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NURS 313R > Final Exam Study Guide > Flashcards

Final Exam Study Guide Flashcards

1
Q

What are the general clinical manifestations of anemia?

A
  • Decreased hemoglobin level
  • Palpitations
  • Dyspnea
  • Fatigue
  • Skin Changes (pallor, jaundice, pruritus secondary to bile salts)
  • Cardiopulmonary manifestations: murmurs, bruit (d/t low viscosity of blood), risk for angina pectoris, MI, HF
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2
Q

What are the treatments for anemia?

A
  1. Oxygen Therapy
  2. Blood Transfusions
  3. Epoetin
  4. Volume Replacement
  5. Dietary and Lifestyle changes (iron best absorbed in acidic environment - best given with orange juice)
  6. Assess for safety
  7. Energy conservation
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3
Q

Epoetin

A

Stimulates the bone marrow to produce RBCs

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4
Q

Megaloblastic anemia

A

Caused by impaired DNA synthesis characterized by the presence of large RBC.
Includes Cobalamin Deficiency (includes pernicious anemia) and Folic Acid Deficiency

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5
Q

What are the specific clinical manifestations of megaloblastic anemias?

A
  • Sore Red Beefy and Shiny Tongue
  • Anorexia
  • N/V
  • Abdominal pain
  • Weakness
  • Paresthesia of hands and feet
  • Decrease vibratory and position senses
  • Ataxia
  • Muscle Weakness
  • Confusion/dementia
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6
Q

Collaborative Care for Megaloblastic Anemia includes

A

-Parenteral, intranasal administration of cyanocobalamin

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7
Q

What are the clinical manifestations of myocardial infarctions?

A
  • Pain is severe, immobilizing
  • Not relieved by rest or nitrate administration.
  • Described as heaviness, pressure, tightness, burning, crushing.
  • N/V, fever
  • Cardiovascular Symptoms: elevated HR, decrease BP and urine output, crackles, hepatic engorgement, peripheral edema
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8
Q

What are the complications of MI?

A
  • Arrhythmias (most common)
  • CHF
  • Cardiogenic Shock
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9
Q

Collaborative Care for MI includes

A
  1. Fibrinolytic therapy
  2. Cardiac Catherization
  3. Drug Therapy
  4. Nutritional Therapy
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10
Q

Fibrinolytic Therapy

A

Produces an open artery by lysis of thrombus to reprefuse the myocardium.

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11
Q

How do you determine candidacy for fibrinolytic therapy?

A

Thrombolytic therapy is only indicated for patients with a ST Elevation Myocardial Infarction(STEMI).

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12
Q

Aortic Aneurysms

A

Outpouching or dilation of aortic wall.

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13
Q

What is the difference between a thoracic aneurysm and aortic aneurysm?

A

..

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14
Q

Clinical Manifestations for Aortic Aneurysm include

A
  • Thoracic aortic aneurysms are often asymptomatic
  • Deep, diffuse chest pain (d/t decreased blood flow to coronary arteries)
  • Hoarseness
  • Dysphagia
  • Jugular venous distention (d/t decreased venous return)
  • Edema of the face and arms
  • Pulsatile mass in the periumbilical area
  • Audible bruit
  • Pain in abdomen or back
  • Discomfort w/ or w/out alteration of bowel elimination
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15
Q

Nursing Considerations for Aortic Aneurysms include

A
  • Decrease risk factors associated w/ atherosclerosis
  • Maintain BP
  • Oxygen supply
  • Prevention of infection / ABT
  • Prevent paralytic ileus
  • Monitor peripheral perfusion status
  • Monitor renal perfusion
  • Avoid heavy lifting 4-6 weeks post op.
  • Monitor sign and symptoms of infections
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16
Q

Thoracentesis

A

Removal of fluid using a large bore needle.

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17
Q

How do you care for a client currently undergoing thoracentesis?

A
  1. Clean with antiseptic solution.
  2. Position patient bent forward for maximum lung expansion. (TRIPAD)
  3. Local anesthetic is used.
  4. Instruct patient not to talk or cough during procedure.
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18
Q

How do you care for a client after thoracentesis?

A
  • Observe for signs of hypoxia and pneumothorax.
  • Verify breath sounds in all fields.
  • Encourage deep breaths to expand lungs.
  • Send labeled specimens to laboratory promptly for analysis.
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19
Q

Pneumothorax

A

Presence of air in the pleural space causing restriction of lung expansion and collapse.

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20
Q

How do you care for a patient with a pneumothorax?

A

…
Administer O2
Position in semi-Fowler’s position
Prepare for chest tube insertion

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21
Q

What is the pathophysiology of a pneumothorax?

A

..

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22
Q

Assessments: Pneumothorax

A

..

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23
Q

Diagnostics: Pneumothorax

A

..

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24
Q

What are some complications of a pneumothorax?

A

…

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25
Q

How do you care for a patient with chest tubes?

A
  • Keep all tubing straight as much as possible below chest level
  • Keep all connections tight and sealed
  • Keep appropriate water level, use sterile water
  • Mark the time of measurement and fluid level
  • Observe air bubbling/ tidaling in water seal chamber
  • Bubbling is intermittent in water seal, if continuous determine leakage by momentary clamping tube distal from the patient until bubbling stops.
  • Monitor Vital Signs and chest Movement
  • Never elevate drainage to the level of patient’s chest
  • Encourage deep breathing and ROM to affected side
  • Do not strip or milk chest tubes
  • If drainage tube breaks place the distal end of the drainage tube in a sterile water at 2 cm level
  • Clamp with rubber stopper a bed side
  • Always have a vaselinize gauze at bedside to reinforce dressing if leakage is present.
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26
Q

What are normal findings in a patient with chest tubes?

A
  • Intermittent bubbling in the second chamber is normal during exhalation, coughing and sneezing
  • Continuous bubbling in third chamber is normal
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27
Q

What are abnormal findings in a patient with chest tubes?

A
  • Continuous bubbling in second chamber is abnormal

- No tidaling could indicate occlusion

28
Q

What factors indicate that the client may be ready to have a chest tube discontinued?

A

Chest tubes are removed when the lungs are reexpanded and fluid drainage has ceased or is minimal.

29
Q

Diverticulitis

A

Inflammation of one or more diverticular, resulting in perforation into the peritoneum.

30
Q

What is the collaborative care for diverticulitis?

A
  • Uncomplicated diverticula: increase fiber in the diet
  • Bulk laxative
  • Increased fluid intake
  • Weight reduction
  • Prevent intra-abdominal pressure
  • NPO, bed rest
  • No “seeds” diet
31
Q

Crohn’s Disease

A
  • Chronic non specific inflammatory disease of the bowel.
  • Cause is unknown.
  • Characterized by inflammation of segments of the GI tract.
32
Q

What is the collaborative care for Crohn’s Disease?

A
  • Rest the bowel
  • Control Inflammation
  • Combat Infection
  • Correct malnutrition
  • Alleviate stress
  • Provide symptomatic relief

-Drug therapy: sulfasalazine (decreases inflammation), corticosteroid (decreases inflammation) and flagyl (treats secondary infection)

33
Q

What are acute exacerbations of Crohn’s Disease?

A

…

34
Q

What are complication of Crohn’s Disease?

A
  • Perforation (w/ possible peritonitis)
  • Perianal abscess and fistulas
  • Strictures
  • C. Diff
  • Hemorrhage
  • Colonic Dilation (toxic megacolon)
35
Q

Cholelithiasis

A

Gallstones

36
Q

What are risk factors for cholelithiasis?

A
  • Women >40 years of age
  • Oral contraceptives or Medications with high estrogen content
  • Sedentary Lifestyle
  • Obesity
  • Diet high in cholesterol and fat, low in fiber
  • Family hx of gallstones
  • Pregnancy
  • Diabetes
  • Rapid weight loss
37
Q

Acute pancreatitis

A

Acute inflammatory process of the pancreas

38
Q

What are clinical manifestations of acute pancreatitis?

A
  • Abdominal pain
  • N/V
  • Hypotension, tachycardia (clinical manifestation of shock)
  • Jaundice
  • Decreased Bowel sounds, abdominal distention (d/t abdominal contraction from pain)
  • Grey Turner’s Sign (bluish, flank discoloration)
  • Cullen’s Sign (purplish discoloration of umbilical region)
39
Q

What are complications of acute pancreatitis?

A

Local: psuedocyst and abscess
Systemic: pulmonary (Pleural effusion, atelectasis, pneumonia, acute respiratory distress syndrome, hypotension)

40
Q

What medications are used to treat UTIs?

A

Uncomplicated UTI: 1-3 days of ABT
Recurrent/Uncomplicated UTI: 3-5 days of ABT
Urinary analgesic

41
Q

What are the side effects of these medications used to treat UTIs?

A

…

42
Q

What are post-op considerations for clients with a cystectomy and ileal conduit?

A

..

43
Q

What are complications of lower urinary tract infections?

A

..

44
Q

What is the collaborative care for a client with glomerulonephritis?

A
  • Rest
  • Sodium Restriction
  • Antihypertensive Therapy
  • Diuretics
  • Low protein diet
45
Q

Define: “Rubor”

A

Redness of the skin.

46
Q

What should you teach a patient regarding diabetic foot care?

A
  1. Wash feet daily with mild soap and warm water. First test water temperature with elbow.
  2. Pat feet dry gently, especially between toes.
  3. Examine feet daily for cuts, blisters, swelling, red, tender areas.
  4. Use lanolin on feet to prevent skin from drying and cracking. Do not apply between toes.
  5. Mild foot powder on sweaty feet.
  6. Cleanse cuts with warm water and mild soap, covering with clean dressing.
  7. Cut toenails evenly with rounded contour of toes. Do not cut down corners. Best time to trim is in shower or bath.
  8. Avoid open toe shoes. Don’t go barefoot.
47
Q

How do you care for a patient in DKA?

A
  • IV administration of rapid acting insulin
  • IV fluids, electrolyte Replacement, I&O
  • Labs: glucose, ketones in urine
  • ECG, Assess CV and Respiration
  • Ensure patent airway
  • O2 therapy
  • IV fluid resuscitation with 0.9% NaCl 1L/hr until BP is stable and urine output of 30-60 ml/hr
  • Insulin drip 0.1 u/kg/hr
  • Potassium to correct hypokalemia/Bicarbonate pH <7.0
48
Q

How do you care for a post-operative client with bilateral adrenalectomy?

A

..

49
Q

Addisonian Crisis

A

A life threatening emergency caused by insufficient adrenocortical hormones or a sudden sharp decrease in these hormones.

50
Q

What are the clinical manifestations of Addisonian Crisis?

A
  • Hyponatremia (sodium wasting d/t lack of aldosterone)
  • Hyperkalemia
  • Hypoglycemia (d/t lack of glucocorticoid production)
  • Dehydration
  • Fever
  • Weakness
  • Confusion (d/t hypoglycemia)
  • Circulatory collapse
  • V/D and pain in abdomen
51
Q

What is the collaborative care for Addisonian Crisis?

A
  • Daily glucocorticoid replacement (2/3 on awakening in AM and 1/3 late in PM)
  • Fluid Replacement (large volume of NS and 5% dextrose): d/t dehydratation
  • Mineralocorticoids Replacement(once daily in the AM)
52
Q

Oncology

A

Understand the clinical manifestations and complications of various types of cancer discussed in class, including all collaborative care…

53
Q

What is the drug therapy for MI?

A 
A. IV nitroglycerin
B. Anti arrhythmic drugs
C. Morphine Sulfate
D. B-Adrenergic Blockers
E. ACE inhibitors
F. Stool softeners
54
Q

Clinical Manifestations of Mitral Valve Stenosis

A

Due to back up of blood flow in the left side of the heart you would have symptoms of left sided heart failure.
• dyspnea
• hemoptysis
• palpitation / atrial fibrillation (atrium can’t empty efficiently causing enlargement leading to arrhythmias)
• fatigue
• murmur
• chest pain
• seizure (from possibility of thromboembolism)
• stroke (same as seizure)

55
Q

Mitral Valve Regurgitation

A

Backward flow of blood from left ventricle to left atrium

56
Q

Clinical Manifestations of Mitral Valve Regurgitation

A
  • pulmonary edema
  • thready peripheral pulses
  • cool clammy extremities
  • systolic murmur
  • weakness
  • fatigue
  • dyspnea, orthopnea, paroxysmal nocturnal dyspnea
  • peripheral edema (if it on the tricuspid and not mitral)
57
Q

Aortic Valve Stenosis

A

Shortening and thickening of the aortic valve.

58
Q

Aortic Valve Regurgitation

A

Backward flow of blood from the aorta into the left ventricle.

59
Q

Clinical Manifestations of Aortic Valve Regurgitation

A

Abrupt onset of profound dyspnea, chest pain, left ventricular failure and cardiogenic shock.
Fatigue, exertional dyspnea, orthopnea, PND, water-hammer pulse, heaving precordial impulse, diminished or absent s1, s3 or s4.
Soft high-pitched diastolic murmur

60
Q

Clinical Manifestations of Aortic Valve Stenosis

A 
Angina
Syncope
Dyspnea on exertion
Heart Failure
Normal or soft S1, diminished or absent S2, systolic murmur, prominent S4
61
Q

Collaborative Care for Valvular Heart Disease

A
  • Prevent acquired rheumatic valvular disease
  • Hospitalization due to CHF and arrhythmia
  • Exercise plan to increase cardiac tolerance
  • Smoking cessation
  • Assist in planning for ADL
  • Prophylactic ABT to prevent endocarditis
62
Q

Isotonic Solutions include

A
  • Normal Saline
  • Ringers
  • Lactated Ringer’s
  • Dextrose 5% in Water (D5W)
  • 5%Albumin
  • Hetastarch
  • Normosol
63
Q

Hypotonic Solutions include

A
  • Half Saline (.45% NaCl)
  • 0.33%NaCl
  • Dextrose 2.5% in Water (D2.5W)
64
Q

Hypertonic Solutions include

A
  • Dextrose 5% in Normal Saline
  • Dextrose in Lactated Ringer’s
  • 3% NaCl
  • 25% Albumin
  • 7.5% NaCl
65
Q

Mitral Valve Stenosis

A

Shortening, thickening of the mitral valve.

NURS 313R (18 decks)

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