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Final Exam Flashcards

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1
Q

what to assess for buck traction

A

these are for muscle spasms

weights should be free hanging & not resting on bed/floor

check for pulse, skin q 4 hrs

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2
Q

what to assess / how to clean external fixation

A

should only be mild redness
wash hands
look for s/s of infection
some crusting around pin is normal
clean w/ CHG weekly

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3
Q

what is alendronate for

& how to take it

A

osteoporosis

take in AM on empty stomach w/ full glass of water

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4
Q

s/s of fat emboli (usually after large bone fracture like pelvis or femur within 12 - 72 hours)

A

shortness of breath / hypoxia
petechiae rash
chest pain
tachycardia

can also have decreased oxygenation & fever

treat w/ rest or they may go in to remove it .. give oxygen, may need to vent, or wait for it to resolve

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5
Q

how to treat phantom pain

A

it’s real pain, treat it. don’t withhold meds

give Acteminophen, Gabapentin, NSAIDS OPIOIDS, Ketamine

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6
Q

how to treat osteomyelitis

A

IV antbx 4-6 weeks
take culture FIRST & start broad spectrum antbx while waiting for results

acute will have fever, chronic will not

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7
Q

what to do if pt had stroke & has dysphagia

A

swallow test prior to feeding
HOB elevated at least 30 degrees
monitor airway
monitor for facial drooping, drooling, asymmetry

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8
Q

weak muscles if one of the first signs of this disease. Ocular muscles are the first to get weak (drooping eyelid aka ptosis) then generalized weakness

***caused by a lower neuron lesion at the myoneural junction

A

myasthenia gravis

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9
Q

s/s of brain tumor pt in the ER

A

new persistent h/a
wake up w/ h/a or wakes you up in the night
vision problems
confusion

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10
Q

what to do if pt is having a seizure

A

safety is #1!!!!!
put in recovery position, lay on their side
don’t put anything in their mouth
don’t restrain
remove anything in the way

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11
Q

what to do if pt is going to CT

A

check allergies (shellfish/iodine)
check renal function (BUN should be 10 - 20, & creatinine should be 0.6 - 1.2)

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12
Q

what to do for pt w/ spinal cord injury

A

check LOC
reposition every 2 hours, assess skin each time
apply SCDs or tedhose
passive ROM
put them on anticoagulants

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13
Q

what to do if pt comes in w/ increased ICP

A

keep HOB elevated

give Mannitol which passes the brain barrier (osmotic diuretic to remove fluid), can also give IV 3% saline … pt also might be given steroid!

keep calm, calm environment

don’t cluster care

ICP should be 0 - 10, over 20 is elevated

if pt is slouched in bed, could impact ICP so put in neutral position w/ HOB elevated

make sure seizure pads are on

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14
Q

s/s of increased ICP

A

Cushing’s triad - increased BP, decreased RR, decreased HR

***early sign = decreased LOC

increased restlessness, pressure in head like bad h/a that is blowing up like a balloon

can also be bradycardic & decreased LOC

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15
Q

first thing you should do if ICP is increased

A

increase HOB!!!!

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16
Q

what to educate pt if on NSAIDs

A

it can cause gastric ulcers, take w/ food, NEVER on empty stomach

do not take aspirin with these

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17
Q

pt educate for colostomy

A

don’t take w/ coated meds
make sure stoma is nice beefy pink, moist
empty when 1/3 to 1/2 full
change barrier every 5-10 days
***this will not change their normal activities, still do everything the same!

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18
Q

what should pt take if they have UC or Chron’s and are having an acute flare up

A

take prednisone for IBD flare up

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19
Q

how to treat h. pylori (this causes peptic ulcer disease)

A

TRIPLE TREATMENT REGIMEN - antbx, PPIs, H2 blockers

clarithromycin, metronidazole, and amoxicillin and PPI (-prazole) OR H2 Blockers (-tidine)

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20
Q

meds to take for GERD

A

H2 blockers
PPIs
**Short term use only unless Barretts Esophagus

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21
Q

important education for TPN monitoring

A

monitor glucose bc it can become increased
**always seen off, never stop abruptly

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22
Q

this s/s is boardlike abdomen

A

peritonitis

**can occur from complication of appendicitis due to perforation of appendix in the hospital

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23
Q

s/s of this include renowned tenderness (feels good when you push down, worsens when released), pain in RLQ but starts around umbilicus before it localizes

A

appendicitis

**if pain stops, then this means RUPTURE

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24
Q

what to educate pt on GERD meds

A

don’t lay flat after eating, wait 1-2 hrs prior to laying down

avoid spicy foods, caffeine

make food diary (what are your irritants so you can avoid them)

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25
what to monitor if pt had NG tube
placement (Chest X-Ray) make the rube to see if it slipped out monitor output from NG tube pt is NPO so at risk for dehydration, electrolyte imbalance
26
these are bloody stools or found on hemoccult test or low H&H
melena
27
what to do it pf has catheter and there is no output
check for kinks first!
28
this is infection of the kidney
pyelonephritis
29
difference between pyelonephritis and UTI/cystitis
pyelonephritis has more flank pain and pt looks sick .. will need repeat culture after treatment cystitis is burning w/ lower abd pain and does not need repeat culture after .. pt is not ill with this
30
first phase of this is decreased urine output aka oliguria
AKI (acute kidney injury) 3 types - prenal, intrarenal, post renal
31
pt has ESRD, what to monitor
I&Os (don't expect lots of output) daily weights (for fluid balance shifts) **pt is at risk for significant electrolyte imbalances like potassium (increased)
32
home care for cardiac pt w/ htn
low sodium diet exercise take b/p at home
33
s/s of digtoxicity
yellow green halo, blurry vision, h/a, altered mental status **if pt has low potassium, pt is more at risk for digtoxicity so monitor potassium
34
s/s of pericarditis
chest pain which worsens when laying down or deep inspiration friction rub fever, elevated WBC, signs of infection
35
s/s of MI what to check when pt comes in w/ this
chest pain, feeling of doom, n/v, anxiety, SOB, indigestion check trops, CK-MB (cardiac marker), electrolytes like K, Ca, Na check EKG for ST elevation for STEMI pt will be sent to Cath lab for stent
36
BNP indicates what
heart failure, the higher the worse HF
37
if you have CAD, you're at risk for what
MI so pt should quit smoking, exercise, and lose weight
38
this is in the atrium, pt is at risk for clots, no P waves on EKG what meds to give
A-Fib meds to give include warfarin, rivaroxaban (for DVT), aspirin, amiodarone can cardiovert for these pts!
39
tombstones on EKG what med to give
V-Tach (check if pt has a pulse to determine treatment) no pulse then defibrillate pulse --> cardiovert & apply O2 give amiodarone or lidocaine
40
random EKG, all over the place, scattered craziness
V Fib need to DEFIB!!!! bc pt will die
40
what to anticipate if pt has a DVT
don't use SCDs don't ambulate anticipate heparin drip monitor PTT (will be 1.5 - 2x higher) monitor for s/s of bleeding
41
how to take orthostatic vitals
pt lays supine, sits, and stands with 2 - 5 mins in between
42
pt education for pts on htn meds
ask provider about OTC meds bc a lot of interactions sinus meds vasoconstrictor & raises it more
43
normal ABG values
pH 7.35 - 7.45 PaCO2 35 - 45 PaO2 80 - 100 HCO3 22 - 26 ROME
44
s/s of TB what to do if pt has it
coughing up blood night sweats fever weight loss confirm w/ chest airway & sputum culture pt should be on airborne precaution, N95, negative pressure room notify CDC, they will contact health department
45
what to do if chest tube comes out of pt
sterile gauze on 3 sides, call a rapid!!!!
46
why does a pt get a chest tube
if lung collapses, it can come from pneumothorax (air) or hemothorax (blood) **lungs will sound diminished or absent pt can get one due to pleural effusion, atelectasis, thoracoscopy there should be no bubbling in water seal chamber, but gentle bubbling in dry suction control chamber (one all the way on left)
47
what is a tension pneumothorax
so much pressure and air is building up so you can see tracheal deviation on unaffected side we need to get air out! so chest tube will be placed
48
what is a pulmonary embolism what are s/s first line of diagnostic imaging how to prevent
blood clot in lungs s/s = chest pain, SOB, sudden onset chest pain, PINK FROTHY SPUTUM first line of imaging is CHEST X-RAY prevent by giving incentive spirometer & gettin pt up and moving after surgery
49
what to do for COPD pt
high calorie diet educate on pursed lip breathing encourage rest periods small frequent meals give liquids like ensures avoid cold temps don't smoke! adhere to meds
50
what to do for pt on vent
HOB must be at least 30 degrees oral care q4 hrs suction as needed reposition q2 hrs
51
s/s of lung cancer
coughing up blood cachexia changes in resp patterns hoarseness low grade fever
52
what are you concerned about if pt gets adrenals removed
addison's & Cushing's will be on lifelong meds cortisol & aldosterone & adrenaline are affected (sodium uptake, potassium excretion)
53
this is an autoimmune disease that is a common cause of hyperthyroidism
Grave's Disease
54
s/s of hyperthyroidism what meds to give
hot- so like cool temps agitated anxious tachycardia give PTU (safe for preg but monitor for sore throat and fever) or methimazole
55
what should you have at bedside if pt had thyroidectomy what should you monitor
suction and trach monitor calcium (muscle twitch = low calcium) monitor for bleeding (they will swallow a lot) if you hear stride, airway is closing!
56
this pt is dry inside, very thirsty, peeing a lot, urine is dilute
DI
57
this pt is fluid volume overload, so restrict fluids!!!! what to monitor for
SIADH monitor I&Os, daily weights, electrolytes like sodium
58
TSH levels
hyperthyroid is decreased hypothyroid is increased
59
pt education for DM
foot care monitor glucose, especially when sick stop exercise if ketones positive
60
s/s of hypoglycemic what to give
clammy, cold, diaphoretic also confusion, slurred speech, double vision, tremors, tachy, nervousness give D50 or glucagon
61
normal glucose level
70 - 100
62
what can / can't LPN do
can give meds & insulin, NOT IV push can reinforce, NOT educate can do dressing changes CAN'T hang blood CAN'T TPN CAN'T ASSESS
63
what to do if pt has chest tube, foley, or NG tube
always check for kinks!
64
pt is getting blood transfusion & starts having a rxn, what to do first?
stop the infusion get new tubing, flush, start saline
65
this med is an expectorant so what will it cause
more coughing bc increase in sputum production to get it all out
66
meds for osteoporosis
calcium & vit D alendronate ibandronate
67
diet for post op colostomy
low residue diet for first 6-8 weeks avoid foods high in fiber and foods like popcorn
68
s/s of hiatal hernia how is it diagnosed? what to do for pt
dysphagia pyrosis (heartburn) n/v hemorrhage asymptomatic diagnosed by barium study, Xray, EGD pt needs small frequent meals, elevated HOB, don't lay down for 1 hr after eating
69
s/s of GERD
mimics heart attack like dyspepsia/pyrosis, regurgitation, dysphagia
70
what are these meds magnesium hydroxide simethicone calcium carbonate
antacids
71
complications of appendicitis
gangrene perforation that can lead to peritonitis
72
what meds to give for bradycardic pt and for tachycardic pt
bradycardic - atropine tachycardia - adenosine
73
this looks like a saw tooth shape on EKG
atrial flutter
74
what will a pt look like with ARDs
they don't respond to O2 they will have intercostal retractions & crackles
75
pink puffer vs blue boater COPD
pink puffer = emphysema blue boater = chronic bronchitis
76
what does it mean if you hear low alarm sound on vent vs high alarm?
Low alarm means LEAK!!!! high alarm means obstruction like a kink or needs suctioning bc pt can't breathe
77
desmopressin is used to treat what
DI .. don't restrict fluids! pt will have large amounts of urine output
78
can you give insulin before surgery
YES, you should bc stress increases BG which can cause hyperglycemia
79
what happens if you stop corticosteroids abruptly
can cause adrenal insufficiency
80
DI vs SIADH
DI - give fluids bc dry inside SIADH - restrict fluids bc fluid overload
81
s/s of Addison crisis
shock!!!!!! low bp tachy low sodium, low BG, high K muscle weakness dark pigmentation
82
you may need lifelong corticosteroid therapy for this
Addisons
82
what to do if pt with DM is sick
If unable to retain fluids and BG over 250-300 go to hospital Take insulin or oral medications as usual Test glucose and ketones in the urine q3-4 hours
83
what should you do if pt has HHS which is caused by BG over 600 and is insulin deficient during illness or infection
rehydrate!!!!!!! don't restrict fluids
84
when to not exercise if pt has DM
if BG is over 250 or ketones are in urine
85
post op cardiac Cath
must keep affected leg straight bed rest for 2-6 hours HOB no greater than 30 degrees hold metformin afterwards if you can't prior 48 - 72 hrs
86
s/s of Chron's
RLQ pain diarrhea / cramping after meals weight loss steatorrhea (fatty stools)
87
complication of UC (pt can have 6 or more stools daily)
perforation toxic megacolon hemorrhage
88
what to know about NG tube procedure
suction no more than 10 - 15 seconds non sterile procedure you need to hyperoxygenate
89
what does metroclopramide do
accelerate gastric emptying
90
what is the number 1 cause of death in ESKD
CVD
91
upper vs lower GI bleeding
upper - dark blood lower - bright red
92
when to give amiodarone
A-Fib V-Tach
93
r. sided HF vs l. sided HF symptoms
LHF: weak peripheral pulses, pulmonary congestion RHF: JVD, edema, abd growth, ascites
94
this is an autoimmune attack on the peripheral nerve myelin that causes muscle weakness & diminished reflexes that start low & move up
Guillain barre syndrome
95
what med to avoid if hx of peptic ulcer disease
NSAIDs
96
what is a common bacterium associated w/ peptic ulcers
h. pylori
97
treatment for PUD
bismuth subsalicylate, tetracycline, metronidazole alternative therapy = clarithromycin, amoxicillin, metronidzole
97
TPN nursing care
change line q 24 hrs check pt BG frequently make sure it's room temp if formula is left in bag over 24 hrs, throw it out don't stop abruptly
98
ESRD meds
calcium & vit D erythropoietin (anemia associated w/ ESKD) phosphate binding agent such as sevelamer carbonate antihypertensives & cardiovascular agents ** don't give K bc usually high
99
pt who has bilateral adrenalectomy will require lifelong replacement of what
cortisol
100
s/s of thyroid storm
extremely tachy exaggerated hyerpthyroid symptoms such as weight loss, diarrhea, abd pain, edema, chest pain, dyspnea, palpitations ** altered LOC including psychosis, somnolence, coma
101
worried about muscle spasms and tetany due to low calcium after this procedure
thyroidectomy
102
what to worry about w/ pt on prednisone
BG (can be high!) increase risk for infection risk for osteoporosis steroid withdraw syndrome if abruptly stopped
103
pt presents w/ dehydration, fatigue, increase urine output, polydipsia, polydipsia (thirst), urine specific gravity 1.001 - 1.005, hypernatremia **limiting fluid does not control the disease
DI (decreased ADH!)
103
pt presents hyponatremia, high urine specific gravity, excess ADH, causing retention & hyponatremia this pt has fluid volume excess including edema, htn, tachycardia, JVD
SIADH
104
medication to treat SIADH
diuretics
105
this pt has decreased aldosterone, cortisol levels, & glucose pt will have increased potassium
Addison's
106
s/s of Addisonian crisis how to treat
severe hypotension, cyanosis, fever, n/v, signs indicative of shock **give IV fluids
107
what is typically associated with BG over 600, dehydration, dry mucus membranes
(HHS) Hyperosmolar hyperglycemic state **happens more w/ older ppl type 2 DM .. they drink less
108
rapid insulin names , onset/peak times?
LAG aka lispro, aspart, glulisine onset = 15 - 30 min peak = 30 to 90 min
109
short acting insulin name, onset/peak times?
regular onset = 30 - 60 mins peak = 2 - 3hrs
110
intermediate acting insulin name onset/peak times?
NPH onset = 1 - 1.5 hrs peak = 4 - 12 hrs
111
long acting insulin name onset/peak times
glargine detemir onset = 3 - 6hrs peak = no peak!
112
what puts a pt at risk for digtoxicity
hypokalemia (low K!)
113
normal HCO3 aka bicarb
22 - 26
114
the alveoli become flood which compromises gas exchange, prioritizing airway management is crucial & intubation is necessary
ARDS
115
what med is commonly prescribed for bronchitis
guaifenesin- expectorant that helps loosen congestion bc bronchitis has productive cough
116
aneurysm nursing interventions
minimize stimulation & visitors, elevate HOB to 30, stool softeners, no strenuous activity
117
loperamide
antidiarrheal med, can be used for UC flare ups bc pooping so much LOL
118
what causes DI
not enough ADH/vasopressin so give desmopressin
119
what causes SIADH
too much ADH, pt is retaining water so give diuretics
120
low cortisol & aldosterone
Addison's
121
this results in life threatening situation that results in low BG, low BP, high potassium s/s = hypotensive, lethargy, fatigue
Addisonian's crisis so give IV cortisol!
122
therapeutic digoxin level
0.8 - 2.0

Med Surg (6 decks)

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