1st Flashcards
(144 cards)
1
Q
Normal pH
Co2
Hco2
A
pH 7.35-7.45
Co2 35-45
Hco2 - 22-26
2
Q
Metabolic acidosis
Causes?
A
**Bicarb low ** - GI loss (diarrhea)
Acid high - increase in lactic acid (poor perfusion, carbon monoxide poisioning), DKA, toxin
Impaired renal exretion (not excreting acid)
alcoholism, starvation
3
Q
S/S of Metabolic acidosis
A
Hyperkalemia = ECG monitoring, Tall Tented T waves
Kussmaul respiration (deep labored breathing)
Diarrhea, nausea
Fatique, confusion
4
Q
What is compensation for metabolic acidosis
Nursing interventions - Monitor what labs
A
Lungs compensate by increasing resp/min to blow off co2
Monitor labs, serum lactic acid, replace fluids and electrolytes
5
Q
Metabolic Alkalosis
Reasons
A
Gi loss (vomit, suction)
Ingesting too much bicarb (antiacids)
Diuretics, thiazides (excreting too much hydrogen in urine), hyperaldosteronism
Hypokalemia
6
Q
S/S Metabolic alkalosis
A
Hypokalemia - Muscle cramps, weakness, twitching
Confusion, lethargy, dizzy
Compensatory - Hypoventilation
7
Q
What is compensation for metabolic alkalosis
Nursing interventions
A
lung breath slower to hold on to Co2
ABGs, replace fluids/electrolytes, avoid suction
8
Q
Respiratory acidosis
Causes
Acute vs Chronic
S/S
Compensation
Nursing intervention
A
Cause: hypoventilation/breathing slow
Acute - airway obstruction (choking, aspiration),chemical depression - overdose. Weak lungs - guillain barre, spinal cord injury
Chronic - obesity, COPD, emphysema
S/S hypoxia, confusion, lethargy, drowisness, headache
Compensation - secrete more H+, reabsorb bicarb, kidneys slow
Nursing interventions - Improve air way, HOB up, suction, O2, medications, poss IV push bi carb
9
Q
Respiratory Alkalosis
Causes
S/S - late
Compensation
Nursing interventions
A
Causes: hyperventilation/breathing fast, releasing too much acid, panic attack, pneumonia, asthma exacerbation, pE, fever, high altitude, improper vent setting
**S/S ** lightheaded, dizzy, confusion, tachycardia, calcium imbalances (numbness & tingling), arrhythmias Late = seizure/coma
Compensation - reabsorb H+ , kidneys compensate slow
**Nursing interventions **- improve airway, 02 meds, encourage slow deep breathing. NOT paper bag.
10
Q
Hyperphosphatemia
Causes & always assoc w/?
S/S
Interventions
A
Normal 2.7-4.5 mg/dl (4.5 mg/dl+)
Causes: From tumor lysis syndrome, decreased renal excretion, increased renal reabsorption (hyperparathyroidism), acidosis, hypoparathyroidism. always assoc with hypocalcemia
S/S - numbness, tingling, muscle spasms, tetany, larynogspasm, stridor, chvosteks and trousseau signs
**Nursing interventions **- Monitor serum levels, correct low calcium (calcium gluconate IV), monitor IV site, give phosphate binders (calcium carbonte) ALWAY DISSOLVE NEVER CHEW, 8 ounce water with meals. can cause constipation
11
Q
Hyponatremia
Causes
S/S
Interventions
What precautions?
Replacing too quickly?
A
<135
Causes - too little sodium or too much water
* Sodium loss: Gi loss - vomit, NG suction, renal losses, diuretics, adrenal insufficiency, burns, fasting diets
* Excess water -Hypotonic IV fluids, polydipsia, cirrhosis, HF, SIADH
S/S - neurologic, cerebral edema, headache, nausea, vomiting, lethargy, confusion, seizures, coma.
Nursing interventions - monitor serum sodium, seizure precautions, replace sodium, fluid restriction, loop diuretics, don’t increase sodium too fast can lead to OSMOTIC DEMYELINATION SYNDROME = brain damage, monitor I &O
12
Q
Metered Dose Inhaler
A
Deliver meds straight to lungs / avoid systemic side effects
Short acting beta agonists
Long acting
Inhaled corticosteroids
Primarily used for COPD
**SHake well for 3-5 sec, tilt head back slightly and exhale slowly for 3-5 sec. inhale and hold breath for 10 sec. Wait 1-2 mins before 2nd puff
13
Q
Standard precautions
When do we use
How?
A
- All patients, all situations
- Hand hygiene (before/after contact
- Contact w/ blood, fluids, non-intact skin, mucous membranes, after removing gloves
14
Q
Airborne precautions
When do we use it?
How?
A
Spread by small aerosolized particles
* Measles (Rubeola),
* Tuberculosis,
* Varicella
* Smallpox
* Covid
**MTV in ****S****mall **C**ountries
- Negative pressure room closed door
- N95
- Wear surgical mask when transported out of room
15
Q
Droplet Precautions
When?
How?
A
spread by respiratory droplets
(Pertussis, flu, mumps, pneumoic plague, haemophilus influenza type B, neisseria meningitis) PIMPIN
- Private room
- Surgical mask
- Wear mask when transported out of room
16
Q
Patients with what type of infection should be in isolated room first?
Airborne
Droplet
Contact
A
Airborne
17
Q
What is abdominal Aortic aneurysm?
AAA
How diagnosed?
Risk factors?
S/S?
Trtmt?
A
Weakening in vessel wall creating a blood filled buldge
Diagnosed: Ultrasound, CT scan
Risk factor: Smoking, HTN, plaque, age, male
Pulsatile abdominal mass!!! Intense ab/back/flank pain, hypotension, tachycardia
TRTMT RBC, IV fluids, surgery, monitor I&O, peripheral pulses
18
Q
Angina
Chronic?
Unstable?
Vasospastic?
A
Chest pain in response to MI or vasospasm
Chronic - fixed partial obstruction - occurs during exertion. STABLE and PREDICTABLE 02, beta blockers, Calcium blockers, nitro
Unstable/preinfarction - unpredictable. At rest or exertion. Sit upright, 02, 12 ECG, biomarkers, nitrate, morphine, coronary angiography
Variant/vasospastic - occurs at rest/sleep, triggered by smoking. May or may not be related to blockage, long acting nitrates, or Ca channel blockers
19
Q
Alkalosis symptoms
*As the pH goes, so does my patient
What equiptment?
A
Except for potassium / hypokalemia & metabolic compensation breathing
Irritability, HTN, Tachypnea, tachycardia, Diarrhea, hyperreflexia, borborygmi (^bowel sounds), seizure
*Suction
20
Q
Acidosis symptoms
*As the pH goes, so does my patient
expect what equiptment?
A
Except for potassium / hyperkalemia & metabolic compensation breathing
Hypotension, bradypnea (resp) / Kussmaul (metabolic), bradycardia, paralytic ilieus, constipation, hyporeflexia, flaccid, coma
*Resp arrest / ambu bag
21
Q
What acid/base imbalance is Kussmaul resp
A
Metabolic acidosis
22
Q
Aortic dissection
Type A
Type B
Risk
Diag
Trtment
A
Tear in aorta
Type A - affect heart & above. Sudden onset anterior chest pain. Tachycardic, diaphoretic. Fatal
Type B - heart & below. Ab/back pain. Reduced blood flow = Stroke, AKI, paralysis, cold legs/arms, MI
Risk: HTN, drug use, marfan syndrome
Diag: TEE, chest x ray, CT scan
*Trt: *reduce HR and BP. Labetalol or esmolol, upright position. Systolic between 100-120
23
Q
Chronic venous insufficiency
Risk
S/S
A
Incompetent venous valvues = blood flows backwards and pools in leg
Risk: prolonged standing, DVT, obesity
S/S edema, red brown skin, Thick skin, ULCERS irregular shape above MEDIAL MALLEOLUS & painful in dependant position
24
Q
if patietn has prolonged GI suction or vomit, what acid/base balance is it?
A
Metabolic alkalosis
25
For everything else that isnt lung or prolonged GI suction or vomit, what acid base imbalance?
Metabolic acidosis
26
**Coronary Artery Disease (CAD)**
Risk
S/S
Diag
Trtmt
Hardening of Coronary arteries due to plaque = impaired blood supply to heart
*Risk*: smoking, obesity, diet, stress. Family, sex, age, ethnicity. HTN, Hyperlipidemia
*S/S* asymptomatic until 50-70% is occulated then angina.
* Women - heartburn, epigastric pain
*Diag* - 12 lead, stress test, elevate lipid levels
*Trtment* - aspirin, clopideral, nitrates, statins, beta blockers, ACE, ca blocker, **PCI, CABG**
27
**DVT**
Causes (3)
S/S
Diag
Blood clot logged in deep veins (leg) blocked blood flow = inflammation
**Causes:** stasis (pooling), endothelial damage (surgery/trauma = more clotting factors), hypercoagulable state (preg)
**S/S** unilateral edema, pain, warmth, decreased sensation
**Diag** D-dimer, ultrasound
**Trtmt** anticoagulants, monitor for bleeding
28
**MI**
S/S
Atypical s/s
Diag
Trtmt
**Unstable plaque ruptures and occuldes coronary artery = cell death**
**S/S ** chest pain/ heavy pressure - radiating pain unreleaved by rest & nitro
**Atypical** S/S dizzy, tired, headache, GI syptpoms
**Diag** Changes in ST, cardiac enzymes (troponin, myoglobin, CK-MB) 4-6hours after MI
**Trtmt** Aspirin, Nitrates, Moprhine, 02, beta blockers, heparin
29
NSTEMI
Non ST elevated MI
Thrombus only partial occluding coronary artery / blood flow reduced
30
STEMI
ST seg elevation
Fully occlude / no blood flow
31
PCI
Percutaneous Coronary intervention
Perform within what time frame?
1st line treatment in MI
Perform within 90 mins
Thrombus retrieval, angioplasty, stent
32
CABG
Too large of blockage for a stent/balloon
Open heart / very invasive
Go around blockage from vein in leg
33
**Peripheral Artery Disease (PAD)**
S/S
Diag
Narrowing of arteroes due to atherosclerosis = decreased tissue perfusion
**S/S*** Intermittent claudication - ischemic pain during exertion relieved with rest*
Cool, dry, shiny skin, loss of hair, brittal nails, delayed pulse and cap refill. Tissue necrosis
**Diag** ankle brachial index. Pressures higher in Arm than leg in PAD
34
**Septic Shock**
Causes
S/S
Labs
Exaggerated immune response to microorganism causing vasodilation, leaky capillary, altered blood flow. Wide spread infection
**Causes:** gram - & + bacteria
**S/S** fever or hypothermia, tachycardia, **persistent hypotension** (leaky capillary), bounding pulses, resp distress, mental status changes, cold mottled skin
**Labs** Leukocytosis, positive blood cultures, increased blood glucose, lactic acid increase, coag alterations (DIC)
35
Signs of arterial insufficiency
Muscle pain
Decreased pulses
Hair loss
Cool, dry shiny skin
Gangrene
Thick brittle nails
Small circular deep ulcers
36
Signs of venous insufficiency
Varicose vein
Warm thick skin
Bronze brown color
Large irregular shaped superficial ulcer with drainage
edema
37
**Diabetes insipidus**
Central
Nephrogenic
S/S
Trtmt
Insufficient production of ADH by pit gland or lack of response to ADH
**Central** - Trauma or
**Nephrogenic** - resistance from kidneys from lithium, hypercalcemia, heredity
**S/S** polyuria, diluate and pale urine, freq urine, tachycardia, hypotension, dry mucous membranes, diminished peripheral pulses. Increased serum sodium, decreased urine specific gravity
**Trtmt** - central - desmopressin. Both hypotonic IV (.45% sodium chloride)
38
**Diabetes Mellitus - TYPE 1**
S/S
Need more insulin when?
Hypoglycemia?
Autoimmune destruction of panceatic beta cells
**S/S** - Thin. **3 P's Polyuria, polydipsia, polyphagia**, fruity breath, blurred vision, noturia, yeast infection.
*More insulin during illness, infection or stress
**Hypoglycemia** - under 70. Im glucagon if unconscious
39
**DKA - process**
S/S
Diagnosis
Trt
Lack of insulin = intracellular starvation = body uses fat for energy = high lvls of acidic keytones = kidneys increase excretion of excess glucose
* Diuresis - dehydration - hypovolemic shock
* 3P's, nausea, fruity, kussmaul, lethargy, dry skin, hypotension, tachycardia, dizzy
**Diag** - blood glucose lvl, lvl serum/urine keytones, low serum pH, hyperkalemia
**Trt** - **Fluid volume resus FIRST** , then IV insulin. Then D5W to prevent glucose from getting too low
*pseudo hyperkalemia / monitor for rebound hypokalemia
40
Signs of hyperglycemia
Polyuria
Polydipsia
Nausea/Vomit
Fruity breath
Kussmaul respirations
Lethargy
41
**Hypoparathyroidism**
S/S
Monitor for
Trtmt
Parathyroids secrete PTH which affect calcium level
**S/S** decreased calcium, increased phos & decrease in PTH
Tingling, numbness, trousseau & chvostek sign, muscle cramp, pronlonged QT, Tetany, ***SEIZURES*** & precautions!
Monitor for dysrhythmias, high vit D (dark green & tofu), low phos diet
IV calcium gluconate
42
What does hormone PTH do
Cause bones to release calcium and increase renal absorption of calcium
PTH increases so does calcium. PTH decreases so does calcium
43
How to check Trousseau sign?
Check BP above Sys bp for 3 mins. Thumb and Wrist flex = positive
44
How to check Chvostek sign
Taping on facial nerve and patient spasm facial muscles
45
**Acute Pancreatitis**
Direct injury
Obstruction
S/S
Trtmt
Inflammation of pancreas
* **Direct injury** - alcohol, virus, meds (thiazide diuretics)
* **obstruction** - tumor, gallstones
**S/S** - severe ab pain after eating (epigastric/upper left ab/back), nausea/vomit, elevated lipase & amylase levels, CT shows inflammation
**Trtmt** - pain mgmt, IV fluids, antiemetics, NPO, monitor blood glucose and calcium lvls
46
**Chronic pancreantitis**
S/S
TRTMT
Repeated inflammation Can lead to fibrosis on pancreas
**S/S** ab pain, Malabsorption, fatty stools, weight loss, DM
**TRTMT** - small bland freq meals, give pancreatic enzymes w/ meals, supplement vit and minerals
47
**SIADH**
Causes
S/S
TRTMT
Excessive production of ADH = leads to excessive water retention
**Causes:**
* CNS disturbance (stroke, hemorrhage, trauma)
* Meds (pneumoia)
* Cancers
**S/S** Low urine output, Weight gain, HTN, Hyponatremia (confusion, seizures, coma), increased urine specific gravity
**TRTMT** - daily weight, I&O, neuro checks, Seziure precaution. Diuretics, vasopressin antagonists, monitor electrolytes
48
What are the isotonic solutions?
Used for
0.9Sodium chloride, LR
To replace extracellular fluid: dehydration, hypovolemia, vomiting
Maintenance fluids: surgery or illness
Electrolye imbalances
Blood transfusion
Wound irrigation
49
What are the hypotonic solutions?
Used for?
2.5% dextrose, 0.45 NaCl
Cause water to move from extracellular space into cells
* DKA & HHS
* Hypernatremia
* Conditions of excessive water loss
50
What are the hypertonic solutions?
Used for?
Dextrose 5% & 0.9& NacL, Dextrose & LR, Dextran, albumin
Causes water to move out of cells into extracellular space
* * Hyponatremia
* Reducing ICP
* Volume expansion
* Parenteral nutrition
* Electrolyte imbalances
51
S/S of Addison Disease
AKA Primary adrenal insufficiency
Depression, hypotension, hyperpigmentation, decreased public/axillary hair, decreased appetite, fatique, hypoglycemia, muscle weakness
52
Signs of hypoglycemia
Anxiety
Shakiness
Clammy skin
Diaphoresis
Tachycardia
Hunger
Weakness/fatique
53
S/S Cushing Syndrome
Moon face
Muscle wasting
Fat pads
Bruising
Central obesity
Striae
54
**Appendicitis**
Cause
S/S
Absence of pain?
Avoid?
Inflammation of appendix
**Cause**: Obstruction - hardened fecal matter or infection
**S/S** *GRADE*. Garding, Rebound tenderness **(RLQ)** MCBURNEYS POINT, Anorexia/absent bowel sounds, Diffuse ab pain, Elevated WBC/temp
***Absence of pain = rupture
Avoid heat and enema & cathartics
55
**Bowel obstruction**
Mechanical
Non-mechanical
S/S
Trtmt
Mostly in sm intestine
**Mechanical** - Surgery adhesions, hernia, tumor
**Non-mechanial/paralyitc ileus** - ab surgery, neuromuscular & vascular problems
**S/S** - ab pain, distention, inability to pass stool/fart, Nausea/vomit,
* * Mechanical = increased bowel sounds, nonmechanical = decreased bowel sounds *
* Vomiting = hypokalemia & metabolic alkalosis
**TRTMT** - Avoid opioids, NPO, NG tube, antiemetics (ondansetron)
56
**Celiac Disease**
S/S
What grains to eliminate?
Autoimmune - inability to process gluten
**S/S** Ab discomfort, diarrhea, bloating, steatorrhea, iron def anemia, vit def
**BROW** - Barley, Rye, Oats, Wheat - elimate
57
**Cholecystitis**
Risk
S/S
How to test murphys sign
Inflammation of gallbladder - Cystic duct is obstructed by gallstone
**Risk** Female over 40, multiparous, obesity, birthcontrol, elevated cholesterol
**S/S** pain in upper right quad, radiate to R shoulder/back, pain worse after eating. Nausea, vomit, ***positive murphys sign,*** fever, tachycardia, leukocytosis
**Testing Murphy** - press under right rib / medial to mid clavicular before asking to take a deep breath. Pt will halt inhalation due to pain.
58
**Cirrhosis / End stage liver disease**
4 things liver does and how its affected
Risk factors
Scarring of liver tissue after repeated inflammation
* Decreased bilirubin metabolism - jaundice, itching/dry skin, dark urine, pale stool
* Decreased protein synthesis - bruising, edema ab & lower
* Altered metabolism of hormones - gynecomastia, loss of pubic hair, palmar erythema
* Altered blood flow to liver - portal HTN, esophageal varices, splenomegaly, acscites
**Risk** Chronic hep B or C, Alcoholism, fatty liver disease (obese)
**TRTMT** - sit up, diuretics, paracentesis, daily weight, avoid sedatives, acetaminophen
59
**Cirrhosis**
Increased and decreased lab values
Increased serum bilirubin & serum ammonia
increased PT, PTT, ALT, AST
Decreased albumin, platelets and WBC
60
**C difficle**
How long can spores surivive
S/S
Complications
Precautions?
TRTMT
Spore forming, gram positive
Spores from diarrhea can survive on skin, clothes and environmental surfaces for months
**S/S** profuse watery diarrhea, Ab pain, nausea, fever, dehydration
*TOXIC MEGACOLON - pertonitis*
Contact precautions - wash hands
**TRTMT** Vancomycin, fidaxominicin
61
**Diverticulitis**
S/S
What to avoid
Complication of current diverticulosis that leads to Inflammation/infection
**S/S** Fever, constipation now loose stools or just constipation, occult stools, ab pain LLQ worse with cough, strain or lift.
*No colonoscopy! could cause tears*
High fiber/avoid fried
62
**Diverticulousis**
Risk
Sac like pouches form in colon wall
**Risk**: constipation, obesity, straining, heavy lifting
High fiber diet
63
**Enteral feeding**
Types
Nursing interventions
Means of providing nutrition to pt who cannot eat or drink
Short or long term (Gastrostomy tube or jejunostomy tube)
* Bypass damaged portion of GI tract
**Types**: bolus (30-60min q 3-6hrs), Continuous /24hrs, Cyclical continuosly /8-16hours
**Nursing** verify tube to prevent aspiration, warm feeding to room temp, elevate HOB, check bowel sounds before, during, after.
If resudial is >500ml, stop and call HCP**
64
**Esophageal Varices**
S/S with rupture
Trtmt
Distended torturous blood vessel /Seen with Cirhossis
**S/S** Can rupture - excessive bleeding, could be coffee ground emesis, melena, hypotension, tachycardia
**TRT** with rupture NPO, protect airway, inbutation, IV fluids, PRBCS, Octreotide, PPI, emergency EGD procedure (Sclerotherapy, band ligitation, sengstaken-blakemore tube)
65
**Gasteroenteritis**
Transmitted
Viral
Bacteria
S/S
Acute GI infection
**Transmitted** fecal0oral, containimated food/water, person to person
**Viral** - Norovirus, rotavirus, enteric adenovirus
**Bacteria** - food poisioning
**S/S** Diarrhea, vomit, fever, hyperactive bowel sounds, dehyrdation, hypovolemia
66
**GERD**
Risks
S/S
Barret esophageous
Avoid
Back flow of stomach acid into esophagous / chronic condition
**Risk** Obesity, preg, hiatal hernia, foods/meds
**S/S** heartburn, indegstion, dysphagia, regurgitation, cough, wheezing - increased bending, lying down
**Barrett esophagous** - early indication of cancer
**Avoid** caffeine, chocolate, alcohol, carbonated drinks, spicy foods, citrus, lying down 2-3 hours after eating
67
**Hepatitis**
Causes
A
B/C
S/S
Meds
Widespread inflammation of liver
**Causes** virus, alcohol, meds
A - virus spread fecal-oral
B/C - blood, sex, mother/child - only B & C can lead to chronic infection
**S/S** anorexia, pain RUQ, jaundice, dark urine, pale stool,
**Meds** - antivirals
68
**Ostomies**
Stoma
Stool changes
Signs of returning motility post op
Teaching
Creation of stoma in ab wall for passage of stool to bypass diseased partion of colon
**Stoma** - pink to red, moist/vascular
**Stool changes** - more liquid proximally, more solid distally
**Signs of returning motility post op** - Less nausea, active bowel sounds, flatus in ostomy bag, edema red stoma
**Teaching** -Empty 1/3 of way full, increase fiber, avoid foods that cause odor
69
**Peptic ulcer disease**
Risk
S/S
TRTMT
breakdown of protective lining in stomach
**Risk** - h. pylori, NSAIDS, smoking, alcohol, caffeine, stress, trauma
**S/S** ab pain (1-2 hours after meal), gi bleeding
**TRTMT** - *non bleeding* = antibiotics, PPI, Sucrulafate - forms protective lining (take before PPi)
*Bleeding* - NPO, check hemoglobin, hematocrit
70
**Sickle Cell**
S/S sickle cell crisus
Vaso-occulsive?
Sequestions?
Hyperhemolytic?
S/S
TRTMT
Autosomal recessive - both partents have to have it
Alter in hemoglobin - occuld small blood vessels
**S/S sickle cell crisis -**
* vaso-occulsive - Painful distal ischemia (Hand/feet)
* Sequestration - pooling of blood in liver and spleen
* Hyperhemolytic - anemia
**S/S** Tachyardia, pain/pain in joints, infection, WBC over 10,000, anemia, increased reticulyte count
**Trtmt** - diet, vitmain w/o iron, folic acid, hydration, vaccinations, 02, pain meds
71
**Anaphylaxis**
What happens in body?
Common offenders?
S/S
TRTMT
life threathing immediate hypersensitivity reaction
* Vasodilation & increase cap permeability
* Laryngospasm & bronchospasm
-Peanuts, shellfish, beestings, red dyes, vaccines, rubber blood transfusion
**S/S **- Warm, wet rash. Swollen, SOB, HTN, arrythmias, GI upset
**TRTMT** stop transfusion, emergency response team. IM epi q 5-10 mins, recumbent position and elevate lower extrem, IV fluids, 02, intubate if needed. Albuterol, corticosteroids, antihistamines.
72
**Influenza**
Transmitted via
Most infectious when?
S/S
Interventions
Highly contagious respiratory viral infection
* Transmitted via droplet
* Most infectious 24 hours BEFORE symptoms
**S/S** Sudden onsest of fever/chills, fatique, body aches, resp symptoms
**>65 yr** - altered mental, anorexia, dizzy
**Interventions** - Droplet, flu shot, antipyretics, analgesics, ***OSELTAMIVIR***
73
**Tuberculosis**
Latent
Active & S/S
Miliary
Diag
interventions + Meds
Resp disease / spread through aerosols
**Latent** - no signs of infection
**Active** - spread to other organs// slow onset// *Cough, fever, chills, night sweats, weightloss*
**Miliary** - any organ (brain, liver, kidney, bones)
**Diag** - 15mm is standard, active is seen on chest xray
**Interventions** - neg pressure room, N95 mask, ***ISONIAZID, RIFAMPIN, PYRAZINAMINDE, ETHAMBUTOL*** - Monitor for hepatotxicity
74
**Eczema**
S/S
Complications
Chronic recurring skin disorder
**S/S** dry scaly lesions, erythema, papules
**Complication** - lichenification (thickening skin), 2ndary infection, impetigo (gold crust)
75
**Impetigo**
Spread?
S/S
TRTMT
Highly contagious skin infection caused by staph or strepp
Spread directly or indirectly
**S/S** - Nonbullous - papulses golden thick crust
Bullous - fluid filled vesicle
**TRTMT **- Topical antibiotic, oral antibiotic
76
**Gout**
Risk
S/S
Diag
Trtmt
what food to avoid
Excess uric acid accumlated in synovial joints
**Risk** obesity, hyperlipidemia, Dm, high protein high fat diet, excessive alcohol
**S/S** severe pain, joint warmth, red, swelling
**Diag** serum uric acid
**TRTMT** NSAID, Colchicine, elevate, ice, hydration
**AVOID** food high in purine (organ meat, wines, aged cheese)
77
**Guillain-Barre Syndrome**
Preceeded by
S/S moving in what direction
Auto immune disorder that affects peripheral nerves
* Preceeded by infection
**S/S** symmetric ***ascending*** muscle weakness, diminished deep tendon reflexes, paresthesia, back pain, urinary retention, cardiovascular instability
**TRTMT** - NO CURE, just supportive, resuscitative equipt ready
78
P wave refers to?
QRS wave refers to?
P wave - atrial
QRS wave - Ventricular
79
Normal Sinus rhythm
80
Ventricualr fibrillation
81
Ventricular tachycardia
82
Asystole
83
**Myasthenia Gravis**
S/S
Triggered by
Meds
Myasthenic crisis
Auto immune muscle disease / tumor in thymus gland
**S/S** Fluctuating skeletal weakness, ocular, lower face/neck, resp impairment, neck and limb weakness
**Triggered by** stress, infection, meds, temp changes
Meds **Pyridostigmine** / take before meal
**Myasthenic crisis** - Severe oropharyngeal and respi muscle weakness / intubate & semi fowler. Corticosteroids & plasmapheresis or IV immunoglobin
84
**Osteoporosis**
Risk
S/S
Interventions
Holes in bone / fragile
**Risk** advanced age <60, low estrogen, low testosterone, Thin/low weight, smoking, alcohol
**S/S** kyphosis, typically no symptoms until fracture
**Interventions** Vit D supplements, Calcium carbonate, biphosphonates, sun exposure
85
**Parkinson Disease**
S/S
Interventions
Degeneration of dopamine & uncontrolled acetylchoine = lewie bodies in brain
**S/S** "TRAP" Tremor, Rigidty of muslces, akinesia, postural instability. Shuffling gait & stooped posture
**Interventions** - Carbidopa/Levodopa (replace dopamine)
86
**Rheumatoid Arthritis**
S/S - elevated lab? 2 main deformities?
TRTMT
Chronic autoimmune inflammation and damage to synovial joints
**S/S** periods of remission & exacerabation, joint pain, Prolonged morning stiffness lasting longer than 1 hour. Symmetric joint involvment, Joints tender, swollen and warm to touch
Tired, weightloss, **elevate ESR*** Swan neck deformity, ulnar deviation *
**TRTMT **NSaids, glucocorticords, DMARDS - *methotrexate* / avoid repeatitive movemnet
87
**Spinal cord injury**
Complete VS Incomplete
Diag
Autonomic dysreflexia
S/S & Trtmt
CNS
**Complete** - interruption of all motor/sensory below level of injury
**Incomplete** - motor/sensory not fully interrupted
**Diag** - CT or MRI
**Autonomic Dysreflexia** - Noxious stimuli below level of injury (distended bladder, impacted rectum, constrictive clothing)
* Severe HTN, Severe headache, nasal stuffiness, flushing, bradycardia
* Raise HOB, Loosen clothing, Antihypertensive meds
88
**Bacteria Meningitis**
S/S Adults/peds & neonates
Diagnosis
Interventions
What precautions
Life threathening inflammation or infection of meningies / caused by nisseria or strep pneumonia
**S/S** - ADULTS/peds - Fever, headache vomit, neck stiff
Neonates - Poor feeding, bulging fontanels
**Diagnosis** - CSF exam, lumbar puncture (cloudy, WBC, high protein, low glucose)
**Interventions** - prevent ICP
* Droplet precautions/seizure precautions
89
**Cerebral Edema**
Caused by
S/S
CUSHING TRIAD
Interventions
Excessive fluid in brain
Caused by trauma, surgery, tumor
**S/S** Headache, vomit, change in LOC, Decorticate & Decerebrate, hyperthermia,
**CUSHUNG TRIAD** - HTN w/ widening pulse pressure, Bradycardia, irregular respirations
**Interventions** - **Hypertonic saline**, HOB 30 degrees, Neutral position, **Osmotic diuretic** stool sofetener
90
**Diabetic neurophathy**
Peripheral neuropathy S/S
Autonomic neuropathy S/S
Treatment
Irreversible nerve damage
**Peripheral neuropathy** - Stocking glove paresthesia / tingling & burning, decreased or absent reflexes, ulcers, sensory ataxia (Romberg test)
**Autonomic neuropathy** - hypoglycemia unawareness, orthostatic hypotension, Gastroparesis, bowel dysfunction, neurogenic bladder, erectile dysfunction
**Trtmt** - Antidepressants, anticonvulsants, topical capsaicin
91
**Ischemic Stroke**
Risk
S/S BE FAST
TRTMT
Thrombus (formed in Cerebral artery) or embolus (clot that moved)
**Risk** HTN, DM, Hyperlipidemia, smoking, CAD, Afib,
TIA - Warning sign of stroke. Neurologic deficit last only mins or hours
**S/S BE FAST**. Balance, Eyes, Face (weakness, drooping), Arms/Legs (weakness), Speech, Time
**Diag** - CT w/o contrast. Rules out hemorrhage so they can use TPA
**Trtmt** - TPA must administer with in 4.5hrs, look for active bleeding, recent brain surgery
*Permissive HTN for nonTPA patients *
92
If a patient has a stroke in LEFT hemisphere what will it affect?
Language, reading, reasoning, math and sciences, touch and movmt on right side
93
If a patient has a stroke in RIGHT hemisphere what will it affect?
Spatial processing, emotion, art music. Touch and movment on left side
94
Lack of QRS ?
Saw tooth?
Chaotic always used to describe?
Bizarre?
**Lack of QRS** - Asystole
**Saw tooth** - Flutter
**Chaotic** - fibrillation
**Bizarre** - Tachycardia
95
When to be concerned about PVC?
* More than 6 /min
* 6 in a row
* PVC falls on T-wave of previous beat
96
**Benign Prostatic Hyperplasia**
S/S
Complications
Meds
Surgery?
Gradual and abnormal prostate enlargement - compressing urethra = voiding dysfunction
**S/S** Weak urinary stream, Hesitancy, straining to void, Freq, noctura
**Complications** (Back up of urine) AKI, Hydronephrosis, UTI
**Meds** - Alpha-adrenergic antagonists (Sm muscle relax)- ***Tamsulosin, doxazosin***
5-Alpha reductaste Inhibitors (decreases prostate) ***Finasteride***
TURP - surgery
97
What meds cause urinary retention?
Anticholinergics, antihistamines, decongestants
98
**Acute Respiratory distress Syndrome (ARDS)**
3 patho systems
S/S
Diag
Interventions
Progressive respiratory failure usually after lung injury or multie system organ disease
* Stiff lungs
* Increased permeability = increase of fluid in lungs & decrease of 02 exchange
* Cytokine storm
**S/S** SOB, Refractory hypoxemia, tachypnea, intercostal retractions, tachycardi, fever, pulmonary edema
**Diag** - low Po2 (under 80), repiratory acidosis, Chest Xray - diffuse infilatrates
**interventions** - fowlers positiong, ventilator w/ PEEP, Restrcit fluids, prone, increase 02 to 100% before suctioning
99
**Pneumonia**
4 types
S/S
Diag
Interventions
Inflammatory reaction in lungs - increased secretions & impaired gas exchange
* Community aquired
* Hospital
* Ventilator
* Aspiration
**S/S** Diff breathing, productive cough w/ purulent sputum, increased RR, Chest pain on deep breathing, fever chills, tachycardia, hear crackles
Older - may only be confused/hypoxia
**Diag** - chest Xray, high WBC, Sputum culture
**Interventions** - hydrate, deep cough q 2hour, incentive spirometer 10X every hour, lay on side with infected lung UP
100
**Pneumothorax**
3 types
S/S
interventions
Auir enters pleural space and cuases collapse of lung
* Open - air enters through hole (trauma, gunshot)
* Closed - air enters through hole in lung tissue (surgery injury)
* Tension pneumothorax - air enters but cannot escape -Trachea shifts, hypotension
**S/S** Dyspnea, restless, cyanosis, chest pain, hypotension, tachycardia, low 02 sat, dimished lung sounds
**Interventions** - 3 way occulsive dressing over sucking wound, fowler position, chest tube
101
**Pulmonary Embolism**
Virchow triad
S/S
Diag
Interventions
Occlusion of pulmonary arteries by blood clot, fat, air or amniotic fluid
**Virchow triad **- Stasis, Endothelial damage, Hypercoagulable state
**S/S** dyspnea, pleuritic chest pain, hypoxemia, tachypnea, cough, hemotysis, impending doom, hypotensive, respiratory acidosis
**Diag** - D dimer, CT pulmonary angiogram with contrast
**Intervention** - high fowler, anticoagulants, analgesic, Tpa or embolectomy
102
**Acute Glomerulonephritis**
Causes
S/S
Diag
Complications
inflammation and destruction of glomerulus = loss of kidney function
**Causes** - Strep infection, systemic lupus
**S/S **oliguria, Dark, rust colored urine, protienuria, edema (periorbital), HTN, weight gain, flu like symptoms
**Diag** - Urinalysis, BUN and Creatinine elevated, evidence of recent strep infection
**Complications** - Hypertension encephalopathy, AKI, Fluid overload
102
**Chronic Kidney Disease (CKD)**
Staging
Causes
S/S
TRTMT - HTN, Anemia, Edema, bones, hyperkalemia, hyperphosphatemia, metabolic acidosis
Diet -
Irreversible slow progressive disease
**Staging** is based on GFR. Stages 1-3 kidney still functioning. 4-5 severely impaired
**Causes** DM & HTN
**S/S** Volume overload, edema, pulmonary edema, pleural effusion, HTN, lethary, neurological changes / elevated Potassium & phosphorus. Low calcium. Metabolic acidosis
**TRTMT** - HTN - ACE inhibitor, angiotensin 11 receptor blockers
Anemia - Erythropoietin injection
Edema - Diuretics (stages 1-3)
Bones - Calcium & vit D
Hyperkalemia - PO intestinal K binder
Hyperphosphatemia - PO phosphate binders
Metabolic acidosis - Sodium bicarb
**DIET** - low potassium, phosphorus, sodium and water
103
**Hemodialysis**
Purpose
3 access ports
Closed system outside of body
* Removes waste, excess water, corrects electrolytes, restores acid base
**3 access ports** Central venous double lumen, arteriovenous fistula, arteriovenous graft
**Interventions** - admin heparin, monitor for bleeding, vitals
104
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**Peritoneal Dialysis**
Phases
Interventions
Peritonitis
Abnormal outlfow
Uses peritoneum as semi permeable membrane - surgical placement of cathether
**Phase** - Fill - instill dialysate, Dwell - Dialysate remains in cavity alloweing exhange of fluid, electrolytes and waste, Drain - dialysate, electrolytes, waste are drained via gravity
**Interventions** - aseptic technique, pt wear a mask,
**Peritonitis** - tachycardia, fever, ab pain, cloudy effluent
**Abnormal outflow ** Cloudy = infection, Blood = expect during first few, later indicates vascular issue, Fecal/brown = intestinal perforation
105
**Tumor Lysis Syndrome**
Causing what 3 disorders and assoc complications
S/S
Interventions
Chemo attacks tumor cells - tumor cells open and spill out intercellalur components - Potassium, phosphate, uric acids
**Causing**
* hyperphosphatemia (AKI & Hypocalcemia)
* hyperuricemia (AKI)
* hyperkalemia (Cardiac arrhythmias
**S/S** AKI, elevated BUN & creatinine, flank pain, cardiac arrhythmias, seizures
**Interventions** - aggressive IV fluids (Allop**uri**nol, rasb**uri**case)
106
**UTI**
Diagnosis
Bacterial infection of lower urinary tract (Cystitis) or lower tract (pyelonephritis)
**Diag** - clean catch mid stream urine sample, WBC and nitrates
**S/S** dysuria, urinary freq and urgency, hematuria, lower ab pain, nausea, fever, flank (pyelonephritis)
107
**Macular degeneration**
Risk
Type
S/S
TRTMT
Progressive aged related loss of vision
**Risk** - older age, HTN, tobacco vision
**Types** Dry - ischemia and atrophy of macula from drusen build up
Wet - bleeding and leaking fluid from formation of new vessels
**S/S** blurry vision, wavy vision, scotomas (blind spots), loss of central vision
**TRTMT** - increase Vit C&D, dark leafy veg, *angiogenesis inhibiots, laser therapy*
108
**Meniere Disease**
S/S
Diag
TRTMT
Often affects 1 year but can affect both. Excess fluid build up in inner ear - affecting balance and hearing
**S/S** vertigo, tinnitus, sensorineural hearing loss, feeling fullness in ear
**Diag** audiometry
**TRTMT** - Antiemetics, low dose diuretics,
109
**Otitis Externa**
S/S
TRTMT
Infection of outer ear cannal (swimmers ear)
**S/S** Rapid on set/w/in 48hours, swelling, itching
**TRTMT** - antibiotic drops & hydrocortisone
110
What are different types of loosening of association?
Flight of ideas
Word salad
Neologisms
111
Ideas of reference
You think everyone is talking about you
112
**Anorexia Nervosa**
Restrictive & binge eating types?
S/S
Indications for hospitalizations
Eating disorder - crave control
**Restrictive type** - extreme fasting, excessive excercise
**Binge eating/purging** - eat large portions and binge, laxatives, diuretics
**S/S** - low and slow. Confusion, dry skin, hair loss, decreased libido, low BMI <18.5) fatique, cold intolerance, hypotension, bradycardia, constipation, muscle wasting
**Indications for hospitalization** <70% of expect weight or under 15 BMI, refeeding syndrome, hemodynamic instability, refuse to eat
113
**ADHD**
S/S
Interventions
Deficiency in neurotransmitters - Norepinephrine and dopamine
**S/S** inattention, distractibility, hyperactice for at least 6 months, present before 12years
**Interventions** behavioral therapy, Methylphenidate, amphetamines, SNRI
114
**Bulimia Nervosa**
S/S
Eating disorder by cycle of overeating followed by compensatory behaviors (vomit, excessive excercise, fasting, laxatives) / emotional triggers
**S/S** normal to elevated BMI, enamel erosins, Russel sign (hand calluses), GERD, cardiac arrhythmias, dehydration, hypokalemia, metabolic alkalosis
115
# over
**Tetralogy of Fallot**
4 defects?
S/S
Tet spell intervention
Congenital heart defect characterized by 4 defects
**1. Pulomanry Stenosis** - Narrowing of pulm valve = decreased blood to lungs
**2. Overriding aorta** - positioned between R&L vents which allows deoxygenated blood to enter circulation
**3. Ventricular septal defect** - opening between R and L vents which allows oxgenated and deoxenageted blood to mix
**4. Right ventricular hypertrophy** - Enlargement of R vent = ineffective pumping and blood to body
**S/S** fatique, dyspnea, cyanosis, Central cyansosi worse with exertion, Systolic ejection murmur
**Tet spell intervetnion** - Knee chest position
116
**Hypertrophic Pyloric Stenosis**
S/S
Complications
Thickening of pyloric sphincter in infants = blocks passage of gastric contents into intestines
**S/S** Postprandial projectile vomiting, 3-6 weeks of age, irritable & crying, persistent hunger
**Complications** Dehydration, sunken anterior fontanel, dry mucous membrane, metabolic alkalosis, decreased stool, olive shaped mass in epigastric
117
**Refeeding syndrome**
S/S
reintroducing caloric intake too quickly
**S/S** hypokalemia -cardiac dysrhythmias
Hypophosphatemia - muscle weakness - resp failure
Hypomagnesemia - Seizures or PVC
Hyperglycema
118
**Tracheoesophageal fistula (TEF) and Esophageal Atresia**
S/S
Complications
Congenital malformations/ diagnosed typically as newborn
**Atresia** - a part of body that is closed or absent. Blind pouch
**Fistula** - abnormal connection of two parts of body
**S/S** coughing, choking and vomiting when eatiig, drooling, frothy salivia, ab distension, apnea, coarse breath sounds
**Complications** can lead to aspiration pneumonia
119
**Acute lymphoblastic Leukemia**
S/S
Interventions
Cancer of bone Marrow - affects lymphoblasts - Rapid growth of immature WBC - decreases healthy cells
**S/S** Pancytopenia, Anemia, decreased RBC, Pallor, fatique, decreased platelets, bleeding ,brusing, petechiae, decreased WBC, neutropenia
--Weight loss, bone pain, lymphadenopathy, hepatosplenomegaly
**Intervention** - bone marrow biospy and aspiration, Neutropenic precautions (gown, gloves, mask) Private room. AVOID raw foods/veg, fresh flowers, rectal thermometer, live vaccines, large crowds
120
**Acute Myelogenous Leukemia**
S/S
Complications
Cancerous disorder of bone marrow - Myloid cells (WBC) overproduced immature WBC take up nutrients of mature WBC
**S/S** Pancytopenia (decreased RBC, platelets, WBC)
Interventions - Bone marrow biospy/aspiration, Chemo/radiation, Blood products.
**Complications** - Neutropenia
121
**Mononuceolosis**
Spread via
S/S
Complications
Acute disease caused by epstein barr virus
**Spread** via direct contact with oral secretions, blood or transplantation
**S/S** Severe and prolonged fatique, sore throat, Tomsillar hypertrophy, hepatosplenomegaly, rash
**Complications** - Rupture of spleen (avoid contact sports for 3-4 weeks)
122
**Pertussis**
Spread
S/S
Interventions
Whooping cough/bacterial respiratory infection
**Spread** resp droplets
**S/S**
* *Catarrhal phase* - cough, rhinitis, sneezing, fever for 1-2 weesl
* *Paroxysmal phase* - Violent spasmodic coughing attacks followed by an inspiratory whoop (emesis, syncope, rib fracture, apnea, bleeding)
* *Convalescent phase* - Mild cough for 6-10 weeks
**Interventions** standard + droplet precautions, antibiotics, humidified air
123
**Cerebral Palsy**
Caused by
Risks
Treatment
Nonprogressive, permanent motor and postural disorder
**Caused** by brain injury during or after birth.
**Risk** peirnatal infection, PROM, Premature, low birth weight, cord prolapse, preeclampsia
**S/S** abnormal muscle tone, posture and coordination. Spasticity, disturbance in gait, impairment in speech and swallowing, difficultly learning, seizures
**Treatment** ROM, muscle relaxants, assistive positioning devices
124
**Bacterial Meningitis**
Life threatning inflammation/infection of meningies
S/S
* Adults - fever, headache vomit / neck stiff
* Ped - fever, headache, vomit / rask, neck stiff
* Neonates - Poor feeding / buldging fontanels
125
**Acute Pediatric Epiglottitis**
S/S
Swelling of epiglottis - most commonly caused by HiB (Haemophilus flu typeB)
S/S sudden onset, fever, sore throat, agitated, resp distress, tripod position
*** D**rooling, **D**ysphonia (muffled voice), **D**ysphagia, **D**istress
126
**Asthma**
S/S
Diagnosis
Treatment
Peak flow meter
Chronic obstruction of airway
* Hyperactive airway, inflammation, hypersecretion of mucus
* Triggers - Allergens, medications, environmental, infection
**S/S** chest tightness, diff breathing, wheezing, cough
**Diag** spirometry
**Treatment ** Short acting beta 2 - Albuterol, anticholinergic - ipratropium, corticosteroids
Maintenance - long actinge beta agonist, bronchodilater before steroids
**Peak flow meter** - measures amount of air able to push out lungs.
127
**Bronchiolotis and RSV**
S/S
Interventions
Inflammation of bronchioles - produces thick mucus - obstruction of bronchioles
Spread by droplets and direct contact
**S/S** Rhinorrhea, cough, pharyngitis, sneezing, fever, adventitious lung sounds
**Interventions** - droplet precautions + standard, 02, hydration
128
**Cystic Fibrosis**
Diag -what test?
S/S
Autosomal recessive - both parents
Causes defective chloride channel secreting thick sticky secretion
* Obstruct small airways
* Blocks exocrine ducts - not able to produce enzymes
* Instestinal tract and reproductive tract
**Diag** - postive sweat chloride test.
**S/S** Freq infection of lungs, Chronic cough, Barrel chest, suspect in infants who cannot pass stool in 24-48 hours, steatorrhea, failure to grow, DM,
129
Meds used to treat enuresis
Desmospressin (anitdiuretic)
Oxybutynin (anticholinergic)
Imipraminie (TCA)
130
**Hemolytic Uremic Syndrome** HUS
Caused by E coli bacteria. after a diarrheal illness, results in triad of
* **Hemolytic anemia** - Tired, pallor
* **Thrombocytopenia** - Petechiae, bruising, purpura
* **AKI** - olgiuria, edema, HTN
**Interventions** - contact precautions, maintain fluid balance, monitor strict I&O
131
**Ectopic Pregnancy**
S/S
TREATMENT
Egg implants in fallopian tube
**S/S** pain in ab on one side, abnormal bleeding/spotting, hypotension, referred shoulder pain
**TREATMENT** - Methotrexate (urine toxic up to 72hours), avoid analgesics stronger than acetaminophen, surgery may be required
132
**Preeclampsia**
Pre E W/o
Pre E W/
Complications for maternal and fetal
HTN disorder of pregnancy - High bp after 20 weeks of gestation
**Pre E w/o severe features **- Bp greater than 140/90, preteinuria
**Pre E w/ severe features **- Bp greater than 160 or 110, Thrombocytopenia, increased creatinine, increased LFT, visual or cerebral changes
* Maternal - AKI, pulmonary edema, ischemic stroke, hepatic failure, DIC, eclampsia
* Fetal - Placental abruption, restricted growth, preterm birth, fetal demise
133
**Preterm labor **
Very preterm
Moderate
Late
S/S
Term after 37 wks, Preterm before 37 wks
* Very preterm - less than 32 wks
* Moderate - 33-34wks
* Late - 34-37 wks
**S/S** Painful freq contractions, low back pain
134
**Stages of Labor**
False vs true labor
1st stage
2nd stage
3rd stage
4th stage
Labor - regular contractions which cause progressive cervical dilation and effacement
False labor - irregular contractions, no cervical dialtion, effacement, or fetal descent
True - regular contractions, dilation, effacement, fetal descent
**1st stage** - Start of contractions to pushing
Latent - 05cm cervical dilation
Active - 6-10cm dilations / bloody show
Transition - 8-10 dilations
**2nd Stage** - 10cm dilated to birth
**3rd stage** - delivery of placenta (oxytocin give)
**4th stage** - 1-4hours post delivery
135
**Umbilical Cord prolapse**
S/S
Interventions
Obstetric emergency
**S/S** visualized cord protruding from vagina, palpation of cord during exam, sudden fetal heart rate changes, Fetal bradycardia, moderate to severe decelerations
**Interventions** - Wrap protruding umbilical cord with sterile towel and warm saline, IV fluid bolus + 02, push head upward off cervix, mom to knee chest position,
136
**Cleft lip and Palate**
Increased risk for?
Interventions
**Cleft palate** - small bones of roof of mouth do not fuse appropriately
* Increased risk for aspiration, issues feeding, poor sucking, aspiration pneumonia, recurrent ear infections, speach difficulties
**Interventions** - feed in upright position, burp after every oz, surgery at 6-12 months
-elbow restraints, observe for obessive swallowing, no straws or pacifiers
137
**Hirschsprung Disease**
S/S
Interventions
Congential - Bowel does not contain certain cells that allow it to contract to pass stool. Bowel is tightened
**S/S** Dilated bowel, ab distention, feeding intolerance, bilious vomiting, Ribbon like stools, poor weight gain, delayed meconium passage by 48 hour mark
**Intervention** - Surgery to remove nonfunctional part of bowel
138
**Infant botulism**
S/S
Interventions
Occurs through food poisioning. Toxins released which can inhibit acetylcholine causing muscle paralysis
**S/S** symmetric descending muscle paralysis, ptosis, absent gag reflex, poor feeding, constipation
**Interventions** IVIG, mechanical vent, tube feeding
139
**Neonatal Abstinence Syndrome**
S/S
Interventions
Withdrawl caused by exposure in utero to substances
**S/S** CNS, irritable, high pitched cry, hypertonia, tremors, short sleep cycle, sneezing, yawning, tachypnea, vomit, diarrhea
**Interventions** daily weight, freq small feeding, minimize environment, swaddle tightly, Opioid agonists
140
**Newborn Hypoglycemia**
Risks
S/S
Blood glucose of less than 40
**Risks** preterm, small or large for gestational age, mom has DM, respiratory distress
**S/S** Hypotermic, poor feeding, tremors, irritability, exaggerated moro reflex, tachypnea, lethargy
141
**Spina Bifida**
Closed S/S
Open S/S
Risks
Interventions
Defect within vertebrae of spine. Leaves an opening
**Closed (Occulta) **- Dimple above but or hair tuff, hemangioma, or subcutaneous mass
**Open (Cystica) **- See spinal cord, nerves, fluid, sac protruding. Everything below will be affected. Abnormal hip development, hydrocephalus, neurogenic bladder
**Risk **decreased in folic acid, tetragenic meds,
**Interventions** - use latex free gloves, cover site with saline soaked non adherent dressing, ONLY neurosurgeon can remove dressing, no diaper
142
**Lactational Mastitis**
S/S
Interventions
Occurs when there is inadqueate breast milk drainage or inadequate lactation
Bacteria enters
**S/S** usually just one breast, swelling, redness, flu like symptoms
**Interventions** antibiotics, warm compress, continue breastfeeding
143
**Postpartum Hemorrhage**
Blood loss
Common causes
Interventions
Blood loss greater than 1000ML
**Common causes:** Tone, Trauma, Tissue, Thrombin
**Interventions** Vitals, void, fundal massage, Uterotonics (oxytocin, misoprostol, methlergonovine, carboprost) Fluid resuscitation
