Final exam Flashcards
(44 cards)
What are s/s of autonomic dysrelfexia?
severe HTN, bradycardia, diaphoresis, headache,
what are potential complications of spinal cord injuries
related To immobility:
-pressure ulcers
-pneumonia
-UTI
-incontinence
-fall risk
-
what are nursing priorities for a patient who has had a spinal cord injury?
stabilize C spine
-maintain airway
-perfusion
-oxygenation/ventilation
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types of spinal cord injuries
hyperflexion, hyperextension, axial loading
axial loading
compression fracture- vertical
Over-twisting of neck past natural point
What are interventions for pancreatitis?
-NPO
-NGT (decompression)
-antibiotics
-IVF
-PPI
-pain management; dilaudid, tornados
-
what are some helpful ways to help relieve pain related to pancreatitis without medications?
which of the following is a sign of obstructive cholecystitis?
- ascites
-constipation
-clay colored stools
-pale yellow urine
clay colored stools
what are risk factors for cholecystitis?
Four (five) F’s
-fat
-female
-fertile
-forty
-(high)fat diet
what are the 2 greatest risk factors for chronic kidney disease?
HTN and diabetes
why are clients with CKD anemic
-lack of insulin
- fluid overload
-lack of creatinine
-lack of erythropoietin
lack of erythropoietin
what are the types of acute kidney injury and examples of each?
prerenal-HF, renal artery stenosis, MI, hypotension, hemorrhage, burns, shock
Intrarenal-glomerulonephritis, pyelonephritis, acute tubular necrosis
Postrenal- stones, BPH, Cystitis, colon cancer, ovarian cancer
the nurse is caring for a client going to hemodialysis. Which of the following are approach nursing considerations?
-reviewing the scheduled medications
-monitoring BP closely
-monitoring for bleeding
-monitor dialysis access site
-all of the above
all of the above
parkland formula
4mL X kg X %TBSA burned
A nurse has a burn victim and has calculated the total volume of fluid the patient needs for 24 hours. Over how many hours is the first half given to the patient?
Half of the total need is given to the patient over 8 hours. The time starts at the burn time
if the first half of the total fluid volume needed in 24 hours is already given, over how much time is the second half given?
16 hours
percentages for burns according to the body part:
-Head and neck=
-anterior trunk=
-posterior trunk
-anterior arm(s)=
-posterior arm(s)=
-Anterior leg(s)=
-posterior leg (s)
-head and neck=9% (4.5% anterior and posterior)
-Anterior trunk= 18%
-Posterior trunk=18%
-Total trunk=36%
-Anterior arm=4.5%
-Posterior arm=4.5%
-Total arm=9%
-Both arms(front and back)= 18%
-Anterior leg=9%
-Posterior leg=9%
-Total leg=18%
-Both legs=36%
a patient weighing 176 pounds has burns to both anterior legs. How much fluid does the patient need in the 1st 24 hours?
4mL X kg X TBSA%
4mL X 176/2.2 X 18%
5,760 mL for 24 hours
what are the immediate and early interventions for burns?
-fluid resuscitation
-antibiotics
-pain control
-wound care
what acid/base imbalance is likely with hypovolemic shock?
-respiratory acidosis
-metabolic acidosis
-respiratory alkalosis
-metabolic alkalosis
metabolic acidosis
what is the nursing role in emergency preparedness?
triage officer and nursing(assessment of situation, emergency response plans, needs assessment, discharge and admissions)
heat exhaustion presentation
flulike symptoms
Headache
Weakness
N/V
Cool down-move inside/shade, ice packs, cool water, fan, rehydrate
heat stroke presentation
MEDICAL EMERGENCY
high temperature >104
Dry skin
Altered mental status
Hypotension/tachycardia
Call 911
Cool down
Rehydrate
what safety measures can reduce the risk of drowning?
-dont swim alone
-do not dive in dark/unknown depths of water
-do not swim and drink
-life jackets
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