Final Flashcards
(92 cards)
1
Q
S/Sx of hypernatremia
A
thirst, swollen tongue, sticky mucosa, flushed skin, low-grade fever, edema, confusion, restlessness, weakness
(SALT- Skin flushed, Agitation, Low-grade fever, Thirst)
2
Q
S/sx of hyponatremia
A
neurologic changes- lethargy, confusion, personality changes, seizures
3
Q
S/sx of hyperkalemia
A
cardiac changes, dysrhythmias, muscle weakness, resp impairment, paresthesias, anxiety, and GI manifestations M-muscle weakness U-urine/oliguria R-respiratory distress D-decreased cardiac contract E-ekg changes R-reflexes/hyperreflexia
4
Q
Tx for hyperkalemia
A
- limit K intake
- monitor ECG and use Ca gluconate for arrhythmias
- Kayexalate
- IV sodium bicarb
- reg insulin and hypertonic dextrose IV if met. acidosis
- albuterol
- dialysis
- diuretics to prevent pulm overload and excrete K
5
Q
Hypophosphatemia lab value
A
serum phosphorus <2.0
6
Q
Causes of hypophosphatemia
A
vit D deficiency, malabsorption syndromes, over-use of phosphate binding antacids, alcoholism
7
Q
s/sx of hypophosphatemia
A
confusion, seizures, symptoms mimicking Guillian Barre, decreased oxygen capacity of RBC
8
Q
tx for hypophosphatemia
A
high-phosphorus diet (beans, peas, eggs, chicken, fish, nuts, grains)
P.O. meds (Neutra Phos)
9
Q
Normal osmolality of blood
A
275-295 mOsm/Kg
10
Q
Labs and diagnostic testing for hypoparathyroidism
A
- Low serum Ca
- High phosphorus (PTH is overwhelmed due to hyperphosphatemia)
- Get hx (heredity and nutritional), duration, clinical s/sx, renal failure-PTH ineffective c renal failure, med analysis
- PTH immunoassay
- Vit D metabolites
- Transient (trauma, burns, meds, illness) vs. chronic
11
Q
Labs and Diagnostic testing for hyperparathyroidism
A
-high PTH levels
-Hypercalcemia
alkaline phosphatase levels
12
Q
Causes of Diabetes Insipidus
A
-A deficiency in the synthesis or release of ADH
or
-A decreased renal responsiveness to ADH
13
Q
Treatment for Addison’s disease
A
- Administer cortisone, hydrocortisone, prednisone, or Cortef to replace cortisol
- Administer fludrocortisone to regulate Na and K balance from aldosterone insufficiency
- maintain fluid balance
14
Q
how to administer hydrocortisone
A
with meals, milk, or antacids to avoid GI distress
15
Q
Nursing interventions for Addison’s disease
A
- monitor F&E
- admin hormones
- weigh daily
- I&Os
- bone density test for osteoporosis due to decrease in mineralcorticoids
16
Q
Pt teaching for Addison’s
A
- meds must be taken every day
- wear medic alert bracelet
- keep emergency supply of meds available
- Need for increased cortisol replacements during stress and illness and increased flurocortisone acetate during exercise and sweating*
17
Q
Nursing interventions for Cushing’s
A
- daily weight and monitor fluid status
- I&Os (adequate hydration)
- monitor for glucose and acetone in urine
- allow adequate rest
- avoid trauma to skin (delayed wound healing)
- bone density scan to assess for osteoporosis bc corticosteroids can leech calcium from bone
- ongoing CV and musculoskeletal asmts
- suicide precautions
18
Q
Pt teaching for Cushing’s
A
-maintain high calorie, high-calcium diet to aid in wound repair and replace Ca
19
Q
What is Conn’s Syndrome?
A
aka Primary Aldosteronism
- Adrenal cortex is secreting excessive amounts of aldosterone
- This results in kidneys retaining Na and excreting K
20
Q
S/Sx of Conn’s
A
- increased BP
- HA
- orthostatic hypotension
- muscle weakness and cramps (low K)
- fatigue
- temp paralysis
- constipation
- numbness, prickling, tingling
- polydipsia & polyuria
21
Q
Interpreting test results for Conn’s
A
- low serum K
- 24 hr urine to monitor aldosterone, creatinine, and cortisol
- increased urinary aldosterone
- oral salt or saline loading test
- presence of adrenal tumor on CT
22
Q
Tx for Conn’s
A
- Diuretcs (spironolactone for women and amiloride for men to increase K)
- Ca channel blockers (HTN)
- eplerenone (blocks effects of aldosterone)
23
Q
NSG Dx for Conn’s
A
Risk for imbalanced fluid volume
Risk for activity intol
Impaired physical mobility
24
Q
NSG for Conn’s
A
Monitor VS, restrict Na intake, I&Os, daily weights
Pt teaching: thirst, dry mucous membranes are caused by low sodium. Allow sips of water, ice chips
25
Nasal Polyps usually associated with:
Ashma, Hay fever, Sinus infection, Cystic Fibrosis <16yrs
26
Samter's Triad
asthma, nasal polyps, aspirin intolerance
27
Teaching c nasal polyps
polyps can be recurring even after removal, may need to stay on steroid sprays for extended time to prevent recurrence
28
Causes of mucormycosis
weakened immune system, diabetes, DKA, kidney failure, organ transplant, chemo, Desferal tx for acute iron poisoning, exposure to construction, removal of nonsterile adhesive tape, tongue depressors as splints in neonates
29
Teaching for mucormycosis
- Seek health care immediately if facial swelling and a black discharge from nose occurs
- high-risk pts should avoid sugary foods, decaying plants, moldy bread, manure, and other sources of fungi
30
Clinical Manifestations of Vocal Cord Paralysis
- change in voice (croaky, rough, breathy, aphonic)
- SOB
- noisy breathing
- choking, coughing c eating/swallowing
- need for frequent breaths while speaking
- inability to speak loudly
- inability to "bear down"
31
Medical tx for vocal cord paralysis
For uncontrolled aspiration:
- permanent gastrostomy tube
- tracheostomy
- Semi-Laryngectomy
32
S/sx of Post-obstructive pulmonary edema (POPE)
frothy sputum and moist rales
33
Trach assessment
- auscultate lungs
- monitor 02
- assess for blood in the sputum*, sub-Q emphysema in the neck, resp distress, and tube patency
- monitor for POPE*
34
teaching for sarcoidosis
- limit Ca rich foods, vit D, & sunlight
- take prednisone
- seek medical care with increasing dyspnea, weight gain, more productive cough, or change in sputum from clear to yellowish-brown
35
Chronic Bronchitis
inflammation and increased mucous production in the trachea and bronchi with chronic productive cough
36
Emphysema
chronic inflammation reduces flexibility of walls of alveoli, resulting in over-distention of the alveolar walls. This causes air to be trapped in the lungs, impeding gas exchange
37
s/sx of pulmonary hypertension
```
Most common:
exertional dyspnea
fatigue and lethargy
angina
syncope
Raynaud's
edema
```
Less common:
cough, hemoptysis, hoarsness
38
Other s/sx of pulm htn (heart sounds mainly)
right ventricular heave, split heart sound, accentuated S2, ejection click, third heart sound, JVD, liver congestion, peripheral edema
39
Cor Pulmonale
failure of the right side of the heart due to pulmonary HTN
40
Functions of the Integumentary System
```
Protection
Thermoregulation
Tactile Stimulation
Excretion
Synthesis of Vit D
Determines Identity
Storage of blood and fats
Reflection of emotion
```
41
contributing factors to diabetic wounds
neuropathy
macro/microvascular changes
slow, decreased immune response
42
Venous ulcers
- most occur on lower extremities
| - margins not well defined
43
Arterial ulcers
- located on lower tibia area of leg
- cool to touch, discolored, hair loss
- "punched-out" appearance, well-defined margin
44
Adjunctive Wound Healing Treatments
- Negative pressure therapy
- Skin and tissue grafts or flaps
- Whirlpool therapy
- Hyperbaric oxygen therapy
- Electrical stimulation
- Normothermia
- Pressure reduction and relief
45
First degree burn
- Partial-thickness
- involve only superficial dermis
- heal spontaneously
46
Second degree burn
- Partial-thickness
- involve deep dermis
- may require a prolonged period to heal
47
Third degree burn
- Full-thickness
| - All skin layers
48
Emergency/Resuscitative Period: Burns (when it is and goals)
-From time of injury to 2-3 days
-emergency care: Stop the burning process
Goals:
-maintain airway and oxygen
-correct fluid imbalance
-conserve body heat
-prevent wound infection
-relieve pain
-emotional support
49
Emergency/Resuscitative Period of Burns includes:
- assessments (esp resp and CV)
- saline soaks, keep warm
- prepare catheters, tubes
- protect against infection
- baseline studies, measurements
- fluid resuscitation (after airway stabilization)
- pain mgmt
50
Acute Phase of Burns (when it is and goals)
```
-From hemodynamic stability to wound closure
Goals:
-wound cleansing and healing
-pain relief
-preserve body heat
-prevent infection
-promote nutrition
-splint, position, and exercise affected joints
```
51
Acute phase of burns includes:
- wound debridement
- escharotomies
- topical meds, dressings
- surgeries (wound excision, closures, grafts)
- promote and maintain normal mobility
- nutrition
52
Rehabilitative Phase of Burns (when it is and goals)
```
starts when wound <20% open (2wks-yrs after injury)
Goals:
-physical therapy
-reconstruction
-psychological prep
-pain mgmt
-nutrition
```
53
Rehabilitative Phase Includes:
- scar contracture formation
- functional and cosmetic reconstruction
- psychological, occupational recovery
54
Contraction prevention for burn scars
- Exercise, stretching, scar massage
| - use pressure dressing 23 hours/day (decreases hypertrophic scar formation and increases wound pliability)
55
Rebound tenderness is often a sign of?
Peritonitis
56
Iliopsoas sign
indicates an inflammation of the psoas muscle
57
Obturator sign
indicates inflammation along the obturator internus muscle
| -Positive tests can be related to appendicitis, diverticulitis, PID
58
Murphy's sign
positive with inflammation of the gallbladder
59
Ulcerative Colitis
- affects colon and rectum
- affects only mucosal and submucosal layers
- bloody stools
60
Crohn's Disease
- inflammation can occur in any part of the GI tract
- involves ALL layers of intestinal wall
- results in obstruction, abscess, and fistula formation
61
S/Sx of intestinal obstruction
abdominal swelling, pain, N/V/D, constipation
62
Complications of Gastric Surgery
```
Dumping Syndrome
-undigested contents of stomach move too rapidly into SI
-nervous system symptoms
-secondary hypoglycemia
Vitamin/Mineral Insufficiencies
-pernicious anemia
```
63
S/sx of Prodromal Phase of Hepatitis
Vague, flu-like symptoms
- anorexia, N/V, fatigue
- myalgia, arthralgia
- mild abdominal pain
- fever <103
- increased AST, ALT, ALP
64
S/Sx of Icteric Phase of Hepatitis
- Begins with the onset of jaundice
- worsening of prodromal sx
- dark urine (increased bili)
- clay-colored stools
- increased serum bili
65
S/Sx of Convalescent Phase of Hepatitis
- Begins after 2-3 weeks of acute illness
- Symptoms subside, appetite and energy increase
- jaundice and abdominal pain disappear
- duration of illness varies c different types of hep
66
Early s/sx of Cirrhosis of Liver
- Fatigue
- significant change in weight
- GI sx
- abdominal pain and liver tenderness
- pruritis
67
Late s/sx of Cirrhosis
- jaundice and icterus
- clay-colored stools
- tea-colored urine
- dry skin, rashes, petechiae, ecchymosis
- warm, bright red palms
- spider angiomas
- peripheral dependent edema of extremities and sacrum
68
preparation for liver biopsy
- informed consent
- assess PT, aPTT, INR, and platelet counts
- NPO 6-8 hrs
- placed in supine or left lateral
69
post liver biopsy
- position on right side for 1-2 hrs
| - monitor for bleeding, pneumothorax, infection
70
s/sx of hepatic encephalopathy
- asterixis (tremor of hand when wrist is extended)
- agitation
- combativeness
- confusion
- exaggerated reflexes (DTRs)
(AACCE)
71
tx for hepatic encephalopathy
lactulose- reduces ammonia
neomycin-sterilizes bowel
oxazepam-tx agitation
72
NSG for hepatic encephalopathy
- Mini Mental Stat Exam
- **PROTEIN RESTRICTED diet
- monitor DTRs
73
s/sx of Acute Pancreatitis
- sudden, severe epigastric pain radiating to back
- N/V
- abd distention, decreased bowel sounds, rigidity
- elevated amylase and lipase
- hypocalcemia
- Grey Turner's and Cullen's
- hyperglycemia
74
S/sx of Chronic Pancreatitis
- recurrent epigastric and LUQ pain (less severe than acute)
- tender abdomen, mild muscle guarding over pancreas
- anorexia
- N/V
- flatulence
- constipation
- steatorrhea (excess fat in stool)
75
Med mgmt of acute pancreatitis
- tx focused on resting pancreas
- NPO
- NG tube
- bed rest
- lg amt of IV fluids
- clear liquid diet when bowel sounds return
- slow transition to low-fat diet
- pain mgmt c narcotics
76
Med mgmt for chronic pancreatitis
- supplementation c pancreatic enzymes (always give with food!!)
- narcotics NOT used due to addiction risk
- lifelong lifestyle changes (no alcohol, low-fat diet)
77
gerontologic considerations for musculoskeletal
- decreased flexibility
- decreased Ca absorption
- decreased ROM d/t thinning cartilage
- decreased muscle mass
78
Grade 1 open fracture
- Inside-out fracture
- wound bed clean, <1cm
- minimal soft tissue injury and comminution (crushing, shattering)
79
Grade 2 open fracture
- soft tissue wound >1cm
| - moderate contamination, comminution
80
Grade 3 A open fracture
wound <10cm, crushed tissue, contamination
81
Grade 3 B open fracture
wound >10cm, crushed tissue, contamination, regional or free flap
82
Grade 3 C open fracture
major vascular injury, limb salvage
83
patho behind osteoarthritis
- bony formations on weight-bearing joints
- decrease in collagen synthesis, increase in collagen breakdown
- asymmetrical joint cartilage loss
84
clinical manifestations of osteoarthritis
- morning stiffness
- pain with overuse of joint
- joint bone deformity
85
foods that are high in purine (gout pts cannot eat these)
mushrooms, sardines, asparagus, peas, beans, alcohol, gravy, animal broths
86
NSG dx for Osteoarthritis
```
Pain, chronic
mobility: physical, impaired
falls: risk for
body image: disturbed
readiness for enhanced self-care
imbalanced nutrition: more than body requirements
-powerlessness
```
87
what are usually the first s/sx of IICP?
sudden drowsiness and restlessness
88
other signs of IICP:
- decrease in motor function with presenting weakness in the extremities
- pathologic posturing (decorticate, decerebrate)
- Unusual headache and vomiting
- changes in vital signs that may indicate pressure on the brainstem or hypothalamus (Cushing's triad- HTN, bradycardia, irreg respirations)
89
S/Es of Dilantin
gum hypertrophy, ataxia, diplopia, hirsutism
90
s/sx of autonomic hyperreflexia
- HTN
- headache, flushing, nausea
- blurred vision/restlessness
- bradycardia
91
Spinal Shock
- flaccid paralysis below level of injury followed by spastic reflexes
- loss of sensation
92
Neurogenic Shock
```
-loss of vasomotor and sympathetic nervous system tone
Features:
-Hypotension
-Bradycardia
-Poikilothermia
```
