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Final exam Flashcards

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1
Q

S/S of increased ICP

A

decreased level of consciousness, sudden numbness and tingling, sudden trouble seeing in one or both eyes, sudden dizziness, sudden severe headache, cushing’s triad

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2
Q

cushing’s triad

A

widening pulse pressure, deep shallow respirations (CS), HTN, bradycardia

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3
Q

interventions for increased ICP

A

head midline, elevate HOB 30 degrees, hyper-oxygenate before suctioning, do not cluster activities, lights down low, discourage coughing

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4
Q

acute kidney injury

A

AKI is a reversible, sudden in onset disorder of the kidney that includes 50-95% of the nephrons, impacts many body systems, problems with elimination, fluid and electrolyte balances, and acid-base imbalance.

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5
Q

how much Cr is raised in AKI

A

.3mg/dl or a serum Cr rise of of 1.5 times more

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6
Q

complications of AKI

A

metabolic acidosis, hyperlipidemia, hyperkalemia, hyponatremia, hypocalcemia, hypophosphatemia, edema, heart failure, PE, pericarditis, mental status changes

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7
Q

Patient’s at risk for AKI

A

pre-existing reduced GFR, elevated Cr, diabetes, HTN, peripheral vascular disease, liver disease, CKD

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8
Q

how much fluid should a healthy adult be drinking in a day

A

2-3L of fluid a day

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9
Q

history questions for AKI

A

ask about recent surgery or trauma, transfusions, antibiotics, and NSAIDs

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10
Q

imaging for AKI

A

CT scan without contrast, ultrasonography, MAG3, kidney biopsy, cytoscopy,

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11
Q

nursing goals of AKI

A

prevent volume depletion and provide intervention early

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12
Q

Chronic kidney disease

A

CKD is a progressive, irreversible, kidney disease that results, has 5 stages, progresses into ESKD if not treated properly, 90-95% of the nephrons are included and it impacts all body systems and the kidney’s not recover

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13
Q

Patient ed for CKD

A

carefully manage fluid volume, BP, electrolytes, BUN and Cr, be alert to the general appearance of your urine, note any changes in its color, clarity, and odor, how much urine is passed, 1-2 L of fluid a day (water is the ideal fluid). Decreased Na, Ca and increased P, K,Mg

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14
Q

next steps for CKD

A

if it worsens dialysis is needed and a kidney transplant

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15
Q

hemodialysis nursing interventions

A

monitor perfusion, monitor for hypotension, high calorie foods, high protein diet, monitor Na, monitor BUN and Cr

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16
Q

prerenal causes of AKI

A

blood or fluid loss, hypotension, low EF and low CO, infection, liver failure, aspirin, ibuprofen, NSAIDs, severe dehydration

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17
Q

intrarenal causes of AKI

A

infection, ischemia, bleeding in the kidney, thrombi or emboli, HUS, sepsis, lupus, nsaids, antibiotics, chemo, ,

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18
Q

postrenal causes

A

cancer of the bladder, cervical, colon, prostate, enlarged prostate, kidney stones

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19
Q

IV solutions for AKI

A

isotonic (NS and LR) needed for a fluid bolus

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20
Q

diagnostic tests for AKI

A

GFR, ultrasonography, decrease in UO, urinalysis

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21
Q

fistula

A

used for HD and should be monitored for thrills, avoid putting any pressure on that arm

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22
Q

pre dialysis for HD

A

hold antihypertensives

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23
Q

post-dialysis for HD

A

monitor weight, fatigue, hypotension, headache, N and V muscle cramps and bleeding

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24
Q

intra-abdominal cath

A

used for PD, clean daily with soap and water, betadine to exit, aseptic technique, high risk for peritonitis

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25
psychosocial for PD
body image changes and dialysis is needed daily
26
IV contrast dye test
discuss patients serum Cr, hold medications (metformin), provide hydration (4-5 hours of fluid with normal saline), re-evaluate serum Cr and GFR post exam
27
preventing UTIs
drink fluid liberally 2-3 L a day, be sure to get enough sleep and rest, wipe front to back, loose fitting cotton underwear, cranberry, no scented anything, empty the bladder before and after sex, topical estrogen to the perinium
28
peritonitis
infection when a patient is undergoing PD, the intra abdominal cath then produces an effluent that is cloudy, a fever, nausea, abdominal tenderness, when cloudy effluent is suspected get a sample and get it tested
29
hyperthroidism
most common cause is graves disease which results in decreased TSH which then overstimulates the thyroid which increases T3 and T4
30
S/S of hyperthyroidism
jitteriness, shakiness, nervous, irritability, rapid Hr - possible lead to Afib, feeling hot, weight loss, diarrhea or frequent stools, short menses
31
nursing interventions for hyperthyroidism
monitoring apical pulse, BP, and temp, report any palpitations, dyspnea, vertigo, or chest pain, monitor for thyroid storm (uncontrolled thyroid)
32
hypothyroidism
the most common cause is Hashimoto's which then causes an increase in TSH and a decrease in T3 and T4
33
S/S of hypothyroidism
fatigue, lack of energy, weight gain, heavy period, constipation, cold, slowed thinking
34
nursing interventions for hypothyroidism
monitor for decreased BP, HR, and rhythm, observe for s/s of shock, orient the person to person, place, an ex-plain all of the procedures carefully, safe environment
35
patient ed for hypothyroidism
take meds as prescribed, Synthroid is w/o food. have a high protein and high fiber diet
36
cushings
a disease of the anterior pituitary gland that causes an increase in Na and Blood glucose and a decrease in K and Ca. The anterior pituitary gland releases too much acth which leads to hyperfunction of the adrenal gland
37
S/S of cushing
moon face, buffalo hump, truncal obesity, weight gain, HTN, cardiovascular system, bruising, petechiae, dependent edema, osteoporosis, thinning skin, straie, reduced immunity
38
nursing interventions for cushings
monitor for HF, correct fluid and electrolyte imbalances, restrict sodium intake, daily weight bearing exercises, prevention of infection, monitor for insulin resistance
39
patient ed for cushing
educate pt on sign and systems, restrict fluid and sodium
40
Addison's disease
too little cortisol or and aldosterone which results in too little acth which means a decrease in Na and Blood glucose and an increase in K and Ca
41
Addisonian crisis
caused by stress, infection (wbcs), severe headache, abdomen, leg and back pain, hypotension, hyponatremia, hyperkalemia, shock, treat with hydrocortisone
42
nursing intervention for addison
monitor labs and I/os, observe for addisonian crisis
43
patient ed addison's
taught to recognize crisis, carry hydrocortisone,
44
cushing, HF, and renal
the retention of sodium can cause cardiac problems because the kidneys use the RAAS system which then has to work harder to compensate which can result in kidney dysfunction and then an ultimate lead to cardiac problems. So it is critical to get help before the disease progresses
45
SIADH
syndrome of inappropriate ADH, wayyy to much ADH which then results in a decrease in serum sodium and an increase in ADH,
46
assessment for SIADH
learn about any recent injuries, TB, cancer and drug use, GI disturbances, nausea and vomiting, weight gain
47
nursing interventions for SIADH
restrict fluid, promoting the excretion of fluid, prevent injury, monitor neuro because decreased Na can lead to seizures, vasopressin and diuretics
48
patient ed for SIADH
monitor fluids, increased Na intake
49
lung cancer is a risk factor for SIADH
low urine concentration, increased sodium is all common in lung cancer patients, so it leads to fluid imbalances
50
acromegaly
a disease of the anterior pituitary that results in a overproduction of growth hormone, typically caused by an adenoma on the pituitary gland
51
assessment of acromegaly
overgrowth of bone and cartilage, carpel tunnel, thick, oily skin, enlarged lips, tongue and nose, deep voice, snoring, excessive sweating, fatigue, enlarged organs
52
nursing considerations with acromegaly
support the patient with changes in appearance, promote a good body image, radiation therapy and surgery are all treatment
53
patient ed post hyphosectomy
do not do anything that increases ICP, encourage deep breathing, avoid bending at the waist but to use your knees as a way to get down, avoid straining with a bowel movement, avoid brushing teeth for two weeks post op, saline rinses, monitor for fluid imbalance, vitals Q4.
54
Transnasal, transphenoidial, hyphosectomy
minimally invasive technique used to remove pituitary adenomas, inserts an endoscope through the nose,
55
Cushing lab values
hyperntremia, hyperglycemia, hypokalemia, Hypocalcemia
56
Addison lab values
hypoglycemia, hyponatremia, hyperkalemia, hypercalcemia
57
iron
a defiency is caused caused by bleeding, mensuration, GI, and pregnancy, patients need to eat foods high in iron and iron supplements, their poop might turn green and black, take iron with food, and eat leafy greens and meat
58
blood administration
jehovah's witness do not accept blood so autotransfusion is needed, two nurses need to be present watch for fever, watch tubing and patient's response, do a full CBC post
59
total hip arthroplasty
hip replacement, maintain correct positioning, supine positioning, pillow between the legs, do not sit or stand for long periods, use an ambulatory, do not overextend, resume sexual intercourse, report pain and swelling to the surgeon immediately, no leg crossing
60
splinting
using a pillow over the incision prevents the site from opening up, stand prior to ambulation, when you breathe you need to hold the pillow over the site in order to prevent opening and infection
61
opioid overdose
naloxone
62
benzos overdose
flamanezil
63
HgB
12-18
64
WBC
5000-10000
65
Cr
<2
66
min urine output per hour
30-35
67
platelets
150,000-450,000
68
Na
135-145
69
K
3.5-5
70
preop tests that need to be communicated
urinalysis, blood type and screen, cbc, clotting study, BUN, Cr, pregnancy test
71
bowel and bladder post-op
make sure there is presence of active bowel sounds, no abdominal distention or rigidity, decreased abdominal peristalsis look for a post-op ileus, passing of gas or a bowel movement pot op is ideal, monitor the abdomen, ensure adequate hydration, increased mobility, nonopioid pain management, gum chewing, drug therapy
72
what does chemo affect on a blood levels
due to bone marrow suppression chemo reduces RBC, WBC, platelets which lowers clotting, immunity, and oxygenation
73
alopecia
hair loss, avoid scalp injury and cope with body image changes
74
impaired nutrition
work with a RD, making sure the patient does eat, no one size fits all diet
75
mucositis
open sores in the mouth from chemo, frequent saline oral rinses, brush teeth gently after meals, crotherapy
76
constipation
high fiber and adequate fluids, laxatives
77
xerostomia and thick saliva
well hydrated, mouth rinses with tap water, mouthwash with no alcohol, going to the dentist
78
chemotherapy
treatment of cancer with chemical agents, used to create survival time, given both IV and oral. Both are toxic
79
safe handling IV chemo
assessing the picc line every hour, wear ppe, if you touch the solution with bare hands you need to was hands with soap and water for 5 minutes, double flush, no preggers
80
abdominal paracentesis
used to remove the excess fluid from the abdomen (asities), uses a trocar needle and an ultrasound to remove the fluid, monitor vital signs, measure drainage, tell the patient to void prior, weigh the patient before and after
81
WBC growth factors
neupogen is a great example. So chemo supresses the bone marrow and then the WBCs cannot create an immunity so neupogen comes around and stimulates WBC production which then causes the patient to be able to not be immunocompromised and be able to fight infections instead of getting neutropenic fever
82
neutropenic fever considerations
patient gets their own room, change dressings daily, they get their own bathroom, own supplies, limit people in the room to healthy people, they are not in isolation, no pregnant women, inspect the patients mouth, monitor for fever, take a cbc daily, wash your damn hands
83
oral chemo safe handling
still toxic, do not touch with bare hands, pour the med into the top and then into a cup and then drink from the cup, do not miss doses at all because of resistance, take separately than other drugs, do not crush or split the meds
84
Hep B high risk groups
infants who are born to infected mother's, Sex (MSM), blood, needles
85
hep B modes of transmission
unprotected sexual intercourse, sharing razors and needles, birth, blood brothers, accidental needlesticks
86
vaccine for hep B
Hep B vaccine, also prevents you from getting Hep D
87
prevention of Hep B
wash hands, use a condom, avoid direct contact with blood and bodily fluids
88
cirrhosis
extensive, irreversible scarring of the liver, usually caused by a chronic reaction to hepatic inflammation and necrosis
89
labs for cirrhosis
alt, ast, bilirubin, ammonia
90
cirrhosis can develop into
cancer of the liver
91
things that can result because of cirrhosis
asities, portal HTN, splenomegaly, jaundice, pruritis, esophageal varices, caput medusae, hepatic encephalopathy
92
assessment for cirrhosis
assess for yellowing of the skin, dry skin, purpuric lesions, ecchymosis, vascular lesions, asities, vitamin (ADEK)
93
causes of cirrosis
alcohol, viral hepatitis, drugs and chemical toxins
94
Nursing interventions cirrhosis
paracentesis, respiratory support, avoiding alcohol, high protein low sodium diet, BB, diuretics, fluid restrictions, and a liver transplant
95
external beam radiation side effects
acute and long term site specific changes, local skin changes, hair loss, altered taste sensations, bone marrow supression
96
brachytherapy
internal radiation, direct contact with the tumor
97
nursing implications brachytherapy
private room and bath, keep the door shut as much as possible, lead apron when caring for patient, do not turn your back on the patient, no pregnant visitors, visitors get a one half hour visit a day, never touch with bare hands
98
drug needed post thyroidectomy
calcium gluconate
99
s/s of ovarian cancer
bloating, feeling full fast, abdominal pain, urinary urgency
100
three diagnostic tests for ovarian
pelvic and rectal exam, Ca-125 blood test, transvaginal ultrasound

Med surg (2 decks)

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