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Flashcards in FINAL Deck (51):
1

Hemoglobin

F 12-15
M 13-18

2

hematocrit

F 37-47
M 40-54

3

BUN/CRE

BUN 6-20
CRE 0.5-1.5

4

WBC

4,500-11,000

5

Platelets

150,000-450,000

6

sodium

135-145

7

potassium

3.5-5

8

calcium

9-11

9

hyperglycemia symptoms

>180
excess thirst, headaches, blurry vision, fatigue, frequent urination, weight loss, pruritus, slow healing wounds

10

Treatment of hyperglycemia

Insulins

11

Hypoglycemia symptoms

below 70
s/s: increase epinephrine, shaky, irritable, tachycardia, hunger, pale, blurred vision, lethargy, confusion.

12

Treatment of hypoglycemia

start with 10-15g of carbohydrates: soda, milk, sugar, then 20-30 grams of carbs.

13

Albumin

3.4-5.4

14

GFR

125ml/min

15

risk factors for benign prostatic hypertrophy

age
obesity
OTC cold meds
prostate cancer

16

What is benign prostatic hypertrophy?

Increase muscle tone at bladder neck and proximal urethra, constricted urethral lumen

s/s: PSA>4, little pee every time, protein in urine

*can develop hydronephrosis

17

Treatment and post-op treatment of benign prostatic hypertrophy?

treat: reduce caffeine, and alcohol, Benadryl, antidepressants, Ca channel blockers, couda cath

surgical: TURP, prostatectomy: robotic, bleeding, infection, erectile dysfunction, incontinence

*educate about effects and encourage fluids

18

Ulcerative Colitis

Inflammation: crypt abscess

Not all layers, only mucosa and submucosa

Profuse watery diarrhea with combo of blood,

mucous, pus

Starts in rectum, inflammation, lead to cancer of

the colon and rectum

Contiguous portions of the bowels

19

Crohns Disease

Ileum or large intestines: all layers of the mucosa -can get better in one area in worse in another granular lesion on mucosa fissures penetrate bowel wall, connect bowel to other structures

20

Nursing Issues with crowns disease and ulcerative colitis

Nursing issues: Diarrhea, pain, poor nutrition, coping

Drugs: Asulfidine, glucocorticoids, Immunmodulators

21

GERD diagnosis, treatment, nursing care

1) GERD: Backward flow of GI content into esophagus and stomach acid irritates lining

a. Cause: relaxes lower esophageal sphincter, Hiatal Hernia, Delayed Gastric Emptying

b. s/s: heartburn, dysphagia, sore throat, pain after eating, belching, salty secretion in mouth, severe, may radiate to neck, back, jaw and mimic a cardiac episode

22

Hiatus Hernia diagnosis, treatment, and nursing care

2) Hiatus Hernia: Part of stomach protrudes through diaphragm into thoracic cavity

a. Type I: Sliding (most common) upper stomach & GE displaced upward into thorax

b. Type II: Paraesophageal or Rolling GE junction stays below diaphragm

c. Nursing care: Surgical (Nissen fundoplication- stomach is wrapped around the fundus): major surgery of opening abdomen and thorax, postop care includes prevent resp complications, out of bed and walk to prevent gas and take care of tubes

23

Diverticulosis symptoms, treatment options

Outpouching of the lining of the intestine, most prominent is the descending or sigmoid colon. Common with obesity, high processed food.

May have it for years without symptoms, diarrhea, cramping, IBS

Avoid constipation, increase fluid and exercise,fiber

24

Diverticulitis symptoms, treatment options

Infection in the colon caused by diverticulosis

PAIN, rectal bleeding, inflammation

Antibiotic, change in diet

25

Ostomy care and psychosocial concerns

1) Caring: look at stool in enteric coated pills, assess skin at each pouch change, tolerate foods, chew food more completely, high fiber, urolithiasis (dehydration from loss of fluid in GI tract)

2) Psychosocial: body image issues, activities interfere with pouch

26

COPD symptoms, treatment, medications

a. Symptoms: hard to breath, chronic airflow limitation, bronchial edema, decrease elastic recoil, Sob, wheezing, barrel chest chronic cough

b. Meds: bronchodilators, steroids, oxygen LOW DOSE

27

Asthma symptoms, treatment, medications

2) Asthma: impaired gas exchanges, chronic inflammatory disorder of airways, med b/f puberty, woman after, inherited, started by triggers, inflammation leads to bronchoconstriction and hyper-responsiveness of airways, allergen cross IgE receptors on mast cells, increase mucous production, rush of WBC, vascular congestion, bronchospasm, thickening of airway

a. Symptoms: wheezing, cough, dyspnea, chest tightness, hypoxemia, thick sputum, difficult speaking, anxiety, restlessness, increase Co2 in body

28

Pathology of cancer

Cancer:

-dysplasia: altered size and shape

-hyperplasia: increase number of normal cells

-metastasis: spread of cancer cells from original cells to distant site

-differentiation: cancer involved malfunction in genes that control differentiation and proliferation

29

Chemotherapy

-use when disease is widespread, risk of hidden

disease is high

-different drugs target different cell phases,

cancer cell death multi exposure, combo drugs,

nursing: specific training, side effects, route

patient: watch vesicant extravasation

SE: alopecia, GI effect, anorexia, stomatitis,

pain, myelosuppression

30

Radiation

-targets rapidly multiplying cells, kills other in its path -cell radiosensitivity: cell susceptibility -damages DNA, all cells, not dependent on cell cycle, oxygen free radicals are formed- interact with tissue causing tissue damage care: dry skin, warm/cool water, mild soap, ink marks, avoid powered, lotion, clothing friction, protect from sun, use electric razor SE: skin reaction, fatigue, stomatitis, esophagitis

31

Effects of chemotherapy

Neutropenia, anemia, thrombocytopenia

32

Nursing care of effects of chemo (neutropenia, anemia, thrombocytopenia)

Neutropenia: Less than 1000
Increase risk of infection, protective isolation, steroid use for treatment add to infection risk.
Hand washing, oral care, do not share utensils, fever is emergency, avoid crowds, children, people with infection, avoid animal feces, vitals q4, avoid fresh flowers, change wound dressing, limit visitors

Anemia: Fatigue, dizzy, dyspnea, tachycardia.

Blood transfusion, IV drugs: epogen, procrit Increase iron

Thrombocytopenia: Avoid injury, shave with electric razor, prevent dry cracked skin, good oral care, avoid constipation, enemas, rectal temp, avoid ASA, NSAIDs

Pressure on bleeding 10in, avoid rectal temp, avoid injection, tarry stool, petechiae, watch change in LOC

33

Gastic Ulcers

From smoking and drinking, food causes pain,
vomiting relieves pain

Manage pain, rest and relaxation, teach causes
and prevention, discuss stress reduction

34

Duodenal Ulcer

pain on empty stomach, food eases pain

Manage pain, rest and relaxation, teach causes and prevention, discuss stress reduction, Eat btw meals Take H2 antagonist or antacids

35

Medications to treat Gastric and Duodenal Ulcers

Biaxin, Flagyl (antibacterial), Prilosec (PPI)
Hypo secretory agents
-H2 receptor blockers: Zantac, Pepcid, etc.: Can take 24 hours
-Prostaglandin analog: Cytotec : unusual drug, prostaglandin analog that increase mucous production
¯ acid, mucous
-Proton Pump Inhibitor (PPI): Prilosec or omeprazole
-Antacids (neutralize gastric acid): Mylanta (immediate effect)
-Mucosal barrier fortifier: Carafate: increase healing

36

Understand care of elders – hearing issues, visual issues, safety concerns, exercise needs.

1) Hearing: speak slow, enunciate, lower pitch of voice, use non-verbal cues, face elder

2) Vision: large type, contrasting colors, avoid blues and greens, short paragraphs, non-glare paper

3) Safety concerns: delirium, dementia, depression, substance abuse, falling, pressure ulcers, stress fractures

4) Exercise needs: short sessions, work on balance, weight bearing exercise

37

Review nursing care for a comatose patient

Perform Glasgow coma scale, keep head of bed at 30degress, protect patient, fluid balance, mouth care very 2hrs, soft bristle toothbrush, rotate every 2hrs

38

Glascow Coma Scale

Glasgow coma scale: eye opening, motor response, verbal response, higher the number the better

39

Treatment of head injury

muscle relaxants, nerve block,
a. CT scan, x-ray, MR
b. Watch ICP, medication, dark room, decrease stimulants, sedation

40

Review Guillain-Barre syndrome and highest risk associated with GBS.

Guillain-Barre syndrome: inflammatory unknown cause, degeneration of myelin on peripheral nerve, preceded by URI, or GI infection, Zika Virus, Cytomegalovirus, Epstein-barr, associated with HIV

a. Phase: 1 weak, 2-weakness in resp 3-recover

b. Manage: supportive care, ventilation assistance, ADLs, nutrition support, proper body alignment, aggressive rehab after recovery

High risk: respiratory paralysis, can’t ventilate yourself, paralysis moves from feet to head

41

lab tests required for a patient on anticoagulation therapy- heparin and coumadin

1) Heparin: (given first) inhibits thrombin: monitor APTT (20-36sec) reverse with protamine

2) Coumadin: (inhibits VitK): monitor with INR (2-3.5) takes 24-48hrs to start; antidote is vitamin K

42

Review orthopedic issues: pre-and post-op care and assessment, treatment and complications of fractures

Pre-op: RICE, move slowly, stabilize
Post-op: bathe only accessible skin, apply lotion to exposed skin, avoid using powder in cast, inspect padding, hematoma form 24-72hrs, check for compartment syndrome, assess for infection
Complication:
Compartment syndrome: take cast off
Fat embolism: can lead to pulm embolism, confusion, restlessness, elevated temp, anxiety
Thromboembolism, neurovascular compromise, DVT, PE, necrosis, infection
Osteomyelitis: infection directly in bone: antibiotic for 4-8 weeks, chronic, fever, pain, malaise, amputation

43

Assessment and care/education for a patient with hypertension

1) Assessment: give history, inspect skin, hair, JVD, cap refill, edema, ulcers, palpate temp and edema, auscultate

a. Primary: no ID cause-genetic

b. Secondary, resistant, isolated

c. >140/>90 stage 1; >160/>100 stage 2

2) education/care: weight reduce, DASH diet, exercise, relaxation, decrease smoking, potassium supplementation, meds (ASA, antihypertensive, platelet inhibitor, OTC)

a. meds: diuretics, beta blockers, Ca channel blockers, Arbs, ACE inhibitors,

44

Review medications related to angina; how to take meds, precautions, patient education.

Nitrates (during attack no more than 3, 5minuites in-between), ACE inhibitors/ARBs, Beta blockers, CCBs, Na current Inhibitors, diuretics

45

Know diet and lifestyle factors related to hypertension and cardiovascular disease; labs drawn to assess these diseases: HDL/LDL/Troponin/CKMB

HTN diet: DASH (restrict sodium, fat, alcohol, caffeine), exercise, lose weight

Cardiovascular disease: low salt, saturated fats, exercise, decrease weight

Labs:

a. HDL: want >40 >60 if CHD, good healthy cholesterol

b. LDL: below 160 1 risk factor, below 130 two risk factors, below 100 if CHD

c. Triglycerides less than 150

d. Total cholesterol >200

e. Troponin: heart disease indicator, indicate if heart attack occurred <0.01

f. CKMB: muscle damage and stress 3-5%

46

Nursing care for a patient having an angiogram / cardiac catheterization

1) Angiogram: x-ray photo of blood or lymph vessels, use special dye watch asthma, allergy to meds, taking metformin, don’t drink for eat 4-8hrs before

2) Cardiac Catheterization: thin tube that goes into heart to check coronary arteries, inserted by groin, neck, and threaded to heart

47

SIADH

1) SIADH: (FVE)

a. Cause: CNS disorder, adrenal insufficiency, malignancy (small cell lung), pulm disease, meds (vasopressin, thiazide, SSRI)

b. S/S: decrease urine output, low serum osmo <280, low Na, increase GFR, sudden weight gain, vomit, seizures, pain, muscle cramp, decrease LOC, fatigue, weakness

c. Restrict fluids, measure urine and serum osmo, meds (Opioids, thiazide diuretics, SSRI)

48

Thyroidectomy

Treatment for thyroid cancer. Attempt to save parathyroid gland to prevent hypocalcemia and tetany.

Pre-op: deduce stress and anxiety to avoid
precipitation of thyroid storm
Teaching dietary guidance to meet patient
metabolic needs and avoidance of test and
procedures

Monitor respirations, dressing for potential
bleeding, ability to swallow, semi-fowlers,
prepare for hypocalcemia

49

Parathyroidectomy

Perform for hyperparathyroidism Parathyroid adenoma

Watch Ca levels

50

Hyperthyroidism

Excessive output of thyroid, toxic nodular goiter,excessive intake of thyroid hormones, pituitary tumor, infection, stress, cigarette smoking

Hypertension, insomnia, hunger, weight loss, hyperthermia, goiter, diarrhea, dry skin, anxiety
Expo thalamus

Graves: watch temp, exopthalmus

51

Hypothyroidism

Primary: Iodine deficiency, destruction of tissue, defective hormone synthesis,

Secondary: pituitary disease in release of TRH, hashimoto’s thyroiditis, graves’ disease

Hypotension, constipation, lethargy, hypothermia, weight gain, anorexia, slow speech, hair loss