Flashcards in Final 1600 Deck (215):
Surgery; improve function, enhances appearance (or both); E: on the nose to correct deviated septum to increase airflow; breast reconstruction after mastectomy.
primary purpose for maintaining NPO status 6-8 hours prior to surgery
Classification of medication given to prevent and treat N&V
Antiemetics: Ondansetron ( Zofran)
Hand held breathing device; promote complete lung expansion and prevent pulmonary problems
Surgical consent: nursing responsibility
Sets up OR; coordinates all the activities; make sure supplies are available; positioning of the patient
Set up sterile field; drape patient; handles all sterile equipment; maintains count of supplies.
Ensure right patient, right surgical procedure, right site
Collapse or airless condition of all or part of the lungs; caused by hypoventilation; obstrustion, or compression
Excess fluid build up - inflammation; flue like symptoms: cough, fever, dyspnea
Temporally disappearance of peristalsis ; N&V, pain, distention
Blood clot in pulmonary artery; sudden onset; dyspnea, pleuritic chest pain, restlessness, cough, hemoptysis; Tx: heparin therapy
PE - pulmonary embolism
Blood clot from the deep venous thrombus; calf pain, erythema, unilateral swelling
Wound opening ; apply a sterile non adherent or saline dressing; notify surgeon
Wound opening with protrusion of internal organs; surgical emergency.
Descriptive term; wound is together without any gaps
Well-approximated - Primary intention
Wound healing: shortest, from top down; wound edges closed ; E: sutures
Wound healing: prolonged repair, gradual filling with connective tissue; bottom to top; left open; E: pressure ulcers
Wound healing: initially wound left open to heal, debrided; then wound is surgically closed; E: I&D - incision and drainage.
Grenade looking device; placed in the wound after surgery for removal of the drainage
Jackson-Pratt drain (JP) - suction drain
Wound exudate containing bacteria that yellow, brown and green with foul odor
Constipation, N&V, puritis, sedation, respiratory depression - side effects of ...
Automated device used by patient to self administer prescribed pain medication
PCA Pump - patient controlled analgesia
Source of pain moves or travel to other location
Term used to describe pain such as sharp, aching, or stabbing
Common side effect of opioid usage; TX: Mag-ox (Magnesium Oxide)
Intervention that is most important to teach client about identifying fluid volume status
Weigh yourself daily
Fluid compartment that is equivalent to 40 % - 2/3 of total body water
ICF - intracellular fluid / compartment
Movement of fluid through a permeable membrane due to hydrostatic pressure
Free movement of particles from high concentration to low concentration
Diffusion across a cell membrane that requires assistance; E: insulin/glucose; sodium pumps
Movement of water from lower to higher concentration of solute ; concentration gradient must exist; particles cannot cross
0.9% sodium chloride (NS); lactated ringers, D5W
Isotonic solutions - crystalloids
Same osmolarity as blood (270-300); no fluid shift : outside = inside
0.45 % sodium chloride ( 1/2 NS)
Outside (concentration) < inside ; moves fluid into the cell - cells swell , enlarge
D5LR, D5 0.45 NS, 3 % NS
Outside > inside ; pulls fluid from cells - cells shrink; think of fluid overload (cells are overloaded with fluid)
400-600 ml is min amount of urine per day needed to excrete toxic waste products
Obligatory urine output
500-1000 ml/day water loss from skin, lungs and stool; cannot be controlled
Insensible water loss
hormone secreted when sodium level in ECF decreased; prevent Na+water loss ; acts on kidney nephrons
Hormone secreted when sodium level increases ; acts on kidney tubules - water is reabsorbed to dilute blood.
Antidiuretic hormone - ADH
Inflammation of vein; redness, pain hardened
Leakage of IV fluid in extravascular tissue; cool, moist , redness
Leaking of chemical (vesicant ) or medication
Affects primary CNS ; altered mental status, cerebral edema, confusion
Na - where Na goes, H2O follows ; 135-145
Confusion, muscle weakness ; caused by : diuretic use, low salt diet, decreased aldosterone secretion ; TX: 2-3 % sodium chloride
Restlessness , seizures, muscle twitching; caused by renal failure, exercise, diaphoresis, fever; TX: diuretics, 0.45%NaCl
Affects cardiac/ respiratory/musculoskeletal systems
Potassium K ; 3.5-5
Irregular pulse , dysrythmias , muscle weakness, confusion; caused by diuretics, anorexia, Digoxin toxicity , gastric suction, V&D, hyperaldosteronism . TX: diluted IV K
Client is admitted with K 2.1; Order: 40 KCL STAT; what is most appropriate method for administering?
Diluted IV; never as IV push; never exceed 20 mEq/hr; monitor for infiltration
Crdiac irregularities, muscle twitching, paresthesia (tingling or numbness), hypotension; caused by renal failure, K sparing diuretics (Aldosterone), stored bank blood; TX: Kayexalate (stool); emergency : Insulin IV + CaCl + D50
Stored in bone – strength & density, skeletal
contractions, nerve impulses; absorption requires active form of vitamin D (parathyroid hormone control)
Parathesia, chvosteks( facial twitching), trousseus (spasm + palmar flexion) sign, deep tendon reflex, cardiac changes, seizures ; caused by inadequate intake Ca/ Vitamin D; lactose intolerance , Chrons disease; TX: IV Ca, Vitamin D
High BP, HR; confusion, fatigue, kidney stones; caused by hyperparathyroidis; poor kidney excretion; TX: IV 0.9 NaCl, Lasix, Phosphorus,Calcitonin.
Inverse relationship w/ Ca; assist cell growth & metabolism;
Treat according to Ca level;
Phosphorus 3 -4.5
What tonicity of fluid will used to rehydrate the cells
Solutions with small molecules that flow easily from the bloodstream into cells
Crystalloids - Isotonic, Hypotonic, Hypertonic
Solution used for burns, GI tract fluid loss, acute blood loss; Caution: renal disease : K component; liver failure: lactic acidosis ( cannot convert lactate into bicarbonate) .
LR - Lactated Ringers
Solutions with molecules too large to pass through semipermeable membrane; they remain in intravascular compartment; volume expanders; used: severe burns, blood loss, shock
Colloids (always hypertonic ): Albumin, Dextran, Mannitol, Hespan (Hetastarch)
Fluids classified as
3. Blood products
What are two the most common causes of kidney failure
Types of ARF
3. Post renal
Type of ARF; decreased blood flow to the kidneys; caused by shock, HF, PE, sepsis; s/s: hypotension, decreased UO, tachycardia
Type of ARF; Kidney damage d/t acute tubular nephrosis, infection, toxins;S/S: oliguria, anuria, HTN, SOB
Type of ARF; Obstruction to outflow of urine; S/S: Lethargy, signs of uremia
Nephrotoxic drugs and radiocontrast dies cause what type of acute renal failure ARF
100-400 ml in 24 hr / decreased urine output
> 2000 ml in 24 hr; increased urine output
Less than 100 ml in 24 hr
Chronic renal failure dietary restrictions
5. P high causes hypocalcemia and osteodystrophy - take phosphate binder - Amphojel (constipation)
Increased Na, K, P, Mg; low Ca; metabolic acidosis - Kussmaul respiration ; hypertension, hyperlipidemia, HF, pericarditis, anemia, uremia.
Chronic kidney disease - ESKD ( GFR<15)
Halitosis, stomatitis, anorexia, N&V, peptic ulcers, pruritus, uremic frost, bruises
Type of dialysis; uses the principles of diffusion and ultrafilteration; access: fistula, graft, dialysis cath (Quinton)
Hemodialysis; to check potency
Palpate for the thrill; auscultate for the bruit
Disequilibrium syndrome, muscle cramps, hemorrhage, air embolus, hemodynamic complications (hypotension, anemia),cardiac dysrhythmias are complications of ...
Type of dialysis ; uses the principles of diffusion and osmosis ; instilled into the peritoneal cavity via permanent indwelling catheter ; sterile technique (wear mask)
Peritonitis, Bleeding, Leakage, Abdominal hernias are complications of ...
S/s: hematuria, facial edema, fluid overload, SOB, proteinuria; DX: GFR, ASO titer ( strep bacteria)
S/s: hypertension, fatigue, occasional edema; decreased kidney function
S/s: flank/back pain, fever, N/V, burning, urgency ; DX: U/A (WBS, C&S)
S/s: hypertension, Na excretion, nocturia; DX: U/A
Microbial infection that invade kidneys in the renal pelvis
Presence of calculi ( stones) in the urinary tract
Urolithiasis (urinary calculi )
Type of incontinence; causes involuntary loss of bladder control associated with a strong urge to void
Type of incontinence; occurs when detrusor muscle fails to contract and the bladder become overdistended
Type of incontinence; most common; loss of small amount of urine during coughing, sneezing, jogging, lifting
Type of incontinence; result of factor other than the abnormal function of the bladder or urethra; E: loss of cognitive function
Medical term for surgical removal of all or part of the urinary bladder
Classification of UTI
1. Upper UTI : pyelonephritis
2. Lower UTI: cystitis
S/s: dysuria, frequency, urgency, hesitancy, hematuria, itching, pyuria ...mental status changes
Urinalysis : protein
0-2 per high power field
M: 0-3; F:0-5
Increased glomerular permeability; large molecules pass from blood into the urine; S/s: massive proteinuria, lipiduria, edema...
pH that is not compatible with life !!!
< 6.8 or >7.8
When one is hypoventilating the body doing what ?
Prolong vomiting and nasogastric suctioning leads to acid deficit , causing
Urinary diversion, divert urine into surgically created pouch or pocket that functions as a bladder. The stoma is continent, and the patient removes urine by regular self-catheterization
Kock's pouch - ileal reservoir
Internal reservoir created from part of the small intestine; connected to the urethra; learn to void normally
Type of urinary diversion; diverts urine to the large intestine; no stoma required; urine excreted with bowel movement
Acid-base balance regulatory mechanisms
1. Chemical : fast acting
2. Respiratory: minutes
3. Renal : hours-days
Normal range pH
Normal range CO2
Normal range HCO3-
pH < 7.35; PaCo2 > 45
Normal range O2
Hypoventilation : deep, slow, shallow breathing; retaining CO2; S/s: confusion, drowsiness, tachycardia, dysrhythmias , elevated K; TX: manual ventilation
Hyperventilation: rapid, shallow breathing; blowing off CO2; S/s: numbness and tingling, diaphoresis, tetanic spasms of arms and legs (low Ca) - acute resp.failure; TX: nonrebreather, paper bag
pH > 7.45; PaCo2 < 35
pH < 7.35; HCO3 < 21
Anxiety, fear, pain, fever, sepsis, CNS lesions, resp. stimulants will lead to ...
Head injury, meds (opioids) , spinal cord injury, atelectasis , pneumonia will lead to ...
Diarrhea, intestinal fistulas, renal failure, DKA, starvation , pancreatitis will lead to ...
Ingestion of antacids, excess use of HCO3, lactate in dialysis, vomiting , gastric suctioning , diuretics
Kussmaul breathing , N/V, warmed flushed skin, confusion; (high K); TX: Hydration
pH > 7.45; HCO3 > 28
Weakness, muscle twitching, tetany, dizziness, seizures, N/V, respiratory depression, low Ca ; TX: Diamox (excrete HCO3)
If the pH is outside of normal range it is ...
Uncompensated (or partially compensated )
If the pH is within normal , while other values remain abnormal it is ...
Acid base balance occurs through control of ... production and elimination
Hydrogen ions H+
COPD - CO2 retained - pH decreases - kidney excretes more H+ and increase reabsorption of bicarbonate back into the blood - example of ...
Renal compensation (corrects respiratory problem)
Running - build up of lactic acid - increase in H+ - decrease in pH - breathing is triggered - loose of carbon dioxide - example of
Respiratory compensation (corrects metabolic problem )
Air passing through constricted bronchioles is the symptom of what respiratory disease ?
COPD characterized by what two symptoms ?
Bronchospasm (chronic bronchitis)+ dyspnea (emphysema)
What is the best nursing intervention for person who has Mycobacterium Tuberculosis
The loss of lung elasticity and hyperinflation of the lungs are two major causes of ...
Intermittent, reversible airflow obstruction; affects only airways; inflammation (mucus) and airway hyperresponsivenes (bronchospasm) ; wheezing, SOB, chest tightness
Inhaled corticosteroid, prevent asthma attack caused by inflammation; used daily; reduces local immunity - good mouth care;
Short acting beta 2 agonist (SABA); rescue drug; relaxes bronchial smooth muscles ; used 5 min before other inhaled drug; monitor HR.
Oral corticosteroid; rescue drug; step 6 asthma; side effects: GI ulceration; fat redistribution; weight gain; hyperglycemia ; reduces all immunity responses
Inflammatory process resulting in excess fluid in the lungs; triggered by infective organisms; S/s:flushed cheeks , bright eyes, anxious expression, fever, chest pain, dehydration.... ; vaccine available ( older adults repeat every 5 years )
Highly communicable; airborne transmission ; S/s persistent cough, hemoptysis, fever, anorexia, night sweats, fatigue ...
Combination TB drug therapy ; take 6 month or longer; strict adherence ; stain skin and urine; interact with oral contraceptives; avoid drinking; risk for liver toxicity;
Isoniazid (INH) + Rifampin
Patient is no longer contagious ...
after 2-3 weeks of taking meds; when 3 sputum cultures are negative
expectorant - thin secretions
Mycolitic - destroys or dissolves mucus
Also known as silent disease; this chronic condition is caused by bone loss due to decreased bone density
What is the most common method reducing immobilizing fractures ?
ORIF - open reduction internal fixation
This is a two-part surgery. First, the broken bone is reduced or put back into place. Next, an internal fixation device is placed on the bone; this can be screws, plates, rods, or pins used to hold the broken bone together.
ORIF - open reduction internal fixation
Usually results from a long bone fracture ; occurs 12-48 hrs of injury or illness; chest pain, hypoxia, dyspnea, petechiae; ND: Impaired gas exchange
An emergent situation is caused by blood or fluid build up at the site of injury; emergency fasciotomy is treatment of choice ; kidney failure due to myoglobin release ( rhabdomyolysis)
Acute compartment syndrome
Type of fracture; no visible wound
Closed - simple
Type of fracture; external wound
Open - compound
Assessment of neurovascular status
Risk for falls
Pelvic fracture ND
Risk for bleeding - hypovolemic shock
Can be acute ( fever, swelling, erythema, bone pain) or chronic ( ulceration, pain, drainage) ; caused by staph or MRSA ...
At risk for dislocation; ND: risk for bleeding, infection; abduction pillow between pt's legs; heels of the bed; 6 P's; move day after surgery; 90 degree rule
Post op hip replacement
Application of pulling force to a part of the body; skin (velcro boot); skeletal ( pins, wires), brace.; 6 P's; pain; elevate above heart; T; ice ;ND: Acute pain; Risk for infection
Hold bones in place after reduction; handle with palms of hands ; 6 P's; circulation; nerve damage; infection: "hot spots"; muscle atrophy; ND: Acute pain, Risk for infection
System in which pins or wires are inserted through the skin and affected bone and then connected to a rigid external frame; increased risk for pin site infection that can lead to osteomyelitis ; monitor every 8-12 hours
Long term glycemic control determined by ...
The best 3 ways to manage diabetes
Shaking, sweating , tachycardia, dizziness, anxiousness, irritability are clinical manifestations of ... ; BG < 70.
Which type of insulin has onset 1-3 hrs , peak 4-12, duration 16-24
This type of drug therapy lowers both basal and post meal glucose level in type II diabetics reducing hepatic glucose production and the tissue sensitivity to insulin
Carbohydrate replacement ( 15-20 g of glucose); Glucagon (subcut or IM); 50 % Dextrose (IV); - are treatments of ...
Polyuria (dehydration) - Polydipsia (cell starvation )- Polyphagia - no insulin - fats break down ( ketones) -metabolic acidosis ( Kussmaul )- fruity breath; BG > 250
Caused by infection; other stressors, 3Ps, dry skin, Kussmaul, lethargy, dehydration, BG > 300; sudden onset ; Type 1 diabetes complication ...
DKA - diabetic ketoacidosis
During 24 hrs - 5-10 L of fluids - isotonic saline; 5%D in 0.45 saline; regular insulin by continuous IV infusion ; IV potassium ; are treatments of ...
Caused by infection, poor fluid intake; altered CNS function: seizures, myoclonic jerking; severe dehydration; BG > 600; gradual onset; complication of type 2 diabetes ....
HHS - hyperosmolar state
Systemic effects of diabetes : chronic complications
1. Macrovascular : arteriosclerotic and atherosclerotic changes in large arteries and veins; coronary artery disease(MI), cerebral artery disease (stroke), peripheral vascular disease
2. Microvascular changes : nephropathy (ESKD), retinopathy, neuropathy (foot ulcers)
Long - acting Insulin; never mixed; no peak time
Intermidiate - acting insulin ; peak time 6-12 hrs; can be mixed with regular
NPH (Humulin N, Novolin N)
Short - acting insulin; peak time 2-5 hrs; can be mixed with NPH;
Regular ( Humulin R, Novolin R)
Rapid - acting insulin ; peak time 0.5-1.5 hr;
Diagnosis of diabetes : obtained on 2 occasions
1. FBG > 126 (100) - 8 hrs no caloric intake
2. Glucose tolerance test > 200 (140) - 2 hrs post load
3. HbA1C > 6.5 (4-6) - glycemic control over 120 days
Coplications of insulin therapy
2. Lipoatrophy (tx: inject insulin at the edge)
3. Lipohypertrophy (tx: rotate inj site )
4. Fasting hyperglycemia
- Dawn phenomenon (tx: more insulin before bed)
- Samogyi phenomenon (tx: more food before bed )
This type of drug increase insulin secretion in the treatment of type 2 diabetes ; side effect - hypoglycemia
Sulfonylurea agents : 1st generation - Tolbutamide ; 2nd generation - Glipizide
This type of drug improves tissue sensitivity to insulin in the treatment of type 2 diabetes ; not for patients with liver impairment; can take 2-3 months to work;
TZD - Avandia
What is the treatment of choice for pt. experiencing hypovolemic shock due to pelvic fracture
Crystalloids, colloids, blood products, plasma expenders
The bone marrow produces ...
RBC + WBC + Platelets
What precaution should be implemented with thrombocytopenia ?
Low WBC, CD4 count less than 200, fever, night sweats, and opportunistic infection present manifestations of ...
Everyone who has HIV infection has AIDS, but not everyone who has AIDS has HIV ... True or False ?
Organisms that are present in normal environment and usually kept in check by normal immune response ; can be protozoan , bacterial , fungal or viral
Use of strategies to prevent the actual occurance of cancer : avoid carcinogens; modify associated factors ( alcohol, high fat, low fiber, multiple sex partners); remove at risk tissues ( moles, breasts, colon polyps); chemoprevention ( vitamin D + tamoxifen - breast cancer) ; vaccination
use of screening strategies to detect cancer early, ; yearly mammography (> 40 ); colonoscopy ( 50); digital rectal examination ( men > 50)
Type of surgery; removing part of the tumor
Cytoreductive / debulking surgery
1. Neutropenia: low WBC; infection risk - sepsis
2. Thrombocytopenia : low platelets; risk for excessive bleeding
3. Anemia: low RBC; ineffective tissue perfusion
4. N&V : antiemetics
5. Mucositis ; stomatitis
6. Alopecia ( injury to scalp, body image)
7. Peripheral neuropathy : prevent injury
Side effects of chemotherapy
Oncologic emergency; organisms enter bloodstream ; vasodiilation, hypotension, high T, WBC, RR; low urinary output ; hypoxia .... symptoms of ...
Sepsis / Septicemia
Oncologic emergency ; problem with blood clotting process; clots block blood vessels (pain, oliguria, bowel necrosis... ) ;tx: anticoagulants; bleeding from many sites - hemorrhage ; tx: give clotting factors
DIC - Disseminated intravascular coagulation
Oncologic emergency; seen in carcinoma of the lungs; can occur very quickly; water is reabsorbed causing fluid overload, hyponatremia (seizures, coma), muscle cramps, fatigue; pulmonary edema - HF. TX: fluid restriction , Na intake, cancer therapy .
SIDH - syndrome of inappropriate antidiuretic hormone
Oncologic emergency; damage occurs when a tumor enters the spinal cord or vertebra collapse from tumor degradation of the bone ; S/s: back pain, paralysis, numbness, tingling, muscle weakness ; tx: palliative
Spinal Cord Compression
Oncologic emergency; SVC is compressed or obstructed by tumor growth; blockage of blood flow to head, neck, upper trunk; edema of face; Stokes sign (collar); tx: radiation
SCV- Superior Vena Cava Syndrome
Oncologic emergency; tumor cells destroyed rapidly (K+purines) - faster than body can eliminate them - ARF ( hyperuricemia) ; tx: Hydration ( 3-5 L of water day before, day of, 3 days after chemo or radiation)
Tumor Lysis Syndrome
Most common symptom - fatigue; dyspnea on exertion, orthostatic hypotension, intolerance to cold temperature, clublike nails, pallor of ears, headache ... symptoms of ...
Red meat, organ meat, egg yolks, kidney beans, leafy green vegetables, raisins are food sources of ...
Transfusion reaction; severe pain in kidney and chest; high T, HR, low BP ....
Acute hemolytic reaction
Transfusion reaction; coughing, wheezing, N&V , low BP ....
Severe allergic reaction
transfusion reaction; high T; chills, flushed skin, back pain, V&D, low BP ...
Bacterial reaction (infectious)
Transfusion reaction; high BP, HR, dyspnea, confusion, jugular vein distended
The purpose of this type of treatment is to destroy cancer cells with minimal exposure to normal cells ....
Type of radiation; distant ; external to the patient; patient is not radioactive and is not a hazard to others
Type of radiation; close; direct contact with tumor tissue; uses radioactive isotopes ( solid form or within body fluids); patient is hazard to others
HIV : precaution
Testing for HIV
1. Lymphocyte count : CD4 + T cell; WBC
2. Antibody tests : (made 3 weeks - 3 months ) : ELISA, Western blot;
3. Viral load testing (monitor treatment)
HAART; inhibit viral replication; important issue - drug resistant mutations in the HIV organisms ( bc of missed doses of drug)
Protozoal infection; S/s: dyspnea, dry cough, fever, fatigue, weight loss...
PCP - pneumocystis jiroveci pneumonia
Fungul infection; S/s: mouth - cottage cheese-like yellowish white plaque and inflammation ; women - persistent yeast infection ....
Bacterial infection ; systemic; S/s: fever, weight loss, organ disease, swollen lymph glands ....
MAC - mucobacterium avium complex
Viral infection; S/s: numbness and tingling before blister forms; fever, bleeding, pain ...
HSV - herpes simplex virus
Cancer; develops as small, purpulish brown raised lesions that are not painful; occur anywhere on the body
Kaposi's sarcoma (HIV pts)
Benign breast problems of women approaching menopause; caused by dilation and thickening of collecting ducts
What type of breast surgery removes breast tissue , nipple , lymph nodes and leaves muscle intact
Modified radical mastectomy
Uterine tissue implantation outside of uterine cavity
Caused by changes in the level of serotonin fluid shifts; physical and emotional symptoms occur in women ages 20-40 : depression, angry outbursts, ...
PMS - premenstrual syndrome
What are two characteristic symptoms of BPH
Hyperplasia + Hypertrophy
Alpha adrenargic receptors; constrict the prostate gland