Exam 3 - Summary Set Flashcards
1
Q
the normal physiologic response to disease-causing microorganisms and toxic substances
A
immunity
2
Q
___ and ___ are the two types of immunity
A
innate, adaptive
3
Q
____ is present at birth and non-antigen specific
A
innate immune system
4
Q
what are 3 reasons that older adults are at higher risk of immune issues?
A
(1) reduced response to pathogens
(2) increase in autoimmune diseases
(3) impaired inflammation with comorbidities
5
Q
type I immune responses are ____ reactions
A
allergic
6
Q
tissue-specific or cytotoxic reactions are
A
type II immune responses
7
Q
Serum sickness and Lupus are examples of ___ immune responses
A
type III
8
Q
cell-mediated or delayed hypersensitivity is which immune response?
A
type IV
9
Q
virus that affects the immune system and weakens it
A
HIV
10
Q
which cells are impacted in HIV?
A
CD4+ T-helper cells and memory cells
11
Q
name at least 4 risk factors / causes for HIV contraction
A
(1) direct contact with bodily fluids
(2) unprotected sexual activities
(3) sharing needles
(4) blood transfusion
(5) breast milk
(6) birth canal
12
Q
the 3 phases of HIV are:
A
(1) phase I acute infection
(2) latent phase
(3) AIDS
13
Q
s/s of acute HIV infection
A
(1) fever
(2) sore throat
(3) rash
(4) night sweats
(5) chills
(6) headache
(7) muscle aches
14
Q
the diagnostic criteria for AIDS is
A
CD4+ count <200
15
Q
at the beginning of HIV, we see a sharp increase in ____ and a sharp decrease in _____
A
HIV RNA virus; CD4+ T-cell count
16
Q
the latent phase can last ___
A
1-11 years
17
Q
why is it important to get re-tested for HIV?
A
because during the window period, there is a higher risk for false-negative test results
18
Q
3 supportive diagnostics that indicate progression of HIV include:
A
(1) lymphocyte count
(2) CD4+ count
(3) viral load testing
19
Q
treatment for HIV is ____
A
lifelong antiretroviral therapy (ART)
20
Q
what is the key to HIV medication therapy?
A
combination of a med to decrease viral load and a med to support the immune system
21
Q
The purpose of ART is to ___
A
prevent HIV from replicating AKA to decrease viral load
22
Q
name at least 3 adverse effects of ART
A
(1) weight loss
(2) fatigue
(3) diarrhea
(4) mood changes
(5) high cholesterol
(6) N/V
(7) rash
23
Q
what are the 5 outcomes / goals for HIV?
A
(1) prevent progression of HIV
(2) prevent transmission
(3) prevent opportunistic infections
(4) prevent complications r/t ART
(5) coordinate care
24
Q
extensive, irreversible scarring of the liver from inflammation
A
cirrhosis
25
name 4 common causes of cirrhosis
(1) viral hepatitis
(2) hepatitis C
(3) chronic alcoholism
(4) chronic biliary obstruction
26
the 3 main impacts of cirrhosis are:
(1) fluid overload that can impact breathing
(2) confusion from ammonia
(3) impaired liver functions
27
testing frequency for HIV treatment efficacy should be ____
q4-6 weeks
28
name at least 3 s/s of hypovolemic shock related to cirrhosis
(1) increased HR (first sign)
(2) low BP
(3) low O2
(4) increased RR
(5) cool skin
(6) slow cap refill
29
hepatic encephalopathy in cirrhosis can lead to ____
mental status changes
30
name at least 3 early s/s of cirrhosis
(1) fatigue
(2) weight changes
(3) anorexia
(4) vomiting
(5) pain of abdomen and liver
31
name at least 3 late s/s of cirrhosis
(1) GI bleeding
(2) jaundice
(3) ascites
(4) spontaneous bruising
(5) dry and itchy skin
32
explain the labs that will be present with cirrhosis
(1) elevated - AST, ALT, LDH, Bilirubin, ammonia
(2) low - albumin
(3) prolonged PT / INR ratio
(4) anemia
33
the 3 things used to diagnose cirrhosis are
(1) abdominal x-ray
(2) CT or MRI
(3) liver ultrasound
34
the 6 priorities for cirrhosis are:
(1) fluid overload
(2) hemorrhage
(3) confusion
(4) pruritus
(5) avoid hepatotoxic meds
(6) avoid alcohol
35
what are two things to look at to monitor for ascites?
(1) increased abdominal circumference
(2) weight gain
36
T/F: Ascites can impact breathing
T
37
what are 4 ways to manage fluid overload in cirrhosis?
(1) Low Na diet
(2) IV vitamins
(3) diuretics
(4) paracentesis
38
we can prevent hemorrhage in cirrhosis with ___
beta blockers
39
we can control hemorrhage bleeding in cirrhosis with ___
vasoactive meds like octreotide
40
what is used to reduce the ammonia levels via the stool?
lactulose
41
to avoid confusion in cirrhosis, we want to ___
minimize the number of meds that are metabolized by the liver
42
we can treat pruritus with ...
(1) moisturizers
(2) cool compresses
(3) corticosteroids cream
(4) NSAIDs
43
____ and ___ are both hepatotoxic meds
acetaminophen and NSAIDs
44
severe, critical illness that occurs when the virus infects type 2 alveolar epithelial cells
COVID-19
45
name at least 4 risk factors for COVID-19
(1) >65 yo
(2) cancer
(3) chronic kidney, liver, or lung disease
(4) DM
(5) heart conditions
(6) HIV
(7) smoking
46
name at least 4 s/s of COVID-19
(1) upper respiratory symptoms
(2) fever
(3) chills
(4) N/V
(5) diarrhea
(6) loss of taste and smell
47
what s/s necessitate immediate treatment in COVID-19?
(1) difficulty breathing
(2) tachypnea
(3) hypoxemia
(4) chest pain
(5) confusion
(6) cyanosis
48
the two main diagnostics used for COVID-19 are
(1) Lab - NAAT
(2) Chest x-ray
49
what are the 3 priorities for COVID-19?
(1) prevent transmission
(2) promote gas exchange
(3) reduce risk of progression
50
___ and ___ are the two medications for COVID-19
Nirmatrelvir-Ritonavir; Remdesivir
51
Nirmatrelvir-Ritonavir indication
treat mild to moderate COVID-19 at high risk of progressing to severe
52
Nirmatrelvir-Ritonavir side effects
(1) diarrhea
(2) altered taste
53
Nirmatrelvir-Ritonavir education
take a missed dose within 8 hours of time; if more than 8 hours, skip the missed dose
54
Remdesivir indication
for hospitalized patients with COVD-19 or non-hospitalized within 7 days of onset
55
Remdesivir side effects
(1) nausea
(2) hepatotoxicity
56
Remdesivir monitoring
(1) hepatic panel
(2) PT value before administration
(3) hypersensitivity during and following administration
57
what are the 3 outcomes of COVID-19?
(1) prevent transmission
(2) promote gas exchange
(3) reduce risk of progression
58
lung infection causing inflammation in the airways and fluid or exudate (thick) buildup in the alveoli, leading to impaired gas exchange
pneumonia
59
name the 4 risk factors for community-acquired pneumonia
(1) older adults (over 50)
(2) no pneumococcal vaccine
(3) influenza
(4) COVID-19
60
name at least 4 risk factors for hospital / ventilator-associated pneumonia
(1) older adults (over 50)
(2) chronic lung disease
(3) altered LOC
(4) recent aspiration
(5) endotracheal or NG tube
(6) mechanical ventilation
(7) immobility
61
name at least 3 risk factors for pneumonia because of reduced immunity
(1) babies <1 yo
(2) organ transplants
(3) on corticosteroids
(4) cancer patients
(5) RA
(6) HIV
62
2 ways to prevent hospital-acquired pneumonia are
(1) good oral care BID
(2) pulmonary hygiene
63
4 ways to prevent ventilator-associated pneumonia are
(1) HOB >30 deg
(2) oral care per protocol
(3) HH
(4) sterile suctioning
64
people over ___ yo should get the pneumonia vaccine
50
65
name at least 3 systemic s/s of pneumonia
(1) fever
(2) chills
(3) malaise
(4) loss of appetite
(5) myalgia
66
name at least 3 pulmonary s/s of pneumonia
(1) cough (w/ or w/o sputum)
(2) dyspnea
(3) pleuritic chest pain
(4) increased RR
(5) labored breathing
(6) diminished breath sounds
(7) crackles, rhonchi, wheezing
(8) low O2
67
a sign of pneumonia in older adults is ____
confusion
68
how is pneumonia diagnosed?
(1) increased WBC
(2) sputum culture
(3) blood culture
(4) ABGs
(5) electrolytes
(6) BUN/Creatinine
(7) chest x-ray
69
which acid-base imbalance is associated with pneumonia?
respiratory acidosis
70
the 4 nursing priorities for pneumonia are
(1) impaired gas exchange
(2) possible airway obstruction
(3) possible sepsis
(4) anxiety
71
name at least 3 nursing interventions to support impaired gas exchange in pneumonia
(1) elevate HOB
(2) early mobilization
(3) supplemental O2
(4) incentive spirometry
(5) cough and deep breathing
(6) bronchodilators
72
name at least 3 ways to avoid possible airway obstruction in pneumonia
(1) cough and deep breathing
(2) IS
(3) 2-4 L/day fluids
(4) medications
(5) expectorants
73
what do we want to monitor to avoid sepsis / catch it early in patients with pneumonia?
(1) blood cultures
(2) anti-infectives
(3) monitor vitals
(4) maintain BP
74
the 2 meds to support breathing in pneumonia are
(1) bronchodilator
(2) IV (to PO) steroids - methylprednisolone
75
bronchodilator action
manage bronchospasms
76
bronchodilator side effects
tachycardia, tremors
77
steroids to support breathing action
manage airway inflammation and swelling
78
steroids administration / monitoring
(1) don't stop abruptly
(2) monitor blood glucose levels
79
which 2 meds are used to manage infection in pneumonia?
(1) cephalosporin (ceftriaxone)
(2) fluoroquinolones (levofloxacin)
80
cephalosporin side effects
(1) one of the safest antimicrobials!
(2) rare - allergic rxn
81
fluoroquinolone side effects
(1) c. diff
(2) yeast infection
(3) tendon rupture
(4) N/V
82
fluoroquinolone teaching
(1) take with food
(2) avoid sun exposure
(3) complete the course
83
extreme response to infection that can lead to tissue damage, organ failure, and death
sepsis
84
name the general pathophysiology of sepsis
(1) local infection
(2) systemic infection
(3) SIRS
(4) organ failure
(5) MODS
(6) death
85
the two biggest risk factors for sepsis are
reduced immunity and lines/drains/tubes/etc.
86
3 ways to prevent sepsis are...
(1) get rid of invasive lines ASAP
(2) proper sterile technique
(3) sepsis screening
87
___, ___, and ___ are 3 screening tools for sepsis
MEWS, qSOFA, and SOFA
88
lab results will show an increase in which values for sepsis?
(1) procalcitonin
(2) lactate
(3) WBC (sometimes)
(4) glucose
89
___ will be present in blood cultures in sepsis
bacteria
90
late-stage sepsis will show the following lab values:
(1) low HCT
(2) low Hgb
(3) low fibrinogen
(4) low platelets from DIC
91
in early sepsis, BP and HR will be
high
92
in late sepsis, BP will ___
drop
93
at which stage of sepsis can DIC occur?
septic shock
94
sepsis RR
increased
95
neuro symptoms of sepsis are
restless, something is wrong, confusion
96
skin s/s of sepsis
(1) warm
(2) no cyanosis until shock
(3) cool, clammy, pale, mottling
(4) petechiae and ecchymosis
97
urine output will be ___ in sepsis
low
98
the two nursing priorities for sepsis are
(1) widespread infection
(2) potential for organ dysfunction
99
name the steps of the hour-1 sepsis management bundle
(1) measure lactate level
(2) obtain blood cultures
(3) administer broad-spectrum abx
(4) begin rapid admin of crystalloid
(5) apply vasopressors if hypotensive during or after fluid
100
what is the goal MAP in managing hypotension in sepsis?
>= 65 mmHg
101
when do we know it's time to call for help with sepsis?
when we put someone on a non-rebreather for O2
102
name the outcomes of sepsis / lab values
(1) ABGs normal
(2) UO >= 0.5 mL/kg/hr
(3) MAP >= 65 mmHg
(4) absence of MODS
(5) cap refill <3 sec
(6) extremities warm
103
when a stool can't pass through the GI tract due to an obstruction
intestinal obstruction
104
___ is when there is a physical block by adhesions
mechanical obstruction
105
___ is when peristalsis is decreased or absent due to neuromuscular disturbance
non-mechanical obstruction / paralytic ileus
106
___ is scarring in the intestinal system
adhesions
107
stool stuck right at the rectum is ___
fecal impaction
108
name at least 4 causes of intestinal obstruction
(1) adhesions
(2) tumors
(3) fecal impaction
(4) Crohn's disease
(5) intussusception
(6) volvulus
(7) postoperative ileus
109
the best way to avoid intestinal obstruction is to ___
prevent constipation
110
name at least 3 s/s of a small bowel obstruction
(1) mid-abdominal pain or cramping
(2) upper abdominal distention
(3) N/V
(4) constipation
(5) F&E imbalance
(6) metabolic alkalosis
111
name at least 3 s/s of a large bowel obstruction
(1) intermittent lower abdominal cramping
(2) lower abdominal distention
(3) minimal vomiting
(4) constipation
(5) ribbon stools
(6) metabolic acidosis
112
bowel sounds above the obstruction will be ___
hyperactive
113
bowel sounds below the obstruction will be ____
hypoactive
114
you should immediately report a ___ in intestinal obstruction
perforation
115
name the s/s of a perforation in intestinal obstruction
(1) severe pain followed by relief
(2) fever
(3) tachycardia
(4) hypotension
(5) rigidity
116
how do you diagnose an intestinal obstruction?
(1) Labs
(2) abdominal CT
117
which acid-base imbalance is associated with small bowel obstruction?
metabolic alkalosis
118
which acid-base imbalance is associated with large bowel obstruction?
metabolic acidosis
119
what are the 4 nursing priorities for intestinal obstruction?
(1) reduce risk of life-threatening complications
(2) acute pain
(3) nausea
(4) F&E imbalances
120
be careful with ___ and ___ in intestinal obstruction because they can cause constipation
opioids; antiemetics
121
name the key nursing interventions for intestinal obstruction
(1) NPO
(2) NGT for decompression
(3) IVF and electrolyte replacement
(4) frequent oral care
(5) pain control
122
what is the gold standard for confirming proper NGT placement?
x-ray
123
what do we monitor with NGT and low, continuous suctioning?
(1) output
(2) proper placement
124
2 ways to control pain in intestinal obstructions are
semi-fowler's and analgesics
125
do not remove a NGT until ___ after surgery for intestinal obstruction
GI motility returns or tolerating intake well
126
post-op monitoring for intestinal obstruction includes ___ and ___
high-risk for post-op pneumonia; pain management
127
notify the provider if there is a sudden increase in ____ in NGT output
bile
128
rapid reduction in kidney function
acute kidney injury (AKI)
129
name at least 3 causes of AKI
(1) damage to tissue
(2) dehydration
(3) nephrotoxic meds
(4) sepsis
(5) BP meds
(6) MI
(7) shock
(8) CT contrast
(9) kidney stones
130
name at least 3 risk factors for AKI
(1) Nephrotoxic meds
(2) dehydration
(3) older age
(4) recent surgery
(5) DM
(6) HTN
131
name 4 key nephrotoxic meds
(1) NSAIDs
(2) antibiotics
(3) metformin
(4) CT contrast
132
the 3 ways our body compensates with AKI are:
(1) constriction of kidney blood vessels
(2) activation of RAAS
(3) release of ADH
133
if UO is ____ or ___, report it!
<30 mL/hr for 2 hours or
0.5 mL/kg/hr
134
decreased ___ and ___ are the main s/s of AKI
perfusion, cognition
135
name the s/s of decreased perfusion in AKI
(1) Low BP (MAP <65)
(2) increased HR
(3) weak peripheral pulses
136
how do you diagnose AKI?
(1) labs
(2) CT
(3) US
(4) KUB
(5) kidney biopsy
137
what will lab results be in someone with AKI?
(1) increased creatinine and BUN
(2) increased blood osmolality
(3) increased K
(4) metabolic acidosis
138
what are the 3 nursing priorities for AKI?
(1) impaired elimination
(2) risk for F&E imbalance
(3) risk for acid-base imbalance
139
to prevent AKI, the 3 nursing interventions are...
(1) encourage 2-3 L/day
(2) maintain BP
(3) reduce exposure to nephrotoxic meds
140
when using contrast, what two things should nurses do?
(1) monitor kidney function
(2) increase hydration
141
stop ___ 24 hours before contrast use
Metformin
142
when is temporary dialysis indicated?
(1) symptomatic uremia
(2) K > 6.5
(3) severe metabolic acidosis (pH <7.1)
(4) fluid overload
143
progressive, irreversible, >3 months damage to the kidney that alters elimination
chronic kidney disease (CKD)
144
___ is when elimination is too poor to sustain life
ESKD
145
in stage 1 & 2 of CKD, what are the main goals?
risk factor reduction and mitigation
146
in stage 3 of CKD, we prioritize ___
strategies to slow progression
147
at which stage of CKD might we stop ACEIs temporarily?
stage 3
148
what are the goals of stage 4 CKD?
manage complications and prepare for dialysis
149
during stage ___, you should discuss goals of care
4
150
stage 5 / ESKD treatment options are
(1) dialysis
(2) transplant
151
name at least 4 signs of progression of CKD
(1) increased BUN
(2) increased creatinine
(3) decreased UO
(4) fluid overload
(5) electrolyte buildup
(6) uremia
152
the 3 main causes / risk factors for CKD are
(1) AKI
(2) DM
(3) HTN
153
___ is the best indicator of fluid overload
weight gain
154
metabolic complications associated with CKD:
(1) increased K
(2) metabolic acidosis
(3) increased Phos
(4) decreased Ca
(5) bone fractures (altered Phos, Ca, Vit D)
155
cardiac complications associated with CKD:
(1) HTN
(2) HLD
(3) HF
(4) pericarditis
156
hematologic complication associated with CKD is ____
anemia
157
GI complications associated with CKD are ___ and ___
nausea; anorexia
158
CKD can lead to changes in ___
cognition
159
the main neuro s/s of CKD is
fatigue
160
___ can cause lethargy, seizures, coma, and weakness
CKD
161
the cardiac s/s of CKD are
(1) fluid overload
(2) HTN
162
CKD can lead to ____ acid-base imbalance
metabolic acidosis
163
what are the respiratory impacts of metabolic acidosis in CKD?
(1) Tachypnea
(2) Kussmaul respirations
164
name the 3 hematology s/s of CKD
(1) anemia
(2) bruising / bleeding
(3) reduced WBC
165
name the GI s/s of CKD
(1) anorexia
(2) nausea
(3) metallic taste
(4) foul breath
166
in later stages of CKD we see ___ and ___ (GU symptoms)
oliguria; anuria
167
skin s/s of CKD
(1) pruritus
(2) dry skin
(3) yellow pallor or darkening of skin
168
3 MSK s/s of CKD are
(1) weakness
(2) bone pain
(3) fractures
169
CKD can lead to which psychosocial s/s?
(1) depression
(2) fatigue
(3) sleep disturbances
(4) sexual dysfunction
(5) unemployment
170
labs in CKD:
(1) elevated BUN and creatinine
(2) decreased GFR
(3) hyponatremia - early stages
(4) hypernatremia - late stages
(5) elevated phos
(6) metabolic acidosis - late stages
171
the 5 nursing priorities for CKD are:
(1) F&E imbalances
(2) decreased cardiac function
(3) weight loss
(4) injury
(5) psychosocial compromise
172
___ is usually done 3x per week for 3-4 hours
Hemodialysis (HD)
173
which medications are used for F&E imbalances in CKD?
(1) phosphate binders
(2) multivitamins
174
Diuretics (Thiazide), Ca channel blockers, ACEIs, and beta blockers can all be used to ___ in CKD
control HTN
175
what are the nutrition guidelines for CKD?
(1) protein restriction in early CKD
(2) restrict Na, K, and Phos to manage chronic uremia & for HD
(3) fluid restrictions
(4) give Ca and Vit D supplements; multivits; iron
176
anemia in CKD puts patient at risk for
bleeding
177
which medications can help with anemia and bleeding risk?
(1) iron
(2) epoetin alfa
178
which medications should be avoided / monitored with CKD?
(1) Abx
(2) opioids
(3) antihypertensives
(4) diuretics
(5) insulin
(6) heparin
179
when medication, diet, and fluid restrictions are no longer effective in CKD
hemodialysis (HD)
180
with short-term HD, what is placed?
temporary HD catheter
181
with long-term HD, what is placed?
AV fistula (AVF)
182
what are two key considerations with AVF?
(1) assess for bruit & thrill
(2) clotting can occur (may use heparin)
183
why do we need to give some meds after HD?
some meds can dialyze off
184
name 4 meds that should be given after HD
(1) cephalosporins (cefazolin)
(2) anticonvulsants (phenobarbital)
(3) enalapril
(4) aspirin
185
name the 6 safety considerations with AVFs
(1) No BP cuff
(2) No blood draws or IVs
(3) assess function & perfusion
(4) monitor for bleeding after dialysis
(5) monitor for infection
(6) don't compress the extremity
186
___ exchanges wastes, fluids, and electrolytes in the peritoneal cavity
peritoneal dialysis (PD)
187
___ is the biggest risk factor for PD
infection
188
name at least 3 s/s of infection with PD
(1) cloudy or opaque effluent
(2) fever
(3) abdominal pain
(4) malaise
(5) nausea
189
when using warm bags or warming chambers for PD pain, what should you not do?
microwave them
190
wait time for a kidney transplant can be ____
3-5 years
191
3 candidate criteria for a kidney transplant are:
(1) advanced kidney disease
(2) reasonable life expectancy
(3) medically fit for surgery
192
name the 3 contraindications for kidney transplant
(1) active substance abuse
(2) active cancer
(3) nonadherence
193
the 3 general nursing considerations for post-op of a kidney transplant are:
(1) monitor kidney function
(2) rejection
(3) infection
194
monitor for ___ when assessing risk of rejection of a kidney transplant
abrupt decrease in UO
195
to monitor kidney function after a kidney transplant, we ____
use a catheter to get hourly output
196
s/s of kidney transplant infection are
(1) low-grade fever
(2) mental status change
(3) discomfort
197
phosphate binders example
Ca acetate, Sevelamer (non-Ca)
198
phosphate binders action
prevent absorption of dietary phosphorus
199
phosphate binders / Ca acetate nursing considerations / teaching
(1) take with meals
(2) don't take within 2 hours of other meds
(3) monitor Ca and Phos
(4) monitor for constipation
(5) monitor for muscle weakness, irregular pulse, confusion
200
muscle weakness, irregular pulse, and confusion could be signs of ___
low phos
201
parathyroid hormone modulator example
cinacalcet
202
parathyroid hormone modulator action
reduce PTH to maintain blood Ca and phosphorus levels
203
parathyroid hormone modulator nursing considerations
maintain Ca and phos levels
204
cinacalcet / parathyroid hormone modulator side effects
(1) diarrhea
(2) muscle pain
205
erythropoietin-stimulating agents example
epoetin alfa
206
erythropoietin-stimulating agents action
prevent or correct anemia
207
erythropoietin-stimulating agents monitoring
monitor Hgb (if it's getting too high)
208
Epoietin alfa / erythropoietin-stimulating agents side effects
(1) chest pain
(2) high BP
(3) rapid weight gain
(4) swelling
209
an infection in any area of the urinary tract and kidneys
UTI
210
recurrent UTI is defined as
>2 infections in 6 months or
>3 infections in a year
211
lower UTI is infection of the ___ and ___
urethra; bladder
212
upper UTI is infection of the ___ and ___
ureters; kidneys
213
pyelonephritis and urosepsis are examples of ____
upper UTIs
214
more than 80% of UTIs are caused by ____
e. coli
215
the most common reason for hospital-related UTIs is
CAUTIs
216
the 5 main risk factors for UTIs are
(1) reduced immunity
(2) indwelling foley
(3) female
(4) menopause
(5) low estrogen
217
name at least 3 ways we can prevent UTIs
(1) ask: Is catheter needed?
(2) fluid intake of 2-3 L/day
(3) decrease stress
(4) peri hygiene
(5) empty bladder pre- and post-intercourse
(6) wear cotton and loose-fitting underwear
218
the 4 ways to prevent CAUTI are:
(1) HH
(2) appropriate indication only
(3) sterile technique / closed system
(4) unobstructed flow
219
cardinal s/s of a UTI include
(1) frequency
(2) dysuria
(3) urgency
220
s/s of complicated cystitis include
(1) fever
(2) chills
(3) malaise
(4) N/V
(5) flank pain
221
s/s of UTI in older adults include
(1) confusion
(2) fatigue
(3) delirium
(4) decreased function
(5) incontinence or falls
222
what are the typical VS in someone with a UTI?
(1) fever
(2) increased HR
(3) low BP
(4) increased RR
223
how do we diagnose a UTI?
(1) clean catch urine specimen
(2) serum WBC with differential
(3) CT
(4) H&P with labs
(5) cytoscopy
224
nitrofurantoin, trimethoprim, and fosfomycin are ____
first-line antibiotics for UTI
225
3 comfort measures for pain of a UTI include
(1) analgesics
(2) sitz baths 2-3x/day
(3) avoid cranberry juice
226
the 2 classes of drugs used to treat UTIs are
(1) antibiotics
(2) antispasmodics
227
UTI antibiotics nursing considerations
(1) complete the course
(2) increased sun sensitivity
228
UTI abx side effects
(1) diarrhea
(2) allergic reactions
229
antispasmodics example
phenazopyridine
230
antispasmodics action (UTI)
decrease bladder spasms and promote bladder emptying
231
antispasmodics / phenazopyridine nursing considerations
(1) take with food
(2) urine may be orange / red
232
immunologic defense against tissue injury, infection, or allergy
inflammation
233
elevated levels of nonspecific markers, such as CRP and ESR, are indicators of ___
chronic inflammation
234
swelling, pain, heat, and loss of function are signs of which stage of inflammation?
stage 1
235
inflammatory process due to activated pancreatic enzymes auto-digesting the pancreas, ranging from mild to necrotizing hemorrhagic
acute pancreatitis
236
progressive, destructive disease of inflammation and fibrosis of the pancreas
chronic pancreatitis
237
the primary cause of chronic pancreatitis is ____
alcohol use / abuse
238
name at least 3 risk factors for pancreatitis
(1) alcohol use
(2) biliary tract disease
(3) GI surgery
(4) kidney failure or transplant
(5) trauma
(6) genetic predisposition
(7) penetrating ulcer
(8) cigarette smoking
239
sudden onset of severe, boring pain is a sign of ____
pancreatitis
240
describe the pain associated with pancreatitis
(1) epigastric
(2) radiates to back, left flank, or shoulder
(3) worse when lying down
(4) may worsen with eating
241
besides pain, name at least 3 s/s of pancreatitis
(1) N/V
(2) weight loss
(3) generalized jaundice
(4) absent or decreased BS
(5) warm, moist skin
(6) fruity breath
(7) ascites
(8) tetany
242
pain in pancreatitis can be relieved with ____
fetal position or sitting
243
name at least 3 complications associated with pancreatitis
(1) hypovolemia
(2) pancreatic infection
(3) T1DM
(4) left lung effusion and atelectasis
(5) coagulation defects
(6) multi-system organ failure
244
describe lab results associated with pancreatitis
(1) increased blood amylase
(2) increased WBC
(3) increased glucose
(4) decreased platelets
(5) decreased Ca and Mg
(6) elevated erythrocyte sedimentation rate
245
describe feeding for someone with pancreatitis
(1) NPO until pain-free
(2) enteral or parenteral feedings
(3) bland, high-protein, low-fat diet when resumed
(4) no stimulants
(5) NGT for decompression
246
for which condition should you monitor blood glucose and administer insulin if needed?
pancreatitis (damage to the beta cells potentially)
247
name the 6 meds used for pancreatitis
(1) morphine/hydromorphone
(2) ketorolac (NSAID)
(3) imipenem (abx)
(4) cimitidine (histamine receptor antag)
(5) omeprazole (proton pump inhibitor)
(6) pancrelipase (pancreatic enzymes)
248
ketorolac indication
mild to moderate pain in pancreatitis
249
imipenem indication
acute necrotizing pancreatitis
250
what should you monitor for with imipenem?
(1) evidence of infection
(2) seizures
251
cimetidine indication
to decrease gastric acid secretions in pancreatitis
252
cimetidine nursing considerations
take 1 hour before or 1 hour after antacid
253
omeprazole indication
to decrease gastric acid secretions in pancreatitis
254
omeprazole nursing moniotring
monitor for hypomagnesemia
255
pancrelipase indication
aid with digestion of fats and proteins when taken with meals and snacks
256
pancrelipase nursing considerations / education
(1) monitor and report persistent adverse effects
(2) you can sprinkle the med on non-protein foods
(3) drink a full glass of water following
(4) wipe lips and rinse mouth
(5) take after antacid or histamine receptor antag
(6) take with every meal and snack
257
meperidine is discouraged in pancreatitis d/t the risk of _____, especially in older adults
siezures
258
form of ventilation for patients with severe impairment of gas exchange; providing support until the underlying issue is resolved
mechanical ventilation
259
the main reasons for mechanical ventilation are
(1) hypoxic failure (too little O2)
(2) hypercapnic failure (too much CO2)
(3) mix of both
260
how much volume we take in with each breath is ____
minute ventilation
261
T/F: Ventilators will improve a chronic, end-stage pathology
False - they will NOT
262
name the nursing priorities when caring for a patient on a ventilator
(1) maintain patent airway
(2) assess patient first, ventilator second
(3) HOB 30 degrees
(4) monitor cuff pressure (RTs)
263
explain the DOPE acronym for assessing patients on mechanical ventilation
D - Dislodgement
O - Obstruction
P - Pneumothorax
E - Equipment
264
the 3 priorities for ostomy care are
(1) healthy stoma and peristomal
(2) F&E balance
(3) psychosocial support
265
___ is at the ileum and located at the RLQ
ileostomy
266
initial output can be up to 2 L/day for which type of ostomy?
ileostomy
267
output in a ____ will be green, loose, and odorless
ileostomy
268
stool from a ____ is irritating to the skin
ileostomy
269
___ is at the end of the large intestine
colostomy
270
what are the two diets for ileostomy vs. colostomy?
ileostomy - low-residue diet
colostomy - regular diet
271
colostomy higher in the colon will produce ____ output
more liquid
272
colostomy lower in the colon will produce ____ output
more formed
273
describe attributes of a healthy stoma
(1) red/pink
(2) moist
(3) protrudes 1-3 cm
274
describe a normal stoma immediately post-op
(1) edematous
(2) small bleeding is expected
(3) stool in 2-3 days
275
describe attributes of an unhealthy stoma
(1) dark red / purple / black
(2) dry means ischemia
(3) heavy bleeding
276
notify the surgeon immediately if you see ___ in a stoma
heavy bleeding
277
healthy peristomal will be ___
intact and free of redness
278
unhealthy peristomal will be ___
reddened, painful, moist, itchy
279
how do you prevent an unhealthy peristomal?
(1) cleanse and dry
(2) ensure good secure fit with 1/8" larger than stoma
280
which types of foods should patients avoid initially with an ostomy?
(1) stringy veggies
(2) popcorn
(3) fresh tomatoes
281
name 4 odor-producing foods to educate a patient on with an ostomy
(1) broccoli
(2) cabbage
(3) corn
(4) fish
282
which psychosocial challenge can patients with a stoma face?
impaired body image
283
___ is used for short-term iHD
AV graft
284
the downside to an AV graft is ____
plastic has a higer risk of infection
285
both AV graft and HD line have risk for ___
infection
286
which type of dialysis is used in the ICU and can pull a significant amount of fluid?
CRRT
287
the 5 cardinal signs of inflammation are
redness
heat
pain
swelling
loss of function
288
give ___ to manage adrenal insufficiency in sepsis
corticosteroids
289
what is the first choice blood replacement for poor clotting?
platelets
290
urine specific gravity is ____ in AKI and ____ in CKD
high; low
291
____ is an early sign of shock
increased HR / tachycardia
292
SIRS criteria
(1) temp <36 or >38
(2) tachycardia >90
(3) RR >20
(4) WBC <4000 or >12000 or WB Neutrophils >10%
(5) PaCO2 <32
293
Sepsis is
SIRS with confirmed or suspected infection
294
Severe sepsis requires ____ to maintain MAP >65
vasopressors
295
serum lactate >2 mmol/L despite fluid resuscitation is
severe sepsis
