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Final Exam Flashcards

1
Q

Infiltration

A

=leakage of non-vesicant solution into surrounding tissues
-stop infusion, remove site, elevate extremity, cold/warm compress

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2
Q

Extravasation

A

=leaking of vesicant solution
-stop infusion, surgical intervention may be necessary

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3
Q

Phlebitis

A

=inflammation of the vein
-remove site, heat, and elevate extremity

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4
Q

Site Infection

A

=infection at the insertion point, port pocket, or subq tunnel
-clean site, remove cath, send for culture, cover with a dry sterile dressing

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5
Q

PICC vs. PIV- techniques for use and care

A

PICC=10mL barrel syringes only, contrast injection-power PICC only
PIV=3mL-10mL flush
-avoid joint flexion, choose most distal site, avoid the dominant side, do NOT use the side of mastectomy, AV fistula, lymph nose dissection or paralysis, limit unsuccessful attempts to 2 per clinician

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6
Q

Fluid Imbalances- care of a patient with fluid overload

A
  • Airways, breathing, circulation, stop fluid infusions -
    Ensure patient safety, restore normal fluid balance, Provide supportive care,
    Prevent future fluid overload
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7
Q

Hypokalemia

A

-weak thready pulse
-Ortho hypo
-shallow resp
-anxiety, lethargy, confusion, coma
-paresthesias
-hyporeflexia
-hypoactive bowel sounds

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8
Q

Hyperkalemia

A

-tight and contracted
-muscle cramping and weakness
-urine abnormalities
-resp depression
-decreased cardiac contractility (low HR, BP)
-increased DTR

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9
Q

Hypernatremia

A

-big and bloated
-flushed skin
-restlessness, anxiety, confusion, irritable
-increased BP and fluid retention
-edema (pitting)
-decreased urine output
-skin flushed and dry
-agitation
-low-grade fever
-thirst

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10
Q

Hypocalcemia

A

-Convulsions
-arrhythmias
-tetany
-spasms and stridor
-Positive trousseau’s and chvostek’s

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11
Q

Fluid and Electrolyte Imbalances- Laboratory Values Associated with Dehydration

A

-high H&H
-high BUN
-high urine specific gravity
-high sodium
-high glucose
-high protein

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12
Q

ABG Interpretation – Respiratory Insufficiency

A

pH <7.35 PaCO2 > 45mmHg
-Respiratory acidosis: increasingly difficult breathing, dyspnea, weakness, dizziness, sleepiness, change in alertness

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13
Q

ABG – Indication of Metabolic Acidosis

A

-pH < 7.35 HCO3 < 21mEq/L
-weakness, lethargy, confusion, headache, stupor/unconsciousness, coma or death

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14
Q

Right-sided Heart Failure- Assessment Findings

A
  • peripheral edema, distended jugular veins, distended abdomen, enlarged liver and spleen (hepatomegaly), polyuria at night
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15
Q

Left-sided Heart Failure- Assessment Findings

A

-SOB, pulmonary edema, pink frothy sputum, crackles or wheezing, fluid in lungs, S3/S4 summation gallop, tachypnea, confusion/dizziness, oliguria during day

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16
Q

Heart Failure- Loop Diuretics and Adverse Effects

A

Hypokalemia

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17
Q

Heart Failure- Digoxin and Adverse Effects

A

-Digoxin= lowers BPand heart rate
-Adverse effects= fatigue, bradycardia, anorexia, N/V, dysrhythmias, digoxin toxicity (>2ng/mL), GI distress, CNS effects

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18
Q

Right-sided Heart Failure- Nursing Actions

A

-daily weight @ same time each day

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19
Q

Heart Failure- Patient Education

A

-low sodium diet, low fat, take medications as prescribed, take breaks when exercising, be able to hold a conversation while exercising

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20
Q

Left-sided Heart Failure: Manifestations and Risk Factors

A

Manifestations
-dyspnea (exertional dyspnea, paroxysmal nocturnal dyspnea)
-fatigue
-weakness
-arm heaviness
-chest pain or palpations, skipped beats, fast rate
Risk Factors
-hypertension
-coronary artery disease
-valvular disease

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21
Q

MI- Interventions (consider medication management)

A

-M-morphine
-O-oxygen
-N-nitroglycerin
-A-aspirin

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22
Q

Angina- Teaching about Sublingual Nitroglycerin

A

-3 tabs max every 5 minutes until chest pain is absent

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23
Q

MI- Diagnostic Testing

A

-EKG
-troponin t and I value (normal 0-0.04ng.mL >0.04 for MI)

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24
Q

Coronary Artery Bypass Graft Surgery- Psychosocial Integrity- Relieving Patient’s Anxiety

A

-statement patient makes ab being anxious, have to pick response

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25
Angina and MI- Purpose of Cardiac Enzyme Studies
-to help healthcare providers know if symptoms are due to a heart attack, angina, heart failure, or another problem
26
Patient and Family teaching about Heparin
-s/s of bleeding should be reported immediately
27
PAD vs PVD- plan of care
PAD -promote vasodilation (maintain warm environment, wear socks and avoid cold when possible, avoid caffeine and nicotine-cause vasoconstriction) -encourage appropriate positioning (do NOT cross legs, refrain from wearing restrictive garments, cautiously elevate extremities -dangle legs PVD -encourage ambulation after anticoagulation therapy is initiated, warm moist compress, do NOT massage affected limb -elevate legs -avoid crossing legs -elevate legs for 20min, 4-5/day -elevate legs above heart when in bed
28
Hypertension- Medications used for Drug Therapy, consider the effectiveness of drug therapy
-Diuretics -Calcium Channel Blockers -ACE inhibitors -Angiotensin II receptor blockers (ARBs) -Beta-adrenergic blockers
29
Deep Vein Thrombosis (DVT)
Drug Therapy, Heparin, and Coumadin
30
Diabetes- Criteria for Diagnosis
A1C
31
Hypoglycemia vs Hyperglycemia- Clinical Manifestations
Hypoglycemia -Skin: Cool, Clammy, sweaty -Dehydration: absent -Respirations: No particular or consistent change -Mental status: anxious, nervous, irritable, mental confusion, seizure, coma -Symptoms: weakness, double vision, blurred vision, hunger, tachycardia, palpitations Hyperglycemia -extreme thirst (polydipsia) -frequent urination (polyuria) -hunger (polyphagia) -dry skin -blurred vision -drowsiness -decreased healing
32
Insulin Administration- Technique for Administering
-clean with alcohol, scrub the hub, Administer SQ, 2 inches for the umbilicus, rotate injection site
33
Insulin Administration- Sliding Scale
-know how to use -match the glucose # to number on the sliding scale to know the amount of insulin to administer
34
Preventing Complications – Labs (peri-op)
-WBC -H & H low (indicates bleeding) -Ptt -INR -platelet
35
Surgical Classifications – Elective, Urgent, Emergent
Elective =planned for correction of a nonacute problem (ex. cataract removal, hernia repair) Urgent= requires prompt intervention, potentially life-threatening if delayed more than 24-48 hours (ex intestinal obstruction, bone fracture) Emergent= requires immediate intervention, life-threatening consequences (ex gunshot/ stab, severe bleeding, appendectomy)
35
Informed Consent
-review consent -verify and clarifies facts -confirms consent is signed, dated, and times -may serve as a witness
36
Stage 1 Pressure Injury- Assessment Findings
-intact skin with localized area of non-blanchable erythema -may be precede by changes in sensation, temp, or firmness -color changes are not purple or maroon
37
Stage 2 Pressure Injury- Assessment Findings
-partial-thickness loss of skin with exposed dermis -wound bed is visible, pink, or red and moist -may look like intact or ruptured serum-filled blister
38
Risk for a Pressure Injury- Nursing Actions
-Determine Risk Level (Braden score) -Reduce pressure -Improve pressure tolerance
39
Pressure Injury- Description for Stages 1-4, Unstageable, DTI
stage 1: intact skin with localized area of non-blanchable erythema stage 2: partial thickness loss of skin with the exposed dermis, wound bed pink/red/ moist stage 3: full thickness skin loss with adipose visible in the ulcer, slough, or eschar may be present, undermining and tunneling may be present stage 4: full-thickness skin loss with exposed or palpable fascia, muscle, tendon, ligaments, cartilage, or bone, may have slough, eschar, undermining, tunneling unstageable: full thickness covered by eschar or necrotic tissue DTI: unstageable with suspected deep tissue injury
40
Non Healing Pressure Injury- Nursing Action
-adjuvant therapies -electrical stimulation -therapeutic ultrasound -negative-pressure wound therapy (NPWT) -hyperbaric oxygen
41
Pressure Injury- Patient with Greatest Risk
-low braden score -older adults -incontinect patients, excessive moisture -not being turned
42
Pressure Injury- Lab Assessment
-elevated WBC (4000-11000) -positive blood cultures
43
COPD- Plan of Care- Hydration
drug therapy, airway maintenance, monitoring, breathing techniques, positioning, effective coughing, oxygen therapy, exercise condition, suctioning, and hydration
44
Pulmonary Embolism- Medication Management
-Heparin: anticoagulant
45
Pulmonary Embolism – Interventions
Manage hypoxemia -apply oxygen, elevate HOP, and reassure the patient -oxygen therapy -monitor the patient for changes in status -administer anticoagulation or fibrinolytic therapy Managing hypotension -IV fluid therapy used (using crystalloid solutions) to restore plasma volume and prevent shock -drug therapy with vasopressors (norepinephrine, epinephrine, or dopamine) used if fluid therapy does not help Controlling bleeding -assess for evidence of bleeding, ensure correct dosing and timing of medication, monitor lab values Minimizing anxiety -patient with PE struggles with anxiety, fear and pain -maintain proper communication with your patients -anti-anxiety medication -pain management
46
Asthma Attack- Medication Therapy
-Albuterol inhaler
47
Pneumonia- Assessment Criteria
-General appearance- assess for flushed cheeks, anxious look, chest pain/discomfort, myalgia, headache, chills, fever, cough, tachycardia, dyspnea, hemoptysis (bloody sputum), sputum production -Respiratory assessment- breathing pattern, use of accessory muscles, positioning, cough, sputum assessment, lung sounds (such as crackers) -Vital signs- increased resp rate, hypotension, tachycardia -Dysrhythmias
48
Oxygen Therapy- Tasks to Delegate to a PCA related to oxygen therapy
-measure pt pulse ox -positioning (elevate HOB) -keeping nairs moist
49
Chronic Kidney Disease- Interpreting Lab Values
-reduced GFR <60 -BUN increases >20, urine output decreases
50
Acute Kidney Injury- Interpreting Lab Values
-increase in serum creatinine by 0.3mg/dL or more within 48 hours -increase serum creatinine to 1.5 times or more occurring in the previous 7 days
51
Chronic Kidney Disease- Assessing fluid volume increase
-daily weight -fluid restriction -fluid overload due to the inability of disease kidneys to maintain body fluid balance
52
Know the difference between Types of Incontinence
Stress= when urine leaks out at times when your bladder is under pressure (cough of laugh) Urge= when urine leaks as you feel a sudden, intense urge to pee, or soon afterward Mixed=stress and urge incontinence Overflow (reflex)= when you’re unable to fully empty your bladder, which causes frequent leaking Functional= leakage of urine caused by factors other than disease of the lower urinary tract
53
Urinary Incontinence- Interventions for Preventing Skin Breakdown
-chech regulary, keep skin dry -barrier cream -changing and cleaning after an incontinet episode -checking for skin breakdown
54
Urolithiasis- Interventions
-high fluid intake (3L/day or more) -accurate measurement of I/O’s -drug therapy -nutrition therapy/ diet modification
55
Cystitis- Interventions
Nonsurgical -drug therapy -fluid intake -comfort measures such as pain relief -no cranberry juice, no spices, soy, tomato, caffeinated drinks, alcohol
56
Bladder Cancer- Risk Factors
-GREATEST RISK FACTOR Tobacco use -exposure to toxins such as gasoline and diesel fuel, chemicals used in hair dyes and in rubber paint, electric cable, and textile industries -family history, Schistosoma haematobium (a parasite) infection, excessive use of drugs containing phenacetin, and long-term use of cyclophosphamide
57
Peptic Ulcer Disease- Complications
-Hematemesis Hemorrhage -occurs more often in patients with gastric ulcers and in older adults -patients have a second episode of bleeding if underlying infection with H. Pylori remains untreated or if therapy does not include H2 antagonist -massive bleeding = vomiting bright red or coffee-ground blood -minimal bleeding from ulcers = minimal occult bleeding in a dark “tarry” stool, melena may occur with gastric ulcers, more common with duodenal ulcers Perforation -occurs when the ulcer becomes so deep that the entire thickness of the stomach or duodenum is worn away -the stomach or duodenal contents can then leak into the peritoneal cavity -patients can experience sudden, and sharp pain, peritonitis infection, severe illness within hours, bacterial septicemia and hypovolemic shock, paralytic ileus Pyloric obstruction -vomiting caused by stasis and gastric dilation -symptoms of obstruction include abdominal bloating, nausea, and vomiting Intractable disease -ulcers, excessive stressors in the pt life, or an inability to adhere to long-term therapy
58
Gastrointestinal Perforation- Assessment Findings
-board-like/rigid abdomen -abdomen pain
59
Ulcerative Colitis- Assessment findings and Interventions for Acute Exacerbation
-manage diarrhea -consider nutritional therapy and rest -drug therapy (aminosalicylates, glucocorticoids, antidiarrheal drugs, and immunomodulatory) -complementary and integrative health (herbs (flaxseed), selenium, and vitamin C)
60
Inflammatory Bowel Disease- Manifestations of Ulcerative Colitis
-low grade fever -abd distention along the colon -assess for signs and symptoms associated with extraintestinal complications, such as inflamed joints and lesions inside mouth -usually findings are nonspecific
61
Ulcerative Colitis- Managing Skin Integrity
-barrier cream
62
Crohn’s Disease- Recommended Diet
-bowel rest and nutrition support with TPN, nutritional supplements, avoid caffeine and alcohol -bland food: toast, banana
63
Acute Gastritis- Patient Teaching
-avoid caffeine, highly acidic foods, spicy foods
64
Cirrhosis- Client Teaching for Lactulose
-will be pooping 2-3 times a day -used to reduce the amount of ammonia in the blood of patients with liver disease
65
Cirrhosis and Ascites- Plan of Care
-Go on a low-sodium diet
66
Chronic Cholecystitis- Dietary Teaching
-high-fat diet puts pt at risk -avoid fatty foods, withhold food and fluid if nausea and vomiting occur
67
Chronic Cholecystitis- Assessment Findings
-persistent recurrent RUQ pain -afebrile; may have localized tenderness over a palpable gallbladder
68
Acute Pancreatitis- Lab Findings
-serum amylase elevated -Lipase elevates serum bilirubin and alkaline phosphatase elevated -ALT -WBC -ERS
69
Pancreatitis- Appropriate Diet
-bland diet= chicken, rice, pasta -foods high in carb and protein assist in the healing process, avoid foods high in fat because it causes or increases diarrhea -avoid caffeine and alcohol
70
Colostomy- Assessment Findings, Normal and Abnormal
-healthy: red, beefy, moist, shouldn't be painful -unhealthy: purple/ pale blue, dry -avoid lifting heavy objects, or straining on defecation to prevent tension on the anastomosis site -avoid drinking and extreme physical activity for 4-6 weeks while the incision heals
71
Osteomyelitis – Interventions and Treatment (include considerations of medication)
Nonsurgical -4-6 weeks of antimicrobial therapy -contact precautions with wound drainage -treatment for MRSA infection- IV vancomycin, linezoid -irrigate wound with antimicrobial solution -drug therapy for acute and chronic pain (opioid) -administer hyperbaric oxygen (HBO) therapy=wound healing Surgical -surgical techniques include incision and drainage of skin and subcutaneous infection, wound debridement, and bone excision -sequestrectomy- removes the necrotic bone and allows revascularization of tissue -bone grafts to repair bone defects -microvascular bone transfers or bone graft from donor bone
72
Amputation – Pain Management
-IV infusions of calcitonin during the week after amputation can reduce phantom leg pain -other pain management modalities may be used for pain management
73
Fractures - Traction and purpose of traction
-Buck's traction=for hip fracture -the application of a pulling force to part of the body to provide bone reduction or as a last resort to decrease muscle spasm (thus REDUCING PAIN)
74
Osteoarthritis – Interventions and Treatment
-Tylenol primary drug of choice -topical for temporary relief of mild pian -do not take more than 4000mg a day (weight over 150lbs) -ketorolac, ibuprofen, Celebres -tramadol
75
Rheumatoid Arthritis – Diagnosis (Consider Lab Values)
-RF(rheumatoid factor=measures unusual antibodies) -Anti-CCP (detects early RF) -ANA (determines the cause of tissue death) -ESR -hsCRP

Med Surg (12 decks)

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