primary Intention of wounds

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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

Secondary intention

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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

Tertiary intention

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

Protein

Carbs

Fats

Vitamins

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

Eat small frequent meals

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What food class helps promote wound repair?

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

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

Thin, composed of serum portion of blood

Serous drainage

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Thick

Yellow/green/tan/brown drainage

Indicates infection

Purulent drainage

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Pale

Red, watery

Mixture of serous & sanguineous drainage

Thin

Can occur on the day of surgery

Serosanguineous

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Bright red

Indicates active bleeding

Can occurs on day of surgery

Sanguineous

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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

Jackson-Pratt drainage device

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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

T-Tube drainage system

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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

Wound-Vacuum-Assisted Closure (Wound vac)

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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

Heart Failure

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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

Dry Dressing

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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)

Wet-to-dry dressing

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**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

Irrigation

What does the principles of basic wound irrigation include?

Cleansing in direction from least contaminated area to most contaminated

What are some complications of wound healing?

**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

What are nursing interventions for Evisceration (Medical emergency)?

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

Interventions for dehiscence

Bed rest NPO Encourage pt not to cough Place warm, moist, sterile dressing over area until seen by surgeon Provide reassurance

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

**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

What other Dx does HTN contribute too?

CAD Stroke HF PVD Renal failure

What are nursing interventions for a pt having dysrhythmias?

Monitor vitals Note rate, regurality, & strength of pulse Monitor I/O Observe & report reaction to meds Keep stress to a minimum * Balance rest & activity

What interventions would you provide a pt w/ CAD?

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

What interventions would you provide a pt w/ COPD?

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

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

Culture of any drainage taken before antibiodics

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

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**

What are some S/s of diverticulitis?

Often asymptomatic Changes in bowel habits * Constipation * Diarrhea * Periodic bouts of each Rectal bleeding Pain in left lower abdomen N/V Urinary problems

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**)

HTN

**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

Insulin

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)

Hyperglycemia

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

Hypoglycemia

What are some diagnostic testing for diabetes?

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

What is the lab value for cholesterol?

< 200 mg/dL

What is the lab value for HDL?

Males: > 45mg/dl Females: > 55mg/dl (want high)

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

True - Triglycerides are general reflection of glycemic control

What is the lab value for LDL?

< 70 mg/dL

What is the lab value for triglycerides?

<150 mg/dL

What is the lab value for C-reactive protein?

< 1.0 mg/L

Lispro (Humalog) Aspart (Novolog) - Given AC Clear insulin; most common Given before pt eats Onset: 10-30 minutes Peak: 2hrs Duration 3-5hrs

Rapid insulin

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

Short/ Regular insulin

Humilin N Novolin N Cloudy; roll to mix Onset: 2-4hrs Peak: 4-12hrs Duration: 12-16hrs

Intermediate Insulin/ NPH

Glargine (lantus) - give seperatly Detemir (levemir) Clear; given in AM/PM Onset: 1hr Peak: N/A Duration: up to 24hrs

Long acting insulin

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

True

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**

Warfarin (Coumadin)

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.”

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

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

C.) Regular insulin

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

C.) metabolic syndrome

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

metabolic syndrome

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**

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

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

Na & K levels are elevated & Ca levels are decreased

What is the normal Hemoglobin level?

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

**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 nursing interventions/ treatements will you anticipate for 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)

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

Chronic Kidney disease

What are the most common causes of Chronic Kidney disease?

HTN DM Artherosclerosis

**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**

furosemide (lasix)

**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

morphine

**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)

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 (Chest X-ray)

**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

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

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

BP cuff that is too small = false high BP BP cuff that is too big = false low BP

**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

**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

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)

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 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

What diet should a patient with pernicious anemia be on?

high protein diet * meat * eggs * dairy

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

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.**

What can cause hypercalcemia?

Malignancy Hyperparathyroidism Excessive calcium intake

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)

Hypokalemia

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*

Hyperkalemia

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

Hypercalcemia

What are some Causes of Metabolic Alkalosis?

Vomiting Suctioning hypokalemia

What are some Causes of Metabolic Acidosis?

diarrhea renal failure Diabetic Ketoacidosis Shock Sepsis

What are some Causes of Respiratory Acidosis?

sleep apnea head trauma opioid overdose COPD pneumonia

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)

Ciprofloxacin (Cipro)

**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

Lactated Ringers (LR)

Are the following Isotonic, hypotonic or hypertonic solutions? 0.225% NaCl 0.455 NaCl 0.35 NaCl Dextrose 2.5% in water

Hypotonic solutions

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

Sentinel events

What are the PN IV therapy Can Do's?

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+)

What is the most serious symptom of hypocalcemia?

laryngospasm - treat with oral/ IV supplements

Ph 7.1 PCO2 49 HCO3 26 PO2 70 **Example: Pt has pneumonia**

respiratory acidosis

Ph 7.0 PCO2 50 HCO3 28 PO2 67 Pt has an acute exacerbation COPD

respiratory acidosis

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. Respiratory acidosis

Ph 7.49 PCO2 46 HCO3 30 PO2 90 **Example: Pt has been vomiting for 2 days**

metabolic alkalosis

Ph 6.9 PCO2 30 HCO3 19 PO2 98 **Example: Pt has a bs of 503, ketones in the urine**

metabolic acidosis

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

C. Calcium and potassium levels

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

B. Tachypnea

Which of the following is not a cause of respiratory acidosis? A. Pulmonary edema B. Asthma C. Chronic obstructive pulmonary disease (COPD) D. Hyperventilation

D. Hyperventilation

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

hypocalcemia

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%

Isotonic

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%

Hypertonic

LPN can administer what solutions?

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

What are some Causes of Respiratory Alkalosis?

panic attack fast resp rate

When can an LPN change a PICC/CVC dressing?

If the patient is 18 or older

**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**

Normal Saline (NS)

Prolonged _______________ can lead to the development of acute renal failure. A) hypervolemia B) hypokalemia C) hypovolemia D) hyperkalemia

C) hypovolemia

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) Respiratory acidosis, partially compensated

pH is abnormal and either CO2 or HCO3 is abnormal

Uncompensated

pH, CO2 & HCO3 values will be abnormal

Partially compensated

pH is normal PaCO2 & HCO3 abnormal

Fully compensated

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

B) Metabolic acidosis, uncompensated

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

C) Respiratory alkalosis, partially compensated

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) Respiratory acidosis, fully compensated

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

D) Metabolic alkalosis, fully compensated

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

D) Metabolic alkalosis, uncompensated

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

B) Metabolic acidosis, partially compensated

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) Respiratory acidosis, uncompensated

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) Respiratory alkalosis, uncompensated

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

B) Metabolic acidosis, fully compensated

**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**

Toradol (ketorolac)

**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

Airborne precautions

**Organisms include: VRE, C-Diff, Noroviruses, RSV** PPE: gown, gloves - DON before entering - DOFF before exiting

contact precaustions

What are S/s of an overdose?

decreased respirations, resp. depression decreased SpO2 lethargy change in LOC

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

Droplet precaution

195 exam 2 Flashcards

(134 cards)