Exam 2 Flashcards
(135 cards)
1
Q
Most common cause of injury fatality from falls
A
Age > 65
2
Q
Assessment for fall risk in older adults
A
DAME: D- drug and alcohol abuse A- age related physiologic status M- medical problems E- environment
3
Q
How long is a restraint order valid?
A
24 hours
4
Q
How often should you reassess the need for restraints?
A
Adult: q4h
child > 9: q2h
child
5
Q
How often should you assess a patient with restraints?
A
adult: every hour
child
6
Q
5 Ps
A
Pain Pallor Potty Pulse Position
7
Q
When is a psych consult needed for a patient who is restrained?
A
After 48 hours of retraints
8
Q
factitious disorder
A
clients deliberately make up or inflict symptoms
9
Q
example of factitious disorder
A
Muchausen by proxy: parents or caregivers exaggerate or fabricate illness or symptoms for their child to gain attention
10
Q
somatoform disorder
A
clients experience physcial symptoms despite no underlying medical explanation
11
Q
primary and secondary gains of somatoform disorders
A
- primary: symptoms block psychological conflict or anxiety from conscious awareness
- secondary: relieves clients from expected responsibilities and increases the attention they receive
12
Q
treatment of somatoform disorder
A
antidepressants and don’t focus on the symptoms
13
Q
daily carbs
A
10-100 g/day
45-65% of daily needs
14
Q
average carbs in a large apple
A
31 g
15
Q
daily protein
A
0.8 g/kg/day
10-35% of daily needs
16
Q
complete vs incomplete protein sources
A
- complete: animal products
- incomplete: plants
17
Q
daily fats
A
- No RDA
- 20-35% of daily needs
18
Q
Vitamin A
A
- vision
- formation and maintenance of skin and mucus membranes
- immune function
19
Q
vitamin B1
A
thiamin- produces energy from glucose
20
Q
vitamin B2
A
riboflavin- carb, protein, and fat metabolism
21
Q
vitamin B3
A
niacin- carb, protein, and fat metabolism
22
Q
B6
A
pyridoxine- coenzyme in metabolism
23
Q
folate
A
RNA/DNA synthesis, form/mature RBCs
24
Q
vitamin B12
A
protein metabolism and formation of heme
25
pantothenic acid
carb, protein, and fat metabolism
26
biotin
carb, protein, and fat metabolism
27
vitamin C
ascorbic acid- collagen formation, antioxidant, enhance iron absorption
28
vitamin D
cholecalciferol- Ca+ and phos metabolism, stimualte Ca+ absorbsion
29
vitamin E
tocopherol- antioxidant, heme synthesis, protects vit A
30
vitamin K
blood clotting!
31
my plate
half the plate should be fruits and veg, 1/4 protein, 1/4 grains; half the grains should be whole grains; fat free or low fat milk
32
primary vs secondary obesity
secondary occurs because of health complications
33
ideal body weight
- females: 100lb +/- 5 lbs for each additional inch over 5ft
- males: 106lb +/- 6lb for each additional inch over 5ft
- add or deduct 10% for frame
34
BMI calculations
- Wt in kg/ (ht in meters) x (ht in meters) OR
| - Wt in lbs/ (ht in inches) x (ht in inches) x 703
35
overweight BMI
25-29.9
36
obese BMI
>30
37
extreme obesity BMI
>40
38
normal weight BMI
18.5-24.9
39
restraint documentation
- Date and time restraint applied
- Type
- Alternatives attempted
- Notification of family
- Frequency of assessment
- Findings
- Regular intervals when restraint removed
- Nursing interventions
40
underweight BMI
41
1 lb is equal to how many calories?
3500
42
dietary treatment of obesity
- includes behavior modification and exercise
| - diary over 7 days is better than 1 day because anyone can change their diet for a day
43
drug therapy for obesity
- drugs that reduce food intake by reducing appetite or satiety
- drugs that increase energy expenditure
44
bariatric surgery
- must have BMI >40
- Have to have been obese for >5 years
- Has tried and failed to lose weight
45
life expectancy for anorexic
35 years because of heart failure
46
major diagnostic findings with malnutrition
low serum albumin (but albumin also lowers with age)
47
consistent-cho diet
diabetes, glucose intolerance
48
fat-restricted diet
chronic cholecystitis, cardiovascular disease
49
high fiber diet
prevent or treat constipation, IBS, diverticulosis
50
low fiber diet
before surgery, ulcerative colotis, diverticulitis, Crohn's disease
-
51
Na+ restricted diet
HTN, HF, acute/chronic renal disease, liver disease
| -500-3000 mg/day
52
clear liquid diet
- prep for surgery or endoscopy
| - becomes clear with body temp
53
full liquid diet
made up of liquids and foods that turn to liquid at room temp (like ice cream)
54
time limit for NPO pts
3 days
55
how often should you flush an NG tube
q4h
56
tracheoesophageal fistula
congenital; failure of the esophagus to develop as a continuous passage and failure of the trachea and esopagus to separate into distinct structures
57
clinical manifestations of trachoesophageal fistula
excessive frothy mucus from the nose and mouth, coughing, choking, cyanosis, apnea; increase resp distress during feeding; abdominal distension
58
hypertrophic pyloric stenosis
projectile vomiting, nonbillus (bc it doesn't leave the stomach), fully obstructed
59
cleft palate
bi-uvula so it looks like a W
60
repair of cleft lip/palate
lip precedes palate (bc baby needs to feed); lip at 2-3 months; palate at 6-12 months
61
Diagnostic criteria for abdominal pain
Rome III- complete family Hx, childs health Hx, physical exam, lab test
62
fluid maintenance in children
- allow 100 ml/kg for first 10 kg body wt
- allow 50 ml/kg for second 10 kg body wt
- allow 20 ml/kg for remaining kg body wt
63
If meconium is not passed within 24-36 hours...
Hirschsprung disease, hypothyroidism, meconium plug/ meconium ileus (CF)
64
Hirschsprung disease
congenital ganglionic megacolon- mechanical obstruction from inadequate motility of the intestine from absense of ganglion cells in colon
-could lead to entercolitis
65
Tx of constipation in infant
sucrose or corn syrup
66
most intense site of pain in appendicitis
Mcburney point
67
meckel diverticulum
fibrous band connecting small intestin to umbilicus
68
symptoms of meckel diverticulum
painless rectal bleeding, currant jelly stool or dark red, can cause HTN bc of huge blood loss
69
Dx and Tx of meckel diverticulum
Dx- radiograph
| Tx- sugery
70
cluster A personality disorders
odd or eccentric behavior is core characteristic
- "schizophrenic spectrum cluster"
- odd, withdrawn, suspicious, and irrational
71
paranoid personality disorder
- cluster A
- suspicious and quick to take offense
- project feelings
- few friends, looks for hidden meaning in innocent remarks, guarded
- quick to react with anger
- do not lose touch with reality
72
goal of therapy for paranoid personality disorder
solve immediate crisis or problem
73
schizoid personality disorder
- cluster A
- "lifelong loner"
- show indifference to relationships, flat affect, cold, unsociable
- usually never marry, little interest in sexuality
- solitary jobs that others would hate
- more common in men than women
74
goal of treatment for schizoid
solve immediate crisis or problem
75
schizotypal personality disorder
- cluster A
- extreme discomfort with and intolerance for close relationships
- thought patters are disturbed, with odd behavior, speech and appearance
- inappropriate/ constricted affect
- no friends
- social anxiety
76
goal of treatment for schizotypal
complete social skills training
77
cluster B personality disorders
dramatic, emotional, erratic manifestations
- moods are labile and shallow
- involved in intense interpersonal conflicts
78
antisocial personality disorder
- cluster b
- aggression and irrisponsibility lead to conflicts with society and criminal justice
- fighting, lying, stealing, domestic violence, substance abuse
- lack genuine warmth
- more common in men
79
goal of therapy for antisocial personality disorder
- improve social relationships
| - enhance insight into antisocial feelings and behaviors
80
borderline personality disorder
- cluster b
- instability in mood, impulse control, and interpersonal relationships
- unpredictable and erratic
- splitting- view things as extreme: all good or all bad
- assume little responsibility for their own problems
- enraged if they think they're being ignored
81
treatment goals for borderline
- prevent suicide
| - function independently, maintain emotional balance, and engage in cognitive restructuring
82
histrionic personality disorder
- cluster b
- excessive emotionality and attention seeking
- want to be the center of attention (focus on self, provocative dress, highly emotional displays)
- seductive behaviors to gain approval
- inconsistent and unpredictable
83
treatment goals for histrionic personality disorder
- prevent suicide
| - gain insight into unrealistic expectations and fears
84
narcissistic personality disorder
- cluster b
- self-centeredness, self-absorption, inability to empathize with others, grandiosity, and extreme desire for admiration
- self esteem is till fragile
- haughty arrogant, capable of taking advantage of others to achieve their own ends
85
treatment goal for narcissistic personality disorder
- develop a healthier sense of individuality
- recognize others as separate people
- improve coping mechanisms
86
cluster C personality disorders
marked by anxious or fearful behaviors
- anxious, tense, and overcontrolled
- differentiation is difficult
87
avoidant personality disorder
- cluster C
- social discomfort, timidity, fear of negative evaluation
- preoccupied with their perceived shortcomings
- reluctant to take risks or try new activities for fear of embarrassment, shame, or ridicule
88
treatment goals for avoidant personality disorder
- enhance social functioning
| - solve immediate crisis or problem
89
dependent personality disorder
- cluster C
- Pervasive and excessive need to be taken care of, leading to submissive and clinging behavior and fear of separation
- Need much approval from others that they have trouble making independent decisions
- May go to great lengths to stay in a relationship
- Become extremely anxious if placed in a position of authority
90
treatment goals for dependent personality disorder
- Complete assertiveness training
| - Engage in cognitive restructuring
91
obsessive compulsive disorder
- perfectionism, rigidity, controlling behavior, and extreme orderliness
- traits exist as an expense of efficiency, flexibility, and candor
- Results in indecisiveness, preoccupation with detail, and an insistence that other do things their way
92
treatment goal for OCD
-experience specific symptom relief
93
Most common ER occurrence for eating disorders
anorexia for v-tach
| -treatment would be fluid intake, electrolytes and labs
94
prevalence of eating disorders in the US
1-4% of population
95
ratio of men to women for anorexia and bulimia
anorexia 2:1
| bulimia 3:1
96
manifestations of anorexia
- typically weigh less than 85% of normal for ht and age
- distorted body image
- may have amenorrhea, lanugo hair, hypotension, bradycardia, hypothermia, constipation, polyuria, and electrolyte imbalances
97
assessment priorities for eating disorders
do not weigh them, but look at their fluid intake and electrolytes
98
bipolar I vs bipolar II
I includes manic episodes, II is depressive with hypomanic episodes (less severe than manic)
99
best therapy for treating depression
cognitive behavioral therapy
100
tricyclic antidepressants
block reuptake of norepinephrine and serotonin
| -narrow therapeutic index
101
lithium indications and diet
mood stabilizer for bipolar
| -diet: 2000-3000 ml fluid/day and eat consistent and moderate intake of Na+, avoid diuretics
102
prozac pt teaching and nursing considerations
- don't take with MAOIs
- takes 4-6 wks to work
- highest risk for suicide is in the first 14 days so monitor them in that time frame
103
lamictal indications and teaching
- anticonvulsant used for bipolar
- do not stop drug abruptly- could cause seizures
- could increase suicidal thoughts
- non hormonal contraception
104
warnings for suicide risk
```
IS PATH WARM
Ideation
Substance abuse
Purposelessness
Anxiety
Trapped
Hopelessness
Withdrawal
Anger
Recklessness
Mood change
```
105
suicide risk assessment
```
SAD PERSONS
Sex: women attempt more, men succeed more
Age: white males > 85
Depression
Previous attempt
Ethanol abuse
Rational thinking loss
Social support lacking
Organized plan
No spouse
Sickness
```
106
depersonalization disorder
belief that one's own reality is temporarily lost or altered
- dissociation occurs
- usually rapid onset and occurs in adolescence under extreme stress, fatigue, or anxiety
107
newborn urinary defect
bladder exstrophy: midline closure defect that occurs during embryonic period, leaving the bladder open and exposed outside of the abdomen
108
acute glomerulonephritis
| -age, etiology, manifestations
- school aged children
- inflammation of the glomeruli and onset of hematuria, proteinuria, HTN, azotemia, bacteriuria
- usually caused by strep
109
management of acute glomerulonephritis
-fluid and Na+ restrictions
K+ restrictions with oliguria
-BP, I&O, weight
-management of HTN
110
Normal WBC and specific gravity in urinalysis for children
-WBC
111
high specific gravity vs low
high- dehydration
| low- excessive fluid intake
112
Nephrotic syndrome
group of symptoms including presence of proteinuria, low serum albumin, and edema
113
manifestations of nephrotic syndrome
NAPHROTIC
```
Na+ decrease
Albumin decrease
Proteinuria >3.5 g/day
Hyperlipidemia
Renal vein thrombosis
Orbital edema
Thromboembolism
Infection
Coagulability
```
114
Therapy for nephrotic syndrome
corticosteroids
115
Prep for IVP (intravenous pylogram)
-2 yrs: catharsis, NPO, enema in the morning
116
vescicoureteral reflex
backflow of urine from the bladder into the ureters, which can cause bacteria to grow
-grades 1-5, 5 being the worst
117
goal of and treatment for cescicoureteral reflex
- goal: prevent infection
| - treatment: prophylactic antibiotic qd
118
phimosis
| -normal vs abnormal
a narrowing or stenosis of the preputial opening of the foreskin that prevents retraction of the foreskin over the glans penis
- normal for infnats and young boys but usually disappears
- occasionally narrowing obstructs urine flow
- newborns with this should not be circumcised until repaired
119
most common cause of acute renal failure
dehydration
120
principle feature/manifestation of acute renal failure in children
oliguria
121
management of acute renal failure in children
- treat underlying cause
- monitor I&O
- promote active and normal lifestyle
122
treatment of acute renal failure in adults
- treat precipitating cause
- diuretics
- decrease serum K+ (Kayexalate, Sorbitol, IV hypertonic glucose and regular insulin if severe hyperkalemia)
- IV sodium bicarb
- IV dopamine to enhance renal perfusion
123
diet for acute renal failure
- fluid restriction (strict I&O)
- regulate intake of Na+ and K+
- increase intake of carbs and protein
124
when should dialysis be done for ARF
- volume overload
- BUN> 120mg/dl
- metabolic acidosis with hyperkalemia
- ECG changes, cardiac tamponade
125
daily weight during oliguric phase of ARF
0.2-0.3 kg/day loss
126
meds for chronic renal failure
- decrease K+
- antiHTN
- thiazide and loop diuretics
- erythropoietin for anemia tx
- phos binders and vit D for renal osteodystrophy
127
diet for chronic renal failure
- restrict protein intake to 20-40 g/day
- fluid restriction- 600 to 1000 mL/day
- Na+ and K+ restrictions
128
nursing considerations in hemodialysis access devices
NEVER take BP, blood draws, or unfuse fluids or meds into the access site or the extremity
129
most common side effects of hemodialysis
hypotension, headache, muscle cramps, bleeding from access site
130
complications of hemodialysis
- Dialysis disequilibrium syndrome: cerebral edema and neurologic complications (HA, N/V, Sz) may be minimized by slower dialysis
- Sepsis, Hepatitis B and C
131
medications during hemodialysis
hold CV meds prior to dialysis
132
complications of peritoneal dialysis
- Possible bowel perforation from catheter insertion
| - Peritonitis, bleeding, hypoalbuminemia, hyperglycemia in DM patients
133
positive vs negative symptoms of schizophrenia
- positive- hallucinations and delusions (most noticeable)
| - negative- isolation and detachment... go unnoticed for a long time; precursor to diagnosis
134
med for alcohol and opioid withdrawal
both: naltrexone
alcohol: disulfiram (antabuse) causes unpleasant reactions to alcohol
135
most commonly abused psych drug
benzos
